GYN Neoplasms

Question 1

What is a uterine Leiomyoma?

Answer 1

Benign smooth muscle tumor

Question 2

What is the course of a uterine Leiomyoma? Why?

Answer 2

They may be symptomatic until menopause and then they will shrink and be asymptomatic because they are hormone sensitive

Question 3

What are some possible symptoms of uterine Leiomyomata?

Answer 3

• Heavier bleeding
• Pelvic pressure
• Constipation/Urinary retention

Question 4

How will the uterus feel on examination with uterine Leiomyomata? What diagnostic can you obtain?

Answer 4

Irregularly enlarged uterus
–> TVUS

Question 5

What medications and surgeries can you try for symptomatic uterine leiomyomas?

Answer 5

Medications:
- OCPs/Medroxyprogesterone and NSAIDs
Surgeries:
- Myomectomy or Hysterectomy

Question 6

What is the malignant form of a uterine fibroid?

Answer 6

Leiomyosarcoma

Question 7

Type 1 and Type 2 Endometrial cancers are what?

Answer 7

Type 1 = Endometrioid
Type 2 = Serous/Mucinous

Question 8

How does Type 1 Endometrial cancer arise usually?

Answer 8

Type 1 = Endometrioid
–> UNOPPOSED ESTROGEN

Question 9

What are some protective factors against Endometrial Cancer type 1?

Answer 9

OCPs
Multiparity
Progestins
Breast feeding

Question 10

What mutations are often present with Type 2 Endometrial cancer?

Answer 10

Type 2 = Serous/Mucinous
=> P53, PTEN, BRCA genes

Question 11

How will Endometrial cancer present?

Answer 11

Post-menopausal bleeding or intermenstrual/heavier bleeding in premenopausal women

Question 12

What 2 diagnostics should be obtained if you are concerned about Endometrial cancer?

Answer 12

TVUS – most often if premenopausal
Biopsy – especially if postmenopausal

Question 13

An endometrial stripe > ____ mm is concerning for Endometrial hyperplasia/cancer

Answer 13

> 4 mm

Question 14

What medication can be used for Endometrial Hyperplasia?

Answer 14

Progestins

Question 15

What cells are normally found at the Endocervix? Ectocervix?

Answer 15

Endocervix = Columnar cells
Ectocervix = Squamous cells

Question 16

What are some risk factors for Cervical cancer?

Answer 16

HPV 16/18
Tobacco use, HIV, STDs
Multiparity

Question 17

How will Cervical cancer present?

Answer 17

Post-coital bleeding +/- heavier and IMB

Question 18

HPV infection is often the cause of Cervical cancer. What cells may be present and what do they look like?

Answer 18

Koilocytes = bilobed nucleus + perinuclear halo

Question 19

With a majority of abnormal pap smears, what is often done next?

Answer 19

Colposcopy +/- biopsy/endocervical curretage

Question 20

If a patients pap result is ASC-US with a history of normal paps and (-) HPV, what is the workup?

Answer 20

Repeat pap in 1 year

Question 21

If a patients pap result is ASC-US with a history of that on prior paps or they are HPV (+), what is the workup?

Answer 21

Colposcopy

Question 22

If a patients pap result is ASC-Glandular, what is the workup?

Answer 22

Colposcopy + Endocervical curretage + Endometrial biopsy

Question 23

If a patients pap result is ASC-H, LSIL, HSIL, what is the workup?

Answer 23

Colposcopy

Question 24

What pap result is CIN1?

Answer 24

LSIL

Question 25

What pap result is CIN2 and CIN3?

Answer 25

HSIL

Question 26

What are some risk factors for Vulvar cancer?

Answer 26

HPV 16/18 Lichen Sclerosus and chronic irritation Tobacco use

Question 27

What are the symptoms/signs of Vulvar cancer?

Answer 27

Ulceration/mass Itching and pain

Question 28

What is the workup for possible Vulvar cancer?

Answer 28

Punch biopsy

Question 29

How does Lichen Sclerosus present?

Answer 29

Whitening and thinning of the vulvar skin with itching and pain usually

Question 30

What is the treatment for Lichen Sclerosus?

Answer 30

Topical corticosteroids

Question 31

If a woman has Clear Cell Vaginal carcinoma, what what she exposed to?

Answer 31

DES

Question 32

What are some risk factors for Vaginal cancer?

Answer 32

HPV 16/18 Chronic irritation Tobacco use DES exposure

Question 33

Ovarian cancers can often be asymptomatic. What features on US are concerning?

Answer 33

Solid mass with thick septations +/- ascites

Question 34

What is the tumor marker for Epithelial Ovarian Carcinoma?

Answer 34

CA-125

Question 35

What is the tumor marker for a Yolk Sac (Endodermal Sinus) ovarian tumor?

Answer 35

AFP

Question 36

If there is a high AFP and concern for an Ovarian mass, what may be seen on histology?

Answer 36

Schiller Duval bodies -- looks like glomerulus = Yolk Sac/Endodermal Sinus tumor

Question 37

What is the tumor marker for a Choriocarcinoma?

Answer 37

Beta-hCG

Question 38

What is the tumor marker for a Dysgerminoma at the ovary?

Answer 38

LDH

Question 39

If there is a high LDH and concern for an ovarian mass, what cells may be seen on histology?

Answer 39

Fried egg cells = Dysgerminoma

Question 40

What is the tumor marker and hormone elevated with Granulosa Theca cell ovarian tumors?

Answer 40

Inhibin Estrogen

Question 41

If there is high Inhibin and concern for an ovarian mass, what cells may be seen on histology?

Answer 41

Call-Exner bodies = Granulosa theca cell tumor

Question 42

Granulosa theca cell tumors produce what hormone which may cause physical signs?

Answer 42

Estrogen!

Question 43

Sertoli-Leydig tumors at the ovaries often produce what hormone?

Answer 43

Testosterone!

Question 44

If a patient has an ovarian mass with high testosterone and NORMAL DHEAS, what may be seen on histology?

Answer 44

Reinke crystals = Sertoli-Leydig tumor

Question 45

List some signs in a female of a Sertoli-Leydig tumor

Answer 45

Hirsutism Acne Deep voice Clitoromegaly Menstrual changes