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

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

1
Q

during female development what is formed from the mullerian/paramesonephric ducts?

A

upper vagina, cervix, fallopian tubes

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2
Q

the absence of a _ chromosome and absence of the _ substances leads to development of the paramesoneprhic system with regression of the mesonephric system

A

Y chromosome

absence of the mullerian inhibiting susbtance

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3
Q

paramesonephric ducts arise at _ weeks and fuse in the midline to form the _ (week 9)

A

6

uterovaginal primodrium

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4
Q

the ____ resolves betwen the paired paramesonephric ducts leading to the development of a single cervix and uterus

A

septum

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5
Q

failure of the paramesonephric ducts to fuse can lead to?

A

uterus didelphysis

bicornuate uterus with a rudimentary horn

bicornuate uterus with or without double cervices

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6
Q

incomplete dissolution of the midline fusion of the paramesonephric ducts can lead to?

A

septate uterus

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7
Q

failure of formation of the mullerian ducts can lead to?

A

mullerian agenesis (no paramesonephric system bi products ie: fallopian tube, uterus) also known as Meye-Rokitanksy-Kuster-Hauser

unicornate uterus

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8
Q

most common congenital abnormalities of the cervix

A

septate cervix
didelphy (double) cervix

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9
Q

uterine and cervical anomalies usually occur _

A

spontaneously

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10
Q

uterine and cervical abnormalities can be caused by early maternal drug exposure to what drug?

A

Diethylstilbesterol with a T shaped endometrial cavity and cervical collar deformitiy

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11
Q

uterine leiomyomas are benign tumors derived from localized proliferation of _ cells of the myometrium

A

smooth muscle cells

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12
Q

are fibroids/uterine leiomyomas malignant

A

rarely

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13
Q

symptoms of a fibroid

A

most are asymptomatic

but: uterine bleeding, pelvic pressure, pelvic pain, infertility

low back pain, increased urinary frequency if pressing on bladder

severe pain is uncommon

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14
Q

what is the most common indication for a hysterectomy

A

symptomatic fibroid

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15
Q

risk factor for developing fibroids

A

african american women: 2-3 more times likely to get fibroids

nullparity, increasing age, family history

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16
Q

pathogenesis of fibroids

A

estrogen stimulates the proliferation of smooth muscle cells in the myometrium

rarely form before menarche or enlarge after menopause (low estrogen states)

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17
Q

40% of fibroids enlarge during _

A

pregnancy

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18
Q

characteristics of a fibroid

A

spherical and well circumscribed, white firm lesion with a whorled apperance on cut section

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19
Q

fibroids may _ escpecially in post-menopausal women

A

calcify

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20
Q

locations of fibroids

A

subserosal, intramural, submucosal, cervical, intraligamentous

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21
Q

what is a subserosal fibroid

A

a fibroid that is benetah the uterine surface and rarely can attach to blood supply of the omentum or bowel and lost uterine connection becoming a parasitic fibroid

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22
Q

what is an intramural fibroid

A

fibroid within the myometrium (most common)

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23
Q

what is a submucosal fibroid

A

fibroid beneath the endometrium and can protude out through the cervical os if it become pedunculated

associated with prolonged or heavt menstural bleeding

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24
Q

increased incidence infertility is seen with what kind of fibroids?

A

submucosal fibroids

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25
Q

signs of an leiomyoma on examination and ultrasound

A

bimanual examination: enlared irregularly shaped uterus, mass moves with cervix

ultrasound: distinshish between adnexal mass and lateral leiomyoma

adnexal: in the ovary or the fallopian tube

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26
Q

the degree of enlargement of a fibroid is described in _

A

week size used to estimate quivalent gestational size

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27
Q

what is the first theraputic option for leiomyomas?

A

combination birthcontrol (estrogen + progesterone)

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28
Q

what else can you used (drugs) to treat leiomyomas?

A

progesterone only therapies like mirena IUD

or

gonadotropin relasing hormones (GnRH agonist) like depo-lupron

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29
Q

how do GnRH agonists work to treat leiomyomas?

A

decrease fibroid size

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30
Q

how can you surgically treat a fibroid?

A

myomectomy (hysteroscopic or laproscopic)

endometrial ablation (burn it, decrease menstural flow)

Uterine artery embolization (occlude uterine artery feeding the fibroid)

Hysterectomy : definitive therapy

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31
Q

in a myomectomy if the endometrial cavity is enterd future deliveres must be by?

A

Cesarean Section

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32
Q

in people who undergo a myomectomy do fibroids grow back?

A

typically yes, 25% of them do

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33
Q

after myomectomy, if inadequate amount of uterine tissue remains a _ may be warrented

A

hysterectomy

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34
Q

endometrial polyps form from the _ and create soft firable prostrusions into the endometrial cavity

A

endometrium

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35
Q

symptoms of endometrial polyps

A

menorrhagia (menstural bleeding that lasts longer than 7 days)

spotaneous or post menopausal bleeding

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36
Q

ultrasound of an endometrial polyp shows?

A

focal thickening of the endometrial stripe

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37
Q

what allows for detecting a endometrial polyp

A

saline hysterosonography and hysteroscopy

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38
Q

endometrial polyps may evade _ endometrial sampling

A

office

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39
Q

most polyps are benign _ masses

A

hyperplastic

need to remove these with hysteroscopy because endometrial hyperplasia and carcinoma can also present as polyps

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40
Q

nabothian cysts are ?

A

a normal cervical variant that range from 3mm to 3cm in size

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41
Q

nabothian cysts result from ?

A

squamous metaplasia in which a layer of superficial squamous epithelial cells entrap a layer of columnar cells beneath its surface

(colmnar cells continue to screte musuc and a mucus retention cyst is formed)

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42
Q

color of a nabothian cyst

A

opaque with yellow or blush hue

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43
Q

cervical polyps can be ectocervical or endocervical, what are the differences

(color, frequency)

A

endocervical polyps are more common and are beef red in color

ectocervical plyps are less common and are pale in appearance

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44
Q

endocervical polyps arise from the?

A

endocervical canal

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45
Q

symptoms of cervical polyps

A

asymptomatic or bleeding after sex, periods longer than 7 days (menorrhagia)

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46
Q

how do we treat cervical polyps

A

remove them in office

rarely become malignant

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47
Q

what is endometrial hyperplasia

what is it caused by

A

overabundance growth of the endometrial lining caused by peristent unopposed estrogen

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48
Q

what are some examples of times where persistent unopposed estrogen occurs

A
  1. PCOS/anovulation
  2. granulosa theca cell tumors
  3. obestity
  4. exogenous estrogens
  5. tamoxifen
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49
Q

granulosa theca cell tumors are _ producing tumors

A

estrogen

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50
Q

endometrial hyperplasia is a precursor to

A

endometrial cancer

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51
Q

endometrial hyperplasia classifications
(4) - rule of 3

A
  1. simple hyperplasia without atypia
  2. complex hyperplasia without atypia
  3. simple hyperplasia with atypia
  4. complex hyperplasia with atypia

1, 3, 9, 27 % chances of progressing to cancer

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52
Q

symptoms of endometrial hyperplasia

A

intermenstrual bleeding, heavy or prolonged bleeding that is unexplained

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53
Q

how do we diagnose endometrial hyperplasia

A

sample the endometrium (in office emblism, d&c)

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54
Q

ultrasound findings of endometrial hyperplasia

A

endometrial lining is greater than 4mm

55
Q

how do we treat simple and complex hyperplasia without atypia

A

progestin and reevaluate in 3 months

56
Q

how do you treat simple and complex hyperplasia with atypia

A

hysterectomy

57
Q

adnexa refers to?

A

ovaries, fallopian tubes, upper protion of the broad ligament and mesosalpinx

mesosalpinx- fold of peritoneum lying over both uterine tubes

58
Q

embryologic abnormalities in the ovary are _ (common/uncommon)

A

uncommon

59
Q

two _ chromosomes are reuired for normal ovarian development

A

x

60
Q

_ and _ are associated with abnormal gonad development in females (2 syndromes)

A

Turner syndrome (45X0)

complete androgen insensitivity syndrome/ testicular feminization (46XY)

61
Q

in turner syndrome there are _ ovaries

A

streaked

62
Q

in testicular feminization there is a lack of _ receptors and people are phenotypically _ but they have functioning _ that need to be removed after puberty due to malignant potential

A

androgen

female

testes

63
Q

_ (drug) may lead to shortened, distored, or clubbed tubes

A

DES (diethystilbestrol)

64
Q

what are the benign conditions of the ovary

A
  1. functional cysts
  2. benign neoplastic cysts
65
Q

what are types of functional ovarian cysts

A

follicularl, lutein, hemorrhagic, polycystic

functional ovarian cysts are Probably Little Heartshaped Flowers,

66
Q

what are the type of benign neoplastic cysts of the ovary

A

Epithelial, Sex-cord stromal, and germ cell

benign neoplastic cysts of the ovary are Exceptionally So Good

67
Q

follicular cysts are lined by _ cells and develop when an _ fails to rupture

A

granulosa cells

ovarian follicle fails to rupture

can get large enough and cause pain

68
Q

corpus luteum cysts may develop if the _ become cystic and fails to regress normally

A

corpus luteum

69
Q

_ cysts are more likely to cause symptoms and are caused by hemorrhage in the corpus luteum cysts 2-3 days after ovulation

A

hemorrhagic cysts

70
Q

polycystic ovaries are

A

enlarged ovaries with multiple simple follicle

71
Q

theca-lutein cysts are usually _ (unilateral/bilateral) and become large, they develop in patients with high serum __

A

bilateral

HCG

72
Q

hCG is elevated in what instances

A

pregnancy, choriocarcinoma or hydatiform molar pregnancy

ovulation induction

73
Q

theca-lutein cysts characteristically regress when _ levels fall

A

gonadotropin (hCG)

74
Q

a luteoma of pregnancy is caused by a hyperplastic reaction of the ovarian _ cells

A

theca

75
Q

a luteoma of pregnancy is secondary to prologed _ stimulation during pregnancy

A

hCG

76
Q

how do luteomas of pregnancy appear

A

reddish brown nodules

77
Q

how do you treat a luteoma of pregnancy

A

DO NOT RESECT, they usually regress postpartum

78
Q

Polycystic ovarian cysts are associated with chronic _ , hyper_ , and _ resistance

A

anovulation

hyperandrogenism

insulin resistance

79
Q

polycystic ovarian cysts produces enlarged ovaries with multiple small follicles that are inactive and are arrested in the _ stage

A

mid antral stage

80
Q

in PCOS there are increased _ levels that promote androgen secretion from the ovarian theca cells leading to elecated levels of ovarian-derived androstenedione and testosterone

A

LH

81
Q

in PCOS peripheral conversion of androgen to estrogen results in elevated _ levels that then suppress _ from the pituitary gland

A

estrogen levels

FSH from the pituitary gland

82
Q

functional ovarian cysts usually regress during the _ cycle

they can often become large and undergo _

A

subsequent

torsion

generally less than 8cm (theca-lutein cyst can get huge)

83
Q

how do we diagnose a functional ovarian cyst

A

bimanual exam - mobile cyst
ultrasound

84
Q

treatment of functional ovarian cysts

A

asymptomatic and premenopausal - place on OCPs

symptomatic- rule out ectopic pregnancy, tuboovarian abcess

85
Q

epithelial ovarian neoplasms derive from?

benign neoplastic epitheliam ovarian ovarian neoplasms

A

mesothelial cells lining the periotnal cavity and the lining from the surface of the ovary

86
Q

mucinous ovarian tumors cytologically resemble that _ epithelium

epithelial ovarian neoplasm

A

endocervical

87
Q

endometriod ovarian tumors resemble the _

epithelial ovarian neoplasms

A

endometrium

88
Q

serous ovarian tumors resemble the lining of the _

A

fallopian tubes

89
Q

what is the most common epithelial ovarian tumor

A

serous cystadenoma

90
Q

treatment of a serous cystadenoma

A

70% are benign but surgery is the recommeded treatment i

type of surgery depends on desire to retain fertility

91
Q

histologically serous cystadenomas show _ bodies

A

psammmoma bodies

these bodies are more common in the malignant forms of serous cystadenomas

92
Q

_ cystadenomas can attain a huge size filling the entire pelvis and abdomen and is the second most common epithelial tumor of the ovary

A

mucinous

most are benign

93
Q

mucinous cystadenomas are associated with a _ of the appendix

A

mucoele

dilation of the appendiceal. lumen as a result of too much mucin accumilation- caused by epithelial proliferation

94
Q

mucinous cystadeomas can rearely lead to _

A

psuedomyxoma peritonei

mucin seeds the bowel and other surfaces producing a large quantity of mucus (jelly belly)

95
Q

the mucinous cystadenoma is generally _ (singularly lobulated/multiloculated)

A

multiloculated

96
Q

brenner tumors are usually _ (benign/malignant) with a large _ component that encases epitheliod cells that resemble _ cells of the bladder

A

benign

fibrous

transition

most of them have mucus- but way smaller than mucinous tumors

97
Q

sex-cord stromal ovarian neoplasms are tumors that derive from the _ _ _ of the developing gonad

A

sex cord stroma

98
Q

sex cord stromal ovarian neoplasm types (3)

A

granulosa-theca

sertoli-leydig

fibromas

99
Q

in sex cord stroma neoplasma- if differentiation is feminine then the tumor is feminine and becomes what kind of cell tumor?

in a sec cord stroma neoplasm- if differentiation is masculine then the tumor is masculing and become what kind of cell tumor ?

A
  • granulosa or theca or a mixed granulosa AND theca

masculine- sertoli leydig tumor

100
Q

granulosa-theca cell tumors can occur at what age group?

they produce _ (estrogen/androgen) components?

they have _ (low/high) malignant potential

A

all age groups

estrogwn

low malignant potential

101
Q

what feminine signs and symptoms can a granuloasa-thecal cel promote?

A

precoccious menarche and thelarche

premenarchal unterine bleeding in infancy and childhood
menorrhagia, endometrial hyperplasia (excess estrogen), breast tenderness, fluid retention, post menopausal bleeding

102
Q

sertoli-leydig tumors produce _ (estrogenic/androgenic)components

they have _ (low/high) malignant potential

A

adrogenic

low malignant potential

103
Q

sertoli-leydig cells promote what kind of effects

A

virtulizing effects: hirituism, temporal baldness, deepening of voice, clitoromegaly, defeminizing og the female body hanitus to a masculine build

104
Q

what is aa fibroma?

A

smooth benign SOLID ovarian tumor comprised of bundles of fibrocytes

105
Q

does a fibroma secrete steroids

A

no

106
Q

on occasion fibromas are associated with _ secondary to transudation of fluid from the ovary

A

ascites

107
Q

what is meigs syndrome

A

ascites and right pleural effusion (hydrothorac) associated with an ovarian fibroma

108
Q

flow of ascitic fluid through the _ lymphatics into the _ leads to meigs syndrome

A

transdiaphragmatic

right pleural cavity

109
Q

germ cell tumors occur at what age?

A

any age

mostly in infants and children

110
Q

a cyctic teratoma also known as a dermoid cyst affects the median age of _ , they are _ (slow/fast) growing tumors that may contain differeniated tissue from _ (ectoderm, mesoder, endoderm, all) germ layers. They are comprised mostly of _ (ectoderm, mesoderm, endoderm) tissue which can produce skin, sweat, sebaceous galnds and hair follicles.

A

30

slow growing

all 3 germ layers

ectoderm tissue (most)

can also include CNS tissue, cartilage, bone, teeth

most are benign

111
Q

the _ (undifferented/well diffentiated) form is the mature form- cystic teratoma

A

well differentiated form

112
Q

characteristic macroscopic presentation of a cystic teratoma (dermoid cyts)

A

multicystic

hair, teeth, miked in thick material

cheesy sebacceous material

113
Q

what is the solid prominence located at the junction between the teratoma and normal ovarian tissue

A

rokintanksys protuberence

114
Q

rupture of a cystic teratoma can lead to _ _

A

chemical peritonitis

115
Q

general features about ovarian tumors

A

most are benign, usually enlarge pretty slowly, can be painful if it twists or a cyst ruptures

116
Q

how do you diagnose an ovarian tumor?

A

ultrasound, abdominal and bimaual pelvic exam, tumor markers (Ca125)
laprascopy

117
Q

no persistent ovarian neoplasm should be assumed to be benign until proved by _

A

surgical expoloration and pathologic examination

118
Q

surgery/biopsy of a ovarian neoplasm requires you do what 2 things

A

collect a pelvic wash for cytologic examination

obtain a frozen section for histologic examination

119
Q

epithelial benign ovarian tumors are usually managed with unilateral _

if mucinous cystadenoma is diagnoised be sure to remove the _ also

A

salpingo-oophorectomy + hysterectomy in old patients
cystectomy in young patients who havent given birth

appendix

120
Q

how do you treat stromal cell tumors

A

unilateral salpingoophorectomy

121
Q

how do you treat fibromas

A

most are almost always benign

you can remove the ovary or recsect off ovary in a women who wants to retain fertility

122
Q

how do you treat a germ cell tumor

A

cystectomy

evaluate other ovary becuase 15% of the time they are bilateral

irrigate pelvis to avoid chemical peritonitis

123
Q

what is hydrosalpinx

A

fluid filled fallopian tubes from previous infection

124
Q

what is pyosalpinx

A

purluent filled fallopian tubes from active infection

125
Q

recent evidence reveals that some serous ovarian tumors may actually arise in the _

A

fallopian tube

126
Q

what is ovarian torsion

A

complete or partial rotation of the ovary on its ligamentous supports which can block blood flow

127
Q

adnexal torsion

A

ovary and fallopian tube both twist

128
Q

_ torsions of just the ovary or fallopian tube are rare

A

isolated

129
Q

what is the primary risk factor for ovarian torsion

A

an ovarian mass

130
Q

clinical presentation of ovarian torsion

A

acute unilateral pain, N/v

131
Q

how do we diagnose a ovarian torsion?

A

ultrasound first
definitive diagnosis by direct visualization

132
Q

treatment of an ovarian torsion

A

detorsion and ovarian conservation with a cystectomy

salpingo-oophorectomy if malignancy is suspected

133
Q

salpingo-oophorectomy

A

removal of ovary and fallopian tube

ENRP II (25 decks)

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