Gynecologic Oncology Practice Questions

Q: A 45-year-old female presents with a rapidly enlarging mass arising from the uterine wall along with perimenopausal bleeding. Histopathological examination is suggestive of malignant smooth muscle tumor. What is the most likely diagnosis?

Leiomyosarcoma. ***Leiomyosarcoma*** - Represents a **malignant smooth muscle tumor** arising from the uterine wall, typically presenting as a **rapidly enlarging mass** which is a hallmark clinical sign distinguishing it from benign lesions. - Histopathological diagnosis requires demonstrating high **mitotic activity**, cellular atypia, and **coagulative tumor cell necrosis**, which are classic features of this sarcoma. *Leiomyoma* - This is a **benign smooth muscle tumor** (fibroid) and is extremely common in perimenopausal women. - Unlike leiomyosarcoma, it grows slowly and lacks the criteria for high-grade malignancy, such as significant **cellular atypia** or extensive necrosis. *Endometrial carcinoma* - This cancer arises from the **glandular epithelium** of the endometrium rather than the smooth muscle of the uterine wall (myometrium). - While it presents with **postmenopausal or perimenopausal bleeding**, the mass effect is typically within the uterine cavity rather than an intramural smooth muscle malignancy. *Adenomyosis* - Characterized by the presence of **endometrial tissue** within the myometrium, leading to a uniformly enlarged, boggy uterus. - It is a **benign condition** and does not present as a discrete, rapidly growing malignant solid mass.

Q: A postmenopausal woman presents with intermittent vaginal bleeding. She subsequently undergoes hysterectomy. The resected specimen is shown. What is the most likely indication for which the hysterectomy was performed?

Endometrial carcinoma. ***Endometrial carcinoma*** - Postmenopausal bleeding is the **hallmark symptom** of endometrial carcinoma, necessitating investigation and often surgical management like a hysterectomy. - The resected specimen in this context would show **malignant glandular proliferation** invading the **myometrium**, confirming the diagnosis of adenocarcinoma. *Adenomyosis* - This condition presents with **menorrhagia** (heavy menstrual bleeding) and painful periods, typically in premenopausal women, rather than postmenopausal bleeding. - Pathology shows the presence of **endometrial glands and stroma** within the **myometrium**, causing a diffusely enlarged (

Q: What is Type IIIB Endometrial cancer according to FIGO staging?

Endometrial cancer with vaginal involvement. **Explanation:** The FIGO staging for endometrial cancer was significantly updated in 2023. Understanding the distinction between local, regional, and distant spread is crucial for NEET-PG. **Why the correct answer is right:** **Stage III** represents regional spread of the tumor. Specifically, **Stage IIIB** is defined by the involvement of the **vagina and/or the parametria**. This indicates that the cancer has extended beyond the uterus but remains within the pelvic structures adjacent to the primary site. **Analysis of incorrect options:** * **Option A (Cervical stroma):** This corresponds to **Stage II**. Stage I is confined to the corpus, while Stage II involves the cervical stroma but does not extend beyond the uterus. * **Option C (Uterine adnexa):** This corresponds to **Stage IIIA1**. Involvement of the adnexa (ovaries or fallopian tubes) or the uterine serosa (Stage IIIA2) constitutes Stage IIIA. * **Option D (Pelvic lymph nodes):** This corresponds to **Stage IIIC1**. If the cancer spreads to the pelvic lymph nodes, it is IIIC1; if it reaches the para-aortic lymph nodes, it is IIIC2. **High-Yield Clinical Pearls for NEET-PG:** * **Most Common Presentation:** Postmenopausal bleeding (PMB). * **Risk Factors:** Obesity, nulliparity, early menarche/late menopause, and Lynch Syndrome (HNPCC). * **Staging Method:** Endometrial cancer is **surgically staged**. * **2023 Update Note:** The new FIGO staging now incorporates histological grades and molecular markers (like POLE mutations or p53 status) into the staging criteria, but the anatomical definitions for Stage III remain a frequent exam focus.

Q: In pseudomyxoma peritonei, mucinous cyst-adenocarcinoma of which of the following organs is involved?

Ovary. **Explanation:** **Pseudomyxoma Peritonei (PMP)** is a clinical syndrome characterized by the accumulation of gelatinous, mucinous ascites ("jelly belly") within the peritoneal cavity. It typically results from the rupture of a mucinous tumor, leading to the seeding of mucus-secreting cells onto the peritoneal surfaces. **Why Ovary is Correct:** In females, the **ovary** is a classic primary site for mucinous cystadenocarcinomas that can lead to PMP. While modern pathology suggests that the majority of PMP cases actually originate from a primary **appendiceal** mucinous tumor (which then involves the ovaries secondarily), the ovary remains the most significant gynecological organ associated with this condition in standard medical examinations. When a mucinous ovarian tumor ruptures or undergoes surface extension, it leads to the characteristic intraperitoneal mucin accumulation. **Why Other Options are Incorrect:** * **Pancreas:** While the pancreas can develop mucinous cystic neoplasms, they rarely present as classic PMP; they are more likely to cause localized spread or biliary obstruction. * **Kidney:** Primary mucinous adenocarcinoma of the kidney is extremely rare and is not a recognized cause of PMP. * **Abdominal Testis:** There is no established clinical association between germ cell tumors or other malignancies of an undescended testis and the development of pseudomyxoma peritonei. **High-Yield Clinical Pearls for NEET-PG:** * **Most Common Source:** The **Appendix** is now considered the most common primary site for PMP (often via a low-grade appendiceal mucinous neoplasm - LAMN). * **Clinical Presentation:** Patients often present with increasing abdominal girth, "jelly belly" on laparotomy, and the "scalloping" of the liver surface on CT scan. * **Treatment:** The gold standard is **Cytoreductive Surgery (CRS)** combined with **Hyperthermic Intraperitoneal Chemotherapy (HIPEC)**, often referred to as the "Sugarbaker Procedure."

Q: In a patient who underwent post molar evacuation by dilatation and curettage, which of the following tests is used to define successful removal of H. Mole?

Beta HCG. **Explanation:** The correct answer is **Beta HCG (Option A)**. Hydatidiform mole (H. Mole) is a gestational trophoblastic disease characterized by the proliferation of trophoblastic tissue, which secretes Human Chorionic Gonadotropin (hCG). Following suction and evacuation, serial monitoring of serum Beta HCG is the **gold standard** for defining successful removal and ensuring the patient has not developed Gestational Trophoblastic Neoplasia (GTN). A successful removal is defined by a progressive decline in Beta HCG levels until they become undetectable. **Why other options are incorrect:** * **Per speculum examination (Option B):** While useful to check for vaginal metastases (theca lutein cysts or suburethral nodules), it cannot quantify the presence of residual microscopic trophoblastic tissue. * **Progesterone (Option C):** Progesterone levels are not specific to trophoblastic activity and play no role in the diagnosis or follow-up of molar pregnancies. * **USG (Option D):** Ultrasound is the investigation of choice for the **initial diagnosis** (showing a "snowstorm appearance"), but it is not sensitive enough to detect microscopic residual disease or define biochemical remission. **Clinical Pearls for NEET-PG:** * **Follow-up Protocol:** Serum Beta HCG should be monitored weekly until three consecutive samples are negative (<5 mIU/mL), then monthly for 6 months. * **GTN Diagnosis:** According to FIGO criteria, GTN is suspected if HCG levels plateau (4 values over 3 weeks) or rise (3 values over 2 weeks). * **Contraception:** Patients must be advised to use reliable contraception (preferably OCPs) during the follow-up period to avoid a new pregnancy, which would confuse HCG interpretation.

Question 1

A 45-year-old female presents with a rapidly enlarging mass arising from the uterine wall along with perimenopausal bleeding. Histopathological examination is suggestive of malignant smooth muscle tumor. What is the most likely diagnosis?

Accepted Answer

Leiomyosarcoma

Answer

Leiomyoma

Answer

Endometrial carcinoma

Answer

Adenomyosis

Question 2

A postmenopausal woman presents with intermittent vaginal bleeding. She subsequently undergoes hysterectomy. The resected specimen is shown. What is the most likely indication for which the hysterectomy was performed?

Accepted Answer

Endometrial carcinoma

Answer

Adenomyosis

Answer

Leiomyoma uterus

Answer

Endometrial hyperplasia

Question 3

A 29-year-old woman at 10 weeks gestation develops severe hyperemesis gravidarum. Ultrasound reveals a complete hydatidiform mole. Her serum hCG is 500,000 mIU/mL. She undergoes suction curettage. Two weeks post-procedure, her hCG is 50,000 mIU/mL. Four weeks post-procedure, it is 45,000 mIU/mL. Analyze these findings to determine the most appropriate next step.

Accepted Answer

Initiate single-agent methotrexate chemotherapy for gestational trophoblastic neoplasia

Answer

Continue weekly hCG monitoring as normal decline is occurring

Answer

Perform hysterectomy for definitive treatment

Answer

Repeat suction curettage for retained molar tissue

Answer

Begin multi-agent chemotherapy with EMA-CO regimen

Question 4

A middle-aged woman presented with a 6-month history of dull abdominal pain. A CT scan of the pelvis revealed a 7 cm mass involving the left ovary with irregular calcifications. The right fallopian tube and ovary were excised. What is the likely diagnosis?

Accepted Answer

Mature cystic teratoma

Answer

Mucinous cystadenoma

Answer

Choriocarcinoma

Answer

Dysgerminoma

Question 5

What is Type IIIB Endometrial cancer according to FIGO staging?

Accepted Answer

Endometrial cancer with vaginal involvement

Answer

Endometrial cancer invading cervical stroma

Answer

Endometrial cancer involving uterine adnexa

Answer

Endometrial cancer invading pelvic lymph nodes

Question 6

A 35-year-old woman presents for a routine gynecological examination. A Pap smear is performed and found to be normal. She is determined to be a low-risk case. Considering she has had normal smears for the last three consecutive years, at what intervals will you recommend Pap smear examinations for her?

Accepted Answer

Every 3 years

Answer

Annually

Answer

Every 2 years

Answer

Every 5 years

Question 7

In pseudomyxoma peritonei, mucinous cyst-adenocarcinoma of which of the following organs is involved?

Accepted Answer

Ovary

Answer

Pancreas

Answer

Kidney

Answer

Abdominal testis

Question 8

What is the treatment of choice for a young patient diagnosed with choriocarcinoma?

Accepted Answer

Chemotherapy

Answer

Hysterectomy

Answer

Chemotherapy followed by hysterectomy

Answer

Hysterectomy followed by chemotherapy

Question 9

In a young woman diagnosed with stage Ib cervical cancer, during a radical hysterectomy, which structure is typically preserved?

Accepted Answer

Periureteral tissues

Answer

Uterosacral and uterovesical ligaments

Answer

Pelvic lymph nodes

Answer

Upper third of the vagina

Question 10

In a patient who underwent post molar evacuation by dilatation and curettage, which of the following tests is used to define successful removal of H. Mole?

Accepted Answer

Beta HCG

Answer

Per speculum examination

Answer

Progesterone

Answer

USG

Gynecologic Oncology — MCQs

Gynecologic Oncology — MCQs

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