Question 1

This biopsy specimen was taken from an excoriated and oozing nipple of a 50-year-old woman. These histologic findings are most consistent with the diagnosis of

Accepted Answer

The epidermis in this breast biopsy contains scattered large atypical cells with clear cytoplasms. These cells represent breast carcinoma cells that have ascended through the ducts into the epidermis and produced the lesions typical of Paget disease of the breast.

Question 2

This uterus was removed from a 58-year-old woman who complained of metrorrhagia. Most likely this lesion is pathogenetically related to

Accepted Answer

This luminal lesion is most likely an endometrial adenocarcinoma. Endometrial adenocarcinoma occurs with increased incidence in many conditions marked by hyperestrinism, and estrogen is considered to have major role in the pathogenesis of these tumors.

Question 3

Comedocarcinoma of the breast is a type of which of the following carcinomas?

Accepted Answer

Comedocarcinoma is a type of ductal carcinoma in situ. This preinvasive type of carcinoma is composed of pleomorphic malignant cells forming solid intraductal sheets with central necrosis. If not removed surgically, comedocarcinoma will progress to invasive ductal carcinoma.

Question 4

The solitary nodular lesion in this uterus removed from a 55-year-old woman is most likely composed of

Accepted Answer

The solitary white nodule is most likely a leiomyoma, a benign tumor composed of smooth muscle cells.

Question 5

Which of the following nonneoplastic breast lesions is associated with the highest risk of mammary cancer?

Accepted Answer

Atypical ductal hyperplasia is associated with a moderate increase in risk of cancer. Thus, of the five microscopic changes listed here, it has the highest risk of cancer. Nonproliferative breast changes such as cysts, as well as fibrosis and adenosis, do not increase the risk of cancer. Proliferative breast disease without atypia, including sclerosing adenosis, radial scars (complex sclerosing lesion), and small duct papillomas are associated with a mild increase in risk.

Question 6

A 25-year-old woman had a workup for infertility. During the laparoscopic examination, the gynecologist found foci of endometriosis. Such foci are most often seen on which of the following sites?

Accepted Answer

Foci of endometriosis are seen most often on the ovaries. Other sites involved are the uterine ligaments, rectovaginal septum, pelvic peritoneum, and appendix, listed in descending order of frequency.

Question 7

A 55-year-old woman who has diabetes mellitus complains of genital itching. Examination shows whitish plaques on the mucosa of the vulva and vagina. Which of the following infectious agents most likely caused these changes?

Accepted Answer

Candida vaginalis infections of the vulva and vagina are the most common genital complications of diabetes mellitus.

Question 8

A 50-year-old woman sees her physician because she has noticed a bloody discharge from the left nipple. Upon physical examination, there are no palpable masses in the breast. Which of the following is the most likely cause of this discharge?

Accepted Answer

Intraductal papilloma is the most likely cause of a bloody discharge from the nipple.

Question 9

Assuming that a vaccination will be discovered for the human papillomavirus in women, it is expected that the vaccination will reduce the incidence of carcinoma at which of the following sites?

Accepted Answer

Cancers associated with the human papillomavirus (HPV) occur most often on the cervix. Vaccination against HPV is expected to reduce the incidence of all human genital cancers caused by HPV, but most prominently carcinoma of the cervix.

Question 10

BRCA1 and BRCA2 genes that are mutated in 25% of all women who have familial breast cancer encode proteins. Which of the following functions do these proteins serve?

Accepted Answer

BRCA1 and BRCA2 are tumor suppressor genes that encode nuclear proteins promoting DNA damage repair.

Question 11

This breast tumor was removed from a 60-year-old woman. On gross examination, the tumor was found to be

Accepted Answer

This tumor is a mucinous carcinoma composed of sparse tumor cells floating in abundant mucus. Such tumors are soft and gelatinous on gross examination.

Question 12

Which of the following genital lesions is associated with a greater than expected risk of carcinoma of the vulva?

Accepted Answer

Lichen sclerosus is not recognized as a precancerous condition, but it has been associated with genetic alteration and a greater than expected risk of subsequent carcinoma in 1%-4% of all patients. Condyloma acuminatum is caused by human papillomavirus types 6 and 11 and tends to involute spontaneously. Condyloma latum is a manifestation of secondary syphilis and is not associated with cancer. Lichen simplex chronicus is caused by rubbing and scratching and is not related to cancer. Papillary hydradenoma is a benign tumor of the vulvar modified apocrine sweat glands and does not predispose to cancer.

Question 13

A high level of expression of the tumor suppressor gene PTEN will most likely be found in which of the following?

Accepted Answer

The tumor suppressor gene PTEN is normally expressed in the endometrial glands in the proliferative phase of the menstrual cycle, but it is not expressed in the secretory phase. It is also lost in 63% of premalignant complex atypical endometrial hyperplasia (also known as endometrial intraepithelial neoplasia) and in 50%-80% of endometrial adenocarcinomas.

Question 14

This pelvic tumor most likely originated from the

Accepted Answer

This is a multilocular cystadenoma. Tumors of this type most often arise from the ovary.

Question 15

These ovaries were removed from an infertile, obese, slightly hirsute 30-year-old woman with persistent menstrual irregularities. The cystic spaces seen in the ovaries represent

Accepted Answer

This woman has polycystic ovarian disease. The ovaries contain numerous cysts, which represent follicular cysts formed from dilated, but unruptured Graafian follicles.

Question 16

Elevated 17-ketosteroid excretion, masculinization, and hirsutism are found in a woman who has a tumor of the ovary. The tumor is composed of polygonal cells with abundant eosinophilic cytoplasm and occasional Reinke crystals. Which of the following is the most likely classification of this tumor?

Accepted Answer

An androgen-producing ovarian tumor composed of cells that resemble Leydig cells is called a hilar tumor. It originates from steroid-secreting cells normally found in the hilum of the ovary.

Question 17

A physical examination of a 5-year-old girl shows a grape-like polypoid mass protruding from the vagina. Histologic examination reveals that the mass has a myxoid stroma that contains small oval-shaped cells. Some of these cells have pink cytoplasm and resemble tennis rackets. These cells reacted positively upon immunohistochemical staining with the antibodies to desmin. Which of the following is the most likely diagnosis?

Accepted Answer

This grape-like tumor is an embryonal rhabdomyosarcoma, also known as sarcoma botryoides (Greek word for "grape-like").

Quiz 18: Female Genital System and Breast