Benign disorders of the upper genital tract

Question 1

why do women w/uterine septums have recurrent pg’y losses? bicornate uterus?

Answer 1

uterine septum has poor blood supply, cannot facilitate proper placentation.
Bicornate uterus is simply too small (plenty of blood supply)

Question 2

when to tx uterine anomalies?

Answer 2

when symptomatic or when causing probs w/childbearing

Question 3

uterine anomalies result from problems in fusion of what ducts?

Answer 3

paramesonephric (mullerian)

Question 4

how do fibroids change throughout life?

Answer 4

form during childbearing years, regress during menopause

Question 5

when is a fibroid problematic?

Answer 5

when it causes heavy/irregular bleeding or infertility, or by mass effect cause urinary or bowel sx’s

Question 6

fibroids are monoclonal, meaning what?

Answer 6

arise from propagation of a single smc cell

Question 7

what are the 3 types of fibroids?

Answer 7

submucosal
intramura
subserosal

Question 8

what is a parasitic leiomyoma?

Answer 8

pedunculated fibroid that becomes attached to pelvic viscera and dvps its own blood supply

Question 9

leiomyoma vs. adenomyosis:

Answer 9

leiomyoma has a pseudocapsule made of a compressed layer of smc’s w/little or no blood supply.
adenomyosis is presence of endometrium in myometrium

Question 10

what can happen to a fibroid when it grows too large?

Answer 10

outgrows its blood supply, infarcts and degenerates. Painful.

Question 11

RFs for fibroid formation:

Answer 11

AfAm
nonsmokers
perimenopausal
ob

Question 12

CP of fibroids:

Answer 12

menorrhagia
may have secondary dysmenorrhea if not enough bf to fibroid
maybe constip
maybe urinary frequency
maybe urinary retention
maybe infertility

Question 13

how to dx fibroids?

Answer 13

maybe can feel them on physical exam
otherwise, u/s

HSG and sonohysterogram (saline infusion sonography) to see submucosal ones and to distinguish them from polyps

Question 14

mgt of pt w/fibroids?

Answer 14

m/definitively r/o other pelvic masses
follow q6mos

if perimenopausal, bridge to menopause with:
medroxyprogesterone (Provera)
danazol (modified TS)
Lupron (GnRH agonist)

uterine a. embolization

myomectomy (maintain fertility)
hysterectomy

Question 15

do fibroids become malignant?

Answer 15

rarely

if rapidly growing in a postmenopausal woman, eval for leiomyosarcoma (rare)

Question 16

is endometrial hyperplasia premalignant?

Answer 16

yes, can be.

Question 17

simple vs. complex endometrial hyperplasia:

Answer 17

simply = abnl prolif of both stroma and glands
complex = abnl prolif of glands only (crowded back-to-back), but no cellular atypia is present.

Question 18

what makes a hyperplasia atypical?

Answer 18

if there is cytologic atypia

Question 19

what type of endometrial hyperplasia has highest rate of conversion to endometrial carcinoma

Answer 19

atypical complex hyperplasia

Question 20

RFs for endometrial hyperpl

Answer 20

unopposed ES:
ob
nulliparity
late menopause
exogenous ES w/o PG
chronic anovulation
PCOS
tamoxifen use
DM

Question 21

CP of endometrial hyperplasia:

Answer 21

periods of oligo or amenorrhea then excessive bleeding
pelvic exam is normal.
signs of chronic anovulation - ab’l ob, acanthosis, acne, hirsutism

Question 22

tx of endometrial hyperplasia

Answer 22

progestin (Depo-Provera, Provera) for 3 mos
repeat bx to confirm regression

if there is no cytologic atypia (aka, just simple or complex, not atypical) then don’t need progestin. Just bx again in 3-6 mos

Atypical complex => hysterectomy due to risk of progression to cancer

Question 23

2 types of ovarian masses:

Answer 23

fct’l cysts

neoplastic

Question 24

2 types of functional cysts:

Answer 24

follicular

corpus luteum

Question 25

what is a follicular cyst:

what problems can arise from them?

Answer 25

failure of a follicle to rupture during follicular phase.
Usually asx’c but can be tender if large.
Can => ovarian torsion of > 4cm

Question 26

what is a CL cyst?

Answer 26

when CL becomes large and hemorrhagic, or doesn’t regress after 14d

Question 27

cp of CL cyst?

Answer 27

delay in menstruation

dull lower quadrant pain

Question 28

what is a theca lutein cyst?

Answer 28

large bilateral cysts filled w/clear, straw-colored fluid

grow in response to beta-hCG levels from molar pg’y, choriocarcinoma, or Clomid

Question 29

what is the most common form of ovarian mass in a reproductive-age pt?

Answer 29

functional

Question 30

what is a RF for functional cysts?

Answer 30

smoking

Question 31

CP of ovarian torsion?

Answer 31

waxing & waning pain

nausea

Question 32

what is a Ca-125 level used for?

Answer 32

to eval a response to chemotherapy, obtained at baseline in high-risk pts. Not a dx’c or screening tool.

Question 33

an adnexal mass in what age group suggests neoplasm?

Answer 33

premenarcheal
postmenopausal
or reproductive-age but cyst > 8cm or persists beyond 60d

Question 34

mgt of cysts in reproductive age pts?

Answer 34

serial u/s to look for resolution
most resolve on their own in 2-3 mos
can start an OCP to prevent formation of additional ones
cystectomy if they don’t regress after 60d