Benign Conditions of the Uterus, Cervix, Ovary, and Fallopian Tubes Flashcards
during female development what is formed from the mullerian/paramesonephric ducts?
upper vagina, cervix, fallopian tubes
the absence of a _ chromosome and absence of the _ substances leads to development of the paramesoneprhic system with regression of the mesonephric system
Y chromosome
absence of the mullerian inhibiting susbtance
paramesonephric ducts arise at _ weeks and fuse in the midline to form the _ (week 9)
6
uterovaginal primodrium
the ____ resolves betwen the paired paramesonephric ducts leading to the development of a single cervix and uterus
septum
failure of the paramesonephric ducts to fuse can lead to?
uterus didelphysis
bicornuate uterus with a rudimentary horn
bicornuate uterus with or without double cervices
incomplete dissolution of the midline fusion of the paramesonephric ducts can lead to?
septate uterus
failure of formation of the mullerian ducts can lead to?
mullerian agenesis (no paramesonephric system bi products ie: fallopian tube, uterus) also known as Meye-Rokitanksy-Kuster-Hauser
unicornate uterus
most common congenital abnormalities of the cervix
septate cervix
didelphy (double) cervix
uterine and cervical anomalies usually occur _
spontaneously
uterine and cervical abnormalities can be caused by early maternal drug exposure to what drug?
Diethylstilbesterol with a T shaped endometrial cavity and cervical collar deformitiy
uterine leiomyomas are benign tumors derived from localized proliferation of _ cells of the myometrium
smooth muscle cells
are fibroids/uterine leiomyomas malignant
rarely
symptoms of a fibroid
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
what is the most common indication for a hysterectomy
symptomatic fibroid
risk factor for developing fibroids
african american women: 2-3 more times likely to get fibroids
nullparity, increasing age, family history
pathogenesis of fibroids
estrogen stimulates the proliferation of smooth muscle cells in the myometrium
rarely form before menarche or enlarge after menopause (low estrogen states)
40% of fibroids enlarge during _
pregnancy
characteristics of a fibroid
spherical and well circumscribed, white firm lesion with a whorled apperance on cut section
fibroids may _ escpecially in post-menopausal women
calcify
locations of fibroids
subserosal, intramural, submucosal, cervical, intraligamentous
what is a subserosal fibroid
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
what is an intramural fibroid
fibroid within the myometrium (most common)
what is a submucosal fibroid
fibroid beneath the endometrium and can protude out through the cervical os if it become pedunculated
associated with prolonged or heavt menstural bleeding
increased incidence infertility is seen with what kind of fibroids?
submucosal fibroids
signs of an leiomyoma on examination and ultrasound
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
the degree of enlargement of a fibroid is described in _
week size used to estimate quivalent gestational size
what is the first theraputic option for leiomyomas?
combination birthcontrol (estrogen + progesterone)
what else can you used (drugs) to treat leiomyomas?
progesterone only therapies like mirena IUD
or
gonadotropin relasing hormones (GnRH agonist) like depo-lupron
how do GnRH agonists work to treat leiomyomas?
decrease fibroid size
how can you surgically treat a fibroid?
myomectomy (hysteroscopic or laproscopic)
endometrial ablation (burn it, decrease menstural flow)
Uterine artery embolization (occlude uterine artery feeding the fibroid)
Hysterectomy : definitive therapy
in a myomectomy if the endometrial cavity is enterd future deliveres must be by?
Cesarean Section
in people who undergo a myomectomy do fibroids grow back?
typically yes, 25% of them do
after myomectomy, if inadequate amount of uterine tissue remains a _ may be warrented
hysterectomy
endometrial polyps form from the _ and create soft firable prostrusions into the endometrial cavity
endometrium
symptoms of endometrial polyps
menorrhagia (menstural bleeding that lasts longer than 7 days)
spotaneous or post menopausal bleeding
ultrasound of an endometrial polyp shows?
focal thickening of the endometrial stripe
what allows for detecting a endometrial polyp
saline hysterosonography and hysteroscopy
endometrial polyps may evade _ endometrial sampling
office
most polyps are benign _ masses
hyperplastic
need to remove these with hysteroscopy because endometrial hyperplasia and carcinoma can also present as polyps
nabothian cysts are ?
a normal cervical variant that range from 3mm to 3cm in size
nabothian cysts result from ?
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)
color of a nabothian cyst
opaque with yellow or blush hue
cervical polyps can be ectocervical or endocervical, what are the differences
(color, frequency)
endocervical polyps are more common and are beef red in color
ectocervical plyps are less common and are pale in appearance
endocervical polyps arise from the?
endocervical canal
symptoms of cervical polyps
asymptomatic or bleeding after sex, periods longer than 7 days (menorrhagia)
how do we treat cervical polyps
remove them in office
rarely become malignant
what is endometrial hyperplasia
what is it caused by
overabundance growth of the endometrial lining caused by peristent unopposed estrogen
what are some examples of times where persistent unopposed estrogen occurs
- PCOS/anovulation
- granulosa theca cell tumors
- obestity
- exogenous estrogens
- tamoxifen
granulosa theca cell tumors are _ producing tumors
estrogen
endometrial hyperplasia is a precursor to
endometrial cancer
endometrial hyperplasia classifications
(4) - rule of 3
- simple hyperplasia without atypia
- complex hyperplasia without atypia
- simple hyperplasia with atypia
- complex hyperplasia with atypia
1, 3, 9, 27 % chances of progressing to cancer
symptoms of endometrial hyperplasia
intermenstrual bleeding, heavy or prolonged bleeding that is unexplained
how do we diagnose endometrial hyperplasia
sample the endometrium (in office emblism, d&c)
ultrasound findings of endometrial hyperplasia
endometrial lining is greater than 4mm
how do we treat simple and complex hyperplasia without atypia
progestin and reevaluate in 3 months
how do you treat simple and complex hyperplasia with atypia
hysterectomy
adnexa refers to?
ovaries, fallopian tubes, upper protion of the broad ligament and mesosalpinx
mesosalpinx- fold of peritoneum lying over both uterine tubes
embryologic abnormalities in the ovary are _ (common/uncommon)
uncommon
two _ chromosomes are reuired for normal ovarian development
x
_ and _ are associated with abnormal gonad development in females (2 syndromes)
Turner syndrome (45X0)
complete androgen insensitivity syndrome/ testicular feminization (46XY)
in turner syndrome there are _ ovaries
streaked
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
androgen
female
testes
_ (drug) may lead to shortened, distored, or clubbed tubes
DES (diethystilbestrol)
what are the benign conditions of the ovary
- functional cysts
- benign neoplastic cysts
what are types of functional ovarian cysts
follicularl, lutein, hemorrhagic, polycystic
functional ovarian cysts are Probably Little Heartshaped Flowers,
what are the type of benign neoplastic cysts of the ovary
Epithelial, Sex-cord stromal, and germ cell
benign neoplastic cysts of the ovary are Exceptionally So Good
follicular cysts are lined by _ cells and develop when an _ fails to rupture
granulosa cells
ovarian follicle fails to rupture
can get large enough and cause pain
corpus luteum cysts may develop if the _ become cystic and fails to regress normally
corpus luteum
_ cysts are more likely to cause symptoms and are caused by hemorrhage in the corpus luteum cysts 2-3 days after ovulation
hemorrhagic cysts
polycystic ovaries are
enlarged ovaries with multiple simple follicle
theca-lutein cysts are usually _ (unilateral/bilateral) and become large, they develop in patients with high serum __
bilateral
HCG
hCG is elevated in what instances
pregnancy, choriocarcinoma or hydatiform molar pregnancy
ovulation induction
theca-lutein cysts characteristically regress when _ levels fall
gonadotropin (hCG)
a luteoma of pregnancy is caused by a hyperplastic reaction of the ovarian _ cells
theca
a luteoma of pregnancy is secondary to prologed _ stimulation during pregnancy
hCG
how do luteomas of pregnancy appear
reddish brown nodules
how do you treat a luteoma of pregnancy
DO NOT RESECT, they usually regress postpartum
Polycystic ovarian cysts are associated with chronic _ , hyper_ , and _ resistance
anovulation
hyperandrogenism
insulin resistance
polycystic ovarian cysts produces enlarged ovaries with multiple small follicles that are inactive and are arrested in the _ stage
mid antral stage
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
LH
in PCOS peripheral conversion of androgen to estrogen results in elevated _ levels that then suppress _ from the pituitary gland
estrogen levels
FSH from the pituitary gland
functional ovarian cysts usually regress during the _ cycle
they can often become large and undergo _
subsequent
torsion
generally less than 8cm (theca-lutein cyst can get huge)
how do we diagnose a functional ovarian cyst
bimanual exam - mobile cyst
ultrasound
treatment of functional ovarian cysts
asymptomatic and premenopausal - place on OCPs
symptomatic- rule out ectopic pregnancy, tuboovarian abcess
epithelial ovarian neoplasms derive from?
benign neoplastic epitheliam ovarian ovarian neoplasms
mesothelial cells lining the periotnal cavity and the lining from the surface of the ovary
mucinous ovarian tumors cytologically resemble that _ epithelium
epithelial ovarian neoplasm
endocervical
endometriod ovarian tumors resemble the _
epithelial ovarian neoplasms
endometrium
serous ovarian tumors resemble the lining of the _
fallopian tubes
what is the most common epithelial ovarian tumor
serous cystadenoma
treatment of a serous cystadenoma
70% are benign but surgery is the recommeded treatment i
type of surgery depends on desire to retain fertility
histologically serous cystadenomas show _ bodies
psammmoma bodies
these bodies are more common in the malignant forms of serous cystadenomas
_ cystadenomas can attain a huge size filling the entire pelvis and abdomen and is the second most common epithelial tumor of the ovary
mucinous
most are benign
mucinous cystadenomas are associated with a _ of the appendix
mucoele
dilation of the appendiceal. lumen as a result of too much mucin accumilation- caused by epithelial proliferation
mucinous cystadeomas can rearely lead to _
psuedomyxoma peritonei
mucin seeds the bowel and other surfaces producing a large quantity of mucus (jelly belly)
the mucinous cystadenoma is generally _ (singularly lobulated/multiloculated)
multiloculated
brenner tumors are usually _ (benign/malignant) with a large _ component that encases epitheliod cells that resemble _ cells of the bladder
benign
fibrous
transition
most of them have mucus- but way smaller than mucinous tumors
sex-cord stromal ovarian neoplasms are tumors that derive from the _ _ _ of the developing gonad
sex cord stroma
sex cord stromal ovarian neoplasm types (3)
granulosa-theca
sertoli-leydig
fibromas
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 ?
- granulosa or theca or a mixed granulosa AND theca
masculine- sertoli leydig tumor
granulosa-theca cell tumors can occur at what age group?
they produce _ (estrogen/androgen) components?
they have _ (low/high) malignant potential
all age groups
estrogwn
low malignant potential
what feminine signs and symptoms can a granuloasa-thecal cel promote?
precoccious menarche and thelarche
premenarchal unterine bleeding in infancy and childhood
menorrhagia, endometrial hyperplasia (excess estrogen), breast tenderness, fluid retention, post menopausal bleeding
sertoli-leydig tumors produce _ (estrogenic/androgenic)components
they have _ (low/high) malignant potential
adrogenic
low malignant potential
sertoli-leydig cells promote what kind of effects
virtulizing effects: hirituism, temporal baldness, deepening of voice, clitoromegaly, defeminizing og the female body hanitus to a masculine build
what is aa fibroma?
smooth benign SOLID ovarian tumor comprised of bundles of fibrocytes
does a fibroma secrete steroids
no
on occasion fibromas are associated with _ secondary to transudation of fluid from the ovary
ascites
what is meigs syndrome
ascites and right pleural effusion (hydrothorac) associated with an ovarian fibroma
flow of ascitic fluid through the _ lymphatics into the _ leads to meigs syndrome
transdiaphragmatic
right pleural cavity
germ cell tumors occur at what age?
any age
mostly in infants and children
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.
30
slow growing
all 3 germ layers
ectoderm tissue (most)
can also include CNS tissue, cartilage, bone, teeth
most are benign
the _ (undifferented/well diffentiated) form is the mature form- cystic teratoma
well differentiated form
characteristic macroscopic presentation of a cystic teratoma (dermoid cyts)
multicystic
hair, teeth, miked in thick material
cheesy sebacceous material
what is the solid prominence located at the junction between the teratoma and normal ovarian tissue
rokintanksys protuberence
rupture of a cystic teratoma can lead to _ _
chemical peritonitis
general features about ovarian tumors
most are benign, usually enlarge pretty slowly, can be painful if it twists or a cyst ruptures
how do you diagnose an ovarian tumor?
ultrasound, abdominal and bimaual pelvic exam, tumor markers (Ca125)
laprascopy
no persistent ovarian neoplasm should be assumed to be benign until proved by _
surgical expoloration and pathologic examination
surgery/biopsy of a ovarian neoplasm requires you do what 2 things
collect a pelvic wash for cytologic examination
obtain a frozen section for histologic examination
epithelial benign ovarian tumors are usually managed with unilateral _
if mucinous cystadenoma is diagnoised be sure to remove the _ also
salpingo-oophorectomy + hysterectomy in old patients
cystectomy in young patients who havent given birth
appendix
how do you treat stromal cell tumors
unilateral salpingoophorectomy
how do you treat fibromas
most are almost always benign
you can remove the ovary or recsect off ovary in a women who wants to retain fertility
how do you treat a germ cell tumor
cystectomy
evaluate other ovary becuase 15% of the time they are bilateral
irrigate pelvis to avoid chemical peritonitis
what is hydrosalpinx
fluid filled fallopian tubes from previous infection
what is pyosalpinx
purluent filled fallopian tubes from active infection
recent evidence reveals that some serous ovarian tumors may actually arise in the _
fallopian tube
what is ovarian torsion
complete or partial rotation of the ovary on its ligamentous supports which can block blood flow
adnexal torsion
ovary and fallopian tube both twist
_ torsions of just the ovary or fallopian tube are rare
isolated
what is the primary risk factor for ovarian torsion
an ovarian mass
clinical presentation of ovarian torsion
acute unilateral pain, N/v
how do we diagnose a ovarian torsion?
ultrasound first
definitive diagnosis by direct visualization
treatment of an ovarian torsion
detorsion and ovarian conservation with a cystectomy
salpingo-oophorectomy if malignancy is suspected
salpingo-oophorectomy
removal of ovary and fallopian tube
