Benign and Malignant Conditions of the Uterus, Cervix, Fallopian Tubes, and Ovaries (Moulton)

Question 1

Upper vagina, cervix, uterus & fallopian tubes are formed embryologically from the?

Answer 1

Paramesonephric (Mullerian) ducts

Question 2

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__.

Answer 2

1) Y chromosome
2) Development of paramesonephric system and Regression of Mesonephric system
3) Six
4) Nine
5) Uterovaginal primordium

Question 3

Uterus didelphysis, Bicornuate uterus w/ a rudimentary horn, or Bicornuate uterus with or without double cervices are all due?

*Look over picture EVERY time

Answer 3

Failure of fusion for Paramesonephric duct

Question 4

Two separate uterine bodies with its own cervix, attached fallopian tube, and vagina is characteristic of?

Answer 4

Uterus didelphysis

Question 5

What is septate uterus due to?

Answer 5

Incomplete dissolution of midline fusion of the paramesonephric ducts

Question 6

What is Unicornate Uterus due to?

Answer 6

Failure of formation of paramesonephric (Mullerian) ducts

Question 7

Meyer-Rokitansky-Kuster-Hauser syndrome is due to the complete lack of embryological development of

This leads to the absence of?

Answer 7

1) Paramesonephric system
2) Uterus and most of the vagina

(Mullerian Agenesis)

Question 8

The most common congenital cervical anomalies such as Didelphys cervix and Septate cervix are the result of?

Answer 8

Poor fusion of the paramesonephric ducts with varying degrees of separation

Question 9

Early maternal exposure to DES causes what?

What does this lead to?

Answer 9

T- Shaped endometrial cavity leading to cervical collar deformity

Question 10

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?

Answer 10

Uterine leiomyomas (Fibroids)

Question 11

While they are usually asymptomatic, symptomatic fibroids can cause?

What are they an indication for?

Answer 11

1) Heavy uterine bleeding
2) Pelvic pressure/pain
3) Infertility

Hysterectomy

Question 12

What race has a 2-3 fold increase risk of leiomyomas?

In terms of childbearing, what increases risk?

Answer 12

1) African American

2) Nulliparity (never having pregnancy after 20 weeks)

Question 13

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

Answer 13

1) Before menarche
2) Enlarge after Menopause
3) Pregnancy
4) Estrogen
5) Calcification

Question 14

How are leiomyomas characterized as?

Answer 14

Spherical
Well-Circumscribed
White firm lesions
Whorled appearance

WWWS

Question 15

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?

Answer 15

1) Myometrium
2) Intramural
3) Submucosal
4) Heavy bleeding
5) Estrogen + Progesterone combination OCPs

Question 16

If a palpated mass moves with the cervix what is it suggestive of?

Answer 16

Fibroids (leiomyoma)

Question 17

1) How do are submucosal fibroids removed?

2) What is the definitive surgical therapy for fibroids?

Answer 17

1) Hysteroscopic myomectomy

2) Hysterectomy

Question 18

What procedure leads to NECROSIS of the fibroid due to microspheres/polyvinyl alcohol particles occluding the artery feeding the fibroid?

Answer 18

Uterine artery embolization

Question 19

1) What are endometrial polyps?
2) What do endometrial polyps create?
2) What do endometrial polyps cause?

Answer 19

1) Benign hyperplastic masses
2) Soft friable polyps
3) Menorrhagia (heavy bleed), Spontaneous, or postmenopausal Bleeding

Question 20

While saline hysterosonography & hysteroscopy allows for better detection of endometrial polyps, ultrasound may reveal what?

Answer 20

Focal thickening of Endometrial stripe

Question 21

While most endometrial polyps are benign hyperplastic masses, they need to be removed with _____ since ____ may also present as polyps.

Answer 21

1) Hysterectomy

2) Endometrial hyperplasia and carcinoma

Question 22

What is Nabothian Cyst and how does it appear?

Answer 22

Cervical Cyst

Appears Opaque with yellow/blue hue

Question 23

Nabothian cyst result from __1__ in which a layer of __2__ entrap a layer of __3__ cells beneath its surface.

Answer 23

1) Squamous metaplasia
2) Superficial Squamous cells
3) Columnar Cells

*Like Barretts esophagus

Question 24

What are the most common benign growths on the cervix?

What color are they?

Which is more common out of the two?

Answer 24

Ectocervical Polyp (Pale)
Endocervical polyp (Beefy Red) -More common

Question 25

Endometrial hyperplasia represents an overabundance growth of the endometrial lining usually as a result of persistent unopposed ____.

Answer 25

Estrogen

Question 26

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?

Answer 26

1) PCOS
2) Granulosa theca cell tumors
3) Obesity
4) Tamoxifen

Question 27

What can endometrial hyperplasia be a precursor to?

Answer 27

Endometrial cancer

Question 28

What are the ways that endometrial hyperplasia is categorized?

Which category has the highest change of progressing into cancer?

Answer 28

1) Simple vs complex and with/without atypia

2) Complex hyperplasia with atypia

Question 29

What symptom does endometrial hyperplasia cause?

Answer 29

Unexplained Intermenstrual, heavy or prolonged bleeding

Question 30

How do you treat simple and complex hyperplasia WITHOUT atypia?

How do you treat simple and complex hyperplasia WITH atypia?

Answer 30

1) Progestin and resample in 3 months

2) A hysterectomy