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

CHAPTER 36
Ovarian Germ Cell and Sex Cord-Stromal Tumors

36–1. What percentage of all ovarian cancers are germ cell and sex cord-stromal tumors?

a. 1

b. 10

c. 20

d. 30

36–2. Which of the following is the most commonly diagnosed International Federation of Gynecology and Obstetrics (FIGO) stage for women with germ cell tumors?

a. I

b. II

c. III

d. IV

36–3. What is the most common presenting symptom in a woman with a germ cell tumor?

a. Bloating

b. Abdominal pain

c. Abdominal distention

d. Menstrual abnormality

36–4. Which of the following is not a tumor marker for germ cell tumors?

a. Inhibin

b. Alpha-fetoprotein (AFP)

c. Lactate dehydrogenase (LDH)

d. Human chorionic gonadotropin (hCG)

36–5. Which of the following is the most commonly diagnosed ovarian malignancy during pregnancy?

a. Dysgerminoma

b. Choriocarcinoma

c. Immature teratoma

d. Granulosa cell tumor

36–6. A 19-year-old female college student is diagnosed with a pelvic mass and an elevated lactate dehydrogenase (LDH) level. She reports that she was amenorrheic until she started taking combination oral contraceptive pills (COCs). She undergoes surgical exploration, and frozen section analysis of the surgical specimen reveals ovarian dysgerminoma. Which of the following is FALSE?

a. Her karyotype is most likely 46,XX.

b. Regardless of stage, she has an excellent prognosis.

c. Her other ovary may contain a gonadoblastoma and should be removed.

d. She should undergo complete surgical staging, but her uterus may be preserved.

36–7. What percentage of gonadoblastomas undergo malignant transformation?

a. 10

b. 20

c. 40

d. 60

36–8. Which germ cell tumor is most likely to be bilateral?

a. Dysgerminoma

b. Mature teratoma

c. Immature teratoma

d. Embryonal carcinoma

36–9. The structure shown in the photomicrograph below is pathognomonic for which germ cell tumor?

Image

Photograph contributed by Dr. Kelley Carrick.

a. Dysgerminoma

b. Yolk sac tumor

c. Immature teratoma

d. Nongestational choriocarcinoma

36–10. Which of the following malignant germ cell tumors has the worst prognosis?

a. Dysgerminoma

b. Yolk sac tumor

c. Immature teratoma

d. Nongestational choriocarcinoma

36–11. What is the most common germ cell malignancy of the ovary?

a. Dysgerminoma

b. Yolk sac tumor

c. Mature teratoma

d. Immature teratoma

36–12. How are immature teratomas graded?

a. Amount of solid component present

b. Amount of immature elements present

c. Amount of immature neural tissue present

d. None of the above

36–13. An 18-year-old female has a history of a stage IC grade 3 immature teratoma. She received adjuvant chemotherapy with bleomycin, etoposide, and cisplatin (BEP). At her 6-month follow-up, she is noted to have an enlarging pelvic mass. Which of the following is the most appropriate management?

a. Chemotherapy

b. Radiation therapy

c. Continued observation

d. Exploratory laparotomy with removal of masses

36–14. What is the most common cancer found in a mature teratoma?

a. Struma ovarii

b. Basal cell carcinoma

c. Neuroectodermal tumors

d. Squamous cell carcinoma

36–15. Which of the following patients does NOT need adjuvant chemotherapy after unilateral salpingo-oophorectomy (USO) with surgical staging?

a. Stage IA dysgerminoma

b. Stage IA yolk sac tumor

c. Stage IA grade 3 immature teratoma

d. All of the above

36–16. Which of the following is NOT a protective factor against the development of a sex cord-stromal tumor?

a. Smoking

b. Obesity

c. Multiparity

d. Combination oral contraceptive (COC) pills

36–17. What is the most common presenting symptom of a sex cord-stromal tumor in a prepubescent girl?

a. Hirsutism

b. Abdominal pain

c. Primary amenorrhea

d. Isosexual precocious puberty

36–18. A 35-year-old nulligravida who desires future fertility is found during frozen section analysis of a right salpingo-oophorectomy (RSO) specimen to have a granulosa cell tumor. What is the appropriate surgical management of this patient?

a. RSO alone

b. RSO, omentectomy, multiple peritoneal biopsies, consider pelvic and para-aortic lymph node dissection

c. RSO, omentectomy, multiple peritoneal biopsies, consider pelvic and para-aortic lymph node dissection, dilatation and curettage (D&C)

d. Total abdominal hysterectomy (TAH), bilateral salpingo-oophorectomy (BSO), omentectomy, multiple peritoneal biopsies, consider pelvic and para-aortic lymph node dissection

36–19. Which of the following is true regarding the tumor represented in the photomicrograph?

Image

Reproduced, with permission, from Schorge JO: Ovarian germ cell and sex cord-stromal tumors. In Schorge JO, Schaffer JI, Halvorson LM, et al (eds): Williams Gynecology, 1st ed. New York, McGraw-Hill, 2008, Figure 36-6A.

a. Inhibin B is often elevated.

b. The tumor can often exceed 10 cm in size.

c. The characteristic feature is the Call-Exner body.

d. All of the above

36–20. Which of the following tumors are hormonally active and most often secrete estrogen?

a. Thecoma

b. Fibroma

c. Sertoli-Leydig tumor

d. None of the above

36–21. A woman undergoes an exploratory laparotomy, total abdominal hysterectomy (TAH), bilateral salpingo-oophorectomy (BSO) for a solid pelvic mass, ascites, and an elevated serum cancer antigen 125 (CA125) level. Her preoperative chest radiograph is shown below. Frozen section demonstrates a benign ovarian neoplasm. What is the most likely diagnosis?

Image

a. Meigs syndrome

b. Benign ovarian neoplasm and cirrhosis

c. Metastatic cancer with a benign adnexal mass

d. Ovarian cancer—the frozen section was inaccurate.

36–22. A 22-year-old woman has the vulvar finding demonstrated below, and an 8-cm pelvic mass is palpated during bimanual examination. What is the most likely diagnosis?

Image

Reproduced, with permission, from Wilson EE: Polycystic ovarian syndrome and hyper-androgenism. In Hoffman BL, Schorge JO, Schaffer JI, et al (eds): Williams Gynecology, 2nd ed. New York, McGraw-Hill, 2012, Figure 17-11.

a. Sertoli tumor

b. Swyer syndrome

c. Leydig cell tumor

d. Sertoli-Leydig tumor

36–23. A 30-year-old woman with the oral finding below is found to have a sex cord-stromal tumor. Which of the following is FALSE?

Image

Reproduced, with permission, from Wolff K, Johnson RA (eds): Skin signs of systemic cancers. Fitzpatrick’s Color Atlas and Synopsis of Clinical Dermatology, 6th ed. New York, McGraw-Hill, 2009, Figure 18-12.

a. Her sex cord-stromal tumor is malignant.

b. Her sex cord-stromal tumor is likely bilateral.

c. She probably has hamartomatous polyps in her colon.

d. She has a 15 percent chance of developing adenoma malignum.

36–24. Which of the following is NOT an appropriate adjuvant treatment for a patient with a stage III granulosa cell tumor?

a. Whole pelvic radiotherapy

b. Carboplatin and paclitaxel

c. Bleomycin-etoposide-cisplatin chemotherapy

d. All of the above are appropriate treatment options

36–25. Which of the following is a prognostic factor for sex cord-stromal tumors?

a. Age

b. Stage

c. Amount of residual disease

d. All of the above

Chapter 36 ANSWER KEY

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