Gynecologic Disease

Question 1

1. What is Vulvitis and what are 4 causes of Vulvitis?

Answer 1

Vulvitis : Inflammation of external female genitalia
Causes : a. Traumatic injury (scratching-induced)
b. Allergic reaction
c. Infection (Candida albicans)
d. Contact irritants (soaps, perfumes, etc)

• T A I C

Question 2

2. What is Vaginitis and pathogens frequently associated with it?

Answer 2

Vaginitis : Inflammation of the vaginal canal
Pathogens : a. Candida albicans
b. Trichomas vaginalis

• pathogens that cause are normal commensal organisms
  but they become pathogenic due to diabetes, systemic antibiotic therapy or immunodeficiency

Question 3

3. What is Cervicitis and how would you diagnose Cervicitis?

Answer 3

Cervicitis : Inflammation of the cervix

Diagnosis: a. Biopsy (differentiate from cancer or STD)

Question 4

4. Cervicitis may be secondary to what 7 infections?

Answer 4

i. Candida albicans
ii. Trichomas vaginalis
iii. Chalmydia
iv. Gonorrhea
v. Syphilis
vi. HPV
vii. Herpes

Question 5

5. What segment of the population are most commonly affected?

Answer 5

Multiparous women (women having given more than one birth) may have cervicitis due to non-specific infections

Question 6

6. Almost all cervical neoplasia arise from what kind of lesion (squamous cell carcinoma)?

Answer 6

Cervical Intraepithelial Neoplasia (CIN)

Question 7

7. What is Epithelial Dysplasia?

Answer 7

Cytologic and maturation disturbances of epithelial seen microscopically.
* CIN I : Mild Dysplasia
CIN II : Moderate Dysplasia
CIN III : Carcinoma in situ

Question 8

8. What does Pap smear work?

Answer 8

Allows identification of precancerous (dysplastic) cytological features of exfoliated cells that are collected from the cervix

Question 9

9. What are 4 risk factors of Human Papilloma Virus?

Answer 9

i. Early age at first intercourse
ii. Multiple sex partners
iii. Male partner with multiple previous sex partners
iv. Persistent infection with “high-risk” HPV

Question 10

10. What are 2 screening approaches for Human Papilloma Virus?

Answer 10

i. Pap Smear

ii. Colposcopy (cervical examination is standard approach)

Question 11

11. What is high and low risk type of HPV?

Answer 11

High Risk HPV : Type 16 and 18 (associated with cancer)
Low Risk HPV : Type 6 and 11 (associated with condyloma)

• Higher the grade, the greater the likelihood of progression to carcinoma

Question 12

12. What is the prognosis for Stage 0 and Stage 4 HPV cancer?

Answer 12

Stage 0 : 100% 5-year survival rate

Stage 4 : 10% 5-year survival rate

Question 13

13. What are clinical manifestations of CIN?

Answer 13

CIN is typically asymptomatic but invasive form may be presented with:

a. Irregular vaginal bleeding
b. Leukorrhea
c. Painful coitus
d. Dysuria

Question 14

14. What are most common symptoms associated with disorders of the uterus?

Answer 14

i. Pelvic pain
ii. Abnormalities in menstrual function :
a. Menorrhagia (profuse bleeding)
b. Metrorrhagia (irregular bleeding)
c. Dysmenorrhea (painful menstrual bleeding)

Question 15

15. What is endometriosis? Common sites affected? Less common sites?

Answer 15

Endometriosis : Functional endometrium (glands and stroma) located outside the uterus undergo cyclic bleeding

Common sites : Pelvis (ovaries, uterine ligaments, tubes and rectovaginal septum)

Less common sites : Peritoneal cavity, umbilicus, lymph node, lungs, bones or heart

• Large blood filled cysts on the ovaries transform to “chocolate” cysts as the blood ages.

Question 16

16. What characterizes Endometrial Hyperplasia?

Answer 16

Over growth of endometrium (epithelial lining of the uterus), due to excess of estrogen whether it may be endogenous or exogenous

Question 17

17. What are 4 risk factors of Endometrial Hyperplasia?

Answer 17

i. Failure of ovulation (anovulatory cycle)
ii. Obesity (estrogen synthesis in fat deposits)
iii. Administration of Estrogen
iv. Estrogen-secreting tumors (polycystic ovarian syndrome)

Question 18

18. T/F : All tumors of the uterus produce abnormal uterine bleeding.

Answer 18

True

Question 19

19. What characterize Leiomyomas?

Answer 19

Benign tumors of smooth muscle, arising from smooth muscle cells of myometrium

• when arising in the uterus, these neoplasms were called “Fibroids”

Question 20

20. What is Endometrial Carcinoma?

Answer 20

Carcinoma of the endometrium arises from the uterine lining and is the most frequent cancer of the female genital tract in the Western world.

This decrease is attributable to Pap smear test.

Question 21

21. What are different types of endometrial carcinoma that is observed among premenopausal women and older women?

Answer 21

Premenopausal : Endometrioid carcinoma (due to excess estrogen)

Older women : Serous carcinoma (endometrial atrophy)

• majority of these cancers are associated with excess estrogen and have similar risk factors as endometrial hyperplasia

Question 22

22. What are 2 common symptoms of Endometrial Carcinoma?

Answer 22

i. Irregular bleeding

ii. Leukorrhea

Question 23

23. How would you treat Endometrial Carcinoma?

Answer 23

Radiotherapy and surgery + anti-estrogen chemotherapy for disseminated case

Question 24

24. What is the prognosis of Endometrial Carcinoma : Stage I, Stage III and IV?

Answer 24

Stage I : 90% 5-year survival rate

Stage III and IV : 20% 5-year survival rate

Question 25

25. What are 3 examples of disorders of ovaries?

Answer 25

i. Polycystic Ovarian Disease ii. Ovarian Carcinoma (5th leading cause of cancer death in women) iii. Teratomas * POD-T-OC

Question 26

26. What is the characteristic of Polycystic Ovarian Disease

Answer 26

i. Presence of multiple cystic follicles in ovaries ii. Result in ovary hyperplasia iii. Excess production of androgens and estrogens * Affects 5-10% of females of reproductive age * 5th leading causes of cancer deaths in women

Question 27

27. Patients with Polycystic Ovarian Diseases are at higher risk for what metabolic disease?

Answer 27

Type II Diabetes Mellitus

Question 28

28. What are 6 clinical manifestations of Polycystic Ovarian Disease?

Answer 28

i. Oligomennorhea (infrequent menstruation) ii. Hirsuitism (increased body hair) iii. ACNE iv. Fertility Problems v. Obesity vi. Delayed or Absent Menstruation * OH AirForce O(h) D(amn)

Question 29

29. What are 4 basic categories of Ovarian Carcinoma?

Answer 29

i. Surface Epithelial Tumors (90% of ovarian cancer) ii. Germ Cell tumors (less common) iii. Sex-Cord-Stromal Tumors (less common) iv. Metastases (5-10% of tumors; unilaterally or bilaterally)

Question 30

30. What are 2 most important risk factors of Ovarian Carcinoma?

Answer 30

i. Family History (5-10% of cases) | ii. Mutation of BRCA genes (BRCA1, BRCA2 mutation increases risk for breast AND ovarian cancer)

Question 31

31. What is the prognosis for the Ovarian Carcinoma?

Answer 31

15% 10-year survival rate (cancer that penetrated the capsule) * prognosis depends heavily on the stage of the disease at the time of diagnosis

Question 32

32. What is Teratomas?

Answer 32

Differentiation of totipotential germ cells into mature tissues, which represents all three germ layers: a. Ectoderm b. Mesoderm c. Endoderm

Question 33

33. What pathologic feature of Teratomas makes it unique from other ovarian disorders?

Answer 33

Has multiple mature elements that may contain : a. Hair b. Bone c. Cartilage d. Teeth e. Bronchial or Gastrointestinal Epithelium

Question 34

34. What is the population that is often affected by Teratomas?

Answer 34

Early 20’s (90% of these germ cell neoplasms are benign) | * Malignancy of the tumor has earlier onset

Question 35

35. What are 3 different types of Breast Disorders?

Answer 35

i. Fibrocystic Changes ii. Fibroadenoma iii. Breast Carcinoma

Question 36

36. What are the characteristics of Fibrocystic Changes of the breast?

Answer 36

i. Very common cyclic breast changes that occur normally in the menstrual cycle ii. Overgrowths of the fibrous stroma, the epithelial elements or a proliferation of both iii. Majority of these lesions do not predispose to cancer, but “lumps” may need to be differentiated from actual cancer

Question 37

37. When does the fibrocystic changes occur in women?

Answer 37

Tend to arise during reproductive life but may persist after menopause.

Question 38

38. What is the most common benign tumor or neoplasm of the female breast?

Answer 38

Fibroadenoma

Question 39

39. What segment of the population does Fibroadenoma affect?

Answer 39

Prepubertal girls and young women | * Peak prevalence in the 20’s or 3rd decade

Question 40

40. What are 3 significant characteristics of Fibroadenoma?

Answer 40

i. Encapsulated tumors that are comprised of both glandular epithelium and fibrous tissues ii. Results from increased estrogen iii. Appear solitary, discrete, and freely movable nodules that must be biopsied to ensure that it is in fact “benign”

Question 41

41. What are the cell origins of Breast Carcinoma?

Answer 41

Glandular and Ductal structures of the breast | * 75% of breast cancer occurs after age of 50

Question 42

42. What are 4 risk factors of Breast Carcinoma?

Answer 42

i. Delayed child bearing ii. Long duration between menarche and menopause iii. Atypical dividing or growing lesions (proliferative lesions) iv. Family history of breast cancer in a 1st degree relative (esp. for multifocal cancer or premenopausal cancer)

Question 43

43. What are 2 classifications of Breast Carcinoma?

Answer 43

i. Ductal (From Ductal epithelium : Ductal Carcinoma in situ (DCIS) ii. Lobular(From Glandular acini : Lobular Carcinoma in situ (LCIS) * both have non-invasive precursor stages DCIS and LCIS, which means the neoplasm has not penetrated the basement membrane. * not penetrating the basement membrane means it has not invaded or infiltrated the connective tissue stroma.

Question 44

44. What are treatment approaches for Breast Carcinoma?

Answer 44

i. Simple Mastectomy ii. Lumpectomy (with- or without lymph node dissection)+(Radiation and/or Chemo) iii. Anti-Estrogen Therapy (such as Tamoxifen)

Question 45

45. What is the prognosis for Breast Carcinoma?

Answer 45

≥50% 10-year survival rate | * prognosis improves with each passing year without the disease