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Endo/Repro > Benign Conditions of the Uterus, Cervix, Ovary, and Fallopian Tubes > Flashcards

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

1
Q

What leads to the development of the paramesonephric system and regression of the mesonephric system?

A
  • Absence of a Y chromosome

- Absence of the mullerian inhibiting system

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2
Q

What is the timeline for paramesonephric system development?

A
  • Arise at 6 weeks

- Fuse in the midline to form the uteroveaginal primordium at 9 weeks

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3
Q

What can failure to fuse of the paramesonephric duct lead to?

A
  • Uterus didelphys
  • Bicornuate uterus with rudimentary horn
  • Bicornuate uterus with or without double cervices
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4
Q

What is uterus didelphysis?

A
  • 2 separate uterine bodies with its own complex, attached fallopian tube and vagina
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5
Q

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

A
  • Septate uterus
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6
Q

What can failure of formation of mullerian ducts lead to?

A
  • Unicornuate uterus
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7
Q

What is mullerian agenesis?

A
  • Complete lack of development of the paramesonephric system
  • Absence of the uterus and most of vagina
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8
Q

What are the most common congenital cervical anomalies of the cervix?

A
  • Result in malfusion of the paramesonephric ducts with varying degrees of separation
  • Didelphys cervix
  • Septate cervix
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9
Q

How do uterine and cervical anomalies occur?

A
  • Majority of the time, these occur spontaneously

- Could be caused by early maternal exposure to drugs (DES)

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10
Q

What are uterine leiomyomas?

A
  • Benign tumors derived from localized proliferation of smooth muscle cells of the myometrium
  • Most common neoplasm of the uterus
  • > 70% of women will have leiomyomas by fifth decade
  • Rarely malingnant
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11
Q

How do leiomyomas present?

A
  • Most are asymptomatic

- Symptomatic fibroids cause: excessive uterine bleeding, pelvic pressure, pelvic pain, and infertility

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12
Q

What is the most common indication for a hysterectomy?

A
  • Symptomatic fibroids
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13
Q

What are some risk factors for developing fibroids?

A
  • Increasing age during reproductive years
  • African American women have a 2-3 fold increase in risk
  • Nulliparity
  • Family history
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14
Q

What are some characteristics of uterine leiomyomas (fibroids)?

A
  • Usually spherical, well circumscribed, white firm lesions with a whorled appearance on cut sections
  • May degenerate and cause pain
  • May calcify in postmenopausal patients
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15
Q

Where is a subserosal fibroid located?

A
  • Beneath the uterine serosal surface
  • Can rarely attach to the blood supply of the omentum or bowel mesentery and lose uterine connection thus becoming a parasitic fibroid
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16
Q

Where is an intramural fibroid located?

A
  • Fibroid arises in the myometrium

- Most common

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17
Q

Where is a submucosal fibroid located?

A
  • Beneath the endometrium
  • Can be pedunculated and come through the cervical os
  • Prolonged or heavy menstrual bleeding is common
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18
Q

Where is a cervical intraligamentous fibroid located?

A
  • Arise between the broad ligaments
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19
Q

What are some symptoms of leiomyomas?

A
  • 80% are asymptomatic
  • Pelvic or low back pain
  • Pelvic pressure or fullness
  • Severe pain is not common
  • Frequency of urination
  • Prolonged or heavy menstrual bleeding (most common presenting system)
  • Increased incidence of infertility
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20
Q

What are some signs of leiomyomas on PE?

A
  • Bimanual examination
  • Enlarged, irregularly shaped uterus
  • If palpated mass moves with the cervix it is suggestive of a fibroid uterus
  • Degree of enlargement is described in “week size” used to estimate equivalent gestational size
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21
Q

What could be on the differential for leiomyomas?

A
  • Ovarian neoplasms
  • Tubo-ovarian inflammatory mass
  • Pelvic kidney
  • Bowel mass
  • Colon cancer
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22
Q

What are some medical treatments for leiomyomas?

A
  • Combination (estrogen and progesterone): OCPs or rings
  • Progesterone-only therapies: Depo-provera, mirena intrauterine system
  • GnRH agonist: Depo-Lupron (can decrease fibroid size by 40% in 3 months and usually used instead of surgery)
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23
Q

What are some surgical treatments for leiomyomas?

A
  • Myomectomy: hysteroscopic myomectomy or laparoscopic myomectomy
  • Endometrial ablation
  • Uterine artery embolization (artery feeding fibroid is occluded)
  • Hysterectomy
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24
Q

What are some caveats to a myomectomy?

A
  • If endometrial cavity is entered, future deliveries must be C section
  • Often fibroids will grow back (25% of patients will need subsequent surgery)
  • If after a myomectomy there is inadequate uterine tissue, a hysterectomy may be warrented
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25
Q

What are endometrial polyps?

A
  • Form from the endometrium to create soft friable protrusion into the endometrial cavity
  • May evade in office endometrial sampling
  • Most are benign hyperplastic masses (need to remove due to endometrial hyperplasia and carcinoma also presenting as polyps)
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26
Q

What can endometrial polyps cause?

A
  • Menorrhagia

- Spontaneous or post menopausal bleeding

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27
Q

What will ultrasound show for endometrial polyps?

A
  • Focal thickening of the endometrial stripe

- Saling hysterosonography and hysteroscopy allow for better detection

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28
Q

What is a nabothian cervical cyst?

A
  • A normal variant

- Appear opaque with a yellowish or bluish hue

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29
Q

What does a nabothian cervical cyst result from?

A
  • Squamous metaplasia in which a layer of superficial squamous epithelial cells entrap a layer of columnar cells beneath its surface
  • Columnar cells continue to secrete mucus and a mucus retention cyst is formed
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30
Q

What is a cervical polyp? Symptoms?

A
  • Ectocervical and endocervical polyps are the most common benign growths on the cervix
  • Can be removed in office
  • Symptoms: non, coital bleeding or menorrhagia
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31
Q

What do endocervical polyps look like?

A
  • More common
  • Beefy red in color
  • Arise from the endocervical canal
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32
Q

What do ectocervical polyps look like?

A
  • Less common

- Pale in appearance

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33
Q

What is endometrial hyperplasia?

A
  • Represents an overabundance growth of endometrial lining usually as a result of persistent unopposed estrogen
  • Precursor to endometrial cancer
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34
Q

What are some causes of endometrial hyperplasia?

A
  • PCOS and anovulation
  • Granulosa theca cell tumors
  • Obesity (second to peripheral conversion of androgens to estrogens)
  • Exogenous estrogens without progesterone
  • Tamoxifen
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35
Q

What are some symptoms of endometrial hyperplasia?

A
  • Intermenstrual, heavy or prolonged bleeding that is unexplained
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36
Q

How is the diagnosis for endometrial hyperplasia made?

A
  • Sample the endometrium in office

- U/S reveals endometrial lining ≥4 mm in a postmenopausal femal

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37
Q

What is the treatment for endometrial hyperplasia?

A
  • Simple and complex hyperplasia WITHOUT atypia: treat with progestin and resample in 3 months
  • SImple and complex hyperplasia WITH atypia: treat with a hysterectomy
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38
Q

What is adnexa?

A
  • Includes the ovaries, fallopian tubes, upper portion of the broad ligament, and mesosalpinx
39
Q

What is needed for normal ovarian development?

A
  • Two X chromosomes
40
Q

What is seen in Turner syndrome?

A
  • Abnormal gonad development
  • Small rudimentary streaked ovaries
  • Develop secondary sexual characteristics but enter menopause shortly after
41
Q

What is seen in complete androgen insensitivity syndrome/testicular feminization?

A
  • Lack of androgen receptors
  • Phenotypically female
  • Gonads (functioning testes) need to be removed after puberty because of malignant potential
42
Q

What are some functional cysts of the ovary?

A
  • Follicular
  • Lutein cyst
  • Hemorrhagic cyst
  • Polycystic ovaries
43
Q

What are some benign neoplastic cysts of the ovary?

A
  • Epithelial: serous cystadenoma and mucinous cystadenoma
  • Sex cord stromal: Fibromas, granulosa theca cell, and sertoli leydig
  • Germ cell: Mature cystic teratoma/dermoid
44
Q

What is a follicular cyst?

A
  • Lined by one or more layers of granulosa cells
  • Develops when an ovarian follicle fails to rupture
  • Is clinically significant when it is large enough to cause pain
45
Q

What is a corpus luteum cyst?

A
  • May develop if the corpus luteum becomes cystic, larger than 3 cm and fails to regress normally after 14 days
46
Q

What is a hemorrhagic cyst?

A
  • More likely to cause symptoms

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

47
Q

What is polycystic ovaries?

A
  • Enlarged ovaries with multiple simple follicles
48
Q

Who is most affected by a theca-lutein cyst?

A
  • Patients with high serum levels of hCG (pregnancy, choriocarcinoma or hydatidiform mole, or undergoing ovulation induction)
49
Q

What is a theca-lutein cyst?

A
  • Usually bilateral and can become large

- Often regress when hCG levels fall

50
Q

What causes a luteoma of pregnancy?

A
  • Hyperplastic reaction of the ovarian theca cells

- Secondary to prolonged hCG stimulation during pregnancy

51
Q

How do a luteoma of pregnancy present?

A
  • Reddish-brown nodules
52
Q

What is a polycystic ovarian cyst?

A
  • Associated with chronic anovulation, hyperandrogenism, and insulin release
  • Produces enlarged ovaries with multiple small follicles that are inactive and arrested in the mid antral stage
53
Q

What happens hormonally with polycystic ovarian cysts?

A
  • Increased LH levels promote androgen secretion from the ovarian theca cells, leading to elevated levels of ovarian derived androstenedione and testosterone
54
Q

What does peripheral conversion of androgens do in polycystic ovarian cysts?

A
  • Leads to elevated estrogen levels that then suppress FSH from the pituitary gland
55
Q

What are some clinical features of polycystic ovarian cysts?

A
  • Usually asymptomatic and simple in nature
  • Generally less than 8 mm in size
  • Usually regress during subsequent cycle
  • Can become large and undergo torsion
56
Q

How is diagnosis made for polycystic ovarian cysts?

A
  • Bimanual exam reveals an enlarged, mobile, unilateral cyst

- U/S

57
Q

What is the management of polycystic ovarian cysts?

A
  • Depends on patient
  • If asymptomatic and premenopausal, can be placed on OCPs to suppress gonadotropin levels and prevent development of other cysts and repeat U/S
  • If symptomatic and premenopausal, need to rule out ectopic pregnancy, torsion, tuboovarian abscess
58
Q

Where do epithelial ovarian neoplasms come from?

A
  • From the mesothelial cells lining the peritoneal cavity and also lining from the surface of the ovary
59
Q

What do the different types of epithelial ovarian neoplasms resemble?

A
  • Mucinous ovarian tumors cytologically resemble the endocervical epithelium
  • Endometrioid ovarian tumors resemble the endometrium
  • Serous ovarian tumors resemble the lining of the fallopian tubes
60
Q

What are serous cystadenomas?

A
  • Most common epithelial ovarian tumors
  • 10% are bilateral
  • 70% are benign
  • 5-10% are borderline
  • 20-25% are malignant
61
Q

What is the treatment for serous cystadenomas?

A
  • Surgical depending on desire to maintain fertility
62
Q

What is seen histologically for serous cystadenomas?

A
  • Psammoma bodies (more common in malignant tumors)
63
Q

What is a mucinous cystadenoma?

A
  • Can attain a huge size filling the entire pelvis and abdomen
  • Second most common epithelial tumor
  • 10% are bilateral
  • 85% are benign
  • 15% are malignant
64
Q

What is a mucinous cystadenoma associated with?

A
  • A mucocele of the appendix

- Rarely leads to pseudomyxoma peritonei

65
Q

What is pseudomyxoma peritonei?

A
  • Condition where numerous benign implants are seeded onto the surface of the bowel and other peritoneal structures producing large quantities of mucus
66
Q

What is a brenner tumor?

A
  • Small smooth solid ovarian neoplasm
  • Usually benign and rarely malignant
  • 33% of tumors associated with mucinous epithelial elements
67
Q

What are sex cord stromal ovarian neoplasms?

A
  • Derived from the sex cords stroma of the developing gonad
68
Q

How are sex cord stromal ovarian neoplasms differentiated?

A
  • If patient is feminine, then the tumor is feminine and is either a granulosa or theca cell tumor
  • If patient is masculine, then the tumor is masculine and is a sertoli leydig tumor
69
Q

What is a granulosa theca cell tumor?

A
  • Can occur at any age
  • Produce estrogenic components
  • Low malignant potential
70
Q

What does a granulosa theca cell tumor promote?

A
  • Precocious menarche and thelarche
  • Premenarcheal uterine bleeding during infancy and childhood
  • Menorrhagia, endometrial hyperplasia, and endometrial cancer
  • Breast tenderness, fluid retention, and postmenopausal bleeding
71
Q

What is a sertoli leydig tumor?

A
  • Less frequent than granulosa theca cell tumor
  • Produce androgenic components
  • Low malignant potential
72
Q

What does a sertoli leydig tumor promote?

A
  • Hirsutism
  • Temporal baldness
  • Deepening of the voice
  • Ciltoromegaly
  • Defeminizing of the female body habitus to a muscular build
73
Q

What is a fibroma?

A
  • Forms a solid, encapsulated, smooth surfaced tumor made up of interlacing bundles of fibrocytes
  • Most common benign SOLID ovarian tumor
  • Does not secrete sex steroid
74
Q

What is occasionally associated with fibromas?

A
  • Ascites secondary to transudation of fluid from the ovarian tissue
75
Q

What is meigs syndrome?

A
  • Ascites and right pleural effusion in association with an ovarian fibroma
  • Flow of ascitic fluid through the transdiaphragmatic lymphatics into the right pleural cavity leads to Meigs’ syndrome
76
Q

What is a cystic teratoma?

A
  • Most common ovarian neoplasm found in women of all ages is the benign cystic teratoma
  • 80% occur during reproductive years (median age is 30)
  • 10-15% are bilateral
  • Slow growing tumors, most <10 cm in size
77
Q

What do dermoids (cystic teratomas) contain?

A
  • Differentiated tissue from all three embryonic germ layers

- Composed primarily of ectodermal tissue (skin, sweat glands, hair follicles)

78
Q

What is the characteristic macroscopic appearance of a cystic teratoma?

A
  • Multicystic mass
  • Hair, teeth, mixed into sebaceous thick material
  • Rokintanksy’s protuberance
79
Q

What is the Rokintanksy’s protuberance?

A
  • Solid prominence located at the junction between the teratoma and normal ovarian tissue
80
Q

What does rupture of a cystic teratoma lead to?

A
  • Chemical peritonitis
81
Q

How are benign ovarian tumors diagnosed?

A
  • Abdominal and bimanual pelvic exam
  • U/S (looking for complex vs simple or for a dermoid cyst)
  • Tumor markers like CA 125
  • Laparoscopy
82
Q

What should be done if surgery is warranted for ovarian neoplasms?

A
  • Collect pelvic washings for cytologic examination

- Obtain a frozen section for histologic diagnosis

83
Q

How are epithelial benign ovarian tumors managed?

A
  • Unilateral salpingo-oophorectomy

- If it is a mucinous cystadenoma –> perform an appendectomy due to possible mucocele

84
Q

What is the difference in management of a benign ovarian tumor in young vs older women?

A
  • Younger women: may perform cystectomy for ovarian preservation
  • Older women: total abdominal hysterectomy with bilateral salpingo-oophorectomy
85
Q

What is the management for a stromal cell tumor?

A
  • Unilateral salpingo-oophorectomy when future pregnancies are a consideration
86
Q

What is the management for a fibroma?

A
  • Even with Meigs’ syndrome, almost always benign

- Remove ovary or treat by resection of the ovary in a young woman who desires future family

87
Q

What is the management of a cystic teratoma?

A
  • Ovarian cystectomy
  • Carefully evaluate other ovary since bilateral is a change
  • Rare recurrence after surgery
  • Copiously irrigated pelvis to prevent chemical peritonitis
88
Q

What are most benign conditions of the fallopian tubes?

A
  • Infectious or inflammatory
  • Hydrosalpinx –> fluid filled tubes from previous infection
  • Pyosalpinx –> fluid filled tubes from active infection
89
Q

What is ovarian torsion?

A
  • Complete or partial rotation of the ovary on its ligamentous supports resulting in impedance of blood supply
  • Most common gynecologic emergency
90
Q

What are the two types of ovarian torsion?

A
  • Adnexal torsion: ovary and fallopian tube both twist

- Isolated torsion of just fallopian tube

91
Q

What is a primary risk for an ovarian torsion?

A
  • Ovarian mass ≥ 5 cm
92
Q

What is a classical presentation of an ovarian torsion?

A
  • Acute onset of unilateral pain

- Nausea and possibly vomiting

93
Q

How is an ovarian torsion diagnosed?

A
  • U/S if first line

- Definitive diagnosis is made by direct visualization

94
Q

What is the treatment of ovarian torsion?

A
  • Detorsion and ovarian conservation with an ovarian cystectomy
  • Salpingo-oophorectomy done if ovary is necrotic or malignancy is suspected

Endo/Repro (31 decks)

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