Number of questions: 18

PDF File Each question has only one answer.

1.   The lesion is seen in a cone biopsy from a 24-year old female who has a history of CIN 3. What are the antibodies that are most useful to diagnose this lesion being illustrated below? Answer

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A.     Cytokeratin (AE1/AE3) and vimentin.

B.     CD10 and p63.

C.     HLA-G and p16.

D.     hCG and hPL.

2.   A mass, 3.0 x 3.0 cm, was found in the lower uterine segment from a 38 years old lady. The lesion is illustrated below with H&E stained sections on the left and immunohistochemistry for cytokeratin 18 on the right. The lesion is most likely associated with which of the followings? Answer

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A.     HPV 16/18 infection.

B.     Very high level of serum beta-hCG.

C.     Postive for smooth muscle markers.

D.     Y-chromosome.

E.     Diffuse positive for hPL.

3.   A 42 years old female presented with heavy vaginal bleeding. Which is NOT correct to describe the tumor being illustrated below? Answer

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A.     High serum beta-hCG level.

B.    Likely to have a molar gestation in the past.

C.     With current therapy and follow up, the cure rate of the tumor approaches 100%.

D.     Lung is the most common metastatic site.

E.     TAH/BSO is the standard treatment of choice.

4.   Which of the followings is most commonly associated with an early complete hydatidiform mole? Answer

A.     Intravillous cistern formation and scalloping of villous surface.

B.    Polarization of trophoblastic column.

C.     Grape-like vesicles on gross examination.

D.     Mild circumferential trophoblastic hyperplasia on the villous surface.

E.     An in situ choriocarcinoma.

5.  To rule out a tubal pregnancy in the absence of chorionic villi and fetal part on endometrial D&C, the most specific immunostaining one may consider is: Answer

A.     Cytokeratin.

B.    hPL.

C.     hCG.

D.     Ki-67.

E.     p16.

6.   The differential diagnosis of a D&C specimen showing abnormal villous morphology includes: Answer

A.     Blighted ovum.

B.    Trisomy 18.

C.     Partial mole.

D.     Complete mole.

E.     All of above.

7.   Which of the following is true about hyperrectio lutenalis: Answer

1.      This is a condition of the myometrium due to over stimulation by hCG.

2.      Can be resulted from the use of FSH, hCG, and clomiphene to induce pregnancy.

3.      It occurs only during the third trimester.

4.      Ascites and hydrothorax may occur in severe cases.

A.      Only 1, 2, and 3 are true.

B.     Only 1 and 3 are ture.

C.     Only 2 ane 4 are true.

D.     Only 4 is true.

8.   Which of the following is true regarding the differential diagnosis between molar pregnancy and hydropic abortus: Answer

1.      Fluorescent in situ hybridization can be used.

2.      Serum hCG levels.

3.      The presence of fetal tissue indicate hydropic abortus.

4.      Prominent cisterna in practically every villus.

A.      Only 1, 2, and 3 are true.

B.     Only 1 and 3 are ture.

C.     Only 2 ane 4 are true.

D.     Only 4 is true.

9.   The incidence of molar pregnancy is associated with: Answer

A.   Low social-economical status.

B.     Women with low parity.

C.     HPV infection.

D.     High fat diet.

E.     All of above.

10. Which of the following is NOT true about placental site trophoblastic tumors: Answer

A.   The tumor is usually associated with villi when identified on sections.

B.     They are usually indolent tumors and metastasis is infrequent.

C.     The cells have features of implantation site intermediate trophoblasts.

D.     Fibrinoid depositions can be seen around blood vessels.

E.     Histologic features are not always predictive of malignant behavior although necrosis, high mitotic activity and Ki67 labeling index over 50% are unfavorable prognostic sign.

11. Placenta increta and percreta is the same as invasive mole: Answer

A.   True.

B.     False.

12. Which is the followings that describe a complete hydatidiform mole is correct: Answer

A.   It is a neoplastic disease.

B.  It is always triploidy.

C.  “Snow storm” appearance in sonograph is the most common seen in early complete moles.

D.  Presence of fetal parts is not generally compatible with complete moles.

E.   Complete mole is frequently derived from a partial mole.

13.  Which of the following immunohistochemical stains would be the LEAST helpful in the workup to support a  diagnosis of gestational trophoblastic disease? Answer

A.      hPL.

B.     beta hCG.

C.     PLAP.

D.     Cytokeratins 5,6.

E.     CD 146.

14. All of the following are TRUE regarding epitheliod trophoblastic tumor (ETT) EXCEPT? Answer

A.      Serum hCG is usually low (< 2000 mIU/ml).

B.     Many cases may not have a previous history of a mole.

C.     Chemotherapy is the first line treatment of choice.

D.     Often show extensive cellular necrosis with calcification.

E.     Cells tend to be small, round, uniform in distinct nests or masses as compared to placental site trophoblastic tumor (PSTT).

15. All of the followings are TRUE regarding exaggerated placental site, EXCEPT: Answer

A.      Intermediate type implantation site trophoblasts show extensive infiltration into the endomyometrium.

B.     Usually stain negative for EMA, NCAM, Ber-EP4.

C.     Ki-67 activity is increased.

D.     Follow up is usually not necessary.

E.     Confers no increased risk for invasive mole or persistent trophoblastic disease.

16. All of the following are TRUE regarding molar pregnancy EXCEPT: Answer

A.     Complete moles consist of hyperplastic trophoblatic tissue that is usually associated with fetal development.

B.     Complete mole may derive from an ovum fertilized by a single sperm.

C.     Complete mole may derive from an ovum fertilized by two sperm.

D.     Partial moles are often triploid.

E.     Complete moles confer a greater risk of invasion than partial moles.

17. Which of the following are not included in the WHO prognostic scoring system for gestational trophoblastic disease? Answer

A.     ABO blood group type of patient and father of conceptus.

B.     Interval between pregnancy and the start of chemotherapy.

C.     Site of metastases.

D.     Type of previous chemotherapy used.

E.     Pre-treatment hCG.

18. All of the following statements regarding the gross findings in early complete hydatiform mole are true, EXCEPT: Answer

A.     Botryoid clutsters are usually visible in first trimester abortuses.

B.     Enlarged villi forming clusters with fuzzy surfaces are rarely seen.

C.     Specimen rarely requires multiple containers for transport.

D.     During curretage, expanded villi may collapse making their presence difficult to detect.

E.     Hydropic change may not be apparent.