WH- Vulvar/Ovarian Flashcards
EPITHELIAL ovarian CA
elevated CA-125
Bilateral
Older age
GERM cell ovarian CA
elevated hcg, AFP, LDH
Unilateral
Younger women
Pruritis
Usually POST menopausal
Lichen Schlerosus
if d/t trauma: Kobners phenomenom
sharp, well demarcated plaques
Lichen Schlerosus
Cellophane paper is pathognomic for
Lichen Schlerosus
Fragility (purpura, erosions, fissures) are hallmark for
Lichen Schlerosus
5% risk of Vulvar CA if left untreated bc Hyperkeratotic lesions can be PreCA
Lichen Schlerosus
Tx for Lichen Schlerosus
Ultrapotent Steroid ointment: Temovate
and Topical Estrogen
Bartholin Cyst
4 and 8oclock
1-3 cm
Unilateral acute pain
d/t ductal obstruction
Tx is I and D and insert Word catheter
Culture definitely if POST menopausal bc concerned about CA
Bartholin cyst
Empiric tx for Bartholin cyst
Keflex or
Doxy
and Sitz bath
Burning
Stinging
Pt is frustrated, hard to treat
Vulvodynia
Vulvodynia (burning) tends to occur in what age
Peri or Post menopausal
Associations w Vulvodynia
Estrogen
Pelvic floor dysfx
Mood/anxiety disorder
Neuro sensitive
Pain is triggered in the Vestibule for what disorder
Q tip test
Vulvodynia
Tx options for Vulvodynia (all over the place)
Avoid triggers (scents, tight clothes, vigorous exercise)
Sitz bath Couples counseling Topical vaginal estrogen w/Testosterone Pelvic floor Physical Therapy Nortriptyline Gabapentin Local nerve block
Vulvar Intraepithelial Neoplasia (VIN)
vinU: usual. younger
VinD: diff. older women
Vin 1 is likely to
resolve on its own
Vin U
mostly asymptomatic
ALWAYS associated with HPV
Younger women
Vin U
Risk factors: smoking, immunosupp, many sex partners
Dx: Vulvar Colposcopy
Vin U tx
Surgery is standard of care
Co2 laser- not if invasion is expected, Wide excision, Vulvectomy
Vin U tx
Med options (off label)
5FU
Imiquimod (Aldara)cream **
Interferon
What to consider with Vin U and Vin D
Vaccinate with Gardisil!!! up to age 45
Vin D
Not related to HPV
Lower 1/3 epithelium
Older women who previously had Lichen (untreate)
Vin D etiology
Undiff Carcinogenic agents combined w environment (ie chronically irritated)
Tx for Vin D
Handle underlying condition
Surgical excision-mainstay tx
4th most common GYN CA
Vulvar CA
Vulvar CA sx
usually none
if any: Prutitis
Vulvar CA is uncommon
10% have underlying DM
50% are obese/HTN
Bimodal peak of Vulvar CA
younger 20-40 (vinU related)
older 60-70 (vinD related)
Vulvar CA can present many diff ways
squamous, basal, malignant melanome
cauliflower
ulcers
rolled border
raised, dark lesion
Tx for Vulvar CA
Complete surgical removal with Inguinal node dissection
radiation if lymph spread
VIN
vulvar neoplasia
VAIN
vaginal neoplasia
VAIN
HPV must be present
upper 1/3 of vagina
extremely rare
35-55 YO
Dx of VAIN
Pap smear
Colposcopy
Tx of VAIN
type 1: observe
type 2/3: Surgical vs Chemo (vaginectomy, laser, topical 5FU/chemo)
If someone has VAIN, likely
pre-existing or coexisting squamous CA of vulva or cervix
VAIN takes longer to develop (HPV must be present) because
the vaginal tissue is different and HPV prefers the cervix
Vaginal CA usually arises from
METs
from: endometrium, breast, or cervix
can only be called Vaginal CA if this is the primary site
Vaginal CA
abnormal d/c (leukorrhea)
vaginal odor
post coital bleed
Acetowhite changes
Punctation
Tx of Vaginal CA
no standard since its so rare
Combined Vaginectomy and Radiation
Most common type of Vaginal CA
Squamous cell
PCOS
Infertility Oligo/Amenorrhea Acne Hirsutism Acanthosis nigricans
PCOS
Hyperinsulinemia
The following must be present to dx PCOS
Oligomenorrhea
High androgen
(+ polycystic ovaries as well for Rotterdam criteria)
Following must be excluded when dx PCOS
Hyperprolactin
CAH (congenital)
Cushings
What to start w when testing for PCOS
Testosterone
if normal: dx confirmed
if elevated: need to r/o other causes
US shows String of pearls
PCOS
Tx for PCOS
Weight loss!!!
Metformin
Birth control-COC
Provera (if dont want birth control, this is Prog to protect uterus)
NIH and
Rotterdam
criteria for PCOS
Concerning signs of CA in Adnexal Masses
Solid part looks Nodular or Papillary
Thick septation
Blood flow to solid part
Signs that Adnexal mass is prob BENIGN
thin walled <3 cm if pre meno <1 cm if post meno hyperechoic w distal shadowing (teratoma) curvilinear pattern (hemorrhagic cyst) homogenous echo
Most common type of ovarian cyst
Follicular
failure to release ovum or failure of leftover part to break down
regresses after 1-2 cycles
Corpus luteum cyst
Just blood if the extra blood doesnt resorb after ovulation and corpus luteum is >3cm, considered cyst
regresses after 1-2 cycles
Theca Lutein cyst
Bilateral
Usually seen during infertility tx when ovary is being Hyperstimulated
Fluid is clear and straw colored in what type of ovarian cyst
Theca Lutein
Originate from primordial germ cells
Unilateral
arise from Ectoderm usually
Unilateral, hypoechoic
Mature teratoma
Gel like mucous
Mucinous>serous
women 30-50 YO
can look bad on US, need to remove to be sure its Benign AND to avoid torsion
Serous/Mucinous Cystadenoma in the ovary
Tx of Serous/Mucinous cystadenoma
Surgical excision
2nd most common GYN CA
Ovarian CA
Highest incidence of Ovarian CA is age
65-75
Risk factors of Ovarian CA
Basically having menses for longer
Nulliparity
Early menses
Late menopause
Ovarian CA sx
Acute sx:
Pleural effusion
Bowel obstruction
Subacute: Adenxal mass Bloating Abd distension Early satiety Abn vaginal bleed Altered bowel habit
Dx of Ovarian CA
Transabdominal/Vaginal US
Epithelial ovarian CA
CA-125 marker
Germ Cell ovarian CA
hCG
AFP
LDH
Tx of Ovarian CA
Bilateral tubal ligation
Low fat diet
Bilateral salpingectomy
Most common type of Ovarian CA
Epithelial: High grade serous
Epithelial CA
Older age
Bilateral
High grade serous CA
p53 gene
Fallopian tube
CA starting here
Germ cell CA
Younger age
Unilateral
Germ Cell Ca
grow RAPIDLY
lymph spread
YOUNG women- 20-30 YO
hCG, AFP, LDH
Sex cord and Stromal ovarian CA
Granulosa cell (most common) causes Hyperestrogen –> precocious puberty or Post meno bleeding
