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FRCR 2A (Crack The FRCR 2A) > 4. Gynaecology > Flashcards

4. Gynaecology Flashcards

1
Q

Uterus - changes during life (6)

A

Neonate
- Uterus is larger than expected for baby (maternal/placental hormones are still working)
- Cervic is often larger than the fundus
Pre-puberty
- Shape of uterus changes, becoming more tube like, cervix and uterus are same size.
Puberty
- Shape changes again, now looking more adult like (pear shape, fundus larger than uterus)
- Uterus starts to have a visible endometrium, phases vary during cycle

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2
Q

Ovaries - changes during life (2)

A

Infants tend to have large ovaries (1cc), then decreases and remains just under 1cc until age 6.
Ovaries then gradually increase to normal adult size as puberty approaches and occurs.

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3
Q

Turner syndrome (3)

A

45XO.
Often get aortic coarctation and horseshoe kidneys.
Pre-puberty uterus and streaky ovaries.

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4
Q

Embryology (8)

A

Mullerian ducts make the uterus, fallopian tubes and upper 2/3 of vagina.
Urogenital sinus makes bottom 1/3 of vagina (and prostate in males).
Wolfian ducts become male parts (Vas deferens, seminal vesicles, epididymis), and should completely regress in female embryology.
The uterus is made from the same embryological origin material as the kidneys, so right and left halves fuse together at some point to make it. The central cavity is then formed by cleaving from bottom to top.

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5
Q

3 main ways for embroylogy to fail (3)

A

Failure to form.
Failure to fuse.
Failure to cleave.

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6
Q

Failure to form (4)

A

No embryological material one one side means no kidney or half of uterus (unicornate uterus) on one side.
Unilateral kidney is associated with Unicornate uterus.
Failure to form can be Mullerian agenesis or Unicornate uterus

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7
Q

Mullerian agenesis (5)

A

Mayer-Rokitansky-Kuster-Hauser syndrome.
- Vaginal atresia
- Absent or rudimentary uterus (unicornate or bicornate)
- Normal overies.
Kidneys have issues (agenesis, ectopia) in half of cases

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8
Q

Unicornate uterus (4)

A

4 subtypes (+/- rudimentary horn, +/- endometrial tissue).
Endometrial tissue in non-communicating horn will cause pelvic pain.
Endometrial tissue in a rudimentary horn (communicating or not) will increase risk of miscarriage and uterine rupture.
40% will have renal issue (usually agenesis) ipsilateral to the rudimentary horn.

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9
Q

Failure to fuse (2)

A

Spectrum of mostly not fused (basically separate, uterus didelphys) or mostly fused except top (Bicornus, looks like a heart).
Both get vaginal septa (didelphis more than biconus, because it’s the more severe anomaly)

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10
Q

Uterus Didelphis (4)

A

Complete uterine duplication (2 cervices, 2 uteri, 2 upper 1/3 of vagina).
Vaginal septum present in 75%.
Usually asymptomatic unless they have vaginal obstruction.

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11
Q

Bicornus (4)

A

either 1 cervix (Unicollis) or 2 (bicollis).
Separation of uterus by deep myometrial cleft, looking heart shaped.
Vaginal septum is seen around 25%, less than didelphys.
Increased risk of foetal loss, less of an issue compared to septae.

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12
Q

T-shaped (2)

A

DES related anomaly.
DES was a synthetic oestrogen given to prevent miscarriage in the 1940s. Daughters of such patients ended up with vaginal clear cell carcinoma and uterine anomalies, classsically T shaped uterus

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13
Q

Failure to cleave (2)

A

Failure to create the cavity within the central uterus.
Classic example is Septate uterus, where a septum remains between the 2 uterine cavities.

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14
Q

Septate uterus (5)

A

2 endometrial canals separated by fibrous or muscular septum.
Fibrous vs muscular can be determined by MRI, changes surgical management.
Increased risk of infertility and recurrent spontaneous abortion.
Septum has poor blood supply, and if there’s implantation on it, it will fail early.
Resecting the septum improves outcomes.

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15
Q

Arcuate uterus (3)

A

Mild, smooth concavity of the uterine fundus (instead of normal, straight or convex).
Normal variant rather than malformation.
NOT associated with infertility or obstetric complications.

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16
Q

Bicornuate vs Septate (6)

A

Bicornuate:
- heart shaped (fundal contour is less than 5mm above tubal ostia)
- No significant infertility issues
- Resection of the septum results in poor outcomes
Septate
- Fundal contour is normal, more than 5mm above tubal ostia
- Infertility issues - implantation fails on septim due to poor blood supply.
- Resection of the septum can help

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17
Q

Hysterosalpingogram (HSG) (5)

A

Cannulation of cervix and injection of contrast under fluoro.
Done to evaluate cavity of the uterus and patency of fallopian tubes.
Performed on days 7-10 of menstrual cycle.
Contraindications: PID, active bleeding, pregnancy, contrast allergy.
Bicornate vs Septate is difficult to appreciate on HSG, needs MRI or 3D US to evaluate the outer fundal contour

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18
Q

Salpingitis Isthmica Nodosa (4)

A

Nodular scarring of the fallopian tubes.
Usually involves proximal 2/3 of tube.
Unknown aetiology, likely post inflammatory/infection.
Strongly associated with infertility and ectopic pregnancy.

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19
Q

Uterine AVM (4)

A

Congenital or acquired, acquired more commonly.
Can cause fatal haemorrhage.
Caused by
- Previous D&C, therapeutic abortion, C-section or multiple pregnancies.
Doppler US shows serpiginous and/or tubular anechoic structures within the myometrium with high velocity flow.

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20
Q

Intrauterine adhesions (4)

A

aka Ashermans
Scarring in uterus, due to injury (prior D&C, surgery, pregnancy or infection (classically TB))
HSG: non-filing of uterus or multiple, irregular linear filing defects (lacunar pattern), with inability to appropriately distend the endometrium.
MRI: T2 dark bands
Causes infertility

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21
Q

Endometritis (5)

A

In the spectrum of PID.
Often 2-5 days post delivery, especially in prolonged laour or premature rupture.
Fluid and thickened endometrial cavity.
Can have gas in the cavity (not specific in post partum women).
Can progress to pyometrium, seen as expansion with pus.

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22
Q

Fibroids (uterine leiomyoma) (5)

A

Most common uterine mass.
Benign smooth muscle tumours, most common in women African ancestry.
Most common in reproductive age women.
Due to relationship with oestrogen, they grow rapidly during pregnancy, and involute in menopause.
Location is either intramural (most common), submucosal (least common) or subserosal.

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23
Q

Fibroids - typical appearance (5)

A

Can look like anything, but usually hypoechoic on US, with preipheral blood flow and shadowing in a Venetian Blind pattern.
CT: peripheral calcifications (popcorn).
MRI: T1 dark to intermediate, T2 dark, variable enhancement.
Higher T2 Fibroids respond better to IR treatment.
Lipoleiomyoma is a fat containing subtype.

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24
Q

Fibroid degeneration (4)

A

4 types, all have lack of enhancement (fibroids normally enhance avidly):
Hyaline
- Most common, fibroid outgrows it’s blood supply, end up with accumulation of proteinaceous tissue.
- T2 dark, no Gd enhancement.
Red (Carneous)
- Occurs during pregnancy. Cause of venous thrombosis.
- Peripheral rim of T1 brightness. T2 varies
Myxoid
- Uncommon, T1 dark, T2 bright and minimal gradual enhancementt
Cystic
- Uncommon

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25
Q

Uterine leiomyosarcoma (3)

A

Risk of malignant transformation is low (0.1%).
Look like fibroid, but rapidly enlarging.
Areas of necrosis often seen.

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26
Q

Adenomyosis (4)

A

Endometrial tissue migrated into myometrium.
Seen in multiparous women of reproductive age, especially with Hx of uterine procedures (C-section, D&C).
Several types, but usually generalised and favouring large portions of the uterus, especially posterior wall, but sparing cervix.
Classically causes marked enlargement of uterus, with preserved overall contour.

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27
Q

Adenomyosis - imaging (4)

A

US is less specific: heterogenous uterus (hyperechoic adenomyosis with hypoechoic muscular hypertrophy), or just posterior wall enlargement.
MRI is better test: thickening of junctional zone of uterus >12mm (normal <5mm).
Thickening can be focal or diffuse.
Small high T2 signal regions corresponding to regions of cystic change.

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28
Q

Thickened endometrium (6)

A

Stripe is measured without including any fluid in the canal.
Focal or generalised thickening in post menopausal women >5mm needs biopsy.
Premenopausal: up to 20mm can be normal.
Oestrogen secreting tumours - Granulosa Cell tumours of the ovary thicken the endometrium.
HNPCC have 30-50x increased risk of endometrial cancer.

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29
Q

Tamoxifen changes (5)

A

Tamoxifen is a SERM (acts like oestrogen in the pelvus, blocks it in the breast).
Used for breast cancer, but increases risk of endometrial Ca.
Causes subendometrial cysts and endometrial polyps (30%).
Normal postmenopausal endometrial tissue should be <4mm, but on tamoxifen <8mm is normal.
>8mm needs biopsy.

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30
Q

Endometrial fluid (2)

A

Common in premenopausal women.
In postmenopausal women, it means either cervical stenosis or obstructing mass (usually cervical stenosis)

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31
Q

Cervical cancer (3)

A

Usually squamous cell, related to HPV (90%).
Stage IIa or below treated surgically.
Stage IIb (parametrial invasion) or involvement of the lower 1/3 of vagina needs chemo/radiation.

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32
Q

Parametrial invasion (3)

A

The parametrium is a fibrous band that separates the supravaginal cervix from the bladder.
It extends between the layers of the broad ligament.
The uterine artery runs inside the parametrium, hence the need for chemo once invaded.

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33
Q

Solid vaginal masses (2)

A

Can be secondary (cervical or uterine carcinoma protruding into vagina) or Primary (clear cell adenocarcinoma or Rhabdomyosarcoma)

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34
Q

Leiomyoma

A

Rare in the vagina, but can occur. Mostly in the anterior wall.

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35
Q

Squamous cell carcinoma (2)

A

Most common cancer of vagina (85%).
Associated with HPV, just like cervix.

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36
Q

Clear cell adenocarcinoma (2)

A

Seen in women who’s mothers took DES.
T-shaped uterus.

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37
Q

Mets (2)

A

Met to the vagina in anterior wall upper 1/3 is usually upper genital tract.
Met to vagina in posterior wall lower 1/3 is usually from GI tract

37
Q

Gartner duct cysts (3)

A

Due to incomplete regression of the wolffian ducts.
Classically located along the anterior lateral wall of the upper vagina.
If located at the level of the urethra, can cause mass effect on the urethra and symptoms.

37
Q

Vaginal rhabdomyosarcoma (5)

A

The most common tumour of the vagina in kids.
Bimodal age distribution (ages 2-6 and 14-18).
Usually come off the anterior wall near the cervix.
Can occur in the uterus, but typically invades it secondarily.
Think of this if solid T2 bright enhancing mass in the vagina/lower uterus in child.

38
Q

Nabothian cysts (2)

A

Usually on the cervix. Common.
Result of inflammation causing epithelium plugging of mucous glands

39
Q

Skene gland cysts (2)

A

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

39
Q

Bartholin cysts (3)

A

Due to obstruction of the Bartholin glands (mucin secreting glands from the urogenital sinus).
Found below the pubic symphysis (helps distinguish from Gartner duct)

40
Q

Ovaries - trivia (3)

A

Never biopsy or recommend biopsy of an ovary.
To find an ovary on CT, follow the gonadal vein.
Haemorrhage in a cystic mass usually means it’s benign.

41
Q

Ovulation (7)

A

Follicles seen during early menstrual cycle are usually small (<5mm).
By day 10, there’s usually one dominant follicle. By mid cycle, this is usually around 20mm, and contains a mature ovum.
LH surge causes dominant follicle to rupture, releasing the egg.
Follicle then regresses in size, forming Corpus Luteum.
Small amount of fluid can be seen in the cul-de-sac.
Occasionally, a follicle bleeds and re-expands (haemorrhagic cyst)

42
Q

Cumulus Oophorus (2)

A

Collection of cells in a mature dominant follicle that protrudes into the follicular cavity, and signals imminent ovulation.

43
Q

Clomiphene (2)

A

Fertility meds like this force maturation of multiple bilateral ovarian cysts.
Common to see multiple follicles at >20mm in diameter by mid cycle.

44
Q

Theca lutein cysts. (5)

A

Functional cyst related to overstimulation from b-HCG.
Large cysts 2-3cm and ovary with multilocular “spoke wheel” appearance.
Three main causes:
- Multifetal pregnancy
- Gestational trophoblastic disease (moles)
- Ovarian hyperstimulation syndrome

45
Q

Old vs Young ovaries (9)

A

Premenstrual:
- Ovaries of paediatric patient stay small until age 8-9. May contain small follicles.
Premenopausal:
- Premenopausal ovaries may be HOT on PET, depending on menstrual cycle.
- PET should be done in first week of cycle.
Postmenopausal:
- Considered abnormal if exceeding upper limit of normal, or twice the size of other ovary (even if no mass)
- Small cysts (<3cm) seen in 20% of women.
- Postmenopausal ovaries are generally atrophic, lack follicles and difficult to find on US.
- Ovarian volume decreases from 8cc at 40 to 1cc at 70. Max postmenopausal ovarian volume is 6cc.
- should NOT be hot on PET.

46
Q

Ovarian hyperstimulation syndrome (4)

A

Complication associated with fertility therapy (5% of cases).
Ovaries with theca lutein cysts, ascites and pleural effusions.
May also have pericardial effusions.
Complications include increased risk of overian torsion (big ovaries) and hypovolaemic shock

46
Q

Cyst in postmenopausal woman (4)

A

If simple, generally benign, however:
- >1cm gets yearly follow up
- Less than 5cm (still likely benign) gets 3-6 monthly follow up
- >7cm gets MRI
If seen on CT first, US needed to confirm totally cystic, without suspicious features like papillary projections, nodules, thick septations etc.

47
Q

Corpus luteum vs ectopic pregnancy (5)

A

Both can have ring of fire appearance.
Most ectopic pregnancies occur in the tube (corpus luteum is an ovarian structure).
Corpus luteum should move with the ovary, ectopic will move separately (can push the ectopic away from the ovary).
Tubal ring of ectopic pregnancy is more echogenic compared to ovarian parenchyma, whereas wall of corpus luteum is usually less echogenic.
Specific (not sensitive) finding in ectopic pregnancy is RI of <0.4 or >0.7.

48
Q

Benign ovarian masses - types (6)

A

Physiologic and functioning follicles.
Corpora lutea
Haemorrhagic cysts
Endometriomas
Benign cystic teratomas (dermoids)
Polycystic ovaries

49
Q

Corpus luteum (3)

A

Normal corpus luteum arises from a dominant follicle.
Can be large (5-6cm), with variable appearance.
Most common is solid and hypoechoic, with “ring of fire” (intense peripheral blood flow).

50
Q

Functioning ovarian cysts (5)

A

Affected by the menstrual cucle.
Usually <25mm in diameter, and will change or disappear in 6 weeks.
If cyst persists and doesn’t change or increase in size, considered a non-functioning cyst (not under hormonal control)
Simple cysts >7cm in size need surgical or MR evaluation, due to difficulty to completely evaluate them that big on US, and risk of torsion.

51
Q

Endometrioma (7)

A

Affects women of childbearing age, can cause chronic pelvic pain associated with menstruation.
Classically triad of infertility, dysmenorrhoea and dyspareunia.
Buzzword appearance is rounded mass with homogenous low level internal echoes and increased through transmission.
Fluid-fluid levels and internal septations can also be seen.
More unusual/varied the echogenicity and the more ovoid or irregular the shape, the more likely the mass is to be an endometrioma.
Endometriomas won’t change on follow up, whereas haemorrhagic cysts will.
Complications of endometriosis (bowel obstruction, infertility) are due to fibrotic reaction associated with the implant.
Most common location for solid endometriosis is uterosacral ligaments.

52
Q

Endometriomas and malignancy (4)

A

1% of endometriomas become malignant, usually endometrioid or clear cell carcinoma.
Malignancy is rare in endometriomas under 6cm.
Usually occurs in ones >9cm.
Majority of cases are older than 45.

53
Q

Endometrioma and pregnancy (3)

A

Decidualised endometriomas: solid nodule with blood flow in endometrioma of pregnant woman.
Mimic of malignancy, will get followed up.
If patient is not pregnant, a solid nodule with blood flow represents malignant degeneration.

54
Q

Endometrioma on MRI (3)

A

T1 bright (blood). Fat signal will not suppress (shows it’s not a teratoma).
T2 dark (from iron in endometrioma).
Shading sign is a buzzword on MR. T2 will show “shading” - T2 shortening (darkening) of a lesion that is T2 bright.

55
Q

Haemorrhagic cysts (4)

A

Ruptured follicle bleeds internally and re-expands, resulting in a homogenous mass with enhanced through transmission (tumour won’t do this), similar look to endometrioma.
Lacy “fishnet” appearance is sometimes seen, considered classic.
Doppler flow absent.
Haemorrhagic cyst will disappear in 1-2 menstrual cycles, whereas an endometrioma won’t.

56
Q

Haemorrhagic cyst on MRI (2)

A

T1 bright (blood), not fat suppressed (not teratoma).
Will NOT enhance.

57
Q

Haemorrhagic cyst in postmenopausal (2)

A

Postmenopausal women may occasionally ovulate. Follow up in 6-12 weeks.
Late postmenopausal women should NEVER have a haemorrhagic cyst, so if something looks like one, it’s cancer until proven otherwise.

58
Q

Dermoid (3)

A

Usually young women (20-30s), commonest ovarian neoplasm in under 20s.
Tip of the Iceberg sign: absorption of most of the US beam at the top of the mass.
Typical US appearance is cystic mass with hyperechoic solid mural nodule (Rokitansky nodule or dermoid plug).
Septatins seen in about 10%.

59
Q

Dermoid on MRI

A

T1 bright (from fat), fat suppresses.

60
Q

Dermoid and malignancy (2_

A

1% of dermoids become cancer (usually squamous).
Risk factors are size (>10cm) and age (>50).

61
Q

Polycystic ovarian syndrome (4)

A

Typically overweight girl with infertility, acne and hirsutism.
Imaging criteria
- Ten or more peripheral simple cysts (typically small <5mm)
- Usually characteristic ‘string of pearls’ appearance.
- Ovaries typically enlarged (>10cc), although in 30% of patients the ovaries have a normal volume.

62
Q

Ovarian cancer (5)

A

Ovarian cancers often present as complex, cystic masses.
Typically intra-ovarian (most extra-ovarian masses are benign).
The role of imaging is to distinguish benign from malignant.
Malignancy suggested by
- Unilateral (or bilateral) complex cystic adnexal masses with thich (>3mm) septations and papillary projections (nodule with blood flow).
- Solid adnexal masses with variable necrosis.

63
Q

Ovarian cancer - concerning features (3)

A

Multiple thick or thin septations
Nodule with flow
Solid nodules without flow
- Get MR to ensure not a dermoid plug

64
Q

Serous ovarian/Cystadenocarcinoma/Cystadenoma (5)

A

Serous tumours are commonest ovarian malignancy.
60% of serious tumours are benign, 15% borderline, rest are malignant.
Favour women of childbearing age, malignant ones tend to occur in older women.
Usually unilocular with few septations.
Frequently bilateral (especially if malignant).
Papillary projections are common finding, siggests malignancy.
Ascites suggests mets (70% have peritoneal involvement at time of diagnosis).

65
Q

Muconous ovarian cystadenocarcinoma (6)

A

Often large mass.
Typically multiloculated, septa are often thin.
Papillary projections are less common with serous tumours.
Low level echos (from mucin).
Can get pseudomyxoma peritonei, with scalloping along solid orgns.
Smoking is a risk factor (espeically mucinous types).

66
Q

Serous vs Mucinous (4)

A

Serous
- Unilocular (fewer septations)
- Papillary projections common
Mucinous
- Multi-locular (more septations)
- Papillary projections are less common

67
Q

Endometrioid ovarian cancer (4)

A

Second most common ovarian cancer (serous is number one, mucinous is 3)
Bilateral 15% of time.
25% of women will have concomitant endometrial cancer (endometrial is primary, ovarian is met).
Endometriomas can turn into endometriod cancer.

68
Q

Ovarian mass + endometrial thickening (2)

A

Can be endometrioid cancer (often has both endometrial Ca and ovarian Ca) or Granulosa-Theca Call tumour (produces oestrogen, causing endometrial hyperplasia)

69
Q

Big Masses differential - adults (3)

A

Ovarian masses (Mucinous and serous)
Desmoids
Sarcomas

70
Q

Fibroma/fibrothecoma (5)

A

Ovarian fibroma is a benign ovarian tumour, commonly in middle aged women.
Fibrothecoma/thecoma spectrum has similar histology. Very similar to fibroid.
US: Hypoechoic and solid.
MRI: T1 and T2 dark, band of T2 dark signal around the tumour on all planes.
Calcifications are rare

71
Q

Meigs syndrome (3)

A

Ascites, Pleural effusion, Benign ovarian tumour (commonly fibroma)

72
Q

Fibromatosis (5)

A

Tumour like enlargement of the ovaries due to fibrosis.
Usually affects women around 25YO.
Associated with omental fibrosis and sclerosing peritonitis.
Dark T1 and T2 signal, with “Black Garland sign” on T2.
Benign, sometimes managed with removal of ovaries.

73
Q

Brenner tumour (4)

A

Epithelial tumour of the ovary, seen in women in 50s-70s.
Fibrous and T2 dark.
Calcifications are common (80%)
Also known as Ovarian Transitional Cell Carcinoma

74
Q

Struma Ovarii (4)

A

Subtype of ovarian teratoma.
Multolocular, predominantly cystic mass with intensely enhancing solid component.
MRI: very low T2 signal in “cystic” areas (actually thick colloid).
They contain thyroid tissue, can rarely get hyperthyroidism.

75
Q

Mets to ovary (3)

A

10% of malignant ovarian tumours are mets.
Primary is commonly colon, gastric, breast, lung, contralateral ovary.
Most common appearance is bilateral solid tumours.
Krukenburg tumour is a metastatic tumour to the ovaries from the GI tract, usually stomach.

76
Q

Ovarian torsion (5)

A

Rotation of ovary around ovarian pedicle can result in venous and arterial obstruction.
Associated with mass (cyst or tumour).
Most constant finding is a large ovary (unilaterally large ovary >4cm).
Peripheral cysts and free fluid often seen.
Lack of arterial or venous flow, however the ovary has dual blood supply, so flow doesn’t rule out torsion unlike a testicle.

77
Q

Hydrosalpinx (5)

A

Thin (or thick if chronic) elongated tubular structure in the pelvis.
“Cogwheel appearance” - normal longitudinal folds of fallopian tube becomming thickened.
“String sign” - incomplete septae.
“Waist sign” = tubular mass with indentations of its opposing walls (helps differentiate hydrosalpinx from ovarian mass)
Several causes, including PID, endometriosis, tubal cancer, post hysterectomy (without oophorectomy) and tubal ligation.
Tubal torsion is a rare and late complication

78
Q

PID (5)

A

Infection or inflammation of the upper female genital tract.
Secondary to Gonorrhoea or Chlamydia.
US: Hydrosalpinx.
Margin of uterus may become ill defined (Indefinite uterus is a buzzword).
Later can get tubo-ovarian abscess or pelvic abscess.
Can get bowel or urinary tract inflammation.

79
Q

Paraovarian cyst (5)

A

Congenital remnant arising from Wolffian duct.
Account for 10-20% of adnexal masses.
Classically round or oval, simple in appearance, and don’t distort the adjacent ovary (key finding).
Can indent the ovary and mimic exophytic cyst.

80
Q

Ovarian vein thrombophlebitis (4)

A

Most common in post partum women, often with acute pelvic pain and fever.
80% occur on the right.
CT or US shows tubular structure with enhancing wall and low attenuation thrombus in the expected location of ovarian vein.
Can lead to pulmonary embolus.

81
Q

Peritoneal Inclusion cyst (8)

A

Inflammatory cyst of the peritoneal cavity, occurs when adhesions envelop an ovary.
Normal peritoneum can absorb fluid, adhesions cannot.
Normal secretions from actuve ovary, confined by adhesions, resulting on expanding pelvic mass.
Classic Hx is prior pelvis surgery, now with pain. Could say PID or endometriosis Hx.
US or MR with complex fluid collection, occupying pelvic recesses and containing the ovary.
Septations, loculations and particulate matter can occur within the contained fluid
Key features
- Lack of walls: passive shape that conforms to surrounding structures.
- Entrapment of an ovary, either in the collection or at the periphery.

82
Q

Gestational Trophoblastic disease (6)

A

Marked elevation of bHCG. Trend is useful to monitor tumour activity.
Often causes hyperemesis.
Often affects age >40, prior moles increase likelihood of another.
Types include
- Hydatiform mole
- Invasive mole
- Choriocarcinoma

83
Q

Hydatoform mole (3)

A

Most common trophoblastic disease, and benign.
Subtypes are complete mole or partial mole.
Theca lutein cysts are seen in molar pregnancies, most common in second trimester and are bilateral.

84
Q

Complete mole (classic mole) (6)

A

More common than partial.
Involves entire placenta, will be no fetus.
Diploid karyotype.
Pathogenesis is fertilization of an egg that has lost it’s chromosomes (46XX).
- First trimester US: uterus filled with echogenic, solid, highly vascular mass. Often described as Snowstorm appearance
- Second trimester US: vesicles that make up the mole enlarge into individual cysts (2-30mm), producing bunch of grapes appearance

85
Q

Partial mole (4)

A

Less common than complete, only involved part of placenta.
Triploid foetus, due to fertilisation of an ovum by 2 sperm (69XXY).
Lethal to the foetus.
- US: Placenta enlarged, areas of multiple diffuse anechoic lesions. May see fetal parts.

86
Q

Invasive mole (4)

A

Invasion of molar tissue into myometrium.
Typically seen after treatment of hydatiform mole (10% of cases).
US: echogenic tissue in myometrium.
MRI: Demonstrates muscle invasion better. Focal myometrial masses, dilated vessels and areas of haemorrhage and necrosis.

87
Q

Choriocarcinoma (6)

A

Aggressive malignancy which forms only trophoblasts, no villous structure.
Typical attacking pattern of choriocarcinoma is spreading locally (into myometrium and parametrium), then spread via blood to any site in the body.
Very vascular.
Classic scenario is serum bHCG rising in 8-10 weeks following evacuation of molar pregnancy.
US: Choriocarcinoma (at any site) results in highly echogenic solid mass
Rx: Methotrexate

FRCR 2A (Crack The FRCR 2A) (55 decks)

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