Benign & Neoplastic Vulvar & Ovarian Disease

Question 1

Presentation

a. Post-menopause
b. Pruritis +/- dysuria, dyspareunia
c. Doesn’t go away

Answer 1

Lichen Sclerosis

Question 2

Lichen Sclerosis is associated w.

Answer 2

SCC > melanoma

Question 3

i. Sharp, “Cellophane Paper” white plaques
ii. Fragility: purpura, erosions
iii. Begins periclitorally, not seen in hair bearing areas

Answer 3

Lichen Sclerosis

Question 4

Dx of Lichen Sclerosis

Answer 4

vulvar punch bx

Question 5

Tx of Lichen Sclerosis

Answer 5

Topical Ultrapotent Steroid Ointment: Temovate 0.05%

+/- topical estrogen

Question 6

Pt. p/w

b. Acute unilateral labial swelling
c. Pain, dyspareunia

Answer 6

Bartholin Cysts

Question 7

Tender fluctuant labial mass with erythema/edema

+/- abscess w. fever, cellulitis

Answer 7

Bartholin Cysts

Question 8

Tx for Bartholin Cysts

Answer 8

I & D + Word Catheter +/- abx

Question 9

Pt. p/w

a. Burning, stinging, raw or stabbing sensation
b. Introital/vestibular pain
c. No underlying pathology

Answer 9

Vulvodynia

Question 10

Dx of Vulvodynia

Answer 10

Q-tip to see if pain limited to vestibule

Digital exam for spasm/tenderness

non-specific vestibular erythema

Question 11

VINd or VINu?

a. Younger women
b. HPV

Answer 11

VINu

Question 12

2 Sxs of VINu

Answer 12

a. Mostly asxs

b. Vulvar burning/pruritis

Question 13

colposcopy w. 5% acetic acid shows color from gray to white or red to black on lesion only

Answer 13

VINd and VINu

Question 14

3 medical options to tx VINu

Answer 14

(off-label uses)

i. 5FU
ii. Interferon
iii. Imiquimod 5%

Question 15

3 surgical options to tx VINu…

Answer 15

i. CO2 laser
ii. Wide excision
iii. Vulvectomy

Question 16

how often does VINu recur?

Answer 16

30-50%

Question 17

VINu or VINd?

a. SCC
b. Lichen Sclerosis
c. Older women

Answer 17

VUNd

Question 18

Where is VINd confined to?

Answer 18

lower 1/3 of epithelium

Question 19

Tx for VINd…

Answer 19

surgical excision

Question 20

age distro of vulvar CA

Answer 20

i. 20-40 (VINu) and 60-70 (VINd)

Question 21

Main Sx of Vulvar CA…

Answer 21

pruritis

Question 22

What type of vulvar CA?

cauliflower lesions or small ulcerative lesions w. hyperkeratosis

Answer 22

SCC

Question 23

What type of vulvar CA?

raised, rolled borders + ulcerated center

Answer 23

BCC

Question 24

Tx of vulvar CA

Answer 24

Surgical Removal + Inguinal Node Dissection

Question 25

Pt. p/w... a. Hx of HPV b. Lesions in upper 1/3 of vagina

Answer 25

VAIN

Question 26

Dx of VAIN (2)

Answer 26

Pap Smear Colposcopy

Question 27

Tx of VAIN 1

Answer 27

observation + testing q 6 mo

Question 28

Tx of VAIN 2/3

Answer 28

Vaginectomy > laser > 5FU (last line)

Question 29

MC type of vaginal CA

Answer 29

SCC

Question 30

Vaginal CA results in mets from...

Answer 30

Mets from endometrium, ovary, cervix

Question 31

MC presentation of vaginal CA? (3)

Answer 31

a. Asxs | b. Leukorrhea, odor

Question 32

Tx of vaginal CA

Answer 32

Vaginectomy + radiation

Question 33

Pt. p/w: a. Infertility: Oligo/Amenorrhea, Anovulation b. Acne c. Hirsutism

Answer 33

PCOS

Question 34

Rotterdam criteria for PCOS requires 2 of what 3 sxs?

Answer 34

i. Oligomenorrhea ii. Hyperandrogenism iii. Polycystic ovaries

Question 35

On US, you see... i. > 12 follicles ii. String of Pearls iii. 2-9 cm diameter

Answer 35

PCOS

Question 36

to evaluate PCOS, you must get a total testosterone. If it is elevated, what 6 labs should you also get?

Answer 36

a. 17-OH Progesterone (r/o adrenal hyperplasia) b. DHEA c. Cortisol (r/o cushings) d. Prolactin (should be normal) e. TSH (r/o hyperthyroid) f. B-HCG

Question 37

3 tx options for PCOS

Answer 37

a. Weight Loss b. COCs c. Metformin only if hyperinsulinemia + clomid

Question 38

Benign or Malignant Adnexal mass? a. Thick septations b. Solid appears nodular or papillary c. + blood flow

Answer 38

malignant

Question 39

Which type of ovarian cyst? MC types 2-8 cm diameter Regress after 1-2 cycles

Answer 39

follicular

Question 40

Which type of ovarian cyst? 3-11 cm Blurred borders on US due to blood accumulation Resolves after 1-2 cycles

Answer 40

Corpus luteum

Question 41

Which type of ovarian cyst? Elevated chrionic gonadotropin Bilateral Clear, straw colored fluid

Answer 41

Theca Lutein

Question 42

Tx for theca lutein cyst?

Answer 42

tx underlying d/o

Question 43

Pt. p/w: Pelvic Pain, urinary frequency, back pain Pelvic mass on bimanual

Answer 43

Mature Teratoma

Question 44

Are mature teratomas benign or malignant?

Answer 44

benign

Question 45

US reveals unilateral, complicated ovarian cyst

Answer 45

mature teratoma

Question 46

Labs for tumor markers?

Answer 46

CEA, CA-125, AFP, BHCG

Question 47

Tx for mature teratoma

Answer 47

a. Laparotomy vs laparoscopy

Question 48

Pt. p/w below ovarian cyst... a. 30-50 yo b. Lined w. columnar epithelium, secretes mucin c. Thin walled, uni or multilocular d. 5 to over 20 cm

Answer 48

serous/mucinous cystadenoma

Question 49

Tx for serous/mucinous cystadenoma

Answer 49

surgical excision and path

Question 50

2nd MC gynecologic CA MC gyn CA death

Answer 50

Ovarian CA

Question 51

Major RF for ovarian CA...

Answer 51

Increased menses | nulliparity, early menarche, late menopause

Question 52

2 options to reduce risk of ovarian CA...

Answer 52

COCs Bilateral salpingectomy

Question 53

Pt. p/w... ``` Pleural Effusion Bowel Obstruction Ascites inguinal LAD adnexal mass ```

Answer 53

ovarian CA

Question 54

Are the below sxs indicative of acute or subacute ovarian CA? ``` bloating early satiety pain bleeding altered bowel habits ```

Answer 54

subacute

Question 55

Which type of ovarian CA is likely? elevated CA 125

Answer 55

epithelial ovarian CA

Question 56

Which type of ovarian CA is likely? elevated HCG, AFT, LDH

Answer 56

Germ Cell Ovarian CA

Question 57

Imaging for ovarian CA (6

Answer 57

US +/- CT, Mammogram, Colonoscopy, MRI, CXR

Question 58

Which type of ovarian CA? a. Older pts. b. Bilateral c. Assoc. w. High Grade Serous papillary CA

Answer 58

epithelial

Question 59

Which type of ovarian CA? a. 20-30 yo b. Unilateral c. Elevated HCG, AFP, LDH

Answer 59

Germ Cell

Question 60

MC type of Germ Cell Ovarian CA...

Answer 60

Dysgerminoma

Question 61

an immature teratoma is a ____ type of ____ CA

Answer 61

malignant germ cell ovarian CA

Question 62

Which type of Sex Cord Stromal Ovarian CA? i. Hyperestrogenism ii. 5th decade of life

Answer 62

Granulosa Cell

Question 63

Which type of Sex Cord Stromal Ovarian CA? i. Hyperandrogenism ii. 3-4th decade of life

Answer 63

Sertoli-Stromal