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Epidermal Inclusion Cyst (Sebaceous Cyst)
-Location?
-Occurrence?
-Etiology?
-Sx?
-Tx?
- -Most common cystic lesion of vulva
- -Located below epidermis
- -Caused by occlusion of sebacious gland in labia majora or minora
- -Usually no Sx
- -Usually don't need to Tx, but can incise and drain or excise if troublesome
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Bartholin's Cyst
-Etiology
-Sx
-Tx
-Complications
- -Caused by chronic inflammation or trauma resulting in occlusion of Bartholin's duct
- -Sx: Usually asymptomatic
- -Tx: If Sx, marsupialization and insert Word catheter
- -Excision if malignant, esp. important in menopausal women
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Lichen Sclerosis
-Etiology
-Sx
-Tx
-Complications
- -White, flaky, onion-like skin on labia; usually in older women
- -Sx: pruritus, burning, introital stenosis, dyspurenia in menopausal women; labia min. gets lost, labia maj. flattens, clitoris inverted
- -Complications: has 4-6% chance of developing SCC
- -Tx: Topical steroids (clobetasol), Intralesional steroid injection in refractory cases, Oral antihistamine for pruritis
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Location of leiomyomas
- -Subserosal: under serosa (outermost layer); palpable on pelvic exam
- -Intramural: within wall of uterus (middle layer); palpable
- -Submucosal: under endometrium (innermost layer); causes abnormal uterine bleeding
- -Pedunculated: attached to stalk; torsion and necrosis can occur, can parasitically use blood supply of omentum
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Changes in leiomyomas
- 1. Fatty degeneration
- 2. Cystic, calcified
- 3. Red or carneous degeneration during pregnancy from bleeding into tumor
- 4. Sarcomas - rare and after menopause
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Leiomyomas
-Sx
-Tx
- -Sx: mostly asymptomatic; 35-50% have Sx (uterine bleeding, long heavy menses, pelvic mass, pelvic pressure, pedunculated one going through cervix/vagina, infertility & spontaneous abortion)
- *leads to anemia, pain w/ torsion, frequent urination, pressure, bloating, GI symptoms
-Tx: menorrhagia managed w/ hormones, GnRH (effects only last as long as it's taken; only used 6 months or less), myomectomy after GnRH, hysterectomy, embolization
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Follicle Cyst of Ovary
-Sx
-PE
-Dx
-Tx
- -Most common cyst of ovary; seen in reproductive years
- -Sx: none or pain w/ rupture, mentrual changes, dyspareunia
- -PE: unilateral tenderness, mobile, cystic adnexal mass
- -Dx: bimanual exam, US
- -Tx: Observation cus most disappear in 60 days; OC to suppress gonadotropin; cystectomy if needed
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Corpus Luteum Cysts
-Sx
-PE
-Dx
-Tx
- -Sx: pelvic pain, menstrual irregularities; hemmorrage and torsion may ocur
- -PE: lage, tender cystic or solid adnexal mass
- -Dx: bimanual exam, pelvic US,
- -Tx: OC for 2-3 cycles to speed up resolution of cysts; surgery if medical therapy not successful
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Thuca Letein Cysts
-Sx
-Tx
- -Occurs during pregnancy or with gonadotropic stim. (hydatidoform mole or choriocarcinoma)
- -Usually bilaterally filled with straw colored fluid
- -Can become large
- -regaress following treatment of causative condition'
- -Sx: pelvic heaviness, aching; regresses when gonadotropic levels fall
- -Tx: Observation. Surgery if complications (torsion, hemorrhage)
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Hydatidiform Mole
-Sx
-Dx
-Tx
- -Sx: bleeding in 1st half of preganancy; vomiting; passage of vesicles; preeclampsia before 24 weeks
- -Dx: US, high hCG
- -Tx: Evacuation
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Choriocarcinoma
-Sx
-Dx
-Tx
- -Malignant transformation of trophoblastic tissue; may follow molar, normal, or ectopic pregnancy
- -Sx: enlarged uterus and ovaries, vaginal bleeding, high hCG
- -Dx: CT scan
- -Tx: methotrexate
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Benign Cystic Teratoma (Dermoid Cyst)
-Dx
-Tx
-Cx
- -Most common ovarian neoplasm
- -Contains a bunch of weird shit inside
- -Dx: transvaginal US or Ct
- -TX: cystectomy with pervation of ovarian tissue
- -Cx: torsion due to weight of tumor, chemical peritonitis if ruptured
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Polycystic Ovarian Syndrome (PCOS)
-Sx
-Dx
-Tx
- -Persistent anovulation
- -Sx: hirsutism (female hairyness), menstrual irregularities, acne, inferitility, obesity, ovaries have multiple small follical cysts
- *high LH, androgen, and estrogen levels, you get fucked up
- -Dx: US of ovaries, eval of hyperinsulinism, lipid studies, HDL, LDL, androgen levels, LH, FSH
- -Tx: suppress LH w/ OC, hair removal, weight loss
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Endometriosis
- -Benign condition where endometrial tissue is present outside uterine cavity; typical case is woman in 30's who is nulliparous and infertile
- -Theories:
- 1. Retrograde Menstruation Theory of Sampson - endometrial fragments travel through fallopian during during menturation and implant and grow in weird places; does not explain lesions in distant areas (lung, axilla)
- 2. Coelomic Metaplasia Theory of Meyer - endometriosis is from metaplastic transformation of peritoneal mesothelium into endometrium cus of some stimulus
- 3. Lymphatic Spread Theory of Halban - endometrial tissue is taken up by lymphatics with drain uterus and go to various pelvic sites where tissue continues to grow
It is most likely from the 3 theories, immunologic factors, and genetics
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Endometrius - Sx
- -Sx: triad = dysmenorrhea (painful menstruation), dyspareunia (hard to sex), and dyschesia (hard to shit)
- *pelvic pain
- *infertility more frequent
- *may be asymptomatic
- No clear correlation between extent of disease and severity of pain
- *tender nodularity in culdesac; pelvic pain; firm fixed tender adnexal mass
- *gotta use laparotomy or laparoscopy
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Endometriosis - Tx
-Expectant Mgmt = no med or surgical therapy in patients with mild disease
- -Surgical mgmt = when bowel or bladder involved, adhesions, endometrioma > 3 cm, distortion of pelvin organs
- *Conservative surgical mgmt = excision, cauterization, laser, or electrocoagulation ablation
- *Definitive surgical mgmt = hysterectomy, salpingo-oophorectomy, destruction of all implants and adhesions
- -Medical mgmt =
- 1. Danazol (inhibits LH and FSH which lowers estrogen, induces pseudomenopause)
- 2. GnRH agonists
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Adenomyosis
-Sx
-Tx
-Extension of uterine glands and stroma into uterine musculature. Uterus is diffusely enlarged with thickened myometrium.
- Sx: dysmenorrhea, menorrhagia
- Tx: NSAIDS, OC's, hormone patches, hysterectomy
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