vulva, vagina, ovaries Flashcards
“cellophane paper” plaques
lichen sclerosus
fragility is the hallmark of this vulvar disorder
lichen sclerosus
where are you NOT going to see lichen sclerosus
keratinized, hair covered labia majora or mucus membranes
this vulvar disease has a higher incidence associated with hypothyroidism
lichen sclerosus
where are the bartholin cysts located
4 o’clock and 8 o’clock position adjacent to the introitus
word catheter
bartholin cyst treatment (plus I and D)
I and D with insertion of a word catheter
bartholin cyst
with vulvodynia, pain is limited to the
vestibule
which vulvar disorder gets treated with TCAs and gabapentin
vulvodynia
HPV types ___ and ___ are associated with VIN and CIN
16 and 18
with VINU, what is part of the mandatory treatment
colposcopy (because it is often associated with high grade CIN)
which VIN and CIN are related to HPV
usual types
which part of the epithelium does VIN-D affect
the lower 1/3 of epithelium
what is lichen sclerosus a risk factor for
SCC if left untreated
30-50% of women with vulvar cancer are ___ or ___ while 10% are ___
30-50% of women with vulvar cancer are OBESE or HYPERTENSIVE while 10% are DIABETIC
vulvar CA: large, exophytic cauliflower like lesion or small ulcerative lesions with surrounding hyperkeratosis
SCC
vulvar CA: raised lesions with ulcerated center and rolled borders
BCC
vulvar CA: darkly pigmented, raised lesions on the labia minora and clitoris
malignant melanoma
Vaginal Intraepithelial Neoplasia (VaIN) is directly caused by
HPV
in order to be called vaginal cancer, ____
but the most common cancer in the vaginal area is due to ____
in order to be called vaginal cancer, the vagina has to be the primary site of growth
but the most common cancer in the vaginal area is due to metastasis from the endometrium/ ovary/ cervix
infertility/ oligomenorrhea/ amenorrhea
hirsutism
acne
PCOS
Rotterdam criteria
PCOS
need 2/3 (oligomenorrhea, hirsutism, cystic ovaries)
string of pearls on US
PCOS
PCOS:
follicles: how many and what size
ovarian volume: how much
- follicles
- more than 12 per ovary
- 2 to 9 mm
- ovarian volume
- more than 10 mL
how do you treat the hyperinsulinemia assoc w/ PCOS
metformin 500 mg BID
how do you treat the infertility associated with PCOS
clomid
what tx of PCOS:
increases SHBG
decreases free testosterone
and restores predictive cycling
combo oral contraceptives
what is the main lifestyle change that needs to happen with PCOS
weight loss
people w/ PCOS are at increased risk of
endometrial hyperplasia/ CA
metabolic syndrome, T2DM
CVD, HTN, hyperlipidemia
infertility
stroke
sleep apnea
adnexal mass on US:
homogenous echos
benign:
endometrioma
adnexal mass on US:
thin walled
benign
adnexal mass on US:
hyperechoic nodule w/ distal acoustic shadowing
benign:
teratoma
network of linear/ curvilinear pattern
benign:
hemorrhagic cyst
adnexal mass on US:
under 3 cm in a premenopausal woman
under 1 cm in a post menopausal woman
benign:
simple cyst
adnexal mass on US:
thick septations > 2 mm
malignant
adnexal mass on US:
solid component appears nodular/ papillary
malignant
adnexal mass on US:
blood flow to solid component
malignant
most common benign ovarian cyst
follicular
these benign cysts are:
caused by a failure of the mature follicle to rupture and release its ovum
follicular cysts
(other cause is failure of the non-dominant follicles to undergo atresia in the presence of the mature follicle)
these benign cysts are:
caused by a failure of the non-dominant follicles to undergo atresia in the presence of the mature follicle
follicular cyst
(other cause is ailure of the mature follicle to rupture and release its ovum)
how long will it take follicular cysts to regress
1-2 menstrual cycles
these benign cysts are:
caused by blood accumulating in the corpus luteum cavity after ovulation
corpus luteum cysts
(normally this would be absorbed but if it does not and it is greater than 3 cm then it’s a cyst)
how long will it take for corpus luteum cysts to resolve
1-2 menstural cycles
these benign cysts are:
associated with elevated chorionic gonadotropin levels
due to hydatidiform mole, choriocarcinoma, clomid infertility therapy
theca lutein cysts
how long will it take for theca lutein cysts to resolve
spontaneously w/ tx of underlying disorder
most common benign cyst in young women of reproductive age
mature teratoma
these benign cysts are caused by:
originate from primordial germ cells
often found along the germ cell migration pathway from the yolk sac to the gonads
composed of tissue from any of the 3 germ layers
mature teratoma
mature teratomas are lined with keratinized squamous epithelium and have abundant
glands
sebaceous and apocrine
what is the most common germ cell of origin in a mature teratoma
ectodermal
hair and teeth
mature teratoma tx
laparotomy or laparoscopy
ovarian cystectomy or oophorectomy
10% recurrence
these benign cysts are:
lined with columnar epithelium
secrete thick, gelatinous mucin
thin walled, uni/multilocular
serous/ mucionous cystadenoma
which are more common,
serous or mucinous cystadenomas
mucinous
serous/ mucinous cystadenoma treatment
surgical excision
ensure benign pathology
what factors increase the risk of ovarian CA
obesity
endometriosis
PCOS
BRCA1 or BRCA2 mutations
Lynch Syndrom (hereditary nonpolyposis colorectal CA)
more periods (nulliparity/ early menarche/ late menopause)
what factors decrease the risk of ovarian CA
decreased ovulation
pregnancy
breast feeding
oral contraceptives
abdominal distention
bloating
abdominal/ pelvic pain
ascites
abdominal masses
bowel obstruction
dyspareunia
sister mary joseph nodule
sxs of ovarian CA
high grade serous carcinoma
endometroids carcinoma
clear cell carcinoma
mucinous carcinoma
the subtypes of epithelial ovarian CA
dysgerminoma
endodermal sinus
immature teratoma
embryonal carcinoma
choriocarcinoma
subtypes of germ cell ovarian CA
granulosa cell
sertoli-stromal cell
subtypes of sex cord and stromal ovarian CA
where do neoplasms that metastasize to the ovary usually originate
stomach
colon
breast
this epithelial ovarian CA arises from the fallopian tube from the p53 suppressor gene
high grade serous carcinoma
(70-80%)
these epithelial ovarian CA are caused by ovarian trauma due to repeated follicular rupture and repair ⇒ malignant transformation
endometroid carcinoma
clear cell carcinoma
mucinous carcinoma
these ovarian CA tend to
grow rapidly
favor lymphatic spread
contain mixture of tumor types
typically unilateral
germ cell ovarian CA
a choriocarcinoma is made of
placental tissue
(pluripotent germ cell CA)
a dysgerminoma is made of
oocytes
(a pleuripotent germ cell CA)
an endodermal sinus tumor is made of
yolk sac
(a pleuripotent germ cell CA)
most common germ cell ovarian CA
typically unilateral
typically occur in women under 30
dysgerminoma
most common germ cell ovarian CA in children
the most rapidly growing germ cell tumor
bilateral
endodermal sinus tumor
aka
yolk sac tumor
which germ cell ovarian CA’s produce alpha fetoprotein
endodermal sinus tumor
immature teratoma
embryonal carcinoma
which germ cell ovarian CAs produce HCG
embryonal
choriocarcinoma
2nd most common type of germ cell ovarian CA
seen mostly in females under 20
immature teratoma
this uncommon germ cell ovarian CA has rapid growth, extensive spread, and produces alpha fetoprotein and HCG
embryonal carcinoma
which germ cell ovarian CA are often bilateral
endoermal sinus tumor
aka
yolk sac tumor
germ cell ovarian CA can be a combination of
dysgerminoma
endodermal sinus tumor
immature teratoma
which germ cell ovarian CA that is presents most commonly in teenage years and is associated with precocious puberty, uterine bleeding, or amenorrhea
choriocarcinoma
which sex cord stromal ovarian CA causes hyperandrogenism and is often seen in females in their 20’s or 30s
sertoli-stromal cell
which sex cord stromal ovarian CA causes hyperestrogenism, is often seen in females in their 40s, and is associated with precocious puberty, breast tenderness, and post-menopausal bleeding
granulosa cell
call exner bodies
granulosa cell
(sex cord stromal ovarian CA)
reinke crystals
sertoli leydig cell
sex cord stromal ovarian CA
schiller duval breasts
(rings of cells around a central blood vessel)
endodermal sinus
germ cell ovarian tumor
which ovarian CAs have
pleural effusion
bowel obstruction, early satiety, bloating, abdominal distention, dyspepsia, ascites
inguinal lymphadenopathy, pelvic mass, pelvic mass,
sex cord stromal ovarian CA
this type of ovarian CA is benign and made of fibroblast cells that can grow to be large
presents with
ascites and pleural effusion caused by Meigs syndrome
pulling sensation in the groin caused by compressed round ligament
fibroma
meigs syndrome
seen in fibromas (benign sex cord stromal ovarian CA)
the tumor irritates the peritoneal and pleural surfaces causing ascites and pleural effusion
if the CA-125 is elevated, what type of ovarian CA do you suspect
epithelial ovarian CA
> 65
if the hCG, AFP, or LDH is elevated, what type of ovarian CA do you suspect
germ cell ovarian CA
epithelial ovarian CA are often associated with ____ age while germ cell ovarian CA are often associated with ___ age
epithelial- older
germ cell- younger
epithelial ovarian CA are often ____ (side) while germ cell ovarian CA are often ____
epithelial- bilateral
germ cell- unilateral (except yolk sac)
