GU Benign and Malignant Flashcards
What is lichen sclerosis?
- chronic inflammatory condition
- likely autoimmune
S/S of Lichen Sclerosis
- chronic vulvar pruritus and pain
- dysuria
- dyspareunia
- rectal bleeding
- diffuse, thin, white wrinkled skin localized to labia
Dx of Lichen Sclerosis
-punch biopsy to confirm and r/o malignancy
Tx of Lichen Sclerosis
-topical steroids 2-3 months until resolved then weekly for maintenance
What is lichen simplex chronicus?
- lichenified skin reaction to chronic scratching
- caused by atopic dermatitis, tinea or candida infection
- worsens with heat, excessive sweating, clothing irritation
S/S of Lichen Simplex Chronicus
- progressive pruritus and burning
- red papules form lichenified, thickened, scaly localized plaques
Dx of Lichen Simplex Chronicus
- clinical
- biopsy if not resolving
Tx of Lichen Simplex Chronicus
- treat underlying cause
- antipruritus medications
- topical steroid cream
What is lichen planus?
- autoimmune inflammatory condition
- age 50-60
S/S of Lichen Planus
- intense chronic pruritus
- insertional dyspareunia, post-coital bleeding
- vulvar pain
- erosive type: red/white patchy, ulcerative lesions
- vagina often involved (differentiates from lichen sclerosis which is external only)
Dx of Lichen Planus
- clinical
- consider biopsy to r/o malignancy or wet prep to r/o infx
Tx of Lichen Planus
- steroids for vulvar lesions
- intravaginal steroids for vaginal lesions
- oral prednisone if refractory to topical tx
Psoriasis
- autosomal dominant
- mildly pruritic
- scaly, silvery patch atop an erythematous base
Dx and Tx of Psoriasis
Dx: biopsy
Tx: topical steroid
Dermatitis
- Etiology
- Dx
- Tx
- etiology: eczema, seborrheic dermatitis
- Dx: clinical
- Tx: remove offending agent, topical steroids
S/S Vestibulitis
- localized vulvar pain w/o dermatitis
- severe pain provoked by focal touch of vulva
- insertional dyspareunia over weeks-months
- small, reddened patchy areas over glands and vestibule
Dx of Vestibulitis
-light touch over vestibule recreates pain
Tx of Vestibulitis
- controversial
- topical lidocaine if localized, oral nortriptyline or gabapentin
- remove irritants
- abstinence
- steroid ointments
Bartholin Gland Cyst
- obstruction of bartholin glands
- mucus accumulates usually due to bacterial cause
S/S of Bartholin Gland Cyst
- often asymptomatic
- pain and tenderness with sex, sitting, ambulation
- firm swelling at posterior vaginal introitus
Dx of Bartholin Gland Cyst
clinical
Tx of Bartholin Gland Cyst
- asymptomatic: no intervention
- symptomatic: I/D with word cath placement, marsupialization, excision
Vulvar Hygiene
- cotton underwear
- loose garments
- tampons instead of pads
- fragrance free soap
- omit sprays, powders, douches
- pat dry
Vulvar Neoplasia
- S/S
- Dx
- Tx
- may be associated w/ HPV
- vulvar irritation, pruritus, raised lesions
- Dx: biopsy
- Tx: excision
Vaginal Intraepithelial Neoplasia (VAIN)
-more commonly neoplasia is result of spread from another site (eg cervical)
S/S of Vaginal Cancer
- asymptomatic
- vaginal bleeding
Dx of Vaginal Cancer
- PAP
- biopsy
Tx of Vaginal Cancer
- radiation
- radical hysterectomy, upper vaginectomy, pelvic lymphadenectomy
Nabothian Cysts
- benign cervical tumor
- squamous cells cover columnar cells, which continue to secrete mucoid material
Polpys
- benign cervical tumors
- polypectomy if symptomatic or large
Role of HPV in Cervical Cancer
- infx with HPV is central factor
- HPV easily transmitted via sex
Why are PAP smears now every 3-5 years instead of yearly?
-precursor lesions precede invasive disease by 10 years so easy to catch in time to treat it and b/c most healthy women will clear HPV infx in 2 years
PAP Test
- collection of cervical cells using speculum
- detect cervical abnormalities
- want the report to say satisfactory for exam, transformation zone present
Transformation Zone
- junction of squamous and columnar cells on the cervix
- these are the least mature cells of cervix and more prone to metaplasia
- carcinoma usually arises in squamocolumnar junction or transformation zone
Screening Guidelines for PAP Test
- none under 21
- 21-29: cytology q3 years
- 30-65: cytology and HPV every 5 years or cytology alone every 3 years
- over 65: no screening if negative history
HPV
- precursor to cervical carcinoma
- most common types: 16, 18, 31, 45
Risk Factors for HPV
- multiple sex partners
- early age at first intercourse
- smoking
- immunocompromised
HPV Vaccination
- routine for boys and girls 11-12 years old
- catch up until age 26
Colposcopy
- microscopic guided evaluation with biopsy and endocervical curettage
- identify areas of dysplasia
- test for confirmation of PAP results
Cervical Carcinoma S/S
- asymptomatic
- watery vaginal discharge
- intermittent spotting
- postcoital bleeding
Dx of Cervical Carcinoma
- pap test
- colposcopy
- conization
Tx of Cervical Carcinoma
- conization of cervix (LEEP excision)
- hysterectomy
- lymph node dissection
- radiation therapy
- chemotherapy
Uterine Leiomyoma (Fibroids)
- localized proliferation of smooth muscle cells
- benign
- pt presents with abnormal bleeding
- common in 50s
S/S of Uterine Leiomyoma (Fibroids)
- menorrhagia
- pelvic pressure
- secondary dysmenorrhea
- pelvic mass
Dx of Uterine Leiomyoma (Fibroids)
- clinical
- pelvic US
- endometrial biopsy to r/o carcinoma
Tx of Uterine Leiomyoma (Fibroids)
- reassurance, observation
- intermittent progestin
- myomectomy
- hysterectomy
- GnRH agonists
Uterine Leiomyoma (Fibroids) and Pregnancy
- usually associated w/ infertility
- 3cm: preterm labor, placental abruption, pelvic pain, C-section
- Tx with analgesics and bedrest
What is adenomyosis?
-disorder in which endometrial glands and stroma are present within uterine musculature
S/S of Adenomyosis
- menorrhagia
- dysmenorrhea
- enlarged uterus
Dx of Adenomyosis
- MRI
- histology from hysterectomy confirms
Tx of Adenomyosis
hysterectomy if significant symptoms
What are endometrial polyps and who gets them?
- focal, benign processes
- may be found in association with endometrial hyperplasia or carcinoma
- perimenopausal women
S/S of Endometrial Polyps
- abnormal bleeding
- pelvic pain
Dx of Endometrial Polyps
- ultrasound
- excision
- histology
Tx of Endometrial Polyps
-polypectomy if symptomatic
What is endometrial hyperplasia and what causes it?
- proliferation of endometrial glands
- due to excess estrogen: obesity, estrogen therapy w/o progestin, anovulation, ovarian tumors, nulliparity, older age, late menopause
S/S of Endometrial Hyperplasia
-abnormal uterine bleeding
Dx of Endometrial Hyperplasia
- endometrial biopsy
- transvaginal US
Tx of Endometrial Hyperplasia
- D&C
- cyclic progestins
- medroxyprogesterone
- progesterone intrauterine contraceptive
- hysterectomy after childbearing is complete
S/S of Endometrial Cancer
- postmenopausal bleeding
- vaginal dischare
- endometrial cells on cervical cytology
Tx of Endometrial CA
- hysterectomy
- high dose progestin
- advanced dz needs radiation and chemo
Symptoms of Benign Ovarian Cysts and Tumors
- asymptomatic
- mass
- pelvic pain
- dyspareunia
- dysmenorrhea
Dx of Benign Ovarian Masses
- pelvic exam
- US
- pathology
- CBC, UPT
When do theca lutein cysts occur and why?
- pregnancy
- overstimulation with high hCG levels
- usually bilateral and large
Mature Cystic Teratoma
-may contain teeth, hair, sebum, bone, skin
S/S of Ovarian Neoplasms
- abdominal fullness/bloating
- pelvic, abd, back pain
- early satiety, difficulty eating
- decreased energy
- urinary frequency
- irregular, fixed, solid pelvic mass
- asymptomatic or vague sxs = usually diagnosed late
Dx of Malignant Ovarian Neoplasms
-US and histopathology
Tx of Malignant Ovarian Neoplasms
TAH-BSO
Risks for Ovarian CA
- Caucasian
- nulliparous
- primary infertility
- endometriosis
Protective Factors for Ovarian CA
- OCP use
- breastfeeding
- multiparity
- tubal ligation
What might cause elevated CA-125 levels?
- CA: ovarian, endometrial, breast, colon
- endometriosis
- fibroids
- pregnancy
- PID
- liver dz, heart failure, renal dz
- diabetes, sarcoid, TB, ascites
What is the most deadly GYN cancer?
What is the most common malignant carcinoma?
- ovarian is most deadly
- malignant epithelial cell carcinoma is most common
Ovarian Torsion
- What is it?
- What can happen?
- twisting of ovary on ligamentous support impedes blood supply
- ovarian ischemia: necrosis, infarction, local hemorrhage, systemic infx
What increases the risk of ovarian torsion?
- ovarian cyst
- ovarian neoplasm
- pg
S/S of Ovarian Torsion
- acute pelvic pain
- N/V
- adnexal mass
- Dx of Ovarian Torsion
2. Tx of Ovarian Torsion
- CBC, electrolytes, US, surgical
2. surgery to preserve ovarian function
