Benign Disorders Female Repro Flashcards
What is the most common cystic lesion of the vulva?
Epidermal inclusion cyst (sebaceous cysts)
What is an epidermal Inclusion cyst most likely a result of? where is it located?
Located below the epidermidis
Most result from occlusion of sebaceous gland on the labia majora or minora
What are some characteristics of epidermal inclusion cyst?
FLUID FLUID- should not have signs of infection
These are lined with stratified epithelium
Mobile, nontender, spherical, slow-growing
May rupture spontaneously
What is the treatment for an epidermal inclusion cyst?
Treatment not required, unless they become infected or troublesome
Intralesional injection of triamcinolone +/- oral antibiotics
Incision and drainage is usually sufficient, but cysts commonly reoccur (removal of cyst in wall to prevent recurrence)
What is a Bartholin’s duct cyst or abscess and what can be caused by?
Chronic cystic, dilation and inclusion of the main Bartholin duct
May be caused by chronic inflammatory reactions, trauma from lacerations or incisions in the area or infection
Difference between cyst and abscess
Cyst is just filled with fluid
Abscess has erythema and pus
How to distinguish between Bartholin and Labial cyst
Have to insert finger into vagina to distinguish
Bartholin you can feel
Labial you can’t feel
Where are the treatments of the Bartholin duct cyst or abscess?
Most are asymptomatic and Therapy is unnecessary
Small cyst maybe be managed with sitz bath or drainage
If symptomatic, recurrent or abscess insertion of an indwelling Word catheter is therapy
What is a Word catheter?
Linear incision and drain of Bartholin cyst or abscess catheter
Irrigate
Catheter is deflated and inserted then reinflated
Remains 446 weeks to stimulate fibrosis and produce permanent opening
Local anesthetic office procedure
What is marsupialization?
To create a permanent opening to prevent reoccurrence
Excision of entire gland and suture it
Excision may be necessary if infection cannot be controlled with marsupialization or if malignancy is suspected
What antibiotics do you give for a Bartholin duct cyst or abscess?
Antibiotics to cover MRSA
Sulfamethoxazole and trimethoprim (SMX-TMP) (Bactrim/Septra) ***
OR
Amoxicillin clavulanate (augmentin) PLUS clindamycin
What should you suspect in enlargement of Bartholin gland in postmenopausal woman?
Malignancy must be ruled out
Evaluation includes excision and histologic evaluation
What is lichen sclerosis? What is it caused by?
Who is most affected?
Patchy white change in skin of labia minora
Etiology unknown
Seen in all age women, but more common in older patients
What does lichen sclerosus cause in postmenopausal woman?
Intense pruritus, dyspareunia, burning pain, and introital stenosis, dryness
What are common indications of lichen sclerosis?
Skin is thin, inelastic, with “cigarette paper” or “onion skin” appearance
What could happen as lichen sclerosus progresses?
Labia minora may be lost, labia majora flattens, clitoris becomes inverted (inflammation, loses landmarks)
Dysplasia may develop
4 to 6% develop squamous cell carcinoma
Suspicious area should be biopsied (always biopsy especially in older women)
What is the treatment for lichen sclerosus?
Intralesional **steroid injection in refractory cases
Immune modulating medication, such as pimecrolimus (Elidel) or tacrolimus (protopic)
Tricyclic antidepressants for pain- amitriptyline (Elavil) or desipramine (norpramin) lower dose than for depression
Vaginal dilators with lidocaine (for sexually active patients)
Oral antihistamine for pruritus
Surgical correction if they want
Inclusion cyst of vagina
Common lesions resulting from lacerations during childbirth or gynecologic surgery
Usually small and asymptomatic
Treatment not usually necessary
Surgery or antibiotics if cyst becomes infected
What is the most common reason for gynecologic surgery?
Uterine leiomyoma’s
(Fibroids)
What are fibroids? What are they derived from?
Frequent, benign tumors of the uterus
Derive from smooth muscle cells of the myometrium
Most are asymptomatic
Epidemiology of Leiomyomas? In what race is it most common?
More common in black women than any other race
Rare before, and after reproductive years
Increased risk with nulliparity, family history, obesity (estrogen)
Myoma growth is rare in menopausal women
What is the pathophysiology of Leiomyomas?
Cause not known
Myomas begin from a single muscle cell
Usually multiple, discrete
buff colored, round, smooth and firm
As a large pseudo capsule forms
Myomas may be anywhere in the uterus
What do myomas have a higher concentration of than the rest of the myometrium?
Estrogen receptors
What is a subserosal fibroid?
Under the serosa of the uterus
Mass palpable on pelvic exam
What is an intramural fibroid?
Within wall of uterus
Symmetric pelvic mass palpable
Miscarriage is common and has more pelvic pain
What is a submucosal fibroid?
Under endometrium, abnormal uterine bleeding
What is a pedunculated Leiomyoma
Fibroid that develops a stalk
Torsion and ischemic necrosis make occur
May attached to blood supply of omentum or bowel (parasitic)
Changes in Leiomyomas during pregnancy
May enlarge and undergo painful red or carneous degeneration from bleeding into tumor
Other changes in Leiomyomas
May undergo fatty degeneration
May become cystic, calcified as they get older
Rarely myomas may become sarcomas (usually after menopause)
Symptoms of fibroids
Most are asymptomatic
Abnormal uterine bleeding (submucosal), prolonged heavy menses, pelvic mass, pelvic pressure, passing clots
Pain is rare unless torsion, infection, degeneration, or vascular occlusion occurs
Pressure symptoms - frequent urination, G.I. symptoms, bloating
What type of fibroid can be delivered through the cervix? What symptoms are associated?
Subserous pedunculated myoma
Results in cramps , vaginal discharge, mass exiting introitus
What do fibroids seem to be associated with?
Infertility and spontaneous abortion
Because of competing nutrients
Don’t excise until after pregnancy, because risk is too high
Fibroids usually will regress in size within five months
Differential diagnosis of fibroids
Pregnancy
Ovarian cancer
TOA
Endometriosis
Endometrial cancer
Diagnosis of fibroids
Abdominal/pelvic examination
Ultrasound shows myomas and capsule
Radiographs show mass and calcifications
MRI can be used (usually the last imaging done)
Hysteroscopy
