Ovarian Diseases and Tumors — MCQs
Which of the following statements about seminomas is false?
Most common ovarian tumor in young lady is ?
Which of the following is the platinum-based chemotherapeutic agent used as first-line treatment for ovarian carcinoma?
Sections from a solid-cystic unilateral ovarian tumor in a 30-year old female show a tumor composed of diffuse sheets of small cells with doubtful nuclear grooving and scanty cytoplasm. No Call-Exner bodies are seen. The ideal immunohistochemistry panel would include
Which of the following cancers is least associated with BRCA2 mutations?
A 2-year-old child presents with a testicular lump and elevated AFP levels. What is the most likely diagnosis?
Which of the following is the ovarian counterpart of testicular seminoma?
Tumor marker of epithelial ovarian carcinoma is:
Serum level of CA 125 is raised in which of the following conditions?
Most useful investigation in a 55-year-old postmenopausal woman with diabetes mellitus and hypertension who has presented with postmenopausal bleeding is:
Ovarian Diseases and Tumors Indian Medical PG Practice Questions and MCQs
Question 1: Which of the following statements about seminomas is false?
- A. Serum HCG levels are elevated
- B. Spermatocytic seminomas are usually slow growing
- C. Most common type of germ cell tumor
- D. Schiller-Duval bodies are commonly seen (Correct Answer)
Explanation: ***Schiller-Duval bodies are commonly seen*** - **Schiller-Duval bodies** are pathognomonic for **yolk sac tumors**, a different type of germ cell tumor, not seminomas [1]. - Their presence would indicate a diagnosis other than pure seminoma. *Serum HCG levels are elevated* - While most pure seminomas do not produce tumor markers, about 10-15% of seminomas have **elevated beta-HCG** due to the presence of **syncytiotrophoblast-like cells** [1]. - This elevation is typically less pronounced than in choriocarcinoma but still occurs [1]. *Spermatocytic seminomas are usually slow growing* - **Spermatocytic seminoma** is a rare subtype of seminoma that typically affects older men and is known for its **indolent, slow-growing** nature [1]. - It usually has an excellent prognosis and rarely metastasizes. *Most common type of germ cell tumor* - **Seminoma** is indeed the most common type of **testicular germ cell tumor**, accounting for approximately 50-60% of all germ cell neoplasms. - It typically affects men in their 30s and 40s. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Lower Urinary Tract and Male Genital System, pp. 979-982.
Question 2: Most common ovarian tumor in young lady is ?
- A. Mature cystic teratoma (dermoid cyst) (Correct Answer)
- B. Ovarian Serous Cystadenocarcinoma
- C. Ovarian Mucinous Cystadenocarcinoma
- D. Dysgerminoma
Explanation: ***Mature cystic teratoma (dermoid cyst)*** - **Mature cystic teratoma** is the **most common ovarian tumor in young women and adolescents**, accounting for 10-25% of all ovarian tumors. - These benign tumors are derived from **germ cells** and contain differentiated tissues from all three germ layers (ectoderm, mesoderm, endoderm), such as hair, teeth, skin, and sebaceous material. - They occur most frequently in women of **reproductive age** (20-40 years) and are usually **asymptomatic** unless complicated by torsion or rupture. *Dysgerminoma* - **Dysgerminoma** is the most common **malignant** germ cell tumor of the ovary, but represents only 1-2% of all ovarian malignancies. - It occurs predominantly in young women and adolescents and is highly sensitive to **radiation and chemotherapy** with excellent prognosis. - The question asks for "most common ovarian tumor" (not specifically malignant), making this incorrect. *Ovarian Serous Cystadenocarcinoma* - **Serous cystadenocarcinomas** are the most common type of epithelial ovarian cancer, but they typically occur in **older, postmenopausal women** (mean age 60-65 years). - They are characterized by **serous fluid-filled cysts** and are often bilateral. *Ovarian Mucinous Cystadenocarcinoma* - **Mucinous cystadenocarcinomas** are also epithelial ovarian cancers, less common than serous types, and generally affect **older women**. - These tumors are characterized by large, often **multiloculated cysts** filled with mucinous material.
Question 3: Which of the following is the platinum-based chemotherapeutic agent used as first-line treatment for ovarian carcinoma?
- A. Cyclophosphamide
- B. Methotrexate
- C. Cisplatin (Correct Answer)
- D. Dacarbazine
Explanation: ***Cisplatin*** - **Cisplatin** is a platinum-based chemotherapy drug that forms **DNA cross-links**, inhibiting DNA synthesis and leading to the death of rapidly dividing cells, making it highly effective against **ovarian carcinoma**. - It is a cornerstone of chemotherapy regimens for ovarian cancer, often used in combination with other agents such as paclitaxel. *Methotrexate* - **Methotrexate** is an **antimetabolite** that inhibits dihydrofolate reductase, thereby interfering with DNA synthesis. - While it is used in various cancers like leukemia, lymphoma, and some solid tumors (e.g., breast cancer, gestational trophoblastic disease), it is **not a primary recommended drug for ovarian carcinoma**. *Cyclophosphamide* - **Cyclophosphamide** is an **alkylating agent** that causes DNA damage, leading to cell death. - It is used in many cancers, including lymphoma, breast cancer, and some leukemias, but it is **not a first-line or primary agent for ovarian carcinoma** in contemporary treatment guidelines. *Dacarbazine* - **Dacarbazine** is an **alkylating agent** primarily used in the treatment of **malignant melanoma** and Hodgkin lymphoma. - It is **not indicated for the treatment of ovarian carcinoma**.
Question 4: Sections from a solid-cystic unilateral ovarian tumor in a 30-year old female show a tumor composed of diffuse sheets of small cells with doubtful nuclear grooving and scanty cytoplasm. No Call-Exner bodies are seen. The ideal immunohistochemistry panel would include
- A. CD3, chromagranin, CD 45, synaptophysin
- B. Chromogranin, CD45, CD99, CD20
- C. Desmin, S- 100 protein, smooth muscle antigen, cytokeratin
- D. Vimentin, epithelial membrane antigen, inhibin, CD99 (Correct Answer)
Explanation: ***Vimentin, epithelial membrane antigen, inhibin, CD99*** - This panel covers markers for **sex cord-stromal tumors** (inhibin, vimentin), **granulosa cell tumors** (inhibin) [2], **primitive neuroectodermal tumors/Ewing sarcoma** (CD99), and allows for the exclusion of epithelial tumors (EMA can be positive in some non-epithelial tumors but is less specific). - Given the "diffuse sheets of small cells with doubtful nuclear grooving and scanty cytoplasm" and "solid-cystic unilateral ovarian tumor," this panel helps differentiate between various small round blue cell tumors or sex cord-stromal tumors, including **adult granulosa cell tumors** (inhibin, vimentin positive) [1], **primary ovarian Ewing sarcoma/PNET** (CD99 positive), and others. *CD3, chromagranin, CD 45, synaptophysin* - This panel primarily targets **lymphomas** (CD3, CD45), **neuroendocrine tumors** (chromogranin, synaptophysin, although synaptophysin can be positive in some sex cord-stromal tumors). - The morphologic description does not strongly suggest lymphoma or classic neuroendocrine tumor, and key markers for sex cord-stromal differentiation (like inhibin) are missing [2]. *Chromogranin, CD45, CD99, CD20* - This panel includes markers for **neuroendocrine differentiation** (chromogranin), **lymphoma** (CD45, CD20), and **small round blue cell tumors** (CD99). - While CD99 can be useful, the absence of inhibin and vimentin makes this panel less optimal for distinguishing common ovarian tumors from potential mimics, and CD20 is specific for B-cell lymphomas, which is less likely based on the given morphology. *Desmin, S- 100 protein, smooth muscle antigen, cytokeratin* - This panel includes markers for **muscle differentiation** (desmin, smooth muscle antigen), **melanoma/neural tumors** (S-100 protein), and **epithelial tumors** (cytokeratin). - While some of these might be positive in rare ovarian tumors, the primary small cell differential and the potential for a granulosa cell tumor suggested by "doubtful nuclear grooving" are not adequately addressed by this panel. **References:** [1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Female Genital Tract Disease, pp. 481-482. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Female Genital Tract, pp. 1026-1037.
Question 5: Which of the following cancers is least associated with BRCA2 mutations?
- A. Breast cancer
- B. Prostate cancer
- C. Ovarian cancer
- D. Vulval cancer (Correct Answer)
Explanation: ***Vulval cancer*** - While there may be some rare, sporadic cases, **vulval cancer** is generally not considered a primary cancer with a strong, well-established association with **BRCA2 mutations**. - Its etiology is more commonly linked to **HPV infection** and other risk factors not directly related to hereditary breast and ovarian cancer syndromes. *Breast cancer* - **BRCA2 mutations** are strongly associated with an increased lifetime risk of developing **breast cancer**, particularly for **male breast cancer**. - These mutations impair DNA repair mechanisms, leading to genomic instability that can result in cancerous transformation of breast tissue. *Prostate cancer* - Men with **BRCA2 mutations** have a significantly elevated risk of developing **prostate cancer**, often at an earlier age and with a more aggressive phenotype. - This association is well-documented, making BRCA2 testing relevant in high-risk prostate cancer populations. *Ovarian cancer* - **BRCA2 mutations** are a significant risk factor for **ovarian cancer**, particularly **high-grade serous ovarian cancer**. - The risk is substantial, though generally lower than that conferred by BRCA1 mutations for ovarian cancer in particular.
Question 6: A 2-year-old child presents with a testicular lump and elevated AFP levels. What is the most likely diagnosis?
- A. Choriocarcinoma
- B. Seminoma
- C. Yolk sac tumor (Correct Answer)
- D. Teratoma
Explanation: ***Yolk sac tumor*** - This is the most common testicular tumor in children, especially prevalent before the age of 3, and is highly associated with **elevated alpha-fetoprotein (AFP)** levels. - Histologically, it is characterized by the presence of **Schiller-Duval bodies**, which are pathognomonic structures. *Choriocarcinoma* - This tumor is known for producing very high levels of **human chorionic gonadotropin (hCG)**, not AFP, and is rare in pure form in children. - It often metastasizes early and aggressively, typically presenting in older males. *Seminoma* - This is the most common testicular cancer in adult males, typically occurring in the third to fourth decades of life, making it highly unlikely in a 2-year-old. - Seminomas usually present with normal AFP levels, although some may have mildly elevated beta-hCG. *Teratoma* - While teratomas can occur in children, pure teratomas in prepubertal males are typically benign and usually do not cause elevated AFP, unless there are elements of other germ cell tumors such as yolk sac tumor within them. - Teratomas are characterized by the presence of tissues derived from all three germ layers.
Question 7: Which of the following is the ovarian counterpart of testicular seminoma?
- A. Dermoid
- B. Dysgerminoma (Correct Answer)
- C. Endodermal sinus tumor
- D. Brenner tumor
Explanation: ***Dysgerminoma*** - **Dysgerminoma** is the most common malignant germ cell tumor of the ovary and is histologically identical to testicular **seminoma** [1]. - Both tumors arise from **primordial germ cells** and share similar morphology, including large, uniform cells with clear cytoplasm and prominent nucleoli, often arranged in nests and separated by fibrous septa with lymphocytic infiltration [1], [3]. *Dermoid* - **Dermoid cysts**, also known as mature cystic teratomas, are germ cell tumors composed of well-differentiated tissues from all three germ layers (ectoderm, mesoderm, endoderm) [2]. - They are typically benign and do not have a direct testicular counterpart that is histologically identical to seminoma. *Brenner tumor* - **Brenner tumors** are uncommon epithelial ovarian tumors characterized by nests of transitional epithelial cells resembling urothelium, separated by a fibrous stroma. - They are not germ cell tumors and do not have a testicular counterpart to seminoma. *Endodermal sinus tumor* - The **endodermal sinus tumor** (yolk sac tumor) is another type of malignant germ cell tumor of the ovary, but it is characterized by structures resembling the primitive yolk sac and the presence of **Schiller-Duval bodies**. - While it has a testicular counterpart, it is not histologically identical to seminoma; its testicular counterpart is also called a yolk sac tumor and is distinct from seminoma [3]. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Female Genital Tract, pp. 1034-1035. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Female Genital Tract, pp. 1035-1036. [3] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Lower Urinary Tract and Male Genital System, pp. 979-980.
Question 8: Tumor marker of epithelial ovarian carcinoma is:
- A. Alpha feto protein
- B. CA-125 (Correct Answer)
- C. Beta HCG
- D. LDH
Explanation: ***CA-125*** - **CA-125 (Cancer Antigen 125)** is the most widely used and validated tumor marker for detecting and monitoring **epithelial ovarian carcinoma**. - Elevated levels are found in approximately 80% of women with epithelial ovarian cancer, making it useful in guiding treatment decisions and assessing recurrence. *Alpha feto protein* - **Alpha-fetoprotein (AFP)** is primarily elevated in **germ cell tumors** of the ovary (e.g., endodermal sinus tumor) or in hepatocellular carcinoma and some testicular cancers, not epithelial ovarian carcinoma. - Its presence usually indicates a different histological subtype of ovarian malignancy. *Beta HCG* - **Beta-human chorionic gonadotropin (β-hCG)** is a tumor marker utilized for detecting **germ cell tumors**, particularly **choriocarcinoma** and some embryonal carcinomas, as well as pregnancy. - It is not typically elevated in epithelial ovarian carcinoma. *LDH* - **Lactate dehydrogenase (LDH)** is a general marker of **tissue damage or high cell turnover**, elevated in many cancers, including dysgerminoma (an ovarian germ cell tumor), but it is not specific for epithelial ovarian carcinoma. - Due to its lack of specificity, LDH alone is not considered the primary tumor marker for epithelial ovarian cancer.
Question 9: Serum level of CA 125 is raised in which of the following conditions?
- A. Epithelial ovarian cancer
- B. Pelvic inflammatory disease
- C. Endometriosis
- D. All of the options (Correct Answer)
Explanation: ***All of the options*** - **CA 125** levels can be elevated in various gynecological conditions, both malignant and benign. - While most recognized for its role in **epithelial ovarian cancer**, it is not exclusively specific to this condition. *Epithelial ovarian cancer* - **CA 125** is a commonly used tumor marker for **epithelial ovarian cancer**, playing a role in its diagnosis, monitoring, and recurrence detection. - While elevated in a high percentage of advanced ovarian cancers, it can also be normal in early-stage disease. *Pelvic inflammatory disease* - **Inflammation** of the pelvic organs, such as in **Pelvic Inflammatory Disease (PID)**, can cause an increase in **CA 125** levels. - The elevation is typically due to the irritation of the peritoneal surface or the presence of inflammatory exudates. *Endometriosis* - **Endometriosis**, a condition where endometrial-like tissue grows outside the uterus, is a well-known cause of elevated **CA 125**. - The level of **CA 125** often correlates with the severity and extent of the endometrial implants.
Question 10: Most useful investigation in a 55-year-old postmenopausal woman with diabetes mellitus and hypertension who has presented with postmenopausal bleeding is:
- A. Pap test
- B. Endometrial biopsy (Correct Answer)
- C. Transvaginal ultrasound examination
- D. CA-125 blood test
Explanation: ***Endometrial biopsy*** - This is the **most crucial investigation** for postmenopausal bleeding to rule out **endometrial cancer** or **hyperplasia**, especially in a patient with risk factors like diabetes and hypertension. - An endometrial biopsy directly samples the **uterine lining** for histological examination, providing a definitive diagnosis of any abnormal tissue changes. *Pap test* - A Pap test, or **Papanicolaou test**, primarily screens for **cervical cancer** by examining cells from the cervix. - It is **not effective** for detecting uterine (endometrial) abnormalities or cancer, which is the main concern with postmenopausal bleeding. *Transvaginal ultrasound examination* - While useful for assessing **endometrial thickness** and identifying structural abnormalities like polyps or fibroids, it is **not diagnostic** on its own. - An abnormal ultrasound finding, such as a thickened endometrium (usually >4-5mm in postmenopausal women), would typically prompt an endometrial biopsy for definitive diagnosis. *CA-125 blood test* - **CA-125** is a tumor marker primarily used for monitoring the response to treatment in **ovarian cancer** and can be elevated in other conditions like endometriosis or fibroids. - It is **not a screening tool** for endometrial cancer and is **not specific or sensitive enough** to be the primary investigation for postmenopausal bleeding.
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