3- Female Repro

Question 1

What is genital herpes

Answer 1

grouped vesicles on vulva or perineal skin that become pigmented after rupturing

Question 2

What is HPV

Answer 2

+/- Condyloma Accuminatum- venereal warts (cauliflower lesions) on vulva, vagina, or cervix
Asymptomatic (so underreported)

Question 3

What do the HPV serotypes represent

Answer 3

the higher the serotype, the higher the cancer risk
16&18= cervical cancer
6&11= benign condyloma

Question 4

What is Syphillis

Answer 4

vulvar lessons and chancers, cervicitis, or vaginal lesions

If left untreated can progress to secondary or tertiary

Question 5

What is chlamydia

Answer 5

non-specific inflammation of vulva and internal genital organs causing lower abdominal pain +/- fever and infertility

Question 6

What does chlamydia usually present with

Answer 6

dysuria and urethritis

Question 7

What is a bartholin gland cyst

Answer 7

obstruction of the bartholin gland (staph, strep, or chlamydia) causing an abscess
-Need I&D and abx

Question 8

What is Lichen sclerosis

Answer 8

white plaques and parchment consistency to vulvar skin usually in older women
-Hyperkeratosis (thick keratin layer)

Question 9

Is Lichen sclerosis malignant

Answer 9

No- but has a slight association with SCC

Question 10

What is a Dysgerminoma

Answer 10

counterpart to male Seminoma- childhood, aggressive, uncommon

Question 11

What is Endodermal sinus tumor

Answer 11

counterpart to Yolk Sac tumor of male testes- rich in AFP, rare, and rapid aggressive growth (kids and teens)

Question 12

What is a choriocarcinoma

Answer 12

highly malignant carcinoma made of trophoblastic cells arising from left over placenta (s/p abortion or birth) that produces hCG

Question 13

What does a choriocarcinoma look like

Answer 13

bulky, hemorrhagic nodules in placental bed invading veins and implanting in the vagina

Question 14

How does choriocarcinoma spread (mets)

Answer 14

#1- to lungs
Also liver and bones

Question 15

Is choriocarcinoma easy to treat

Answer 15

responds well to chemotherapy (methotrexate)

Question 16

What are RF for endometrial cancer

Answer 16

taking exogenous estrogen
Have an estrogen producing tumor
Obese/DM/HTN
Nulliparous, early menarche, late menopause

Question 17

What is an endometrial adenocarcinoma

Answer 17

most common malignant tumor, from epithelial cents lining endometrial glands
-Estrogen stimulates proliferation and causes malignant transformation

Question 18

How can you break the estrogen cycle

Answer 18

Getting pregnant- a progesterone dominant state

Question 19

Is taking exogenous estrogen when post-menopausal bad

Answer 19

Only has a small risk of carcinoma, but is good because it prevents bone loss

Question 20

What does an endometrial adenocarcinoma look like

Answer 20

fungiating mass protruding into uterine lining, friable and soft (little storm) causing bleeding

Question 21

What si the most important prognostic feature of endometrial cancer

Answer 21

Stage based on size and spread
stage 1- confined to endometrium
stage 4- infiltrates bladder, rectum, outside pelvis

Question 22

What are symptoms of endometrial cancer

Answer 22

vaginal bleeding/spotting between menses
menorrhagia
eventual metrorrhagia (massive bleed)

Question 23

Can you treat endometrial cancer?

Answer 23

can do a D&C, but eventually need hysterectomy w or w/o ovaries
If advanced or distant mets= radiation
If inoperable, chemo

Question 24

Explain the grading of cervical intraepithelial neoplasias

Answer 24

CIN I: mild dysplasia
CIN II: moderate dysplasia
CIN III: severe dysplasia

Question 25

Explain the cervical cancer stages

Answer 25

0: CIN limited to mucosa
1: invasive but confined to cervix (87% survival)
2: beyond cervix, not pelvic wall or upper vag
3: reaches pelvic wall and lower vag
4: beyond pelvis into adjacent organs (15%)

Question 26

What are the types of ovarian cancers

Answer 26

Tumor of surface (germinal) epithelium *(MC, deadliest)
Tumor of germ cells
Tumor of sex word stroll cells
(Mets involving ovaries)

Question 27

What are the types of germinal tumors

Answer 27

serous, mucinous, or endometriod

or Brener tumors

Question 28

What are serous tumors (germinal)

Answer 28

Most common, usually benign (15% borderline)
Mimic fallopian epithelium
Worse if bilateral or solid
Better if cystic

Question 29

What are mutinous tumors (germinal)

Answer 29

Benign, unilateral (can be borderline)

Filled with clear jelly and cause Pseudomyxoma peritonea with rupture (belly filled with mucus)

Question 30

What are endometroid tumors (germinal)

Answer 30

solid tumors made of glands that resemble endometrial glands

Question 31

What are Brener tumors

Answer 31

dense stroma in transitional epithelium that mimic renal epithelial tissue

Question 32

What are symptoms of germinal epithelium tumors

Answer 32

Asymptomatic- chemo and radiation font really help but if benign or borderline, have good prognosis

Question 33

What are germ cell tumors

Answer 33

Most common in benign cystic teratoma (dermoid cyst)
Usually <25 y/o
If not resected, the skin and neural tissue in the cyst can develop malignancy

Question 34

What is the origin of sex cord stromal cell tumors

Answer 34

Ovarian stroma cells that form follicles- they are hormone producing

Question 35

What is the origin of mets involving ovaries

Answer 35

usually endometrial or breast carcinoma, due to estrogen receptors

Question 36

What is a Krukenberg tumor

Answer 36

GI tumor with mets to ovaries

Question 37

What are Thecomas

Answer 37

solid benign tumors that secrete ESTROGEN

cause menstrual irregularities

Question 38

What is a granulosa

Answer 38

small and benign or large and malignant tumors that secrete ESTROGEN
-Cause precocious puberty or breast/endometrial cancer in older women

Question 39

What are sertoli-Leydig tumors

Answer 39

Benign or malignant tumors that secrete androgens and cause virilization (deep voice, hirsutism, micropenis)

Question 40

What are complications of PID

Answer 40

infertility from scarring of tubes
Ectopic pregnancy
Rupture of tuboovarian abscess

Question 41

What are RF of cervical carcinoma

Answer 41

Sex at early age
multiple partners
HPV infection
other VD (herpes, syphilis)

Question 42

What is a cervical carcinoma

Answer 42

SCC that originates in the transformation zone
Altered cells are susceptible to viral infections so getting HPV can cause neoplastic transformation
-Transformed cells stay undifferentiated and proliferate uncontrollably (squamous epithelium never matures=Dysplasia)

Question 43

What is significant about the transformation zone and carcinoma

Answer 43

The zone can widen after trauma, like child birth, or chronic inflammation

Question 44

What is Carcinoma in-situ

Answer 44

severe dysplasia limited to the BM (confined)

Once the cancer crosses the BM, it is considered invasive

Question 45

What do you see on colposcope exam for cervical carcinoma

Answer 45

Mosaic pattern
Tortuous vessels
normally shiny, smooth mucosa is crater like (ulcerated)

Question 46

What happens as cervical carcinoma progresses

Answer 46

purulent foul smelling drainage, but NO pain until it spreads beyond the cervix

Question 47

What is the MCC of death in cervical carcinoma

Answer 47

slowly progressive renal failure

Question 48

How do you treat cervical carcinoma

Answer 48

If recognized early, can remove with knife, laser ablation, or cryotherapy/electrocautery
If advanced, chemo+radiation
-All foci should be removed preventatively

Question 49

What are benign cystic teratomas (dermoid cysts)

Answer 49

filled with sebaceous and sweat glands, hair, teeth, skin, neural tissue
smell bad d/t sebaceous and sweat glands