Benign GYN Pathology Flashcards
What is uterine didelphys?
Failure of Mullerian ducts to fuse, 2 uterine cavities, 2 cervices, 2 vaginal canals
What complications are associated with didelphys?
malposition, preterm labor, miscarriage
What is bicornuate uterus? Bicollis vs unicollis?
Partial failure of Mullerian duct fusion
Bicollis: 2 uterine cavities, 2 cervices, 1 vaginal canal
Unicollis: 2 uterine cavities, 1 cervix, 1 vaginal canal
What is unicornuate uterus?
Half develops: 1 uterine horn, 1 tube, 1 ovary
What is septate uterus?
Reabsorption/duplication anomaly: septum creates 2 uterine cavities, 2 cervices within 1 fundus
What is the MC uterine shape abnormality?
Septate
What is subseptate uterus?
Septum divides endometrial canal but not cervix
What is commonly associated with septate uterus?
Infertility
What is aplasia?
Failure of uterus to develop from Mullerian duct
What is male pseudohermaphroditism?
Gonads are testes but secondary sex characteristics/ext genitalia resemble female
What is female pseudohermaphroditism?
Person with ovaries but secondary sex characteristics/ext genitalia resemble male
What is true hermaphroditism?
Person born with ovarian and testicular tissue, commonly 1 or both are ovotestis (both tissues)
What is ambiguous genitalia?
Intersex, any variation in gonadal sex chromosome chain
What is precocious puberty?
Abnormal early development of sexual maturity, usually before 8
What is the sono app of precocious puberty?
Adult shaped uterus, ovary volume > 1 cm cubed
What is hydrometra?
- Abnormal fluid collection in uterus
- MC premenarche
What are causes of hydrometra?
Imperforate hymen, congenital vaginal atresia
What is pyometra?
Mucinous and infectious fluid collection in uterus
What is hydrometrocolpos?
Serous fluid within vagina and uterus
What is hematometrocolpos and what causes it?
Menses accumulates within vagina/uterus, caused by cervical obstruction/malignancy/stenosis in older pts
What are clinical symptoms of fluid collections?
Pelvic discomfort, painful defecation/urination
What is the MC benign GYN tumor?
Leiomyoma
What are characteristics of leiomyomas?
Highly degenerative/proliferative, change size, calc formation
What are the four classifications of leiomyomas?
- Intramural: in myometrium
- Subserosal: in perimetrium
- Submucosal: adjacent/abutting endo
- Pedunculated: attached to uterine tissue by stalk
What are clinical symptoms of leiomyoma?
Pain, menorrhagia, enlarged uterus, irregular menses
What is sono app of leiomyoma?
- variable echogenicity
- shadowing
- well defined
- solid
- doppler, stalk flow
What is adenomyosis?
Endo tissue embedded into myometrium
What are clinical signs of adenomyosis?
Cramping, dysmenorrhea, enlarged uterus
What is the sono app of adenomyosis?
- hypoechoic ut
- heterogeneous myometrium
- diffusely enlarged
- myometrial microcysts
- echogenic foci
What is endometrial hyperplasia? What should be done if a pt has this?
Abnormal thickening of endo due to high levels of estrogen, biopsy due to risk of atypical precancerous cells
What is associated with endo hyperplasia?
Tamoxifen
What are symptoms and sono app of endo hyperplasia?
Uterine bleeding, thickened endo w/ or w/o cystic changes
What is endometrial polyp and what are the signs?
Overgrowth of endo tissue, abnormal uterine bleeding
What is the sono app of endo polyp?
- diffuse/focal endo thickening
- possible vascularity
- pedunculated
- use of sonohysterogram to visualize when distended w/ fluid
What are nabothian cysts?
Benign asymptomatic cervical cysts
What is the sono app of nabothian cyst?
anechoic, well defined, within cervical os
What is endometriosis?
Endometrial tissue located outside of endo/myometrium, benign proliferative disease
Who is endometriosis MC in?
White women of higher socioeconomic class who delay children
What are the 2 forms of endometriosis?
Diffuse: implants, localized: endometrioma
What are the four stages of endometriosis?
1: minimal, few/superficial implants
2: mild: addl implants, deeper involvement
3: moderate: numerous implants, ov involvement, sono visible adhesions, infertility
4: severe: multiple dense adhesions
Where are implants common with endometriosis?
- ovaries (80% of cases)
- fallopian tubes
- broad ligament
- posterior CDS
- pelvic peritoneum
What are the symptoms of endometriosis?
- chronic pain
- infertility
4 Ds: - dysmenorrhea
- dyspareunia: painful sex
- dysuria
- dyschezia: painful defecation
What is a follicular cyst?
When dominant follicle fails to ovulate, may cause menstrual irregularities
What is a corpus luteum cyst?
After dominant follicle ruptures and ova is expelled, mild hemorrhage at rupture site
What are the signs of corpus luteum cyst?
Pain, N/V (progesterone), enlarged, tender ovary
What is the appearance of a corpus luteum?
- complex cyst
- ring of fire
- persistent in early OB exams
- FF in post CDS
What is a theca lutein cyst? What are they associated with?
Develops due to high hCG
- gestation trophoblastic neoplasia
- ovarian hyperstimulation syndrome
- multiple/single preg
What are the clinical signs of theca lutein cyst? Sono app?
- Pain, light bleeding, early preg symptoms
- Always bilat, large, multilocular cysts
What is a paraovarian cyst?
From Gartner’s Duct/Wolffian Duct remnant, found in broad ligament
What is the clinical presentation of a paraovarian cyst?
20-40 yo, asymptomatic, pain if large
What is the sono app of paraovarian cyst?
Anechoic, thin-walled, defined, variable size
What is a serous cystadenoma? Clinical signs?
Common epithelial tumor
- asymptomatic
- complications due to size
- pelvic pain, discomfort
- bloating
What is the sono app of a serous cystadenoma?
- 1-3 cm
- unilateral
- cystic with debris
- smooth walls, possible septations
What is a mucinous cystadenoma?
Epithelial tumor that produces mucin/gelatinous material that fills the cyst/loculations
What are the clinical signs of mucinous cystadenoma?
- complications due to size
- abdominal distention and pain
- vomiting, indigestion, constipation
- urinary incontinence
- fatigue
What is the sono app of mucinous cystadenoma?
Large, multi septations, medium echoes
What is a mature cystic teratoma?
Germ cell tumor w/ teeth, hair, bone (dermoid)
What is the clinical presentation of mature cystic teratoma?
- young women (repro age)
- mild-acute pain
- adnexal fullness
- pressure
What is the sono app of mature cystic teratoma?
Cystic/complex, calcification w/ shadowing
“tip of the iceberg”
What is theca cell tumor? Clinical signs?
Solid, unilateral mass found in meno/postmeno women, pain and pressure
What is the sono app of theca cell tumor?
- enlarged ov
- solid
- shadowing
- calcs
- cystic degeneration
What is a fibroma?
Stromal tumor associated with Meig’s syndrome
What is the clinical triad associated with fibroma? Other symptoms?
- Benign ovarian tumor
- Hydrothorax/pleural effusion
- Ascites
Other: focal pelvic pain, pressure if large
What is the sono app of fibroma?
Solid, hyperechoic
What is a Brenner tumor?
- Rare, solid mass
- Possible association with Meig’s syndrome
- Rarely malignant, possibility
What are the signs of Brenner tumor?
- asymptomatic
- vaginal bleeding
- palpable pelvic mass
- pelvic pain
What is the sono app of Brenner tumor?
- hypoechoic, homogeneous
- defined
- typically unilat
What pathologies are associated with Meig’s syndrome?
Fibroma, Brenner tumor
What is an endometrioma? What is it AKA?
- Implantation of endometrial tissue outside of uterus
- Chocolate cyst: large cysts filled w/ brown fluid
What are clinical symptoms of endometriomas?
Dyspareunia, metromenorrhagia, dysmenorrhea
What is the sono app of endometrioma?
Defined, cystic mass with low-level echoes, punctate calcs
What causes ovarian torsion? What are the signs?
Caused by ovarian mass or cyst
Sudden onset of severe pain, N/V, palp adnexal mass
What is the sono app of torsion?
- enlarged ov
- hyperechoic, heterogeneous
- dilated peripheral vessels
- lack of doppler flow or decrease
What are the effects of polycystic ovarian disease?
Associated with Stein-Leventhal syndrome
- polycystic ovaries
- hirsutism
- amenorrhea
- enlarged ovaries
- obesity
- impaired fertility
What is the appearance of polycystic ovarian disease?
Bilat, enlarged ovaries, multiple peripheral cysts
“string of pearls”
What is pelvic inflammatory disease?
Acute or chronic inflammatory condition of uterus, cervix, ovaries, fallopian tubes, peritoneal surfaces
What is PID caused by?
STI, IUD, extension of abdominal/pelvic abscesses, complication of post-abortion or childbirth
What is the clinical presentation of PID?
- severe pelvic pain
- fever, shaking, chills, leukocytosis
- vaginal discharge/bleeding
- rebound tenderness
- dyspareunia
What is endometritis?
Inflammation of endometrium, complication of PID
What is the sono app of endometritis?
- normal or thickened endo
- air or fluid in endo cavity
- increased vascularity
What is salpingitis?
Inflammation of fallopian tube, complication of PID
What is the sono app of salpingitis?
- distended tube w/ thickened walls
- pyosalpinx in acute cases
- hydrosalpinx in chronic cases
- increased vascularity
What is tubo-ovarian abscess?
Abscess formation w/i fallopian tube and ovarian tissue, complication of severe PID
What are the clinical signs of tubo-ovarian abscess?
- high fever, elev WBC
- severe pelvic/RUQ pain
- N/V
- peritonitis
- Fitz-Hugh-Curtis syndrome (liver capsule inflammation, adhesions)
What is the sono app of tubo-ovarian abscess?
- multilocular complex uterine/adnexal mass
- debris, septations, irregular thick walls
- commonly bilat
- debris in pelvis
What is pelvic congestion sydrome? Who does it affect?
Dilated tortuous veins >4-5 mm near uterus, possibly adnexas
Common in women who had multiple pregnancies
What are signs of pelvic congestion syndrome?
Chronic pelvic pain
