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Case:
A 20-year-old G3P0030 obese female comes to your office for a routine gynecologic exam. single, (+) currently sexually active, (+)history of five sexual partners in the past, (+) age of coitarche: 15 three first-trimester voluntary pregnancy terminations. control: Depo-Provera & condoms treated for chlamydia last year
(+)
(+)
Birth (+)
Denies
Question #1:
All of the following factors in this patients history are risk factors for cervical dysplasia except a. Young age at initiation of sexual activity b. Multiple sexual partners c. Previous history of chlamydia d. Use of Depo-Provera e. Smoking
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Question #1:
All of the following factors in this patients history are risk factors for cervical dysplasia except a. Young age at initiation of sexual activity b. Multiple sexual partners c. Previous history of chlamydia d. Use of Depo-Provera e. Smoking
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Genital infection with high risk HPV type (16 & 18) Early onset of sexual activity Multiple sexual partners Cigarette smoking Immunocompromised state (HIV, chemotherapeutic agents) Low socioeconomic status
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Question # 2:
Whats the appropriate next step?
a. b.
Do a pap smear Since gynecological exam is normal, advise her to do regular follow up Do a cervical biopsy Request for HPV DNA testing
c. d.
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Question # 2:
Whats the appropriate next step?
a. b.
Do a pap smear Since gynecological exam is normal, advise her to do regular follow up Do a cervical biopsy Request for HPV DNA testing
c. d.
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women onset of sexual activity or at the age of 21 should undergo pap smear for cervical cancer screeningry
Interval:
Done annually negative for 3 consecutive years, can be done once every 2-3 years
If
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Importance of screening:
Risk Pap
of cancer is 5x higher in women who are not screened smear detects cancerous and precancerous cells
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Adequacy of sample: satisfactory / unsatisfactory Squamous cell abnormalities Glandular cell abnormalities Other cancers (lymphoma, metastatic, sarcoma)
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Adequacy of sample: satisfactory / unsatisfactory Squamous cell abnormalities Glandular cell abnormalities Other cancers (lymphoma, metastatic, sarcoma)
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Histopathology: Comparison
Source:
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Question # 3:
A pap smear was done which showed High grade squamous intraepithelial lesion. Whats the appropriate next step?
a. b. c. d. e.
Repeat the Pap smear in 4 to 6 months Perform a cone biopsy Order HPV testing Do random biopsies of the cervix Perform colposcopy
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Question # 3:
A pap smear was done which showed High grade squamous intraepithelial lesion. Whats the appropriate next step?
a. b. c. d. e.
Repeat the Pap smear in 4 to 6 months Perform a cone biopsy Order HPV testing Do random biopsies of the cervix Perform colposcopy
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First step in the evaluation of a woman with abnormal cervical cytology report:
colposcopy
Inspection Apply
of the cervix using a low grade microscope acetic acid visualize cervix
MOA:
acetic acid enhances and marks a precancerous lesion or cancer by turning it whitish blue (acetowhite change)
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Management: CIN 1
High
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Lesions
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Lesions
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Question #4:
You obtain cervical biopsies, which come back without any abnormalities. What is the next appropriate step in the management of this patient?
a. b. c. d. e.
Cryotherapy of the cervix Laser ablation of the cervix Conization of the cervix Hysterectomy Re-Pap in 3 to 6 months
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Question #4:
You obtain cervical biopsies, which come back without any abnormalities. What is the next appropriate step in the management of this patient?
a. b. c. d. e.
Cryotherapy of the cervix Laser ablation of the cervix Conization of the cervix Hysterectomy Re-Pap in 3 to 6 months
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treatment
Ablative
methods
Cryotherapy thermoablation
Excisional
LEEP Cold
methods
knife conization
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all are papillary serous histology, arising from the tubal epithelium common are metastatic lesions arising from the ovary, uterus or GI tract
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factors: tuberculous salpingitis, chronic PID, infertility, low parity, tubal endometriosis 54-65 years old
Age:
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discharge (20%)
Latskos
triad: intermittent serosanguinous discharge + colicky pain + mass (pathognomonic of fallopian tube cancer) tubae profluens expulsion of watery fluid from the vagina by contraction of a distended tube blocked at the distal end
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Hydrops
Diagnosis:
(+)
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Diagnosis:
(+)
Classic
ultrasound findings: fluid filled tubular or ovoid mass with internal papillations, mural nodules, septations, separate from the uterus and ovaries. Ascites present
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Pathological examination:
Diagnostic 1.
criteria:
The main tumor lies in the tube and arises from the endosalpinx The histologic pattern reproduces the epithelium of tubal mucosa (papillary) Transition can be demonstrated between the malignant and nonmalignant epithelium The ovaries and uterus must be normal or contain less tumor than the fallopian tube
2.
3.
4.
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Lymphatic
spread: pelvic nodes + paraortic nodes + retroperitoneal nodes (most commonly involved node)
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Management:
Surgical
management
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