Benign Disorders of the Upper Genital Tract

Question 1

Classification of uterine fibroids:

Answer 1

• Submucosal
• Intramural (most common)
• Subserosal

Question 2

How to distinguish between fibroid and adenomyosis:

Answer 2

Fibroids have a pseudocapsule (composed of compressed areolar tissue and smooth muscle)
- MRI

Question 3

Clinical symptoms of uterine leiomyomas:

Answer 3

Frequency and retention of urine
Iron deficiency anemia
Bleeding abnormalities
Reproductive difficulty
Obstipation and rectal pressure
Infertility
Dysmenorrhea, dyspareunia
Symptomless

Question 4

Nonhormonal therapy for fibroids:

Answer 4

NSAIDs, anti-fibrinolytics

- Limited use in treating dysmenorrhea

Question 5

Hormonal therapy for fibroids:

Answer 5

• Combined OCPs
• Progestins (Mirena IUD)
• GnRH agonists (can shrink fibroids)

Question 6

Interventions for uterine fibroids:

Answer 6

• Uterine artery embolization
• MRI-guided high-intensity ultrasound
• Surgery: myomectomy, hysterectomy

Question 7

Common causes of postmenopausal bleeding:

Answer 7

• Endometrial polyps (25%)

- Endometrial hyperplasia

Question 8

Pathogenesis of endometrial hyperplasia:

Answer 8

Exposure of the endometrium to continuous estrogen stimulation in the absence of progesterone

Question 9

Cytologic changes in endometrial hyperplasia:

Answer 9

Cytologic atypia: simple vs. complex

• Large nuclei, lost polarity
• Increased nucleus:cytoplasm ratios
• Irregular clumped chromatin

Question 10

Simple vs. complex hyperplasia

Answer 10

Simple: proliferation of stroma + glandular elements
Complex: only proliferation of glandular elements
- Crowded glands
- No cytologic atypia

Question 11

Atypical simple vs. atypical complex hyperplasia

Answer 11

Simple: cellular atypia, mitotic figures, glandular crowding
Complex: ???

Question 12

Risk factors for endometrial hyperplasia:

Answer 12

Unopposed estrogen exposure: 
Excess estrogen w/o progesteorne
Nulliparity
DM
Obesity
Menstrual irregularity
Elevated blood pressure
Tamoxifen
Rectal cancer (HNPCC)
Infertility
Unopposed estrogen
Menopause after 55

Question 13

Treatment for simple/complex hyperplasia (no atypia):

Answer 13

Progestin therapy (activates progesterone receptors to cause thinning of the endometrium)

• Depo-Provera
• Mirena

Question 14

Management of atypical hyperplasia:

Answer 14

• Endometrial biopsy
• Evaluate w/ D&C
• Hysterectomy if no future fertility desired

Question 15

Most common functional ovarian cyst:

Answer 15

Follicular cyst (unless during luteal phase- corpus luteum cyst)

Question 16

Initial evaluation of ovarian cyst:

Answer 16

• Pelvic ultrasound
• Serial ultrasounds (60-90d) for resolution
• CA-125 if risk for ovarian CA

Question 17

Palpable ovary or adnexal mass in premenarchal or post-menopausal patient is suggestive of:

Answer 17

Ovarian neoplasm; not likely to be a functional cyst