Benign Conditions Uterus, Cervix, Ovary, Fallopian Tubes - Dr. Moulton Flashcards
Didelphysis is what and caused from
2 uterus bodies with their own cervix and 1 fallopian tube and 1 vagina
= paramesonephric ducts dont fuse
Septate uterus happens from
midline fusion of paramesonephric ducts does not dissolve
no mullarian duct formed causes
unicornuate uterus
mother exposure to what can cause anomalies
Diethylstilbestrol (DES) = T shaped endometrium cavity, cervical collar deformity
Uterine Leiomyomas are what other name
- what are they and who
- sx
- risks
FIBROIDS
- benign tumor from SM (myometrium) proliferation (usually high E), 5th decade F
- asymptomatic only can cause (uterine bleeding, pelvic P / pain, infertility)
- AA, age, no pregs, FH
Fibroids = uterine leiomyomas feel like what, enlarge when, calcify when
- rubbery solid ball,
- pregnancy, can also degenerate during preg and cause pain
- postmenopausal calcification
Types of Fibroids, what thy mean : Subserosal Intramural Submucosal Cervical Intraligamentous
- Subserosal = under uterine serosa, can at times attach to Bowel BF, loosing uterine connection
- Intramural = myometrium fibroids
- Submucosal = endometrium fibroids, can go through cervix (PROLONGED heavy menstrual bleeding)
paracytic fibroid
when a subserosal fibroid attached to bowel and disconnects from uterus
- heavy menstrual bleeding happens from what 2 fibroids
2. infertility usually from what fibroid
- intramueral + submucosal
2. submucosal
size of fibroid is said how + when palpating how to know its a fibroid
- week size (preg size at that week is how you name the enlargement of fibroid and uterus)
- it moves with the cervix
imaging of fibroid
US (lateral vs adnexal)
adnexal = next to uterus (on fallopian tube or ovary)
TX fibroids
- oral contraceptives (E +P) * first line*
- Depo-Provera, Mirena Intrauterine System (P only)
- Depo-Lupron (GnRH agonist) = decreases 40% in 30 mo fast, usually before surgery**
5 surgeries for TX Leiomyomas
- Hysteroscopic Myomectomy = submucosal
- Laparoscopic / robotic myomectomy = pedunculated, subserosal, intramural
- Endometrial ablation
- Uterine A Embolism = fibroid necrosis + painful
- Hysterectomy = definitive tx
uterine A embolism is done how
inject microspheres/polyvinyl alcohol particles through the femoral A –> uterine A
Myomectomy IMPORTANT to know for pts who have had this and are pregnant
CAN ONLY DO C-SECTION (if endometrial cavity was entered during surgery = to avoid contractions)
Myomectomy success
usually gets rid of them however 25% grow back
= if too much is removed then surgeon does hysterectomy
endometrial polyps are what
- sx
- what to do with them
- imaging
benign hyperplasia soft friable protrusions into endometrial cavity
- heavy bleeding, postmenopausal bleeding
- hysteroscopy removal and sent to pathology = check for cancer invasion or benign
- sampling usually miss these, US saline + hysterosonography/ hysteroscopy**
Nabothian Cervical Cyst
- looks like
- are what
- histo and how it forms
- yellow or blue tint on opaque (white)
- Squamous metaplasia (superficical squamous epithelium entraps columnar cells under
- columnar cells inside secrete mucous and cause cyst to grow
Cervical polyp
- most common 2 types
- what are they
- sx
- what to do with them
- Endocervical**, + Ectocervical
- benign growths
- heavy bleeding or none
- remove and send to path (rare to invade)
Endocervical Polyps rate + color
Ectocervical polyp rate + color
- most common, beefy red
2. not as common, pale color
Endometrial Hyperplasia can be cused by what 5 things **
- unopposed E (no preg, long mestruating period in life)
- PCOS, anovulation
- granulosa theca cell tumor = makes E
- obesity (leptin)
- Tamoxifen (increase E in endometrium, lowers in breasts)
Endometrial Hyperplasia is precursor to
endometrial carcinoma
Endometrial Hyperplasia classified by what and 4 types they classify into risks of carcinoma progression
WORLD HEALTH ORG. CLASSIFICATION
- Simple + no atypia = 1%
- Simple + no atypia = 3%
- Simple + Atypia = 9%
- Complex + Atypia = 27%
Endometrial Hyperplasia
- sx
- DX how
- TX
- heavy or prolonged bleeding, esp if during menopause (any spotting)
- Embx sample endo., + US (if 4mm or thicker in postmenopausal endometrium** KNOW THIS**)
- no atypia —> PROGESTIN and resample in 3mo
Atypia —> hysterectomy
abnormal ovarian development is usually associated with
not having an XX baby 1. (45XO Turner syndrome) 2. (46XY complete androgen insensitivity syndrome, testicular feminization) = male looks like female
Turner Syndrome SX
ovarian streaks, secondary sexual characteristics entering menopause after
Complete androgen insensitivity syndrome
- important thing to do
- sx
- remove gonads after puberty = can turn malignant
2. X androgen receptors = male looking like female
fallopian tube developmental problem usually happens from
DES (short clubbed)
Follicular Cysts
when ovarian follicle dies not rupture , lined by granulosa cells
Corpus Luteum Cysts
corpus luteum becomes cystic (larger 3cm) and does not regress after 14days
Hemorrhagic cysts
PAIN
hemorrhage in corpus luteum cyst (2-3 days after ovulation)
Polycyctic Ovaries
enlarged ovaries with many simple follicles
Theca-Lutein Cyst happen how and from what + TX
- high hCG levels
- preg, choriocarcinoma, hydatiform molar preg
- TX : regress when gonadotropin levels fall
Luteoma of Pregnancy
- caused by
- looks like
- what to do with this
- hyperplastic reaction of theca cells in ovary (from high hCG)
- red/brown
- DONT surgically remove, regresses postpartum*
Polycystic Ovarian Cyst
- associated with what 3 conditions
- looks like on what imaging
- chronic anovulation
- hypreandrogenism
- insulin resistance
= large ovaries with many follicles arrested in min-antral stage on US
Polycystic Ovarian Cyst happens how
- high LH = androgen secretion from thecal cells = androstenedione + testosterone ovarian derived INCREASE
- high androgens —-> Estrogen elevation —-I FSH (chronic E exposure**)
antral follicle
graffian follicle, teritary follicle (6-12 normal amount)
Functional Ovarian Cysts (follicular, corpus luteual, hemorrhagic, PCOS, theca-lutein, luteoma of preg)
- sx
- DX
- manage
- risk
- asymptomatic, regress usually in next cycle
- US after 6 weeks (At next cycle), bimanual exam to see it also
- *asympto +premenopausal = Oral contraceptives (lower hCG) + repeat US
- sx and premenopausal = RULE out ectopic, torsion, tubo ovarian abscess
4. can grow and cause torsion
Benign neoplastic ovarian tumores 3 types
- epithelial = serous, mucinous, brenner, clear cell
- sex cord stroma tumors = fibroma, s-l cell, granulosa-theca cell
- germ cell tumors = benign cystic teratoma
mucinous ovarian tumors resemble what lining
endocervical epithelium
endometrioid ovarian tumors resemble what lining
endometrium
serous ovarian tumors resemble what lining
fallopian tubes
most common epithelial ovarian tumor
- what type is it usually
- tx
- histo
Serous cystadenoma
- benign (25% malignant)
- cystectomy, oophorectomy, hyst with bilateral oophorectomy (depening on fertility desire)
- psammoma bodies (usually in malignant)
Mucinous cystadenoma
- type usually
- associated with what
- can lead to what rarely
- looks like
- benign
- mucocele of appendix
- pseudomyxoma peritonei (in bowel benign implants making a bunch of mucus)
- jelly in the belly, fillinf pelvis and abdomen
