Benign and Malignant Conditions of the Uterus, Cervix, Fallopian Tubes, and Ovaries (Moulton) Flashcards
Upper vagina, cervix, uterus & fallopian tubes are formed embryologically from the?
Paramesonephric (Mullerian) ducts
The absence of a __1__ and absence of the Mullerian inhibiting substance leads to what?
Paramesonephric ducts arise at __3__ weeks gestational.
By __4__ weeks they fuse in the midline to form the __5__.
1) Y chromosome
2) Development of paramesonephric system and Regression of Mesonephric system
3) Six
4) Nine
5) Uterovaginal primordium
Uterus didelphysis, Bicornuate uterus w/ a rudimentary horn, or Bicornuate uterus with or without double cervices are all due?
*Look over picture EVERY time
Failure of fusion for Paramesonephric duct
Two separate uterine bodies with its own cervix, attached fallopian tube, and vagina is characteristic of?
Uterus didelphysis
What is septate uterus due to?
Incomplete dissolution of midline fusion of the paramesonephric ducts
What is Unicornate Uterus due to?
Failure of formation of paramesonephric (Mullerian) ducts
Meyer-Rokitansky-Kuster-Hauser syndrome is due to the complete lack of embryological development of
This leads to the absence of?
1) Paramesonephric system
2) Uterus and most of the vagina
(Mullerian Agenesis)
The most common congenital cervical anomalies such as Didelphys cervix and Septate cervix are the result of?
Poor fusion of the paramesonephric ducts with varying degrees of separation
Early maternal exposure to DES causes what?
What does this lead to?
T- Shaped endometrial cavity leading to cervical collar deformity
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?
What are they an indication for?
1) Heavy uterine bleeding
2) Pelvic pressure/pain
3) Infertility
Hysterectomy
What race has a 2-3 fold increase risk of leiomyomas?
In terms of childbearing, what increases risk?
1) African American
2) Nulliparity (never having pregnancy after 20 weeks)
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.
5) What can Happen in postmenopausal woman with leiomyoma
1) Before menarche
2) Enlarge after Menopause
3) Pregnancy
4) Estrogen
5) Calcification
How are leiomyomas characterized as?
Spherical
Well-Circumscribed
White firm lesions
Whorled appearance
WWWS
Fibroids arise within the __1__.
2) Which type of fibroid is most common?
3) Which type of leiomyoma has the highest incidence of infertility?
4) What is the most common presenting symptom
5) What is usually the first therapeutic option for leiomyomas?
1) Myometrium
2) Intramural
3) Submucosal
4) Heavy bleeding
5) Estrogen + Progesterone combination OCPs
If a palpated mass moves with the cervix what is it suggestive of?
Fibroids (leiomyoma)
1) How do are submucosal fibroids removed?
2) What is the definitive surgical therapy for fibroids?
1) Hysteroscopic myomectomy
2) Hysterectomy
What procedure leads to NECROSIS of the fibroid due to microspheres/polyvinyl alcohol particles occluding the artery feeding the fibroid?
Uterine artery embolization
1) What are endometrial polyps?
2) What do endometrial polyps create?
2) What do endometrial polyps cause?
1) Benign hyperplastic masses
2) Soft friable polyps
3) Menorrhagia (heavy bleed), Spontaneous, or postmenopausal Bleeding
While saline hysterosonography & hysteroscopy allows for better detection of endometrial polyps, ultrasound may reveal what?
Focal thickening of Endometrial stripe
While most endometrial polyps are benign hyperplastic masses, they need to be removed with _____ since ____ may also present as polyps.
1) Hysterectomy
2) Endometrial hyperplasia and carcinoma
What is Nabothian Cyst and how does it appear?
Cervical Cyst
Appears Opaque with yellow/blue hue
Nabothian cyst result from __1__ in which a layer of __2__ entrap a layer of __3__ cells beneath its surface.
1) Squamous metaplasia
2) Superficial Squamous cells
3) Columnar Cells
*Like Barretts esophagus
What are the most common benign growths on the cervix?
What color are they?
Which is more common out of the two?
Ectocervical Polyp (Pale) Endocervical polyp (Beefy Red) -More common
Endometrial hyperplasia represents an overabundance growth of the endometrial lining usually as a result of persistent unopposed ____.
Estrogen
What 4 Issues can cause Endometrial Hyperplasia?
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
What can endometrial hyperplasia be a precursor to?
Endometrial cancer
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?
Unexplained Intermenstrual, heavy or prolonged bleeding
How do you treat simple and complex hyperplasia WITHOUT atypia?
How do you treat simple and complex hyperplasia WITH atypia?
1) Progestin and resample in 3 months
2) A hysterectomy
