| Them Genes Though | GTD is the new GTL | The dreaded intraop pimp | #BreastisBest #VulvaVorld | At Your Cervix |
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Cowden Syndrome
Mutation in PTEN gene, phosphatase/tensin gene which is involved in cell cycle control Cancer: thyroid, breast & uterus Papillomas, hamartomas Risk of breast cancer 25-50% Risk of endometrial 5-10%
What disease is characterized by the overexpression of PTEN?
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below 6 or stage 2/3 single agent
Stage 4 or 7 or more multi-drug treatment MTX vs, act-D EMACO
This score, the only of its kind in GYN ONC, determines what chemotherapy you get, single agent versus a ton, ton more.
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Enters the pelvis at the bifurcation of the common iliac and runs under the IP ligament.
Runs retroperitoneally along pelvic side wall and goes under the uterine artery and enters the paracervical tunnel. Distance from cervix to ureter is about 2cm.
Describe the path of the ureter.
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Fibroadenoma in benign
Invasive ductal carcinoma for cancer
Breast Mass, the most common is this. For benign and for cancer.
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Repeat colpo and pap in 6-month intervals for 12 months
if CIN2 persists for >2 years, progresses to CIN3, or inadequate then LEEP.
That family med patient referral of a 21 y/o with HGSIL. But then you do a colpo and its CIN2 but gyn onc declined your referral...so, uh, what now?
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Lynch Syndrome
MLH1, MSH2, PMS1, PMS2, and MSH6 Think CEO - Colon (50-82%), Endometrial (25-60%), Ovarian cancer (4-24%)
The five most commonly affected genes in this syndrome causes an increased risk for colon, endometrial and ovarian cancer.
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Gestational choriocarcinoma
GTD subtype where systemic metastases occur frequently
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BSO: When taking down the IP
Laspy hyst: when taking down the uterine Vaginal: near the trigone
Good, you found it. But how are you going to injure it during a BSO, during a laparoscopic hysterectomy, and during a vaginal hysterectomy? Options are endless
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1A <2cm and <1mm DOI, excision OUT withOUT LND
1B - III radical excision WITH LND, if within 1cm need bilateral
1A vs. 1B-III vulvar cancer. Didn't realize there was a difference in treatment to be honest...
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Stage IIIb
Chemo RT
Things go bump in the night when you get this consult for a patient with a fungating mass and a bump in her creatinine. What stage and treatment?
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TP53
Li-Fraumeni syndrome soft tissue sarcomas, leukemia, adrenocortical cancer, breast cancer, brain cancer
This syndrome known for soft tissue sarcomas, leukemia, adrenal corticoid cancers, breast, and brain cancers is caused by a mutation in this infamously notorious gene.
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complete mole
Which GTD subtype has risk of persistence after D&E of ~20%?
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Femoral nerve L2-L4
Sensory change to anteromedial thigh motor weakness with hip flexion and knee extension
When you are retracting in a hysterectomy but the attending is getting on your last nerve so you accidentally injure this one.
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Multifocal disease
Diffuse calcifications on imaging history of radiation therapy to the chest wall Positive margins on re-excision Large tumor size in relation to the breast
But I have breast cancer, can't you conserve my breast? But why not?
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re-excision via CKC if margins are negative then pap, colpo, ECC with testing every 6 months vs. rad hyst if childbearing is complete.
Not sure what AIS but my 28 y/o patient has it and it extends into the deep margin. She's not sure if she's done having kids though.
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Putz-Jegher's Syndrome
Autosomal Dominant Mutations in serine/threonine kinase II (STK11) gene Presence of 2/3 criteria: 1) 2+ hamartomatous polyps in GI tract 2) mucocutaneous hyperpigmentation (mouth, lips, nose, eyes, genitalia, fingers) 3) family history of PJ syndrome or any of the cancers associated with it. Cancer: breast, ovarian, cervical, uterine, pancreas, lung, stomach, gastric, colon, ovarian sex cord tumors
Presence of 2/3 of the following symptoms needed to diagnose this autosomal dominant syndrome: hamartomas of the GI tract, mucocutaneous pigmentation, family history of cancers.
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partial mole
Which GTD subtype has fetal vessels often are seen on hematoxylin & eosin stain?
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Ilioinguinal, iliohypogastric nerve injury
Transverse incision or trocar
Sharp burning pain over the suprapubic area, labia, and inner thigh. Girl what did you do and how did you do it?
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Ultrasound, MRI, Digital Mammography, and Film mammography
Just trying to live your life with dense breasts, you'll likely need one of these 4 screening modalities.
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Stage 4B
When you feel supraclavicular nodes in this type of cancer, you know it's end game or this stage.
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Breast MRI with screening mammogram alternating every 6 months starting at the age of 30 for patients younger 25-29 clinical breast exam every 6-12 months and annual MRI.
When you have BRCA but need a mammogram. Age matters!
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Placental site trophoblastic tumor
The treatment for this cancer, where the histology is characterized by the proliferation of intermediate trophoblastic cells is a hysterectomy because of chemotherapy resistance.
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Hypogastric artery ligation
Get liggy with it. Ligate this during a uterine artery pedicle bleed that you just can't Tisseel over it.
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Stage II
The cancer can be any size and is growing into the anus or the lower third of the vagina or urethra but has not spread to lymph nodes is this stage of vulvar cancer.
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64% CIN3+ risk
ECC, EMB and treatment w/o bx are not acceptable in pregnancy. A diagnostic excisional procedure or repeat bx is recommended only if cancer is suspected.
When you're back in Ob clinic, your happy place, until your 32 y/o 10+4 patient's pap smear comes back as HGSIL HPV Positive. What is her CIN3 risk?
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