B8-082 Benign Uterine Disorders Flashcards
differential of AUB in postmenopausal females [3]
endometrial cancer
atrophic vaginitis
vaginal/cervical tumor
structural causes of AUB in females of reproductive age
Polyp
Adenomyosis
Leiomyoma
Malignancy
PALM
non-structural causes of AUB in females of reproductive age [5]
Coagulopathy (VWD)
Ovulatory disorder
Endometrial
Iatrogenic
Not otherwise classified
COEIN
benign collection of endometrial tissue in the uterine wall that extend into the uterine cavity
endometrial polyps
endometrial polyps grow in response to […]
estrogen
tamoxifen is a risk factor for the development of
endometrial polyps
(polyps should be removed to prevent malignancy)
evaluation of endometrial polyps should include [3]
TVUS
hysteroscopy
biopsy to confirm benign
treatment of endometrial polyps [3]
surgical removal
progestins
temporary GnRH analogs
endometrial polyp removal is always recommended for what patient population?
postmenopausal females
(highest risk of malignancy)
in premenopausal females, endometrial polyps greater than […] cm should be removed due to increased risk of malignancy
1.5
first-line imaging study for evaluation of AUB
TVUS
firm, mobile uterus that is nontender and enlarged with discrete nodules
leiomyoma
(may present with pelvic pain due to pressure of size of fibroid)
benign uterine tumor presenting with multiple, discrete tumors
uterine leiomyoma
prevalence of leiomyoma is higher in what patient populations?
african americans
sensitive to estrogen/progesterone levels
increased symptoms during pregnancy
leiomyoma
in a patient presenting with symptoms of leiomyoma, make sure to get what lab?
bHCG
treatment for asymptomatic leiomyoma
observation
(will shrink postpartum/menopause)
most frequently mutated gene in muliple leiomyomas
MED12
(mediator of RNA pol. II transcription)
gene associated with large, singular leiomyomas
HMGA2
enlarged, tender, boggy uterus
adenomyosis
“venetian blinds” appearance on TVUS
adenomyosis
[adenomyosis vs leiomyoma]
indistinct borders
adenomyosis
[adenomyosis vs leiomyoma]
distinct, round borders
leiomyoma
[adenomyosis vs leiomyoma]
thin, parallel, vertical shadowing on TVUS
“venetian blinds”
adenomyosis
[adenomyosis vs leiomyoma]
dense with edge shadowing on TVUS
leiomyoma
[adenomyosis vs leiomyoma]
tiny cysts/cystic striations
adenomyosis
[adenomyosis vs leiomyoma]
solid cyst
leiomyoma
[adenomyosis vs leiomyoma]
increased vascularity with penetrating vessels
adenomyosis
[adenomyosis vs leiomyoma]
can be submucosal, intramural, or subserosal
leiomyoma
[adenomyosis vs leiomyoma]
contiguous or centrally located in myometrium
adenomyosis
diffusely enlarged uterus with some cystic areas within myometrium
adenomyosis
initial test to order in patient with enlarged uterus
bHCG
most effective treatment for patients with adenomyosis
levonorgestrel releasing IUD
mirena
treatment of adenomyosis when fertility is not a consideration
hysterectomy
(cannot “cut out” adenomyosis like you can fibroids)
risk factors for adenomyosis
multiparous
c-section
endometrial curettage/evacuation
(inside out theory mediated via TIAR pathway)
treatment for symptom resolution of leiomyoma
oral contraceptives
myomectomy is a viable treatment option for [adenomyosis/leiomyoma]
leiomyoma
develops outside the uterus, and is therefore not associated with uterine bleeding
endometriosis
