Repro 17-19
Terms
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- PID Casues
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– most polymicrobial
– N. gonorrhea most common single, upward migration from mucinous glands gets tubo-ovarian region
– also E. coli, Staph, Strep, Clostridium via lymph or vascular after surgery
– Also Chlamydia, Mycoplasma, Actinomyces (IUDs) - Adenomatoid tumor
- benign fallopian tumor of mesothelial origin
- Surface epi inclusion cysts of ovaries
- small cysts from involution of surface epi, benign
- Functional ovarian cysts
- follicular and corpus luteal cysts, benign
- PCO path
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– Increased ovarian production of androgens that act locally to cause premature follicular atresia, multiple follicular cysts, persistent anovulatory state and decreased P
– Excess androgens converted to E in peripheral adipose tissue - Sporadic ovarian cancer
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– activation of oncogenes (c-myc, K-ras, HER2/neu)
– Inactivation of tumor suppressor genes (p53, p16)
– Aneuploidy - Hereditary ovarian cancer
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– 5-10% in women w/ familial susceptibility to ovarian and/or breast cancer
– Germline mutations in DNA repair genes
– BRCA-1 (chromo 17), BRCA-2 (chromo 13) - Most common germ cell tumor in adults
- 95% are benign mature cystic teratomas (dermoid cyst)
- Ovarian mets
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– stomach (Krukenberg tumor) colon, pancreas and appendix
– also breast, endometrium - Ovarian tumor cell markers
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– Serous/endometrioid is CA125
– Mucinous is CEA
– Yolk sac tumor is AFP
– Choriocarcinoma is hCG - Imperforate hymen
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– no obvious vaginal orifice
– thin, bulging, blue perineal membrane
– fluctuant pelvic - Mullerian agenesis
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– Absent vagina, absent/ rudimentary uterus
– 46,XX, – Normal ovaries
– Normal 2o sexual development
– ASx - Transverse vaginal septum/cervical atresia
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– Blind vaginal pouch, 46,XX
– Normal ovaries
– Normal 2o sexual development
– Cryptomenorrhea - Asherman Syndrome
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– Synechiae
– Dx w/ strong suspicion
– based on hx uterine curettage (retained POC, endometritis)
– hx of IUD infection or PID
– hx of genital TB, schistosomiasis
– Hysterosalpingogram (HSG) - Drugs that could cause amenorrhea
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Phenothiazines
Reserpine
Amphetamines
Opiates
Benzos
Butyrophenones
TCA’s
Metaclopramide - Enzyme deficiencies that can cause ammenorhea w/ high FSH
- P450c17, aromatase
- Evaluation for PCOD
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– 1) T (producing neoplasm) > 200 – Transvaginal U/S – Adrenal CT/MRI
– 2) 17-hydroxyP (nonclassical CAH) > 2 – ACTH stim test
– 3) 24 hr cortisol if cushing signs and Sx - Abnormal Uterine bleeding Evlauation
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– 1) Exclude pregnancy
– 2) Identify anemia, thrombocyto
– 3) Assess ovulatory function – Menstrual hx, Timed serum P, Endometrial bx (Age > 40 yr – Hx of chronic anovulation – Confusing/suspicious hx) - Hypoestrogenism
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– Thin, inactive endometrium
– don’t tx w/ P, b/c it organizes and attenuates bleeding
– Dx if Biopsy yields minimal tissue and there is Attenuated endometrium (Stripe < 4 mm)
– Tx must begin w/ estrogen to build a foundation, then do progestin - Why is nulliparity an RF for endometrial cancer
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– Infertility common link
– Anovulation
– high serum levels of androstenedione
– lack of monthly menses more common in this population - Endometrial cancer and ultrasound
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– Normal has a very thin lining
– if lining less than 5 mm, possibility of having endometrial cancer is very small
– if asian, less than 3 means you are ok - Endometrial Cancer Staging
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– Stage I is Uterus only
– Stage II is Cervical involvement
– Stage III is Ab involvement (tubes/ovaries/washings/nodes) or vaginal involvement
– Stage IV is Bowel, bladder, or mets - First line Tx for ovarian cancer
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– Debulking Surgery/Staging
– then Chemotherapy (Platinum + Taxol) every 3 weeks for 6 cycles
– then second look surgery - 2nd line Tx for ovarian cancer
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– Ovarian cancer recurrence
– then Other chemo? Hormonal treatment? Interval debulking surgery? Radiation - Ovarian Cancer Staging
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– Stage I is Ovaries only
– Stage II is Pelvic extension
– Stage III is Abdominal implants or lymph node spread
– Stage IV is Distant METs