BENIGN GYNECOLOGIC LESIONS 1.3 (TB8 Flashcards
What is an endometrial polyp?
A localized overgrowth of endometrial glands and stroma that project beyond the endometrial surface.
What are the characteristics of endometrial polyps?
Soft and pliable, single or multiple, range from a few mm to several cm, may be broad-based or have a slender pedicle.
What is polypoid hyperplasia?
A benign condition where numerous small polyps are discovered throughout the endometrial cavity.
What is the most common symptom of endometrial polyps?
Metrorrhagia (irregular or intermenstrual bleeding).
What imaging finding suggests an endometrial polyp?
A well-defined, uniformly hyperechoic mass <2 cm in diameter on vaginal ultrasound.
What is the gold standard for diagnosing and treating endometrial polyps?
Hysteroscopy with dilatation and curettage.
What is adenomyosis?
A condition where ectopic endometrial glands and stroma from the basalis layer invade the myometrium.
What are the types of adenomyosis involvement?
Focal (localized to part of the uterus) and diffuse (affecting the whole uterus).
What is the hallmark symptom of adenomyosis?
Painful menstruation (dysmenorrhea) and menorrhagia.
How is adenomyosis confirmed?
Histologic examination of uterine tissue.
What is the definitive treatment for adenomyosis?
Hysterectomy.
What are the risk factors for adenomyosis?
Increased parity, previous surgeries (D&C, NSD), and uterine trauma.
How does adenomyosis cause abnormal uterine bleeding (AUB)?
Increased endometrial surface, altered prostaglandin balance, impaired myometrial contractility, and abnormal myometrial angiogenesis.
What is leiomyoma?
A benign monoclonal smooth muscle tumor of the uterus, also known as fibroid or myoma.
What are risk factors for leiomyoma?
Increasing age, black race, high BMI, early menarche, low parity, high-fat diet, PCOS, chronic anovulation.
What are protective factors against leiomyoma?
Pregnancy, combined oral contraceptives (COC), smoking, and breastfeeding.
What are the histologic features of leiomyoma?
Round, rubbery tumors with a whorled pattern, elongated smooth muscle cells aggregated in dense bundles.
What is the most common type of degeneration in leiomyoma?
Hyaline degeneration (65%).
What is red (carneous) degeneration in leiomyoma?
Occurs in 5-10% of pregnant women, causing severe pain due to extensive coagulative necrosis.
What are the four main clinical manifestations of leiomyoma?
Abnormal uterine bleeding, pain/pressure, infertility, and miscarriage.
What is hematometra?
Blood accumulation in the uterus due to obstruction.
What is hematocolpos?
Blood accumulation in the vagina.
What is the most common congenital cause of hematometra?
Imperforate hymen or transverse vaginal septum.
What is the treatment for hematometra?
Operative relief of obstruction through excision and drainage.
Where is the interstitial part of the fallopian tube located?
Within the muscular wall of the uterus.
What is a severe maternal morbidity associated with interstitial ectopic pregnancy?
Severe maternal morbidity due to rupture.
Which portion of the fallopian tube has the most highly developed musculature?
Isthmus.
Which part of the fallopian tube is the narrowest?
Isthmus.
Which part of the fallopian tube is the preferred portion for tubal ligation?
Isthmus.
Where does fertilization occur in the fallopian tube?
Ampulla.
Which part of the fallopian tube is the most common site of ectopic pregnancy?
Ampulla.
What is the function of the infundibulum of the fallopian tube?
It has a fimbriated extremity, serving as a tunnel-shaped opening.
What is another name for an angiomyoma?
Adenomatoid tumor.
What is the most prevalent benign tumor of the oviduct?
Angiomyoma.
What are the characteristics of an angiomyoma?
Small, gray-white, circumscribed nodules, 1 to 2 cm in diameter, usually unilateral, and mostly asymptomatic.
Where are angiomyomas typically located?
Just under the tubal serosa.
How are paratubal cysts usually discovered?
Incidentally during gynecologic operations for other abnormalities.
What is the typical size range of paratubal cysts?
From 0.5 cm to more than 20 cm in diameter.
What is the most common clinical manifestation of paratubal cysts?
Most are small, asymptomatic, and slow-growing.
What is the approximate size of a fallopian tube compared to a finger?
If you divide the pinky finger longitudinally, that’s the size of the fallopian tube.
What are the three types of ovarian cysts?
Follicular cyst, Corpus luteum cyst, Theca lutein cyst.
What is the most common cystic structure in normal ovaries?
Follicular cyst.
At what stage can follicular cysts be found?
As early as 20 weeks AOG in female fetuses and throughout a woman’s reproductive life.
What is the main cause of follicular cysts?
Dominant mature follicle failing to rupture or immature follicles failing to undergo normal atresia.
What is the usual size range of follicular cysts?
A few mm to as large as 15 cm in diameter.
What is the primary diagnostic tool for ovarian cysts in postmenopausal women?
CA-125.
What is the preferred management for persistent ovarian masses?
Operative intervention to differentiate from a true neoplasm.
What is the function of the corpus luteum cyst?
It develops from mature Graafian follicles and secretes progesterone.
What can happen if a corpus luteum cyst ruptures?
It may cause bleeding and potentially hemoperitoneum due to ovarian artery rupture.
What ultrasound finding differentiates a corpus luteum cyst from a follicular cyst?
Corpus luteum cyst appears irregularly shaped like clouds, while follicular cyst is a perfect circle.
What is Halban’s syndrome?
A persistently functioning corpus luteum cyst with clinical features similar to an unruptured ectopic pregnancy.
Which ovarian cyst is almost always bilateral?
Theca lutein cyst.
What hormone is associated with theca lutein cysts?
hCG (human chorionic gonadotropin).
What is the most common epithelial ovarian tumor?
Serous cystadenoma.
At what age is serous cystadenoma most commonly seen?
In women in their 40s and 50s.
What is the typical size range of serous cystadenoma?
Up to 30 cm, with a mean size of 10 cm.
What is the main symptom of serous cystadenoma?
Heaviness or pressure if large, causing bloating, abdominal enlargement, and a palpable mass.
What is the management of serous cystadenoma?
Cystectomy.
What percentage of epithelial ovarian neoplasms are mucinous cystadenomas?
10-15%.
What is a key characteristic of mucinous cystadenomas?
Generally multilocular and filled with mucus-containing loculi.
What is the risk if a mucinous cystadenoma ruptures?
Pseudomyxoma peritonei due to mucin-secreting epithelium in the peritoneal cavity.
What is the most common benign solid neoplasm of the ovary?
Fibroma.
What syndrome is associated with ovarian fibroma?
Meig’s syndrome (association of ovarian fibroma, ascites, and hydrothorax).
What is the management of ovarian fibroma?
Surgical removal if symptomatic or large.
What is another name for ovarian teratomas?
Dermoid cysts
Under which category of ovarian tumors do teratomas fall?
Germ cell tumors
What is the most common benign neoplastic tumor of the ovary?
Ovarian teratoma (dermoid cyst)
Why are teratomas called ‘monstrous growths’?
Because they contain hair, teeth, cartilage, and sebum.
What percentage of ovarian neoplasms do ovarian teratomas account for?
20-25% of all ovarian neoplasms
What percentage of benign ovarian neoplasms are teratomas?
Approximately 33%
What percentage of germ cell tumors are dermoid cysts?
More than 90%
In which age group are dermoid cysts most commonly found?
Prepubertal females and teenagers
What is the most common ovarian neoplasm in prepubertal females?
Dermoid cyst
What age group has the highest occurrence of benign teratomas?
Women between 25-50 years old
What percentage of dermoid cysts are asymptomatic?
50-60%
What is the recommended treatment for an ovarian teratoma <7 cm?
Surgery is not recommended
What is the recommended treatment for an ovarian teratoma >7 cm?
Cystectomy
What complications can occur if an ovarian teratoma grows large?
Compression of surrounding tissues, torsion, rupture
What happens in ovarian torsion?
The blood supply is altered, causing pain and possibly hemorrhage or rupture.
What are the potential manifestations of ovarian teratomas?
Pain, pelvic pressure, torsion, rupture, infection, hemorrhage, malignant degeneration
What rare systemic conditions can be caused by teratomas?
Thyrotoxicosis, carcinoid syndrome, autoimmune hemolytic anemia
What is the typical structure of a mature cystic teratoma?
Usually unilocular with smooth, shiny, opaque white walls
What is commonly found inside a dermoid cyst?
Thick sebaceous fluid, hair, cartilage, teeth
What is the Rokitansky tubercle?
A protrusion in the cyst wall where sebaceous fluid is contained
What germ layers are present in a benign teratoma?
All three germ layers
What is Struma Ovarii?
A type of teratoma where thyroid tissue predominates
What percentage of benign teratomas are Struma Ovarii?
0.12
What percentage of ovarian teratomas are Struma Ovarii?
2-3%
What percentage of women with Struma Ovarii develop thyrotoxicosis?
Less than 5%
What is the preferred surgical management of Struma Ovarii in premenopausal women?
Laparoscopic ovarian cystectomy
What is the preferred surgical management of Struma Ovarii in menopausal patients?
Total hysterectomy with bilateral salpingo-oophorectomy
What is the benign form of Brenner tumor also known as?
Transitional cell tumor
What percentage of ovarian tumors are Brenner tumors?
Approximately 2%
What age group is most commonly affected by Brenner tumors?
Women aged 40-60 years
What is the suspected origin of Brenner tumors?
Metaplasia of coelomic epithelium into uroepithelium
What percentage of Brenner tumors undergo malignant change?
1-2%
What are the two principal components of Brenner tumors?
Solid masses or nests of epithelial cells surrounding fibrous stroma
How are most small Brenner tumors discovered?
Incidentally during gynecologic operations
What symptoms can large Brenner tumors cause?
Unilateral pelvic discomfort, postmenopausal bleeding
What imaging finding is characteristic of Brenner tumors?
Extensive amorphous calcification on CT scan
What is endometriosis in the ovary called?
Endometrioma
Is endometriosis classified as an ovarian new growth?
No, because it is not epithelial, germ cell, or sex cord in origin
How does endometriosis cause pain?
Endometrial glands implant in the ovary and bleed during menstruation, accumulating and growing larger
What percentage of women with endometriosis have ovarian involvement?
Two out of three
What percentage of women with ovarian endometriosis have detectable ovarian enlargement?
0.05
What is the typical appearance of small endometriotic implants?
Superficial, blue-black implants 1-5 mm in diameter
What is the size range of large endometriotic cysts?
5-20 cm
What medical therapy is given for small, deep infiltrating endometriosis?
GnRH agonists (e.g., Buprenorphine acetate) for 6 months
What surgical procedure is necessary for women with endometrioma who desire pregnancy?
Cystectomy
Why is cystectomy necessary for fertility preservation in endometriosis?
Because the ovary needs to ovulate, and the endometrioma prevents follicular development
What is the most common age group affected by adnexal torsion?
Mid-20s
What condition predisposes to adnexal torsion?
Pregnancy
Why does pregnancy increase the risk of adnexal torsion?
The uterus undergoes dextrorotation, suspending the ovary and compressing surrounding structures
What is a highly predictive Doppler ultrasound finding for adnexal torsion?
Abnormal color Doppler flow
What percentage of adnexal torsion cases have normal Doppler flow?
0.5
What is the primary treatment for adnexal torsion?
Surgical detorsion and possible cystectomy
What is tubo-ovarian abscess (TOA) often associated with?
Pelvic inflammatory disease (PID)
What are the common symptoms of tubo-ovarian abscess?
Severe pelvic pain, fever, nausea, vomiting
What percentage of patients hospitalized with PID develop tubo-ovarian abscess?
14-38%
What is the main imaging modality for diagnosing TOA?
Transvaginal ultrasound
What is the first-line antibiotic treatment for TOA?
Triple antibiotic therapy (ampicillin, gentamicin, clindamycin or metronidazole)
What bacteria are commonly associated with TOA?
Gonorrhea and Chlamydia
What is the surgical treatment for TOA if antibiotics fail?
Drain placement, laparoscopic or open surgery
What is the risk of pulmonary embolism in adnexal torsion?
0.002
