A 25-year-old woman underwent surgery for an ovarian cyst that was found to be a serous cystadenocarcinoma on histopathology. The next recommended management is a hysterectomy and bilateral salpingo-oophorectomy to remove the ovaries and uterus due to the cancer diagnosis and the patient's young age. Serial CA-125 measurement and follow-up alone would not be sufficient treatment. Radiotherapy is not recommended for this diagnosis and stage of cancer.

5. Q) A 25-year-old married nullipara undergoes laparoscopic cystectomy for
ovarian cyst which on histopathology reveals ovarian serous
cystadenocarcinoma. What should be the next management?
(AIIMS Nov 08)
a. Serial Ca-125 measurement and follow-up
b. Hysterectomy and bilateral salpingo oophorectomy
c. Hysterectomy + Radiotherapy
d. Radiotherapy

6. Q) A 25-year-old married nullipara undergoes laparoscopic cystectomy for
ovarian cyst which on histopathology reveals ovarian serous
cystadenocarcinoma. What should be the next management?
(AIIMS Nov 08)
a. Serial Ca-125 measurement and follow-up
b. Hysterectomy and bilateral salpingo oophorectomy
c. Hysterectomy + Radiotherapy
d. Radiotherapy

7. SOLUTION
• Young female
• U/L SO done—check for capsule breakage
• Family not complete
• TAH not an option
• RTH will damage the ovaries
• CTH preferable
• Serous cystadenocarcinoma is not very aggressive
• CA-125 along with MRI/PET

8. Q) True about CA-125:
1.Glycoprotein
2.It is a specific marker
3.Increased in colon carcinoma
4.The normal range in premenopausal females is 200 U/ml
5.May be elevated in pelvic inflammatory disease

9. True about CA-125:
1.Glycoprotein
2.It is a specific marker
3.Increased in colon carcinoma
4.The normal range in premenopausal females is 200 U/Ml
5.May be elevated in pelvic inflammatory disease

10. TUMOR TUMOR MARKERS
SURFACE EPITHELIAL TUMORS CA125
MUCINOUS EPITHELIAL TUMOUR CA 19-9, CEA
YOLK SAC TUMOR AFP, ALPHA1 ANTITRYPSIN
CHORIOCARCINOMA BETA HCG
DYSGERMINOMA LDH, PLAP
EMBRYONAL TUMOURS HCG, AFP
GRANULOSA CELL TUMOURS INHIBIN

12. Q) All are correctly matched except:
a. Dermoid cyst: bone
b. Mucinous tumor: Psammoma bodies
c. Krukenberg tumor: Signet ring cells
d. Brenner tumor: Walthard cell rest

13. Q) All are correctly matched except:
a. Dermoid cyst: bone
b. Mucinous tumor: Psammoma bodies
c. Krukenberg tumor: Signet ring cells
d. Brenner tumor: Walthard cell rest

17. Q) A 35-years-old female presented with an adnexal mass. CA125 was slightly raised, CA19.9
was normal and LDH was elevated. Tumor was resected and the gross and microscopic image
were as given below. What is the most likely diagnosis?
a. Papillary cystadenocarcinoma
b. Dysgerminoma
c. Teratoma
d. Choriocarcinoma
(AlIMS Nov 2016)

18. Q) A 35-years-old female presented with an adnexal mass. CA125 was slightly raised, CA19.9
was normal and LDH was elevated. Tumor was resected and the gross and microscopic image
were as given below. What is the most likely diagnosis?
a. Papillary cystadenocarcinoma
b. Dysgerminoma
c. Teratoma
d. Choriocarcinoma
(AlIMS Nov 2016)

19. SOLUTION
• Dysgerminoma is 2nd most common GCT
• 10-20% B/L
• Corresponds to Seminoma of testis
• Best prognosis
• May be associated with Endodermal sinus tumour, Choriocarcinoma
• Gross & Cut Section-- Dr Preeti Sharma

20. Q) A 20-year female presents with a ovarian mass 6× 6 × 6 cm in size. Ultra sonography reveals
solid structures in the mass. Her serum biomarkers such as AFP, Beta-HCG and CA 125 are
normal, however, her serum alkaline phosphatase was found to be elevated. The most likely
diagnosis is: (AIIMS Nov 2011)
a. Dysgerminoma
b. Endodermal sinus tumor
c. Malignant teratoma
d. Mucinous cystadenocarcinoma

21. Q) A 20-year female presents with a ovarian mass 6× 6 × 6 cm in size. Ultra sonography reveals
solid structures in the mass. Her serum biomarkers such as AFP, Beta-HCG and CA 125 are
normal, however, her serum alkaline phosphatase was found to be elevated. The most likely
diagnosis is: (AIIMS Nov 2011)
a. Dysgerminoma
b. Endodermal sinus tumor
c. Malignant teratoma
d. Mucinous cystadenocarcinoma

22. Q) In a case of Dysgerminoma of ovary one of the following tumor markers is likely to
be raised:
a. Serum HCG
b. Serum alpha fetoprotein
c. Serum lactic dehydrogenase
d. Serum inhibin

23. Q) In a case of Dysgerminoma of ovary one of the following tumor markers is likely to
be raised:
a. Serum HCG
b. Serum alpha fetoprotein
c. Serum lactic dehydrogenase
d. Serum inhibin

26. Q) 30 year old female presents with abdominal pain. USG reveals an abdominal
mass which is resected. Gross appearance shows gray white solid tumor with
focal yellow areas. Microscopic examination reveals spindle cells admixed with
vacuolated cells. Diagnosis?
a) fibroma
b) thecoma
c) Fibro-thecoma
d) granulosa cell tumors

27. Q) 30 year old female presents with abdominal pain. USG reveals an abdominal
mass which is resected. Gross appearance shows gray white solid tumor with
focal yellow areas. Microscopic examination reveals spindle cells admixed with
vacuolated cells. Diagnosis?
a) fibroma
b) thecoma
c) Fibro-thecoma
d) granulosa cell tumors

30. BRENNER’S TUMOUR
•SOLID, < 2cm diameter
•8-10% B/L
•Usually arise from squamous metaplasia of surface
epithelium
•Cut section: Greyish, gritty, rubbery consistency like
fibroma
•Walthard cell rest in a fibrous stroma + Coffee bean
nucleus
•May secrete Estrogen
•Pseudo Meig syndrome

31. FIBROMA
•Firm, harder than myoma
•Tumours arising from connective tissue
of ovary
•<10% are B/L
•Frequently undergoes degeneration
•Spindle shaped cells resemble ovarian
cortex
•Meig’s syndrome

32. Q) You receive an intraoperative consultation for bilateral multinodular ovarian
masses in a 16 year old patient. Microscopic examination demonstrates bland,
monomorphic spindled cells within a collagenous stroma. Mutation of which of
the following genes is most likely associated with this entity?
1.HMGA2
2.JAZF1
3.PTCH
4.FOXL2

33. Q) You receive an intraoperative consultation for bilateral multinodular
ovarian masses in a 16 year old patient. Microscopic examination
demonstrates bland, monomorphic spindled cells within a collagenous
stroma. Mutation of which of the following genes is most likely associated
with this entity?
1.HMGA2
2.JAZF1
3.PTCH
4.FOXL2

34. Q) 23 year old sexually active female presented with dyspareunia followed by
vaginal bleeding showing a red, friable, nodular mass on the anterior wall of
the vagina. Histopathology of lesion is shown in the image. Which of the
following is likely associated with the lesion
a) CMV
b) TRICHOMONAS
c) DES
d) ADRENAL HYPERPLASIA

35. Q) 23 year old sexually active female presented with dyspareunia followed by
vaginal bleeding showing a red, friable, nodular mass on the anterior wall of
the vagina. Histopathology of lesion is shown in the image. Which of the
following is likely associated with the lesion
a) CMV
b) TRICHOMONAS
c) DES
d) ADRENAL HYPERPLASIA

36. DIETHYL STILBESTEROL
A synthetic form of Estrogen
Was prescribed to pregnant women between 1940-1971 to prevent
miscarriage, PTL, etc. Used rarely in Prostatic cancers now
DES (Diethylstilbestrol) exposure in utero related abnormalities—NOT USED
NOW
3 types of Ca in female fetus—Vag clear cell Ca// Vag Adenoca//Adenoca of Cx
Uterus—Hypoplastic//T shaped Ut// Ut synechiae
Cx—Cx hood like cockscomb// Cx Collar// CIN
Vag—Vag adenosis
FT—Cornual budding// Abnormal Fimbriae
In male fetus---Hypospadias, Cryptorchidism, Testicular Hypoplasia, Renal
abnormalities

37. Q) A lady with abdominal mass was investigated. On surgery, she was found to have bilateral
ovarian masses with smooth surface. On microscopy they revealed mucin secreting cells with
signet ring shapes. Diagnosis?
a. Dysgerminoma
b. Krukenberg tumor
c. Mucinous adenocarcinoma of the varies
d. Dermoid cyst
(AlMS May 2015)

38. Q) A lady with abdominal mass was investigated. On surgery, she was found to have bilateral
ovarian masses with smooth surface. On microscopy they revealed mucin secreting cells with
signet ring shapes. Diagnosis?
a. Dysgerminoma
b. Krukenberg tumor
c. Mucinous adenocarcinoma of the varies
d. Dermoid cyst
(AlMS May 2015)

39. KRUKENBERG TUMOR
• It may be Primary as well
• Most common primary sites from where metastasis to ovaries occur
are GIT (Pylorus, colon, rarely Small intestine), GB, pancreas, breast,
Endometrial Ca
• Usually B/L, MOD is retrograde lymphatics, hematogenous spread,
implantation from mass within peritoneal cavity
• Solid surface with no adhesions
• Typical—resemble primary Ca
• Atypical– Histologically differ from primary
• Poor Px, median survival < 1 year
• Metastatic tumours from GIT may produce sex hormones hence may
cause PMB