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Difficulty: MediumGynecologic Oncology

Match each clinical presentation and characteristic biomarker profile with the most likely specific gynecologic malignancy.

  • Postmenopausal bleeding with malignant glandular histology; associated with obesity, nulliparity, and unopposed estrogen exposure.Endometrial adenocarcinoma
  • Abdominal bloating, early satiety, and a complex adnexal mass with ascites; commonly monitored using CA-125 levels.Epithelial ovarian carcinoma
  • Rapidly growing adnexal mass in an adolescent female; histology demonstrates Schiller-Duval bodies and serum alpha-fetoprotein (AFP) is elevated.Yolk sac tumor
  • Irregular vaginal bleeding and hemoptysis following a recent molar pregnancy; characterized by a marked elevation in beta-hCG.Choriocarcinoma
  • Postmenopausal bleeding with a solid adnexal mass; histology shows Call-Exner bodies and serum inhibin levels are elevated.Granulosa cell tumor

Answer

Endometrial adenocarcinoma corresponds to the presentation of unopposed estrogen and postmenopausal bleeding. Epithelial ovarian carcinoma matches the vague abdominal symptoms and elevated CA-125. Yolk sac tumor corresponds to the adolescent with elevated AFP and Schiller-Duval bodies. Choriocarcinoma pairs with the post-molar bleeding, hemoptysis, and elevated beta-hCG. Granulosa cell tumor matches the solid mass with elevated inhibin and Call-Exner bodies.
Each clinical vignette provides pathognomonic clues for a specific gynecologic malignancy. Endometrial adenocarcinoma is the most common gynecologic cancer and is primarily driven by unopposed estrogen. Epithelial ovarian carcinoma is notorious for vague symptoms and CA-125 elevation. Yolk sac tumors are germ cell tumors characterized by AFP secretion and Schiller-Duval bodies. Choriocarcinomas are highly malignant gestational tumors secreting beta-hCG and frequently metastasizing to the lungs. Granulosa cell tumors are sex cord-stromal tumors secreting estrogen and inhibin, characterized pathologically by Call-Exner bodies.

Step-by-Step Solution

1
Analyze the clinical presentation of postmenopausal bleeding associated with obesity and nulliparity.
This clinical picture describes unopposed estrogen exposure leading to endometrial adenocarcinoma.
Obesity increases peripheral conversion of androgens to estrogens, leading to endometrial hyperplasia and eventually carcinoma.
2
Evaluate the patient with abdominal bloating, ascites, and elevated CA-125.
These symptoms and tumor marker point to epithelial ovarian carcinoma.
Epithelial ovarian cancers typically present late with widespread peritoneal seeding, ascites, and CA-125 production.
3
Identify the adnexal mass in an adolescent with Schiller-Duval bodies and elevated AFP.
This histological and biomarker profile is pathognomonic for a yolk sac tumor.
Germ cell tumors affect younger patients, and yolk sac tumors specifically secrete alpha-fetoprotein and exhibit Schiller-Duval bodies.
4
Assess the presentation of hemoptysis and elevated beta-hCG after a molar pregnancy.
This highly suggests choriocarcinoma with pulmonary metastasis.
Choriocarcinoma is a malignancy of trophoblastic tissue that produces beta-hCG and has a strong propensity for early hematogenous spread to the lungs.
5
Review the histology of Call-Exner bodies alongside elevated serum inhibin in a postmenopausal female.
These findings are characteristic of a granulosa cell tumor.
Granulosa cell tumors are ovarian sex cord-stromal tumors that classically secrete inhibin and estrogen, which can secondarily cause postmenopausal bleeding.

Key Concept

Clinical presentation, tumor markers, and characteristic histology of common gynecologic malignancies.
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Topics

Gynecologic Oncology

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