Gynecologic Oncology Practice Questions

Q: A fifty-year-old woman presents with bilateral solid ovarian tumors and ascites. Upper gastro-intestinal endoscopy reveals an ulcerative growth in the pyloric region of the stomach. What is the most likely diagnosis?

Carcinoma stomach with Krukenberg's tumor. **Explanation:** The clinical presentation of **bilateral solid ovarian tumors** associated with a **gastric lesion** (ulcerative growth in the pylorus) and ascites is a classic description of **Krukenberg’s tumor**. **1. Why Option D is Correct:** A Krukenberg tumor is a metastatic signet-ring cell adenocarcinoma of the ovary, where the primary malignancy most commonly originates in the **stomach** (approx. 70%), followed by the colon, breast, or appendix. Key diagnostic features present in this case include: * **Bilateral involvement:** Over 80% of Krukenberg tumors are bilateral. * **Solid nature:** Unlike primary epithelial tumors which are often cystic-solid, these are typically firm and solid. * **Route of spread:** Traditionally thought to occur via retrograde lymphatic spread rather than direct peritoneal seeding. **2. Why Other Options are Incorrect:** * **Option A:** While epithelial ovarian tumors can cause ascites, they rarely metastasize to the stomach mucosa. It is far more common for the stomach to be the primary site and the ovary to be the secondary site. * **Options B & C:** Germ cell tumors (common in younger women) and Sex-cord stromal tumors (like Fibromas in Meigs Syndrome) do not typically coexist with gastric malignancies. The presence of an ulcerative gastric growth strongly points toward a primary GI malignancy. **3. NEET-PG High-Yield Pearls:** * **Microscopy:** Look for **Signet-ring cells** (mucin-filled cytoplasm displacing the nucleus to the periphery). * **Primary Site:** Stomach (most common); specifically the pylorus. * **Differential:** If the patient had a solid ovarian tumor, ascites, and right-sided pleural effusion but *no* gastric growth, the diagnosis would be **Meigs Syndrome**. * **Age:** Usually presents in the 5th decade of life.

Q: What is the FIGO staging of carcinoma of the ovary with negative nodes, limited to the true pelvis, and microscopic implants on the peritoneal surface?

Stage III A. **Explanation:** The FIGO staging for Ovarian Cancer is primarily surgical and pathological. This question tests the specific differentiation within **Stage III**, which involves spread to the peritoneum outside the pelvis and/or regional lymph nodes. **Why Stage III A is correct:** Stage III is defined by tumor involving one or both ovaries with cytologically or histologically confirmed spread to the peritoneum outside the pelvis and/or metastasis to the retroperitoneal lymph nodes. * **Stage III A1:** Spread limited to retroperitoneal lymph nodes only. * **Stage III A2:** **Microscopic** extrapelvic (above the pelvic brim) peritoneal involvement with or without positive retroperitoneal lymph nodes. Since the question specifies **microscopic implants** on the peritoneal surface and negative nodes, it fits the criteria for Stage III A. **Why the other options are incorrect:** * **Stage III B:** This involves **macroscopic** peritoneal metastasis beyond the pelvis, where the largest diameter of the implants is **≤ 2 cm**. * **Stage III C:** This involves **macroscopic** peritoneal metastasis beyond the pelvis where the largest diameter of the implants is **> 2 cm** (may include extension to the capsule of liver/spleen). **High-Yield Clinical Pearls for NEET-PG:** * **Stage I:** Limited to ovaries/fallopian tubes. * **Stage II:** Limited to pelvic organs (uterus, tubes, bladder, rectum) below the pelvic brim. * **Stage IV:** Distant metastasis (IV A: Pleural effusion with positive cytology; IV B: Parenchymal metastasis to liver/spleen or extra-abdominal organs). * **Key Distinction:** The transition from Stage II to Stage III occurs the moment the tumor crosses the **pelvic brim** onto the abdominal peritoneal surface. If it's only visible under a microscope, it is III A2.

Q: Latzko triad is characteristic of which of the following conditions?

Fallopian tube carcinoma. **Explanation:** **Latzko’s Triad** (also known as the Hydrops Tubae Profluens triad) is the classic clinical presentation of **Primary Fallopian Tube Carcinoma**. Although this triad is pathognomonic, it is seen in only about 15% of patients. The triad consists of: 1. **Intermittent profuse serosanguinous vaginal discharge:** Caused by the periodic emptying of the distended tube. 2. **Colicky pelvic pain:** Relieved by the discharge of fluid (as the pressure within the tube decreases). 3. **Palpable adnexal mass:** Which often shrinks or disappears after the discharge of fluid (**Hydrops Tubae Profluens**). **Analysis of Incorrect Options:** * **Ovarian Carcinoma:** Typically presents with vague abdominal bloating, early satiety, or a persistent solid adnexal mass. It does not feature the characteristic intermittent watery discharge seen in tubal cancer. * **Endometrial Carcinoma:** Usually presents with postmenopausal bleeding or abnormal uterine bleeding. While it involves the uterine cavity, it does not present with the specific "pain-relief-discharge" cycle of Latzko’s triad. * **Cervical Carcinoma:** Commonly presents with post-coital bleeding, foul-smelling discharge, or a visible growth on the cervix during speculum examination. **High-Yield Clinical Pearls for NEET-PG:** * **Most common histology:** Serous adenocarcinoma (similar to ovarian cancer). * **Lynch II Syndrome & BRCA mutations:** Both increase the risk of fallopian tube carcinoma. * **STIC (Serous Tubal Intraepithelial Carcinoma):** Currently considered the precursor lesion for many "ovarian" high-grade serous carcinomas. * **Management:** Staging and debulking surgery, followed by platinum-based chemotherapy (similar to the protocol for epithelial ovarian cancer).

Q: A 55-year-old female presents with abdominal pain, distension, ascites, and dyspnea. Her CA 125 levels are elevated. What is the most likely diagnosis?

Ovarian cancer. ### Explanation **Correct Option: A. Ovarian Cancer** The clinical presentation of abdominal pain, distension, and ascites in a postmenopausal woman is a classic "red flag" for **Epithelial Ovarian Cancer (EOC)**. Ascites in these patients often results from peritoneal carcinomatosis, where tumor cells disrupt lymphatic drainage and increase capillary permeability. The presence of **dyspnea** suggests a pleural effusion (likely Stage IV disease), forming part of the clinical picture of advanced malignancy. **CA-125** is the most significant tumor marker for EOC; while not specific (it can rise in endometriosis or PID), its elevation in a postmenopausal woman with a pelvic mass and ascites is highly suggestive of ovarian malignancy. **Incorrect Options:** * **B. Cervical Cancer:** Usually presents with post-coital or irregular vaginal bleeding. Ascites and elevated CA-125 are not typical primary features unless there is widespread intra-abdominal metastasis. * **C. Lung Cancer:** While it can cause dyspnea and pleural effusion, it would not typically present with a primary picture of ascites and elevated CA-125. * **D. Lymphoma:** Can cause ascites and lymphadenopathy, but CA-125 is not a standard marker for lymphoma, and the constellation of symptoms more strongly points toward a gynecological primary in this age group. **NEET-PG High-Yield Pearls:** * **Sister Mary Joseph Nodule:** A palpable nodule at the umbilicus representing metastasis from pelvic/abdominal cancers (most commonly Ovarian or Gastric). * **Meigs Syndrome:** A triad of Benign Ovarian Tumor (Fibroma), Ascites, and Right-sided Pleural Effusion. * **Staging:** Ovarian cancer is staged **surgically** (FIGO staging). * **Tumor Markers:** CA-125 is used for monitoring treatment response and recurrence rather than primary screening in the general population.

Q: Which of the following is true about granulosa cell tumors, EXCEPT?

The most common malignant tumor of the ovary. **Explanation:** The correct answer is **A (The most common malignant tumor of the ovary)** because this statement is false. The most common malignant ovarian tumors are **Serous Cystadenocarcinomas** (surface epithelial tumors). Granulosa cell tumors (GCTs) are rare, accounting for only 2–5% of all ovarian malignancies. They belong to the **Sex Cord-Stromal** category and are considered "low-grade" malignancies with a generally indolent course. **Analysis of other options:** * **B (Secretes hormones):** GCTs are functionally active tumors that primarily secrete **Estrogen**. This is a hallmark feature used for clinical diagnosis. * **C (Associated with endometrial hyperplasia):** Due to chronic, unopposed estrogen secretion, up to 25–50% of patients develop endometrial hyperplasia, and 5–10% may develop co-existing **Endometrial Carcinoma**. * **D (Chemotherapy sensitive):** While surgery is the primary treatment, GCTs are sensitive to chemotherapy (typically the **BEP regimen**: Bleomycin, Etoposide, and Cisplatin), which is used for advanced or recurrent stages. **NEET-PG High-Yield Pearls:** * **Pathognomonic Feature:** **Call-Exner bodies** (small follicles filled with eosinophilic material) seen on histology. * **Tumor Marker:** **Inhibin B** is the most reliable marker for diagnosis and monitoring recurrence. * **Clinical Presentation:** Often presents as **precocious puberty** in children (Juvenile type) or **postmenopausal bleeding** in older adults (Adult type). * **Nuclear Feature:** "Coffee-bean" nuclei (longitudinal nuclear grooves).

Q: Lower urethral involvement of vulval carcinoma without inguinofemoral nodes is seen in which stage?

Stage II. **Explanation:** The staging of vulvar carcinoma follows the **FIGO (2021)** classification. The correct answer is **Stage II** because this stage is defined by a tumor of any size with extension to adjacent perineal structures, specifically the **lower 1/3 of the urethra**, lower 1/3 of the vagina, or the anus, provided there is **no regional lymph node involvement**. * **Stage I:** The tumor is confined to the vulva or perineum with no nodal involvement. It is subdivided into IA (≤2 cm, stromal invasion ≤1 mm) and IB (>2 cm or invasion >1 mm). * **Stage III:** This stage is characterized by **inguinofemoral lymph node metastasis**, regardless of the size of the primary tumor or local extension to the lower urethra/vagina. * **Stage IV:** This represents advanced disease involving the **upper** parts of the pelvic organs (upper 2/3 of the urethra, upper 2/3 of the vagina, bladder mucosa, or rectal mucosa) or distant metastasis. **High-Yield Clinical Pearls for NEET-PG:** * **Lymphatic Spread:** Vulvar cancer primarily spreads via the lymphatics to the **inguinofemoral nodes**. The "Sentinel Lymph Node" biopsy is indicated in Stage IB/II tumors <4 cm. * **The "Lower vs. Upper" Rule:** Involvement of the **lower 1/3** of the urethra/vagina is **Stage II**; involvement of the **upper 2/3** is **Stage IVA**. * **Most Common Type:** Squamous cell carcinoma (SCC) is the most common histological type, often associated with HPV (in younger patients) or Lichen Sclerosus (in elderly patients).

Q: Which of the following statements are true about a complete mole?

Presence of fetal parts and cardiac activity. In a **Complete Hydatidiform Mole**, the genetic material is entirely paternal (usually 46,XX), resulting from the fertilization of an "empty" egg by one or two sperm. This leads to generalized trophoblastic proliferation and diffuse swelling of chorionic villi. ### **Analysis of Options** * **A. Presence of fetal parts and cardiac activity (Correct):** In a complete mole, there is **no fetal tissue** or amniotic fluid. The presence of fetal parts, a fetus, or cardiac activity is characteristic of a **Partial Mole** (usually 69,XXY). * **B. Normal uterine size:** In complete moles, the uterus is typically **larger than the period of gestation** (in ~50% of cases) due to excessive trophoblastic proliferation and retained blood. * **C. Beta hCG doubling time:** In a normal pregnancy, hCG doubles every 48–72 hours. In molar pregnancies, hCG levels are **abnormally high** (often >100,000 mIU/mL) and do not follow the standard doubling curve. * **D. Pre-eclampsia at < 24 weeks:** This is a **classic feature** of a complete mole. Developing hypertension/proteinuria in the first or early second trimester is a pathognomonic "red flag" for gestational trophoblastic disease. ### **NEET-PG High-Yield Pearls** * **USG Appearance:** "Snowstorm appearance" or "Bunch of grapes." * **Theca Lutein Cysts:** Often present bilaterally due to massive hCG stimulation. * **Karyotype:** Complete Mole (46,XX/XY; Paternal only) vs. Partial Mole (69,XXY; Triploid). * **Risk of Malignancy:** Complete moles have a higher risk (15–20%) of progressing to Choriocarcinoma compared to partial moles (<5%). * **Management:** Suction and evacuation is the treatment of choice.

Q: Extramammary Paget's disease is most commonly seen in which of the following locations?

Vulva. **Explanation:** **Extramammary Paget’s Disease (EMPD)** is a rare intraepithelial adenocarcinoma that occurs in skin areas rich in apocrine glands. 1. **Why Vulva is Correct:** The **vulva** is the most common site for EMPD, accounting for approximately 65% of cases. It typically presents in postmenopausal Caucasian women as a well-demarcated, erythematous, eczematous-like plaque, often described as having a **"strawberry-and-cream"** appearance. Histologically, it is characterized by the presence of **Paget cells** (large cells with clear, pale cytoplasm) within the epidermis. 2. **Why Other Options are Incorrect:** * **Uterus, Vagina, and Ovary:** These are internal genital organs. EMPD is specifically a disease of the **skin and adnexal structures**. While Paget’s disease can rarely involve the vagina by secondary extension, it does not primary originate in the non-cutaneous mucosal or stromal tissues of the uterus or ovaries. **High-Yield Clinical Pearls for NEET-PG:** * **Associated Malignancy:** Unlike mammary Paget’s (which is almost always associated with underlying breast cancer), EMPD of the vulva is associated with an underlying internal malignancy (e.g., bladder, colorectal, or cervical cancer) in about **20-30%** of cases. * **Histochemistry:** Paget cells are **PAS positive**, **Alcian blue positive**, and **Mucicarmine positive** (indicating mucin production). * **Immunohistochemistry (IHC):** They are typically **CK7 positive** and **CEA positive**, which helps differentiate them from melanoma (S100+) or Bowen’s disease (p63+). * **Treatment:** Wide local excision is the gold standard, though recurrence rates are high due to the multifocal nature of the disease.

Question 1

A fifty-year-old woman presents with bilateral solid ovarian tumors and ascites. Upper gastro-intestinal endoscopy reveals an ulcerative growth in the pyloric region of the stomach. What is the most likely diagnosis?

Accepted Answer

Carcinoma stomach with Krukenberg's tumor

Answer

Malignant epithelial ovarian tumor with gastric metastasis

Answer

Germ cell ovarian tumor with concurrent gastric malignancy

Answer

Sex cord stromal tumor with concurrent gastric malignancy

Question 2

What is the FIGO staging of carcinoma of the ovary with negative nodes, limited to the true pelvis, and microscopic implants on the peritoneal surface?

Accepted Answer

Stage III A

Answer

Stage III B

Answer

Stage III C

Answer

None of the above

Question 3

What is the treatment of choice for a 28-week size molar pregnancy in a 40-year-old parous woman?

Accepted Answer

Hysterectomy

Answer

Vacuum extraction

Answer

Hysterotomy

Answer

Vaginal delivery

Question 4

Latzko triad is characteristic of which of the following conditions?

Accepted Answer

Fallopian tube carcinoma

Answer

Ovarian carcinoma

Answer

Endometrial carcinoma

Answer

Cervical carcinoma

Question 5

A 55-year-old female presents with abdominal pain, distension, ascites, and dyspnea. Her CA 125 levels are elevated. What is the most likely diagnosis?

Accepted Answer

Ovarian cancer

Answer

Cervical cancer

Answer

Lung cancer

Answer

Lymphoma

Question 6

Bilateral hydronephrosis is seen in which of the following conditions?

Accepted Answer

Carcinoma cervix stage 3 or 4

Answer

Vaginal carcinoma

Answer

Hepatic cirrhosis

Answer

Colon cancer

Question 7

Which of the following is true about granulosa cell tumors, EXCEPT?

Accepted Answer

The most common malignant tumor of the ovary

Answer

It secretes hormones

Answer

Associated with endometrial hyperplasia

Answer

Chemotherapy sensitive

Question 8

Lower urethral involvement of vulval carcinoma without inguinofemoral nodes is seen in which stage?

Accepted Answer

Stage II

Answer

Stage I

Answer

Stage III

Answer

Stage IV

Question 9

Which of the following statements are true about a complete mole?

Accepted Answer

Presence of fetal parts and cardiac activity

Answer

Normal uterine size

Answer

Beta hCG doubling time is 7-10 days

Answer

Pre-eclampsia at < 24 weeks

Question 10

Extramammary Paget's disease is most commonly seen in which of the following locations?

Accepted Answer

Vulva

Answer

Uterus

Answer

Vagina

Answer

Ovary

Gynecologic Oncology — MCQs

Gynecologic Oncology — MCQs

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