GYN Oncology- Vulvar Neoplasia, Ovarian cancer

Question 1

What is VIN?

Answer 1

Vulvar intraepithelial neoplasia
High risk disease
Vulvar HSIL

Question 2

What are the categories of VIN?

Answer 2

Differentiated VIN
or
Usual type VIN

Question 3

What is differentiated VIN?

Answer 3

Not associated with HPV
Associated with dermatologic conditions

Question 4

What is usual type VIN?

Answer 4

Associated with carcinogenic genotypes of HPV, smoking and immunosuppression

Question 5

What is the treatment for VIN?

Answer 5

1. Wider local excision
2. Laser ablation
3. medical therapy

Question 6

What is the follow up after treatment for VIN?

Answer 6

Surveillance at 6 and 12 months and then yearly

Question 7

In the case of genital warts when should you perform a biopsy?

Answer 7

If patient is menopausal
or
In any patient in which topical therapy fails

Question 8

How many stages of ovarian cancer are there?

Answer 8

4 stages

Question 9

What is stage 1 ovarian cancer?

Answer 9

Confined to 1 or both ovaries or fallopian tubes

Question 10

What is stage 2 ovarian cancer?

Answer 10

Spread to pelvis below pelvic brim or primary peritoneal cancer

Question 11

What is stage 3 ovarian cancer?

Answer 11

Peritoneal metastasis outside pelvic or positive retroperitoneal nodes

Question 12

What is stage 4 ovarian cancer?

Answer 12

Distant metastasis

Question 13

What are the features of a benign adnexal mass?

Answer 13

1. Younger age
2. Unilateral
3. Size <6cm
4. No solid component
5. No septation
6. Not complex

Question 14

What are the features of a malignant adnexal mass?

Answer 14

1. Persistent
2. Older age
3. Solid
4. Papillary projections
5. Increased septations
6. Increased complexity
7. Size >10 cm
8. Bilateral

Question 15

What is the management for a simple adnexal mass?

Answer 15

Can observe no matter if pre or post menopause.

Question 16

What is the differential diagnosis for solid adnexal mass?

Answer 16

1. Fibroid
2. Thecoma
3. Fibroma
4. Brenner
5. Granulosa cell tumor
6. Dysgerminoma

Question 17

What is the differential diagnosis for cystic adnexal mass?

Answer 17

1. Functional cysts
2. Serous and mucinous tumors
3. Mature cystic teratoma

Question 18

What can cause a false positive Ca125?

Answer 18

Appendicitis
Cholecystitis
PID
Fibroids
Endometriosis
Diverticulosis

Question 19

What is Ca125 a marker for?

Answer 19

Serous epithelial tumors

Question 20

What can cause a false negative Ca125?

Answer 20

Nonepithelial ovarian tumor

Question 21

What is the tumor marker CEA representative of?

Answer 21

Mucinous epithelial tumors

Question 22

What is the tumor marker AFP representative of?

Answer 22

Endodermal sinus tumor
Embryonal tumors

Question 23

What is the tumor marker hCG representative of?

Answer 23

Choriocarcinoma
Embryonal carcinoma
dysgerminoma

Question 24

What is the tumor marker Estrogen representative of?

Answer 24

Granulosa cell tumor

Question 25

What adnexal masses has androgens as tumor marker?

Answer 25

Thecoma Fibroma Sertoli leydig cell

Question 26

What is the tumor marker inhibin representative of?

Answer 26

Granulosa cell tumor

Question 27

What is the tumor marker LDH representative of?

Answer 27

Dysgerminoma

Question 28

What tumor marker(s) does a dysgerminoma have?

Answer 28

hCG, LDH

Question 29

What tumor marker(s) does endodermal sinus tumor have?

Answer 29

AFP

Question 30

What tumor marker(s) does choriocarcinoma have?

Answer 30

hCG

Question 31

What tumor marker(s) does immature teratoma have?

Answer 31

AFP Ca125 LDH

Question 32

What tumor marker(s) does embryonal carcinoma have?

Answer 32

AFP, hCG

Question 33

What is representative of a borderline tumor?

Answer 33

Nuclear typia Epithelial stratification

Question 34

What is the order of work up for a postmenopausal patient with an adnexal mass?

Answer 34

1. History and Physical 2. Ultrasound 3. Tumor markers 4. Consider CT scan 5. Bowel prep 6. Surgery 7. Cytological lashings upon entry in abdomen 8. Frozen section 9. Definitive treatment for malignancy (hyst, BSO, omentectomy, lymphadenectomy, debulking

Question 35

What is a dysgerminoma?

Answer 35

Malignant ovarian germ cell tumor derived from the embryonic gonads

Question 36

What is the treatment of dysgerminoma?

Answer 36

Sensitive to radio and chemo therapy (BEP) Bleomycin, Etoposide, Cisplatin Surgery: Unilateral Salphingoopherectomy, limited staging, serial tumor markers

Question 37

What do you see on histology with granulosa cell tumor?

Answer 37

Call Exner bodies Coffee bean nuclei

Question 38

Ovarian cancers associated with underdeveloped or streaked gonads?

Answer 38

Gonadoblastoma Dysgerminoma