The Ovaries and Vagina Flashcards
1
Q
Ovarian epithelial tumours
A
- Accounts for 65% of all ovarian tumours and 95% of malignant ovarian tumours.
- Derived from the covering of the ovary.
- Commonly seen in postmenopausal women.
2
Q
Ovarian Epithelial Tumours - Examples
A
- Serous adenocarcinoma - the malignant form is most common malignant ovarian tumour (50%).
- Mucinous adenocarcinoma - can be very large but less commonly malignant - account for 10%.
- Endometroid carcinoma - the malignant varient accounts for 25% of ovarian malignancies.
- Clear cell carcinoma - malignant varient accounts for <10% but has a very poor prognosis.
3
Q
Germ Cell Tumours
A
- Originate from undifferentiated primordial germ cells of the gonad.
- Teratoma or dermoid cyst - common benign tumour seen in young premenopausal women. Can contain hair and teet.
- Dysgerminoma - the female equivalent of seminoma - most common ovarian malignancy in young women.
4
Q
Sex Cord Tumours
A
- Originate from stroma of the gonad.
- Granulosa cell tumour - usually malignant but slow growing - found in postmenopausal women.
- Thecomas - very rare and usually benign.
- Fibromas - rare and benign - can cause Meig’s syndrome with ascites and pleural effusion.
5
Q
Ovarian Carcinoma
A
- Often present late so often poor prognosis.
- 85% of cases occur women >50 years of age.
- >90% epithelial cell tumours but germ cell tumours are most common in women <30 years.
6
Q
Ovarian Ca - Risk Factors
A
- Higher risk with increased number of ovulations - early menarche, late menopause, nulliparity.
- Protective factors include pregnancy, lactation and use of the cocp.
- 5% of cases are familial - BRCA1, BRCA2 or HNPCC mutations increase the risk.
7
Q
Ovarian Ca - Features
A
- Often asymptomatic to begin with.
- Can cause abdominal distension, mass or occasionally pelvic pain or abnormal bleeding.
- CA125 is raised in 80% of cases.
8
Q
Ovarian Ca - Staging
A
- Disease is confined to the ovaries.
- Confined to the pelvis.
- Disease is confined to the abdomen.
- Spread beyond the abdomen.
9
Q
Ovarian Ca - Mx
A
Total abdominal hysterectomy with bilateral salpingo-oophrectomy followed by chemotherapy - increases 5 year survival from 74% to 82%.
10
Q
Lichen Simplex
A
- Vulval itching and soreness - the area is inflamed, thickened with hypo or hyperpigmentation.
- Mx - irritant avoidance, regular emollient, moderate strength steroid cream or antihistamine.
11
Q
Lichen Planus
A
- Irritation with flat, papular, purple lesions on the anogenital region.
- Can also affect hair, nails and mucous membranes.
- Mx - high potency steroid creams.
12
Q
Lichen Sclerosis
A
- The vulval epithelium is thin with loss of collagen and there is pruritis and soreness.
- Can have an autoimmune basis and be associated with vitiligo or thyroid disease.
- Ix - biopsy as vulval ca occurs in 5%.
- Mx - high potency steroid cream.
13
Q
Bartholin’s gland cyst or abscess
A
- Two glands behind the labia minora that secrete lubrication for coitus.
- Blockage of the duct causes cyst formation.
- Infection with staph or E coli can occur and lead to an abscess - painful and tender swelling.
- Mx - incision and drainage.
14
Q
VIN - Vulval Intraepithelial Neoplasia
A
- HPV responsible in women <45 years of age otherwise secondary to lichen sclerosis.
- Mx - local excision, laser therapy or immunomodulators e.g. Imiquimod.
- Reoccurance rate is 30%.
- Annual risk of vulval carcinoma os 10% is untreated and between 2-5% if treated.
15
Q
Vulval Carcinoma
A
- Accounts for 5% of genital tract malignancies.
- 95% are squamous cell tumours.
- Risk factors - lichen sclerosis, smoking, immunosupression or Pagets disease.
