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Endo/Repro II Test 1 > 18. Benign Conditions of Uterus, Cervix and Ovary/FT > Flashcards

18. Benign Conditions of Uterus, Cervix and Ovary/FT Flashcards

1
Q

What embryonic changes do we see in female development?

A

[Absence of Y chromosome] and [Mullerian-Inhibiting Substance] =>

  1. Fusion of the mullerian (paramesonephric) ducts
  2. Degeneration of the mesonephric ducts
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2
Q

Most common congenital cervical anomalies are a result of what?

A

Malfusion of the paramesonephric ducts, with varying degrees of septation (didelphys cervix and septate cervix)

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3
Q

Failure of the paramesonephric (Mullerian) ducts to fuse causes:

A
  1. Uterus didelphysis => 2 seperate uterus with their own cervix attached to a fallopian tubes and vagina.
  2. Bicornuate uterus
  3. Bicornuate uterus with a double cervix
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4
Q

2 causes of uterine and cervical anomalies.

A
  1. Most occur spontaneously
  2. Early maternal exposure to DES
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5
Q

Early maternal exposure to DES can cause uterine/cervical anomalies?

A
  1. Small T-shaped endometrial cavity
  2. Cervical collar deformity
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6
Q

What is the most common neoplasm of the uterus and what does it arise from?

A

Uterine leiomyomas “fibroids”

  • Benign tumors (rarely malignant) derived from local proliferation of smooth muscle cells of myometrium
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7
Q

70% of women will have a _____ by 50YO.

A

Fibroids

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8
Q

Uterine leiomyomas “fibroids” are mostly asymptomatic, but if symptomatic, what sx’s are seen and this is the most common indication for what?

A
  • Excessive [uterine bleeding, pelvic pressure, pain and infertility]
  • Most common indication for hysterectomy
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9
Q

4 risk factors for developing uterine leiomyomas “fibroids”

A
  1. ↑ age during reproductive years
  2. African American W
  3. Nulliparity
  4. Family hx
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10
Q

When do fibroids typically enlarge?

A
  • 40% enlarge during pregnancy bc growth is stimulated by estrogen
    • Rarely form BEFORE menarche
    • Rarely enlarge AFTER menopause
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11
Q

What are the gross characteristics of uterine fibroids?

A
  • Gross: Spherical, well-circumscribed, white firm lesions
  • Cut section: whorled
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12
Q

What is the most common subtype of uterine fibroids; arise where?

A

INTRAMURAL, arising within myometrium

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13
Q

Which type of uterine fibroid is more at risk of becoming a parasitic fibroid?

A

Subserosal (beneath serosal surface) fibroid = Loosely connected to uterus and rarely attaches to BS or bowel mesentary.

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14
Q

Which type of fibroid causes more prolonged or heavy bleeding?

A

Submucosal fibroid = located beneath endometrium and can become pedunculated and go through cervical os

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15
Q

What is the most common presenting sx of uterine leiomyomas “fibroids?”

A

Prolonged or heavy bleeding (mostly with submucosal or intramural fibroids), but 80% are asx

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16
Q

Which type of fibroid is most likely to cause infertility?

A

Submucosal fibroid

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17
Q

What are some of the signs of a uterine fibroid on bimanual exam; how is the degree of enlargement characterized?

A
  • Enlarged, irregularly shaped uterus. If a palpated mass moves => FIBROID UTERUS
  • Degree of enlargement is described in “week size” used to estimate equivalent gestational size
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18
Q

What is used to distinguihs [adnexal masses vs lateral leiomyomas]?

A

US

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19
Q

What is the typically the 1st line of therapy for uterine leiomyomas?

A
  1. Combination (estogen + progesterone) –> OCP’s and rings
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20
Q

When are GnRH agonist (Depo-Lupon) used to treat uterine leiomyomas?

A

Used to ↓ fibroid size to alter route of surgery

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21
Q

How is uterine artery embolization used to treatment fibroids?

A

Microspheres/polyvinyl alcohol particles are introduced into the uterine a. => thrombose & occlude the artery feeding the fibroid –> necrosis of the fibroid => shrink 40-60%

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22
Q

Performing a myomectomy (cut the fibroid out) to treat the fibroid will result in what 2 things?

A
  1. If enter endometrial cavity => all future bbs must be delivered by c-section
  2. Fibroids often grow back
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23
Q

What is a endometrial polyp?

A
  • Soft friable protrusion into endometrial cavity.
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24
Q

What may be seen on ultrasound with endometrial polyps; which type of imaging allows for better detection?

A
  • Focal thickening of the endometrial stripe
  • Saline hysterosonography and hysteroscopy*** allow for better detection
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25
Q

How are endometrial polyps managed clinically?

A

Need to remove via hysteroscopy because they COULD be endometrial hyperplasia and carcinoma.

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26
Q

Most endometrial polyps are benign/malignant hyperplastic masses.

A

benign

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27
Q

What are Nabothian cysts?

A
  • NL [yellow/blue mucus-filled cysts] on the cervix that occur due to squamous metaplasia, where a layer of superficial squamous epithelium entraps a layer of columnar cells beneath, which still makes and secretes mucus.
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28
Q

What are the most common benign growths on the cervix?

A

Ectocervical/endocervical polyps

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29
Q

How do endocervical polyps differ from ectocervical polyps; which is most common?

A
  • Endocervical polyp= more common; beefy red in color; arise from endocervical canal
  • Ectocervical polyp = less common; pale in appearance
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30
Q

Symptoms and clinical management of cervical polyps

A
  1. Sx
    1. None
    2. Coital bleeding (bleeding after sex)
    3. Menorrhagia (heavy periods)
  2. Management
    1. Remove in office bc rarely malignany
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31
Q

What is endometrial hyperplasia caused by?

A

Persistant unopposed estrogen

  1. PCOS and anovulation
  2. Granulosa theca cell tumors, which make estrogen
  3. Obesity
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32
Q

Endometrial hyperplasia is a precursor to __________.

A

Endometrial carcinoma

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33
Q

Common symptoms of endometrial hyperplasia?

A
  1. Intermenstrual bleeding
  2. Unexplained heavy or prolonged bleeding
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34
Q

Which finding of the US is indicative of endometrial hyperplasia and what is the next step?

A
  • Endometrial lining > 4mm in a post-menopausal F.
  • => do a biopsy
35
Q

What are the 4 types of endometrial hyperplasia and what % progress to cancer?

A
  1. Simple hyperplasia W/O atypia (1%)
  2. Complex hyperplasia W/O atypia (3%)
  3. Simple hyperplasia WITH atypia (9%)
  4. Complex hyperplasia WITH atypia (27%)
36
Q

What is the treatment for simple and complex endometrial hyperplasia with and without atypia?

A
  • Without atypia => progestin and resample in 3 months
  • With atypia => hysterectomy
37
Q

In 46 XY, complete androgen insensitivity syndrome / testicular feminization, how do we treat?

A

Remove functioning gonads (testes) bc they have malignant potential.

38
Q

What are the functional cysts of the ovaries?

A
  1. Follicular cyst
  2. Lutein cyst
  3. Hemorrhagic cyst
  4. Polycystic cyst
39
Q

Which functional cyst of the ovary is more likely to cause symptoms?

A

Hemorrhagic cysts

40
Q

Are theca-lutein cysts (bi-/unilateral) and what are distinguishing characteristics?

A
  • Usually bilateral, large (>30 cm) cysts filled w straw-colored fluid due to excessive hCG and regress when levels fall.
41
Q

When are theca-lutein cysts most common?

A

When hCG is high

  1. Pregnancy
  2. Choriocarcinoma or hydratiform molar pregnancy
  3. Undergoing ovulation induction
42
Q

Functional ovarian cysts, pregnancy luteomas, are caused by what?

A
  • Pregnancy ovarian cysts (red/brown nodule) that form bc prolonged hCG causes hyperplastic rxn of the ovarian theca cells.
    • Goes away spontaneously after PG.
43
Q

PCOS (polycystic ovarian cysts) is can cause what 4 things?

A
  1. Anovulatory infertility
  2. Menstrual abnormalities (amenorrhea)
  3. Hyperandrogenism (hirtuism, acne, deep voice)
  4. Insulin resistance (T2DM)
44
Q

What causes PCOS?

A
  • Multiple ovarian follicular cysts in enlarged ovary form due to hormone imbalance (increase LH; low FSH)
    • LH => theca cells => androgen => 1. hirtuism (body hair); 2. goes to adipose tissue and is converted to estrone (estrogen)
    • Estrone then feedbacks and decreases FSH from AP => - granulosa cells => decrease in estradiol
      • => follicle does not mature => cystic degeneration of the follicle.
45
Q

What is a complication of PCOS?

A
  • Increase risk of endometrial hyperplasia => endometrial carcinoma (d/t high levels of estrone)
46
Q

Classic presentation of a pt with PCOS

A

Obese young W with infertility, oligomenorrhea and hirtuism, with insulin resistance and may develop T2DM years later.

47
Q

What are the most commons benign surface epithelial ovarian tumors?

A
  1. Serous tumors
  2. Mucinous tumors
  3. Brenners tumors
48
Q

What are the most commons benign sex cord-stroma ovarian tumors?

A
  1. Fibromas
  2. Granulosa - theca cell tumors
  3. Sertoli-Leydic cell tumors
49
Q

What are the most common benign germ-cell ovarian tumors?

A
  1. Cystic teratoma (dermoid)
50
Q

What is the single most common benign ovarian neoplasm in a PREMENOPAUSAL female?

A

Cystic teratoma (dermoid) = germ cell tumor

51
Q

What is the most common type of epithelial ovarian tumor?

A

Serous cystadenoma (75%), which are benign (70%), BL or malignant (20-25%)

52
Q

Malignant serous cystadenocarcinomas will often have what histologic finding?

A

Psammoma bodies

53
Q

Treatment of serous cystadenoma?

A
  • Surgery depends on if you want to maintain fertility
    • => cystectomy
    • => oophorectomy
    • => hyst with bilateral oopherectomy
54
Q

Which type of epithelial ovarian tumor is multiloculated can attain a huge size, sometime filling the entire pelvis and abdomen?

Benign/maligant?

A

Mucinous cystadenoma (2nd most common epithelial tumor), 80% benign

55
Q

Mucinous cystadenomas are associated with _________ and can rarely lead to _______.

A
  • Mucocele of the appendix
  • Pseudomyxoma peritonei = > benign implants are seeded onto surface of bowel and peritoneal => make alot of mucus
56
Q

What is a Brenner tumor?

A

Small, smooth, solid ovarian neoplasm made up of fibrotic component that surrounds bladder-like transitional cells that is usually benign.

57
Q

33% of Brenners tumors are associated with _______ epithelial elements.

A

Mucinous

58
Q

IF the ultimate differentiation of cell types in the tumor are feminine, then the tumor is what?

A

Feminine =>

  1. Granulosa cell tumor
  2. Theca cell tumor
    1. or
  3. Granulosa- theca cell tumor
59
Q

IF the ultimate differentiation of cell types in the tumor are masculine, then the tumor is what?

A

Sertoli-leydig tumor

60
Q

Granulosa-theca cell ovarian tumors

  • Occur when?
  • Sx and signs
  • Malignant potential
A
  • Any age => produce estrogen => femininzing signs
    • B4 puberty => precocious puberty (menarche and thelarche = dev of boobs), premanarchal uterine bleeding
    • Reproductive age => meorrhagia
    • Postmenopause => endometrial hyperplasia/cancer and post-menopausal bleeding
  • Low
61
Q

Sertoli-leydig ovarian tumors

  • Histo
  • Sx and signs
  • Malignant potential
A
  • Sertoli cells make tubules and leydig cells make Reinke crystals
  • Makes androgenic components
    1. Hirtuism/baldness/ deep voice
    2. Clitormegaly
    3. Defeminzing F body => muscular build
62
Q

What is the most common benign solid ovarian tumor?

A

Fibroma (sex cord-stromal tumor)= benign tumor of fibroblasts but does NOT secrete sex steroids

63
Q

Ovarian fibromas can be associated with what syndrome?

A
  1. Meigs syndrome: ascites => (flows into R pleural cavity)=> right pleural effusion (hydrothorax)
64
Q

What is the most common ovarain neoplasm found in women of all ages?

A

Germ cell tumor –> Cystic Teratoma

65
Q

What is a Cystic teratoma?

  • -MC-
  • -Unilateral/bilateral-
  • -size-
A
  • Benign cystic tumor made up of fetal tissue from all 3 embroyological layers, mainly ectodermal tissue
  • 80% occur in reproductive years (30YO)
  • Bilateral (10%)
  • Slow growing, most < 10cm.
66
Q

What is the appearance of the Cystic Teratoma?

What happens if it ruptures?

A
  • Multicystic with hair, teeth, sebaceous material
  • Ruptures => chemical peritonitis
67
Q

Rokintanksy’s protuberance is seen with what type of ovarian tumor?

What is it^?

A

Rokintanksy’s protuberance = prominence at the junction of the [teratoma and NL ovarian tissue]. If found, can have malignant cells.

Cystic teratoma (germ cell tumor)

68
Q

Benign ovarian tumors are often asymptomatic, but can be painful in what situations?

A
  1. If tumor twists on its pedicle (torsion)
  2. Rupture of the cyst –> pain + peritoneal inflammation; can occur spontaneously, with trauma, during bimanual exam, or with intercourse
69
Q

Which is preferable for diagnosis of benign ovarian tumors, laparotomy or laparoscopy?

A

Laparotomy, is preferable unless the mass can be removed without rupture bc laparoscopy can be used to distinguish between [uterine fibroids vs ovarian tumors vs hydrosalpinx]/

70
Q

What can US help us with when diagnosing Benign ovarian tumors?

A
  • Simple vs complex in nature
  • ID Dermoid cyst: will look like a tooth-like calcification
71
Q

What tumor marker is used to diagnose benign ovarian tumors and who is it best in?

A

CA 125 => post-menopausal W

72
Q

Can a persistent ovarian neoplasm be assumed benign?

A

No, must be proven by surgical exploration and pathologic exam

73
Q

If surgery is warranted for ovarian neoplasm, what 2 things must be done?

A
    • Collect pelvic washings for cytologic examination
    • Obtain frozen section for histologic diagnosis
74
Q

How are benign epithelial ovarian tumors typically managed; what if the diagnosis is a mucinous type?

A
  • Typically managed w/ unilateral salpingo-oophorectomy
  • If mucinous, perform an appendectomy bc there may be a appendiceal mucocele
75
Q

What is appropriate management of epithelial ovarian neoplasm in young nulliparous patients vs. older women?

A
  • Young = may perform a cystectomy to preserve ovaries
  • Older = total abdominal hysterectomy w/ bilateral salpingo-oophrectomy
76
Q

What is appropriate management and steps for benign mature cystic teratomas “dermoid?”

A
  1. Can be tx w/ ovarian cystectomy
  2. Carefully evaluate other ovary since they are bilateral in 15-20% of case
  3. Irrigate pelvis to avoid chemical peritonitis
77
Q

How are stromal cell tumors MC treated?

A

Unilateral salpingo-oophorectomy

78
Q

What is hydrosalpinx vs. pyosalpinx?

A
  • Hydrosalpinx = fluid filled FT’s from previous infection
  • Pyosalpinx = purulent filld tube from active infection
79
Q

What is more common in fallopian tubes: benign/malignant tumors.

A

Benign (infectious or inflamm)

Malignancy is rare

80
Q

What is one of the most common gynecologic emergencies?

A

Ovarian torsion = rotation of ovary on ligaments, which can impede blood supply

81
Q

What is the primary risk factor for ovarian torsion?

A

Ovarian mass ≥5 cm

82
Q

What is the classic presentation for ovarian torsion?

A
  • ACUTE onset of unilateral pain
  • Nausea and possibly vomiting
83
Q

How is diagnosis of ovarian torsion made?

A
  • US = first line imaging study to identify mass
  • Definitive dx is made by direct visualization
84
Q

What is treatment for ovarian torsion; how does this change if ovary is necrotic or you suspect malignancy?

A
  • Detorsion and ovarian cystectomy to preserve ovaries
  • Salpingo-oophorectomy is performed if ovary is necroticor you suspect malignancy

Endo/Repro II Test 1 (23 decks)

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