VIN, Cervical disorders (Afsoon)

Question 1

Vulvar intraepithelial neoplasia (VIN)

Answer 1

Premalignant squamous lesions in vulva

Question 2

LSIL is associated with what HPV types

Answer 2

HPV 6 and 11

Question 3

HSIL is associated with what HPV types

Answer 3

HPV 16 and 18

Question 4

Risk factors for HSIL

Answer 4

• HPV infection
• Smoking
• Immunosuppression

Question 5

Tx HSIL

Answer 5

With lesion → surgical excision

No lesion → ablation

Question 6

Initial work up for atypical glandular cells (AGC)

Answer 6

Colposcopy + endocervical sampling

Add endometrial sampling if age 35+ or at risk for endometrial neoplasia

Question 7

Management of atypical glandular cells (AGC)

Answer 7

No CIN, AIS, or cancer → cotest at 12-24 months → cotest at 3 yrs (negative) or colposcopy (abnormal)

AGC or IAS → diagnostic excisional procedure

Question 8

Management of Cervical adenocarcinoma in situ (AIS)

Answer 8

Hysterectomy b/c only known precursor to cervical adenocarcinoma

Question 9

Dx AIS

Answer 9

Colposcopy-directed bx
Endocervical curettage
Conization

Question 10

Classify endometrial hyperplasia

Answer 10

• Hyperplasia without atypia

- Atypical hyperplasia (endometrial intraepithelial neoplasia)

Question 11

Presentation of endometrial hyperplasia

Answer 11

AUB

Question 12

Presentation of endometrial carcinoma

Answer 12

AUB

• Age <45 → abnormal AND persistent
• Age >45 to menopause → abnormal
• Postmenopausal → any bleeding

Question 13

Tx endometrial carcinoma

Answer 13

Low-risk → staging w/ total hysterectomy + bilat salpingooophorectomy + LN

Med. if fertility desired

Radiation if recurrent or metastatic

Question 14

______, _____, and _____ are considered single clinical entity in regards to ovarian cancer

Answer 14

• High-grade epithelial ovarian cancer
• Fallopian tubal
• Peritoneal carcinoma

Question 15

Risk factors for ovarian cancer

Answer 15

• Lynch
• BRCA mutation
• Age
• Infertility
• Endmetriosis
• PCOS
• Cigarette smoking

Question 16

Factors that decrease risk of ovarian cancer

Answer 16

• Previous pregnancy
• OCP
• Breastfeeding

Question 17

Early sx’s of ovarian cancer

Answer 17

Bloating
Nausea
Early satiety d/t ascites and bowel mets

Pelvic or abdominal pain

Question 18

Significance of cervical transformation zone

Answer 18

• Primary site of HPV infection

- Site of cervical neoplasia

Question 19

HPV molecular mechanisms

Answer 19

• Latent infection → no physical, cytologic, or histologic manifestations b/c not actively replication
• Active infection → replication but no integration into genome; cytologic abnormalities
• Neoplastic transformation → integration into host genome

Question 20

Important factor in early stages following HPV infection

Answer 20

Pt’s susceptibility to oncogenic HPV types, determined by immune system

Question 21

4 major steps of cervical cancer development

Answer 21

1. Oncogenic HPV infection at cervical T-zone
2. Persistence
3. Progression to pre-cancer
4. Carcinoma & invasion through basement membrane