Day 13 - Gyn3

Question 1

Most important prognostic factor in endometrial CA

Answer 1

Histologic grade (more important than depth of myometrium invasion)

Question 2

Current recommendations for pap smears in pts w/ no history of abnormal pap

Answer 2

Start age 21; q 2 yrs if age 21-29; q 2-3 yr if 30+; Women 30+ yrs old may have HPV testing q 3-5 yrs in addition Pap smear cytology; Screening may be stopped at 65; If hysterectomy, no need to screen (may need cuff pap smears if uterus taken out due to cancer)

Question 3

General tx strategies for squamous cell CA of vagina

Answer 3

Similar to squamous cell CA of cervical (VIN1-3); Stage 1 CA (less than 2 cm) - Surgical removal or intracavitary radiation; Stage 1 CA (greater than 2 cm) - External beam radiation; Stage 3 or 4 CA - External beam radiation +/- other therapies (generally not chemotherapy)

Question 4

Lichen sclerosis - Definition, typical pt pop, Classic findings,

Answer 4

Chronic inflammatory condition of anogenital region, most commonly affecting postmenopausal women; Classic but Late findings - Ivory or porcelain plaques and papules w/ pruritus;

Question 5

Tx Lichen sclerosis

Answer 5

Presents similary to squamous cell CA, so low threshold for punch bx to r/o squamous ca; Steroids (topical clobetasole - can thin skin; pimecrolimus)

Question 6

Gynecomastia - DDx

Answer 6

Abnormal breast tissue in male pts; DDX - Puberty (resolves spontaneous, 6 mo - 2 yr age), Meds (spironolactone, digoxin, cimetidine, amiloride, ketoconazole, haloperidol, HIV HAART), Drugs (alcohol - cirrhosis, marijuana, heroin, anabolic steroids), Herbal agents (tea tree oil, lavendar oil), Cirrhosis, Hypogonadism, Testicular germ cell tumors (estrogen-secreting), Hypothyroidism, Hemodialysis

Question 7

W/u for fibroadenoma appearing mass in F

Answer 7

F/u 3-5 days after menstruation for eval; If mass persists, start w/ FNA; If solid & benign or inconclusive, repeat FNA, core bx, or excisional bx; If solid & malignant, tx like breast CA; If cystic with clear fluid & mass disappears, reassurance & discard fluid, f/u in one month (assume fibrocystic change); If cystic with bloody fluid, send for cytology, may or may not want core or excisional bx; If cystic or residual thickening, core or excisional bx; Mammogram not part of this w/u - do above regardless of mammogram findings