Question 61
A 39-year-old woman had noted intermenstrual spotting of blood for the past 3 months. On pelvic examination, she is found to have a nodular 2 x 3 cm mass in the upper vagina. Biopsy of the mass is performed and on microscopic examination shows a clear cell carcinoma. Which of the following risk factors probably preceded development of this carcinoma?
A Human papilloma virus infection
B Previous endometriosis
C Irregular menstrual cycles
D Exposure to diethylstilbestrol in utero
E Precocious pseudopuberty
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(D) CORRECT. Although DES has not been used for decades, the women who were exposed to it are past their 40's and developing adenosis and clear cell carcinoma.(A) Incorrect. HPV infections are associated with increased risk for cervical neoplasia.(B) Incorrect. Endometriosis is a risk for endometrioid carcinoma decades later.(C) Incorrect. Such irregular cycles are a risk for development of endometrial carcinoma.(E) Incorrect. This occurs with an ovarian neoplasm, such as a granulosa-theca cell tumor, that secretes estrogen.------------------------------------------------------------------
Question 62
A 19-year-old woman has noted the increasing size and number of warty lesions on her external genitalia for the past 5 years. On physical examination she has several pink-tan rounded 1 to 2 cm slightly raised lesions on the perineum and vulva. Biopsy of one of the lesions is performed and on microscopic examination demonstrates acanthosis of the squamous epithelium along with koilocytosis. Which of the following is the most appropriate interpretation of these findings?A The lesions are usually cystic.
B Most often they occur in the endometrium.
C There is an association with Candida infection.
D She may develop a squamous cell carcinoma.
E This condition is commonly seen in prepubertal males.
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(D) CORRECT. Condyloma is one of the manifestations of human papillomavirus infection. Some subtypes of HPV, such as 16, increase the risk for squamous dysplasias and carcinomas of the cervix.(A) Incorrect. Condylomas are usually raised white wart-like lesions.(B) Incorrect. Most occur on the external genitalia and perineum, and some on the cervix.(C) Incorrect. There is an association with human papillomavirus (HPV) infection.(E) Incorrect. They are most common in sexually promiscuous persons (or persons whose sexual partners are promiscuous).
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Question 63
A 40-year-old woman has experienced pelvic discomfort for over a month, along with a 4 kg weight loss, nervousness, and diaphoresis. A pelvic examination reveals a large left adnexal mass that, on transvaginal ultrasound, appears as a discrete 10 cm cystic mass. The uterus appears normal in size. A Pap smear is normal. The mass is removed and on gross pathologic examination is filled with hair and sebum, along with solid tan areas next to the smooth-surfaced outer wall. Which of the following laboratory test findings is most likely to have been present just prior to her surgery?
A Thyroxine of 11.3 microgm/dL
B HCG of 45,000 IU/L
C Potassium of 2.9 mmol/L
D Estradiol of 1700 pg/mL
E Cancer antigen 125 of 540 U/mL
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(A) CORRECT. The abundant hair is typical for an ectodermal component of a mature cystic teratoma, but mesodermal and endodermal components will also be present. This one probably has thyroid tissue, also called struma ovarii when the majority of the teratoma is composed of thyroid tissue. It is a rare cause for hyperthyroidism.(B) Incorrect. An elevated HCG could indicate an intrauterine pregnancy or a choriocarcinoma.(C) Incorrect. Hypokalemia is seen with aldosteronomas of the adrenal gland.(D) Incorrect. Elevated estrogen levels are seen with pregnancy, but high levels such as this are rarely present, even with neoplasms such as thecomas.(E) Incorrect. The CA-125 is a marker for ovarian malignancies.
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Question 64
A 32-year-old G3 P2 pregnant woman goes for a routine prenatal check at 12 weeks. On physical examination she is found to be large for dates, and no fetal heart tones are audible. An ultrasound is performed and revealed that no fetus was present, only many echogenic cystic areas within the uterus. Which of the following is the most likely diagnosis?
A Invasive mole
B Partial hydatidiform mole
C Placental site trophoblastic tumor
D Choriocarcinoma
E Complete hydatidiform mole
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(E) CORRECT. No fetus is present, only grape-like chorionic villi. Complete mole is the most common form of gestational trophoblastic disease.(A) Incorrect. An invasive mole is less common than a complete mole.(B) Incorrect. A fetus is usually present with a partial mole.(C) Incorrect. This is a rare tumor that consists of intermediate trophoblast that invades deeply into the myometrium. The cells make human placental lactogen, not HCG. There is no cytotrophoblast or syncytiotrophoblast. These tumors are locally invasive but often self-limited to the pregnanc.(D) Incorrect. Choriocarcinomas are solid, but hemorrhagic lesions that invade the myometrial wall, though the uterus can be enlarged. They can follow a hydatidiform mole.
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Question 65
A 38-year-old woman goes to her physician for a routine checkup. On physical examination there are no abnormal findings. A Pap smear is taken and cytologically there are dysplastic cells present. A cervical biopsy is performed. Microscopic examination shows dysplasia involving the full thickness of the cervical epithelium. Which of the following is the most likely diagnosis?
A Cervical intraepithelial neoplasia III
B Severe chronic cervicitis with Herpes simplex virus
C Previous diethylstilbestrol (DES) exposure
D Endocervical adenocarcinoma
E Extramammary Paget disease
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(A) CORRECT. With proper therapy, the lesion will be removed and not given a chance to progress to invasive carcinoma.(B) Incorrect. Inflammation will produce some inflammatory atypia, but not dysplasia.(C) Incorrect. DES exposure in utero predisposes women to vaginal clear cell carcinoma and to adenosis.(D) Incorrect. DES exposure can lead to microglandular hyperplasia and to vaginal clear cell carcinomas.(E) Incorrect. This is seen on the vulva and consists of malignant cells in the epithelium that are mucin positive, indicating adenocarcinoma.
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