5, 6 moles, vulvar/vaginal cancer

Question 1

Lichen sclerosis:

• sx/presentation
• tx
• cancer risk?

Answer 1

1. ‘porcelain-white’ lesions, pruritis, pain with menstruation/sex
2. topical steroids. Bx to r/o SCC
3. Low risk of becoming SCC

Question 2

How to differentiate Vulvar melanoma from SCC?

Answer 2

Must do bx to differentiate. Both present similarly: black, itchy lesion.

Question 3

Vaginal CA:

types (2) and their etiology

Answer 3

1. SCC: HPV
2. Adenocarcinoma: DES exposure in utero. Presents as “grape like” structure in vagina (don’t confuse with CC)

Question 4

Moles:

1. How to dx
2. Tx and f/u

Answer 4

1. confirm symptoms with U/S showing snowstorm.
2. Tx with suction curettage. F/u with weekly B-HCG levels and OCPs for 1 year in order to catch possible development of CC

Question 5

Complete vs incomplete mole

Answer 5

Complete: egg and sperm meet, but egg has no nucleus. So, sperm doubles its chromosomes (46)

-no fetal parts

Incomplete: 2 sperm and 1 egg meet. So, chromosomes from 3 different gametes (69)

-contains fetal parts

Question 6

Vulvar cancers (3) and their tx

-what is a complication?

Answer 6

1. SCC: vulvectomy and LN dissection
2. Melanoma: vulvectomy and LN dissection
3. Paget’s: (benign.) local resection.

Vulvectomy/LN dissection can cause sexual dysfuction and lower leg edema

Question 7

Condyloma accuminata:

What can you apply on a vulvar lesion to dx?

Answer 7

You can apply acetic acid (vinegar). Condyloma accuminata turns white.

Question 8

Why do U/S in patient that has Hyperemesis Gravidarum?

Answer 8

Look for possible molar pregnancy

Question 9

Moles:

• sx/presentation (3)
• pelvic exam finding
• U/S finding

Answer 9

1. size-date discrepancy, from very high B-HCG
2. hyperthyroidism: B-HCG mimics TSH
3. Hyperemesis gravidarum: lots of B-HCG causes severe morning sickness

Pelvic exam: grape like mass in vagina

U/S: snowstorm

Question 10

After treating molar pregnancy, how often to track B-HCG?

Answer 10

Weekly B-HCG levels

Question 11

Choriocarcinoma

• how to dx
• tx

Answer 11

Dx: Start with U/S, use suction curettage to remove and bx, then stage with CT.

Tx: Debulking surgery, and MTX (and add Actinomycin and Cyclophosphamide if severe)

Question 12

“Grape-like” structure in vagina

What 2 things?

Answer 12

1. Mole
2. Vaginal adenocarcinoma (DES exposure in utero)

Question 13

Vulvar cancer:

3 types. What are their presentations?

Answer 13

1. SCC (HPV): black lesion
2. Melanoma: black lesion
3. Paget’s disease: red lesion

All present with pruritis