Gynecologic Oncology Practice Questions

Q: A 37-year-old woman presents with an abdominal mass. Ultrasound reveals a solid tumor with elevated LDH and HCG. What is the diagnosis?

Dysgerminoma. **Explanation:** The correct diagnosis is **Dysgerminoma**. This is the most common malignant germ cell tumor of the ovary, typically occurring in young women (second and third decades). **Why Dysgerminoma is correct:** Dysgerminoma is characterized by specific biochemical markers. It classically causes an elevation in **LDH (Lactate Dehydrogenase)**, which serves as a reliable tumor marker for diagnosis and monitoring recurrence. While most dysgerminomas are non-secretory, approximately 3-5% contain syncytiotrophoblastic giant cells that produce **HCG**, leading to its elevation. On ultrasound, these tumors typically appear as solid, multinodular masses with prominent fibrovascular septa. **Why other options are incorrect:** * **Teratoma:** Mature cystic teratomas (dermoid cysts) are usually cystic, not solid, and do not typically elevate LDH or HCG. Immature teratomas may elevate AFP (Alpha-fetoprotein). * **Fibroma:** A benign sex cord-stromal tumor. It is a solid tumor but is not associated with LDH or HCG markers. It is classically associated with Meigs’ Syndrome (ascites and pleural effusion). * **Brenner Tumor:** A rare surface epithelial tumor (usually benign) containing "Walthard cell rests." It does not produce LDH or HCG. **High-Yield Clinical Pearls for NEET-PG:** * **Most common** malignant germ cell tumor in pregnancy and in patients with gonadal dysgenesis (Turner Syndrome). * **Tumor Markers:** LDH (Most specific), HCG (if syncytiotrophoblastic cells present), and Alkaline Phosphatase (ALP). * **Radiosensitivity:** It is the most radiosensitive ovarian tumor, though fertility-sparing surgery and chemotherapy are preferred. * **Histology:** Characteristic "fried egg" appearance (large cells with clear cytoplasm and central nuclei) separated by fibrous septa infiltrated with lymphocytes.

Q: Colposcopy shows a CIN-III grade lesion in a 45-year-old multiparous lady. What is the next line of management?

Hysterectomy. **Explanation:** The management of **CIN-III (Cervical Intraepithelial Neoplasia Grade III)** depends on the patient's age, parity, and desire for future fertility. CIN-III is considered a high-grade squamous intraepithelial lesion (HSIL) and is a direct precursor to invasive cervical cancer. **Why Hysterectomy is the Correct Answer:** In this clinical scenario, the patient is **45 years old and multiparous**, implying she has likely completed her family. For women who have completed their childbearing and present with CIN-III, **Total Hysterectomy** is considered the definitive treatment. It eliminates the risk of recurrence and progression to invasive carcinoma, providing a permanent solution compared to conservative excisional procedures. **Analysis of Incorrect Options:** * **A. Repeat Pap smear:** This is incorrect. A Pap smear is a screening tool, not a treatment. Once a high-grade lesion (CIN-III) is confirmed via colposcopy/biopsy, active intervention is required. * **C. Cone biopsy:** While LEEP (Loop Electrosurgical Excision Procedure) or Cone Biopsy is the treatment of choice for younger patients who wish to **preserve fertility**, it is not the "best" definitive management for a 45-year-old multiparous woman where the risk of recurrence outweighs the need for uterine preservation. **High-Yield Clinical Pearls for NEET-PG:** * **CIN-I:** Usually managed by observation (repeat Pap/HPV testing in 1 year) as most regress spontaneously. * **CIN-II/III (Young/Fertile):** Cervical Conization or LEEP is preferred to preserve the cervix for pregnancy. * **CIN-III (Completed Family):** Hysterectomy is the definitive management. * **Gold Standard for Diagnosis:** Colposcopy-directed biopsy. * **Most common site for CIN:** The Transformation Zone (Squamocolumnar junction).

Q: What is the karyotype of a partial mole?

69XXY. ### Explanation **Correct Answer: C. 69XXY** **Underlying Medical Concept:** A **Partial Hydatidiform Mole** is characterized by **triploidy**. It occurs when a normal haploid ovum (23X) is fertilized by two sperm (dispermy) or by one sperm that duplicates its chromosomes. This results in 69 chromosomes. The most common karyotype is **69,XXY** (70%), followed by 69,XXX and 69,XYY. Unlike complete moles, partial moles contain fetal tissue and some normal chorionic villi alongside hydropic changes. **Analysis of Incorrect Options:** * **A & B (46,XY and 46,XX):** These are **diploid** karyotypes. A **Complete Hydatidiform Mole** is typically 46,XX (90%) or 46,XY (10%). Complete moles result from "empty egg" fertilization (androgenesis), where maternal nuclear DNA is absent, and all genetic material is paternal. * **D (23,X):** This is a normal **haploid** gamete. A molar pregnancy requires fertilization and abnormal chromosomal multiplication or addition. **High-Yield Clinical Pearls for NEET-PG:** * **Paternal vs. Maternal:** Complete moles are 100% paternal in origin; Partial moles have both maternal and paternal DNA (2:1 paternal-to-maternal ratio). * **Malignancy Risk:** Complete moles have a higher risk of progressing to Choriocarcinoma (15–20%) compared to partial moles (<5%). * **Clinical Presentation:** Partial moles often present as an "incomplete abortion," and the diagnosis is frequently made only after histopathology. * **p57 Expression:** Partial moles are **p57 positive** (stains for maternal DNA), whereas complete moles are **p57 negative**.

Q: Radical hysterectomy is indicated in which of the following conditions?

Carcinoma of the cervix stage IB. **Explanation:** The primary treatment for early-stage cervical cancer (Stage IA2 to IB2) is **Radical Hysterectomy (Wertheim’s Hysterectomy)** with pelvic lymphadenectomy. **Why Option D is Correct:** In **Stage IB**, the tumor is clinically visible and confined to the cervix. At this stage, there is a significant risk of parametrial involvement and lymph node metastasis. A Radical Hysterectomy is necessary because, unlike a simple hysterectomy, it involves the en-bloc removal of the uterus, cervix, the upper 1/3rd to 1/2 of the vagina, the **parametrium** (lateral, cardinal, and uterosacral ligaments), and bilateral pelvic lymph nodes. This ensures adequate surgical margins. **Why Other Options are Incorrect:** * **A. Carcinoma in situ (CIN III/Stage 0):** This is a pre-invasive lesion. Treatment is conservative, typically involving **Cervical Conization** (LEEP/Cold knife cone) or a Simple Hysterectomy if the patient has completed her family. * **B & C. Microinvasive Carcinoma (Stage IA1):** Defined as stromal invasion ≤3 mm in depth. The risk of lymph node spread is <1%. Therefore, a **Simple (Extrafascial) Hysterectomy** is sufficient. Radical surgery is over-treatment for Stage IA1 unless there is lymphovascular space invasion (LVSI). **High-Yield Clinical Pearls for NEET-PG:** 1. **Meigs’ Operation:** Another name for Radical Hysterectomy with pelvic lymphadenectomy. 2. **Nerve-Sparing Radical Hysterectomy:** Aimed at preserving the autonomic nerves (hypogastric plexus) to prevent bladder and sexual dysfunction. 3. **Radiotherapy vs. Surgery:** For Stage IB1 and IB2, both surgery and radiotherapy have equal efficacy; however, surgery is preferred in young women to preserve ovarian function and vaginal elasticity. 4. **Cut-off for Surgery:** Generally, Stage IIB (parametrial involvement) and above are treated with **Concurrent Chemoradiotherapy (CCRT)**, not surgery.

Q: A 60-year-old woman, twelve years postmenopausal, presents with an ovarian carcinoma discovered during laparotomy. Which ovarian tumor is most likely to respond to radiotherapy?

Dysgerminoma. **Explanation:** **1. Why Dysgerminoma is Correct:** Dysgerminoma is the most common malignant germ cell tumor of the ovary. Its defining clinical characteristic is its **exquisite radiosensitivity**. While the primary treatment for most ovarian cancers is surgical debulking followed by chemotherapy, dysgerminoma is unique because it can be cured with radiotherapy even in advanced stages. It is the ovarian counterpart of the testicular seminoma, both of which are highly responsive to radiation. **2. Why the Other Options are Incorrect:** * **Krukenberg’s Tumor:** This is a metastatic signet-ring cell carcinoma (usually from the stomach). It carries a very poor prognosis and is generally resistant to both radiotherapy and chemotherapy. * **Arrhenoblastoma (Sertoli-Leydig Cell Tumor):** This is a sex cord-stromal tumor that produces androgens. Treatment is primarily surgical; these tumors are not considered radiosensitive. * **Granulosa Cell Tumor:** Another sex cord-stromal tumor known for estrogen production. While it has a low malignant potential and a tendency for late recurrence, the primary treatment is surgery. It does not show the same high level of response to radiation as dysgerminoma. **3. NEET-PG High-Yield Pearls:** * **Radiosensitivity:** Dysgerminoma is the **most radiosensitive** ovarian tumor. * **Tumor Markers:** Dysgerminoma is associated with elevated **LDH** and sometimes **hCG**. (Note: AFP is typically normal). * **Age Factor:** Although the patient in this question is 60, dysgerminomas typically occur in young women (75% occur between ages 10–30). * **Associated Condition:** It is the most common ovarian neoplasm found in patients with **gonadal dysgenesis** (Swyer syndrome). * **Treatment Trend:** Despite its radiosensitivity, chemotherapy (BEP regimen) is now often preferred over radiation to preserve fertility and avoid radiation-induced bowel/bladder damage.

Q: What is the next line of management for a perimenopausal woman who has an ASCUS (atypical squamous cells of unknown significance) reported on a Pap smear?

Colposcopy. **Explanation:** The management of an abnormal Pap smear follows a risk-based triage system. **ASCUS (Atypical Squamous Cells of Undetermined Significance)** is the most common abnormal finding. According to the ASCCP guidelines, the management for ASCUS depends on the patient's age and HPV status. **1. Why Colposcopy is the correct answer:** In a perimenopausal woman with ASCUS, the standard "next step" is either **HPV DNA testing (Reflex HPV)** or **repeat cytology**. However, if HPV testing is positive for high-risk types, or if the clinical scenario dictates immediate further evaluation (as often tested in NEET-PG scenarios where triage isn't specified), **Colposcopy** is the definitive diagnostic procedure. It allows for direct visualization of the transformation zone and directed biopsies to rule out Cervical Intraepithelial Neoplasia (CIN) or malignancy. **2. Why the other options are incorrect:** * **A & B (Loop excision/Conization):** These are therapeutic/excisional procedures. They are indicated only after a biopsy confirms high-grade dysplasia (CIN II/III) or if there is a discrepancy between cytology and colposcopy. Performing them for ASCUS is "over-treatment." * **D (Hysterectomy):** This is never the primary management for an abnormal Pap smear. It is only considered for confirmed invasive cancer or specific cases of recurrent high-grade dysplasia where fertility is not desired. **High-Yield Clinical Pearls for NEET-PG:** * **ASCUS Triage:** If HPV negative → Repeat Pap in 3 years. If HPV positive → Proceed to **Colposcopy**. * **LSIL/HSIL:** Generally proceed directly to colposcopy (except in specific age groups like adolescents). * **Pregnancy:** If ASCUS is found during pregnancy, colposcopy is safe, but endocervical curettage and biopsies are generally avoided unless invasive cancer is suspected. * **Bethesda System:** Remember that ASCUS is the most common but least specific abnormality on a Pap smear.

Question 1

A 37-year-old woman presents with an abdominal mass. Ultrasound reveals a solid tumor with elevated LDH and HCG. What is the diagnosis?

Accepted Answer

Dysgerminoma

Answer

Teratoma

Answer

Fibroma

Answer

Brenner tumor

Question 2

A 35-year-old P2L2 female has CIN extending to the vaginal fornix, confirmed on colposcopy. What is the best management?

Accepted Answer

Laser ablation

Answer

Conization

Answer

LEEP (Loop Electrosurgical Excision Procedure)

Answer

Cryosurgery

Question 3

Colposcopy shows a CIN-III grade lesion in a 45-year-old multiparous lady. What is the next line of management?

Accepted Answer

Hysterectomy

Answer

Repeat Pap smear

Answer

Cone biopsy

Answer

None of the above

Question 4

Which of the following is true about cervical cancer?

Accepted Answer

Immunocompromised patients

Answer

Associated with Human Papillomavirus (HPV)

Answer

Nulliparity

Answer

Oral contraceptive pills (OCP)

Question 5

What is the karyotype of a partial mole?

Accepted Answer

69XXY

Answer

46XY

Answer

46XX

Answer

23X

Question 6

Which of the following statements is false regarding Hydatidiform mole?

Accepted Answer

In partial mole, all genetic material is paternally derived.

Answer

In complete mole, fetal parts are not seen.

Answer

It increases the risk of invasive mole and choriocarcinoma.

Answer

The karyotype of a complete mole can be 46 XX.

Question 7

Radical hysterectomy is indicated in which of the following conditions?

Accepted Answer

Carcinoma of the cervix stage IB

Answer

Carcinoma in situ

Answer

Endocervix cancer stage IA

Answer

Microinvasive carcinoma of the cervix

Question 8

A 60-year-old woman, twelve years postmenopausal, presents with an ovarian carcinoma discovered during laparotomy. Which ovarian tumor is most likely to respond to radiotherapy?

Accepted Answer

Dysgerminoma

Answer

Krukenberg's tumor

Answer

Arrhenoblastoma

Answer

Granulosa cell tumor

Question 9

In a young woman diagnosed with stage Ib cervical cancer, which structure is not removed during a radical hysterectomy?

Accepted Answer

Both ovaries

Answer

Uterosacral and uterovesical ligaments

Answer

Pelvic lymph nodes

Answer

Upper third of the vagina

Question 10

What is the next line of management for a perimenopausal woman who has an ASCUS (atypical squamous cells of unknown significance) reported on a Pap smear?

Accepted Answer

Colposcopy

Answer

Loop excision

Answer

Conization

Answer

Hysterectomy

Gynecologic Oncology — MCQs

Gynecologic Oncology — MCQs

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