Gynecology
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| CIN 1 = | Cervical intraepithelial neoplasia 1: low grade lesion, mild dysplasia in lower 3rd of epithelium; LSIL
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| CIN 2 = | high grade lesion; mod dysplasia, atypical changes in basal 2/3 of epithelium; HSIL
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| CIN 3 = | high grade lesion, severe dysplasia/ ca in situ; >lower 2/3 of epi plus full thickness lesions; HSIL
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| CIN & HPV | HPV 6&11: LSIL, warts; benign; HPV 16 & 18: HSIL, ca
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| Uterine fibroid sx | Dysmenorrhea; Dyspareunia; Urinary frequency; Lower back pain
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| Most common symptom of endometrial neoplasia: | AUB (90% of pts)
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| 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
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| Simple/Complex Endometrial Hyperplasia: causes unopposed estrogen: Premenopause etio: | Obesity; PCOS; eating disorders; Thyroid; Herbals; other anovulation
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| Simple/Complex Endometrial Hyperplasia: causes unopposed estrogen: Postmenopause etio: | Obesity; HRT; herbals w/estrogen (soy); Ovar/ adrenal estrogen producing tumor
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| Postmenopausal, dyspareunia, thin vaginal discharge, atrophic vulvar changes, vaginal petechiae | Atrophic vaginitis; Tx = topical estrogen
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| 20 yo female w/ rubbery, firm, well-circumscribed, non-tender breast lesion, doesn’t change w/ cycle | Fibroadenoma
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| Firm irregular shaped, NONTENDER enlarged uterus | Leiomyoma
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| Softened, tender, diffusely globular uterine enlargement | Adenomyosis
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| Postmenopausal vaginal bleeding | Endometrial cancer: do endometrial biopsy
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| Postmenopausal adnexal mass | Ovarian Ca
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| Adenomyosis = | implantation of endometrial tissue in myometrium; tender, symmetrically enlarged boggy uterus
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| ovarian cysts in postmenopausal women are presumed to be: | malignant until proven otherwise
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| OCPs are protective against cancer of: | endometrial, ovarian; not against ovarian cysts
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| 2 forms hereditary ovarian cancer | BOC (BR & ov); HNPCC
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| Vulvar malignancy epidemiology & pathology | Rarest of Gyn cancers. Usually SCC. Slow growing.
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| in utero exp to DES = | risk of clear cell adenocarcinoma of vagina
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| vulvar malignancy comorbidities | obesity, DM, HTN, arteriosclerosis; in younger F, also SMK & HPV
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| 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
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| fibroadenoma s/s | round firm smooth discrete mobile nontender
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| Risk factors for cervical cancer | Smoker, HPV 16&18, OCP/hormones, multiple sexual partners, sex before 18, immunocompromised pt
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| Effective methods to prevent cervical cancer | Routine pap tests, avoid smoking, condom use, limit partners, HPV vaccine
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| 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)
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| Degeneration = | 2/2 ischemia when fibroid outgrows its blood supply. Painful, may present as acute abdomen. Sarcomatous (malignant) degeneration is rare.
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| Follicular cysts = | mature follicle that fails to rupture
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| Corpus luteum cyst = | result of bleeding into center of corpus luteum
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| Theca lutein cysts = | associated with elevated HCG levels (possibly also hydatidiform mole, choriocarcinoma)
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| 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.
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| Annual pap smear reduces invasive cervical ca incidence by: | 95%
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| ASCUS result on Pap: | HPV neg: repeat 1 yr. HPV pos: colposcopy.
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| LGSIL result on Pap: | colposcopy, bx, and tx. Repeat Pap at 6 months & 1 yr OR HPV testing in 1 yr.
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| HGSIL result on Pap: | colposcopy, bx, and tx. Close follow-up for 2 years.
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| SCC on Pap: | refer to Gyn for colposcopy & tx
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| Reactive / Reparative changes on Pap: | If cytology is neg, follow up in 2-3 years
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| Cervical cancer pathology | 80% SCC (95% are within transformational zone). 20% adenocarcinoma, adenosquamous, undifferentiated
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| Cervical cancer mets | Lungs, mediastinal, inguinal, axillary, supraclavicular LN, bones, liver
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| VIN mgmt | Surgery +/- XRT. Follow up: early lesion Q3 month x2 yrs, then Q6 months x3 yrs, annually thereafter
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| Protective factors against ovarian cancer | OCP, multiparity, breastfeeding, tubal ligation
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| Ovarian cancer risk factors | W > AA. BrCa 1&2, Lynch syndrome. HNPCC, colon ca. Nulliparity. FH Gyn ca. Endometriosis. Age
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| Ovarian cancer histologic classes (3) | Epithelial (80-90%). Stromal (10%). Germ cell (5% - young women).
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| Uterine cancer risk factors | Triad: obesity, HTN, DM. Hx of unopposed estrogen. Nulliparity. FH. Tamoxifen. Lynch syndrome.
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| Leiomyoma location | submucosal / myometrium
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| Endometriosis location | outside uterus
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| Gyn adenocarcinomas | Ovarian (highest M&M), endometrial (post-menopausal bleeding). Prostate
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| Gyn SCCs | vulvar, vaginal
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