Benign and Malignant Conditions of the Uterus, Cervix, Fallopian Tubes, and Ovaries (Moulton) Flashcards
Upper vagina, cervix, uterus & fallopian tubes are formed from the?
Paramesonephric (Mullerian) ducts
The absence of a __1__ and absence of the Mullerian inhibiting substance leads to the development of the
paramesonephric system with the regression of the
mesonephric system.
Paramesonephric ducts arise at __2__ weeks gestational and by __3__ weeks they fuse in the midline to form the __4__.
1) Y chromosome
2) Six
3) Nine
4) Uterovaginal primordium
Uterus didelphysis, Bicornuate uterus w/ a rudimentary horn, or Bicornuate uterus with or without double cervices are all due to failure of?
Paramesonephric duct to fuse
Two separate uterine bodies with its own cervix, attached fallopian tube, and vagina is characteristic of?
Uterus didelphysis
Incomplete dissolution of the midline fusion of the paramesonephric ducts leads to?
Septate uterus
Failure of formation of Mullerian ducts can be lead to a?
Unicornate uterus
Meyer-Rokitansky-Kuster-Hauser syndrome is due to the complete lack of development of?
This leads to the absence of?
1) Paramesonephric system
2) Uterus and most of the vagina
The most common congenital cervical anomalies such as Didelphys cervix and Septate cervix are the result of?
Malfusion of the paramesonephric ducts with varying degrees of separation
Early maternal exposure to what drug causes a small T-shaped endometrial cavity leading to cervical collar deformity?
Diethylstilbestrol (DES)
What are the most common neoplasm of the uterus and are characterized by benign tumors derived from localized proliferation of smooth muscle cells of the myometrium?
Uterine leiomyomas (Fibroids)
While they are usually asymptomatic, symptomatic fibroids can cause?
1) Heavy uterine bleeding
2) Pelvic pressure/pain
3) Infertility
Symptomatic fibroids are the most indication for?
Hysterectomy
What race has a 2-3 fold increase risk of leiomyomas?
In terms of childbearing, what increases risk?
1) African American
2) Nulliparity
Fibroids rarely form before __1__ or enlarge after __2__.
They enlarge most frequently during __3__?
This is due to __4__ playing a huge role in its development by stimulating the proliferation of smooth muscle cells.
1) Menarche
2) Menopause
3) Pregnancy
4) Estrogen
What are characterized as spherical, well circumscribed, white firm lesions with a whorled appearance on cut sections?
Leiomyomas
Fibroids arise within the __1__.
This is why __2__ fibroids are the most common.
1) Myometrium
2) Intramural
Which type of fibroid has the highest incidence of infertility?
Submucosal fibroids
The most common presenting symptom of leiomyoma is?
Heavy bleeding
If a palpated mass moves with the cervix is it highly suggestive of a carcinoma?
No, it is highly suggestive of fibroid
What is usually the first therapeutic option for leiomyomas?
Estrogen + Progesterone combination OCPs
A hysteroscopic myomectomy can be performed to remove which type of fibroids?
Submucosal fibroids
What is the definitive surgical therapy for fibroids?
Hysterectomy
What procedure leads to necrosis of the fibroid due to microspheres/polyvinyl alcohol particles occluding the artery feeding the fibroid?
Uterine artery embolization
What soft friable polyps can cause menorrhagia, spontaneous, or post menopausal bleeding?
Endometrial polyps
While saline hysterosonography & hysteroscopy allows for better detection of endometrial polyps, ultrasound may reveal focal thickening of the ____?
Endometrial stripe
While most endometrial polyps are benign hyperplastic masses, they need to be removed with hysteroscopy since ____ may also present as polyps.
Endometrial hyperplasia and carcinoma
What cervical cyst appear opaque with a yellowish or bluish hue?
Nabothian cyst
Nabothian cyst result from __1__ metaplasia in which a layer of superficial __1__ epithelial cells entrap a layer of __2__ cells beneath its surface.
1) Squamous
2) Columnar
What are the most common benign growths on the cervix?
Ectocervical and endocervical polyps
Which cervical polyp are more common and are beefy red in color?
Which are pale in appearance?
1) Endocervical polyps
2) Ectocervical polyps
Endometrial hyperplasia represents an overabundance growth of the endometrial lining usually as a result of persistent unopposed ____.
Estrogen
What syndrome can cause endometrial hyperplasia?
What estrogen producing tumor can cause endometrial hyperplasia?
What can cause endometrial hyperplasia due to peripheral conversion of androgens to estrogens in cells that are abundant in this condition?
What drug used in the treatment in breast cancer can cause endometrial hyperplasia?
1) PCOS
2) Granulosa theca cell tumors
3) Obesity
4) Tamoxifen
Can endometrial hyperplasia be a precursor to endometrial cancer?
Yes
What are the ways that endometrial hyperplasia is categorized?
Which category has the highest change of progressing into cancer?
1) Simple vs complex and with/without atypia
2) Complex hyperplasia with atypia
What symptom does endometrial hyperplasia cause?
Intermenstrual, heavy or prolonged bleeding that is unexplained
With simple and complex hyperplasia WITHOUT atypia treat with __1__ and resample in 3 months.
Simple and complex hyperplasia WITH atypia is best treated with __2__.
1) Progestin
2) A hysterectomy
What term includes the ovaries, fallopian tubes, upper portion of the broad ligament, and mesosalpinx?
Adnexa
What syndrome is associated with abnormal gonad development, small rudimentary streaked ovaries, and development of secondary sexual characteristics but enete menopause shortly after?
What is the karyotyping?
1) Turner syndrome
2) 45XO
What is characterized by a lack of androgen receptors, phenotypically female, and gonads (functioning testes) need to remove after puberty because of malignant potential?
What is the karyotyping?
1) Complete Androgen Insensitivity Syndrome/Testicular feminization
2) 46XY
What may lead to shortened, distorted or clubbed fallopian tubes?
DES (diethylstilbestrol)
Follicular, Lutein cyst, Hemorrhagic cyst, and Polycystic ovaries are categorized as?
Functional cysts
Follicular Cysts are lined by one or more layers of __1__ cells.
They develop when a(n) __2__ fails to rupture.
1) Granulosa
2) Ovarian follicle
Corpus Luteum Cysts may develop if the corpus luteum becomes __1__, larger than __2__ cm
and fails to regress normally after __3__ days.
1) Cystic
2) Three
3) 14
Hemorrhagic cysts are more likely to cause symptoms
and are caused by hemorrhage in the ____ 2-3 days after ovulation.
Corpus luteum cyst
Theca-lutein cysts are usually bilateral, can become large (>30 cm) and may develop in patients with high serum levels of?
What can cause high levels of this?
1) hCG
2) Pregnancy, choriocarcinoma, or hydatidiform molar pregnancy
__1__ is caused by a hyperplastic reaction of the ovarian theca cells secondary to prolonged hCG stimulation during pregnancy.
They appear as __(color)__ nodules.
1) Luteoma of pregnancy
2) Reddish-brown
What cysts are associated with chronic anovulation, hyperandrogenism and insulin resistance?
Polycystic ovarian cysts
Polycystic ovarian cysts causes increased __1__ levels that promote __2__ secretion from the ovarian theca cells, leading to elevated levels of ovarian derived __3__ and __3__.
Then the peripheral conversion of __2__ to
estrogen results in elevated estrogen levels that then suppress __4__ from the pituitary gland
1) LH
2) Androgen
3) Androstenedione and testosterone
4) FSH
If the polycystic ovarian cysts are asymptomatic and the patient is premenopausal, you can place them on __1__ in order to suppress__2__ levels and prevent development of other cysts.
1) OCP’s
2) Gonadotropin
If the polycystic ovarian cysts are symptomatic and the patient is premenopausal, you must first rule out?
1) Ectopic pregnancy
2) Torsion
3) Tubo ovarian abscess
As a group which benign neoplastic ovarian tumors are the most common?
What are the tumors that make up this group?
1) Epithelial ovarian neoplasms
2) Serous cystadenoma, mucinous cystadenoma, and Brenner tumors
Epithelial tumors are thought to derive from the __1__ cells lining the peritoneal cavity and also the
lining from the surface of the ovary.
Mucinous ovarian tumors cytologically resemble the
__2__ epithelium.
Endometrioid ovarian tumors resemble the __3__.
Serous ovarian tumors resemble the lining of the __4__.
1) Mesothelial
2) Endocervical
3) Endometrium
4) Fallopian tubes
What are the most common epithelial ovarian tumors (75%)?
Serous cystadenoma
What can be found histologically in serous cystadenomas but are more common in malignant serous cystadenocarcinomas?
Psammoma bodies
Mucinous cystadenoma are the second most common epithelial tumor, can attain a huge size filling the entire pelvis/abdomen, and are associated with a mucocele of the __1__.
They can rarely lead to __2__, which is a condition in which numerous benign implants are seeded onto the surface of the bowel & other peritoneal surfaces producing large quantities of mucus.
1) Appendix
2) Pseudomyxoma peritonei
Brenner tumors are small smooth solid ovarian neoplasms that are usually benign with a large fibrotic component that encases __1__ cells that resemble __2__ cells of the bladder.
33% of cases these tumors are associated with __3__ epithelial elements.
1) Epithelioid
2) Transitional
3) Mucinous
What are the sex-cord stromal benign neoplastic cysts?
1) Fibromas
2) Granulosa-theca cell
3) Sertoli-Leydig
If the ultimate differentiation of cell types occurring in the tumor is feminine then the tumor is feminine and becomes a __1__ cell tumor.
If the cells take on a masculine differentiation then the tumor becomes a __2__ tumor.
1) Granulosa-theca
2) Sertoli leydig
Which sex cord-stromal ovarian tumor can cause precocious menarche, premenarchal uterine bleeding, menorrhagia and breast tenderness?
Granulosa-theca cell tumors
15% of Granulosa-theca cell tumors have an associated ____ cancer.
Endometrial
Which sex cord-stromal ovarian tumor can cause hirsutism, temporal baldness, deepening of the voice, and clitormegaly?
Sertoli leydig tumors
What is the most common benign solid ovarian tumor?
They are made up of interlacing bundles of?
1) Fibroma
2) Fibrocytes
What syndrome can ovarian fibromas cause?
What is this syndrome characterized by?
1) Meigs syndrome
2) Ascites and right pleural effusion (hydrothorax)
What is the germ cell benign neoplastic cyst and it is the single most common benign ovarian neoplasm in a premenopausal female?
Mature cystic teratoma (Dermoid)
Mature cystic teratoma (Dermoid) contain differentiated tissue from which embryonic germ layers?
Which are they composed primarily of which causes the presence of skin, sweat, sebaceous glands, and hair follicles?
1) All three: ectoderm, mesoderm, and endoderm
2) Ectoderm
Rupture of a cystic teratoma or mucinous tumor can result in ____.
Peritonitis
What finding related to calcification can be diagnostic of a dermoid cyst when using ultrasonography?
Seeing a tooth
What tumor serum marker is used to monitor ovarian tumors, especially in postmenopausal women?
CA-125
Epithelial benign ovarian tumors are usually managed with unilateral ____.
Salpingo-oophorectomy
If mucinous cystadenoma tumor is diagnosed perform an ____ secondary to possible coexistence of a mucocele in this organ.
Appendectomy
Stromal cell tumors are generally treated by ____ when future pregnancies are a consideration.
Unilateral salpingo-oophorectomy
__1__ is characterized by fluid filled fallopian tubes from previous infection.
__2__ is characterized by purulent filled fallopian tube from active infection.
1) Hydrosalpinx
2) Pyosalpinx
What refers to the complete or partial rotation of the ovary on its ligamentous supports, which often results in impedance of its blood supply?
Ovarian torsion
Adnexal torsion is when the ____ and ____ both twists.
Ovary and fallopian tube
What is the classic presentation for ovarian torsion?
1) Acute onset of unilateral pain
2) Nausea and possibly vomiting
What is first line imaging study to identify mass causing torsion?
Ultrasound
