Benign Disorders Female Repro

Question 1

What is the most common cystic lesion of the vulva?

Answer 1

Epidermal inclusion cyst (sebaceous cysts)

Question 2

What is an epidermal Inclusion cyst most likely a result of? where is it located?

Answer 2

Located below the epidermidis
Most result from occlusion of sebaceous gland on the labia majora or minora

Question 3

What are some characteristics of epidermal inclusion cyst?

Answer 3

FLUID FLUID- should not have signs of infection
These are lined with stratified epithelium
Mobile, nontender, spherical, slow-growing
May rupture spontaneously

Question 4

What is the treatment for an epidermal inclusion cyst?

Answer 4

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)

Question 5

What is a Bartholin’s duct cyst or abscess and what can be caused by?

Answer 5

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

Question 6

Difference between cyst and abscess

Answer 6

Cyst is just filled with fluid
Abscess has erythema and pus

Question 7

How to distinguish between Bartholin and Labial cyst

Answer 7

Have to insert finger into vagina to distinguish
Bartholin you can feel
Labial you can’t feel

Question 8

Where are the treatments of the Bartholin duct cyst or abscess?

Answer 8

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

Question 9

What is a Word catheter?

Answer 9

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

Question 10

What is marsupialization?

Answer 10

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

Question 11

What antibiotics do you give for a Bartholin duct cyst or abscess?

Answer 11

Antibiotics to cover MRSA
Sulfamethoxazole and trimethoprim (SMX-TMP) (Bactrim/Septra) ***
OR
Amoxicillin clavulanate (augmentin) PLUS clindamycin

Question 12

What should you suspect in enlargement of Bartholin gland in postmenopausal woman?

Answer 12

Malignancy must be ruled out
Evaluation includes excision and histologic evaluation

Question 13

What is lichen sclerosis? What is it caused by?
Who is most affected?

Answer 13

Patchy white change in skin of labia minora
Etiology unknown
Seen in all age women, but more common in older patients

Question 14

What does lichen sclerosus cause in postmenopausal woman?

Answer 14

Intense pruritus, dyspareunia, burning pain, and introital stenosis, dryness

Question 15

What are common indications of lichen sclerosis?

Answer 15

Skin is thin, inelastic, with “cigarette paper” or “onion skin” appearance

Question 16

What could happen as lichen sclerosus progresses?

Answer 16

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)

Question 17

What is the treatment for lichen sclerosus?

Answer 17

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

Question 18

Inclusion cyst of vagina

Answer 18

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

Question 19

What is the most common reason for gynecologic surgery?

Answer 19

Uterine leiomyoma’s
(Fibroids)

Question 20

What are fibroids? What are they derived from?

Answer 20

Frequent, benign tumors of the uterus
Derive from smooth muscle cells of the myometrium
Most are asymptomatic

Question 21

Epidemiology of Leiomyomas? In what race is it most common?

Answer 21

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

Question 22

What is the pathophysiology of Leiomyomas?

Answer 22

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

Question 23

What do myomas have a higher concentration of than the rest of the myometrium?

Answer 23

Estrogen receptors

Question 24

What is a subserosal fibroid?

Answer 24

Under the serosa of the uterus
Mass palpable on pelvic exam

Question 25

What is an intramural fibroid?

Answer 25

Within wall of uterus
Symmetric pelvic mass palpable
Miscarriage is common and has more pelvic pain

Question 26

What is a submucosal fibroid?

Answer 26

Under endometrium, abnormal uterine bleeding

Question 27

What is a pedunculated Leiomyoma

Answer 27

Fibroid that develops a stalk
Torsion and ischemic necrosis make occur
May attached to blood supply of omentum or bowel (parasitic)

Question 28

Changes in Leiomyomas during pregnancy

Answer 28

May enlarge and undergo painful red or carneous degeneration from bleeding into tumor

Question 29

Other changes in Leiomyomas

Answer 29

May undergo fatty degeneration
May become cystic, calcified as they get older
Rarely myomas may become sarcomas (usually after menopause)

Question 30

Symptoms of fibroids

Answer 30

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

Question 31

What type of fibroid can be delivered through the cervix? What symptoms are associated?

Answer 31

Subserous pedunculated myoma
Results in cramps , vaginal discharge, mass exiting introitus

Question 32

What do fibroids seem to be associated with?

Answer 32

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

Question 33

Differential diagnosis of fibroids

Answer 33

Pregnancy
Ovarian cancer
TOA
Endometriosis
Endometrial cancer

Question 34

Diagnosis of fibroids

Answer 34

Abdominal/pelvic examination
Ultrasound shows myomas and capsule
Radiographs show mass and calcifications
MRI can be used (usually the last imaging done)
Hysteroscopy