vulvar and ovarian Flashcards
(54 cards)
1
Q
lichen sclerosus is most commonly seen in what patient population
A
- postmenopausal women
2
Q
clinical presentation
- pruritus
- dysuria (when urine hits vulvar tissue); dyspareunia
- well-demarcated white plaques
- “cellophane paper”
- fragility
A
lichen sclerosus
3
Q
lichen sclerosus usually starts where
A
- begins periclitorally with spread to perineal skin
- not usually seen at keratinzied, hair-bearing labia majoria or mucus membranes
4
Q
patients with hyperkeratotic lesions associated with lichen sclerosus have a risk for
A
squamous cell carcinoma
5
Q
how is lichen sclerosus diagnosed
A
vulvar punch biopsy
6
Q
treatment of lichen sclerosus
A
- topical ultrapotent steroid ointment
- Temovate ointment
*does not go away -> long term f/u
7
Q
where are bartholin glands located? function?
A
- 4 and 8-oclock positions within labia minora. ducts open into vestibule adjacent to vaginal introitus
- secrete mucus to maintain moisture of vaginal mucosa
8
Q
clinical presentation
- acute, painful unilateral labial swelling
- dyspareunia
- pain with sitting or walking
- tender, fluctuant labial mass
A
bartholin cyst
9
Q
treatment of bartholin cyst
A
- I&D with insertion of word catheter
- culture; +/- empirical abx therapy
- sitz bath 2-3 days after I&D
10
Q
when does vulvodynia typically present
A
- onset around menopause
11
Q
clinical presentation
- vulvar discomfort “burning” sensation
- absent clinical findings, pain limited to vestibule
- introital pain with intercourse
- mood or anxiety disorders (4x more likely)
A
Vulvodynia
12
Q
treatment of Vulvodynia
A
- avoid scented products, tight clothing, pads
- sitz bath followed by thin film petroleum jelly
- gabapentin
13
Q
define vulvar intraepithelial neoplasia
A
- neoplastic cells confined to squamous epithelium
- VIN2/3 are precursors to vulvar cancer
14
Q
vulvar intraepithelial neoplasia 2/3 are further differentiated into
A
- VINu: usual type
- VINd: differentiated type
15
Q
VINu: usual type is associated with what condition? what patient population is it normally seen in
A
- HPV type 16, 18
- younger women
16
Q
how is VINu: usual type diagnosed
A
- vulvar colposcopy
- acetic acid over lesion will bring out characteristics
- biopsy all pigmented lesions
17
Q
why is VINu: usual type concerning
A
associated with high grade CIN: Cervical intraepithelial neoplasia
18
Q
How is VINd: differentiated type different from VINu
A
- unrelated to HPV
- seen in older women
- involves lower 1/3 of epithelium
19
Q
VINd: differentiated type is associated with
A
squamous cell hyperplasia
20
Q
clinical presentation of vulvar cancer
A
-
asymptomatic
- inspect vulva
- pruritus is the most common symptom
21
Q
vulvar cancer can be what 3 types
A
- squamous cell carcinoma
- basal cell carcinoma
- malignant melanoma
22
Q
what has to be present in order to develop vaginal intraepithelial neoplasia (VaIN)
A
- HPV
23
Q
risk factors for vaginal intraepithelial neoplasia (VaIN) AND CIN
A
- smoking
- multiple sex partners
- early onset of sexual activity
24
Q
most lesions of vaginal intraepithelial neoplasia (VaIN) are located where
A
upper 1/3 of vagina
25
list the classifications for vaginal intraepithelial neoplasia (VaIN)
* VaIN 1: benign viral proliferation
* VaIN 2: intermediate risk
* VaIN 3: true precursor to vaginal cancer
26
how is vaginal intraepithelial neoplasia (VaIN) diagnosed
* pap smear
* colposcopy
27
what is the most common cause of invasive vaginal cancer
* metastasis from
* endometrium
* ovary
* cervix
* only when primary site of growth is from vagina can it be called vaginal cancer
28
what is the most common type of vaginal cancer
* squamous cell
29
pathophysiology of polycystic ovarian syndrome
* abnormal androgen and estrogen metabolism
* hyperinsulinemia
* elevated LH (greater LH:FSH ratio)
30
clinical presentation
* infertility
* **oligomenorrhea/amenorrhea**
* **acne**
* **hirsuitism**
* acanthosis nigricans
polycystic ovarian syndrome
31
US findings of **"string of pearls"** on ovaries is consistent with
polycystic ovarian syndrome
32
what is the **initial workup** with assessing for polycystic ovarian syndrome
* **total testosterone**
* ****if elevated \> 60 ng/dl, then further lab evaluation
33
hyperandrogenism requires the following workup
* 17-OH progesterone
* r/o congential adrenal hyperplasia
* DHEA-S
* r/o adrenal source
* cortisol
* r/o cushing's syndrome
* TSH
* prolactin
34
treatment for polycystic ovarian syndrome
* **weight loss**
* ****will inc SHBG and lower free testosterone
* metformin **only** in pts with hyperinsulinemia
* combination oral contraceptives
35
thick septations \> 2mm on ultrasound of an adnexal mass is consistent with a
malignant mass
36
solid component that appears nodular or papillary on ultrasound of an adnexal mass is consistent with a
malignant mass
37
(+) blood flow to solid component on ultrasound of an adnexal mass is consistent with a
malignant mass
38
thin walled mass on ultrasound of an adnexal mass is consistent with a
benign mass
39
List the types of ovarian cysts
* follicular cysts
* corpus luteum cyst
* theca lutein cyst
* mature teratoma
* serous and mucinous cystadenoma
40
what is the most common ovarian cyst? will it go away
* follicular cyst
* non-malignant
* regress after 1-2 menstrual cycles
41
follicular cysts result from
1. failure of mature follicle to rupture (release the ovum)
2. failure of non-dominant follicles to undergo atresia in the presence of the mature follicle
42
how do corpus luteum ovarian cysts develop
* following ovulation, blood accumulates within the cavity of the corpus lutuem.
* if resorption doesn't occur and corpus luteum \> 3 cm -\> cyst
* usually resolves after 1-2 menstrual cycles
43
how do theca lutein cysts form
* seen with elevated **chorionic gonadotropin levels** (infertility tx)
* usually bilaterally
44
mature teratoma are composed of
* well differentiated tissue derived from any of the three germ layers
* ectodermal germ cell is most common (hair, teeth)
45
ovarian cancer is divided into what 4 major histological types
1. epithelial
2. germ cell
3. sex cord and stromal
4. neoplasms metastatic to ovary
46
What is the incessant ovulation theory of **epithelial** ovarian cancer
* repeated ovarian epithelial trauma by follicular rupture and subsequent epithelial repair results in malignant transformation
47
explain **how** and **where** epithelial ovarian cancer arises in the fallopian tube
* mutant p53
* distal fallopian tube
48
what is the most common type of ovarian cancer epithelial neoplasm? where does it arises from
* high grade serous carcinoma
* the fallopian tube
49
germ cell ovarian cancer are most common in what age range?
20-30s
50
describe characteristic of germ cell ovarian cancer
* germ cell tumors grow rapidly
* favor lymphatic spread
* **unilateral**
51
**Dysgerminoma** is the most common germ cell ovarian cancer. Does it usually present unilaterally or bilaterally
* unilateral
52
what are the two acute symptoms of ovarian cancer
* pleural effusion
* bowel obstruction
53
what lab tests for **epithelial** ovarian cancer
* CA-125 elevated
54
what labs test for germ cell ovarian cancer
* elevated
* hCG
* AFP
* LDH
