PA29.2-10 | Female Genital Tract — Practice Quiz

A 28-year-old woman presents with postcoital bleeding and a mucopurulent cervical discharge. Cervical swab grows Chlamydia trachomatis. Cervical biopsy shows a dense lymphoplasmacytic infiltrate in the stroma with reactive squamous metaplasia and occasional lymphoid follicles with germinal centres. Which term best describes this histological pattern?

A 34-year-old nulliparous woman reports cyclical pelvic pain that worsens with menstruation and dyspareunia. Laparoscopy reveals bluish-black 'powder-burn' lesions on the ovarian surface and posterior broad ligament. The right ovary contains a 6 cm cyst filled with thick, dark-brown fluid. Histology of the cyst wall shows endometrial glands and stroma with haemosiderin-laden macrophages. What is the most likely diagnosis?

A 42-year-old multiparous woman presents with heavy irregular menstrual bleeding and secondary dysmenorrhoea. Uterus is uniformly enlarged and tender. MRI shows diffuse thickening of the junctional zone >12 mm. Hysterectomy specimen shows the myometrium studded with small haemorrhagic foci; microscopically these are endometrial glands and stroma within the myometrial smooth muscle, more than 2.5 mm from the basalis. The endometrial surface is intact. What is the diagnosis?

A 55-year-old postmenopausal woman on long-term unopposed oestrogen therapy presents with vaginal bleeding. Endometrial biopsy shows crowded glands (gland-to-stroma ratio >3:1) with back-to-back glandular architecture and nuclear stratification, but no cytological atypia and no stromal invasion. What is the most appropriate histological diagnosis?

A 65-year-old obese, hypertensive, diabetic postmenopausal woman presents with postmenopausal bleeding. Endometrial biopsy shows grade-1 endometrioid adenocarcinoma with minimal myometrial invasion. Her tumour is oestrogen-receptor positive and microsatellite stable. A colleague's 70-year-old thin patient with a different endometrial carcinoma shows a serous papillary histology, p53 overexpression, deep myometrial invasion, and lymphovascular permeation. Which statement BEST distinguishes these two tumour types?

A 38-year-old woman presents with heavy menstrual bleeding and pelvic pressure. Pelvic ultrasound shows a well-defined 8 cm intramural uterine mass with a whorled appearance. Hysterectomy is performed. The cut surface of the mass is firm, white, and whorled with no necrosis. Microscopically it shows interlacing bundles of uniform spindle cells with cigar-shaped nuclei, rare mitoses (<2/10 HPF), and no cytological atypia. What is the diagnosis and expected behaviour?

A 22-year-old woman presents with an adnexal mass. Serum CA-125 is markedly elevated. Ultrasound shows a 12 cm multilocular cystic ovarian mass with thin internal septations and multiple mural nodules. Intraoperative fluid spill reveals glistening papillary excrescences. Histology shows psammoma bodies (concentric calcified structures), stratified cuboidal-to-columnar epithelium, and hierarchical papillary branching. What is the most likely ovarian tumour?

A 19-year-old woman has a 15 cm unilateral solid ovarian mass. Serum AFP is markedly elevated; β-hCG is normal; LDH is elevated. Histology shows a solid tumour composed of primitive cells arranged in sheets and cords around a papillary structure lined by cuboidal to columnar cells surrounding a central hyalinised core. This structure is periodic acid-Schiff (PAS) positive and contains alpha-fetoprotein by immunohistochemistry. What structure has been identified, and what is the tumour?

A 17-year-old girl presents with a unilateral solid ovarian mass. Serum LDH and PLAP (placental alkaline phosphatase) are elevated; AFP and β-hCG are normal. Histology shows large round cells with pale cytoplasm, prominent nucleoli, and central nuclei arranged in nests separated by fibrous septa containing lymphocytic infiltrate. The tumour is PAS positive (glycogen). What is the most likely diagnosis?

A 52-year-old woman undergoes bilateral salpingo-oophorectomy for bilateral ovarian masses found incidentally during colectomy for sigmoid adenocarcinoma. The ovarian cut surfaces show solid, mucoid masses. Histology reveals diffuse infiltration by large cells with vacuolated cytoplasm displacing the nucleus eccentrically to the periphery, giving a 'signet-ring' appearance. The stroma shows abundant fibrous tissue. What is the likely diagnosis and its origin?

A 24-year-old woman presents with hyperemesis, vaginal bleeding at 10 weeks, and a uterus larger than dates. Serum β-hCG is 350,000 mIU/mL. Ultrasound shows a 'snowstorm' pattern with no foetal parts. The uterus is evacuated; histology shows hydropic villi with central cistern formation and circumferential trophoblastic hyperplasia involving both cyto- and syncytiotrophoblast. Karyotype of the products of conception is 46,XX. What is the diagnosis?

Three months after evacuation of a complete hydatidiform mole, a 26-year-old woman has persistently elevated β-hCG. CT chest shows bilateral 'cannonball' pulmonary metastases. Endometrial curettage shows sheets of pleomorphic cyto- and syncytiotrophoblastic cells with extensive haemorrhage and necrosis but NO chorionic villi are identified. What is the most likely diagnosis?

A histology slide from a 45-year-old woman's ovary shows a solid-cystic tumour. Microscopically, the tumour cells are arranged in nests and cords with formation of small, hollow ring-like structures containing central eosinophilic material (resembling an ovarian follicle). Immunohistochemistry shows inhibin positivity. The patient reports amenorrhoea and abnormal vaginal bleeding. Which tumour is this, and what is the relevant pathophysiological consequence?

During a prosection practical, Year-2 students examine a hysterectomy specimen. The uterus is grossly enlarged with an irregular contour. On serial slicing, multiple well-circumscribed white whorled intramural nodules (2–7 cm) are identified, with one 3 cm nodule protruding into the endometrial cavity (submucosal) and another bulging on the serosal surface (subserosal). The endometrial lining appears intact. No necrosis is visible in the nodules. What is the single most likely diagnosis?