Benign and Malignant conditions of GU tract

Question 1

Lichen sclerosus

Answer 1

chronic inflam. likely autoimmune. chronic vulvar itching and pain, dysuria, dyspareunia, rectal bleeding may occur. Diffuse, thin, white, wrinkled skin localized to labia. punch bx to confirm and r/o malignancy. tx: topical steroids for 2-3 months and then weekly for maintenance

Question 2

Lichen simplex chronicus

Answer 2

lichenified skin reaction to chronic scratching. causes=atopic dermatitis (most common). worsens with heat, excessive sweating, clothing irritation, topical lotions or products. progressive pruritis and burning, red papules form lichenified, thickened, and scaly localized plaques.

Question 3

lichen planus

Answer 3

autoimmune inflammatory condition. intense chronic pruitis, insertional dyspareunia, post-coital bleeding, vulvar pain, vagina often involved. dx-clinical treatment topical steroids for vulvar lesions, intravaginal.

Question 4

psoriasis

Answer 4

scaly, silvery patch atop an erythematous base. dx bx tx is topical steroids.

Question 5

dermatitis

Answer 5

eczema (irritant, allergic and atopic) and seborrheic dermatitis. Dx clinical. Tx remove offending agent, topical steroids

Question 6

vaginal intraepithelial neoplasia (VAIN)

Answer 6

result of spread from another primary site. pap smear and colposcopy.

Question 7

vaginal cancer

Answer 7

types: squamous cell, adenocarcinoma, melanoma.
risk: hpv, vain, CIN
asymptomatic vag bleeding
dx: pap, bx
tx: radiation. radical hysterectomy, upper vaginectomy, pelvic lymphadenectomy

Question 8

nabothian cysts

Answer 8

squamous cells cover columnar cells which continue to secrete mucoid material. (benign)

Question 9

polyps

Answer 9

polypectomy if symptomatic, large, atypical. malignancy rare.

Question 10

pap test screening

Answer 10

younger than 21- no test
21-29 cytology alone every 3 years
30-65 co testing preferred (hpv and cytology) every 5 years OR cytology every 3 years
over 65 no screening needed if adequate negative hx regardless sex. activity.

Question 11

cervical carcinoma

Answer 11

asymptomatic, watery vaginal discharge, intermittent spotting, postcoital bleeding.

dx: pap test, colposcopy, conization
treatment: conization o the cervix, hysterectomy, lymph node dissection, raiation therapy, chemo

Question 12

cervical cancer prevention

Answer 12

sexual abstinence, barrier protection, regular gyn exams, cytologic screenings, treatment of precancerous lesions, hpv vaccine and education.

Question 13

Uterine leiomyoma (fibroids)

Answer 13

localized proliferation of smooth muscle cells. (usually 50s yo). can be present: cervix, broad ligament, peritoneal cavity.

Question 14

sxs, dx, tx of fibroids

Answer 14

estrogen responsive (increase with pg decrease with menopause). menorrhagia -iron def. anemia. pelvic pressure, secondary dysmenorrhea, pelvic mass.

dx: clincal, pelvic US, endometrial bx to r/o carcinoma.
tx: reassurance, observation, intermittent progestin, myomectomy, hysterectomy, GnRH agonists, uterine artery embolization

Question 15

adenomyosis

Answer 15

disorder in which endometrial glands and stroma are present within the uterine musculature. menorrhagia, dysmenorrhea, enlarged uterus. Dx: MRI, histology from hysterectomy confirms.
Tx: hysterectomy if significant sxs

Question 16

endometrial polyps

Answer 16

focal, benign. perimenopausal women. large polyp-protrude through cervix. abnormal bleeding, pelvic pain. US, excision and histology. polypectomy for sxs.

Question 17

endometrial hyperplasia

Answer 17

proliferation of endometrial glands due to excess estrogen exposure. 6 mos prolif becomes hyperplasia. 4-10 yrs hyperplasia progresses to carcinoma. abnormal uterine bleeding. dx is endometrial bx, transvaginal us. Dilation and curettage (D & C).

Question 18

endometrial cancer

Answer 18

postmenopausal women, most are symptomatic and dx in stage 1. postmenopausal bleeding, vag discharge, endometrial cells on cervical cytology. dx: endometrial bx, transvaginal US. physical and pelvic exam, pap smear. CA 125. Tx: hysterectomy, high-dose progestin, advanced disease-radiation and or chemo

Question 19

fallopian tube tumors

Answer 19

adenocarcinoma, asymptomatic postmenopausal bleeding, vag discharge. Tx: surgical.

Question 20

benign ovarian cysts and tumors

Answer 20

asymptomatic, mass, pelvic pain, dyspareunia, dysmenorrhea. Dx on pelvic exam, US, pathology, CBC UPT. tx based on dx. symptomatic removal.

Question 21

functional cysts

Answer 21

result of normal ovarian function. follicular cyst, corpus luteal cyst-pg. simple cyst.

Question 22

Theca luetin cyst

Answer 22

occurs in pg, result from overstimulation of high hCG level, usually bilateral and large, resolves without intervention.

Question 23

corpus hemorrhagicum

Answer 23

rupture into corpus luteum.

Question 24

benign ovarian tumors

Answer 24

mature cystic teratoma
endometrioma-chocolate cyst. growth of extopic endometrial tissue within ovary. Elevated CA 125 in premenopausal woman with adnexal mass.