Benign Conditions Flashcards
What is a leiomyoma of the uterus?
What is this better known as?
In terms of epidemiology, when are these most likely to be seen?
A benign smooth muscle tumour of the myometrium
Uterine fibroids
Most common aged > 40, more common in the Afro-Caribbean population
It is unknown what causes a uterine fibroid to start growing, but once they have grown they are responsive to what?
What effect does a) pregnancy and b) menopause have on the growth of fibroids?
Are fibroids usually single or multiple?
How big are they?
Can they be palpated?
Oestrogen and progesterone
a) growth b) shrink
Multiple
Range from microscopic - 20cm
Usually, on either abdominal or pelvic exam
Uterine fibroids can grow so fast and large that they outgrow their own blood supply - when does this often occur?
What does it present with?
A common cause of abdominal pain in mid-pregnancy
Most uterine fibroids are asymptomatic and are an incidental finding, however they can present with what?
Menorrhagia
Pressure symptoms affecting the bladder or bowel
Abdominal pain
Subfertility or recurrent miscarriage
Describe the investigation procedure for uterine fibroids?
Often a clinical diagnosis which is confirmed with transvaginal US scanning
May also be worth measuring Hb to check for anaemia
Most patients with fibroids do not require treatment because they are asymptomatic. However, if they were, what are some options?
What is given to shrink the fibroids before any surgery and how long for?
What is the first line surgical option for women wanting to maintain their fertility?
What is the option for women who do not want to maintain their fertility?
COCP, Mirena coil oral progestins
GnRH analogue (e.g. gozarelin) for 6 months
Myomectomy
Hysterectomy
What are leiomyosarcomas?
When do they tend to occur?
Where can they come from?
What is a risk factor for their development?
What is the prognosis?
Rare malignant tumours of the myometrium
In women aged 40-60
Can develop from a fibroid (though rare) or can be de novo
Radiotherapy for a previous pelvic malignancy
Poor
What are some symptoms of a leiomyosarcoma?
Abnormal vaginal bleeding
Palpable pelvic mass
Pelvic pain
What are some benign endometrial causes for dysfunctional uterine bleeding?
When does the second cause tend to present?
Endometrial hyperplasia (simple, complex, atypical) or endometrial polyps
Around or after the menopause
What lines the ectocervix?
What lines the endocervix?
What is the transformation zone?
Is the transformation zone always the same?
What tests should always be taken from this zone?
Non-keratinised squamous epithelium
A single layer of columnar, mucinous endothelium
The area between the endo and ecto cervical epithelium
No, it changes in response to menarche, pregnancy and menopause
Any biopsy/smear of the cervix
Any cervical erosion will lead to the exposure of the delicate endocervical environment to the acidic environment of the vagina. What does this result in?
Physiological squamous metaplasia and possibly the formation of Nabothian follicles
What are some potential causes of cervicitis?
What complication can this lead do?
Cervical polyps are a cause of localised inflammatory outgrowth- what symptom does this cause?
Are cervical polyps pre-malignant? How are they treated?
Non-specific inflammation, chlamydia, herpes simplex infection
Fallopian tube damage
Vaginal bleeding
No - polypectomy
What are benign ovarian cysts?
What are the 3 main types?
What are the main symptoms?
Fluid filled sacs within the ovary
Functional, endometriotic (chocolate) and germ cell
Pain, swelling, endocrine effects
How do follicular cysts form?
Which group of people are these especially common in?
When do they tend to resolve?
If there has been no ovulation and the follicle does not release an egg, it grows into a cyst
PCOS
In a few months
How do luteal cysts form?
The corpus luteum does not break down as usual in the absence of a pregnancy, instead it expands with blood or fluid
What is another name for mature teratomas?
These are common and may become very large - they typically contain what?
Dermoid cysts
Bone, teeeth, hair, sebum
How are ovarian cysts usually detected?
What system is used to help differentiate between a cyst and a malignant mass?
Incidentally during imaging for other reasons
RMI
What is the first step of management for an ovarian cyst?
What is the second step? When should this be used?
When and why are endometriomas > 6cm removed?
Simple cysts (< 5cm) are monitored with serial US scans
Laparoscopic removal - if symptomatic or cannot rule out malignancy
Before assisted reproduction to improve pregnancy rates
What are ‘cyst accidents’?
How do they present?
Which one needs fixed urgently to preserve ovarian viability?
Rupture, bleeding or torsion of ovarian cysts
Acute abdomen
Torsion
A stromal fibroma of the ovary can be seen in the context of what syndrome?
What are the other features?
Meig’s syndrome
Pleural effusions and ascites
What is a hydrosalpinx?
What is a pyosalpinx?
What are para-tubal cysts?
Distally blocked Fallopian tube with serous/clear fluid
Fallopian tube swells up with pus (acute, inflammatory)
Usually small and incidental embryological remnants
How does vulvular Paget’s disease present?
Where does the tumour arise from?
Is this pre-malignant?
A crusting rash
Sweat glands in the skin
It can be
Candida infections of the vulva are especially seen in who?
Which types of HPV are responsible for vulval warts?
What causes a Bartholin’s gland abscess?
Diabetics
6 and 11
Blockage of the duct
What are some non-neoplastic epithelial disorders which can affect the vulva?
Who does vulval atrophy tend to occur in?
Lichen planus, lichen sclerosis and psoriasis
Post-menopausal women
