Name: Test (10): Gynecological Oncology2 (100 Marks)

I. Choose the most correct single answer: (1 Mark each)

1. Which of the following is not a risk factor for ovarian cancer:
a. Nulliparity
b. Lynch type II
c. Late menopause
d. COCPs
e. Hereditary nonpolyposis colon cancer (HNPCC)

2. A 43-year-old NG who desires fertility underwent a laparoscopic left salpingo

oopherectomy for a 7cm cyst. The cyst was removed intact, and washings were negative.
Pathology: serous cystadenoma. Most appropriate management:
a. Close observation
b. Right salpingo-oopherectomy, omentectomy, multiple peritoneal biopsies
c. RSO, omentectomy, peritoneal biopsies, pelvic and para-aortic LN dissection
d. TAH, RSO, omentectomy, peritoneal biopsies, pelvic &para-aortic LN dissection
e. Postoperative chemotherapy.

3. The following women is the least needing referral to a gynecologic oncologist:

a. a 35yrs old with a complex 7cm adnexal mass and CA125 level of 75
b. a 60yrs old with a complex 7cm adnexal mass, and CA125 level of 75
c. a 35yrs old with complex solid adnexal mass and CA125 of 75
d. a 35yrs old with a complex 7cm adnexal mass, ascites and CA125 level of 75
e. a 50yrs old with a complex 7cm fixed adnexal ass and CA 125 level of 25

4. All the following are characteristics of Krukenberg tumors, EXCEPT:

a. They are bilateral
b. They are small solid tumors
c. They usually arise from primary gastric tumors
d. They are usually the only site of metastatic disease
e. They are comprised of mucinous and signet ring cells

5. The most common method of ovarian cancer spread is:

a. Lymphatic
b. Hematogenous
c. Direct extension
d. Tumor exfoliation
e. All of the following equally

6. All the following are tumor marker for germ cell tumors, EXCEPT:
a. Inhibin
b. Alpha-fetoprotein (AFP)
c. Lactate dehydrogenase (LDH)
d. Human chorionic gonadotrophin (HCG)
e. Thyroxin

7. An 18yrs old female has a history of a stage IC grade 3 immature teratoma and received
chemotherapy. At 6month follow-up, there is an enlarging pelvic mass. Next step is:
a. Chemotherapy
b. Radiation therapy
c. Continued observation
d. Laparoscopy
e. Exploratory laparotomy with removal of masses

8. The presenting symptom of a granulosa cell tumor in a prepubescent girl:

a. Hirsutism
b. Abdominal pain
c. Abdominal mass
d. Primary amenorrhea
e. Isosexual precocious puberty

9. The following tumors are hormonally active and most often secrete estrogen:
a. Thecoma
b. Fibroma
c. Sertoli-Leydig tumor
d. Dermoid tumor
e. None of the above

10. A 62yrs old woman presents for her annual examination. You note an asymptomatic 2
cm area of thickened white plaque. The next step is:
a. Excisional biopsy of the lesion
b. Prescribe estrogen cream and follow up in 3months
c. Perform a wide local excision
d. Prescribe clobetasol cream and follow up in 3months
e. Start chemotherapy

11. A Schiller Duvall body, found during histologic evaluation and an elevated AFP level
may be found with which type of vaginal cancer:
a. Yolk sac tumor
b. Leiomyosarcoma
c. Clear cell adenocarcinoma
d. Embryonal rhabdomyosarcoma
e. Immature cystic teratoma

12. A 5yrs old girl is noted to have breast enlargement, vaginal bleeding and an 8cm pelvic
mass. which of the following is the most likely etiology?
a. Benign cystic teratoma (dermoid)
b. Endodermal sinus tumor
c. Choriocarcinoma
d. Granulose theca cell tumor
e. Sertoli Leydig cell tumor

13. A 25yrs old woman is noted to have a 4cm simple cyst of the right ovary. She denies any
abdominal pain, nausea or vomiting. The next step is:
a. Expectant management
b. Laparoscopy
c. Exploratory laparotomy
d. US guided aspiration
e. Chemotherapy

14. Best treatment for a 5cm dermoid cyst in an 18year old nulliparous woman:
a. Total abdominal hysterectomy
b. Unilateral salpingo-oopherectomy
c. Ovarian cystectomy
d. Observation
e. Chemotherapy

15. A 44-year-old woman is having a 30cm tumor of the ovary. it is most likely:
a. Functional ovarian cyst
b. Dermoid cyst
c. Granulose cell tumor
d. Serous tumor
e. Mucinous tumor

16. A 34-year –old woman is diagnosed to have VIN3 on a punch biopsy from a vulval
lesion. What is the recommended treatment for this condition?
a. Interferon therapy
b. Laser ablation of the lesion
c. Local surgical excision
d. Simple vulvectomy
e. Topical imiquimod cream

17. A 27yrs old NG had Pap test showing LSIL. Colposcopy is negative for lesions, but
vaginal lesions are observed after application of 5% acetic acid. A biopsy shows features of
HPV infection and low-grade VaIN 1. The patient is asymptomatic. The best option is:
a. Observation
b Laser ablation
c. HPV vaccination
d. Intravaginal fluorouracil (5-FU) cream
e. Vaginectomy and radical hysterectomy

18. Vulval Cancer of 2 cm and confined to vulva with stroma invasion of 2mm is staged as:
a. Ia
b. Ib
c. IIa
d. IIB
e. IIIA

19. The ovarian tumor that is most prone to undergo torsion during pregnancy is:
a. Serous cystadenoma
b. Mucinous cystadenoma
c. Dermoid cyst
d. Theca lutein cyst
e. simple serous cyst

20. A uni-locular ovarian cyst measuring 4x 5cm found on US during the 8th week of
gestation. Best management for this case is:
a. Conservative management
b. Laparoscopic aspiration of the cyst
c. Immediate laparotomy and cystectomy
d. Immediate laparotomy and ovariectomy
e. Laparotomy and cystectomy postponed to 14 weeks
21. A 54-year woman have endometrial hyperplasia on endometrial biopsy. ovarian tumor
to be suspected:
a. Dysgerminoma.
b. Granulosa-theca cell tumor.
c. Sertoli-Leydig tumor.
d. Mucinous cystadenocarcinoma.
e. Endodermal sinus tumor

22. A patient wz history of molar pregnancy, complains of lower abdominal pain wz

tenderness on palpation and HCG shows high levels, US shows ovarian cysts, these cysts are
most likely:
a. Follicular cyst
b. Theca lutein cyst
c. Corpus luteum cyst
d. Endometriomas
e. Non-gestational choriocarcinoma of the ovary

23. A 19-year-old female complains of left lower quadrant vague pain for 2 months. She has
had no changes in menstruation, no bowel or bladder dysfunction. Urine hCG is negative.
TVS shows a 6 cm complex left adnexal mass. Abdominal X-ray shows different areas of
high density. most appropriate next step in management?
a. Repeat pelvic examination in 1 year
b. Repeat pelvic ultrasound in 6 weeks
c. Prescribe the oral contraceptive pill
d. Perform US guided cyst aspiration
e. Perform laparotomy

24. Myxoma peritonei may occur as a consequence of rupture of:

a. Dermoid cyst
b. Struma ovarii
c. Serous cystadenoma
d. Mucinous cystadenoma
e. Cystadenofibroma

25. A 47-year-old woman has a pressure sensation in her pelvis for the past 5 months. O/E,
there is Rt adnexal mass. US shows a 10 cm fluid-filled cystic mass in Rt ovary. FNAC
reveals malignant epithelial cells surrounding psammoma bodies. she is most likely to have:
a. Endometrial adenocarcinoma
b. Ovarian serous cystadenoma
c. Mesothelioma
d. Ovarian mature cystic teratoma
e. Adenocarcinoma of fallopian tube

26. A 48-year-old woman noted mild irregular vaginal bleeding for the past 2 months. PV
reveals no cervical lesions and normal Pap smear. Endometrial biopsy shows endometrial
hyperplasia. An abdominal US reveals a solid Rt ovarian mass. this is most likely:
a. Mature cystic teratoma
b. Choriocarcinoma
c. Sertoli-Leydig cell tumor
d. Fibrothecoma
e. Krukenberg tumor
27. Exploratory laparotomy shows a tumor involving the right ovary. Several implants on
the peritoneum of the small bowel and omentum. The liver appears normal and there are
no distant metastases. What is the initial intraoperative assessment of stage?
a. 0
b. I
c. II
d. III
e. IV

28. The following postmenopausal woman is protected from epithelial ovarian malignancy:
a. A married woman with history of use of induction of ovulation drugs.
b. A nun with a history of late menopause.
c. A nulliparous with a history of regular menses.
d. An unmarried woman with a history of breast cancer.
e. A multiparous who used OCPs.

29. A 67y old woman presents with abdominal discomfort, bloating, loss of weight. Her vital
signs are stable. O/E, a large Lt adnexal mass is felt. US shows a 10cm complex mass with
solid and cystic components and mild fluid in Douglas Pouch. Most likely management:
a. Chemotherapy
b. Abdominal exploration with surgical resection
c. Chemotherapy followed by abdominal exploration and surgical resection.
d. Abdominal exploration with surgical resection followed by chemotherapy
e. Abdominal exploration with surgical resection followed by radiotherapy

30. Ovarian neoplasms most commonly arise from which of the following cell lines?
a. Ovarian epithelium
b. Ovarian stroma
c. Ovarian germ cells
d. Ovarian sex cords
e. Metastatic disease

31. A 76y old wz H/O of cancer 6y ago presents wz abdominal discomfort, bloating and loss
of weight. Symptoms have been increasing for about 3 months. O/E, masses are palpable
bilaterally with small nodules in Douglas pouch. Assuming the masses are malignant, most
likely 1ry source of the tumors?
a. Colon
b. Pylorus
c. Liver
d. Breast
a. Lymph node

32. A 17y old complains of left lower quadrant pain. O/E, a pelvic mass is felt. An ovarian
neoplasm is identified by US. Most common ovarian tumor in this patient:
a. Germ cell tumor
b. Papillary serous epithelial
c. Brenner tumor
d. Fibrosarcoma
e. Sarcoma botryoides

33. Which ovarian neoplasm has the lowest malignancy rate?

a. Serous tumors
b. Mucinous tumors
c. Endometrioid tumors
d. Clear cell carcinoma
e. Brenner tumors

34. Which ovarian neoplasm has the highest rate of bilaterality?

a. Brenner tumors
b. Endometrioid tumors
c. Serous cyst adenocarcinoma
d. Mucinous cyst adenocarcinoma
e. Dysgerminoma

35. A 17yrs old girl presents with left iliac fossa pain. US shows a 5cm complex solid cyst
with calcified and fatty elements on the left ovary. the likely diagnosis:
a. Theca lutein cyst
b. Tuboovarian abscess
c. Serous cystadenoma
d. Fibroma
e. Dermoid cyst

36. Which ovarian neoplasm is similar histologically to primary tubal carcinoma?

a. Clear cell carcinoma
b. Sex cord stromal tumors
c. Mucinous cyst adenocarcinoma
d. Serous cyst adenocarcinoma
e. Endodermal sinus tumor

37. The staging of ovarian carcinoma is based upon:

a. Pelvic examination
b. Paracentesis of ascitic fluid
c. CT imaging of abdomen and pelvis
d. Surgical evaluation of the extent of intrapelvic and intraabdominal disease
e. Barium enema

38. Which of the following ovarian tumors is derived from germinal epithelium?
a. Dysgerminoma
b. Fibroma
c. Theca cell tumor
d. Endometrioid tumor
e. Germ cell tumor

39. Which of the following ovarian tumors is the most common?

a. Granulosa cell tumor
b. Sertoli- Leydig cell tumor
c. Yolk sac tumor
d. Gonadoblastoma
e. Mucinous cystadenoma

40. A woman has a mutation in BRCA1 gene. She is at increased risk of developing:
a. Breast and ovarian cancers
b. Endometrial and breast cancers
c. Endometrial and colon cancers
d. Ovarian and colon cancers
e. Ovarian and endometrial cancers

41. A 27y old woman with regular cycles has Rt sided abdominal pain. US on Day 13 shows
ET: 12mm, normal Lt ovary, an echoluscent cystic structure 20x18mm is seen within the Rt
ovary. This structure in Rt ovary is most likely:
a. Dermoid cyst
b. Endometrioma
c. Dominant follicle
d. Corpus luteum cyst
e. Follicular cyst

42. A 26y old NG presents to ER with acute abdominal pain and Rt lower quadrant
tenderness. BP: 90/50, pulse: 120, T: afebrile. PV shows 10cm Rt adnexal mass. Serum
pregnancy test is -ve and hct is 24%. Exploratory laparotomy confirms a hemoperitoneum.
A smooth Rt ovarian tumor is bleeding from its ruptured capsule. Uterus, fallopian tubes
and Lt ovary are normal. Right salpingo-oophorectomy is performed. Frozen section shows
primitive germ cells with intervening connective tissue infiltrated by lymphocytes. The
tumor is most likely:
a. Dysgerminoma
b. Endodermal sinus tumor
c. Choriocarcinoma
d. Granulosa cell tumor
e. Dermoid cyst

43. A 32y old woman has a TVS, as part of investigation of 1ry subfertility, showing
bilateral 5cm “kissing” ovarian cysts in the Douglas pouch, both containing diffuse, low-
level echoes giving a solid “ground- glass” appearance. she reports severe dysmenorrheal
and dyspareunia. these ovarian cysts are most likely:
a. Hemorrhagic functional ovarian cysts
b. Dermoid cysts
c. Endometriomas
d. Tubo-ovarian abscesses
e. Serous cystadenomas

44. A 58y old woman presents with a large pelviabdominal mass extending to the level of the
xiphisternum. it has a heterogenous appearance on scan with solid and cystic components.
the rest of the pelvis and abdomen appears normal and there is no free fluid. CA 125 is
430Units. she is asymptomatic. how would you manage her:
a. Laparoscopic ovarian cystectomy
b. Laparotomy, TAH+BSO, pelvic and para-aortic lymph node sampling, omentectomy and
debulking of tumor deposits.
c. Repeat scan and CA 125 in 3months to check for interval change
d. Six cycles of neoadjuvant carboplatin and paclitaxel-based chemotherapy followed by
restaging CT scan at 3months
e. US guided transcutaneous aspiration of ovarian cyst fluid and cytological assessment.
Questions 45- 47: A 65y old woman has abdominal distention of 3 months wz shifting
dullness. PV reveals a Rt adnexal mass that is fixed in the pelvis. Lt ovary is not palpable.
CA- 125 is 250U/mL. Blood chemistries, urine analysis, PAP smear, mammography and
chest X-ray are normal. GIT studies are normal.
45. Which of the following is the most likely diagnosis?
a. Gonadoblastoma
b. Meigs’ syndrome
c. Krukenberg tumor
d. Serous cyst adenocarcinoma
e. Endodermal sinus tumor
46. If her TVS shows papillae projections of this mass, that shows partly solid areas and
minimal ascites, her RMI is (risk of malignancy index is):
a. 35
b. 200
c. 250
d. 750
e. 2250
47. Her surgical treatment should include which of the following?
a. Removal of all gross disease more than 1cm.
b. TAH+ BSO and instillation of radioactive material
c. TAH+BSO and removal of any lesion ≥ 1 cm
d. Radical hysterectomy
e. Immediate chemotherapy

48. An unmarried 20-year-old female had an accidentally discovered 8 cm dermoid cyst

during a regular ultrasound checkup. Which of the following is the best treatment for her?
a. Aspiration of the cyst guided by ultrasound.
b. Unilateral ovariectomy.
c. Ovarian cystectomy.
d. Assurance, conservative management and follow up.
e. Combined oral contraceptive pills for 3 months.

49. An unmarried 20-year-old female has an accidentally discovered 2 cm hemorrhagic cyst

during an abdominal ultrasound. Which of the following is the best treatment for her?
a. Aspiration of the cyst guided by ultrasound.
b. Unilateral ovariectomy.
c. Ovarian cystectomy.
d. Follow up.
e. Cyclic combined oral contraceptive pills for 3 months.

Questions 50- 54: An unmarried 60-year-old presents with abdominal distension, vague
abdominal pain and progressive weight loss. Pelvic examination and ultrasound reveal
bilateral adnexal masses about 5 cm in diameter partly cystic and partly solid with
restricted mobility.
50. What is the most likely diagnosis?
a. Dermoid cyst.
b. Functional ovarian cysts.
c. Endometriomas.
d. Chronic pelvic inflammatory disease.
e. Ovarian malignancy.
51. In the previous case, what is the most valuable serum marker to be done?
 a. hCG.
b. CA-125.
c. α feto-protein.
d. Lactic acid dehydrogenase.
e. Dehydro epiandrosterone (DHEA).
52. Which of the following conditions should be highly considered in this case?
a. Subsequent torsion.
b. Chemical peritonitis.
c. Subsequent vesico-vaginal fistula.
d. Breast cancer could be the 1ry site.
e. Associated diabetes and hypertension.
53. What is your suggested main treatment for this patient?
a. Serial follow up.
b. Gn-RH analogues for 6 months.
c. Ovarian cystectomy.
d. Exploratory laparotomy.
e. Radiotherapy/chemotherapy.
54. What is the expected prognosis for this case?
a. Functional problem with no long-term squeal.
b. Unfavorable 5-year survival is expected.
c. It is the best gynecological tumor that responds to chemotherapy.
d. It is the best gynecologic tumor that responds to radiotherapy.
e. Any kind of treatment will not affect life expectancy.

55. Which of the following ovarian masses is neoplastic?

a. Follicular cysts.
b. Simple serous cysts
c. Corpus luteum cysts.
d. Theca lutein cysts.
e. Endometriotic cyst.

56. Functioning ovarian tumors include:

a. Mucinous cystadenoma.
b. Endodermal sinus tumor.
c. Dermoid cyst.
d. Papillary serous cystadenoma.
e. Granulosa theca cell tumor.

57. Myxoma peritonei may occur as a consequence of rupture of which ovarian cyst?
a. Dermoid.
b. Struma ovarii.
c. Serous cystadenoma.
d. Mucinous cystadenoma.
e. Cystadenofibroma.

58. A 60-year-old multipara, diabetic and hypertensive, presented to the clinic with vague
lower abdominal pain. Pelvic ultrasound revealed a normal sized anteverted uterus with
endometrial thickness of 4 mm and a Right adnexal cystic structure 7 cm in diameter with
internal solid areas. How can you counsel this case?
a. Mostly functional cyst for follow up.
b. Request for CA 125 and MRI pelvis and abdomen before taking an action.
 c. Laparoscopy for evaluation and biopsy is mandatory.
d. Ovariectomy is highly considered.
e. Ultrasonography guided aspiration is a diagnostic and therapeutic non- invasive
procedure.

59. All the followings are mandatory for proper staging of cancer ovary EXCEPT:
a. Cytological assessment of peritoneal fluid.
b. Hysteroscopy.
c. CT chest.
d. Bone scan for metastatic nodules.
e. Lymph nodes and omental biopsies.

60. Comparing various gynecologic malignancies as regard prognosis, which of the

following gynecologic malignancy is considered to be the worse?
a. Cancer breast.
b. Cancer cervix.
c. Endometrial carcinoma.
d. Choriocarcinoma.
e. Ovarian carcinoma.
61. Why this malignancy, chosen in the previous question, has the worst prognosis?
a. Early vascular spread.
b. Early lymphatic dissemination.
c. Late clinical presentation.
d. Chemotherapy is ineffective.
e. Patient is usually old and unfit for surgery.

For each of the ovarian tumors in questions 62- 66, choose the most useful marker from the
list of options, each option can be used once, more than once or not at all.
a. LDH
b. AFP
c. CA 125
d. CA 19.9
e. Inhibin
f. HCG

62. Endodermal sinus tumor (yolk sac tumor).

63. Choriocarcinoma.
64. Dysgerminoma.
65. Granulosa cell tumor.
66. Serous cystadenocarcinoma.

Questions 67- 75 are preceded by a list of tumor markers. Select the single most accurate
answer for the questions below. Each option may be used once, more than once or not at all.
a. Estradiol
b. Androgen
c. Lactate dehydrogenase
d. Human chorionic gonadotrophin
e. CA 19.9
f. CA 125
g. Alpha fetoprotein
h. Thyroxine
67. Theca cell tumor.
68. Granulosa cell tumor.
69. Sertoli-Leydig cell tumor.
70. Serous cystadenoma.
71. Struma ovarii.
72. Yolk sac tumor.
73. Choriocarcinoma.
74. Mucinous cystadenocarcinoma.
75. Endometrioid tumor.

For each description in questions 76- 82, choose the SINGLE most appropriate answer from
the below list of options. each option may be used once, more than once or not at all.
a. Mucinous epithelial tumor
b. Dysgerminoma
c. Endodermal sinus tumor
d. Granulosa cell tumor
e. Sertoli- Leydig ovarian tumor
f. Dermoid cyst
g. Krukenberg tumor

76. May present with amenorrhea, deep voice, hirsutism and acne.
77. Associated with appendiceal tumors and pseudomyxoma peritoneii.
78. May contain hair, teeth, bone, cartilage and sebum.
79. Metastatic ovarian tumor from pylorus and GIT.
80. Contains Shiller-Duval bodies on microscopic examination.
81. Shows multiple lymphocytes on microscopic examination.
82. Shows Call-Exner’s bodies arranged in rosette on microscopic examination.

For each description in questions 83- 86, choose the SINGLE most appropriate answer from
the below list of options, each option may be used once, more than once or not at all.
a. Serous cystadenoma
b. Dermoid cyst
c. Endometrioma
d. Granulose cell tumor
e. Brenner’s tumor
f. Mucinous cystadenoma

83. A unilocular cyst with papillous processes that may occur bilaterally.

84. A large unilateral multilocular cyst lined by columnar epithelium and complicated with
pseudomyxoma peritoneii.

85. A large cyst usually containing unclotted blood with a ground glass appearance on
ultrasound.

86. This has a solid appearance with islands of transitional epithelium with coffee bean
nuclei in dense fibrotic stroma.
Questions from 87- 89, match the US findings with the ovarian tumor type.
a. Completely solid echogenic mass
b. Simple echoluscent cyst
c. Complex cyst with heterogenous echogenecity
d. Ascites and fluid in hepatorenal pouch

87. Granulose cell tumor.

88. Benign cystic teratoma (dermoid cyst).
89. Follicular cyst.

For each of the statements below, mark True (T) or False (F):
90. In dermoid cyst, complications include torsion, chemical peritonitis and rupture.
91. All granulosa cell tumors are malignant, but are usually confined to the ovary and have
a good prognosis.
92. Meig’s syndrome is the combination of fibroma, ascites and pleural effusions.
93. Multiple small cysts at the periphery of the ovary with a dense stroma on US are
suspicious for malignancy.
94. Calcification and fats are suspicious for malignancy.
95. Carcinoma of ovary is most common in developing countries.
96. The peak age of ovarian cancer is 60- 70yrs old.
97. Mainstay of treatment of ovarian carcinoma is surgery and radiotherapy combined.
98. Benign ovarian tumor with highest incidence to turn malignant is dermoid cyst.
99. Benign ovarian tumor with highest incidence to turn malignant is papillary serous
cystadenoma.
100. Malignant ovarian neoplasm may be metastatic from a 1ry in the breast or GIT.

Best of Luck☺