benign and malignant conditions of the uterus, cervix, ovary and FT Flashcards
define the characteristics of theca-lutein cysts
- BL large ovarian cysts
- develpos in pts with high levels of bHCG (pregnancy, choriocarcinoma, hyatidaform mole)
- NL regression with the gonadotropin levels fall
what is endometrial hyperplasia and how is it caused
- hyperplasia of endometrium (glands more than storm) due to unopposed estrogen
- assoc: anovolution cycle, PCOS, obesity, T2DM, granulosa theca cells tumors, exogenous estrogen
- associated with PTEN mutation and a atypical type is precursor to endometrial adenocarcinoma
- sx: ABNL bleeding
what is the most common indication for hysterectomy
symptomatic leiomyoma of there uterus (fibroids)
what causes uterus didelphysis (2 uterine bodies with own cervix, FT, and vagina) or bicornuate uterus
failure of mullerian (paramesonephric) duct fusion
what is the most common type of uterine fibroid
intramural ( arises from within the myometrium)
RF of uterine leiomyoma
-older age at reproductive years
-african american
-nullparity
-FH
(estrogen)
what is one of the most common GYN emergency and what is the RF
- ovarian torsion (adnexal torsion includes twisting of the FT and ovary)
- RF: ovarian mass >5cm
traits of granulose theca cells tumors
- low grade malignant neoplasm
- can occur at any age
- secrete estrogen
- causes early puberty, heavy menstrual bleeding, or endometrial hyperplasia/carcinoma and breast proliferative dz
- dx: confirmed by call exner bodies
- increased inhihbin levels and FOXL2 mutation
how is benign epithelial ovarian tumors and stomal cell tumors usually managed
unilateral salpingo-oophorectomy (esp if BRCA1 carrier)
*if mucinous due appendectomy
what causes a unicornate uterus
failure of the mullerain duct to form
-complete absence of the mullerian duct to development causes no uterus and lack of most vagina (meyer rokitansky duster hauser syndrome)
follicular cysts (and therefore PCOS) is a RF for
ovarian torsion
US of endometrial polyp shows what, but what is best detection of the polyp
reveals focal thickening of the endometrial stripe
-saline infusion sonohysterogram and hysteroscopy (dx and tx)
define luteoma of pregnancy
- hyperplastic rxn of the ovarian theca cells due to prolonged bHCG in pregnancy
- reddish brown nodules
- spontaneous regression there NO SURGERY
sx of endometrial polyps
- menorrhagia, spontaneous, or post menopausal bleeding
- benign (but remove with hysteroscopy bc endometrial hyperplasia and carcinoma may also present as polyps)
dermoid cysts are mainly comprised of what type of tissue
- fetal tissues of all three layers possible (ectoderm,mesoderm, endoderm)
- ectoderm is most common with hair and sebaceous material
what is the most common neoplasm of the uterus and its features
uterine leiomyoma (fibroids)
(benign tumor of smooth muscle of myometrium)
-most asx!
sx: prolonged or heavy uterine bleeding (esp if submucosal type), pelvic pressure, pelvic pain, infertility, (MC indication for hysterectomy)
*40 % enlarge during pregnancy
*white whorly masses on gross
what are the types of cysts in the ovaries
- functional cyst (follicular, luteal, hemorrhagic, PCOS)
- benign neoplastic cysts (epithelial cystadenoma, sex cord stromal tumors, germ cells tumors)
- malignant cysts
how to dx benign ovarian tumors
- abdominal and bimanual pelvic exam
- US (simple vs complex, can show dermoid tumor material like tooth calcifications)
- tumor markers (CA 125) - esp epithelial tumors
- laprascopy (distinguish between ovarian/uterina/ FT condition) *laparotomy is preferred
what is the single most common benign ovarian neoplasm of premenopausal women
benign cystic teratoma (dermoid cyst)
most common epithelial ovarian tumor ? what do you see on histo with it?
serous cystadenoma
- 70% benign
- more BL than unilateral mucinous
- histo: Psammoma bodies (more seeing the malignant serous cystadenocarcinomas)
- *MC malignant ovarian tumor even though most are benign
how to dx and Tx endometrial hyperplasia
dx:
1. sample endometrium (in office D&C)
2. US shows endometrial lining is >4mm in postmenopausal female
tx:
without atypia: progestin and resample in 3 mo
with atypia: hysterectomy (bc is a precursor for endometrial cancer)
define PCOS
- tons of follicular cyst (polycystic ovaries)
- characterized by: hyperandrogegism, infertility, PCOS, chronic anovolution cycle, ABNL menses
- usually young women of repro age
- assoc with: obesity and insulin resistance T2DM
- hormonal imbalance LH: FSH > 2 and that causes HIGH LEVELS OF ESTRONE
- *estrone levels is a RF for endometrial hyperplasia and carcinoma
what is the most common benign growth on the cervix
ectocervical and endocervical polyp
-endocervical is more common (beefy red)
sx and tx of cervical polyp
none, coital bleeding, menorhaggia
endocervical = beefy red
ectocervical= pale
tx: remove in office
most common ovarian neoplasm found in women of all ages
cystic teratoma (germ cell tumor) -dermoid cysts
signs of a leiomyoma with dx techniques
- bimanual exam = large irregular shaped uterus, mobile mass moves with the cervix!!
- US shows masses
- bimanual exam = large irregular shaped uterus, mobile mass moves with the cervix!!
mucinous ovarian tumors cytologically resemble the ____ epithelium ; serous ovarian tumors resemble the lining of _____
mucinous: endocervical epithelium (simple columnar non ciliated)
serous: lining of the fallopian tubes (ciliated pseduostratified columnar)
* **SEROUS IS CILIATED
at what week does the paramesonephric duct arise in gestation and when does it fuse
arises at week 6 and fuses at week 9 to form the uterovaginal primordium
(later the septum resolves to result in single cervix and uterus )
tx of fibroids
Meds:
- combo (estrogen and progesterone) OC (FIRST LINE)
- progesterone only
- GnRH agonist (shrinks fibroids)
Surgery:
- myomectomy
- endometrial ablation
- uterine artery embolization
- hysterectomy
how to dx and TX PCOS
- bimanual exam reveals enlarged mobile unilateral cysts on ovaries
- US
tx: if premenopausal and asx then use OCPs
- if sx and premenopausal then rule out ectopic, torsion, abscess
define a follicular cyst
- a simple cyst that develops due to failure of ovarian follicle to rupture
- can get large enough and rupture to cause peritonitis (pain)
- lined by granulosa cells
define luteal cysts
-when the corpus luteum does not regress and becomes larger and fills with fluid
( if corpus luteum fills with fluid = hemorrhagic cyst)
how to to dx and tx ovarian torsion
- US to identify mass
- dx confirmed with direct visualization
tx: detorsion and ovarian cystectomy (for conservation)
* if necrotic/malignant: salphingo-oophorectomy
fibroma (fibrothecoma) ovarian tumor traits
*type of sex cord stomal tumor even though it doesn’t secrete sex steroids
- most common benign solid ovarian tumor
- benign tumor of fibroblasts and scant storm (spindle cells)
- sx: pelvic mass with pelvic pain
- assoc with MEIGS syndrome (ovarian fibroma, ascites, and pleural effusion/hydrothorax on the right side that resolves with tumor removal)
what is a nabothian cervical cyst
- normal small cyst on cervix with blueish hue
- caused by squamous metaplasia over columnar cells, the columnar cells still secrete mucus and mucus cyst is formed
what is the most common congenital cervical anomaly
- caused by malfusion of the paramesonephric duct with varying degrees of separation
1. didelphys cervix
2. septate cervix
