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Endrocrine & Reproduction II Exam #1 > Benign Conditions of the Uterus, Cervix, Ovary & Fallopian Tubes > Flashcards

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

1
Q

What comes from the paramesonephric (Mullerian) ducts?

Absence of which “inhibiting substance” leads to the development of the paramesonephric system with regression of mesonephric system?

A

Upper vagina, cervix, uterus and fallopian tubes.

Absence of the Mullerian inhibiting substance and absence of Y chromosome.

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2
Q

What causes uterus didelphysis? What is it?

A

Failure of the paramesonephric duct to fuse. It results in 2 separate uterine bodies with its own cervix, fallopian tubes and vagina.

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3
Q

What causes a septate uterus?

A

Incomplete dissolution of the midline fusion of the paramesonephric ducts.

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4
Q

What causes unicornate uterus?

A

Failure of formation of the Mullerian ducts

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5
Q

What is Mullerian agenesis AKA?

What is it?

A

Meyer-Rokitansky-Kuster-Hauser syndrome

The complete lack of development of the paramesonephric system - absence of uterus and most of vagina.

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6
Q

The most common congenital cervical anomalies are the result of what?

A

Malfusion of the paramesonephric ducts with varying degrees of separation.

  • didelphys cervix
  • septate cervix
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7
Q

Most of the time, how do uterine and cervical anomalies occur?

What drug is implicated in some anomalies?

A

They occur spontaneously.

Early maternal exposure to DES: small T-shaped endometrial cavity, cervical collar deformity

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8
Q

Most common neoplasm of the uterus:

What age is most common?

What is the most common presentation?

It is the most common indication for what procedure?

What happens to them during pregnancy? What might happen in post-menopausal women?

What are some risk factors?

A

Fibroids: benign tumors from localized SM cells of the myometrium.

> 70% of women have them by 5th decade. Rarely form before menarch or enlarge after menopause.

Most are asymptomatic. Symptomatic fibroids can cause bleeding, pelvic pain and infertility.

Hysterectomy

40% will enlarge in pregnancy. May calcify in post-menopausal women.

Increasing age during reproductive years, AA 2-3x risk, nulliparity, FH

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9
Q

Subserosal fibroids

Intramural fibroids

Submucosal fibroids

A

Subserosal fibroids: fibroid beneath the uterine serosal surface. May rarely attach to blood supply of the omentum or bowel mesentery and lose uterine connection to become parasitic.

Intramural fibroids: fibroid arises in the myometrium. **Most common.

Submucosal fibroids: fibroid beneath the endometrium. Can become pedunculated and protrude through the cervical os. Prolonged or heavy menses is common.

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10
Q

What are signs of Leiomyoma on bimanual exam?

How is US helpful?

A

Bimanual exam: can reveal enlarged, irregularly shaped uterus. If the palpated mass moves with the cervix, it is suggestive of fibroid uterus. Degree of enlargement is described in “week size” to estimate equivalent gestational size.

US: it may help distinguish between adnexal masses and lateral leiomyomas.

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11
Q

What is the medical treatment options for Leiomyomas? (3)

A

Combination therapy (estrogen + progesterone)

  • oral contraceptive pills, rings
  • usually first option used**

Progesterone-only
-Depo-provera, Mirena intrauterine system

Gonadotropin releasing hormones (GnRH agonists)

  • Depo-Lupron
  • used as a surgical alternative
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12
Q

What is the definitive surgical treatment of fibroids?

What are 3 other surgical options?

A

Hysterectomy

Myomectomy: submucosal fibroids. Can be done laparoscopically or robotically.
Endometrial ablation: may cause decreased menstrual flow.
Uterine artery embolization: causes fibroid necrosis and 40-60% shrinkage.

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13
Q

What are some complications of myomectomy? (3)

A

If the endometrial cavity is entered, future deliveries must be via C-section.

Oftentimes the fibroids will grow back - 25% of patients will need subsequent operations.

If there is inadequate uterine tissue remaining post-myomectomy, a hysterectomy may be indicated.

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14
Q

What is an endometrial polyp?

What are symptoms?

What might be revealed on US? What are better diagnositics? (2)

Are the usually benign or malignant? What is the treatment generally?

A

Polyps in the endometrium that are soft, friable and protrude into the endometrial cavity.

Menorrhagia, spontaneous or post-menopausal bleeding.

US may reveal focal thickening of the endometrial stripe.
-Saline hysterosonography and hysterography are better.

Most are benign; however, they need to be removed via hysteroscopy since endometrial hyperplasia and carcinoma may also present as polyps.

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15
Q

What is a nabothian cyst?

What do they look like?

What causes it?

A

A normal finding on the cervix.

Opaque with yellowish or bluish hue. Approx. 3 mm to 3 cm.

Squamous metaplasia in which a layer of superficial squamous epithelial cells entrap a layer of columnar cells beneath, which continue to produce mucus, leading to a cyst.

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16
Q

Where do cervical polyps occur? What are features of each?

A

Endocervical polyps

  • more common
  • beefy red in color
  • arise in endocervical canal

Ectocervical polyps

  • less common
  • pale in appearance
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17
Q

What are the symptoms of cervical polyps (endo- and ecto-)?

What is the treatment?

A

None (common), coital bleeding or menorrhagia.

Removed in office - rarely malignant (<1/1000 will become sarcomas).

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18
Q

What is the major cause of endometrial hyperplasia?

Which underlying processes are associated? (4)

What is it a precursor to?

A

Persistent unopposed estrogen.

PCOS and anovulatory cycle
Granulosa tumors - estrogen producing tumors
Obesity (peripheral conversion)
Tamoxifen

Precursor to endometrial cancer.

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19
Q

What are the 4 WHO classifications of endometrial hyperplasia? Which is most likely to progress to cancer?

A

Simple hyperplasia w/o atypia
Complex hyperplasia w/o atypia
Simple hyperplasia w/ atypia
Complex hyperplasia w/ atypia - 27% progress to cancer

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20
Q

What are the symptoms of endometrial hyperplasia?

What is needed to diagnose?

What is the treatment if there is atypia vs. if there is no atypia?

A

intermenstrual, heavy or prolonged bleeding that is otherwise unexplained.

Endometrial sample. US revelaing >4 mm in post-menopausal women.

Simple and complex with atypia - hysterectomy
Simple and complex w/o atypia - progestin and resample in 3 mo.

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21
Q

What are the 2 congenital abnormalities of the ovaries?

A

Turner syndrome - 45XO

Complete androgen insensitivity syndrome/testicular feminization (46XY) - lack of androgen receptors, phenotypically female but have functioning testes and need to be removed after puberty due to malignant transformation

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22
Q

What is the classification of a theca-lutein cyst?

What is the size of them and laterality?

They may develop in patients with: (3)

When do they go away?

A

Functional ovarian cyst

Large (>30 cm) and BL

Patients with high hCG

  • pregnancy
  • choriocarcinoma or molar pregnancy
  • patients undergoing ovulation induction (gonadotropins or clomid)

Regress when gonadotropins (hCG) fall

23
Q

What is the classification of a luteoma of pregnancy?

What causes it?

What is the appearance?

What is the treatment?

A

Functional ovarian cyst

Hyperplastic reaction of the ovarian theca cells (secondary to prolonged hCG stimulation during pregnancy)

Reddish-brown nodules

They will regress after delivery - no surgery needed

24
Q

What is the classification of polycystic ovarian cyst?

What causes it?

What is the classic feature?

What hormones are elevated? (3)
What hormone is low?

A

Functional ovarian cyst

Chronic anovulation, hyperandrogenism and insulin resistance

Enlarged ovaries - multiple small follicles that are inactive and arrested in mid antral stage

LH, androgens (androstenedione and testosterone), estrogen
Low FSH

25
Q

Follicular, corpus luteum, polycystic and hemorrhagic cysts are all classified as what kind of cysts?

A

Functional cysts

26
Q

What is a follicular cyst made of?

When does it develop?

When does it become clinically significant?

A

It is lined by 1 or more layers of granulosa cells

Develops when an ovarian follicle fails to rupture

If it becomes large enough to cause pain

27
Q

What causes a corpus luteum cyst to develop?

A

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

28
Q

Which ovarian cyst is most likely to cause symptoms?

What is the cause of this cyst?

A

Hemorrhagic cysts

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

29
Q

Generally, follicular ovarian cysts have which clinical features? (4)

A

Asymptomatic

Less than 8 cm in size

Usually regress during subsequent cycle

Can become large and undergo torsion

30
Q

How can functional ovarian cysts be diagnosed? (2)

A

Bimanual exam revealing enlarged, multiple, unilateral cysts

US

31
Q

What is the management of functional ovarian cysts if:

Asymptomatic and premenopausal

Symptomatic and premenopausal (what must be r/o?)

A

Asymptomatic and premenopausal: place on OCPs (suppress hCG and prevent future cyst development) and repeat US

Symptomatic and premenopausal: must r/o ectopic pregnancy, torion, tubo-ovarian abscess

32
Q

How are benign neoplastic ovarian tumors classified? (3)

A

By cell type of origin.

Epithelial: most common - serous, mucinous, Brenner tumors

Sex-cord stromal: fibromas, granulosa-theca cell, Sertoli-Leydig cell tumors

Germ cell: teratoma (dermoid) - most common benign neoplasm of pre-menopausal women

33
Q

Endometrioid ovarian tumors resemble:

Serous ovarian tumors resemble:

A

Endometrioid ovarian tumors resemble the endometrium

Serous ovarian tumors resemble the lining of the fallopian tubes

34
Q

Most common epithelial ovarian tumor (75%) is…

How many become malignant?

What is the treatment?

What is the classic histological finding?

A

Serous cystadenoma

20-25% become malignant

Surgically removed - operation depends on desire to remain fertile

Psammoma bodies - more common in malignant type

35
Q

What is unique about mucinous cystadenomas?

How many become malignant?

What is it associated with?

A

They can become massive and invade the pelvis/abdomen

15% malignant (85% benign)

Mucocele apendicitis - Pseudomyxoma peritonei

36
Q

Brenner tumors are benign or malignant?

What do they look like?

33% of cases are associated with…

A

Usually benign, rarely malignant

Large fibrotic component that encases epithelioid cells resembling transitional cells of the bladder

33% associated with mucinous epithelial elements

37
Q

If the sex-cord stromal tumor differentiates feminine, then the tumor becomes…

If the sex-cord stromal tumor differentiates masculine, then the tumor becomes…

A

Feminine - Granulosa or theca cell tumor or mixed

Masculine - Sertoli-Leydig tumor

38
Q

What is the classification of granulosa-theca cell tumors?

When do they occur?

What do they produce?

What is the malignant potential?

What signs/symptoms are common?

A

Sex cord-stromal tumors

May occur at any age

Produce estrogen

Low malignant potential

Feminizing signs and symptoms

  • precocious menarch and thelarche
  • premenarchal bleeding
  • menorrhagia, hyperplasia, endometrial CA
  • breast tendernes, post-menopausal bleeding, etc.
39
Q

What is the classification of Sertoli-Leydig tumors?

What do they produce?

What is the malignant potential?

What signs/symptoms are common?

A

Sex cord-stromal tumor

Androgenic components

Low malignant potential

Virilization

  • hirsutism
  • baldness
  • deepening of voice
  • clitoromegaly
  • defeminization of female body
40
Q

What is the most common solid ovarian tumor?

What is unique about it in terms of sex-cord stromal tumors?

What is the unique association with these tumors?

A

Fibroma

They do NOT secrete any hormones

Meigs syndrome - ascites, right pleural effusion and ovarian fibroma

41
Q

Germ cell tumors may occur at what age? What age is most common?

A

Can occur at any age, but they make up 60% of ovarian neoplasm in infants and children

42
Q

Most common ovarian neoplasm =

How big are they? How many are BL?

If they rupture, what is a complication?

A

Cystic teratoma = dermoid cyst

Slow growing and < 10 cm (10-15% are BL)

Rupture may cause chemical peritonitis

43
Q

What is Rokintansky’s protuberance?

A

Solid prominence located at junction of teratoma and normal ovarian tissue

44
Q

When is CA 125 helpful? Why?

A

Helpful to follow ovarian tumors in post-menopausal women. It is not a very sensitive test, so it is not used as much in younger women.

45
Q

4 ways to help diagnose ovarian tumors

A

Abdominal/Bimanual pelvic exam

US

Tumor markers - CA 125

Laparoscopy/Laparotomy

46
Q

Never assume what in a patient with an ovarian tumor?

If surgery is warranted, what should be done before? (2)

Defnitive Tx depends on:

A

Don’t assume it is benign - work it up (exploration or pathology)

Collect pelvic washing for cytologic exam
Obtain frozen section for histological dx

Pt. age and desire for future pregnancies

47
Q

How are epithelial ovarian neoplasms typically managed?

What if mucinous cystadenoma is dx?

What about in young nulliparous patients (they want to preserve fertility)?

What about in an older woman?

A

Usually with UL salpingo-oophorectomy

Mucinous cystadenoma - appendectomy also

Young - cystectomy to preserve ovaries

Old - total hysterectomy w/ BL salpingo-oophorectomy

48
Q

How are stromal tumors usually managed?

A

UL salpingo-oophorectomy when future pregnancies are a consideration

49
Q

How are fibromas managed?

A

May remove ovary or fibroma removal if fertility is desired

50
Q

What is the management of germ cell tumors (teratomas)?

A

Ovarian cystectomy, but evaluate other ovary as some teratomas are BL.

*copiously irrigate pelvis to avoid chemical peritonitis

51
Q

What causes most benign lesions of the fallopian tubes?

A

Infection or inflammatory processes

Hydrosalpinx - fluid-filled tubes from prior infection
Pyosalpinx - purulent-filled tube from active infection

52
Q

What is an ovarian torsion?
What is the primary risk factor for ovarian torsion?

What is an adnexal torsion?

A

Complete or partial rotation of the ovary on its ligamentous support, which often impedes blood supply.
Major risk factor = ovarian mass > 5 cm

Adnexal torsion is twisting of ovary and fallopian tube.

53
Q

Ovarian torsion

Presentation

Dx

Tx

A

Presentation: acute onset of UL pain, possible N/V

Dx: US is first-line, then direct visualization

Tx: detorsion and ovarian conservation with ovarian cystectomy is first-line. If ovary is necrotic/malignant, then a salpingo-oophorectomy is done.

Endrocrine & Reproduction II Exam #1 (17 decks)

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