18. Benign and Malignant Conditions of the Uterus, Cervix and Ovaries

Question 1

Upper vagina, cervix, uterus, fallopina tubes formed by mullerian/paramesonephric ducts, asbence of Y chr and absence of mullerian inhibiting substand leads to devel of mullerian and degen of wolfian.. failure of paramesonephric ducts to fuse can lead to what which is 2 spearate uterine bodies with its own cervix, attached fallopian tube and vagina?

Answer 1

Uterus didelphysis

Question 2

Incomplete dissolution of midline fusion of para duct leads to septate uterus, Mullerian agenesis (meyer rokitansky kuster hauser syndrome) is the complete lack of development of para system, causing absence of uterus and most of the vagina… the MC congenital cervical anomalies are didelphys cervix and?

Answer 2

septate cervix

*uterine/cervical are spontaneous or due to DES where you see Tshaped endometrial cavity

Question 3

What is a b9 tumor of smooth muscle cells of myometrium, MC neoplasm of uterus, 70% women have them by 50s, asymptomatic, symptomatic: AUB, pelvic pressure, pelvic pain, infertility, MC indication for hysterectomy, risk: inc age during reproductive years, AA women 2-3 fold, nulliparity and family hx?

Answer 3

Uterine Leiomyomas “Fibroids”

Question 4

Leiomyomas “Fibroids” path is unknown, 40% enlarge during preg, they are spherical, well circumscribed, white firm lesions w WHORLED appearance, may degenerate or cause pain, or bleed, may calcify in postmeno pts, located subserosally beneath uterine serosal surface, submucosally beneath endometrium , or located where, which is MC?

Answer 4

Intramural fibroids within the myometrium

Question 5

Leiomyomas “Fibroids” - 80% are asymptomatic, sx have lower back or pelvic pain, fullness, freq urination, prolonged/heavy bleeding incresed incidence of infertility, bimanual examination can reveal enlarged irregular uterus, - if mass moves = fibroid, what is often performed and can help distinguish between adnexal mass and lateral leiomyomas?

Answer 5

ULTRASOUND

Question 6

Leiomyomas “Fibroids” are treated via combination of estrogen and progesterone OCP- first line, progesterone only therapies such as depoprovera or mirena IU system, gonadotropin releasing hormones (GnRH agonist) such as depo lupron which can decrease fibroid size up to 40% in 3 months instead of surgery. Surgical tx via myomectomy, endometrial ablation, uterine artery embolization (microsphers polyvinyl alcohol particles are introduce into uterine artery and occlude feeding vessel)—- definitive therapy is?

Answer 6

Hysterectomy

Question 7

Myomectomy tx for Leiomyomas “Fibroids” - if endometrial cavity is entered future delivers must be c section, fibroids will grow back. What polyps create small friable protustion into endometrial cavity, causing menorrhagia, spontaneous or post meno bleeding, US shows focal thinkening of endometrial STRIPE*, most are BENIGN hyperplastic masses?

Answer 7

Endometrial Polyps

*visualization via hysteroscopy

Question 8

What cyst is a normal vairant, appear opaque with yellowish or bluishe hue, vary in size 3mm to 3cm, result from squamous metaplasia in which a layer of squamous epi cells entrap layer of columnar cells beneath its surface- columnar cells continue to secrete mucus and a mucus retnetion cyst is formed?

Answer 8

Nabothian cervical cyst

Question 9

What polyp is MC b9 growth of cervix, sx are none, coital bleeding or menorrhagia, removed in office, rarely malignant, endocervical polyps are MC and beefy red in color and arise from endocervical canal?

Answer 9

Cervical polyps

*ectocervical polyps less common and pale

Question 10

What represents overabundance growth of endometrial lining as a result of persistent unopposed estrogen such as PCOS/anovoluation, granulosa theca cell tumor, obesity, exogenous estrogen and tamoxifen, is a precursor to endometrial cancer (2-3%)?

Answer 10

Endometrial hyperplasia

Question 11

Endometrial hyperplasia has 3 types: 
simple hyperplasia without atypia (1% progress to cancer)
complex hyperplasia without atypia (3%)
Simple hyperplasia with atypia (9%)
complex hyperplasia with atypia (27%)

Answer 11

MEOW

Question 12

Endometrial hyperplasia symptoms include intermenstrual heavy or prolonged bleeding, dx via bx of endometrium, US reveals endometrial lining is >4mm in postmeno woman, tx simple/complex without atypia with progestin and rebx in 3 months, treat simple/complex with atypia with?

Answer 12

HYSTERECTOMY

Question 13

What ovarian cysts are lined by one or more layers of granulosa cells, develops when ovarian follicle fails to rupture, clinically signifcant if large enough to cause pain?

Answer 13

Follicular Cyst

Question 14

What ovarian cyst is bilateral and can become large, may develop in pts with high serum levels of hCG, pregnancy, choriocarcinoma or hydatidiform molar pregnancy, who are undergoing ovulation induction, characteristically regress when gonadotropin levels fall- functional cyst?

Answer 14

Theca-Lutein Cyst

Question 15

Luteom of pregnancy is cuased by hyperplastic reaction of the ovarian theca cells, secondary to prolonged hCG stimulation during pregnanacy, appears as reddish brown nodules, usually regress spontaneously postpartum. What is associated with chronic anovulation, hyperandrogenism, and insulin resistance with multiple small follicles that are inactive and arresting in antral stage, increased LH levels promote androgen secertion from ovarian theca cells leading to elevation levels of androstenedione and testosterone, peripheral converions of androgen to estrogen results in elevated estrogen levels that then suppress FSH from the pituitary gland?

Answer 15

POLYCYSTIC OVARIAN SYNDROME

Question 16

functional ovarian cysts with clinical features are usuallyasymptomatic and simple - less than 8cm, regress, can become large and cause torsion…. What is the MC epithelial ovarian tumor (75%), bilateral, 70% benign, 25% malignant, tx surgically depending on desire to maintain fertility, and histologically you will see PSAMMOMA bodies?

Answer 16

Serous Cystadenoma (smooth ball- not multiloculated)

Question 17

Mucinous cystadenoma (multiloculated/large) can attain a huge size filling the entire pelvis and abdomen, 2nd MC epi tumor, not bilateral (?), 15% MALIGNANT, associated with mucocele of the appendix, can lead to what condition in which numerous benign implants are seeded onto the surface of the bowel and other surfaces producing large quantities of mucous?

Answer 17

Pseudomyxoma peritonei

Question 18

What epithelial ovarian tumor is a small smooth solid neoplasm, usually benign, rarely malignant, benign with large fibrotic component that encases epitheliooid cells that resemble transition cells of the bladder, 33% of cases these tumors are associated with mucinous epithelial elements?

Answer 18

Brenner Tumor

Question 19

Granulosa or theca cell tumors cause femininization, and sertoli leydig tumor causes masculinization. What sex cord tumor occurs at any age, produces estrogen, low malig potential, see precocious menarche/thelarche, premenarchal uterine bleeding young, breast tenderness, fluid retention and postmenopausal bleeding?

Answer 19

Granulosa Theca Cell

Question 20

Sertoli Leydig sex cord stromal ovarian tumors are less frequent then granuloa theca, produce *androgenic, low malig potential, promote virilizing effects like hirsutism, temporal baldness, deepening of the voice, defeminization of the female body habitus to muscualr build and?

Answer 20

Clitoromegaly

Question 21

What sex cord tumor is the MC BENIGN SOLID OVARIAN TUMOR, forms a solid encapsulated smooth surfaced tumor made up of interlacing bundles of fibrocytes, sometimes assoc w ascites secondary to transudation of fluid from ovarian tissue… MEIGS syndrome: ascites + right pleural effusion (hydrothorax) in assocaition w this tumor?

Answer 21

Fibroma

Question 22

What is germ cell tumor is MC ovarian neoplasm of all women, benign or dermoid cyst*, 80% during reporductive years - age 30, 15% bilateral, slow growing, dermoid contain differentiated tissue of ALL THREE germ layers, most are benign?

Answer 22

Cystic Teratoma
*multicystic mass, w hair, teeth- rupture = chemical peritonitis

*rokitanskys protuberance: solid prominence located at the junction between teratoma and normal ovarian tissue

Question 23

Clinical features of b9 ovarian tumors: asymptomatic, enlarge slowly pain is mild to mod, painful if tumor twists or rupture of cyst. Dx via phys exam, US, tumor markers (CA125 ONLY for postmenopausal women), laparascopy… stromal cell tumors and epithelial ovarian tumors are treated with?

Answer 23

unilateral salpingo-oophorectomy

*fibromas/teratomas tx w resection ovary

Question 24

Primary risk factor for ovarian torsion is ovarian mass larger than 5cm, presents with acute onset of unilaterla pain, N/V, dx via US first and definitive dx via direct visualization, tx via detosion and ovarian conservation or salpingooophrectomy if the ovary is?

Answer 24

necrotic or u suspect malignancy