Gyne Malignancies Flashcards
1
Q
Most lethal gyne malignancy
Fifth leading cause of death in women
Lifetime risk is 1:72
A
Ovarian cancer
2
Q
Most common ovarian cancer
A
Serous 80%
Endometrioid 10%
3
Q
Glandular epithelial lining of fallopian
A
Serous
4
Q
Walthard rest and bladder urothelium
A
Brenner
5
Q
Serous borderline
Low grade serous
Genetically stable
KRAS and BRAF
A
Type I serous
6
Q
Rapidly growing
Highyl agressive
P53
A
Type II Serous
7
Q
Rare serous carcinoma with massive psammoma body formation and low grade cytological feature
A
Psamomma ovarian
8
Q
Metastasis to breast colon appendicieal gastric and pancreatic termed as
Drop metastasis
Bilateral
A
Krukenberg tumor
9
Q
Rare ovarian tumor defined by presence of thyroid tissue
More than 50% of overall mass
A
Struma ovarii
10
Q
Risk factors for ovarian ca
A
Nulloparity
Obesity
Hormone replacement
11
Q
Only documented chemoprevention for ovsrian cancer
A
Oral contraceptive pill
12
Q
Vitamin A derivative for women with unilat breast ca to reduce risk of contralateral breast ca
A
Fenritidine
4-hydroxyretinoic acid
13
Q
Clear cell ovarian CA is related to chemical exposure to
A
DES
14
Q
Related to smoking
A
Mucinous carcinoma
15
Q
Precursor cell to serous ovarian ca
A
Fimbriae
16
Q
Serous tubular intraepithelial carcinoma related to
A
BRCA1 and BRCA2
17
Q
BRCA1 + lifetime risk
A
30-50%
Ch 17
18
Q
BRCA2 +
A
20-40% risk
Ch 14
19
Q
Colon, endometrial, ovarian and other malig
A
HNPCC
Lynch syndrome
20
Q
Most common presentation of epithelial ovarian ca
A
pelvic mass
21
Q
Abundant mucoid or gelatinous material in pelvis or abdominal cavity surrounded by fibrous tissue
A
Pseudomyxoma peritonei
22
Q
Elevated biomarker assoc with ovarian ca
Used in monitoring tx
A
CA 125
>200 96% PPV for malignancy
23
Q
Cystic mass >8cm in TV UTZ
A
Malignant
24
Q
Adnexal pelvic mass utz
A
Irregular border
Mult echofenjc pattern withhb mass
Dense multiple seltae
Biakteral
25
Ovarian ca dx
Ex lap with biopsy
26
Most common and earliest mode of ovarian ca dissemination
Transcoelomic
Lymphatic
Hematogenous
27
Stage 1
Confined to ovary
28
Stage 2
Pelvis
29
Stage 3
Intrabdomjnal spread
30
Stage IV
Spread outside abdomen
31
Ovarian ca tx
Unilat salpingo oophorectomy
Chemo: carboplatin + paclitaxel
Targeted: bevacizumab
Hormonal: tamoxifen and AI
32
Most common in 50-60
Mesenchymal component of the ovary
Low malignant potential
Unilateral solis mass
Ovarian sex cord tumor
| Stromal tumor
33
Ovarian sex cord presentation
Abd mass
Abd lain
Signs and sx due to hormonal production
34
Hirsutism
Viriluzation
Cushing
Sertoli-leydig tumor
35
Most conmon malignant germ cell 30-40%
Dysgerminoma
36
Feature of endodermal sinus tumor or yolk sac
| Glomerulus like tuft with central vascular core
Schiller Duval body
37
Henderson Peterson body
Molluscum contagiousum
38
Asteroid body
Sporotrichosis
39
Schuemann body
TB
40
Germ cell tx
BEP
Bleomycin
Etoposide
Cysplatin
41
Most common malignancy of female genital tract
Postmenopausal
Assoc with unopposed estrogen exposure
Endometrial ca
42
Endometrial ca precursor
Atypical endometrial hyperplasia
43
RF for endometrial ca
Nulliparity
HNPCC
LATE MENOPAUSE
Obesity
44
```
Younger perimenop
Hx of unopposed estrogen exposure
Hyperplastic endometrium
Better diff epithelium
Favorable prognosis
PTEN KRAS
```
Type I endometrial
45
```
Older postmenopausal
No estrogenic stim
Thin women
Atrophic endometrium
Less differentiates
P53 poor prognosis
```
Type II endometrial
46
Hyperplasia with greatest risk of progression to ca
Complex adenomatous with atypia 29%
| Simple cystic with atypia 8%
47
Endometrial ca presenting sx 90%
Vaginal bleeding or discharge
| Hematometria pyometria
48
First step in eval AUB
Endometrial aspiration biopsy
49
Transvaginal utz endometrial ca
Endometrial thickness >4mm
Polypoid endometrial mass
Collection of fluid within uterus
50
Most common cause of postmen bleeding
Endometrial atrophy 60-80
| ERT
51
Most common endometrial ca
Endometrioid adenoca 80%
| Mucinous carcinoma
52
Prognostic factors of endometrial ca
```
Age
histology
Myometrial invasion
Lymph invasion
Isthmus cervix extension
Adnexal involvement
LN metastasis
Tumor size
```
53
Endomet ca tx
TAHBSO
peritoneal cytology
LN dissection
Radio - EBT, vaginal vault radii
54
2nd most common cause of cancer in women
Assoc with HPV:
Cervical cancer
16 and 18
55
Rf for cervical ca
```
young age at intercourse <16
Multiple sex partner
Smoking
Race
High parity
Low socio
Chronic immunosup
```
56
Initiating event in cervical ca
cervical dysplasia and carcinogenesis
16 and 18 - 62%
99% SCC
57
Prevents cell cycle arrest and apoptosis
E6
| P53 inhibition
58
Unregulated cellular proliferation
Inhibition of Rb
| E7
59
Most common symptom of cervical ca
Postcoital bleeding
60
Most common histologic type of cervical ca
Invasive SCC
- large cell
- small cell
- verrucous
- papillary
Other: adeno, adenosqua
61
Poorly diff form of adenosquamous ca
| Poor dx is linked to understaging and resistance to radiotherapy
Glassy Cell carcinoma
62
Cervical stage I
Confined to cervix
63
Cervical stage II
Beyond cervix
Not to pelvic wall
Lower 1/3
64
Cervical Stage III
Pelvic wall
| Lower 1/3
65
Cervical sarcoma with grapelike polypoid nodules
| Recognition of rhabdomyoblast
Embryonal rhabdomyosarcoma
66
Cervical stage IV
bladder, adnexae etc
67
Uncommon
2-3% malignant neoplasm of genital
Assoc with HPV
Vaginal cancer
68
Vaginal ca most common site
Upper 1/3 of vagina on posterior wall
69
Precursor lesion
Vaginal intraepithelial neoplasm
70
Vaginal ca most common symptom
Painless vaginal bleeding/dc
71
Most common type of vaginal ca
squamous cell ca HPV16
Mean age: 60 years
Most are extension of cervical ca
72
Second most common vaginal ca
Malignant melanoma in lower 1/3 vagina
73
Rare
| Arise from wolffian rest element
Primary adenoca
74
DES exposure
Clear cell vaginal ca
75
Heterogenous group of interrelated lesion arising from abnormal proliferation of placental trophoblast
Gestational cancer
76
Maternal age more than has inc risk for complete mole
35 y/o
77
```
Absent fetal tissue
Diffuse hyda swelling of chorionic villi
Diffuse trophi hyperplasia
Scalloping of chorionic villi
Tropho
```
Complete H mole
78
Most common presentation of h mole
vaginal bleeding
79
3-5% of all gyne cancers
Assoc with HPV
most common histology
Vulvar ca
| SCC
80
Vulvar ca rf
HPV
HSV2
Smoking
81
2nd most common vulvar ca
Prognosis:
Clark and Beslow classification
Tx
Melanoma
0.76 mm
Excision
Radical local with 2cm margin
82
Extra mammary disease
80% intraepithelial no invasion
Mc site of spread:
Paget’s red lesion
Inguinal LN
Postmenopausal
Sx: pruritus, vulvar soreness
83
Paget’s disease of vulva pathognomonic
Eczematoid lesion
30% association with another primary neoplasm
Postmenopausal
84
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
new primary lesion
85
Malignant melanoms are found in
RF
Most common lethal recurrence
Lower 3rd of vagina
White women
Hematogenous spread
86
97% of clear cell adenocarcinoma is related to
Site
vaginal adenosis
Upper 3rd Anterior wall of vagina and exocervix
Mean age: 19 y/o
87
Most common histologic abnormality in women exposed to DES
Red grapelike cluster
Presence of persistent mullerian type glandular epithelium
Vaginal adenosis
88
Most common malignant mesenchymal tumor in vagina of children and infants
Botryoid
89
Cervical pap smear finding
Elderly with lack of estrogrn and progesterone
Atrophic smear with parabasal cell and inflammation
90
```
Obese young
Infertility
Oligomenorrhea
Hirsutism
Some with insulin resistance
High level of estrone -> inc endometrial ca
```
PCOS
91
Inc risk for CAD
Raven’s syndrome
| Metabolic syndrome
92
Lesions of ovary
Physiologic cyst
Endometriotic cyst
Neoplastic tumor
Secondary metastatic
93
2nd most common malignancy of female genital tract
Ninth most common cancer
High case fatality
Inc age esp at 50
Ovarian cancer
94
Most common ovarian cancer
Epithelial ovarian cancer
Germ cell tumor 2nd
Sex cord stromal
95
Glycoprotein secreted by EOC cells
except mucinous
Cannot be used for screening but in treatment
Present in benign disorders
Serum Ca 125
96
```
Abd discomfort
Swelling
Fullness
Early satiety
Enlargement of abdominal girth
Ascites
Nodularity of rectovaginal septum
```
Ovarian ca symptoms
97
Epithelial stromal ovarian neoplasm
Mullerian-derived epithelium
Serous
Mucinous
Endometrioid
Clear cell
Brenner
98
Most common malignant ovarian
Columnar ciliated and nonciliated epithelial cell filled with clear serous fluid (tubal like epithelium)
Serous CA
99
Less common than serous 30%
Midline adult life
80% benign or borderline
Gene mutation:
Mucinous tumor
KRAS protooncogene
100
Pseudomyxoma peritonei is extra ovarian and originates in the
appendix
presence of bilateral mucinous tumor req exclusion of non ovarian origin
101
Ovarian fibroma
| Pleural effusion
Meigs syndrome
102
Only documented form of chemoprevention for ovarian ca
OCP
103
Most common malignancy of female genital tract
Endometrial carcinoma
