Block 15 Path Female Rep Sys Prt 2

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Block 15 Path Female Rep Sys Prt 2 - Quiz

Yakubovskyy. Pathology of Female Reproductive System - Part 2
"Yakubovskyy. Pathology of Female Reproductive System - PREGNANCY"


Questions and Answers
  • 1. 

    The shown endometrial biopsy from a 42-year-old obese woman complaining of vaginal spotting represents

    • A.

      Endometrial intraepithelial neoplasia

    • B.

      Keratinizing squamous cell carcinoma

    • C.

      Non-keratinizing squamous cell carcinoma

    • D.

      Endometrioid endometrial carcinoma

    • E.

      Choriocarcinoma

    • F.

      Hydatidiform mole

    • G.

      Leiomyosarcoma

    Correct Answer
    D. Endometrioid endometrial carcinoma
    Explanation
    The correct answer is Endometrioid endometrial carcinoma. This is the most common type of endometrial cancer and typically occurs in postmenopausal women. It is characterized by the presence of glandular structures resembling the normal endometrium. Obese women are at a higher risk for developing endometrial carcinoma due to increased levels of estrogen. Vaginal spotting is a common symptom of endometrial carcinoma.

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  • 2. 

    The shown endometrial biopsy from a 42-year-old obese woman complaining of vaginal spotting The most likely predisposing factor?

    • A.

      BRAC1 or BRAC2 mutation

    • B.

      P53 mutation

    • C.

      Endometriosis

    • D.

      HPV infection

    • E.

      Polycystic ovary syndrome

    Correct Answer
    E. Polycystic ovary syndrome
    Explanation
    Polycystic ovary syndrome (PCOS) is the most likely predisposing factor in this case. PCOS is a hormonal disorder that affects women of reproductive age and is commonly associated with obesity. It can cause irregular menstrual cycles, which may result in vaginal spotting. Additionally, PCOS can lead to hormonal imbalances that can affect the endometrium, increasing the risk of abnormal bleeding. While the other options may have potential associations with gynecological issues, PCOS is the most likely explanation given the patient's age, obesity, and symptomatology.

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  • 3. 

    Presence of subnuclear vacuoles in the endometrial glands in an endometrial biopsy indicates

    • A.

      Proliferative phase

    • B.

      Early secretory phase

    • C.

      Mid-secretory luteal phase

    • D.

      Late secretory phase

    • E.

      Persistent proliferative phase

    Correct Answer
    B. Early secretory phase
    Explanation
    The presence of subnuclear vacuoles in the endometrial glands in an endometrial biopsy indicates the early secretory phase. This phase occurs after ovulation and is characterized by the development of secretory glands in the endometrium. The subnuclear vacuoles are a histological feature of the early secretory phase, representing the secretory activity of the endometrial glands as they prepare for potential implantation of a fertilized egg.

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  • 4. 

    A 33-year-old woman presents with a 3-year history of infertility. The microscopic appearance of the endometrium is shown for you evaluation. Which of the following is the most likely phase of the menstrual cycle at which the endometrial biopsy was taken?

    • A.

      Proliferative

    • B.

      Early secretory

    • C.

      Mid-secretory

    • D.

      Late secretory

    • E.

      Menstrual

    Correct Answer
    B. Early secretory
    Explanation
    The correct answer is Early secretory. This is indicated by the presence of numerous glands with variable shapes and sizes, as well as stromal edema and leukocyte infiltration. These findings are consistent with the early phase of the menstrual cycle when the endometrium is undergoing proliferation and preparation for potential implantation of a fertilized egg.

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  • 5. 

    Who of the following patients is more prone to serous endometrial adenocarcinoma?

    • A.

      A girl with precocious puberty

    • B.

      An obese young women with hirsutism and alopecia

    • C.

      A middle age woman with history of spontaneous abortions

    • D.

      A middle-age woman with an ovarian tumor

    • E.

      An elder women with osteoporosis

    Correct Answer
    E. An elder women with osteoporosis
    Explanation
    Elder women with osteoporosis are more prone to serous endometrial adenocarcinoma because there is a known association between osteoporosis and endometrial cancer. Estrogen plays a role in both osteoporosis and endometrial cancer, and as women age, their estrogen levels decrease. This decrease in estrogen can lead to osteoporosis as well as an increased risk of endometrial cancer. Therefore, the elder woman with osteoporosis is more likely to develop serous endometrial adenocarcinoma compared to the other patients listed.

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  • 6. 

    A young couple is evaluated for infertility. The wife, 28 years of age reports a long-standing history of oligomenorrhea alternating with amenorrhea. Physical examination reveals an obese woman with male escutcheon.  She is at increased risk for

    • A.

      Ovarian carcinoma

    • B.

      Cervical carcinoma

    • C.

      Uterine leiomyosarcoma

    • D.

      Endometriod endometrial adenocarcinoma

    • E.

      Choriocarcinoma

    Correct Answer
    D. Endometriod endometrial adenocarcinoma
    Explanation
    The correct answer is endometriod endometrial adenocarcinoma. The description of the patient's symptoms and physical examination findings suggest a condition called polycystic ovary syndrome (PCOS). PCOS is characterized by hormonal imbalances that can lead to irregular menstrual cycles, obesity, and excess hair growth (male escutcheon). Women with PCOS have an increased risk of developing endometrioid endometrial adenocarcinoma, a type of cancer that arises from the lining of the uterus (endometrium). This is because the hormonal imbalances in PCOS can cause the endometrium to become thickened and overgrown, increasing the risk of cancerous changes.

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  • 7. 

    Major source(s) of progesterone in a normal ovary

    • A.

      Ovum

    • B.

      Granulosa cells

    • C.

      Theca interna

    • D.

      Theca externa

    • E.

      Hilus cells

    • F.

      Fibrous stroma

    Correct Answer
    B. Granulosa cells
    Explanation
    Granulosa cells are one of the major sources of progesterone in a normal ovary. These cells are found in the ovarian follicles and are responsible for producing and releasing hormones, including progesterone. Progesterone plays a crucial role in the menstrual cycle and pregnancy, as it helps prepare the uterus for implantation and supports the development of the embryo. Therefore, the presence of granulosa cells in the ovary ensures an adequate production of progesterone.

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  • 8. 

    A 38-year-old Caucasian female presents with dysfunctional intrauterine bleeding. Physical examination reveals deep voice and hirsutism. Physical examination reveals enlargement of the left ovary. Oophorectomy is performed and subsequent examination of the specimen reveals the ovarian lesion shown for your evaluation. Histologic examination reveals diffuse growth of slightly pleomorphic and vacuolated theca cells. Which of the following is the most likely diagnosis?

    • A.

      Polycystic ovary syndrome

    • B.

      Fibroma

    • C.

      Thecoma

    • D.

      Dysgerminoma

    • E.

      Yolk sac tumor

    • F.

      Granulosa cell tumor

    • G.

      Sertoli-Leydig cell tumor

    Correct Answer
    C. Thecoma
    Explanation
    Thecomas or theca cell tumors are benign ovarian neoplasms composed only of theca cells. Histogenetically they are classified as sex cord-stromal tumours.

    They are typically estrogen-producing and they occur in older women (mean age 59; 84% after menopause). (They can, however, appear before menopause.)

    Sixty percent of patients present with abnormal uterine bleeding, and 20% have endometrial carcinoma.
    Grossly, the tumour is solid and yellow.

    Grossly and microscopically, it compress of the ovarian cortex.

    Microscopically, the tumour cells have abundant lipid-filled cytoplasm.

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  • 9. 

    A 43-year-old Hispanic female presents with intermittent lower abdominal pain. Physical examination with subsequent sonography reveals a cystic mass growing from the right ovary. Laparotomy with oophorectomy is performed and the removed ovary is shown for your evaluation. Histologic examination reveals small papillae and glands lined by stratified secreting columnar epithelium; neither cellular nor nuclear atypia is noticed. Which of the following is the most likely diagnosis?

    • A.

      Serous cystadenoma

    • B.

      Serous borderline tumor

    • C.

      Serous cystadenocarcinoma

    • D.

      Mucinous cystadenoma

    • E.

      Mucinous borderline tumor

    • F.

      Mucinous cystadenocarcinoma

    Correct Answer
    E. Mucinous borderline tumor
    Explanation
    The most likely diagnosis based on the histologic examination findings is a mucinous borderline tumor. This is indicated by the presence of small papillae and glands lined by stratified secreting columnar epithelium, without any cellular or nuclear atypia. Mucinous cystadenoma and mucinous cystadenocarcinoma typically show more significant cellular and nuclear atypia, while serous cystadenoma, serous borderline tumor, and serous cystadenocarcinoma have different histologic features.

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  • 10. 

    A 41-year-old woman presents with a 3-month history of intermittent lower abdominal pain. At pelvic examination, bilateral ovarian enlargement is found. Laparotomy with oophorectomy is performed and the gross appearance of one of the ovaries is shown for your evaluation. Histologic examination reveals multiple papillae covered by stratified pleomorphic epithelium single psammoma bodies are seen; mitotic activity is high. Which of the following is the most likely diagnosis?

    • A.

      Serous cystadenoma

    • B.

      Serous borderline tumor

    • C.

      Serous cystadenocarcinoma

    • D.

      Mucinous cystadenoma

    • E.

      Mucinous borderline tumor

    • F.

      Mucinous cystadenocarcinoma

    • G.

      Mature cystic teratoma

    Correct Answer
    C. Serous cystadenocarcinoma
    Explanation
    The most likely diagnosis based on the given information is serous cystadenocarcinoma. This is indicated by the presence of multiple papillae covered by stratified pleomorphic epithelium, high mitotic activity, and the presence of psammoma bodies. These features are consistent with a malignant tumor of the ovary. Serous cystadenocarcinoma is a type of ovarian cancer that arises from the epithelial cells lining the ovarian surface.

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  • 11. 

    A 45-year-old woman presents with an left ovarian mass. Oophorectomy is performed and microscopic examination of the resected material reveals the histologic structures shown for your evaluation.  Elevation of which of the following serum markers you would expect in this patient before surgery?

    • A.

      Acid phosphatase

    • B.

      Alkaline phosphatase

    • C.

      Alpha-fetoprotein

    • D.

      Human chorionic gonatotropin

    • E.

      Prostate specific antigen

    Correct Answer
    C. Alpha-fetoprotein
    Explanation
    Alpha-fetoprotein (AFP) is a serum marker that is commonly used in the diagnosis and monitoring of ovarian cancer. Elevated levels of AFP in the serum can indicate the presence of a malignant ovarian mass. Therefore, in this patient with a left ovarian mass, an elevation of AFP would be expected before surgery. Acid phosphatase, alkaline phosphatase, human chorionic gonatotropin, and prostate-specific antigen are not typically associated with ovarian cancer and would not be expected to be elevated in this patient.

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  • 12. 

    A 28-year-old woman in her 12 weeks’ pregnancy presents to the Emergency Department with vaginal bleeding. Physical examination reveals an enlarged uterus. Ultrasound investigation detects snow-storm pattern of the distended uterine content; a fetus is not found. D&C is performed and the microscopic appearance of the specimen is shown for your evaluation. Which of the following is the most likely genetic background for the described pathology?

    • A.

      Fertilization of the normal ovum with two sperms

    • B.

      Reduplication of the ovum haplotype without fertilization

    • C.

      Fertilization of the normal ovum with one sperm

    • D.

      Fertilization of the empty ovum with two sperms

    • E.

      Fertilization of the normal ovum with one sperm with subsequent reduplication of sperm haplotype

    Correct Answer
    D. Fertilization of the empty ovum with two sperms
    Explanation
    The most likely genetic background for the described pathology is fertilization of the empty ovum with two sperms. This is indicated by the presence of a snow-storm pattern of the distended uterine content on ultrasound, which is characteristic of a complete mole. In a complete mole, an empty ovum is fertilized by two sperms, resulting in an abnormal pregnancy with no fetus. The microscopic appearance of the specimen would further support this diagnosis.

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  • 13. 

    A 42-year-old African-American pregnant woman presents with vaginal bleeding. Physical examination reveals the uterus larger than predicted for her gestational age. Dilation and curettage is performed and histologic examination reveals the tissue shown for you evaluation. Which of the following is the most likely diagnosis?

    • A.

      Complete hydatidiform mole

    • B.

      Partial hydatidiform mole

    • C.

      Invasive hydatidiform mole

    • D.

      Choriocarcinoma

    • E.

      Endometrial carcinoma

    • F.

      Leiomyosarcoma

    Correct Answer
    B. Partial hydatidiform mole
    Explanation
    The most likely diagnosis in this case is a partial hydatidiform mole. This is suggested by the patient's clinical presentation of vaginal bleeding and a uterus larger than expected for her gestational age. Additionally, the histologic examination of the tissue confirms the diagnosis. A partial hydatidiform mole is characterized by an abnormal fertilization of an egg with two sets of paternal chromosomes and one set of maternal chromosomes. It typically presents with milder symptoms compared to a complete hydatidiform mole and has a lower risk of developing into choriocarcinoma.

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  • 14. 

    A 53-year-old Indian female presents with vaginal bleeding. On questioning, she reports her last menstrual period three months ago. She is not promiscuous and has lived in happy marriage with her husband over the past 30 years. She does not smoke, does not drink alcohol, and does not use recreational drugs. Ultrasound investigation reveals uterine pregnancy with a small hemorrhage between the placenta and uterine wall.  Which of the following risk factors is most likely implicated in this case?

    • A.

      Chorioamnionitis

    • B.

      Smoking

    • C.

      Cocaine abuse

    • D.

      Advanced maternal age

    • E.

      All of above

    Correct Answer
    E. All of above
    Explanation
    apparently middle aged Indian women are big coke heads!!!!!

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  • 15. 

    A 32-year-old African American female in her 36 week of pregnancy is brought to the emergency department in comatose state. On questioning, the patient’s husband reports a history of elevated blood pressure and edema. Which of the following is the most likely cause of patient’s condition?

    • A.

      Fetal chromosomal abnormalities

    • B.

      Inadequate invasion of trophoblastic cells into the spiral arteries

    • C.

      A sexual transmitted disease with chorioamnionitis

    • D.

      A pelvic inflammatory disease with ectopic pregnancy

    • E.

      Inadequate decidua formation due to deficiency of pituitary gonadotropins

    • F.

      Too deep invasion of trophoblast into the underlying myometrium

    Correct Answer
    B. Inadequate invasion of trophoblastic cells into the spiral arteries
    Explanation
    The most likely cause of the patient's condition is inadequate invasion of trophoblastic cells into the spiral arteries. This can lead to a condition called preeclampsia, which is characterized by elevated blood pressure and edema. Inadequate invasion of trophoblastic cells can result in impaired blood flow to the placenta, leading to fetal distress and maternal complications such as seizures and coma.

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  • 16. 

    The image represents an endometrial biopsy obtained from a 28-year-old pregnant Asian woman with unexpectedly rapidly enlarging uterus. Which of the following chromosomal set is most likely to be found in the cells of this lesion?

    • A.

      46YY

    • B.

      46XX, both sets are paternal

    • C.

      69XXX, one set is maternal and two are paternal

    • D.

      69XXY, one set is paternal and two are maternal

    • E.

      46XY

    Correct Answer
    C. 69XXX, one set is maternal and two are paternal
    Explanation
    The presence of 69XXX in the cells of the lesion suggests that there is an extra X chromosome. This condition is known as Triple X syndrome or Trisomy X. In this case, one set of chromosomes is maternal (from the mother) and two sets are paternal (from the father). This chromosomal abnormality can lead to various physical and developmental symptoms, but it is important to note that not all individuals with Trisomy X will experience the same symptoms or severity of symptoms.

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  • 17. 

    A 21-year-old African American woman acutely develops lower abdominal pain and vaginal bleeding. While in the bathroom she passes a cast of tissue composed of clot material. Histologic examination of the specimen reveals blood clots and endometrial tissue shown below for your evaluation.  Which of the following conditions is most likely present in this patient?

    • A.

      Ectopic pregnancy

    • B.

      Aborted intrauterine pregnancy

    • C.

      Hydatidiform mole

    • D.

      Endometrial hyperplasia

    • E.

      Endometrioid endometrial carcinoma

    • F.

      Choriocarcinoma

    Correct Answer
    A. Ectopic pregnancy
    Explanation
    The correct answer is ectopic pregnancy. This is suggested by the acute onset of lower abdominal pain and vaginal bleeding, as well as the passage of clot material. Ectopic pregnancy occurs when a fertilized egg implants outside of the uterus, most commonly in the fallopian tube. The presence of endometrial tissue in the specimen supports this diagnosis, as the endometrium is the lining of the uterus and would not normally be found outside of it.

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