PAT - Female Genital Cases Exam
Questions & Answers10
A 33-year-old woman taking oral contraceptives for a year has noted vaginal bleeding that is not
severe, but it occurs nearly every day over the past 5 weeks. On pelvic examination, there is a
0.7 cm polypoid mass noted to extend outward from the endocervical region. The ectocervix
appears normal. The uterus is normal in size. The adnexa have no palpable masses. A biopsy of
this lesion is performed. Which of the following microscopic findings is most likely to be found in
this lesion? - ANSWERS-Microglandular hyperplasia forms a mass lesion grossly, and must be
distinguished from adenocarcinoma histologically. Some cases may occur in the setting of oral
contraceptive use, but a causal relationship is not well established.
A 48-year-old woman has noted a small amount of irregular vaginal bleeding for the past 2
months. She has a pelvic examination that reveals no cervical lesions, and a Pap smear that
shows no abnormal cells. Next, an endometrial biopsy is performed, and there is microscopic
evidence for endometrial hyperplasia. An abdominal ultrasound reveals a solid right ovarian
mass. Which of the following neoplasms is this woman is most likely to have? - ANSWERS-
Fibrothecomas and granulosa cell tumors can be estrogen producing. The excessive estrogen
drives endometrial hyperplasia, which can progress to atypical hyperplasia, which can progress
to endometrial carcinoma.
A 51-year-old perimenopausal woman has had vaginal bleeding for the past 6 months. On
physical examination she has an enlarged, nodular uterus. A hysterectomy is performed. The
surgeon notes several 0.2 to 1 cm translucent, smooth-surfaced, thin-walled, fluid-filled cysts
near the fimbriated end of the right fallopian tube. Which of the following is the most likely
diagn - ANSWERS-Also called paratubal cysts, these are common incidental findings. They are
embryologic remnants of the wolffian duct. They are not related to neoplasia. This woman had
leiomyomas of the uterus which led to the hysterectomy.
A 36-year-old woman has had episodes of lower abdominal and pelvic pain for the past 10
years. A bimanual pelvic examination reveals no abnormalities. A Pap smear is negative. She has
an abdominal ultrasound scan that reveals no abnormalities. She undergoes laparoscopy, and
, several 0.2 to 0.5 cm brown nodular lesions are seen on serosal surfaces of the uterus, fallopian
tubes, and appendix. These lesions are excised. Which of the following microscopic findings is
most likely to be present in these lesions? - ANSWERS-Pain is a key feature of endometriosis.
The foci of endometriosis are most often found on serosal surfaces in the pelvis, but can be
found in other locations such as the surface of the bowel. Endometrial glands, stroma, and
hemorrhage are microscopic features.
A 47-year-old woman has noted a pressure sensation, but no pain, in her pelvic region for the
past 5 months. On physical examination there is a right adnexal mass. An ultrasound scan shows
a 10 cm fluid-filled cystic mass in the right ovary, along with ascitic fluid. A fine needle aspirate
of the mass is performed and cytologic examination of clear fluid aspirated from the mass
reveals clusters of malignant epithelial cells surrounding psammoma bodies. Which of the
following neoplasms is she most likely to have? - ANSWERS-Serous cystadenocarcinoma.
Ovarian carcinomas are often associated with ascites, because they have a propensity to seed
throughout the peritoneal cavity. Psammoma body formation is common to malignant serous
tumors of the ovary.
A 30-year-old infertile woman has had episodic lower abdominal and pelvic pain for 2 years. A
physical examination, including pelvic exam, reveals no abnormalities. A Pap smear shows only a
few trichomonads and no dysplastic cells. A laparoscopy is performed, and the gynecologist
notes the presence of several blue to red 0.2 to 0.4 cm slighted raised lesions scattered on the
pelvic peritoneum in the cul-de-sac and broad ligaments. Which of the following is the most
likely diagnosis? - ANSWERS-These 'powder burns' are typical for the small hemorrhagic foci of
endometriosis on pelvic peritoneum that can produce so much discomfort for their size.
A 43-year-old woman has noted menstrual periods that have been exceptionally heavy, lasting 6
to 8 days, for 4 months. She has also noted minor intermenstrual bleeding. On physical
examination her uterine cervix appears normal, and a Pap smear shows no abnormal cells.
Pelvic examination reveals that the uterus is enlarged to twice normal size and is nodular. There
are no adnexal masses. Which of the following is the most likely diagnosis? - ANSWERS-The
most common neoplasm of the uterus is a leiomyoma. They can be multiple, can slowly enlarge,
and can lead to abnormal bleeding.
Questions & Answers10
A 33-year-old woman taking oral contraceptives for a year has noted vaginal bleeding that is not
severe, but it occurs nearly every day over the past 5 weeks. On pelvic examination, there is a
0.7 cm polypoid mass noted to extend outward from the endocervical region. The ectocervix
appears normal. The uterus is normal in size. The adnexa have no palpable masses. A biopsy of
this lesion is performed. Which of the following microscopic findings is most likely to be found in
this lesion? - ANSWERS-Microglandular hyperplasia forms a mass lesion grossly, and must be
distinguished from adenocarcinoma histologically. Some cases may occur in the setting of oral
contraceptive use, but a causal relationship is not well established.
A 48-year-old woman has noted a small amount of irregular vaginal bleeding for the past 2
months. She has a pelvic examination that reveals no cervical lesions, and a Pap smear that
shows no abnormal cells. Next, an endometrial biopsy is performed, and there is microscopic
evidence for endometrial hyperplasia. An abdominal ultrasound reveals a solid right ovarian
mass. Which of the following neoplasms is this woman is most likely to have? - ANSWERS-
Fibrothecomas and granulosa cell tumors can be estrogen producing. The excessive estrogen
drives endometrial hyperplasia, which can progress to atypical hyperplasia, which can progress
to endometrial carcinoma.
A 51-year-old perimenopausal woman has had vaginal bleeding for the past 6 months. On
physical examination she has an enlarged, nodular uterus. A hysterectomy is performed. The
surgeon notes several 0.2 to 1 cm translucent, smooth-surfaced, thin-walled, fluid-filled cysts
near the fimbriated end of the right fallopian tube. Which of the following is the most likely
diagn - ANSWERS-Also called paratubal cysts, these are common incidental findings. They are
embryologic remnants of the wolffian duct. They are not related to neoplasia. This woman had
leiomyomas of the uterus which led to the hysterectomy.
A 36-year-old woman has had episodes of lower abdominal and pelvic pain for the past 10
years. A bimanual pelvic examination reveals no abnormalities. A Pap smear is negative. She has
an abdominal ultrasound scan that reveals no abnormalities. She undergoes laparoscopy, and
, several 0.2 to 0.5 cm brown nodular lesions are seen on serosal surfaces of the uterus, fallopian
tubes, and appendix. These lesions are excised. Which of the following microscopic findings is
most likely to be present in these lesions? - ANSWERS-Pain is a key feature of endometriosis.
The foci of endometriosis are most often found on serosal surfaces in the pelvis, but can be
found in other locations such as the surface of the bowel. Endometrial glands, stroma, and
hemorrhage are microscopic features.
A 47-year-old woman has noted a pressure sensation, but no pain, in her pelvic region for the
past 5 months. On physical examination there is a right adnexal mass. An ultrasound scan shows
a 10 cm fluid-filled cystic mass in the right ovary, along with ascitic fluid. A fine needle aspirate
of the mass is performed and cytologic examination of clear fluid aspirated from the mass
reveals clusters of malignant epithelial cells surrounding psammoma bodies. Which of the
following neoplasms is she most likely to have? - ANSWERS-Serous cystadenocarcinoma.
Ovarian carcinomas are often associated with ascites, because they have a propensity to seed
throughout the peritoneal cavity. Psammoma body formation is common to malignant serous
tumors of the ovary.
A 30-year-old infertile woman has had episodic lower abdominal and pelvic pain for 2 years. A
physical examination, including pelvic exam, reveals no abnormalities. A Pap smear shows only a
few trichomonads and no dysplastic cells. A laparoscopy is performed, and the gynecologist
notes the presence of several blue to red 0.2 to 0.4 cm slighted raised lesions scattered on the
pelvic peritoneum in the cul-de-sac and broad ligaments. Which of the following is the most
likely diagnosis? - ANSWERS-These 'powder burns' are typical for the small hemorrhagic foci of
endometriosis on pelvic peritoneum that can produce so much discomfort for their size.
A 43-year-old woman has noted menstrual periods that have been exceptionally heavy, lasting 6
to 8 days, for 4 months. She has also noted minor intermenstrual bleeding. On physical
examination her uterine cervix appears normal, and a Pap smear shows no abnormal cells.
Pelvic examination reveals that the uterus is enlarged to twice normal size and is nodular. There
are no adnexal masses. Which of the following is the most likely diagnosis? - ANSWERS-The
most common neoplasm of the uterus is a leiomyoma. They can be multiple, can slowly enlarge,
and can lead to abnormal bleeding.
