GYN Neoplasms Flashcards
What is a uterine Leiomyoma?
Benign smooth muscle tumor
What is the course of a uterine Leiomyoma? Why?
They may be symptomatic until menopause and then they will shrink and be asymptomatic because they are hormone sensitive
What are some possible symptoms of uterine Leiomyomata?
- Heavier bleeding
- Pelvic pressure
- Constipation/Urinary retention
How will the uterus feel on examination with uterine Leiomyomata? What diagnostic can you obtain?
Irregularly enlarged uterus
–> TVUS
What medications and surgeries can you try for symptomatic uterine leiomyomas?
Medications:
- OCPs/Medroxyprogesterone and NSAIDs
Surgeries:
- Myomectomy or Hysterectomy
What is the malignant form of a uterine fibroid?
Leiomyosarcoma
Type 1 and Type 2 Endometrial cancers are what?
Type 1 = Endometrioid
Type 2 = Serous/Mucinous
How does Type 1 Endometrial cancer arise usually?
Type 1 = Endometrioid
–> UNOPPOSED ESTROGEN
What are some protective factors against Endometrial Cancer type 1?
OCPs
Multiparity
Progestins
Breast feeding
What mutations are often present with Type 2 Endometrial cancer?
Type 2 = Serous/Mucinous
=> P53, PTEN, BRCA genes
How will Endometrial cancer present?
Post-menopausal bleeding or intermenstrual/heavier bleeding in premenopausal women
What 2 diagnostics should be obtained if you are concerned about Endometrial cancer?
TVUS – most often if premenopausal
Biopsy – especially if postmenopausal
An endometrial stripe > ____ mm is concerning for Endometrial hyperplasia/cancer
> 4 mm
What medication can be used for Endometrial Hyperplasia?
Progestins
What cells are normally found at the Endocervix? Ectocervix?
Endocervix = Columnar cells
Ectocervix = Squamous cells
What are some risk factors for Cervical cancer?
HPV 16/18
Tobacco use, HIV, STDs
Multiparity
How will Cervical cancer present?
Post-coital bleeding +/- heavier and IMB
HPV infection is often the cause of Cervical cancer. What cells may be present and what do they look like?
Koilocytes = bilobed nucleus + perinuclear halo
With a majority of abnormal pap smears, what is often done next?
Colposcopy +/- biopsy/endocervical curretage
If a patients pap result is ASC-US with a history of normal paps and (-) HPV, what is the workup?
Repeat pap in 1 year
If a patients pap result is ASC-US with a history of that on prior paps or they are HPV (+), what is the workup?
Colposcopy
If a patients pap result is ASC-Glandular, what is the workup?
Colposcopy + Endocervical curretage + Endometrial biopsy
If a patients pap result is ASC-H, LSIL, HSIL, what is the workup?
Colposcopy
What pap result is CIN1?
LSIL
What pap result is CIN2 and CIN3?
HSIL
What are some risk factors for Vulvar cancer?
HPV 16/18
Lichen Sclerosus and chronic irritation
Tobacco use
What are the symptoms/signs of Vulvar cancer?
Ulceration/mass
Itching and pain
What is the workup for possible Vulvar cancer?
Punch biopsy
How does Lichen Sclerosus present?
Whitening and thinning of the vulvar skin with itching and pain usually
What is the treatment for Lichen Sclerosus?
Topical corticosteroids
If a woman has Clear Cell Vaginal carcinoma, what what she exposed to?
DES
What are some risk factors for Vaginal cancer?
HPV 16/18
Chronic irritation
Tobacco use
DES exposure
Ovarian cancers can often be asymptomatic. What features on US are concerning?
Solid mass with thick septations
+/- ascites
What is the tumor marker for Epithelial Ovarian Carcinoma?
CA-125
What is the tumor marker for a Yolk Sac (Endodermal Sinus) ovarian tumor?
AFP
If there is a high AFP and concern for an Ovarian mass, what may be seen on histology?
Schiller Duval bodies – looks like glomerulus
= Yolk Sac/Endodermal Sinus tumor
What is the tumor marker for a Choriocarcinoma?
Beta-hCG
What is the tumor marker for a Dysgerminoma at the ovary?
LDH
If there is a high LDH and concern for an ovarian mass, what cells may be seen on histology?
Fried egg cells
= Dysgerminoma
What is the tumor marker and hormone elevated with Granulosa Theca cell ovarian tumors?
Inhibin
Estrogen
If there is high Inhibin and concern for an ovarian mass, what cells may be seen on histology?
Call-Exner bodies
= Granulosa theca cell tumor
Granulosa theca cell tumors produce what hormone which may cause physical signs?
Estrogen!
Sertoli-Leydig tumors at the ovaries often produce what hormone?
Testosterone!
If a patient has an ovarian mass with high testosterone and NORMAL DHEAS, what may be seen on histology?
Reinke crystals
= Sertoli-Leydig tumor
List some signs in a female of a Sertoli-Leydig tumor
Hirsutism
Acne
Deep voice
Clitoromegaly
Menstrual changes
