Benign D/O of Breast & Genital tract Flashcards
What is a fibroadenoma composed of
glandular / cystic epithelial structures surrounded by cellular stroma
Most common breasr mass ID’d in adolescent female
Fibroadenoma
what is considered “Fibrocystic changes” to breast tissue
palpably nodular breast tissue
histologic pattern dilated ducts / acini invested w/ dense collagenous stroma
Are “Fibrocystic changes” to breast tissue by themselves considered a cancer risk?
No
How is fibrocystic breast disease characterized by
Hyperplasia; multi bilat cysts w/pain & tenderness (greater Sx in premenstrual)
how to decrease Sx in fibrocystic breast disease
decrease chocolate
+/- caffine
wear support bra
avoid breast trauma
what is a green breast discharge r/t
content of cholesterol dieposides
not infx / malignancy
What type of breast discharge must be evaluated
spontaneous discharge
How do Pt’s present with mastitis in the Puerperal setting (during child birth/ immediately after)
warm / tender / diffuse breast erythema
+/- fever / malaise /myalgias / leukocytosis
MC organism of mastitis
staphylococcus
those breast feeding w/ mastitis, can they continue to breast feed?
yes
If mastitis does not improve after ABX what should be done?
US to r/o abcess
what should be done w/ those that develop mastitis in Nonpuerperal setting (not during child birth/ immediately after)
Image / biopsy to exclude inflammatory breast cancer;
Uncommon
If a Nonpuerperal Pt has a peripheral breast abscess what are the usual causes
infx from folliculitis / EIC / Montgomery gland
Tx of peripheral breast abscess
I&D & ABX
If a Nonpuerperal Pt has a Subareolar breast abscess what are the usual causes
keratin-plugged mild ducts
Tx of subareolar breast abscess
duct excision & removal of sinus tracts
Mastalagia is ___, and seen more in women ____
breast pain; women nearing menopause
breast pain that is bilat, diffuse, most severe during late luteal phase is ____, and requires ____
Cyclic;
no specific eval needed, Tx Sx
Breasr pain that is focal & no relation to menstral cycle is ____, & could be ____or ___
Noncyclic, frequently simple cyst, could be Cancer
this vulvar Dx presents classically in post-menopausal women w/inflamed dermis
Lichen Sclerosis
What are the Sx’s of Lichen Sclerosis
Early: pruritus, irritation, vulvar thickening
Late: burning & dyspareunia, introital stenosis
how does Lichen Sclerosis on the vulva appear as
cellophane paper
tissue paper
crinckled cigarette paper
Tx of Lichen Sclerosis
Sx Tx; min chem/mech irritation topical steroid (Clobestasol) Retinoids for severe/unremitting Sx Phototherapy/5aminolevulinic acid for severe Sx
This results from an intense itch/scratch cycle and has non-neoplastic morphologic alteration of vulvar skin
Lichen simplex chronicus
MC site and early findings of Lichen Simplex Chronicus
Labia Majora;
excoriations w/background erythema
Tx of Lichen Simplex Chronicus
Eliminate Triggers Lube affected area Sitz baths oral antihistamines wear cotton gloves @ night Topical steroids
If Lichen Simplex Chronicus id not resolved in 1-3 wks?
biopsy
this is uncommon autoimmune d/o of T-cells/ Rx induced (NSAIDS, B-blockers) involves cutaneous & mucosal surfaces
Lichen Planus
Pts w/ lichen planus complain of
chronic vaginal discharge w/ intense vulvovaginal pruritis, burning pain, dyspareunia & postcoital bleeding
what are the 3 variants of lichen planus
Erosive (MC & most difficult)
Papulosquamous
Hypertrophic
description of lichen planus
purple pruritic polygonal papules plaques
Tx of Lichen Planus
Topical: Clobetasol
Vaginal hydrocortisone supp.
this occurs in skin folds from friction between moist skin w/signs/Sx of burning / itching hyperpigmentation
Intertrigo
Tx of Intertrigo
Drying agents (corn starch, etc.) Inflammation: mild top steroids Infx: Tx cause weight loss light-weight loose clothing
what is the MCC of vaginal irritation after menopause
Atrophic Vaginitis
Signs/Sx of Atrophic Vaginitis
vulvar irritation
clear/yellow/blood tinged discharge
urinary Sx
Dyspareunia
diagnosis of atrophic vaginitis
friable vaginal epithelium
los of rugae
pale mucosa
pap smear changes
Tx of Atrophic Vaginitis
Topical estrogen
Tx concomitant Infx
This cyst occurs in duct w/ NO PAIN / common in reproductive age women
Bartholin Cyst
A Bartholin Cyst in a women > 40 is
concerning for Cancer; refer for Bx
Tx of Bartholin Cyst
None if Asymptomatic; I&D alone discouraged
Word Cath for both cyst & abscess
Marsupialization (if Failed Word)
A Bartholins Abscess is associated with what bug
polymicrobial but correlates w/ gonorrhea/chlamydia
Sx of Bartholins Abscess
Severe pain
Difficulty walking / sitting
dyspareunia
Tx of Bartholins Abscess
fluctuant I&D for relief & placement of Word Cath
ABX if recurrent or High risk for complicated infection
WHo are at high risk of complicated infx with Bartholins abscess
Pregnant
cellulitis
systemic infection
immunosuppressed
what ABX should be used for thoe at high risk of complicated infection w/ bartholins abscess
Augmentin 875mg 2x daily + Clindamycin 300mg 4x daily x 1 week
Cervical stenosis is characterized by
contraction of scar tissue / adhesions w/in endocervical canal blocks os
Sx of Cervical Stenosis
dysmenorrhea
amenorrhea
infertility
Tx of cervical stenosis
cervical dilators
vaginal estrogens x 4 wks in hypoestrogenic women (post-menopausal)
“trapped” Columnar cells beneath squamous cells during metaplasia continue to secrete mucus = descrete cyst
(smooth clear white/yellow rounded elevations)
Nabothian Cyst
Nabothian Cysts are usually
asymptomatic w/ no Tx needed
these may have leucorrhea / postcoital spotting, arise in endocervical canal in reproductive yrs; typically < 3cm
Cervical Polyp
Tx of Cervical Polyp depends on
size (Tx large, symptomatic, or atypical)
Tx of small pedunculated cervical polyp
grasp @ base w/ forcep & twist
Tx of sessile cervical polyp
remove w/ Bx forceps, cauterize base
what are the estrogen dependent uterine D/O
Leiomyomata “Fibroids”
Adenomyosis
Endometrial hyperplasia
what is the MC pelvic tumor in women
Leiomyomata “Fibroids”
Types of Leiomyomata “Fibroids”
Intramural
Submucosal
Subserosal
Sx of Leiomyomata “Fibroids”
most asymptomatic bleeding mass effect; pressure, urinary freq, incontinence, constipation Pelvic Pain Infertility
Preferred method to diagnose Leiomyomata “Fibroids”
Ultrasound
Nests of endometrial glands & stroma embedded w/in muscular uterine wall
Adenomyosis
adenomyosis presents as
heavy abnormal uterine bleeding /dysmenorrhea in parous women ages 40-50
Tx of adenomyosis
Classic: hysterectomy
Medical: GnRH agonist, Danazol
Progestins (Mirena)
when is a ovarian cyst considered functional
> 3cm
Premenopausal womanw/ =5cm simple/hemorrhagic ovarian cyst. what do you do to eval?
no additional Tx required
Premenopausal womanw/ >5cm but <7cm simple/hemorrhagic ovarian cyst. what do you do to eval?
TVS (TVUS?) repeat in 6-12wks; if persistent TVS yearly
Premenopausal womanw/ >7cm simple/hemorrhagic ovarian cyst. what do you do to eval?
MRI or surgical eval
Post-menopausal woman with =1cm simple ovarian cyst what is needed
nothing; normal finding
Post-menopausal woman with =5cm simple ovarian cyst what is needed
CA125 level –> normal –> TVS (TVUS?) repeated in 6-12wks–> if persistent TVS yearly
Post-menopausal woman with >7cm simple ovarian cyst what is needed
MRI or surgical consult
In premenopausal woman w/ indeterminate/probably benign cyst (hemorrhagic, matureteratoma, andometrioma) what should be done?
TVS repeated @ 6-12wks if persistent –> consider MRI / surgical consult
Ovarian cyst with qualities suggesting malignancy appear as and need?
Thick (>3mm) irregular septations
Nodule w/blood flow
consider surgical eval
50-80% of ovarian torsion cases have what?
ovarian mass
What increases the risk of ovarian torsion & what has the highest rates for torsion
1) ovaries >6cm
2) adnexa 6-10cm
Which adnexa is more commonly affected by torsion
Right, b/c left mobility limited r/t sigmoid colon
Female Pt presents w/ sudden onset sharp lower ABD pain that is worse over several hours & radiates to flank / groin / thigh (may have low grade fever which suggest what is this
1) Ovarian Torsion
2) Necrosis
Tx of ovarian torsion
Salvage as possible
resect tumor/cyst
possible oophoropexy
w/ necrosis/rupture w/hemorrhage –> removal of adnexal structures
