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6. REPRODUCTIVE > 3. Masses and Tumors of the Uterus and Vagene > Flashcards

3. Masses and Tumors of the Uterus and Vagene Flashcards

1
Q

most common uterine mass.

A

Fibroids (Uterine Leiomyoma)

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2
Q

Fibroids (Uterine Leiomyoma) prefers:

A

estrogen + reproductive age (rare in prepubertal)

= Grows rapidly during pregnancy - Involute with menopause

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3
Q

Uterine fibroid locations

A

Submucosal (lease common)
Intramural (MOST common)
Subserosal

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4
Q

Most common Uterine fibroid type

A

Hyaline (Classic)

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5
Q

Uterine Fibroid

Dark T1/T2 + Homogeneous enhancment

A

Hyaline Fibroid

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6
Q

Uterine Fibroid

Dark T1
Bright T2
T1+C: Homogeneous Enhancement

A

Hypercellular fibroid

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7
Q

Uterine Fibroid

Bright T1/T2
May be RIm enhancement

A

Lipoleiomyoma

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8
Q

Uterine Fibroid
Densely packed smooth muscle (without much
connective tissue). Respond well to embolization

A

Hypercellular

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9
Q

Rare fat containing subtype (maybe the result of degeneration).

A

Lipoleiomyoma

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10
Q

4 types of Fibrdoid Degeneration

A

Hyaline (Classic) Degeneration
Red (Carneus) Degeneration
Myxoid Degeneration
Cystic Degeneration

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11
Q

Dark T1/T2
No enhancement

A

Hyaline

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12
Q

Fibroid Degeneration

Most common type.
The fibroid outgrows its blood supply, and you end up getting the accumulation of proteinaceous tissue.

A

Hyaline (Classic) Degeneration

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13
Q

Fibroid Degeneration

Pregnancy
by venous thrombosis.

peripheral rim of T1 high signal.

A

Red (Carneus)

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14
Q

Fibroid Degeneration

Uncommon
Dark T1
Bright T2

A
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15
Q

The risk of malignant transformation to a leiomyosarcoma is super low (0.1%). These look like a fibroid, but rapidly enlarge. Areas of necrosis are often seen.

A

uterine Leiomyosarcoma

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16
Q

This is endometrial tissue that has migrated into the
myometrium.

A

Adenomyosis

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17
Q

Adenomyosis is common in what female population?

A

Multipara + reproductive age + Hx of uterine procedures (CS/D&C)

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18
Q
A

Adenomyosis

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19
Q
A

Adenomyosis

Focal or diffuse thickening of the junctional zone of the uterus to more than 12 mm (normal is < 5 mm)

small high T2 signal regions corresponding to regions of cystic change

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20
Q

Adenomyosis favors this location

A

Posterior wall
Spares the cervix

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21
Q

marked enlargement of the uterus, with preservation of the overall contour.

A

Adenomyosis

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22
Q

Uterine anatomy in T2

A
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23
Q

When is it normal to NOT see the 3 zone pattern of the Uterus on MRI?

A

A. Younglings - Premenarchal
B. Old - Postmenopausal
C. During pregnancy
D. After pregnancy

Young Old Pregnant Postpartum

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24
Q
A
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25
Q
A
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26
Q
A
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27
Q
A
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28
Q

Normal Trilaminar Appearance

A

Thin Bright Center
Dark Middle
SoundingEchogenic LAyer

~ 4 - 12 mm

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29
Q

Common causes of Abnormal uterine bleeding

A

Submucosal fibroid
Polyps
Atrophy
Ca

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30
Q

Causes of AUB you have to worry in elderly =

A

Atrophy
Cancer

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31
Q

Focal or generalized thickening in post menopausal women greater than 5mm should get sampled if its > __ mm.

A

More than 5 mm

32
Q

Premenaupausal endometrium can get very thick and can be normal

A

upt to 20 mm

33
Q

Postmenopausal bleeding + < 5mm endometrium =

A

Probably Atrophy

34
Q

Postmenopausal bleeding + > 5mm endometroium =

A

Hypertrophy vs Cancers

GET BIOPSY!

35
Q

What Ovarian tumor can thicken the endometrium?

A

Estrogen secreting tumors - Granulosa Cell tumors

36
Q

What Colon CA increases the risk of endometrial CA? by how much?

A

Hereditary Non-Polyposis Colon Cancer (HNPCC) - 30-50x

37
Q

Basically all uterine cancers are _______, EXCEPT _____

A

Adenocarcinoma (90%)

Except leiomyosarcoma (looks like a giant fucking fibroid

38
Q

STEPS

First Step Postmenopausal Bleeder =
Too Thick (>4-5mm) =
The extent of local disease =
Distal mets =

A

First Step Postmenopausal Bleeder = Ultrasound
Too Thick (>4-5mm) = Biopsy
Extent of local disease = MRI
Distal mets = PET CT

39
Q

There are 3 basic sequences you need to know in Endometrial Cancer Evaluation in MRI

A
  1. Diffusion
  2. T2
  3. Post Contrast T1
40
Q

Key MRI Findings for Endometrial Cancer

A
  1. Myometrial invation
  2. Cervical Stromal invation
41
Q

What is the diffusion sequence in Endometral CA good for?

A

Tumor restriction (shown on ADC)

“Drop Mets” into the vagina
Lymph nodes

42
Q

Endometrial CA on T2 tend to give what signal?

A

Intermediate

(Brighter than dark junctional zone)

43
Q

The Myometrium on post contrast MRI should enhance homogeneously.

Endometrial CA enhancement =

A

Tumor enhancement < adjacent myometrium

44
Q
A

Endometrial CA

Intermediate T2
Mildly enhancing on T1+C compared to myometrium

45
Q

Normal T2 Cervix

vs

Abnormal T2 Ca invading the Cervix

A
46
Q

Who Gets Nodal Mets ?

A

Deeper and Bigger

Superficial tumor = 5% risk

Deep myometrial Invation = ~45%

47
Q

Cervical Invasion risk

Tumor < 2cm = %
Tumor > 4 cm = %

A

< 2cm = 5%

> 4cm = 35%

48
Q

Best study for nodal metastasis?

A

PET CT

49
Q

The single most important morphologic prognostic factor in endometrial Ca?

A

“Extension of the tumor into the myometrium”

50
Q

Stage 2 disease is defined as =

A

Cervical Stroma invasion

51
Q

Diagnostic key in endometrail Ca detection?

A

Post contrast imaging (2-3 mins post injection - cervix does not enhance quickly, outer/inner fibrous stroma - gradual enhancement)

Normal cervical stromal enhancement? = you have excluded cervical invasion

52
Q

: This is a SERM (acts like estrogen in the pelvis, blocks the estrogen effects on the breast). It’s used for breast
cancer, but marginally increases the risk of endometrial cancer (1% per year).

A

Tamoxifen

53
Q

Tamoxifen will cause:

A

Subendometrial cysts
Endometrial polyps

54
Q

Normally, post menopausal endometrial tissue shouldn’t be thicker than 4mm, but on Tamoxifen the endometrium is often thick - about

A

12mm at 5 years

55
Q

tamoxifen + thickened endometrium =

A

If post menopausal + bleeding = biopsy

IF asymptomatic = No routine screening

56
Q
A

Endometrial polyps

57
Q

How do you assess endometrial Polyps?

A

Saline infused into the uterus (sonohysterography)

58
Q

When should you perform sonohysterography?

A

Early prolipherative phase (4-6) when the endometrium is at its thinnest

59
Q

Cevical Ca is usually

A

Squamous Cell related to HPV

60
Q

Cervcial Ca Stage: Parametrial Invasion

A

Stage II

61
Q

Cervical Ca treated with surgery

A

Stage IIa or below

62
Q

When do you do chemo/radiation on Cercvical Cancer?

A

Parametrial Invasion (Stage IIb) or
Involvement of the lower 1/3 of the vagina

63
Q

What is this parametrium ?

A

a fibrous band that separates the supravaginal cervix from the bladder.

It extends between the layers of the broad ligament.

64
Q

why is the parametrium important?

A

The UTERINE artery runs inside the parametrium, hence the need for chemo - once invaded.

65
Q

How do you tell if tha parametrium is invaded on MRI?

A

Normally the cervix has a T2 dark ring. That thing should be intact. If the tumor goes through that thing, you gotta call it invaded.

66
Q

endometrial fluid + premenopausal =

A

common finding

67
Q

endometrial fluid + menopausal =

A

Cervical stenosis or obstructing mass

usually cervical stenosis

68
Q

The most common cancer of the vagina (85%).

A

Squamous Cell Carcinoma

Associated with HPV. Just like the cervix

69
Q

This is the zebra cancer seen in women whose mothers took DES (a synthetic estrogen thought to prevent miscarriage).

A

Clear Cell Adenocarcinoma

70
Q

Most common Vaginal tumor + children

A

Vaginal Rhabdomyosarcoma

Ages (2-6, and 14-18)

71
Q

When you see a solid T2 bright enhancing mass in the vaginal/lower uterus of a child =

A

Vaginal Rhabdomyosarcoma

72
Q

A met to the vagina in the anterior wall upper 1/3 is “always” (90%)

A

Upper Genital tract

73
Q

Amettothevaginaintheposteriorwalllower1/3is “always”(90%)

A

GI tract

74
Q

These are usually on the cervix and you see them all the time. They are the result of inflammation causing epithelium plugging of mucous glands.

A

Nabothian Cyst

75
Q

These are the result of incomplete regression of the Wolffian ducts along the anterior lateral wall of the vagina.

Can cause mass effect on the urethra

A

Gartner Ducts Cysts

76
Q

The cystic vaginal/cervical masses:

A
77
Q

Cysts in these periurethral glands, can cause recurrent UTIs and urethral obstruction.

A

Bartholin Cysts

6. REPRODUCTIVE (17 decks)

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