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Gyn Neoplasm


CIN 1 = Cervical intraepithelial neoplasia 1: low grade lesion, mild dysplasia in lower 3rd of epithelium; LSIL
CIN 2 = high grade lesion; mod dysplasia, atypical changes in basal 2/3 of epithelium; HSIL
CIN 3 = high grade lesion, severe dysplasia/ ca in situ; >lower 2/3 of epi plus full thickness lesions; HSIL
CIN & HPV HPV 6&11: LSIL, warts; benign; HPV 16 & 18: HSIL, ca
Uterine fibroid sx Dysmenorrhea; Dyspareunia; Urinary frequency; Lower back pain
Most common symptom of endometrial neoplasia: AUB (90% of pts)
endometrial cancer risk factor Post or late menopause; FH/PMH ca (ov, BrCa, colon, endomet); Tamoxifen; PCOS; Obesity; nulliparity; Estrogen Tx w/o progestin; Prior Endometrial Hyperplasia; DM, HTN
Simple/Complex Endometrial Hyperplasia: causes unopposed estrogen: Premenopause etio: Obesity; PCOS; eating disorders; Thyroid; Herbals; other anovulation
Simple/Complex Endometrial Hyperplasia: causes unopposed estrogen: Postmenopause etio: Obesity; HRT; herbals w/estrogen (soy); Ovar/ adrenal estrogen producing tumor
Postmenopausal, dyspareunia, thin vaginal discharge, atrophic vulvar changes, vaginal petechiae Atrophic vaginitis; Tx = topical estrogen
20 yo female w/ rubbery, firm, well-circumscribed, non-tender breast lesion, doesn’t change w/ cycle Fibroadenoma
Firm irregular shaped, NONTENDER enlarged uterus Leiomyoma
Softened, tender, diffusely globular uterine enlargement Adenomyosis
Postmenopausal vaginal bleeding Endometrial cancer: do endometrial biopsy
Postmenopausal adnexal mass Ovarian Ca
Adenomyosis = implantation of endometrial tissue in myometrium; tender, symmetrically enlarged boggy uterus
ovarian cysts in postmenopausal women are presumed to be: malignant until proven otherwise
OCPs are protective against cancer of: endometrial, ovarian; not against ovarian cysts
2 forms hereditary ovarian cancer BOC (BR & ov); HNPCC
Vulvar malignancy epidemiology & pathology Rarest of Gyn cancers. Usually SCC. Slow growing.
in utero exp to DES = risk of clear cell adenocarcinoma of vagina
vulvar malignancy comorbidities obesity, DM, HTN, arteriosclerosis; in younger F, also SMK & HPV
VIN pathology 85% SCC, other adeno, sarcoma, melanoma. Upper third of vagina most common site of mets; middle third mets to inguinal or deep pelvic LN; lower third mets to inguinal
fibroadenoma s/s round firm smooth discrete mobile nontender
Risk factors for cervical cancer Smoker, HPV 16&18, OCP/hormones, multiple sexual partners, sex before 18, immunocompromised pt
Effective methods to prevent cervical cancer Routine pap tests, avoid smoking, condom use, limit partners, HPV vaccine
Cervical polyp clinical features Soft smooth fragile red lesion 1cm x 2cm in canal or protruding from cervix. Usually benign (0.5-1% malig / dysplasia)
Degeneration = 2/2 ischemia when fibroid outgrows its blood supply. Painful, may present as acute abdomen. Sarcomatous (malignant) degeneration is rare.
Follicular cysts = mature follicle that fails to rupture
Corpus luteum cyst = result of bleeding into center of corpus luteum
Theca lutein cysts = associated with elevated HCG levels (possibly also hydatidiform mole, choriocarcinoma)
Cervical cancer screening Paps start at age 21. Q2 years for pt 21-29 yo if paps are neg. 30 yo+: Q3 years if pt had 3 consecutive neg paps & no hx of CIN 2 or 3; or if combined with HPV testing. Stop at 65-70 yo if 3 neg tests & no hx for 10 yrs.
Annual pap smear reduces invasive cervical ca incidence by: 95%
ASCUS result on Pap: HPV neg: repeat 1 yr. HPV pos: colposcopy.
LGSIL result on Pap: colposcopy, bx, and tx. Repeat Pap at 6 months & 1 yr OR HPV testing in 1 yr.
HGSIL result on Pap: colposcopy, bx, and tx. Close follow-up for 2 years.
SCC on Pap: refer to Gyn for colposcopy & tx
Reactive / Reparative changes on Pap: If cytology is neg, follow up in 2-3 years
Cervical cancer pathology 80% SCC (95% are within transformational zone). 20% adenocarcinoma, adenosquamous, undifferentiated
Cervical cancer mets Lungs, mediastinal, inguinal, axillary, supraclavicular LN, bones, liver
VIN mgmt Surgery +/- XRT. Follow up: early lesion Q3 month x2 yrs, then Q6 months x3 yrs, annually thereafter
Protective factors against ovarian cancer OCP, multiparity, breastfeeding, tubal ligation
Ovarian cancer risk factors W > AA. BrCa 1&2, Lynch syndrome. HNPCC, colon ca. Nulliparity. FH Gyn ca. Endometriosis. Age
Ovarian cancer histologic classes (3) Epithelial (80-90%). Stromal (10%). Germ cell (5% - young women).
Uterine cancer risk factors Triad: obesity, HTN, DM. Hx of unopposed estrogen. Nulliparity. FH. Tamoxifen. Lynch syndrome.
Leiomyoma location submucosal / myometrium
Endometriosis location outside uterus
Gyn adenocarcinomas Ovarian (highest M&M), endometrial (post-menopausal bleeding). Prostate
Gyn SCCs vulvar, vaginal
Created by: Abarnard