A 41-year-old woman undergoes exploratory laparotomy for a persistent adnexal mass. Frozen section diagnosis is serous carcinoma.
What is the likelihood that the contralateral ovary is involved in this malignancy?
Serous carcinoma is the most common epithelial tumor of the ovary. Bilateral involvement characterizes about one-third of all serous carcinomas.
A postmenopausal woman presents with pruritic white lesions on the vulva. Punch biopsy of a representative area is obtained and is consistent with lichen sclerosus.
Which of the following is the most appropriate treatment for this patient?
The prevalence of lichen sclerosus is unknown, because some women with this condition may be asymptomatic. The exact etiology is unknown, but there may be an autoimmune or genetic component. Patients with lichen sclerosus of the vulva tend to be older, and they typically present with pruritus, irritation, burning, dyspareunia, and tearing. On examination, the lesions are usually white papules and plaques, often with areas of ecchymosis or purpura. The skin often appears thinned, whitened, and crinkling. There may also be fusion of the labia minora, phimosis of the clitoral hood, and fissures, all of which can lead to narrowing of the introitus and dyspareunia. The histologic appearance of lichen sclerosus includes loss of the rete pegs within the dermis, chronic inflammatory infiltrate below the dermis, the development of a homogenous subepithelial layer in the dermis, a decrease in the number of cellular layers, and a decrease in the number of melanocytes. Lichen sclerosus is not a premalignant lesion; however, women with it have an increased risk of vulvar malignancy, and it must be distinguished from vulvar squamous cancer. Therefore, biopsy is necessary to confirm the diagnosis. First line therapy is ultrapotent corticosteroids such as clobetasol, halobetasol, or diflorasone. Topical estrogen may also be indicated if labial adhesions are present. Experience with intralesional corticosteroids is limited and is not recommended for first-line therapy. Surgical intervention is reserved for cases associated with malignancy or disease unresponsive to medical therapy.
A 22-year-old woman returns to your office for evaluation of an abnormal Pap smear. The Pap smear was reported as HSIL. Colposcopic biopsy confirms the presence of a cervical lesion consistent with severe cervical dysplasia (CIN III).
Which of the following human papilloma virus (HPV) types is most often associated with this type of lesion?
The HPVs are a group of double-stranded DNA viruses that infect epithelial cells. They do not cause systemic infection. There are numerous viruses within the group, and they are named by number according to the order of their discovery. HPVs can be sexually transmitted. HPV 16 has the highest carcinogenic potential and accounts for approximately 55% to 60% of cases of cervical cancer. HPV 18 is the next most carcinogenic type, and accounts for 10% to 15% of cases of cervical cancer. Approximately 10 other genotypes of HPV are associated with the remaining cases of cervical cancer. HPV types 6 and 11 are considered “low risk” subtypes, and are associated with benign condyloma and low grade cervical lesions. Women with condyloma are at an increased risk for anogenital cancers.
A 20-year-old woman presents complaining of bumps around her vaginal opening. The bumps have been there for several months and are getting bigger. Her boyfriend has the same type of bumps on his penis. On physical examination, the patient has multiple 2- to 10-mm lesions around her introitus consistent with condyloma. Her cervix has no gross lesions. A Pap smear is performed. One week later, the Pap smear returns showing atypical squamous cells of undetermined significance (ASCUS). Reflex HPV typing showed no high-risk HPV.
Which of the following viral types is most likely responsible for the patient’s condyloma?
A 26-year-old G2P1 presents to the gynecologist complaining of increasing hair growth on her face, chest, and abdomen, but the hair on her head is receding in the temporal regions. She also has had problems with acne. On physical examination, the patient has significant amounts of coarse, dark hair on her face, chest, and abdomen. On pelvic examination she has an enlarged clitoris. She has a 7-cm left adnexal mass.
Select the ovarian tumor from the following list that is most likely to be associated with the clinical picture.
Sertoli-Leydig cell tumors, which represent less than 1% of ovarian tumors, may produce symptoms of virilization. Histologically, they resemble fetal testes; clinically, they must be distinguished from other functioning ovarian neoplasms as well as tumors of the adrenal glands, since both adrenal tumors and Sertoli-Leydig tumors produce androgens. The androgen production can result in seborrhea, acne, menstrual irregularity, hirsutism, breast atrophy, alopecia, deepening of the voice, and clitoromegaly. Granulosa and theca cell tumors are often associated with excessive estrogen production, which may cause pseudoprecocious puberty, postmenopausal bleeding, or menorrhagia. These tumors are associated with endometrial carcinoma in 15% of patients. Because these tumors are quite friable, affected women may present with symptoms caused by tumor rupture and intraperitoneal bleeding. Gonadoblastomas frequently contain calcifications that can be detected by plain radiography of the pelvis. Women who have gonadoblastomas often have ambiguous genitalia. The tumors are usually small, and are bilateral in one-third of affected women. The malignant potential of immature teratomas correlates with the degree of immature or embryonic tissue present. The presence of choriocarcinoma can be determined histologically as well as by human chorionic gonadotropin (hCG) assays. The presence of choriocarcinoma in an immature teratoma worsens the prognosis. Krukenberg tumors are typically bilateral, solid masses of the ovary that nearly always represent metastases from another organ, usually the stomach or large intestine. They contain large numbers of signet ring adenocarcinoma cells within a cellular hyper-plastic but nonneoplastic ovarian stroma.
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