Ovarian Tumors (Benign, Malignant, Classification) MCQs

Obstetrics & Gynaecology · 184 free questions with answers & explanations.

A 22-year-old woman presents with progressive pelvic pain. Transvaginal ultrasound shows a 6 cm complex right ovarian cyst with areas of echogenic material and acoustic shadowing, consistent with a dermoid cyst. Serum CA-125 is mildly elevated at 48 U/mL. Which of the following is the MOST appropriate management?
A 55-year-old postmenopausal woman presents with abdominal distension and weight loss for 3 months. Examination reveals a hard, fixed pelvic mass with ascites. CT scan confirms bilateral adnexal masses with omental caking and peritoneal deposits. Serum CA-125 is 1200 U/mL. What is the MOST common histological type of ovarian malignancy in this age group?
An 18-year-old girl presents with rapidly enlarging abdominal mass and markedly elevated serum AFP (2500 ng/mL) and LDH. CT scan shows a large heterogeneous right ovarian mass. Which germ cell tumor is MOST likely and what is its characteristic histological feature?
A 45-year-old woman is diagnosed with FIGO Stage IC epithelial ovarian cancer (serous type) after total abdominal hysterectomy, bilateral salpingo-oophorectomy, and omentectomy. Which of the following is the STANDARD adjuvant treatment?
Which ovarian tumor is associated with Meigs syndrome and what is the CORRECT triad?
A 22-year-old woman undergoes laparotomy for a right ovarian mass. The histology shows a tumor composed of cells resembling primitive germ cells with large nuclei and vesicular chromatin arranged in lobules separated by fibrous septa infiltrated by lymphocytes. What is the MOST likely diagnosis and its cell of origin?
A 55-year-old postmenopausal woman has a right ovarian mass with CA-125 of 890 U/mL. Intraoperative frozen section confirms high-grade serous carcinoma. Surgical staging reveals right ovarian involvement with a 2 cm implant on the sigmoid colon serosa and positive cytology of peritoneal washings but no distant spread. What is her FIGO 2014 stage?
Which ovarian tumor is associated with Meigs syndrome and hyperestrogenism in postmenopausal women, and what is Meigs syndrome?
A 45-year-old woman is found to have an ovarian cyst of 6 cm with a smooth wall, no septae, and no solid component on ultrasound. CA-125 is 28 U/mL. RMI (Risk of Malignancy Index) is calculated as 36. Which of the following is the MOST appropriate management?
A 62-year-old postmenopausal woman undergoes staging laparotomy for epithelial ovarian cancer. Histology reveals malignant cells in the right ovary, bilateral diaphragm, and liver surface, but no parenchymal liver involvement. What is the FIGO stage?
The most common site of BRCA1/2-associated hereditary ovarian cancer has recently been shown by fimbrioscopy and pathological studies to originate primarily from:
A 25-year-old woman has a 10 cm complex ovarian mass. Serum AFP = 890 ng/mL, LDH elevated, beta-hCG normal. Which histological type does this tumor pattern MOST suggest, and what is the characteristic gross finding?
In the Risk of Malignancy Index (RMI), which combination of sonographic features, menopausal status, and CA-125 identifies an RMI above 200 as high risk for malignancy?
PARP inhibitors (olaparib, niraparib) are used as maintenance therapy in ovarian cancer primarily because they exploit which cellular vulnerability in BRCA-mutated tumors?
A 55-year-old postmenopausal woman undergoes salpingo-oophorectomy for a 12-cm complex ovarian mass. Histology reveals a borderline serous tumour with micropapillary architecture and no stromal invasion. Which prognostic feature in this tumour confers a higher risk of recurrence and worse outcome?
A 22-year-old woman presents with a 6-week history of rapidly enlarging abdomen, weight loss, and elevated AFP (620 ng/mL) and hCG (1800 mIU/mL). Pelvic ultrasound shows a 15-cm solid right ovarian mass with areas of necrosis. After staging, she receives BEP chemotherapy. Which histological component of her mixed germ cell tumour specifically produces AFP, guiding response monitoring?
According to the WHO 2020 classification of ovarian epithelial tumours, which molecular alteration specifically characterises the development pathway of high-grade serous carcinoma (HGSC) of the ovary, distinguishing it from low-grade serous carcinoma (LGSC)?
A 68-year-old presents with bilateral solid-cystic ovarian masses (8 cm each) and a pelvic mass. Serum CA-125 is 2,400 U/mL and CEA is 58 ng/mL. Histology shows signet-ring cells infiltrating a cellular fibrous stroma. Which is the correct diagnosis and its most likely primary site?
In FIGO 2014 staging of ovarian carcinoma, which change from prior FIGO staging is most clinically significant for Stage I disease?
A 55-year-old woman undergoes surgery for a pelvic mass. Histology shows an ovarian carcinoma with characteristic psammoma bodies, slit-like spaces, and papillary architecture with solid nests. The molecular signature most likely involves:
Regarding the FIGO 2014 staging of ovarian cancer, which of the following correctly distinguishes Stage IC1 from IC2?
A 28-year-old woman with dysgerminoma of the right ovary, FIGO Stage IA, desires future fertility. What is the most appropriate management?
Which ovarian tumour is characterised by the histological presence of Call-Exner bodies and produces oestrogen leading to endometrial hyperplasia?
BRCA1 mutation carriers have the greatest lifetime risk of which ovarian/fallopian tube cancer histotype, and at what approximate lifetime cumulative risk?
A 55-year-old woman with stage IIIC epithelial ovarian cancer (serous high-grade) undergoes optimal cytoreductive surgery followed by carboplatin and paclitaxel chemotherapy. She achieves complete remission. Genetic testing reveals BRCA1 germline mutation. Which maintenance therapy, supported by the SOLO-1 trial, is most appropriate to significantly reduce recurrence?
A 22-year-old woman presents with acute abdomen and a 10 cm right-sided cystic ovarian mass. At surgery, the mass is a mature cystic teratoma (dermoid cyst) with ovarian torsion. Spillage of sebaceous material into the peritoneal cavity occurred during decompression. Which specific complication may result from this spillage?
CA-125 levels are measured in a 58-year-old postmenopausal woman with a pelvic mass. The RMI (Risk of Malignancy Index) is calculated. Which formula is used to calculate RMI-I?
A 40-year-old woman has bilateral ovarian masses, ascites, and elevated CA-125 of 2800 U/mL. Staging laparotomy reveals high-grade serous ovarian cancer FIGO stage IIIC with >1 cm residual disease after surgery. Which molecular alteration is most commonly found in high-grade serous ovarian carcinoma (HGSOC)?
A 25-year-old woman is found to have a 6 cm unilateral ovarian mass containing cells with Call-Exner bodies on histology. AFP is normal, LDH is normal, but estradiol is elevated at 400 pg/mL. She has menstrual irregularity and endometrial hyperplasia. What is the diagnosis, and what is the associated FOXL2 mutation?
A 55-year-old postmenopausal woman undergoes surgery for a 12 cm ovarian mass with bilateral involvement, ascites, and peritoneal deposits in the omentum. Final histopathology shows high-grade serous carcinoma of ovary. BRCA mutation testing is planned. According to FIGO 2014 staging, the stage is IIIC. What is the current first-line chemotherapy regimen according to ICON7/GOG 218 trials?
A 28-year-old woman has an elevated serum AFP (2400 IU/mL) and normal beta-hCG. CA-125 is mildly elevated at 65 U/mL. Pelvic ultrasound shows a 9 cm complex predominantly solid right ovarian mass. The most likely diagnosis and appropriate surgical approach are:
In the Risk of Malignancy Index (RMI) calculation for ovarian cysts, which combination of score components is used?
Pseudomyxoma peritonei most commonly arises from which primary site and what is its characteristic macroscopic finding?
The BRCA1/2 risk-reduction salpingo-oophorectomy (RRSO) is recommended at a specific age to balance cancer prevention with surgical menopause effects. For BRCA1 mutation carriers, RRSO is recommended between:
A 60-year-old postmenopausal woman is found to have a pelvic mass. CA-125 is 280 U/mL and HE4 (Human Epididymis Protein 4) is markedly elevated. The ROMA (Risk of Ovarian Malignancy Algorithm) score is calculated using CA-125, HE4, and:
A young woman undergoes surgery for a right ovarian germ cell tumor found to be dysgerminoma, Stage IA. Histopathology shows pure dysgerminoma with no lymphovascular invasion. The most appropriate adjuvant management is:
Granulosa cell tumors of the ovary (adult type) are characterized by Call-Exner bodies histologically and secrete which hormone leading to its associated endometrial pathology?
In the ICON7 trial, bevacizumab (anti-VEGF monoclonal antibody) was added to carboplatin-paclitaxel in ovarian cancer. The subgroup that showed the greatest overall survival benefit was:
A 55-year-old woman has a complex adnexal mass with CA-125 of 320 U/mL. The IOTA (International Ovarian Tumor Analysis) 'simple rules' classify a mass as likely malignant if there are features of malignancy (M-features) WITHOUT features of benignity (B-features). Which of the following is an M-feature in the IOTA simple rules?
BRCA1-associated ovarian carcinoma compared to sporadic high-grade serous ovarian carcinoma is characterized by:
A 22-year-old woman has a right ovarian mass. Tumor markers show AFP 850 ng/mL, LDH elevated, beta-hCG normal. The most likely diagnosis is:
Sex cord-stromal ovarian tumors can cause endocrine manifestations. Which tumor is MOST specifically associated with inhibin B as a serum tumor marker?
Regarding ovarian borderline tumors (tumors of low malignant potential), which statement is MOST accurate?
A 55-year-old postmenopausal woman is found to have a 12 cm complex ovarian mass with solid components, bilateral involvement, and ascites. CA-125 is 480 U/mL. According to the IOTA (International Ovarian Tumour Analysis) classification system, which ultrasound feature most strongly predicts malignancy?
A 28-year-old woman with a unilateral 8 cm ovarian mass undergoes laparotomy. Intraoperative frozen section shows a borderline serous tumor (serous borderline ovarian tumor, SBOT). The pathologist reports micropapillary variant. What is the clinical significance of this variant over classic SBOT?
A 62-year-old woman with Stage IIIC high-grade serous ovarian carcinoma (HGSOC) completes 6 cycles of carboplatin-paclitaxel with complete clinical response. BRCA1/2 germline testing returns positive (BRCA1 mutation). According to current ESMO/ASCO guidelines, the most appropriate maintenance strategy is:
A 19-year-old woman undergoes right salpingo-oophorectomy for a 10 cm right ovarian mass. Pathology reports an immature teratoma Grade 2. Which additional histological feature, if present, would upstage her prognosis to more aggressive behavior and mandate adjuvant chemotherapy?
A postmenopausal woman presents with pelvic mass, ascites, and elevated CA-125 of 320 U/mL. Risk of Malignancy Index (RMI) is calculated. Which formula correctly computes the RMI-1?
A 55-year-old postmenopausal woman is found on ultrasound to have a 9 cm right ovarian cyst with internal septations, papillary projections, and ascites. CA-125 is 380 U/mL. IOTA (International Ovarian Tumour Analysis) ADNEX model predicts 94% malignancy risk. At staging laparotomy, cytology is positive, disease is confined to both ovaries with pelvic peritoneal deposits only. According to FIGO 2014 staging, she is staged as IIIA1(i). What is the key distinction between IIIA1(i) and IIIA1(ii)?
A young woman with a 12 cm ovarian mass has serum AFP of 1800 ng/mL, β-hCG normal, LDH elevated. Histology shows a tumour with Schiller-Duval bodies. Which specific chemotherapy regimen is considered standard first-line treatment for this tumour following fertility-sparing surgery?
In the context of hereditary ovarian cancer risk reduction, the BRCA1 mutation confers a lifetime risk of ovarian cancer of approximately 44% versus 17% for BRCA2. PARP (poly-ADP ribose polymerase) inhibitor maintenance therapy exploits which cellular mechanism in BRCA-mutated tumours?
A 70-year-old woman with Stage IIIC high-grade serous ovarian carcinoma (HGSOC) undergoes primary debulking surgery with residual disease <1 cm. She is initiated on carboplatin/paclitaxel plus bevacizumab. The GOG-0218 and ICON7 trials investigated bevacizumab in this setting. Bevacizumab works by targeting which molecule?
A 40-year-old woman is found to have a 5 cm right ovarian mass with features of a granulosa cell tumour. She presents with menorrhagia. Which serum tumour marker is most specific for adult-type granulosa cell tumour and is used to monitor treatment response and detect recurrence?
A 55-year-old woman undergoes surgery for an ovarian mass with a final histology showing a low-grade serous carcinoma (LGSC). Compared to high-grade serous carcinoma (HGSC), which molecular pathway is characteristically altered in LGSC?
A 35-year-old with a 10 cm left ovarian cyst undergoes laparoscopy. Frozen section shows a serous borderline tumour (SBT) with microinvasion (<5 mm). What is the most appropriate next step in management?
A 62-year-old woman with stage IIIC high-grade serous ovarian carcinoma achieves complete cytoreduction followed by carboplatin-paclitaxel chemotherapy plus bevacizumab. She is found to be BRCA1-mutated. According to SOLO-1 trial data, which maintenance therapy offers the greatest reduction in disease progression at 3 years?
A 22-year-old with a right ovarian mass undergoes surgery. Histology reveals a dysgerminoma with syncytiotrophoblastic giant cells. Serum markers include elevated LDH and mildly elevated β-hCG (200 mIU/mL) with normal AFP. The presence of syncytiotrophoblastic cells in dysgerminoma has which specific implication?
The ICON8 trial evaluated the benefit of dose-dense weekly paclitaxel versus 3-weekly paclitaxel combined with carboplatin in newly diagnosed ovarian cancer. Which conclusion did ICON8 reach, contrasting with the results of the Japanese JGOG-3016 trial?
A 65-year-old woman presents with abdominal distension and a pelvic mass. CA-125 is 820 U/mL. She undergoes staging laparotomy, and the tumor is found to involve both ovaries, with implants on the bladder serosa and positive peritoneal cytology. No distant metastases. According to FIGO 2014 staging of ovarian cancer, what is her correct stage?
In the management of apparent early-stage (Stage IC–IIA) high-grade serous ovarian cancer, which adjuvant chemotherapy regimen is currently recommended as standard of care and what is the basis for the number of cycles?
A 45-year-old woman undergoes salpingo-oophorectomy for a 12 cm ovarian mass. Histology shows a mucinous tumor with nuclear stratification up to 3 layers, mild architectural atypia, but no stromal invasion. Which WHO classification category does this belong to, and what is the appropriate management?
A BRCA1-positive woman with advanced high-grade serous ovarian cancer achieves complete clinical response after 6 cycles of carboplatin/paclitaxel. She is started on maintenance therapy. Which mechanism best explains the synthetic lethality exploited by PARP inhibitors in BRCA-mutated cancers?
A 62-year-old woman undergoes laparotomy for a right ovarian mass. Histology shows a papillary serous cystadenoma with nuclear atypia and 1 mitosis per 10 HPF but without stromal invasion. What is the WHO 2020 classification of this tumour and its typical clinical behaviour?
Germline BRCA1/2 testing is recommended in women with ovarian cancer. Which histological subtype of epithelial ovarian carcinoma has the HIGHEST frequency of BRCA1/2 germline mutations?
The ICON7 trial evaluated the addition of bevacizumab to standard chemotherapy in ovarian cancer. In which subgroup of patients did bevacizumab maintenance provide the greatest progression-free survival benefit?
A 28-year-old presents with an ovarian mass showing calcifications on ultrasound. Histopathology reveals nests of cells with central keratinization (Rosenthal fibres absent), inter-cellular bridges, and areas of squamous differentiation. Serum AFP is normal, βhCG is normal. What is the most likely diagnosis?
A 55-year-old postmenopausal woman has a right ovarian mass with a CA-125 of 620 U/mL, solid-cystic morphology on ultrasound, and bilateral involvement. Her Risk of Malignancy Index (RMI) is calculated. Which RMI threshold, according to RCOG/NHS guidelines, warrants referral to a gynaecological oncology centre?
A 22-year-old woman with a solid ovarian mass and elevated AFP and beta-hCG undergoes surgery revealing a mixed germ cell tumour. Histology shows components of endodermal sinus tumour (yolk sac tumour) and choriocarcinoma. Which serum marker correlates BEST with the yolk sac tumour component and guides chemotherapy response?
A 45-year-old woman undergoes surgery for advanced ovarian cancer (Stage IIIC). Her surgeon achieves optimal cytoreduction with residual disease <1 cm. According to FIGO staging and current oncology practice, which combination of chemotherapy best demonstrates benefit in the ICON7 and GOG-0218 trials?
Pseudomyxoma peritonei most commonly arises from which primary site?
A 55-year-old postmenopausal woman with bilateral ovarian masses, CA-125 of 480 U/mL, and omental caking on CT undergoes staging. Intraoperatively, disease is found on the pelvic peritoneum, retroperitoneal nodes, and the right hemidiaphragm with a 2.5 cm deposit. The FIGO 2014 stage is:
The BRCA1 and BRCA2 mutations most commonly predispose to which histological subtype of ovarian cancer, and what is the lifetime risk of ovarian cancer in BRCA1 mutation carriers?
Granulosa cell tumour of the ovary belongs to which WHO classification category and characteristically secretes which hormone responsible for its feminizing effects?
In the ICON7 trial studying the addition of bevacizumab to standard carboplatin-paclitaxel chemotherapy for ovarian cancer, bevacizumab showed significant improvement in progression-free survival only in which subgroup?
A 55-year-old postmenopausal woman has a 9 cm right ovarian complex cyst with solid components, bilateral involvement, ascites, and CA-125 of 680 U/mL. Surgery reveals a papillary serous adenocarcinoma with omental cake but no extra-abdominal spread. Histology confirms high-grade serous carcinoma. What is the FIGO 2014 staging?
A 22-year-old woman has a 7 cm right ovarian mass with elevated serum AFP (1200 ng/mL) and normal beta-hCG. Histology shows a solid tumor with Schiller-Duval bodies. What is the most appropriate chemotherapy regimen for this tumor?
A woman has bilateral ovarian tumors with fibrotic, white surface nodules, ascites, and pleural effusion. Histology shows small nests of signet ring cells in a fibrotic stroma. This is most consistent with:
BRCA1/2 mutation carriers who have completed their families are counseled regarding risk-reducing salpingo-oophorectomy (RRSO). Which statement about RRSO timing is MOST accurate for BRCA1 mutation carriers?
A 55-year-old postmenopausal woman has a pelvic mass with CA-125 = 890 U/mL. The ROMA (Risk of Ovarian Malignancy Algorithm) score incorporates CA-125 and which other biomarker to calculate risk, and what threshold defines high risk in postmenopausal women?
A 28-year-old woman undergoes unilateral salpingo-oophorectomy for a 12 cm ovarian tumor. Histology shows a teratoma containing thyroid tissue that is the predominant component and shows all microscopic features of a well-differentiated follicular carcinoma. This is BEST classified as:
According to the 2014 FIGO staging for ovarian cancer, a patient is found to have bilateral ovarian serous carcinoma with tumor on the external surface of one ovary, positive cytology in peritoneal washings but no macroscopic peritoneal deposits, and negative retroperitoneal nodes. What is the correct FIGO stage?
A 45-year-old woman with epithelial ovarian cancer (high-grade serous, Stage IIIC) undergoes optimal debulking surgery followed by carboplatin-paclitaxel. She carries a germline BRCA2 mutation. Which targeted maintenance therapy has shown GREATEST improvement in progression-free survival in this clinical scenario?
A granulosa cell tumor secreting estrogen is resected from the left ovary of a 50-year-old woman. Histology shows coffee bean nuclei with nuclear grooves in a microfollicular pattern. This tumor belongs to which WHO classification category, and what is its classic marker?
A 55-year-old postmenopausal woman has a 10 cm right ovarian mass with solid components, septations, and ascites on ultrasound. CA-125 is 680 U/mL. At laparotomy, peritoneal implants are found on the omentum and diaphragm. The most common histological subtype of epithelial ovarian cancer in this scenario is:
A 22-year-old presents with acute lower abdominal pain, nausea, and vomiting. Ultrasound shows a 7 cm right ovarian cyst with absent blood flow on Doppler. At laparoscopy, the ovary is found to be dusky blue-black with a twisted pedicle. The most common type of ovarian cyst that undergoes torsion is:
A 14-year-old girl has a large pelvic mass, serum AFP 1800 ng/mL, and β-hCG within normal limits. CT shows a right ovarian mass with no metastases. Which ovarian germ cell tumor is most likely and what is the primary treatment?
A 45-year-old has a right ovarian tumor. Histopathology shows a tumor of low malignant potential (borderline) of serous type with desmoplastic implants on the peritoneum. These implants are best classified as:
A 60-year-old presents with bilateral ovarian masses, ascites, and a normal CA-125 but elevated CEA and CA 19-9. Endoscopy reveals a gastric antral adenocarcinoma. The ovarian masses are most likely:
A 55-year-old post-menopausal woman has a unilateral solid-cystic ovarian mass 8 cm, serum CA-125 of 420 U/mL, and ascites on CT. CT shows no extra-ovarian disease. At surgery the capsule is found intact, no ascites, and final histology confirms high-grade serous carcinoma confined to one ovary with no surface involvement. FIGO 2023 staging is:
A 22-year-old woman has a unilateral 6 cm ovarian mass. Serum AFP is markedly elevated; serum hCG and LDH are normal. The MOST likely histological diagnosis is:
BRCA1/2 mutation carriers undergoing risk-reducing salpingo-oophorectomy (RRSO): which pathological finding on the 'SEE-FIM' protocol is considered the precursor lesion for high-grade serous carcinoma?
A 45-year-old woman with Stage IIIC high-grade serous ovarian carcinoma undergoes optimal primary cytoreductive surgery (residual disease < 1 cm). According to ICON7/GOG-0218 trial data, the addition of bevacizumab to carboplatin-paclitaxel chemotherapy provides the greatest PFS benefit in which subgroup?
According to FIGO 2023 staging of ovarian cancer, a patient has bilateral ovarian tumors with capsule rupture during surgery. Peritoneal washings are negative for malignant cells. What is the correct FIGO stage?
A 45-year-old woman has a right ovarian cyst with a CA-125 of 420 U/mL, a solid component on ultrasound, and elevated LDH. Which serum marker is MOST specific for dysgerminoma among the following?
In the ICON7 trial evaluating bevacizumab in ovarian cancer, in which patient subgroup was the GREATEST overall survival benefit demonstrated?
Brenner tumor of the ovary is histologically characterised by nests of epithelial cells resembling which tissue type embedded in dense fibrous stroma?
A 28-year-old woman with a 7 cm right adnexal mass has serum AFP of 1800 ng/mL and β-hCG of 120 IU/L. CA-125 is normal. Intraoperatively, the tumor is unilateral with a yellow-grey cut surface and areas of hemorrhage. Which is the MOST likely diagnosis?
A 55-year-old postmenopausal woman presents with abdominal distension and early satiety. CA-125 is 620 U/mL. CT scan shows bilateral solid-cystic adnexal masses with omental cake, ascites, and peritoneal deposits. Optimal cytoreduction is performed, leaving <1 cm residual disease. According to FIGO 2014 staging, which stage applies?
A 22-year-old presents with a rapidly growing right adnexal mass. Serum AFP is markedly elevated; beta-hCG and LDH are normal. On laparotomy, the mass is confined to the right ovary, capsule intact, no peritoneal involvement. Histology shows primitive glandular structures with Schiller-Duval bodies. FIGO stage is IA. Standard postoperative chemotherapy is:
The Risk of Malignancy Index (RMI) combines ultrasound score (U), menopausal status (M), and CA-125. An ultrasound shows a multilocular cyst with solid areas bilaterally, with ascites and metastases (U=3, M=3 for postmenopausal, CA-125=180). RMI = U × M × CA-125. The calculated RMI and appropriate management are:
A 45-year-old woman has a 12 cm left ovarian mass with a smooth wall, serous fluid, and no internal septations on ultrasound. CA-125 is 18 U/mL. Her sister had ovarian cancer at age 50. BRCA testing reveals BRCA1 mutation. Which best describes the recommended management?
A 55-year-old woman is diagnosed with epithelial ovarian cancer with macroscopic peritoneal implants measuring 1.8 cm outside the pelvis and no lymph node metastases. According to FIGO 2014 staging, this is:
The SOLO-1 trial (2018) established maintenance therapy with olaparib in newly diagnosed advanced ovarian cancer. Which patient population was enrolled in SOLO-1?
Sertoli-Leydig cell tumour (arrhenoblastoma) of the ovary most commonly belongs to which WHO classification category?
A 25-year-old woman has a 12 cm ovarian mass with elevated AFP 2500 IU/mL and LDH raised. MRI shows a heterogeneous solid-cystic mass. The most likely diagnosis is:
Mucinous ovarian tumours of intestinal type are most important to distinguish from metastatic colorectal carcinoma. Which immunohistochemical marker combination best identifies a primary ovarian mucinous tumour versus Krukenberg tumour?
A 55-year-old post-menopausal woman is found to have a stage IIIC epithelial ovarian carcinoma at staging laparotomy — bilateral ovarian masses with omental cake and peritoneal deposits ≤2 cm after optimal cytoreduction. According to FIGO 2014 staging, what distinguishes stage IIIC from IIIB in epithelial ovarian cancer?
A 22-year-old woman has a right ovarian solid-cystic mass. Serum AFP is 1,200 ng/mL and beta-hCG is 4 mIU/mL. Histology shows immature teratoma with endodermal sinus tumour elements. Which tumour marker best monitors response to BEP chemotherapy in this patient?
A fibroma of the ovary weighing 700 g is found in a 52-year-old woman with right pleural effusion and ascites. The effusion resolves after oophorectomy. This condition is known as:
In the ICON7 trial for ovarian cancer, bevacizumab was added to standard carboplatin-paclitaxel chemotherapy. What was the primary finding regarding bevacizumab's benefit?
A 35-year-old woman with a granulosa cell tumour (GCT) of the ovary undergoes fertility-sparing surgery. Which hormonal marker is MOST useful for long-term surveillance for recurrence of adult GCT?
A 55-year-old postmenopausal woman undergoes staging laparotomy for ovarian cancer. Histology shows serous carcinoma of the left ovary. The tumor is confined to the left ovary only, with capsule intact, no surface tumour, negative peritoneal washings. FIGO 2014 stage is:
A 22-year-old woman undergoes right salpingo-oophorectomy for a 12 cm ovarian mass. Histology reveals a dysgerminoma confined to the right ovary with intact capsule (FIGO Stage IA). She strongly desires future fertility. What is the recommended adjuvant treatment?
Serum CA-125 is LEAST useful as a primary diagnostic marker for which of the following ovarian tumour subtypes?
A 45-year-old woman presents with a complex left adnexal mass, ascites, and CA-125 of 380 U/mL. CT scan shows bilateral adnexal masses with peritoneal studding and omental cake. Which FIGO 2014 stage best fits this presentation?
A Brenner tumour of the ovary is histologically characterised by nests of transitional-type epithelium embedded in a dense fibrous stroma. Which tumour marker, if any, is classically associated with malignant Brenner tumour?
A 55-year-old postmenopausal woman is found to have a 9 cm right ovarian mass with solid components, papillary projections, and CA-125 of 280 U/mL. Imaging shows bilateral ovarian involvement and ascites but no evidence of spread beyond pelvis. According to FIGO 2014 staging, what stage is this?
Which ovarian germ cell tumour is associated with elevated serum AFP, contains Schiller-Duval bodies on histology, and has the WORST prognosis among pure germ cell tumours?
In the ICON7 trial evaluating bevacizumab in advanced ovarian cancer (Stage III–IV), bevacizumab was added to carboplatin-paclitaxel and continued as maintenance. The trial demonstrated the greatest benefit in which subgroup?
A 45-year-old woman undergoes surgery for a 12 cm right ovarian tumour. Intraoperatively, the tumour appears multiloculated with papillary projections. Frozen section shows serous borderline tumour (low malignant potential). She has completed her family. The most appropriate surgical management is:
A 55-year-old post-menopausal woman is staged surgically for ovarian cancer. Histology confirms high-grade serous carcinoma. Intraoperative findings: bilateral ovarian involvement, omental cake, no extraperitoneal spread, with ascites cytology positive. According to FIGO 2014 staging, this is:
Which of the following ovarian tumors is MOST strongly associated with Meigs syndrome (triad of ovarian tumor, ascites, and hydrothorax)?
A 19-year-old woman undergoes laparotomy for a solid ovarian mass. Histology shows sheets of large cells with clear cytoplasm, central nuclei, and intervening lymphocytic stroma. Serum LDH is markedly elevated. What is the most likely diagnosis and its serum marker?
A borderline serous ovarian tumor (serous borderline tumor of low malignant potential) is resected in a 28-year-old wishing to preserve fertility. Which feature, if found in the specimen, would MOST increase the risk of relapse and potentially indicate the need for staging surgery?
According to the FIGO 2014 staging system for ovarian cancer, a tumour limited to one ovary with positive peritoneal washings is staged as:
A 55-year-old post-menopausal woman presents with a 10 cm right ovarian mass, omental caking on CT, and CA-125 of 650 U/mL. Intraoperative finding shows contiguous spread to the sigmoid colon requiring resection. According to FIGO 2014, this is staged as:
Which immunohistochemical marker distinguishes primary peritoneal carcinoma from serosal mesothelioma on biopsy in a woman with diffuse peritoneal disease?
A 19-year-old presents with a 14 cm right ovarian mass and elevated AFP 420 ng/mL, normal beta-hCG. The most likely histological diagnosis is:
BRCA1/2 mutation carriers undergoing risk-reducing salpingo-oophorectomy (RRSO) should preferably have the procedure performed by which age to optimally reduce ovarian cancer risk?
A 55-year-old postmenopausal woman has a right ovarian mass. CA-125 is 420 U/mL. Imaging shows ascites and omental caking. After staging laparotomy, disease is found in both ovaries, the omentum, and liver surface implants but not the liver parenchyma. According to FIGO 2014 staging, she is:
Granulosa cell tumor of the ovary characteristically secretes which hormone responsible for its feminizing effects and the associated endometrial pathology?
Which ovarian tumor is associated with pseudo-Meigs syndrome and elevated CA-125, and is derived from ovarian surface epithelium with benign histology?
A 30-year-old woman has a right ovarian cyst with ultrasound features of dermoid (echogenic focus, posterior shadowing). CA-125 is normal. At laparoscopy, the contralateral ovary appears normal. The most appropriate surgical management is:
According to FIGO 2014 staging for ovarian cancer, a patient has disease involving both ovaries with capsule intact, no tumor on surface, negative washings, and unilateral pelvic implants on the pelvic peritoneum. What is her stage?
A 45-year-old woman undergoes left oophorectomy for a 10 cm ovarian mass. Histology shows uniform spindle cells in a storiform pattern with mild atypia, mitoses 5/10 HPF, and foci of myxoid change. Which ovarian tumor does this BEST describe?
Which ovarian tumor is associated with Sertoli-Leydig cell tumor and produces virilizing symptoms most characteristically in women under 30 years?
The ICON7 trial evaluated bevacizumab in ovarian cancer. What was the key finding regarding its benefit?
BRCA1-associated ovarian cancer has which characteristic histological type and site of origin?
Meigs' syndrome consists of which classic triad?
A 55-year-old postmenopausal woman undergoes staging laparotomy for a serous ovarian carcinoma. Histology shows tumour involving the left ovary only, with capsule intact, no ascites, and negative peritoneal washings. According to FIGO 2014 staging, her stage is:
Regarding borderline ovarian tumours (BOT), which statement is MOST accurate?
A 70-year-old woman presents with abdominal distension and postmenopausal bleeding. CA-125 is 890 U/mL. CT shows bilateral ovarian masses with omental caking. Ascites is drained and cytology confirms adenocarcinoma. The most appropriate initial chemotherapy regimen for advanced high-grade serous ovarian cancer is:
Which mutation is most strongly associated with hereditary epithelial ovarian cancer and increases lifetime risk to approximately 40–60%?
A 24-year-old woman is found to have a 12 cm left ovarian mass. Serum AFP is markedly elevated at 890 ng/mL; beta-hCG and LDH are normal. Histology reveals a yolk sac tumour. The most appropriate management is:
A 58-year-old postmenopausal woman has a complex ovarian mass. CA-125 is 320 U/mL. CT shows omental caking and ascites. FIGO staging is performed and she is found to have bilateral ovarian involvement with omental metastases but no peritoneal implants beyond the pelvis. Her FIGO stage is:
A 25-year-old woman has a unilateral 8 cm ovarian tumor. Intraoperatively, the tumor appears solid-cystic with areas of calcification. Histology shows Schiller-Duval bodies. The MOST appropriate tumor marker to monitor in follow-up is:
Which ovarian tumor is characterized histologically by Call-Exner bodies and is associated with estrogenic manifestations including endometrial hyperplasia?
A woman with stage IA, grade 1 ovarian epithelial carcinoma (serous histotype) undergoes complete surgical staging with total abdominal hysterectomy and bilateral salpingo-oophorectomy. Post-operative management should be:
A 35-year-old woman has bilateral ovarian masses. Histology shows epithelial proliferation with nuclear atypia but no destructive stromal invasion. The diagnosis is:
In a woman with suspected epithelial ovarian carcinoma, the IOTA (International Ovarian Tumour Analysis) simple rules classify an adnexal lesion as malignant if which of the following benign features is absent and malignant features are present?
A 62-year-old woman undergoes staging laparotomy for ovarian carcinoma. Intraoperative findings: bilateral ovarian masses with surface excrescences, peritoneal deposits in the pelvis only, and omental biopsy negative for tumour. According to FIGO 2014 staging, what stage is this?
A 25-year-old woman has a left ovarian cyst on ultrasound with the following features: unilocular, thin-walled, no internal echoes, no septae, no papillary projections, 6 cm diameter. CA-125 is 18 U/mL. What is the most appropriate management?
Meigs syndrome classically consists of which triad?
Which ovarian surface epithelial tumour type most commonly presents as a bilateral ovarian mass and is associated with pseudomyxoma peritonei?
A 16-year-old presents with a 12 cm right ovarian mass. Tumour markers: AFP 2200 ng/mL, beta-hCG 5 IU/L, LDH mildly elevated. What is the most likely diagnosis?
A 60-year-old postmenopausal woman undergoes surgery for a 10 cm ovarian mass. Histology shows bilateral serous adenocarcinoma confined to both ovaries with capsule intact and no surface involvement, negative washings. According to FIGO 2014 staging, the stage is:
Which ovarian tumour is characterised by 'Call-Exner bodies' on histology and commonly presents with features of oestrogen excess such as endometrial hyperplasia?
A 22-year-old woman has a unilateral solid ovarian mass. Serum AFP is markedly elevated. Which tumour should be MOST suspected?
Pseudo-Meigs' syndrome (elevated CA-125, ascites, and pleural effusion) can occur with which ovarian tumour?
A 55-year-old woman is diagnosed with advanced high-grade serous ovarian carcinoma (HGSOC). She is found to carry a germline BRCA1 mutation. Which maintenance therapy is MOST appropriate after platinum–taxane chemotherapy, based on current guidelines?
A 45-year-old woman has a unilateral 8 cm complex ovarian cyst with papillary projections, thick septations, and CA-125 of 420 U/mL. Intraoperative frozen section shows borderline serous tumour. The MOST appropriate surgical management is:
A 16-year-old presents with acute abdomen. Ultrasound shows a 7 cm right ovarian mass with areas of calcification and fat density. Serum AFP and β-hCG are normal; LDH is mildly elevated. The MOST likely diagnosis is:
Meigs syndrome is CLASSICALLY associated with which ovarian tumour?
According to FIGO 2014 staging for ovarian cancer, Stage IC2 is defined as:
A 55-year-old woman treated for Stage IIIC high-grade serous ovarian carcinoma with optimal debulking and paclitaxel-carboplatin achieves complete clinical remission. CA-125 normalises. Which maintenance therapy has the strongest evidence to improve progression-free survival in BRCA1/2-mutated patients?
According to FIGO 2014 staging, a patient with ovarian carcinoma where tumor cells are found in the peritoneal washings but there is no macroscopic peritoneal disease and the tumor is confined to one ovary with intact capsule is classified as:
A 24-year-old woman has a 10 cm right ovarian cyst with elevated serum AFP (450 ng/mL) and normal CA-125 and LDH. The MOST LIKELY diagnosis is:
Which ovarian germ cell tumor secretes BOTH alpha-fetoprotein AND beta-hCG, and which is the most chemosensitive malignant germ cell tumor?
A 32-year-old woman with borderline serous ovarian tumor (Stage IA) desires future fertility. What is the appropriate surgical management?
Meigs syndrome consists of which triad?
A 55-year-old postmenopausal woman has a solid-cystic ovarian mass 10 cm in diameter with papillary projections and ascites. CA-125 is 480 U/mL. Intraoperatively, bilateral ovarian involvement is found with omental deposits but no spread beyond the peritoneal cavity. What is the FIGO 2014 stage?
Which ovarian germ cell tumour is characterised by the presence of Schiller-Duval bodies on histology and is associated with elevated serum AFP?
A 28-year-old woman presents with virilisation, clitoromegaly, and a solid unilateral ovarian mass 6 cm in size. Testosterone is markedly elevated. The most likely diagnosis is:
In the ICON7 trial evaluating bevacizumab in advanced ovarian cancer, the addition of bevacizumab to carboplatin-paclitaxel showed the greatest overall survival benefit in which subgroup?
BRCA1 mutation in ovarian cancer is associated with which histological subtype that demonstrates BRCA1/2-associated prognosis?
The SOLO-1 trial demonstrated the benefit of which PARP inhibitor as maintenance therapy in BRCA-mutated, newly diagnosed advanced ovarian cancer after first-line platinum-based chemotherapy?
PARP inhibitors (olaparib, niraparib, rucaparib) have transformed the maintenance therapy of advanced ovarian cancer. The mechanism of PARP inhibitor synthetic lethality in BRCA-mutated cells is:
A 68-year-old woman presents with Stage IIIC high-grade serous ovarian cancer. She undergoes upfront debulking surgery achieving complete cytoreduction (R0, no visible residual disease). CA-125 normalises after 3 cycles of carboplatin-paclitaxel. After completing 6 cycles, she is BRCA1 wild-type and HRD-negative. According to current evidence (SOLO1, PRIMA, PAOLA-1 trials), which maintenance strategy has Level 1 evidence for improving PFS in her specific molecular profile?
A 55-year-old woman with BRCA1 mutation is counselled regarding risk-reducing salpingo-oophorectomy (RRSO). Which additional cancer risk does RRSO most significantly reduce in BRCA1 carriers?
A 60-year-old woman undergoes cytoreductive surgery for high-grade serous ovarian carcinoma (Stage IIIC). She achieves R0 resection. She is BRCA2 mutated. What maintenance therapy has demonstrated the greatest improvement in progression-free survival in this setting?
An 18-year-old girl undergoes right oophorectomy for a 12 cm ovarian mass. Histology shows immature teratoma Grade 3. What is the recommended adjuvant management?
Granulosa cell tumors of the ovary secrete estrogen, which can cause which of the following endometrial changes in a premenopausal woman?
BRCA1 and BRCA2 mutations are associated with hereditary ovarian cancer. Which histological subtype of epithelial ovarian cancer is NOT typically associated with BRCA mutations?
The IOTA (International Ovarian Tumour Analysis) group's Simple Rules for adnexal mass characterisation include 'malignancy features' (M-features). Which of the following is a MALIGNANCY feature (M-feature) in IOTA Simple Rules?

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