BENIGN GYNECOLOGIC LESIONS 1.3 (TB8

Question 1

What is an endometrial polyp?

Answer 1

A localized overgrowth of endometrial glands and stroma that project beyond the endometrial surface.

Question 2

What are the characteristics of endometrial polyps?

Answer 2

Soft and pliable, single or multiple, range from a few mm to several cm, may be broad-based or have a slender pedicle.

Question 3

What is polypoid hyperplasia?

Answer 3

A benign condition where numerous small polyps are discovered throughout the endometrial cavity.

Question 4

What is the most common symptom of endometrial polyps?

Answer 4

Metrorrhagia (irregular or intermenstrual bleeding).

Question 5

What imaging finding suggests an endometrial polyp?

Answer 5

A well-defined, uniformly hyperechoic mass <2 cm in diameter on vaginal ultrasound.

Question 6

What is the gold standard for diagnosing and treating endometrial polyps?

Answer 6

Hysteroscopy with dilatation and curettage.

Question 7

What is adenomyosis?

Answer 7

A condition where ectopic endometrial glands and stroma from the basalis layer invade the myometrium.

Question 8

What are the types of adenomyosis involvement?

Answer 8

Focal (localized to part of the uterus) and diffuse (affecting the whole uterus).

Question 9

What is the hallmark symptom of adenomyosis?

Answer 9

Painful menstruation (dysmenorrhea) and menorrhagia.

Question 10

How is adenomyosis confirmed?

Answer 10

Histologic examination of uterine tissue.

Question 11

What is the definitive treatment for adenomyosis?

Answer 11

Hysterectomy.

Question 12

What are the risk factors for adenomyosis?

Answer 12

Increased parity, previous surgeries (D&C, NSD), and uterine trauma.

Question 13

How does adenomyosis cause abnormal uterine bleeding (AUB)?

Answer 13

Increased endometrial surface, altered prostaglandin balance, impaired myometrial contractility, and abnormal myometrial angiogenesis.

Question 14

What is leiomyoma?

Answer 14

A benign monoclonal smooth muscle tumor of the uterus, also known as fibroid or myoma.

Question 15

What are risk factors for leiomyoma?

Answer 15

Increasing age, black race, high BMI, early menarche, low parity, high-fat diet, PCOS, chronic anovulation.

Question 16

What are protective factors against leiomyoma?

Answer 16

Pregnancy, combined oral contraceptives (COC), smoking, and breastfeeding.

Question 17

What are the histologic features of leiomyoma?

Answer 17

Round, rubbery tumors with a whorled pattern, elongated smooth muscle cells aggregated in dense bundles.

Question 18

What is the most common type of degeneration in leiomyoma?

Answer 18

Hyaline degeneration (65%).

Question 19

What is red (carneous) degeneration in leiomyoma?

Answer 19

Occurs in 5-10% of pregnant women, causing severe pain due to extensive coagulative necrosis.

Question 20

What are the four main clinical manifestations of leiomyoma?

Answer 20

Abnormal uterine bleeding, pain/pressure, infertility, and miscarriage.

Question 21

What is hematometra?

Answer 21

Blood accumulation in the uterus due to obstruction.

Question 22

What is hematocolpos?

Answer 22

Blood accumulation in the vagina.

Question 23

What is the most common congenital cause of hematometra?

Answer 23

Imperforate hymen or transverse vaginal septum.

Question 24

What is the treatment for hematometra?

Answer 24

Operative relief of obstruction through excision and drainage.

Question 25

Where is the interstitial part of the fallopian tube located?

Answer 25

Within the muscular wall of the uterus.

Question 26

What is a severe maternal morbidity associated with interstitial ectopic pregnancy?

Answer 26

Severe maternal morbidity due to rupture.

Question 27

Which portion of the fallopian tube has the most highly developed musculature?

Answer 27

Isthmus.

Question 28

Which part of the fallopian tube is the narrowest?

Answer 28

Isthmus.

Question 29

Which part of the fallopian tube is the preferred portion for tubal ligation?

Answer 29

Isthmus.

Question 30

Where does fertilization occur in the fallopian tube?

Answer 30

Ampulla.

Question 31

Which part of the fallopian tube is the most common site of ectopic pregnancy?

Answer 31

Ampulla.

Question 32

What is the function of the infundibulum of the fallopian tube?

Answer 32

It has a fimbriated extremity, serving as a tunnel-shaped opening.

Question 33

What is another name for an angiomyoma?

Answer 33

Adenomatoid tumor.

Question 34

What is the most prevalent benign tumor of the oviduct?

Answer 34

Angiomyoma.

Question 35

What are the characteristics of an angiomyoma?

Answer 35

Small, gray-white, circumscribed nodules, 1 to 2 cm in diameter, usually unilateral, and mostly asymptomatic.

Question 36

Where are angiomyomas typically located?

Answer 36

Just under the tubal serosa.

Question 37

How are paratubal cysts usually discovered?

Answer 37

Incidentally during gynecologic operations for other abnormalities.

Question 38

What is the typical size range of paratubal cysts?

Answer 38

From 0.5 cm to more than 20 cm in diameter.

Question 39

What is the most common clinical manifestation of paratubal cysts?

Answer 39

Most are small, asymptomatic, and slow-growing.

Question 40

What is the approximate size of a fallopian tube compared to a finger?

Answer 40

If you divide the pinky finger longitudinally, that's the size of the fallopian tube.

Question 41

What are the three types of ovarian cysts?

Answer 41

Follicular cyst, Corpus luteum cyst, Theca lutein cyst.

Question 42

What is the most common cystic structure in normal ovaries?

Answer 42

Follicular cyst.

Question 43

At what stage can follicular cysts be found?

Answer 43

As early as 20 weeks AOG in female fetuses and throughout a woman's reproductive life.

Question 44

What is the main cause of follicular cysts?

Answer 44

Dominant mature follicle failing to rupture or immature follicles failing to undergo normal atresia.

Question 45

What is the usual size range of follicular cysts?

Answer 45

A few mm to as large as 15 cm in diameter.

Question 46

What is the primary diagnostic tool for ovarian cysts in postmenopausal women?

Answer 46

CA-125.

Question 47

What is the preferred management for persistent ovarian masses?

Answer 47

Operative intervention to differentiate from a true neoplasm.

Question 48

What is the function of the corpus luteum cyst?

Answer 48

It develops from mature Graafian follicles and secretes progesterone.

Question 49

What can happen if a corpus luteum cyst ruptures?

Answer 49

It may cause bleeding and potentially hemoperitoneum due to ovarian artery rupture.

Question 50

What ultrasound finding differentiates a corpus luteum cyst from a follicular cyst?

Answer 50

Corpus luteum cyst appears irregularly shaped like clouds, while follicular cyst is a perfect circle.

Question 51

What is Halban's syndrome?

Answer 51

A persistently functioning corpus luteum cyst with clinical features similar to an unruptured ectopic pregnancy.

Question 52

Which ovarian cyst is almost always bilateral?

Answer 52

Theca lutein cyst.

Question 53

What hormone is associated with theca lutein cysts?

Answer 53

hCG (human chorionic gonadotropin).

Question 54

What is the most common epithelial ovarian tumor?

Answer 54

Serous cystadenoma.

Question 55

At what age is serous cystadenoma most commonly seen?

Answer 55

In women in their 40s and 50s.

Question 56

What is the typical size range of serous cystadenoma?

Answer 56

Up to 30 cm, with a mean size of 10 cm.

Question 57

What is the main symptom of serous cystadenoma?

Answer 57

Heaviness or pressure if large, causing bloating, abdominal enlargement, and a palpable mass.

Question 58

What is the management of serous cystadenoma?

Answer 58

Cystectomy.

Question 59

What percentage of epithelial ovarian neoplasms are mucinous cystadenomas?

Answer 59

10-15%.

Question 60

What is a key characteristic of mucinous cystadenomas?

Answer 60

Generally multilocular and filled with mucus-containing loculi.

Question 61

What is the risk if a mucinous cystadenoma ruptures?

Answer 61

Pseudomyxoma peritonei due to mucin-secreting epithelium in the peritoneal cavity.

Question 62

What is the most common benign solid neoplasm of the ovary?

Answer 62

Fibroma.

Question 63

What syndrome is associated with ovarian fibroma?

Answer 63

Meig’s syndrome (association of ovarian fibroma, ascites, and hydrothorax).

Question 64

What is the management of ovarian fibroma?

Answer 64

Surgical removal if symptomatic or large.

Question 65

What is another name for ovarian teratomas?

Answer 65

Dermoid cysts

Question 66

Under which category of ovarian tumors do teratomas fall?

Answer 66

Germ cell tumors

Question 67

What is the most common benign neoplastic tumor of the ovary?

Answer 67

Ovarian teratoma (dermoid cyst)

Question 68

Why are teratomas called 'monstrous growths'?

Answer 68

Because they contain hair, teeth, cartilage, and sebum.

Question 69

What percentage of ovarian neoplasms do ovarian teratomas account for?

Answer 69

20-25% of all ovarian neoplasms

Question 70

What percentage of benign ovarian neoplasms are teratomas?

Answer 70

Approximately 33%

Question 71

What percentage of germ cell tumors are dermoid cysts?

Answer 71

More than 90%

Question 72

In which age group are dermoid cysts most commonly found?

Answer 72

Prepubertal females and teenagers

Question 73

What is the most common ovarian neoplasm in prepubertal females?

Answer 73

Dermoid cyst

Question 74

What age group has the highest occurrence of benign teratomas?

Answer 74

Women between 25-50 years old

Question 75

What percentage of dermoid cysts are asymptomatic?

Answer 75

50-60%

Question 76

What is the recommended treatment for an ovarian teratoma <7 cm?

Answer 76

Surgery is not recommended

Question 77

What is the recommended treatment for an ovarian teratoma >7 cm?

Answer 77

Cystectomy

Question 78

What complications can occur if an ovarian teratoma grows large?

Answer 78

Compression of surrounding tissues, torsion, rupture

Question 79

What happens in ovarian torsion?

Answer 79

The blood supply is altered, causing pain and possibly hemorrhage or rupture.

Question 80

What are the potential manifestations of ovarian teratomas?

Answer 80

Pain, pelvic pressure, torsion, rupture, infection, hemorrhage, malignant degeneration

Question 81

What rare systemic conditions can be caused by teratomas?

Answer 81

Thyrotoxicosis, carcinoid syndrome, autoimmune hemolytic anemia

Question 82

What is the typical structure of a mature cystic teratoma?

Answer 82

Usually unilocular with smooth, shiny, opaque white walls

Question 83

What is commonly found inside a dermoid cyst?

Answer 83

Thick sebaceous fluid, hair, cartilage, teeth

Question 84

What is the Rokitansky tubercle?

Answer 84

A protrusion in the cyst wall where sebaceous fluid is contained

Question 85

What germ layers are present in a benign teratoma?

Answer 85

All three germ layers

Question 86

What is Struma Ovarii?

Answer 86

A type of teratoma where thyroid tissue predominates

Question 87

What percentage of benign teratomas are Struma Ovarii?

Answer 87

0.12

Question 88

What percentage of ovarian teratomas are Struma Ovarii?

Answer 88

2-3%

Question 89

What percentage of women with Struma Ovarii develop thyrotoxicosis?

Answer 89

Less than 5%

Question 90

What is the preferred surgical management of Struma Ovarii in premenopausal women?

Answer 90

Laparoscopic ovarian cystectomy

Question 91

What is the preferred surgical management of Struma Ovarii in menopausal patients?

Answer 91

Total hysterectomy with bilateral salpingo-oophorectomy

Question 92

What is the benign form of Brenner tumor also known as?

Answer 92

Transitional cell tumor

Question 93

What percentage of ovarian tumors are Brenner tumors?

Answer 93

Approximately 2%

Question 94

What age group is most commonly affected by Brenner tumors?

Answer 94

Women aged 40-60 years

Question 95

What is the suspected origin of Brenner tumors?

Answer 95

Metaplasia of coelomic epithelium into uroepithelium

Question 96

What percentage of Brenner tumors undergo malignant change?

Answer 96

1-2%

Question 97

What are the two principal components of Brenner tumors?

Answer 97

Solid masses or nests of epithelial cells surrounding fibrous stroma

Question 98

How are most small Brenner tumors discovered?

Answer 98

Incidentally during gynecologic operations

Question 99

What symptoms can large Brenner tumors cause?

Answer 99

Unilateral pelvic discomfort, postmenopausal bleeding

Question 100

What imaging finding is characteristic of Brenner tumors?

Answer 100

Extensive amorphous calcification on CT scan

Question 101

What is endometriosis in the ovary called?

Answer 101

Endometrioma

Question 102

Is endometriosis classified as an ovarian new growth?

Answer 102

No, because it is not epithelial, germ cell, or sex cord in origin

Question 103

How does endometriosis cause pain?

Answer 103

Endometrial glands implant in the ovary and bleed during menstruation, accumulating and growing larger

Question 104

What percentage of women with endometriosis have ovarian involvement?

Answer 104

Two out of three

Question 105

What percentage of women with ovarian endometriosis have detectable ovarian enlargement?

Answer 105

0.05

Question 106

What is the typical appearance of small endometriotic implants?

Answer 106

Superficial, blue-black implants 1-5 mm in diameter

Question 107

What is the size range of large endometriotic cysts?

Answer 107

5-20 cm

Question 108

What medical therapy is given for small, deep infiltrating endometriosis?

Answer 108

GnRH agonists (e.g., Buprenorphine acetate) for 6 months

Question 109

What surgical procedure is necessary for women with endometrioma who desire pregnancy?

Answer 109

Cystectomy

Question 110

Why is cystectomy necessary for fertility preservation in endometriosis?

Answer 110

Because the ovary needs to ovulate, and the endometrioma prevents follicular development

Question 111

What is the most common age group affected by adnexal torsion?

Answer 111

Mid-20s

Question 112

What condition predisposes to adnexal torsion?

Answer 112

Pregnancy

Question 113

Why does pregnancy increase the risk of adnexal torsion?

Answer 113

The uterus undergoes dextrorotation, suspending the ovary and compressing surrounding structures

Question 114

What is a highly predictive Doppler ultrasound finding for adnexal torsion?

Answer 114

Abnormal color Doppler flow

Question 115

What percentage of adnexal torsion cases have normal Doppler flow?

Answer 115

0.5

Question 116

What is the primary treatment for adnexal torsion?

Answer 116

Surgical detorsion and possible cystectomy

Question 117

What is tubo-ovarian abscess (TOA) often associated with?

Answer 117

Pelvic inflammatory disease (PID)

Question 118

What are the common symptoms of tubo-ovarian abscess?

Answer 118

Severe pelvic pain, fever, nausea, vomiting

Question 119

What percentage of patients hospitalized with PID develop tubo-ovarian abscess?

Answer 119

14-38%

Question 120

What is the main imaging modality for diagnosing TOA?

Answer 120

Transvaginal ultrasound

Question 121

What is the first-line antibiotic treatment for TOA?

Answer 121

Triple antibiotic therapy (ampicillin, gentamicin, clindamycin or metronidazole)

Question 122

What bacteria are commonly associated with TOA?

Answer 122

Gonorrhea and Chlamydia

Question 123

What is the surgical treatment for TOA if antibiotics fail?

Answer 123

Drain placement, laparoscopic or open surgery

Question 124

What is the risk of pulmonary embolism in adnexal torsion?

Answer 124

0.002