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Hannah Endo/Repro year 2 > benign and malignant conditions of the uterus, cervix, ovary and FT > Flashcards

benign and malignant conditions of the uterus, cervix, ovary and FT Flashcards

1
Q

define the characteristics of theca-lutein cysts

A
  • BL large ovarian cysts
  • develpos in pts with high levels of bHCG (pregnancy, choriocarcinoma, hyatidaform mole)
  • NL regression with the gonadotropin levels fall
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2
Q

what is endometrial hyperplasia and how is it caused

A
  • 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
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3
Q

what is the most common indication for hysterectomy

A

symptomatic leiomyoma of there uterus (fibroids)

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4
Q

what causes uterus didelphysis (2 uterine bodies with own cervix, FT, and vagina) or bicornuate uterus

A

failure of mullerian (paramesonephric) duct fusion

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5
Q

what is the most common type of uterine fibroid

A

intramural ( arises from within the myometrium)

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6
Q

RF of uterine leiomyoma

A

-older age at reproductive years
-african american
-nullparity
-FH
(estrogen)

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7
Q

what is one of the most common GYN emergency and what is the RF

A
  • ovarian torsion (adnexal torsion includes twisting of the FT and ovary)
  • RF: ovarian mass >5cm
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8
Q

traits of granulose theca cells tumors

A
  • 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
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9
Q

how is benign epithelial ovarian tumors and stomal cell tumors usually managed

A

unilateral salpingo-oophorectomy (esp if BRCA1 carrier)

*if mucinous due appendectomy

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10
Q

what causes a unicornate uterus

A

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)

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11
Q

follicular cysts (and therefore PCOS) is a RF for

A

ovarian torsion

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12
Q

US of endometrial polyp shows what, but what is best detection of the polyp

A

reveals focal thickening of the endometrial stripe

-saline infusion sonohysterogram and hysteroscopy (dx and tx)

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13
Q

define luteoma of pregnancy

A
  • hyperplastic rxn of the ovarian theca cells due to prolonged bHCG in pregnancy
  • reddish brown nodules
  • spontaneous regression there NO SURGERY
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14
Q

sx of endometrial polyps

A
  • menorrhagia, spontaneous, or post menopausal bleeding

- benign (but remove with hysteroscopy bc endometrial hyperplasia and carcinoma may also present as polyps)

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15
Q

dermoid cysts are mainly comprised of what type of tissue

A
  • fetal tissues of all three layers possible (ectoderm,mesoderm, endoderm)
  • ectoderm is most common with hair and sebaceous material
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16
Q

what is the most common neoplasm of the uterus and its features

A

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

17
Q

what are the types of cysts in the ovaries

A
  1. functional cyst (follicular, luteal, hemorrhagic, PCOS)
  2. benign neoplastic cysts (epithelial cystadenoma, sex cord stromal tumors, germ cells tumors)
  3. malignant cysts
18
Q

how to dx benign ovarian tumors

A
  • 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
19
Q

what is the single most common benign ovarian neoplasm of premenopausal women

A

benign cystic teratoma (dermoid cyst)

20
Q

most common epithelial ovarian tumor ? what do you see on histo with it?

A

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
21
Q

how to dx and Tx endometrial hyperplasia

A

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)

22
Q

define PCOS

A
  • 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
23
Q

what is the most common benign growth on the cervix

A

ectocervical and endocervical polyp

-endocervical is more common (beefy red)

24
Q

sx and tx of cervical polyp

A

none, coital bleeding, menorhaggia
endocervical = beefy red
ectocervical= pale
tx: remove in office

25
Q

most common ovarian neoplasm found in women of all ages

A 
cystic teratoma (germ cell tumor) 
-dermoid cysts
26
Q

signs of a leiomyoma with dx techniques

A
    1. bimanual exam = large irregular shaped uterus, mobile mass moves with the cervix!!
      1. US shows masses
27
Q

mucinous ovarian tumors cytologically resemble the ____ epithelium ; serous ovarian tumors resemble the lining of _____

A

mucinous: endocervical epithelium (simple columnar non ciliated)

serous: lining of the fallopian tubes (ciliated pseduostratified columnar)
* **SEROUS IS CILIATED

28
Q

at what week does the paramesonephric duct arise in gestation and when does it fuse

A

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 )

29
Q

tx of fibroids

A

Meds:

  • combo (estrogen and progesterone) OC (FIRST LINE)
  • progesterone only
  • GnRH agonist (shrinks fibroids)

Surgery:

  • myomectomy
  • endometrial ablation
  • uterine artery embolization
  • hysterectomy
30
Q

how to dx and TX PCOS

A
  1. bimanual exam reveals enlarged mobile unilateral cysts on ovaries
  2. US

tx: if premenopausal and asx then use OCPs
- if sx and premenopausal then rule out ectopic, torsion, abscess

31
Q

define a follicular cyst

A
  • 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
32
Q

define luteal cysts

A

-when the corpus luteum does not regress and becomes larger and fills with fluid
( if corpus luteum fills with fluid = hemorrhagic cyst)

33
Q

how to to dx and tx ovarian torsion

A
  1. US to identify mass
  2. dx confirmed with direct visualization

tx: detorsion and ovarian cystectomy (for conservation)
* if necrotic/malignant: salphingo-oophorectomy

34
Q

fibroma (fibrothecoma) ovarian tumor traits

*type of sex cord stomal tumor even though it doesn’t secrete sex steroids

A
  • 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)
35
Q

what is a nabothian cervical cyst

A
  • 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

36
Q

what is the most common congenital cervical anomaly

A
  • caused by malfusion of the paramesonephric duct with varying degrees of separation
    1. didelphys cervix
    2. septate cervix

Hannah Endo/Repro year 2 (11 decks)

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