Which gyne tumor is likely?

[Farazdaq]

A 70 year old nulligravid woman presented with 2 months vaginal bleeding. Physical examination was normal apart from slightly enlarged uterus. She's been diagnosed with diabetes 30 years ago.
Which of the following is the most likely diagnosis?

A- Adenocarcinoma of the ovary
B- Adenocarcinoma of the endometrium
C- Leiomyosarcoma of the uterus
D- Squamous cell carcinoma of the vagina
E- Squamous cell carcinoma of the cervix

[Sarah-cali]

Choice B is the correct answer

[Aditya]

i think its B.. because ovarian carcinomas dont really present with bleeding as a main symptom.. they would present with metastatic symptoms like malignant pleural effusion or ascites etc,... since she is nulliparous and physical examination is normal it is unlikely to be carcinoma cervix or vagina... becoz in either cases there would be bleeding and foul white discharge.. it cant be a fibroid becoz the age is 70 and fibroids need estrogen.. typical fibroid age grp wud be 35 to 50.. second fibroids wud typically present with other symptoms like back pain, urinary incontinence, dyspareunia, constipation etc.. so it shud be endometrial carcinoma

[saintdizzy]

The answer is A. her age and vaginal bleeding points strongly towards A

[dr.digant]

Originally Posted by Farazdaq

A 70 year old nulligravid woman presented with 2 months vaginal bleeding. Physical examination was normal apart from slightly enlarged uterus. She's been diagnosed with diabetes 30 years ago.
Which of the following is the most likely diagnosis?

A- Adenocarcinoma of the ovary
B- Adenocarcinoma of the endometrium
C- Leiomyosarcoma of the uterus
D- Squamous cell carcinoma of the vagina
E- Squamous cell carcinoma of the cervix

b...ADENOCARCINOMA OF ENDOMETRIUM...

[patelMD]

Originally Posted by saintdizzy

The answer is A. her age and vaginal bleeding points strongly towards A

I think A) would present as palpable masses (ovarian enlargement), not bleeding?

Im also with B) AdenoCa of Endometrium: key point was bleeding after menopause.

[saintdizzy]

Originally Posted by patelMD

I think A) would present as palpable masses (ovarian enlargement), not bleeding?

Im also with B) AdenoCa of Endometrium: key point was bleeding after menopause.

they both cause bleeding in menopause, i mean endometrial cancer and ovarian cancer(granulosa cell variant)..........if you factor in the age distribution of the diseases, endometrial cancer occurs in mid 50s to early 60s while ovarian cancer occurs mostly in mid 60s and 70s.
or is there anything in the question stem that i have missed?

[usmle2011]

i think A
Gojlan says Ovarian ca peak at 7th decade
and yes ovaian ca may present as Postmenopausal bleed

[patelMD]

Originally Posted by saintdizzy

they both cause bleeding in menopause, i mean endometrial cancer and ovarian cancer(granulosa cell variant)..........if you factor in the age distribution of the diseases, endometrial cancer occurs in mid 50s to early 60s while ovarian cancer occurs mostly in mid 60s and 70s.
or is there anything in the question stem that i have missed?

I think you're following goljan closely

I think the nulliparity would mean increased risk of endometrial! (you might have missed this part)

Check out this http://emedicine.medscape.com/articl...overview#a0102

[saintdizzy]

Originally Posted by patelMD

I think you're following goljan closely

I think the nulliparity would mean increased risk of endometrial! (you might have missed this part)

Check out this http://emedicine.medscape.com/articl...overview#a0102

Well i have to follow Goljan closely, it is a tried and tested source though there are some mistakes.
Well i found some publications too that says Nulliparity also increases risk of ovarian cancer
http://www.medscape.com/viewarticle/456560_7
http://www.wcn.org/articles/quality_...ncer_link.html
so i dont really know which is correct anymore

[qurat21]

Originally Posted by Farazdaq

A 70 year old nulligravid woman presented with 2 months vaginal bleeding. Physical examination was normal apart from slightly enlarged uterus. She's been diagnosed with diabetes 30 years ago.
Which of the following is the most likely diagnosis?

A- Adenocarcinoma of the ovary
B- Adenocarcinoma of the endometrium
C- Leiomyosarcoma of the uterus
D- Squamous cell carcinoma of the vagina
E- Squamous cell carcinoma of the cervix

adenocarcinoma of endometrium

[usmle2011]

Gojlan clearly mentions that nulliparity is the risk factor for both Ovarian and endomtrial cancer.

So its the age factor which is the point distinguishing this disease.

So whats the answer ultimately!!!!!!!!

[LookAtMeNow]

Originally Posted by usmle2011

Gojlan clearly mentions that nulliparity is the risk factor for both Ovarian and endomtrial cancer.

So its the age factor which is the point distinguishing this disease.

So whats the answer ultimately!!!!!!!!

This is adenocarcinoma of the endometrium.

Look on page 489 of First Aid 2011 for further info

but basically she's a little old for it (peak at 55-65 y/o) but all her other symptoms fit: vaginal bleeding, obesity, diabetes, nulliparity etc etc

[star88]

its b! she could be a case of pco..cause she;s been diagnosed with diabetes years ago + she's nulligravid. pco patients r at increased risk of endometrial cancer