Benign lesions of the genital tract Flashcards
What is the hypothesis to the origin of endocervical and cervical polys?
Which is more common?
Describe them
Give the sequelae
Describe the stalk
- inflammation or abnormal focal responsiveness to hormonal stimulation
- endocervical is more common than cervical
- smooth, soft, reddish cherry purple
- Infertility, chronic pelvic pain
- composed of edematous, inflamed, lookse richly vascular tissue
Differentiate endocervical vs cervical polyp
- Arise from endocervix vs ectocervix
- Occurs during reproductive years vs postmenopausal women
- narrow, long pedicle vs broad base
- Mostly cherry red vs greyish white
What is the most common subtype of EP or CP?
is malignant degeneration common?
- Adenomatous
- others are fibrous, cystic, vascular, inflammatory, fibromyomatous
- it is extremely rare
Give the differential diagnoses for EP and CP (6)
- prolapsed myoma
- endometrial polyp
- remaining products of conception
- squamous papilloma
- sarcoma
- cervical malignancy
Give the differential diagnoses for EP and CP (6)
- prolapsed myoma
- endometrial polyp
- remaining products of conception
- squamous papilloma
- sarcoma
- cervical malignancy
Management of endocervical and cervical polyps?
when should you evaluate the endometrium?
- polypectomy - grasp base of polyp then use twisting motion to remove it
- if bleeding from base ensues, perform electrocautery
- women >40 should have their endometrium evaluated if they presented with abnormal bleeding to rule out coexisting pathology
Where do majority of cervical myomas arise? why?
What is the clinical presentation of myomas?
Diagnosis?
Management?
- cervical isthmus due to relative paucity of smooth muscle fibers
- mostly small and asymptomatic, but may produce dysuria, urgency, urethral or ureteral obstruction secondary to the myoma exerting pressure on adjacent structures
- inspection and palpation
- If small and asymptomatic, observe. if less than 3cm no need to operate.
- If persistent, medical therapy with GnRH or Myomectomy or Hysterectomy
Where do endometrial polyps mostly arise from? what about myomas?
Differentiate sessile vs pedunculated polyps
How does endometrial polyp appear in UTZ?
Give the differential diagnoses for EP\
Management?
- EP from the fundus of uterus while myomas on the isthmus
- Sessile polyps have a broad base while pedunculated have a slender base
- well-defined, uniformly hyperechoic
- submucous leiomyoma
- Adenomyomas
- Retained products of conception
- Endometrial hyperplasia
- Carcinoma
- Sarcomas
- Hysteroscopy then removal via D & C
Skim through hematometra in the book/trans
Skim through epithelial stromal tumors
Where are majority of leiomyomas found?
Give the risk factor for leiomyomas
3 common types of myomas?
Clinical presentation?
Diagnosis?
Differential diagnosis?
Management?
Indications for myomectomy?
Contraindications to myomectomy?
Indication for hysterectomy?
- corpus of the uterus
- increasing age, early menarche, low parity, tamoxifen use, obesity
- influenced by relative levels of estrogen and progesterone
- Intramural - inside muscle
- Subserous - beneath serosa (outside wall of uterus), gives uterus KNOBBY CONTOUR
- Submucous - underneath mucosa (inner wall of uterus), MOST TROUBLESOME CLINICALLY. associated with AUB, infertility or miscarriage
- Two thirds are symptomatic, but the most common presentation is pressure from an enlarging pelvic mass, dysmenorrhea, and AUB
- acquired dysmenorrhea is one of the most frequent complaints
- Physical examination, upon palpation you will feel a large, firm irregular or asymmetrical uterus
- Ultrasonography or hysteroscopy can also be done
- Pregnancy OR POLYP
- Adenomyosis
- Ovarian neoplasm
- Malignancy (PALM COIEN)
- if small, asymptomatic -> observe
- If medical -> GnRH agonists, Danazol, MPA
- if surgical -> myomectomy and hysterectomy
- Persistent abnormal bleeding
- Pain or pressure
- Enlargement of asymptomatic myoma to 8cm in a woman who has not completed childbearing
- PREGNANCY
- Advanced adnexal disease
- Malignancy
- possible reduction of endometrial surface via enucleation
- all indications in myomectomy + myoma has reached 14-16 week gestation, or rapid growth after menopause (possible leiomyosarcoma)
Give two theories to formation of adenomyosis
Describe adenomyosis
Clinical presentation?
Diagnosis?
Treatment?
- Disruption of the barrier between endometrium and myometrium
- Trauma to endometrial-myometrial interface
- Derived from aberrant glands in the basalis layer
- Presence of endometrial glands in the stroma within the myometrium
- 50% - asymptomatic
- Symptomatic between ages 35-50 years old
- May have secondary dysmenorrhea
- may have Menorrhagia
- Uterus is diffusely UNIFORMLY enlarged, globular, around 2x-3x normal size/ Diagnosis confirmed following histologic examination of hysterectomy specimen.
- TVS and MRI with sensitivities and specificities ranging from 50-90%
- If asymptomatic, no management
- goal is to stop bleeding, either pseudo-pregnant or pseudo menopausal state
- DEFINITIVE TREATMENT: hysterectomy cause no satisfactory medical treatment
What is the most common ovarian mass?
What are the 3 different types of cysts? give their:
- Etiology (if available)
- Symptoms (if available)
- Management
- Functional cysts
- Follicular cysts
a. may arise from dominant follicle failing to rupture
b. immature follicle failure to undergo atresia
c. minimum diameter of 2.5-3cm - Management
a. observation
b. majority will disappear in 4-8 weeks
c. OCPs for medical management and cystectomy for persistent masses - Corpus luteum cyst
a. arise from graafian follicles - they may be asymptomatic or can cause massive intraperitoneal bleeding
- triad: delayed menses followed by spotting, unilateral pelvic pain, small tender adnexal mass - Cystectomy + surgical exploration
- Theca lutein cyst
a. ALMOST ALWAYS BILATERAL
b. prolonged or excessive stimulation of the ovaries by gonadotrophins/increased sensitivity of ovaries to gonadotropins
c. complications can lead to torsion of pedicle and intraperitoneal bleeding - Management is observation
- CANNOT EXCISE -> heavily engorged with blood vessels
What is the most common epithelial stromal tumor?
What is/are its characteristic or defining feature(s)?
What are its components?
Treatment?
- serous cystadenoma
- Psammoma bodies
- cells resemble that of fallopian tube
- has fibrous and epithelial components
- TAHBSO
Where do adenofibromas usually rise from?
Which menopausal status do they usually occur in?
Signs and symptoms?
Diagnostics?
Treatment?
Can the same for diagnostics and management be considered for cystadenofibroma? YES
- they usually arise from the surface of the ovary
- they usually occur in postmenopausal women
- smaller tumors can be asymptomatic, but larger tumors can cause adnexal torsion or apply pressure to adjacent structures
- incidental findings in abdominal or pelvic operations. MRI can also be used
- if post menopausal: TAHBSO
- if young, simple excision and inspection of contralateral ovary
What is the most common benign solid neoplasm in the ovary?
Average age affected?
Symptoms of this tumor?
What is Meig’s syndrome?
Treatment?
- fibroma
- 48 years old
- pressure on adjacent structures + abdominal enlargement
- triad of ascites (same size as tumor), ovarian fibroma, and hydrothorax
- TAHBSO
