cancers

Question 1

malodorous vaginal discharge, postmenopausal/postcoital vaginal bleeding, irregular mass/plaque/ulcer on vagina

Answer 1

vaginal cancer

1. 60yo, HPV+, h/o cervical dysplasia/cancer, smoking, located in upper 1/3 of posterior wall: squamous cell carcinoma

Question 2

21-24 yo w/ atypical squamous cells of undetermined significance on pap smear

Answer 2

repeat pap in 1 yr

Question 3

> =25yo w/ atypical squamous cells of undetermined significance on pap smear

Answer 3

HPV test:
+ -> colposcopy
- -> repeat HPV and pap in 3 yrs

Question 4

ddx for vaginal itching

Answer 4

lichen sclerosis(anal and vulvar, “cigarette paper”, thinned epidermis, hyperkeratosis, elongation of the rete pegs), lichen planus (involves vagina), psoriasis (involves extensor surfaces), vulvar intraepithelial neoplasia (reason for biopsy), vitiligo, long-standing candidal infection (less likely 2/2 high pH in postmenopausal women)

Question 5

anatomical borders of vulva

Answer 5

mons pubis superiorly
anus inferiorly
genitocrural folds laterally

Question 6

ovarian tumor types, in decreasing commonality

Answer 6

epithlial (old) > germ cell (young) > sex cord-stromal tumors

Question 7

germ cell ovarian tumors. Sx?

Answer 7

teratoma (dermoid is benign and most common)
Malignant is rapid growing, thus causes pain

polyembryoma, embryonal carcinoma, dysgerminoma, endodermal sinus tumor, choriocarcinoma

Question 8

epithelial ovarian tumors

Answer 8

serous > mucinous, endometrioid, brenner, clear cell

Question 9

sex cord-stromal tumors

Answer 9

granulosa cell tumors, sertoli-leydig, gynandroblastoma, thecoma, fibroma

Question 10

evaluation of adnexal masses based on age

prepubertal w/ ovary >2cm

Answer 10

operate

Question 11

evaluation of adnexal masses based on age

reproductive w/ ovary <5cm

Answer 11

observe

Question 12

evaluation of adnexal masses based on age

reproductive w/ ovary 5-10cm

Answer 12

US: observe for 1 month if simple cyst, otherwise operate

Question 13

evaluation of adnexal masses based on age

reproductive w/ ovary >10cm

Answer 13

operate

Question 14

menopausal w/ ovary >5cm

Answer 14

operate

Question 15

pelvic masses

1. midline and irregular
2. adnexal tenderness
3. androgen effects
4. dysmenorrhea, dyspareunia, dyschezia

Answer 15

1. fibroids
2. tubo-ovarian abscess
3. sertoli-leydig cell tumor
4. endometrioma

Question 16

ovarian cancer staging steps

Answer 16

TAH, BSO, omentectomy, peritoneal washings / biopsies, ascites sampling, lymphadenectomy

Question 17

ovarian cancer staging

Answer 17

I: confined to ovaries
II: left ovaries but in pelvis
III: peritoneal
IV: distant mets