Neoplasms Flashcards
What is definitive treatment for moderately differentiate vulvar squamous cell carcinoma?
Radical vulvectomy and groin node dissection
Squamous cell carcinoma is most common vulvar malignancy and may arise in setting of chronic irritation from lichen sclerosus.
DDx for vulvar squamous cell carcinoma:
- Shiny red/purple polygonal papules and plaques
- Thin, inelastic, white, “crinkled tissue paper” appearance
- White plaque-like lesions and poorly demarcated erythema
- Cauliflower-like lesions
- Lichen planus
- Lichen sclerosus
- Paget’s disease of the vulva (in situ carcinoma of vulva)
- Verrucous carcinoma
Bartholin gland mass - making the differential
Abrupt onset, post-menopausal: Primary vulvar adenocarcinoma is most likely
Slower onset: Fibroma, lipoma; younger age - benign Gartner’s duct cyst
Indications for trichloroacetic acid or imiquimod
Condyloma
Indication for cryotherapy
Cervical dysplasia
Flat, subtle, white vulvar lesions
Suggestive of vulvar dysplasia from HPV
DDx: Condyloma would be less flat
Indications for laser treatment
Vulvar HSIL with multifocal lesions
What are the guidelines regarding cervical screening? What are the special rules for ages 21-24?
If cytology shows ASCUS, either test for HPV now (+ —> colposcopy, — —> resume 3 years) or test with cytology in 1 year (+ —> colposcopy, — —> resume 3 years)
If 21-24 yo, if HPV+, repeat cytology at 12 months rather than colposcopy
What are signs of cervical cancer, and which are most concerning?
Atypical vessels (hairpin shapes or larger vessels branching from smaller ones)
Punctation = new blood vessels on end
Mosaicism = new blood vessels on their sides
Ectropion = columnar epithelium not yet undergone squamous metaplasia - reddish ring of tissue surrounding external os
Acetowhite epithelium can represent dysplasia but is less concerning
When should cervical screening be stopped?
Age 65 if negative 3x in a row or co-test negative 2x in a row in past 10 years
Continue if history of moderate-severe dysplasia or cancer
Risk factors for ovarian cancer; what is protective?
Low parity; delayed childbearing
Long-term suppression of ovulation appears to be protective against ovarian cancer - use OCPs
Different types of ovarian cysts
Functional ovarian cyst - 3-5 cm, form at time of ovulation; no blood, soft tissue elements or excrescences
Endometrioma - isolated collection of endometriosis involving ovary
Serous cystadenoma - larger than functional cysts; increased abdominal girth
Mucinous cystadenoma - multilocular and large
Dermoid tumor - solid components, echogenic; teeth, cartilage, bone, fat, hair
What is a routine part of ovarian cancer staging?
Omentectomy - does not spread hematogenously, but rather transcoelomic (across peritoneal surfaces)
Pelvic lymphadenectomy (but not inguinal)
What are the ovarian tumor subtypes? What are their risks?
Epithelial (90%) - malignant usually 6th decade of life
Germ cell (5%) - 10-30 yo
Sex-cord stromal (1-2%): granulosa cell tumors secrete high levels of estrogen —> endometrial hyperplasia or cancer
What typically causes ovarian torsion (lower quadrant pain, abdominal tenderness, on exam adnexal fullness and moderate tenderness and some voluntary guarding)
Dermoid cyst/mature cystic teratoma - enlarges ovary and are oily, which means less dense than surrounding tissue, rising to more anterior position and creating instability of infundibulopelvic ligament
