Benign disorders of the upper genital tract Flashcards
why do women w/uterine septums have recurrent pg’y losses? bicornate uterus?
uterine septum has poor blood supply, cannot facilitate proper placentation.
Bicornate uterus is simply too small (plenty of blood supply)
when to tx uterine anomalies?
when symptomatic or when causing probs w/childbearing
uterine anomalies result from problems in fusion of what ducts?
paramesonephric (mullerian)
how do fibroids change throughout life?
form during childbearing years, regress during menopause
when is a fibroid problematic?
when it causes heavy/irregular bleeding or infertility, or by mass effect cause urinary or bowel sx’s
fibroids are monoclonal, meaning what?
arise from propagation of a single smc cell
what are the 3 types of fibroids?
submucosal
intramura
subserosal
what is a parasitic leiomyoma?
pedunculated fibroid that becomes attached to pelvic viscera and dvps its own blood supply
leiomyoma vs. adenomyosis:
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
what can happen to a fibroid when it grows too large?
outgrows its blood supply, infarcts and degenerates. Painful.
RFs for fibroid formation:
AfAm
nonsmokers
perimenopausal
ob
CP of fibroids:
menorrhagia may have secondary dysmenorrhea if not enough bf to fibroid maybe constip maybe urinary frequency maybe urinary retention maybe infertility
how to dx fibroids?
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
mgt of pt w/fibroids?
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
do fibroids become malignant?
rarely
if rapidly growing in a postmenopausal woman, eval for leiomyosarcoma (rare)
is endometrial hyperplasia premalignant?
yes, can be.
simple vs. complex endometrial hyperplasia:
simply = abnl prolif of both stroma and glands complex = abnl prolif of glands only (crowded back-to-back), but no cellular atypia is present.
what makes a hyperplasia atypical?
if there is cytologic atypia
what type of endometrial hyperplasia has highest rate of conversion to endometrial carcinoma
atypical complex hyperplasia
RFs for endometrial hyperpl
unopposed ES: ob nulliparity late menopause exogenous ES w/o PG chronic anovulation PCOS tamoxifen use DM
CP of endometrial hyperplasia:
periods of oligo or amenorrhea then excessive bleeding
pelvic exam is normal.
signs of chronic anovulation - ab’l ob, acanthosis, acne, hirsutism
tx of endometrial hyperplasia
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
2 types of ovarian masses:
fct’l cysts
neoplastic
2 types of functional cysts:
follicular
corpus luteum
what is a follicular cyst:
what problems can arise from them?
failure of a follicle to rupture during follicular phase.
Usually asx’c but can be tender if large.
Can => ovarian torsion of > 4cm
what is a CL cyst?
when CL becomes large and hemorrhagic, or doesn’t regress after 14d
cp of CL cyst?
delay in menstruation
dull lower quadrant pain
what is a theca lutein cyst?
large bilateral cysts filled w/clear, straw-colored fluid
grow in response to beta-hCG levels from molar pg’y, choriocarcinoma, or Clomid
what is the most common form of ovarian mass in a reproductive-age pt?
functional
what is a RF for functional cysts?
smoking
CP of ovarian torsion?
waxing & waning pain
nausea
what is a Ca-125 level used for?
to eval a response to chemotherapy, obtained at baseline in high-risk pts. Not a dx’c or screening tool.
an adnexal mass in what age group suggests neoplasm?
premenarcheal
postmenopausal
or reproductive-age but cyst > 8cm or persists beyond 60d
mgt of cysts in reproductive age pts?
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
