prognosis

Question 1

HSV

Answer 1

high mortality rt

Question 2

lichen sclerosis leukoplakia

Answer 2

incr risk SCC of vulva

Question 3

VIN (vulvar intraepithelial neoplasia)

Answer 3

• spont regression

- progresses to invasive carcinoma in females > 45 yrs or immunocompromised. (basaloid and warty)

Question 4

keratinizing scc of vulva

Answer 4

prognosis related to tumor size, depth of invasion and involvement of lymph vessels.

 Lesions < 2cm = 90% 5 yr survival after tx with vulvectomy + ladectomy.
 Larger lesions w involved LNs have worse prognosis

Question 5

DES-related vaginal adenosis

Answer 5

can lead to clear cell carcinoma of vagina

Question 6

extramammary paget dis

Answer 6

o May remain intraepidermal for yrs and not invade or metastasize.
o Invasion = poor prognosis.

Question 7

Embryonal Rhabdomyosarcoma (sarcoma bortyoides)

Answer 7

-invade locally –> death via penetratio peritoneal cavity or obs urinary tract

Question 8

neuroendocrine carcinoma of cervix

Answer 8

poor

Question 9

carcinoma of cervix

Answer 9

oPts tend to die from consequences of local tumor invasion (ureteral obstruction, pyelonephritis, uremia).
o100% 5 yr survival for microinvasive carcinomas.
o< 50% 5 yr survival for tumors extending beyond the pelvis.
–50% are detected in females w/o regular screenings.

Question 10

endometriosis with PTEN ARID1A

Answer 10

increased risk of ovarian and endometrioid and clear cell types

Question 11

endometrial polyps

Answer 11

rarely give rise to adenocarcinoma, can be malig

Question 12

nonatypical endomeriod hyperplasia

Answer 12

• if estrogen withdrawn –>cystic atrophy

- rarely progress to aenocarcinoma

Question 13

-Type 2 endometrial serous carcinoma

Answer 13

• if bleeding, good bc usu catch early
• Propensity for extrauterine spread.
• 18-27% 5 yr survival even if confined to the uterus, 80% recurrence.

Question 14

Types 1 and 2 endometrial carcinoma

Answer 14

-based on depth/stage at prsentaiton
-Stage I (grade 1 or 2): 90% 5 yr survival.
•–Tx w surgery +/- irradiation.
-Stage I (grade 3): 75% 5 yr survival.
-Stage II or III: < 50% 5 yr survival

Question 15

Malignant Mixed Mullerian Tumors (MMMTS) (carcinosarcomas)

Answer 15

o Prognosis based on depth of invasion and stage.
o If tumor has a heterologous mesenchymal component = worse than those who do not.
o 25-30% 5 yr survival for high-stage dz.

Question 16

Leiomyosarcoma

Answer 16

o 40% 5 yr survival.
o Anaplastic lesions: 10-15% 5 yr survival.
o Often recur after surgery

Question 17

serous tumors of ovary (mullerian epithelium)

Answer 17

 Prognosis and tx depend on pathologic classification as both low & high grade may extend to the peritoneum.
 Borderline & malignant, confined to the ovary: 100% & 70% 5 yr survival.
 Borderline & malignant, spread to the peritoneum: 90%, 25% 5 yr survival.

Question 18

mucinous tumors of ovary (mullerian epithelium)

Answer 18

 95% 5 yr survival for stage I, noninvasive.
 90% 5 yr survival for invasive malignant tumors.
 Fatal if spread beyond the ovary.

Question 19

Pseudomyxoma Peritonei

Answer 19

intestinal obstruction and death if extensive

Question 20

endometriod tumors of ovary (mullerian epithelium)

Answer 20

75% 5 yr survival (stage I).

Question 21

clear cell carcinoma of ovary (mullerian epithelium)

Answer 21

 90% 5 yr survival if confined to the ovaries.

 Poor outcome if advanced

Question 22

immature malignant teratoma of ovary

Answer 22

• Stage I, grade 1 = excellent prognosis.
• Prophylactic chemo if higher grade yet confined to the ovary.
• Recurrences occur in first 2 yrs.
• Longer absence = excellent chance of cure.

Question 23

dysgerminoma of ovary

Answer 23

 Excellent prognosis with salpingooophorectomy if seen only in the ovary.
 80% survival in those extended beyond ovary

Question 24

yolk sac tumor of ovary

Answer 24

80% survival with chemo regardless of dz stage.

Question 25

granulosa cell tumor of ovary

Answer 25

 85% 10 yr survival.

 If predominantly composed of theca cells it is unlikely to be malignant.

Question 26

gonadoblastoma

Answer 26

excellent if excised

Question 27

complete mole

Answer 27

o 2.5% risk of choriocarcinoma.

o 15% risk of persistent or invasive mole.

Question 28

partial mole

Answer 28

o ↑ risk of persistent molar dz.

o Not associated with choriocarcinoma

Question 29

choriocarcinoma

Answer 29

o Evacuation of uterine contents + chemo.
o 100% remission and high cure rate.
o Cured pts can have subsequent normal pregnancies and deliveries

Question 30

Placental Site Trophoblastic Tumor (PSTT)

Answer 30

• Localized dz = excellent prognosis.

* Dissminated dz = 10-15% mortality.