GYN Oncology- Vulvar Neoplasia, Ovarian cancer Flashcards
What is VIN?
Vulvar intraepithelial neoplasia
High risk disease
Vulvar HSIL
What are the categories of VIN?
Differentiated VIN
or
Usual type VIN
What is differentiated VIN?
Not associated with HPV
Associated with dermatologic conditions
What is usual type VIN?
Associated with carcinogenic genotypes of HPV, smoking and immunosuppression
What is the treatment for VIN?
- Wider local excision
- Laser ablation
- medical therapy
What is the follow up after treatment for VIN?
Surveillance at 6 and 12 months and then yearly
In the case of genital warts when should you perform a biopsy?
If patient is menopausal
or
In any patient in which topical therapy fails
How many stages of ovarian cancer are there?
4 stages
What is stage 1 ovarian cancer?
Confined to 1 or both ovaries or fallopian tubes
What is stage 2 ovarian cancer?
Spread to pelvis below pelvic brim or primary peritoneal cancer
What is stage 3 ovarian cancer?
Peritoneal metastasis outside pelvic or positive retroperitoneal nodes
What is stage 4 ovarian cancer?
Distant metastasis
What are the features of a benign adnexal mass?
- Younger age
- Unilateral
- Size <6cm
- No solid component
- No septation
- Not complex
What are the features of a malignant adnexal mass?
- Persistent
- Older age
- Solid
- Papillary projections
- Increased septations
- Increased complexity
- Size >10 cm
- Bilateral
What is the management for a simple adnexal mass?
Can observe no matter if pre or post menopause.
What is the differential diagnosis for solid adnexal mass?
- Fibroid
- Thecoma
- Fibroma
- Brenner
- Granulosa cell tumor
- Dysgerminoma
What is the differential diagnosis for cystic adnexal mass?
- Functional cysts
- Serous and mucinous tumors
- Mature cystic teratoma
What can cause a false positive Ca125?
Appendicitis
Cholecystitis
PID
Fibroids
Endometriosis
Diverticulosis
What is Ca125 a marker for?
Serous epithelial tumors
What can cause a false negative Ca125?
Nonepithelial ovarian tumor
What is the tumor marker CEA representative of?
Mucinous epithelial tumors
What is the tumor marker AFP representative of?
Endodermal sinus tumor
Embryonal tumors
What is the tumor marker hCG representative of?
Choriocarcinoma
Embryonal carcinoma
dysgerminoma
What is the tumor marker Estrogen representative of?
Granulosa cell tumor
What adnexal masses has androgens as tumor marker?
Thecoma
Fibroma
Sertoli leydig cell
What is the tumor marker inhibin representative of?
Granulosa cell tumor
What is the tumor marker LDH representative of?
Dysgerminoma
What tumor marker(s) does a dysgerminoma have?
hCG, LDH
What tumor marker(s) does endodermal sinus tumor have?
AFP
What tumor marker(s) does choriocarcinoma have?
hCG
What tumor marker(s) does immature teratoma have?
AFP
Ca125
LDH
What tumor marker(s) does embryonal carcinoma have?
AFP, hCG
What is representative of a borderline tumor?
Nuclear typia
Epithelial stratification
What is the order of work up for a postmenopausal patient with an adnexal mass?
- History and Physical
- Ultrasound
- Tumor markers
- Consider CT scan
- Bowel prep
- Surgery
- Cytological lashings upon entry in abdomen
- Frozen section
- Definitive treatment for malignancy (hyst, BSO, omentectomy, lymphadenectomy, debulking
What is a dysgerminoma?
Malignant ovarian germ cell tumor derived from the embryonic gonads
What is the treatment of dysgerminoma?
Sensitive to radio and chemo therapy (BEP) Bleomycin, Etoposide, Cisplatin
Surgery: Unilateral Salphingoopherectomy, limited staging, serial tumor markers
What do you see on histology with granulosa cell tumor?
Call Exner bodies
Coffee bean nuclei
Ovarian cancers associated with underdeveloped or streaked gonads?
Gonadoblastoma
Dysgerminoma
