Master the board step 3

Master the Boards: USMLE Step 3
A 64-year-old woman with history of gastric ulcer and recent worsening dyspepsia
presents with weight loss and abdominal pain. An adnexal mass is found.
Answer: Metastatic gastric cancer to the ovary (Krukenberg tumor)
Tumor markers: CEA. This is a mucin-producing adenocarcinoma from the stomach that
has metastasized to the ovary, most commonly to both ovaries.
Management
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Sonogram (and CT scan for postmenopausal women)
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Biopsy via laparoscopy for simple cysts suggestive of malignancy (no septations
or solid components) or postmenopausal without ascites
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Tumor markers
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Cystectomy for benign tissue
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Premenstrual women: Salpingo-oophorectomy
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Postmenopausal women: Total abdominal hysterectomy (TAH); bilateral
salpingo-oopherectomy (BSO) and postoperative chemotherapy for malignant
tissue
Cervix: Cervical Neoplasia
The most common HPV types associated with cervical cancer are HPV 16,
18, 31, 33, and 35.
HPV 6 and 11 are benign condyloma acuminata.
HPV is a non-enveloped DNA virus.
Pap smear classifications:
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Indeterminate smears:
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Atypical squamous cells of undetermined significance (ASCUS)
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Abnormal smears:
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Low-grade squamous intraepithelial lesion (LSIL): HPV, mild dysplasia,
or CIN 1
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High-grade squamous intraepithelial lesion (HSIL): Moderate dysplasia,
severe dysplasia, CIS, CIN 2 or 3
--
Cancer: Invasive cancer
The following risk factors are associated with cervical neoplasia:
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Early age of intercourse
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Multiple sexual partners
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Cigarette smoking
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Immunosuppression
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