217 - Diseases of the Uterus

Question 1

What is the typical presentation of endometrial cancer?

Answer 1

Post-menopausal vaginal bleeding

• In this setting, endometrial cancer is a diagnosis of exclusion*
• Requires an exensive workup, but all post-menopausal women who present with new bleeding need to be worked up*

Question 2

List 3 common presenting symptoms of endometriosis

Answer 2

• Dysmenorrhea (painful menses)
• Pain with intercourse
• Chronic pelvic pain

May also have a hx of infertility

Question 3

A “chocolate” blood-filled cyst is most consistent with which uterine pathology?

Answer 3

Endometriosis

Question 4

A patient with heavy, painful menstrual bleeding is found to have a diffusely enlarged uterus.

What is the most likely diagnosis?

Answer 4

Adenomyosis

(Basically, endometriosis confined to the myometrium)

Question 5

List 4 hormonal treatments for endometriosis

Answer 5

• OCPs
  
  • Combined or Progestin-only
• GnRH agonist (leuprolide)
• Danazol (not used often)
• Aromatase inhibitors

Question 6

List 4 risk factors for endometriosis

Answer 6

• Early menarchy
• Nulliparity
• Long menses
• Mullarian abnormalities

Question 7

List 3 risk factors and 1 protective factor for leiomyoma

Answer 7

• Risk
  
  • Obesity
  • Alcohol intake
  • Dietary factors
• Protective
  
  • Parity (at lease 1 pregnancy beyond 20 weeks)

Question 8

What is the first-line imaging method used to evaluate endometriosis?

What findings will be consistent with this diagnosis?

Answer 8

Ultrasound

• Unilocular cyst
• Homogenous, low echogenicity
• Poor or mild vascular flow

Do an MRI if not sure after US

Question 9

What is the “standard of care” treatment for endometrial cancer?

In which patients would we elect to use a different treatment?

Answer 9

Hysterectomy w/bilateral salpingo-oophorectomy + lymph node assessment

Select patinets may be managed differently:

• Pre-menopausal patinets who want to have kids
  
  • Use progesterone therapy
  • Only an option for low-grade/type 1 tumors
• Pts who are poor surgical candidates
  
  • Progesterone therapy for type 1 tumor
  • Pelvic radiation for type 2 tumor

Question 10

Is endometriosis considered a pre-malignant lesion?

Answer 10

No

• Highest risk of transmformation to epithelial ovarian cancer is in post-menopausal women
  
  • Clear cell and endometroid epithelial ovarian cancer are most common

Question 11

In what clinical scenario do endometrial polyps have the highest risk of malignancy?

Answer 11

Postmenopausal bleeding (5% risk of malignancy)

• In other settings, endometrial polyps are very rarely malignant

Question 12

What is the most common tumor of reproductive aged women?

What are the symptoms (5)

Answer 12

Leiomyoma (fibroid)

• Heavy/prolonged bleeding
• Bulk/pressure
• Pain
• Infertility
• Recurrent pregnancy loss

Question 13

What causes a leiomyoma?

Answer 13

Transformation of normal myocytes into abnrormal myocytes

Probably due to some kind of “hit” or acquired mutation