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Obstetrics and Gynecology > Gyne Malignancies > Flashcards

Gyne Malignancies Flashcards

1
Q

Most lethal gyne malignancy

Fifth leading cause of death in women

Lifetime risk is 1:72

A

Ovarian cancer

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2
Q

Most common ovarian cancer

A

Serous 80%

Endometrioid 10%

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3
Q

Glandular epithelial lining of fallopian

A

Serous

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4
Q

Walthard rest and bladder urothelium

A

Brenner

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5
Q

Serous borderline
Low grade serous
Genetically stable
KRAS and BRAF

A

Type I serous

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6
Q

Rapidly growing
Highyl agressive
P53

A

Type II Serous

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7
Q

Rare serous carcinoma with massive psammoma body formation and low grade cytological feature

A

Psamomma ovarian

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8
Q

Metastasis to breast colon appendicieal gastric and pancreatic termed as

Drop metastasis

Bilateral

A

Krukenberg tumor

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9
Q

Rare ovarian tumor defined by presence of thyroid tissue

More than 50% of overall mass

A

Struma ovarii

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10
Q

Risk factors for ovarian ca

A

Nulloparity
Obesity
Hormone replacement

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11
Q

Only documented chemoprevention for ovsrian cancer

A

Oral contraceptive pill

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12
Q

Vitamin A derivative for women with unilat breast ca to reduce risk of contralateral breast ca

A

Fenritidine

4-hydroxyretinoic acid

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13
Q

Clear cell ovarian CA is related to chemical exposure to

A

DES

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14
Q

Related to smoking

A

Mucinous carcinoma

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15
Q

Precursor cell to serous ovarian ca

A

Fimbriae

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16
Q

Serous tubular intraepithelial carcinoma related to

A

BRCA1 and BRCA2

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17
Q

BRCA1 + lifetime risk

A

30-50%

Ch 17

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18
Q

BRCA2 +

A

20-40% risk

Ch 14

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19
Q

Colon, endometrial, ovarian and other malig

A

HNPCC

Lynch syndrome

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20
Q

Most common presentation of epithelial ovarian ca

A

pelvic mass

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21
Q

Abundant mucoid or gelatinous material in pelvis or abdominal cavity surrounded by fibrous tissue

A

Pseudomyxoma peritonei

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22
Q

Elevated biomarker assoc with ovarian ca

Used in monitoring tx

A

CA 125

>200 96% PPV for malignancy

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23
Q

Cystic mass >8cm in TV UTZ

A

Malignant

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24
Q

Adnexal pelvic mass utz

A

Irregular border
Mult echofenjc pattern withhb mass
Dense multiple seltae
Biakteral

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25
Q

Ovarian ca dx

A

Ex lap with biopsy

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26
Q

Most common and earliest mode of ovarian ca dissemination

A

Transcoelomic
Lymphatic
Hematogenous

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27
Q

Stage 1

A

Confined to ovary

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28
Q

Stage 2

A

Pelvis

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29
Q

Stage 3

A

Intrabdomjnal spread

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30
Q

Stage IV

A

Spread outside abdomen

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31
Q

Ovarian ca tx

A

Unilat salpingo oophorectomy

Chemo: carboplatin + paclitaxel

Targeted: bevacizumab

Hormonal: tamoxifen and AI

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32
Q

Most common in 50-60
Mesenchymal component of the ovary
Low malignant potential
Unilateral solis mass

A

Ovarian sex cord tumor

Stromal tumor

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33
Q

Ovarian sex cord presentation

A

Abd mass
Abd lain
Signs and sx due to hormonal production

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34
Q

Hirsutism
Viriluzation
Cushing

A

Sertoli-leydig tumor

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35
Q

Most conmon malignant germ cell 30-40%

A

Dysgerminoma

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36
Q

Feature of endodermal sinus tumor or yolk sac

Glomerulus like tuft with central vascular core

A

Schiller Duval body

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37
Q

Henderson Peterson body

A

Molluscum contagiousum

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38
Q

Asteroid body

A

Sporotrichosis

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39
Q

Schuemann body

A

TB

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40
Q

Germ cell tx

A

BEP

Bleomycin
Etoposide
Cysplatin

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41
Q

Most common malignancy of female genital tract

Postmenopausal

Assoc with unopposed estrogen exposure

A

Endometrial ca

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42
Q

Endometrial ca precursor

A

Atypical endometrial hyperplasia

43
Q

RF for endometrial ca

A

Nulliparity
HNPCC
LATE MENOPAUSE
Obesity

44
Q 
Younger perimenop
Hx of unopposed estrogen exposure
Hyperplastic endometrium 
Better diff epithelium
Favorable prognosis
PTEN KRAS
A

Type I endometrial

45
Q 
Older postmenopausal
No estrogenic stim
Thin women
Atrophic endometrium 
Less differentiates
P53 poor prognosis
A

Type II endometrial

46
Q

Hyperplasia with greatest risk of progression to ca

A

Complex adenomatous with atypia 29%

Simple cystic with atypia 8%

47
Q

Endometrial ca presenting sx 90%

A

Vaginal bleeding or discharge

Hematometria pyometria

48
Q

First step in eval AUB

A

Endometrial aspiration biopsy

49
Q

Transvaginal utz endometrial ca

A

Endometrial thickness >4mm
Polypoid endometrial mass
Collection of fluid within uterus

50
Q

Most common cause of postmen bleeding

A

Endometrial atrophy 60-80

ERT

51
Q

Most common endometrial ca

A

Endometrioid adenoca 80%

Mucinous carcinoma

52
Q

Prognostic factors of endometrial ca

A 
Age
histology
Myometrial invasion
Lymph invasion
Isthmus cervix extension
Adnexal involvement
LN metastasis
Tumor size
53
Q

Endomet ca tx

A

TAHBSO
peritoneal cytology
LN dissection

Radio - EBT, vaginal vault radii

54
Q

2nd most common cause of cancer in women

Assoc with HPV:

A

Cervical cancer

16 and 18

55
Q

Rf for cervical ca

A 
young age at intercourse <16
Multiple sex partner
Smoking
Race
High parity
Low socio
Chronic immunosup
56
Q

Initiating event in cervical ca

A

cervical dysplasia and carcinogenesis
16 and 18 - 62%
99% SCC

57
Q

Prevents cell cycle arrest and apoptosis

A

E6

P53 inhibition

58
Q

Unregulated cellular proliferation

A

Inhibition of Rb

E7

59
Q

Most common symptom of cervical ca

A

Postcoital bleeding

60
Q

Most common histologic type of cervical ca

A

Invasive SCC

  • large cell
  • small cell
  • verrucous
  • papillary

Other: adeno, adenosqua

61
Q

Poorly diff form of adenosquamous ca

Poor dx is linked to understaging and resistance to radiotherapy

A

Glassy Cell carcinoma

62
Q

Cervical stage I

A

Confined to cervix

63
Q

Cervical stage II

A

Beyond cervix
Not to pelvic wall
Lower 1/3

64
Q

Cervical Stage III

A

Pelvic wall

Lower 1/3

65
Q

Cervical sarcoma with grapelike polypoid nodules

Recognition of rhabdomyoblast

A

Embryonal rhabdomyosarcoma

66
Q

Cervical stage IV

A

bladder, adnexae etc

67
Q

Uncommon
2-3% malignant neoplasm of genital
Assoc with HPV

A

Vaginal cancer

68
Q

Vaginal ca most common site

A

Upper 1/3 of vagina on posterior wall

69
Q

Precursor lesion

A

Vaginal intraepithelial neoplasm

70
Q

Vaginal ca most common symptom

A

Painless vaginal bleeding/dc

71
Q

Most common type of vaginal ca

A

squamous cell ca HPV16

Mean age: 60 years

Most are extension of cervical ca

72
Q

Second most common vaginal ca

A

Malignant melanoma in lower 1/3 vagina

73
Q

Rare

Arise from wolffian rest element

A

Primary adenoca

74
Q

DES exposure

A

Clear cell vaginal ca

75
Q

Heterogenous group of interrelated lesion arising from abnormal proliferation of placental trophoblast

A

Gestational cancer

76
Q

Maternal age more than has inc risk for complete mole

77
Q 
Absent fetal tissue
Diffuse hyda swelling of chorionic villi
Diffuse trophi hyperplasia
Scalloping of chorionic villi
Tropho
A

Complete H mole

78
Q

Most common presentation of h mole

A

vaginal bleeding

79
Q

3-5% of all gyne cancers
Assoc with HPV
most common histology

A

Vulvar ca

SCC

80
Q

Vulvar ca rf

A

HPV
HSV2
Smoking

81
Q

2nd most common vulvar ca

Prognosis:
Clark and Beslow classification

Tx

A

Melanoma

0.76 mm

Excision

Radical local with 2cm margin

82
Q

Extra mammary disease
80% intraepithelial no invasion

Mc site of spread:

A

Paget’s red lesion

Inguinal LN
Postmenopausal

Sx: pruritus, vulvar soreness

83
Q

Paget’s disease of vulva pathognomonic

A

Eczematoid lesion

30% association with another primary neoplasm

Postmenopausal

84
Q

Assoc with HPV of cervical ca
30% with vaginal ca have hx of cervical

Any new vaginal ca developing at least 5 years after cervical ca should be considered

A

new primary lesion

85
Q

Malignant melanoms are found in

RF

Most common lethal recurrence

A

Lower 3rd of vagina

White women

Hematogenous spread

86
Q

97% of clear cell adenocarcinoma is related to

Site

A

vaginal adenosis

Upper 3rd Anterior wall of vagina and exocervix

Mean age: 19 y/o

87
Q

Most common histologic abnormality in women exposed to DES

Red grapelike cluster

Presence of persistent mullerian type glandular epithelium

A

Vaginal adenosis

88
Q

Most common malignant mesenchymal tumor in vagina of children and infants

89
Q

Cervical pap smear finding

Elderly with lack of estrogrn and progesterone

A

Atrophic smear with parabasal cell and inflammation

90
Q 
Obese young 
Infertility
Oligomenorrhea
Hirsutism
Some with insulin resistance
High level of estrone -> inc endometrial ca
91
Q

Inc risk for CAD

A

Raven’s syndrome

Metabolic syndrome

92
Q

Lesions of ovary

A

Physiologic cyst
Endometriotic cyst
Neoplastic tumor
Secondary metastatic

93
Q

2nd most common malignancy of female genital tract

Ninth most common cancer

High case fatality

Inc age esp at 50

A

Ovarian cancer

94
Q

Most common ovarian cancer

A

Epithelial ovarian cancer
Germ cell tumor 2nd
Sex cord stromal

95
Q

Glycoprotein secreted by EOC cells
except mucinous

Cannot be used for screening but in treatment

Present in benign disorders

A

Serum Ca 125

96
Q 
Abd discomfort
Swelling
Fullness
Early satiety
Enlargement of abdominal girth
Ascites
Nodularity of rectovaginal septum
A

Ovarian ca symptoms

97
Q

Epithelial stromal ovarian neoplasm

Mullerian-derived epithelium

A

Serous
Mucinous
Endometrioid
Clear cell

Brenner

98
Q

Most common malignant ovarian

Columnar ciliated and nonciliated epithelial cell filled with clear serous fluid (tubal like epithelium)

99
Q

Less common than serous 30%
Midline adult life
80% benign or borderline

Gene mutation:

A

Mucinous tumor

KRAS protooncogene

100
Q

Pseudomyxoma peritonei is extra ovarian and originates in the

A

appendix

presence of bilateral mucinous tumor req exclusion of non ovarian origin

101
Q

Ovarian fibroma

Pleural effusion

A

Meigs syndrome

102
Q

Only documented form of chemoprevention for ovarian ca

103
Q

Most common malignancy of female genital tract

A

Endometrial carcinoma

Obstetrics and Gynecology (18 decks)

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