Dermatology and Oncology Flashcards
No primary skin lesions just manifestation of liver disease
Inc SGPT
Bile acid in subcutaneous tissue
Pruritus, icterus/jaundice
Multifetal pregnancy, genetic influence
Intrahepatic cholestasis of pregnancy
Pruritus gravidarum
Pruritus gravidarum Tx
Ursodeoxycholic acid
relief of pruritus
Autoimmune bullous disease manifesting as plaque or pustule
Initially pruritic and urticarial palaques followed by 1-2 weeks vesicles or bullae
Periumbilical distribution with sparing of mucous membranes, scalp and face
Not related to HSV
Reaction between maternal IgG antibody and collagen 17 in basement membrane of skin and amniotic epithelium
Eosinophilic degranulation damaging dermal-epidermal junction
First pregnancy at 2nd or 3rd tri
Pemphigoid gestationis
Herpes gestationis
Associated with adverse perinatal outcomes
Intrahepatic cholestasis of Pregnancy
Pemphigoid gestationis
Resolve following delivery without scarring
Gold standard for Dx of Pemphigoid gestationis
Immunoflourescent skin tissue
Skin biopsy
Pemphigoid gestationis Tx
Topical high potency corticosteroids Oral antihistamine Oral steroid - Prednisone Plasmapheresis IV IG
Direct immunoflouresence of peri-lesional skin showing linear deposition of C3 along BM
Pemphigoid gestationis
Most common lesion in pregnancy
Cause unknown
Pregnancy-specific dermatosis with intensely pruritic 1-2mm erythematous papules that coalesce to form urticarial plaques
Late in pregnancy
Starts with striae manifesting as elevated hyperemia
Excoriations and secondary fungal infection
Rash affects abdomen and proximal thigh (97%)
Pruritic Urticarial Papules and Plaques of Pregnancy
PUPPP Tx
Oral antihistamines
Topical corticosteroids
Emollients.
Resolves within several days of delivery
Leaves no scarring
Most common
Dry, thickened scaly red patches
Extremity flexures, nipples, neck, face
Elevated IgE
Eczema
5-10 mm itchy erythematous papules and nodules
Extensor surfaces, trunk
Prurigo of pregnancy
Rare, small papules and sterile pustules
Trunk
Pruritic folliculitis of Pregnancy
Surgery for neoplasm classically performed after
12-14 weeks to minimize abortion in first trimester
Radiation SE
Microcephaly
Mental retardation
Late exposure: IUGR and brain damage
Chemotherapy is withheld before expected delivery at
3 weeks before
Tumors that frequently metastasize to placenta
Malignant melanoma
Leukemia
Lymphoma
Breast cancer
In the fetus, metastasis takes place in
Liver
Subcutaneous tissue
80% mort
Endocervical polyp asymptomatic in pregnancy tx
Typically (atypical glandular cells of undetermined significance) AGUS
Polypectomy/Excision
HPV vaccination on pregnancy
Not recommended
CIN 1, 2, 3 and adenocarcinoma in situ in pregnancy Tx
Allowed to delivery vaginally and further eval planned after delivery until 6 weeks postpartum
Cervical conizariob or excision of cone shaped cylindrical wedge from cervix that includes transformation zone and all or a portion of endocervical canal may be done with
Loop electrosurgical excisional procedure (LEEP)
Cold knife conization
Can develop scars in such a way that cervix will not dilate during labor
Cicatricial cervical stenosis
Cervix becomes very thin and opening will be difficult to locate the external os wherein cruciate incision should be done
Avoid in pregnancy due to abortion, membrane rupture, hemorrhage and preterm delivery
Conglutinated cervix
Invasive cervical cancer Dx in pregnancy
Cervical punch biopsy
70% stage 1
vaginal bleeding
Stage IA1 Cervical CA tx
Definitive therapy until 6 weeks postpartum
True invasive cancer more than Stage IA1 Tx
First half of pregnancy: immediate treatment regardless of age of gestation
Radiation: death of fetus
Curettage: labor
Later half: pregnancy safely continued until fetal viability/lung maturity; neoadjuvant chemotherapy
Stage IA - Early stage IIA Tx
CS followed by radical hysterectomy with B pelvic lymph node dissection
Before 20 weeks: 12 weeks hysterectomy performed with fetus in situ (double effect)
In later pregnancy, hysterotomy first
Advanced stage: chemoradiation combination
Leiomyoma in pregnancy
Asymptomatic
Chronic pain or acute pain (hemorrhagic infarction)
Tx: analgesics
Not removed in CS bec bloody and known to regress
Corpus luteum cyst
Endometriomas
Benign cystadenomas
Mature cystic teratomas
Tx
Surgical removal 14-20 weeks
give time for masses that will regress to do so
Pregnancy luteoma from luteineized stromal cells
Inc androgen 25% virilized, 50% female fetus with virilization
Tx
Spontaneously regress postpartum
Large theca-lutein cyst after first tri
High HCG
More common in GTD, twins and hydrous
Resolve postpartum
Tx surgery not needed
Ovarian cancer
Most common: Germ cell Sex cord stromal Low malignant potential Epithelial tumors
Tx
Surgery done at diagnosis regardless of gestation once mass is suspected to be malignant
Can be given in diagnosis of ovarian ca while awating pulmonary maturation (after 12 weeks gestation)
Neoadjuvant chemotherapy
Most frequent cancer in pregnant women
Breast cancer
Protective factors for breast cancer
Multiparity
Breast feeding
Most common presenting symptom of breast cancer
Palpable mass 90%
Breast ca diagnosis
Triple test (99%)
Clinical exam
Ultrasound and mammography with abdominal shield
Biopsy
CXR with abdominal shield
Liver UTZ
Skeletal MRI without contrast
Breast cancer Tx
Chemo and surgery delayed to second trimester of pregnancy
Radiation given after delivery
It is recommended that pregnancy be delayed in breast cancer after
2-3 years
Most common lymphoma in childbearing age
Painless enlargement of lymph node above diaphragm
Hodgkin disease
Hodgkin Early-disease Stage Tx
Chemotherapy delayed and done after first trimester
After first tri, give single-agent chemotherapy (Vinblastine)
Multi-agent tx in Hodgkin is only given
upon termination of pregnancy 34 weeks
Hodgkin Advanced stage Tx
Full chemotherapy given regardless of AOG
Before 20 weeks, therapeutic abortion
From B cells, T cells or NK cells
5-10% have HIV
EBV, HHVS 8, Hep C
Non-hodgkin disease
Tx: full tx at second trimester
Chemotherapy and immunotherapy (Rituximab)
Leukemia Mx
Induction therapy during pregnancy
Post remission maintenance after pregnancy and stem-cell
Complications:
Infection and hemorrhage
Inc incidence of preterm delivery and stillbirths
Malignant melanoma tx
Resection of primary tumor LN dissection (sentinel)
Strongest determinant of maternal survival in malignant melanoma
Clinical stage
Worst prognosis: deep cutaneous invasion or regional involvement have the worst prognosis
Pregnancy avoided for 3-5 years after surgical resection
Colon CA in pregnant Tx
In later pregnancy after first tri, therapy can be delayed until fetal maturation
Surgery is avoided bec lower rectal lesion ay cause dystocia or delivery may cause tumor hemorrhage
CS
