Williams Gynecology, Second Edition (Schorge,Williams Gynecology), 2nd Edition

CHAPTER 34
Uterine Sarcoma

34–1. Which of the following sarcomas demonstrates both malignant epithelial and malignant stromal components?

a. Adenosarcoma

b. Carcinosarcoma

c. Leiomyosarcoma

d. Endometrial stromal sarcoma

34–2. Which of the following was previously termed malignant mixed müllerian tumor (MMMT)?

a. Adenosarcoma

b. Leiomyosarcoma

c. Endometrial stroma sarcoma

d. None of the above

34–3. Sarcomas account for approximately what percentage of uterine cancer?

a. 1to2

b. 3to8

c. 11 to 15

d. 17 to 23

34–4. Which of the following is the most common presenting symptom of women with uterine sarcoma?

a. Infertility

b. Shortness of breath

c. Abnormal uterine bleeding

d. Abnormal screening PAP smear result

34–5. Of the sarcoma types, the technique shown here could be most effective for diagnosing which of the following sarcomas?

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Reproduced, with permission, from Sharma M, Hoffman BL: Abnormal uterine bleeding. In Hoffman BL, Schorge JO, Schaffer JI, et al (eds): Williams Gynecology, 2nd ed. New York, McGraw-Hill, 2012, Figure 8-6A.

a. Adenosarcoma

b. Carcinosarcoma

c. Leiomyosarcoma

d. Endometrial stromal sarcoma

34–6. This is the preoperative computed tomography scan of a woman with suspected leiomyosarcoma. Which of the following is an advantage to this type of imaging preoperatively?

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a. Operative treatment plans may be altered according to findings.

b. If varying tissue densities are found, then leiomyosarcoma is reliably diagnosed.

c. If individual tumors within the uterus measure greater than 10 cm, then leiomyosarcoma is reliably diagnosed.

d. All of the above

34–7. Following a total abdominal hysterectomy (TAH) for presumed benign disease, the final pathologic evaluation reveals leiomyosarcoma. After referral to a gynecologic oncologist, subsequent appropriate management may include which of the following?

a. Surveillance

b. Chemotherapy

c. Chemoradiation

d. All of the above

34–8. Most leiomyosarcomas are diagnosed at what International Federation of Gynecology and Obstetrics (FIGO) stage?

a. Stage I

b. Stage II

c. Stage III

d. Stage IV

34–9. As shown in this figure, leiomyosarcomas (A) compared with benign leiomyomas (B) show higher rates of all EXCEPT which of the following histologic criteria?

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Photographs contributed by Dr. Kelley Carrick.

a. Cell necrosis

b. Cytologic atypia

c. Bland spindle-shaped cells

d. More than 15 mitoses per high-powered field

34–10. Which stromal tumor is benign and in many cases may be adequately treated by this procedure alone?

Image

Reproduced, with permission, from Hoffman BL: Surgeries for benign gynecologic conditions. In Schorge JO, Schaffer JI, Halvorson LM, et al (eds): Williams Gynecology, 1st ed. New York, McGraw-Hill, 2008, Figure 41-18.3.

a. Adenosarcoma

b. Carcinosarcoma

c. Leiomyosarcoma

d. Endometrial stromal nodule

34–11. Microscopically, which of the following resembles the stromal cells of proliferative phase endometrium?

a. Adenosarcoma

b. Carcinosarcoma

c. Leiomyosarcoma

d. Endometrial stromal sarcoma

34–12. An adenosarcoma is typified by which of the following?

a. Benign epithelial and malignant mesenchymal components

b. Malignant epithelial and benign mesenchymal components

c. Borderline epithelial and benign mesenchymal components

d. Malignant epithelial and malignant mesenchymal components

34–13. Which of the following pairs is typified by an indolent growth pattern with long disease-free intervals?

a. Leiomyosarcoma, adenosarcoma

b. Leiomyosarcoma, carcinosarcoma

c. Adenosarcoma, endometrial stromal sarcoma

d. Leiomyosarcoma, endometrial stromal sarcoma

34–14. Which of the sarcomas is staged using the same criteria as for endometrial carcinoma?

a. Adenosarcoma

b. Leiomyosarcoma

c. Endometrial stromal sarcoma

d. None of the above

34–15. This figure of an adenosarcoma depicts which International Federation of Gynecology and Obstetrics (FIGO) stage?

Image

Reproduced, with permission, from Miller DS, Schorge JO: Uterine sarcoma. In Hoffman BL, Schorge JO, Schaffer JI, et al (eds): Williams Gynecology, 2nd ed. New York, McGraw-Hill, 2012, Figure 34-11.

a. Stage IC

b. Stage IIB

c. Stage IIIA

d. Stage IVA

34–16. This figure of a leiomyosarcoma depicts which International Federation of Gynecology and Obstetrics (FIGO) stage?

Image

Reproduced, with permission, from Miller DS, Schorge JO: Uterine sarcoma. In Hoffman BL, Schorge JO, Schaffer JI, et al (eds): Williams Gynecology, 2nd ed. New York, McGraw-Hill, 2012, Figure 34-11.

a. Stage IB

b. Stage IIB

c. Stage IIIB

d. Stage IVB

34–17. This figure of a carcinosarcoma depicts which International Federation of Gynecology and Obstetrics (FIGO) stage?

Image

Reproduced, with permission, from Miller DS, Schorge JO: Endometrial cancer. In Hoffman BL, Schorge JO, Schaffer JI, et al (eds): Williams Gynecology, 2nd ed. New York, McGraw-Hill, 2012, Figure 33-12.

a. Stage IB

b. Stage II

c. Stage IIIA

d. Stage IVA

34–18. Which of the following sarcomas is least likely to have lymph node involvement?

a. Adenosarcoma

b. Carcinosarcoma

c. Leiomyosarcoma

d. Endometrial stromal sarcoma

34–19. Following total abdominal hysterectomy (TAH) for a presumed benign diagnosis, the final pathologic evaluation reveals a “smooth muscle tumor of uncertain malignant potential.” Subsequent management typically includes which of the following?

a. Surveillance

b. Chemotherapy

c. Radiation therapy

d. Radiotherapy with adjuvant chemotherapy

34–20. Which of the following sarcomas is most likely to have lymph node involvement?

a. Adenosarcoma

b. Carcinosarcoma

c. Leiomyosarcoma

d. Endometrial stromal sarcoma

34–21. Following total abdominal hysterectomy (TAH) with bilateral salpingo-oophorectomy and complete surgical staging for early stage disease, estrogen replacement therapy may be considered for suitable symptomatic candidates with which of the following sarcoma types?

a. Leiomyosarcoma

b. Carcinosarcoma

c. Endometrial stromal sarcoma

d. All of the above

34–22. Improved survival benefit has been shown with which of the following postoperative adjuvant modalities for stage I or II sarcoma?

a. Cisplatin chemotherapy

b. Pelvic radiation treatment

c. Whole abdominal radiotherapy

d. None of the above

34–23. For advanced-stage leiomyosarcoma, which of the following chemotherapy combinations has the highest proven response rate?

a. Bleomycin, etoposide

b. Ifosfamide, paclitaxel

c. Gemcitabine, docetaxel

d. Etoposide, actinomycin D

34–24. For which of the following sarcoma types is oral progestin therapy effective in the treatment of recurrent disease?

a. Adenosarcoma

b. Leiomyosarcoma

c. Endometrial stromal sarcoma

d. High-grade undifferentiated sarcoma

34–25. For advanced-stage carcinosarcoma, which of the following chemotherapy combinations has the highest proven response rate?

a. Bleomycin, etoposide

b. Ifosfamide, paclitaxel

c. Gemcitabine, docetaxel

d. Etoposide, actinomycin D

34–26. Which of the following based on tumor histology has the worst prognosis?

a. Leiomyosarcoma

b. Endometrial stromal sarcoma

c. Endometrial stromal nodules

d. High-grade undifferentiated sarcoma

Chapter 34 ANSWER KEY

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