cervical & vaginal pathology Flashcards
what bengn condition of the vagina is a remnant of the mesonephric / Wolffian duct
Most common cystic lesion of the vagina
gartner’s duct cyst
_________ develop usually on the side walls of the vagina. This duct is active during fetal development but ordinarily disappears after birth. In some cases, however, portions of the duct may collect fluid and develop into a vaginal wall cyst later in life
Gartner’s duct cysts
where are gartners duct cysts gerneally located
what might they communicate with?
how many develop?
paravaginal & anterolateral
ureter or cervix
single or multiple
what are other names for a gartenrs duct cyst ? (2)
Inclusion cyst
Vaginal cyst - vaginal inclusion cysts are the most common. May form as a result of trauma sustained by the vaginal walls or following an obstetric or gynecologic procedure, when the lining of the vagina doesn’t heal to its normal smoothness
what are these Clinical Findings indicative of
Usually asymptomatic
Usually discovered on routine pelvic exams
If large, may cause
Pressure symptoms & dyspareunia
Ureteric obstruction
gartner’s duct cyst
what do gartner’s duct cysts simulate (symptoms)
Simulate symptoms of imperforate hymen
Hydrometrocolpos
Hematometrocolpos
what is this? how can you tell?
Anechoic mass with well defined margins & good sound transmission
Elongated
Location helps diagnosis
what is The upper size limit of a normal vaginal cuff?
2.1 cm
(If the cuff is larger than this or contains a well-defined mass or areas of high echogenicity, it should be regarded with suspicion for recurrence of malignancy)
when are vaginal cuffs seen?
Seen in patients that are post hysterectomy
(Post radiation there may be nodular areas in the vaginal cuff due to fibrosis)
how do you aim the Td to see vaginal cuff?
more inferior to get more vagina on this post-hysterectomy patient
what are aka Epithelial inclusion cysts
nabothian cysts
what are Benign cystic lesions of the endocervix that range from 2-3 mm in diameter
Common in adult woman
Usually seen following pregnancy
Due to epithelial cells in the cervix blocking or obstructing the opening of a nabothian duct and fluid is ‘retained’
nabothian cysts
what is the range/size of nabothian cysts?
what are the clinical findings?
3mm - 3cm
Usually asymptomatic
Can be single or multiple
Associated with chronic cervicitis
If due to chronic cervicitis patient may have
Vaginal discharge, dyspareunia, urinary frequency, urinary urgency or metrorrhagia
what is this? how can you tell?
Anechoic, fluid-filled mass with smooth borders and posterior enhancement
Size range is from 3 mm to 3 cm
May Hemorrhage
Be single or multiple
Have posterior enhancement
nabothin cysts ddx
Gartner’s duct cyst
Arcuate veins
spherical oval or round whereas gartners is a bit more tubular and location
what benign condition of the cervix
Common
Due to hyperplastic epithelium that protrudes from the cervix by a pedicle, usually caused by chronic inflammation
cervical polyps
Clinical Findings
Typically asymptomatic
Less commonly they may cause profuse bleeding or discharge
US Findings
Echogenic foci in cervix
Difficult to visualize on TA, easier to identify on TV
cervix polyps
what are the other names for HPV?
Human Papilloma virus (HPV)
Condylomata acuminata, genital warts, venereal warts
Usually transmitted sexually
Keep transducer covered & use gloves to protect yourself and otherswhat benign conditon of the cervix…
One of the most common sexually transmitted diseases (STD’s) in the world
Spread easily on the skin of the infected person and pass easily to other people
hpv
Usually transmitted sexually
Keep transducer covered & use gloves to protect yourself and others
what benign condition of the cervix
Acquired by:
Childbirth
Surgery
Prior instrumentation
Cancer
Irradiation
cervical stenosis
what pre and post menopausal clinical findings are associated w/ cervical stenosis
Pre-menopausal
Amenorrhea or oligomenorrhea
Pain & cramping
Post-menopausal
Usually asymptomatic
what is this cervical condtion?
Cervical Stenosis Case
All 3 images of the next images are of the same post-menopausal woman with cervical stenosis secondary to cervical carcinoma
MRI image arrow-heads point to the stenosis
what is a common malignant condition of the cervix?
Carcinoma of the Cervix
what are some common risk factors associated w/ cervical carcinoma?
Early sexual activity
Multiple sexual partners
Multiple pregnancies
Human papilloma virus infection
Recurrent vaginal infections (bacterial or viral, including genital herpes and genital warts)
Smoking
what condition
Early stages, easily treatable
No symptoms
Later stages
Unexplained vaginal bleeding
Persistent vaginal discharge
Pain & bleeding after intercourse
Palpable pelvic mass
Final stages
Abdominal pain, leaking of feces & urine through the vagina
Appetite & weight loss
Anemia
carcinoma of the cervix
the following are staging of cervical carcinoma
________ is Rarely diagnosed with ultrasound unless large
Depends on stage
Typically solid mass, hypoechoic compared to normal cervix, may be hyperechoic, irregular or heterogeneous
Retrovesical mass
May cause hydronephrosis
cervical carcinoma
what other conditions may be associated w/ cervical carcinoma?
Hematometria or pyometria with cervical stenosis
how does carcinoma of the cervix metastasize?
Direct extension
Lymphatics
Hematogenous route
what cnan you see in these images?
Tampon
Echogenic depending on amount of contents
Lower in the vagina than a sponge
If tampon is forgotten or lost string it may be high in vagina
Sponge
Seen high in vagina, curved, shadow
what causes
Uterus & ovaries decreases in size
Vagina looses rugosity
Cervical cells produce less cervical mucous
postmenopausal
Estrogen deficiency & hormone changes cause
what therapy
Decreases symptoms associated with menopause
Estrogen & progesterone - Can be pills, creams or suppositories
Hormone replacement therapy (HTR)
What does this sagittal transvaginal image demonstrate?
2 Nabothian cysts
Name 4 risk factors associated with carcinoma of the cervix
Early sexual activity
Multiple sexual partners
Multiple pregnancies
Human papilloma virus infection
Recurrent vaginal infections (bacterial or viral, including genital herpes and genital warts)
Smoking
This is a 22-year-old female with pelvic pain. Her menstrual cycles are normal, what does the area by the ‘c’ most likely represent?
Gartner’s duct cyst
Describe the sonographic appearance of cervical stenosis
Distended cervical canal filled with fluid with or without echogenic material
