Gynecologic Oncology Practice Questions

Q: Which of the following is a germ cell tumor?

Yolk sac tumor. **Explanation:** Ovarian tumors are classified based on their tissue of origin into three main categories: Surface Epithelial, Germ Cell, and Sex Cord-Stromal tumors. **Correct Option: D. Yolk sac tumor** Yolk sac tumors (Endodermal Sinus Tumors) are highly aggressive **Germ Cell Tumors (GCTs)** derived from the primitive germ cells of the embryonic gonad. They are the second most common malignant GCT. A key diagnostic feature is the presence of **Schiller-Duval bodies** on histology and significantly elevated serum **Alpha-fetoprotein (AFP)** levels. **Incorrect Options:** * **A. Brenner tumor:** This is a **Surface Epithelial-Stromal tumor**. It is characterized by "Walthard cell nests" and transitional epithelium resembling the bladder urothelium. * **B. Granulosa cell tumor:** This is a **Sex Cord-Stromal tumor**. It is known for producing estrogen (leading to endometrial hyperplasia) and histologically features **Call-Exner bodies**. * **C. Leydig cell tumors:** These are also **Sex Cord-Stromal tumors** (specifically pure stromal tumors). They are androgen-secreting and often contain pathognomonic **Reinke crystals**. **High-Yield Clinical Pearls for NEET-PG:** * **Most common Germ Cell Tumor:** Mature Cystic Teratoma (Dermoid cyst). * **Most common malignant GCT:** Dysgerminoma (associated with LDH and hCG). * **Tumor Markers:** * Yolk Sac Tumor → **AFP** * Dysgerminoma → **LDH** * Choriocarcinoma → **beta-hCG** * Granulosa Cell Tumor → **Inhibin B** (most sensitive) and Estrogen.

Q: All of the following ovarian neoplasms secrete hormones, except?

Dysgerminoma. **Explanation:** The core concept tested here is the distinction between **functioning (hormone-secreting)** and **non-functioning** ovarian tumors. **Why Dysgerminoma is the correct answer:** Dysgerminoma is the most common germ cell tumor of the ovary. It is typically **hormonally inert**, meaning it does not produce estrogen, androgens, or progesterone. While it is a classic marker for **LDH (Lactate Dehydrogenase)** and occasionally produces low levels of hCG (if syncytiotrophoblastic giant cells are present), it does not secrete steroid hormones that cause systemic endocrine effects. **Analysis of Incorrect Options:** * **Granulosa Cell Tumor:** A sex cord-stromal tumor known for secreting high levels of **Estrogen**. Clinical presentations include precocious puberty in children or postmenopausal bleeding/endometrial hyperplasia in adults. (Marker: Inhibin). * **Hilus Cell Tumor:** A subtype of Leydig cell tumor. These are pure steroid cell tumors that secrete **Androgens** (testosterone), leading to rapid virilization (hirsutism, clitoromegaly). * **Theca Cell Tumor (Thecoma):** Another sex cord-stromal tumor that is almost always benign and characteristically produces **Estrogen**. **NEET-PG High-Yield Pearls:** 1. **Dysgerminoma Markers:** LDH (Best), Placental Alkaline Phosphatase (PLAP), and hCG (only if syncytiotrophoblastic cells are present). 2. **Most common hormone-secreting tumor:** Granulosa cell tumor (Estrogen). 3. **Struma Ovarii:** A specialized teratoma that secretes **Thyroid hormone**, leading to hyperthyroidism. 4. **Sertoli-Leydig Cell Tumor:** The most common virilizing (Androgen-secreting) tumor of the ovary.

Q: Which of the following is NOT an indication for radiotherapy in carcinoma of the endometrium?

Enlarged uterine cavity. **Explanation:** In endometrial carcinoma, the decision to administer adjuvant radiotherapy (RT) is based on the risk of recurrence, which is determined by surgical-pathological staging. **Why "Enlarged uterine cavity" is the correct answer:** An enlarged uterine cavity is a clinical or radiological finding often associated with the bulk of the tumor or associated leiomyomas. However, it is **not** an independent prognostic factor or a recognized indication for adjuvant radiotherapy in current FIGO guidelines. Management is dictated by the depth of invasion and histological characteristics, not the size of the uterus itself. **Analysis of Incorrect Options (Indications for RT):** * **Deep Myometrial Involvement (Option B):** Invasion of more than 50% of the myometrium (Stage IB) significantly increases the risk of lymph node metastasis and local recurrence, making it a standard indication for RT. * **Poor Differentiation (Option D):** Grade 3 (G3) tumors are biologically aggressive. High-grade histology, even with superficial invasion, often warrants adjuvant treatment (Brachytherapy or External Beam RT). * **Pelvic Node Involvement (Option A):** Positive nodes (Stage IIIC1) indicate regional spread. These patients require External Beam Radiotherapy (EBRT) often combined with chemotherapy to control pelvic disease. **Clinical Pearls for NEET-PG:** * **Standard Treatment:** The primary treatment for endometrial cancer is **Extrafascial Total Abdominal Hysterectomy with Bilateral Salpingo-oophorectomy (TAH+BSO)** with pelvic/para-aortic lymphadenectomy. * **Risk Stratification:** Adjuvant RT is indicated for "High-Intermediate Risk" factors, often remembered by the **GOG-99 criteria**: Age >60, Grade 2 or 3, presence of Lymphovascular Space Invasion (LVSI), and Deep myometrial invasion. * **Type II Endometrial CA:** Serous and Clear Cell carcinomas are high-risk regardless of stage and almost always require adjuvant therapy.

Q: A postmenopausal woman who is obese, hypertensive, and diabetic presents with postmenopausal bleeding. What is the most probable cause?

Endometrial cancer. ### Explanation **Correct Option: B. Endometrial cancer** The clinical presentation described—**postmenopausal bleeding (PMB)** in a patient with the "Corpus Uteri Cancer Syndrome" triad (**Obesity, Hypertension, and Diabetes**) — is a classic textbook scenario for **Endometrial Carcinoma**. The underlying pathophysiology involves **unopposed estrogen**. Obesity leads to increased peripheral conversion of androstenedione to estrone in adipose tissue. Chronic exposure to estrogen without the counter-effect of progesterone causes endometrial hyperplasia, which can progress to malignancy. In any postmenopausal woman presenting with vaginal bleeding, endometrial cancer must be ruled out first via endometrial biopsy or transvaginal ultrasound (TVS). **Why other options are incorrect:** * **A. Malignant ovarian tumor:** While some functional ovarian tumors (like Granulosa cell tumors) can secrete estrogen and cause PMB, they typically present with an adnexal mass and are less common than primary endometrial pathology in this demographic. * **C. Endocervical cancer:** While it can cause bleeding, it is more frequently associated with post-coital bleeding and is not specifically linked to the metabolic triad of obesity and diabetes. * **D. Brenner tumor:** This is a rare, usually benign fibroepithelial ovarian tumor. While it can occasionally be hormonally active, it is a much less probable cause of PMB compared to endometrial cancer. **High-Yield Clinical Pearls for NEET-PG:** * **Most common cause of PMB:** Senile/Atrophic vaginitis (however, malignancy must be excluded first). * **Risk Factors:** Nulliparity, early menarche, late menopause, PCOS, and Tamoxifen use. * **Investigation of Choice:** Endometrial Biopsy (Pipelle biopsy) is the gold standard. * **TVS Cut-off:** An endometrial thickness (ET) of **>4 mm** in a postmenopausal woman warrants further evaluation.

Q: CA-125 is increased in all of the following conditions EXCEPT:

Stein-Leventhal syndrome. **Explanation:** CA-125 (Cancer Antigen 125) is a high-molecular-weight glycoprotein produced by derivatives of the **coelomic epithelium** (peritoneum, pleura, pericardium) and the **Müllerian epithelium** (fallopian tubes, endometrium, endocervix). It is a non-specific marker that increases whenever there is inflammation, irritation, or malignancy involving these surfaces. **Why Stein-Leventhal Syndrome is the correct answer:** Stein-Leventhal syndrome, commonly known as **Polycystic Ovary Syndrome (PCOS)**, is a metabolic and endocrine disorder characterized by hyperandrogenism and anovulation. It does not involve inflammation or destruction of the coelomic epithelium or Müllerian structures. Therefore, CA-125 levels typically remain within the normal range. **Analysis of Incorrect Options:** * **Ovarian Cancer:** CA-125 is the primary tumor marker for **epithelial ovarian tumors** (especially serous cystadenocarcinoma). It is used for monitoring treatment response and detecting recurrence. * **Tuberculosis of the genital organ:** Pelvic TB causes significant peritoneal inflammation and "millet-seed" granulomas on the serosa, leading to markedly elevated CA-125 levels (often mimicking ovarian cancer). * **Endometriosis:** This is an inflammatory condition where ectopic endometrial tissue bleeds and irritates the peritoneum, leading to moderate elevations in CA-125. **High-Yield Clinical Pearls for NEET-PG:** * **Normal Value:** <35 U/mL. * **Specificity:** CA-125 is highly sensitive but has **low specificity** in premenopausal women because it rises in benign conditions like menstruation, pregnancy, and PID. * **Meigs’ Syndrome:** Characterized by a benign ovarian fibroma, ascites, and pleural effusion; CA-125 is often elevated here despite the tumor being benign. * **Best Marker for Mucinous Ovarian Cancer:** CEA and CA 19-9 (CA-125 is often low in mucinous types).

Q: In the Bethesda System for reporting cervical cytology, a low-grade squamous intraepithelial lesion (LSIL) involves which of the following?

CIN I. The Bethesda System (TBS) is the standardized nomenclature for reporting cervical cytology. It categorizes squamous cell abnormalities into two main tiers based on their clinical management and biological behavior: **LSIL** and **HSIL**. ### Explanation of the Correct Answer **LSIL (Low-grade Squamous Intraepithelial Lesion)** corresponds to **CIN I** (Cervical Intraepithelial Neoplasia Grade I). It represents a transient infection with Human Papillomavirus (HPV) and mild dysplasia involving the lower one-third of the cervical epithelium. Cytologically, LSIL is characterized by **koilocytosis** (perinuclear halo and nuclear wrinkling), which is the hallmark of HPV infection. ### Analysis of Incorrect Options * **B and C (CIN II and CIN III):** These are categorized under **HSIL (High-grade Squamous Intraepithelial Lesion)** in the Bethesda System. CIN II (moderate dysplasia) and CIN III (severe dysplasia/carcinoma in situ) carry a higher risk of progression to invasive cancer and require more aggressive management (e.g., LEEP or cold knife conization). * **D (Squamous Metaplasia):** This is a **physiological** process where the columnar epithelium of the endocervix is replaced by squamous epithelium at the transformation zone. It is a benign finding and not a dysplastic lesion. ### High-Yield Clinical Pearls for NEET-PG * **LSIL Management:** In women >25 years, LSIL is generally managed with colposcopy. However, in adolescents (21–24 years), observation with repeat cytology at 12 months is preferred due to high regression rates. * **CIN Classification:** * **CIN I:** Dysplasia in the lower 1/3rd of the epithelium. * **CIN II:** Dysplasia in the lower 2/3rd. * **CIN III:** Dysplasia involving >2/3rd or the full thickness (Carcinoma in situ). * **Key Marker:** **p16** is a surrogate biomarker for high-risk HPV; it is typically negative/focal in LSIL but shows strong, diffuse staining in HSIL.

Question 1

Which of the following is a germ cell tumor?

Accepted Answer

Yolk sac tumor

Answer

Brenner tumor

Answer

Granulosa cell tumor

Answer

Leydig cell tumors

Question 2

In Dysgerminoma stage 1A, what is the treatment of choice?

Accepted Answer

Unilateral ovariotomy with preservation of the uterus

Answer

Total abdominal hysterectomy with bilateral salpingo-oophorectomy

Answer

Bilateral ovariotomy with preservation of the uterus

Answer

Bilateral salpingo-oophorectomy

Question 3

What is the management of stage II endometrial cancer?

Accepted Answer

Modified radical hysterectomy

Answer

Total abdominal hysterectomy with bilateral salpingo-oophorectomy (TAH + BSO)

Answer

Unilateral salpingo-oophorectomy with TAH

Answer

Chemotherapy only

Question 4

All of the following ovarian neoplasms secrete hormones, except?

Accepted Answer

Dysgerminoma

Answer

Granulosa cell tumor

Answer

Hilus cell tumor

Answer

Theca cell tumor

Question 5

Which of the following is NOT an indication for radiotherapy in carcinoma of the endometrium?

Accepted Answer

Enlarged uterine cavity

Answer

Pelvic node involvement

Answer

Deep myometrial involvement

Answer

Poor differentiation

Question 6

A postmenopausal woman who is obese, hypertensive, and diabetic presents with postmenopausal bleeding. What is the most probable cause?

Accepted Answer

Endometrial cancer

Answer

Malignant ovarian tumor

Answer

Endocervical cancer

Answer

Brenner tumor

Question 7

CA-125 is increased in all of the following conditions EXCEPT:

Accepted Answer

Stein-Leventhal syndrome

Answer

Tuberculosis of the genital organ

Answer

Ovarian cancer

Answer

Endometriosis

Question 8

In the Bethesda System for reporting cervical cytology, a low-grade squamous intraepithelial lesion (LSIL) involves which of the following?

Accepted Answer

CIN I

Answer

CIN II

Answer

CIN III

Answer

Squamous metaplasia

Question 9

Carcinoma of the endometrium involving the uterine cavity more than 10 cm long with early myometrial involvement is classified as which stage?

Accepted Answer

Stage Ib

Answer

Stage Ia

Answer

Stage IIa

Answer

Stage IIb

Question 10

What is the management of CIN III?

Accepted Answer

LEEP conization

Answer

Cervical biopsy

Answer

Hysterectomy

Answer

Cone biopsy

Gynecologic Oncology — MCQs

Gynecologic Oncology — MCQs

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