C h a p t e r 4 0
Disorders of the Female Genitourinary System
1047
3.
A 30-year-old woman consults her gynecologist
because of amenorrhea and inability to become
pregnant. Physical examination reveals an obese
woman with hirsutism. The physician tells her that
she might have a condition known as
polycystic
ovary syndrome
and that further laboratory tests
are indicated.
A.
Among tests ordered were a fasting
blood glucose and serum LH, FSH, and
dehydroepiandrosterone levels. What
information can these tests provide that would
help in establishing a diagnosis of polycystic
ovary syndrome?
B.
What is the probable cause of this woman’s
amenorrhea, hirsutism, and failure to become
pregnant?
C.
What type of treatment might be used to help
this woman become pregnant?
4.
A 45-year-old woman makes an appointment to
see her physician because of a painless lump in her
breast that she has discovered.
A.
What tests should be done to confirm the
presence or absence of breast cancer?
B.
During the removal of breast cancer, a sentinel
node biopsy is often done to determine whether
the cancer has spread to the lymph nodes.
Explain how this procedure is done and its value
in determining lymph node spread.
C.
After surgical removal of breast cancer,
tamoxifen may be used as an adjuvant
systemic therapy for women without detectable
metastatic disease. The presence or absence of
estrogen receptors in the cytoplasm of tumor
cells is important in determining the selection
of an agent for use in adjuvant therapy.
Explain.
R E F E R E N C E S
1. Moore KL, Aqur AM, Dalley AF.
Clinically Oriented Anatomy
.
7th ed. Philadelphia, PA: Wolters Kluwer Health/Lippincott
Williams & Wilkins; 2014: 98–108, 382–417.
2. Ross MH, Pawlina W.
Histology: A Text and Atlas
. 6th ed.
Philadelphia, PA: Wolters Kluwer Health/Lippincott Williams &
Wilkins; 2011:830–894.
3. Hall JE.
Guyton & Hall Textbook of Medical Physiology
. 12th
ed. Philadelphia, PA: Elsevier Saunders; 2010:987–1005.
4. Rosen MP, Cedars MI. Female reproductive endocrinology and
infertility. In: Gardner DG, Shoback D, eds.
Greenspan’s Basic &
Clinical Endocrinology
. 9th ed. New York, NY: Lange Medical
Books/McGraw-Hill Medical; 2011:423–475.
5. Gruber CJ, Tschugguel W, Huber J. Production and actions of
estrogens.
N Engl J Med.
2002;346:340–350.
6. Ellenson LH, Pirog EC. The female genital tract. In: Kumar V,
Abbas AK, Fausto N, et al., eds.
Robbins and Cotran Pathologic
Basis of Disease
. 8th ed. Philadelphia, PA: Saunders Elsevier;
2010:1005–1063.
7. Mutter GL, Prat J, Schwartz DA. The female reproductive
system. In: Rubin R, Strayer DA, eds.
Rubin’s Pathology:
Clinicopathologic Foundation of Medicine
. 6th ed. Philadelphia,
PA: Wolters Kluwer Health/Lippincott Williams & Wilkins;
2012:847–923.
8. Kushnir VA, Mosquera C. Novel technique for management
of Bartholin gland cysts and abscesses.
J Emerg Med.
2009;36(4):388–390.
9. Burrows L, Goldstein G, Mowad G, et al. Vulvar dermatoses as
a cause of dyspareunia. In: Goldstein A, Pukall C, Goldstein I,
eds.
Female Sexual Pain Disorders
. 1st ed. Hoboken, NJ:
Wiley-Blackwell; 2009:49–57, 112–116.
10. Ellas JC, Berek JS. Vulvar cancer: staging, treatment, and
prognosis. May 8, 2013. Available at:
com/contents/vulvar-cancer-staging-treatment-and-prognosis.
Accessed July, 10, 2013.
11. Carter JS, Downs LS. Vulvar and vaginal cancer.
Obstet Gynecol
Clin North Am.
2012;213–231.
12. Andrews JC. Vulvodynia interventions—systematic review and
evidence grading.
Obstet Gynecol Surv.
2011;66(5):299–315.
13. Groysman V. Vulvodynia: new concepts and review of the
literature.
Dermatol Clin.
2010;28:681–696.
14. Cox KJ, Neville CE. Assessment and management options for
women with vulvodynia.
J Midwifery Womens Health.
2012;
57(3):231–240.
15. Sobel J. Approach to women with symptoms of vaginitis. May
16, 2013. Available at:
approach-to-women-with-symptoms-of-vaginitis. Accessed July
10, 2013.
16. Hainer BL, Gibson MV. Vaginitis: diagnosis and treatment.
Am
Fam Physician.
2011;83(7):807–815.
17. American Cancer Society.
Detailed Guide: Vaginal Cancer
.
2013. Available at:
detailedguide/. Accessed July 10, 2013.
18. American Cancer Society.
Detailed Guide: Cervical Cancer
.
2013. Available at:
detailedguide/. Accessed July 10, 2013.
19. Centers for Disease Control and Prevention Advisory Committee
on Immunization Practices (ACIP). Recommendations on the use
of quadrivalent human papillomavirus vaccine in males.
Morb
Mortal Wkly Rep.
2011;60(50):1705–1708.
20. Centers for Disease Control and Prevention. FDA licensure of
bivalent human papillomavurus vaccine (HPV
2,
Cerarix) for use
in females and Updated Vaccination Recommendations from
Advisory Committee on Immunization Practices (ACIP).
MMWR
Morb Mortal Wkly Rep.
2010;59(20):626–629.
21. Smith RA, Brooks D, Cokkindes V, et al. Cancer screening in the
United States, 2013.
CA Cancer J Clin.
2013;63:87–105.
22. U.S. Preventive Services Task Force. Screening for cervical cancer.
2012. Available at:
/
uspstf/uspscerv.htm. Accessed July 23, 2013.
23. American College of Obstetricians and Gynecologists.
Screening
for Cervical Cancer.
ACOG Practice Bulletin No. 131. Available
at:
. 2012. Accessed July 16, 2013.
24. Massad LS, et al. 2012 updated consensus guidelines for the
management of abnormal cervical cancer screening tests and
cancer precursors.
J Low Genit Tract Dis.
2013;17(5):S1–S27.
25. Gradison M. Pelvic inflammatory disease.
Am Fam Physician.
2012;85(8):791–796.
26. Lareau SM, Beigi RH. Pelvic inflammatory disease and tubo-
ovarian abscess.
Infect Dis Clin North Am.
2008;22:693–708.
27. Workowski KA, Berman S, Centers for Disease Control and
Prevention (CDC). Sexually transmitted diseases treatment
guidelines.
Morb Mortal Wkly Rep.
2010;59(RR12):1–110.
28. Bulun SE. Endometriosis.
N Engl J Med.
2009;360(3):268–279.
29. Schrager S, Fallerone J, Edgoose J. Evaluation and treatment of
endometriosis.
Am Fam Physician.
2013;87(2):1007–1113.
