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ENRP Exam 1 > Benign Conditions of the Uterus, Cervix, Ovary, and Fallopian Tubes > Flashcards

Benign Conditions of the Uterus, Cervix, Ovary, and Fallopian Tubes Flashcards

1
Q

the absence of a Y chromosome and absence of the mullerian inhibiting substance leads to the development of what?

A

the paramesonephric system with the regression of the mesonephric system

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2
Q

when do the paramesonephric ducts arise?

A

at 6 weeks gestational and by 9 weeks they fuse in midline to form the uterovaginal primordium

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3
Q

Failure of the paramesonephric duct to fuse can lead to:
1.
2.
3.

A
  1. uterus didelphysis: 2 separate uterine bodies with its own cervix, attached fallopian tube, and vagina
  2. Bicornuate uterus with a rudimentary horn
  3. bicornuate uterus with or without double cervices
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4
Q

Incomplete dissolution of the midline fusion of the paramesonephric ducts leads to:

A

septate uterus

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5
Q

failure of formation of mullerian ducts can lead to:

A

unicornate uterus

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6
Q

what is the most common congenital cervical anomalies the result of?

A

malfusion of the paramesonephric ducts with varying degrees of separation

  1. didelyphs cervix
  2. septate cervix
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7
Q

If not spontaneous, what could cause uterine and cervical anomalies?

A

early maternal exposure to drugs: DES
which can cause small T-shaped endometrial cavity or cervical collar deformity

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8
Q

What are uterine leiomyomas “fibroids”?

A

benign tumors derived from localized proliferation of smooth muscle cells of the myometrium

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9
Q

what is the most common neoplasm of the uterus?

A

uterine leiomyomas “fibroids”

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10
Q

what can symptomatic fibroids cause?

A

excessive uterine bleeding, pelvic pressure, pelvic pain and infertility

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11
Q

what is the most common indication for hysterectomy?

A

symptomatic fibroids

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12
Q

What are the risk factors for developing fibroids?

A

increasing age during reproductive years
african american women have a 2-3 fold increase risk
nulliparity
family history

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13
Q

what is the pathogenesis of fibroids?

A

factors that initiate leiomyomas are unknown
rarely form before menarche or enlarge after menopause: estrogen stimulates the proliferation of smooth muscle cells

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14
Q

what are the characteristics of fibroids?

A

usually spherical, well circumscribed, white firm lesions with a whorled appearance on cut sections
may degenerate and cause pain
-during pregnancy 5-10% of women with fibroids undergo a painful red or carneous degeneration caused by bleeding into the tumor
may calcify especially in postmenopausal patients

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15
Q

what are the different locations of fibroids?

A
  • *subserosal**
  • fibroid beneath the uterine serosal surface
  • *intramural**
  • fibroid arises within the myometrium ***most common
  • *submucosal**
  • fibroid beneath the endometrium
  • prolonged or heavy menstrual bleeding is common
  • *cervical intraligamentous**

-arise between the broad ligaments

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16
Q

women with leiomyoma symptoms may complain of what?

A

pelvic or lower back pain

pelvic pressure or fullness

severe pain is not common

frequency of urination if fibroid is pressing on bladder

prolonged or heavy bleeding (***most common presenting symptom and mainly associated with submucosal or intramural fibroids which distort the endometrium

increased incidence of infertility (more common with submucosal fibroids)

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17
Q

what are the signs of leiomyomas?

A

on bimanual examination: can reveal an enlarged, irregularly shaped uterus

if palpated mass moves with the cervix it is suggestive of a fibroid uterus

the degree of enlargement is described in “week size” used to estimate equivalent gestational size

Ultrasound: is often performed and can help distinguish between adnexal masses and lateral leiomyomas

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18
Q

how do you treat leiomyomas? medically

A
  1. Combination (estrogen + progesterone): oral contraceptive pills, rings; this is usually first therapeutic option
  2. progesterone-only therapies: Depo-provera, mirena intrauterine system
  3. Gonadotropin releasing hormones (GnRH agonist): Depo-Lupron
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19
Q

How do you treat leiomyomas surgically?

A

myomectomy, endometrial ablation, uterine artery embolization, and hysterectomy (the definitive therapy)

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20
Q

What is important to note about myomectomy?

A

if endometrial cavity is entered, then future deliveries must be by c-section

often the fibroids will grow back

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21
Q

what are endometrial polyps?

A

they form from the endometrium to create soft friable protrusion into the endometrial cavity

can cause menorrhagia, spontaneous, or post menopausal bleeding

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22
Q

what might US reveal in a patient with endometrial polyps?

A

focal thickening of the endometrial stripe

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23
Q

why is it important to remove endometrial polyps with hysteroscopy?

A

because endometrial hyperplasia and carcinoma may also present as polyps

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24
Q

what are nabothian cervical cysts?

A

appear opaque with a yellowish or bluish hue

vary in size 3mm to 3 cm

results from squamous metaplasia in which a layer of superficial squamous epithelial cells entrap a layer of columnar cells beneath it’s surface

columnar cells continue to secrete mucus and a mucus retention cyst is formed

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25
Q

what are the most common benign growths on the cervix?

A

ectocervical and endocervical polyps

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26
Q

what are the symptoms of cervical polyps?

how do endocervical polyps differ from ectocervical polyps?

A

symptoms: none, coital bleeding or menorrhagia

endocervical polyps: more common, beefy red in color, arise from endocervical canal

ectocervical polyps: less common, pale in appearance

27
Q

what is endometrial hyperplasia?

A

represents an overabundant growth of the endometrial lining usually as a result of persistent unopposed estrogen

28
Q

in what cases might endometrial hyperplasia be seen?

A

PCOS and anovulation

granulosa theca cell tumors

obesity

exogenous estrogens

tamoxifen

29
Q

what is endometrial hyperplasia a precursor to?

A

endometrial cancer

30
Q

what are the different classifications of endometrial hyperplasia?

A

simple hyperplasia without atypia

complex hyperplasia without atypia

simple hyperplasia with atypia

complex hyperplasia with atypia

31
Q

what are the symptoms of endometrial hyperplasia?

A

intermenstrual, heavy or prolonged bleeding that is unexplained

32
Q

how do you make the diagnosis of endometrial hyperplasia?

A

sample the endometrium

ultrasound reveals endometrial lining greater than or equal to 4 mm in a postmenopausal female: need to sample the endometrium

33
Q

how do you treat endometrial hyperplasia?

A

simple and complex hyperplasia without atypia: treat with progestin and resample in 3 months

simple and complex hyperplasia with atypia: best treated with a hysterectomy

34
Q

what is adnexa

A

when something involves the ovaries, fallopian tubes, upper portion of the broad ligament, and mesosalpinx

35
Q

what is required for normal ovarian development?

A

two X chromosomes

36
Q

What is the karyotype for Turner syndrome?

What is it associated with?

A

45XO

associated with abnormal gonad development: small rudimentary streaked ovaries; develop secondary sexual characteristics but enter menopause shortly after

37
Q

What is the karyotype for complete androgen insensitivity syndrome (aka testicular feminization)?

What is this syndrome?

A

46XY

lack androgen receptors, phenotypically female, gonads (functioning testes) need to remove after puberty because of malignant potential

38
Q

How could DES affect the fallopian tubes?

A

may lead to shortened, distorted or clubbed tubes

39
Q

what are the 4 types of functional cysts?

A

follicular cysts

corpus luteum cysts

hemorrhagic cysts

polycystic ovaries

40
Q

what are follicular cysts?

A

lined by one or more layers of granulosa cells

develops when an ovarian follicle fails to rupture

is clinically significant if it gets large enough to cause pain

41
Q

when does a corpus luteum cyst develop?

A

if the corpus luteum becomes cystic, larger than 3 cm, and failes to regress normally after 14 days

42
Q

which functional cyst is more likely to cause symptoms?

A

hemorrhagic cysts

43
Q

what is a hemorrhagic cyst caused by?

A

hemorrhage in the corpus luteum cyst 2-3 days after ovulation

44
Q

what is a theca-lutein cyst?

what patients might they develop in?

A

usually bilateral and can become large

may develop in patients:

with high serum levels of hCG

*characteristically they regress when gonadotropin levels fall

45
Q

what is luteoma of pregnancy?

A

it is caused by a hyperplastic reaction of the ovarian theca cells secondary to prolonged hCG stimulation during pregnancy

appear as reddish-brown nodules

surgical resection is not indicated- they usually regress spontaneously postpartum

46
Q

what is a polycystic ovarian cyst associated with?

What does it produce/lead to?

A

chronic anovulation, hyperandrogenism and insulin resistance

produces enlarged ovaries: with multiple small follicles that are inactive and are arrested in the mid antral stage

47
Q

how do you make the diagnosis of a functional ovarian cyst?

A

bimanual exam reveals an enlarged, mobile, unilateral cyst

or

ultrasound

48
Q

How can the benign neoplastic ovarian tumors be divided?

which type is the most common

A

by cell type of origin

the epithelial ovarian neoplasms are the most common: serous, mucinous, brenner tumors

49
Q

what are the different types of benign neoplastic ovarian tumors?

A

epithelial, sex-cord stroma, and germ cell

50
Q

what are the 3 different sex-cord stroma ovarian neoplasms?

A

fibromas, granulosa-theca cells, sertoli-leydig cell tumors

51
Q

what is an example of a germ cell tumor?

A

benign cystic teratoma (dermoid)

52
Q

what is the single most common benign ovarian neoplasm in a premenopausal females?

A

benign cystic teratoma (dermoid)

53
Q

epithelial ovarian neoplasms are thought to derive from what?

A

the mesothelial cells lining the peritoneal cavity and also the lining from the surface of the ovary

54
Q

what do mucinous ovarian tumors cytologically resemble?

A

the endocervical epithelium

55
Q

what do serous ovarian tumors resemble?

A

the lining of the fallopian tubes

56
Q

what is the most common epithelial ovarian tumor?

A

serous cystadenoma

57
Q

what is the treatment for serous cystadenomas?

A

surgical (cystectomy vs. oophorectomy vs. hyst with bilateral oophorectomy)

58
Q

what is the histologic appearance of serous cystadenoma?

A

psammoma bodies

these are more common in malignant serous cystadenocarcinomas

59
Q

what is the second most common ovarian epithelial tumor?

A

mucinous cystadenoma

60
Q

what is a mucinous cystadenoma associated with?

A

a mucocele of the appendix

61
Q

what could a mucinous cystadenoma (rarely) lead to?

A

pseudomyxoma peritonei: condition in which numerous benign implants are seeded onto the surface of the bowel and other peritoneal surfaces producing large quantities of mucus

62
Q

what is a brenner tumor?

A

an epithelial ovarian neoplasm

small smooth solid ovarian neoplasm

usually benign with a large fibrotic component that encases epithelioid cells that resemble transitional cells of the bladder

63
Q

if the ultimate differentiation of cell types occurring in the sex-cord stromal ovarian tumor is feminine then the tumor is feminine and becomes what?

A

a granulosa or theca cell tumor or often a mixed granulosa-theca cell tumor

64
Q

if the ultimate differentiation of cell types occurring in the sex-cord stromal tumor is masculine then the tumor becomes what?

A

a sertoli leydig tumor

ENRP Exam 1 (30 decks)

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