Benign Conditions Of Uterus

Question 1

The commonest antenatal complication was malpresentation and in all these patients the myomata were larger than

Answer 1

6 cm.

Question 2

Typical features of red degeneration of fibroids occurred in … % of cases.

Answer 2

10

Question 3

Caruncles are frequently subdivided by their histologic appearance into

Answer 3

papillomatous, granulomatous, and angiomatous varieties.

Question 4

The differential diagnosis of urethral caruncles

Answer 4

primary carcinoma of the urethra and prolapse of the urethral mucosa. Malignant lesions are usually hard and irregular in shape and typically are within the urethra itself, The differential diagnosis of a periurethral mass also includes: urethral diverticulum, leiomyoma, vaginal wall inclusion cyst, Skene gland cyst or abscess, and less commonly Gartner duct cyst and ectopic ureterocele

Question 5

The most common small vulvar cysts are

Answer 5

epidermal cysts (epidermoid cysts).

Question 6

the differential diagnosis of vulvar nevi include

Answer 6

hemangiomas, endometriosis, malignant melanoma, vulvar intraepithelial neoplasia, and seborrheic keratosis.

Question 7

The characteristic clinical features of an early malignant melanoma may be remembered by thinking ABCD:

Answer 7

asymmetry, border irregularity, color variation, and a diameter usually greater than 6 mm.

Question 8

the differential diagnosis of an angiokeratoma is

Answer 8

Kaposi sarcoma and angiosarcoma.

Question 9

the most common benign solid tumors of the vulva.

Answer 9

Fibromas

Question 10

SYRINGOMA The most common differential diagnosis is

Answer 10

Fox-Fordyce disease, a condition of multiple retention cysts of apocrine glands accompanied by inflammation of the skin.
often produces intense pruritus, whereas syringoma is generally asymptomatic. Fox-Fordyce disease improves with pregnancy and oral contraceptive use and remits after menopause. It is treated with topical steroids, topical tretinoin cream, and oral isotretinoin.

Question 11

Granular cell myoblastoma

Answer 11

rare, slow-growing, solid vulvar tumor. The tumor originates from neural sheath (Schwann) cells and is sometimes called a schwannoma.

Question 12

The management of nonobstetric vulvar hematomas

Answer 12

is usually conservative unless the hematoma is greater than 10 cm in diameter or is rapidly expanding.

Question 13

Similar to candidiasis, psoriasis may be the first clinical manifestation of.

Answer 13

HIV infection.

Question 14

The disease presents most commonly as a hypertrophic, coalesced plaque similar to lichen sclerosis.but Lichen sclerosis does not involve the vagina

Answer 14

Lichen planus

Question 15

Three types of vulvar lichen planus have been described:

Answer 15

erosive, classical, and hypertrophic. Erosive lichen planus is the most common variant occurring in 85% of the cases

Question 16

The differential diagnosis of hidradenitis suppurativa includes

Answer 16

simple folliculitis, Crohn disease of the vulva, pilonidal cysts, and granulomatous sexually transmitted diseases. The differentiation from Crohn disease is usually made by history with an absence of gastrointestinal (GI)

Question 17

Infectious diseases that are associated with vulvar edema include

Answer 17

necrotizing fasciitis, tuberculosis, syphilis, filariasis, and lymphogranuloma venereum.

Question 18

Vulvar pain syndrome is further subdivided into two categories:

Answer 18

vestibulodynia and dysesthetic vulvodynia. vestibulodynia is found in younger women, most commonly white, with onset shortly after puberty through the mid-20s. Dysesthetic vulvodynia is most common in peri- and postmenopausal women who have rarely if ever had previous vulvar pain.

Question 19

The differential diagnosis of vulvar cysts includes

Answer 19

mesonephric cysts of the vagina and epithelial inclusion cysts.

Question 20

The treatment of enlargement or infection of Bartholin glands

Answer 20

incision and drainage
marsupialization (surgical treatment of choice)
alternative surgical approach is to insert a Word catheter, Antibiotics are not necessary unless there is an associated cellulitis surrounding the Bartholin gland abscess. Women older than 40 years with gland enlargement require a biopsy to exclude adenocarcinoma of the Bartholin gland.

Question 21

The most serious consequences of surgical repair of urethral diverticula are

Answer 21

urinary incontinence and urethrovaginal fistula. Postoperative incontinence usually follows operative repairs of large diverticula that are near the bladder neck. This incontinence may be secondary to damage to the urethral sphincter.

Question 22

Dysontogenetic cysts

Answer 22

soft cysts of embryonic origin. Whether the cysts arise from the mesonephros (Gartner duct cyst), the paramesonephrous (Müllerian cyst), or the urogenital sinus (vestibular cyst).Most mesonephric cysts have cuboidal, nonciliated epithelium. Most perimesonephric cysts have columnar, endocervical-like epithelium.

Question 23

Endocervical polyp Vs. Cervical polyp

Answer 23

Polyps whose base is in the endocervix usually have a narrow, long pedicle and occur during the reproductive years, whereas polyps that arise from the ectocervix have a short, broad base and usually occur in postmenopausal women.

Question 24

the differential diagnosis of cervical Polyp include

Answer 24

endometrial polyps, small prolapsed myomas, retained products of conception, squamous papilloma, sarcoma, and cervical malignancy.

Question 25

the external os of the cervix with a fish-mouthed appearance

Answer 25

When Cervical lacerations that are not repaired

Question 26

The causes of acquired cervical stenosis are

Answer 26

operation, radiation, infection, neoplasia, or atrophic changes. Loop electrocautery excision procedure (LEEP), cone biopsy, and cautery of the cervix (either electrocautery or cryocoagulation) are the operations that most commonly associated with، cervical stenosis.

Question 27

The diagnosis of Cervical stenosis is established by

Answer 27

inability to introduce a 1- to 2-mm dilator into the uterine cavity.

Question 28

Management of cervical stenosis is

Answer 28

dilation of the cervix with dilators under ultrasound guidance. If stenosis recurs, monthly laminaria tents may be used. After cervical dilation, it is often useful to leave a T tube or latex nasopharyngeal airway as a stent in the cervical canal for a few days to maintain patency.

Question 29

Two caveats for using ultrasound in screening of postmenopausal bleeding are (1) ultrasound does not provide a diagnosis—a tissue specimen is necessary for a diagnosis, and (2) all women with bleeding, no matter the endometrial thickness, should have a tissue biopsy. If an endometrial biopsy obtains inadequate tissue and the endometrial thickness is 5 mm or greater, a repeat biopsy, hysteroscopically directed biopsy, or curettage should be performed.

Answer 29

comprehensive GynecoIogy

Question 30

The differential diagnosis of endometrial polyps includes

Answer 30

submucous leiomyomas, adenomyomas, retained products of conception, endometrial hyperplasia, carcinoma, and uterine sarcomas.

Question 31

The most common congenital/acquired causes of hematometra are

Answer 31

Congenital: imperforate hymen and a transverse vaginal septum.
Among the leading causes of acquired lower tract stenosis are senile atrophy of the endocervical canal and endometrium, scarring of the isthmus by synechiae, cervical stenosis associated with surgery, radiation therapy, cryocautery or electrocautery, endometrial ablation, and malignant disease of the endocervical canal.

Question 32

significant proportion of myoma tend to have an inherited basis. Rare genetic conditions such as

Answer 32

hereditary leiomyomatosis and renal cell cancer and Alport syndrome

Question 33

The severity of the discrepancy between the myoma’s growth and its blood supply determines the extent of degeneration: mention the types of degeneration

Answer 33

hyaline, myxomatous, calcific, cystic, fatty, or red degeneration and necrosis.

Question 34

The mildest form of degeneration of a myoma is

And its histological appearance

Answer 34

Hyaline degeneration, an eosinophilic ground-glass appearance.

Question 35

The most acute form of fibroid degeneration is

Answer 35

is red, or carneous, infarction.

occurs during pregnancy in approximately 5% to 10% of gravid women with myomas.

Question 36

Management of fibroid degeneration

Answer 36

The condition is best treated with nonsteroidal anti-inflammatory agents for 72 hours, as long as the woman is less than 32 weeks’ gestation.
the three most common types of fibroid degeneration hyaline degeneration (65%), myxomatous degeneration (15%), and calcific degeneration (10%).

Question 37

The possibility of a uterine tumor being a leiomyoma sarcoma is 10 times greater in a woman in her 60s than in a woman in her 40s.

Answer 37

Rarely, a secondary polycythemia is noted in women with uterine myomas. This syndrome is related to elevated levels of erythropoietin. The polycythemia diminishes following removal of the uterus.

Question 38

Classic indications for a myomectomy include

Answer 38

persistent abnormal bleeding, pain or pressure, or enlargement of an asymptomatic myoma to more than 8 cm in a woman who has not completed childbearing.

Question 39

Contraindications to a myomectomy include

Answer 39

pregnancy, advanced adnexal disease, malignancy, and the situation in which enucleation of the myoma would severely reduce endometrial surface so that the uterus would not be functional.

Question 40

to treat leiomyomas medically by

Answer 40

by reducing the circulating level of estrogen and progesterone. GnRH agonists, medroxyprogesterone acetate (Depo-Provera), danazol, aromatase inhibitors (have been shown to reduce uterine fibroid size (up to 71% in 2 months) and ameliorate uterine fibroid symptoms, including a reduction in menstrual volume and duration of menstruation, and urinary retention , and the antiprogesterone (mifepriston), oral ulipristal acetate (selective progesterone receptor modulator) controls symptoms, reduces tumor size, and improves quality of life compared with placebo and is not inferior to leuprolide acetate when used for 3 months.

Question 41

Complications of UAE affect about 5% of patients and include

Answer 41

postembolization fever; sepsis from infarction of the necrotic myometrium, which may occur several weeks to a few months post procedure; and ovarian failure, affecting up to 3% of cases in women younger than 45 and 15% in women older than 45. shedding of necrotic myomata or portions of myomata into the intrauterine cavity. Shedding may lead to infection or abdominal pain as the uterus tries to pass the material. This may require either a uterine curettage or hysteroscopic removal.

Question 42

Myolysis (the destruction of uterine fibroids or their blood supply via ultrasound, laser, cryotherapy, or other methods) has been studied as a conservative alternative for women who want to preserve their uterus but not fertility. Candidates are

Answer 42

women with small fibroids (typically less than or equal to 5 cm) or the largest fibroid being less than 10 cm in diameter.

Question 43

Adenomyosis is derived from aberrant glands of the basalis layer of the endometrium.

Answer 43

The posterior wall is usually involved more than the anterior wall

Question 44

There are two distinct pathologic presentations of adenomyosis.

Answer 44

diffuse (found in two thirds of cases) / focal

Question 45

The classic symptoms of adenomyosis are

Answer 45

secondary dysmenorrhea and menorrhagia. Occasionally the patient complains of dyspareunia, which is midline in location and deep in the pelvis.

Question 46

The diagnosis of adenomyosis is usually confirmed by

Answer 46

histologic examination of the hysterectomy specimen.

Question 47

Adenomyosis may coexist with

Answer 47

both endometrial hyperplasia and endometrial carcinoma. Approximately two of three women with adenomyosis have coexistent pelvic pathology, most commonly myomas but also endometriosis, endometrial hyperplasia, and salpingitis isthmica nodosa.

Question 48

The most prevalent benign tumor of the oviduct is

Answer 48

the angiomyoma or adenomatoid tumor

Question 49

several characteristics of ovarian masses correlate with malignancy, including

Answer 49

internal papillations (echogenic structures protruding into the mass), loculations, solid lesions or cystic lesions with solid components, thick septations, and smaller cysts adjacent to or part of the wall of the larger cyst–daughter cysts.

Question 50

Management of follicular cyst

Answer 50

The initial management of a suspected follicular cyst is conservative observation. The majority of follicular cysts disappear spontaneously by either reabsorption of the cyst fluid or silent rupture within 4 to 8 weeks of initial diagnosis. However, a persistent ovarian mass necessitates operative intervention to differentiate a physiologic cyst from a true neoplasm of the ovary.
When the diameter of the cyst remains stable for greater than 10 weeks or enlarges, a neoplasia should be ruled out. complex cysts or persistent simple cysts larger than 10 cm should be evaluated. In women with cysts in pregnancy, if the cyst is simple with a normal CA-125, conservative management is acceptable. (CA-125 is generally not obtained in pregnant women with cysts less than 5 cm if they are simple.)

Question 51

A cyst in a perimenopausal or postmenopausal woman should be removed if

Answer 51

• anything other than a simple cyst,

- if the CA-125 is abnormal (>35), or if the cyst is persistent or large (>10 cm)

Question 52

Management of A small simple cyst in a perimenopausal or postmenopausal woman (<5 cm) with a normal CA-125

Answer 52

may be observed with follow-up ultrasound and CA125 testing every 6 months for 2 years. If unchanged at that point routine monitoring can be stopped.

Question 53

Clinically, corpora lutea are not termed corpus luteum cysts unless they are a

Answer 53

a minimum of 3 cm in diameter.
Its associated Bleeding occurs usually between days 20 and 26 of their cycle, and these women have a 31% chance for subsequent hemorrhage from a recurrent corpus luteum cyst.

Question 54

differential diagnosis of a woman with acute pain and suspected ruptured corpus luteum cyst includes

Answer 54

ectopic pregnancy, a ruptured endometrioma, and adnexal torsion. A sensitive serum or urinary assay for human chorionic gonadotropin (HCG) will help to differentiate a bleeding corpus luteum from ectopic pregnancy

Question 55

the three types of physiologic ovarian cysts

Answer 55

1- follicular cyst
2- corpus luteum cyst
3- theca lutein cyst

Question 56

The condition of ovarian enlargement secondary to the development of multiple luteinized follicular cysts is termed

Answer 56

hyperreactio luteinalis

Approximately 50% of molar pregnancies and 10% of choriocarcinomas have associated bilateral theca lutein cysts

Question 57

Benign teratomas occur bilaterally …% to …% of the time.

Answer 57

Benign teratomas occur bilaterally 10% to 15% of the time.

Question 58

Three medical diseases also may be associated with dermoid cysts:

Answer 58

thyrotoxicosis(Adult thyroid tissue is discovered microscopically in approximately 12% of benign teratomas,less than 5% developed thyrotoxicosis), carcinoid syndrome, and autoimmune hemolytic anemia

Question 59

complications of dermoid cyst:

Answer 59

Torsion of a dermoid is the most frequent complication, occurring in 3.5% to 11% of cases. Because of its weight, the benign teratoma is often pedunculated, which may predispose to torsion.
Rupture (more common in pregnancy) If a rupture occurs during surgery, the abdomen should be copiously irrigated with saline, with careful removal of any particulate matter. Chemical peritonitis is reported in less than 1% of ruptured dermoids.
Infection, hemorrhage, and malignant degeneration are all unusual complications of dermoids, occurring in less than 1% of patients.

Question 60

Dermoid cyst US characteristics

Answer 60

include a dense echogenic area within a larger cystic area, a cyst filled with bands of mixed echoes, and an echoic dense cyst.
Ultrasound has a more than 95% positive predictive value and a less than 5% false-positive rate.

Question 61

the most common benign, solid neoplasms of the ovary.

Answer 61

Fibroma

make up approximately 5% of benign ovarian neoplasms and approximately 20% of all solid tumors of the ovary.

Question 62

Meigs’ syndrome is the association of

Answer 62

an ovarian fibroma, ascites, and hydrothorax.
Both the ascites and the hydrothorax resolve after removal of the ovarian tumor. The ascites is caused by transudation of fluid from the ovarian fibroma; Fifty percent of patients have ascites if the tumor is greater than 6 cm. Meigs’ syndrome is rare, occurring in less than 2% of ovarian fibromas. The hydrothorax develops secondary to a flow of ascitic fluid into the pleural space via the lymphatics of the diaphragm. Statistically the right pleural space is involved in 75% of reported cases, the left in 10%, and both sides in 15%.

Question 63

the current preferred term for benign Brenner tumor is transitional cell tumor

Answer 63

usually occur in women ages 40 to 60 years. Approximately 30% of transitional cell tumors are discovered as small, solid tumors in association with a concurrent serous cystic neoplasia, such as serous or mucinous cystadenomas of the ipsilateral ovary

Question 64

Histopathology description of (benign Brenner tumor) transitional cell tumors:

Answer 64

The pale epithelial cells have a coffee bean–appearing nucleus, which is also described as a longitudinal groove in the cell’s nucleus.

Question 65

The most common cause of adnexal torsion is ovarian enlargement by

Answer 65

an 8- to 12-cm benign mass of the ovary.

Question 66

approximately –% of women with surgically confirmed adnexal torsion will have a normal Doppler flow study

Answer 66

approximately 60% of women with surgically confirmed adnexal torsion will have a normal Doppler flow study

Question 67

Approximately —% of women with adnexal torsion have a repetitive episode affecting the contralateral adnexa.

Answer 67

Approximately 10% of women with adnexal torsion have a repetitive episode affecting the contralateral adnexa.

Question 68

T he risk of pulmonary embolus (PE) with adnexal torsion is small, approximately –%. One series noted the risk of PE to be similar when torsion was managed by conservative surgery with untwisting or adnexal removal without untwisting.

Answer 68

The risk of pulmonary embolus (PE) with adnexal torsion is small, approximately 0.2%. One series noted the risk of PE to be similar when torsion was managed by conservative surgery with untwisting or adnexal removal without untwisting.

Question 69

Ovarian Remnant Syndrome

Answer 69

Chronic pelvic pain secondary to a small area of functioning ovarian tissue following intended total removal of both ovaries.
Most of the women who develop this condition had endometriosis or chronic pelvic inflammatory disease and extensive pelvic adhesions discovered during previous surgical procedures.

Question 70

The most common large cyst of the vulva is

Answer 70

a cystic dilation of an obstructed Bartholin duct, with a lifetime risk estimated to be 2%. These cysts occur most often during the third decade.

Question 71

Labial adhesions literally mean the labia minora have adhered or agglutinated together at the midline. Another term sometimes used to describe this condition is

Answer 71

adhesive vulvitis

Question 72

The lesion often appears in an hourglass or figure-8 formation involving the genital and perianal area, The skin may be lichenified with a hypopigmented parchment-like appearance. Parents may note that the genital area appears whitened. Pruritus is typical presenting symptom. Dx ?

Answer 72

Lichen Sclerosus

Question 73

Gonadotropin-releasing hormone agonists for fibroid ? MOA and efficacy in percentage.

Answer 73

Gonadotropin-releasing hormone agonists downregulate the pituitary, which results in hypoestrogenism and amenorrhea. The hypoestrogenic state shrinks leiomyoma volume by as much as 35–65% within 3 months of treatment. the effects of GnRH agonists are not permanent, and leiomyomas often regrow to their pretreatment size within 3 months after the last dose of GnRH agonist.

Question 74

How many percent of lichen sclerosis patient will progress to squamous cell carcinoma

Answer 74

4.5%
With average 4 years latency btw symptomatic Lichen sclerosis and squamous cell carcinoma

Question 75

5tttq