Ch. 43 Pathology of the Uterus Flashcards
_______ develop due to obstructed and dilated transcervical glands. Often seen in middle aged women
nabothian cysts
______ are commonly seen in the area of the cervix as small, anechoic, round structures
nabothian cysts
______ are a result of hyperplasia of the cervical epithelium
cervical polyps
When ______ occur in the cervix, enlargement may lead to bladder or bowel obstruction
leiomyomas
______ is an acquired condition where obstruction of the cervix occurs due to scarring from instrumental procedures, childbirth, surgery, cancer or irradiation
cervical stenosis
Sally performed a sonogram on Mrs. Holman. On transvaginal sonography, she noted a hypoechoic mass with irregular borders in the area of the cervix. The mass appeared to extend posteriorly from the cervix into the wall of the rectum. What was the most likely diagnosis
cervical carcinoma
After hysterectomy, sonography of the pelvis demonstrates the vagina ending at the
vaginal cuff
If the vaginal cuff measurement exceeds 2.1cm, it is suspicious for recurrence of
malignancy
A cystic mass in the vagina is most commonly a
gartners duct cyst
Solid masses in the vagina are usually ______
malignant
_______ are the most gynecologic tumors
leiomyomas
Fibroid is another name for
leiomyoma
Leiomyomas arise from the _____ of the uterine wall
smooth muscle
Leiomyomas are usually hypoechoic due to
hyalinization
Leiomyomas often increase in size during pregnancy because they are sensitive to
estrogen
______ is a term describing the development of a mass of albumin in a cell or tissue
hyalinization
After menopause, if no replacement hormones are used, leiomyomas usually decrease in size due to lack of
estrogen
List three common clinical symptoms of leiomyomas
irregular bleeding, heavier periods, menstrual cramping, enlarged uterus, dysmenorrhea, pelvic pressure
Leiomyomas may contribute to _____ by distorting the fallopian or endometrial cavity
infertility
Leiomyomas are always located in the uterine wall
false
_____ fibroids are located just under the endometrium and cause irregular or heavy menstrual bleeding
submucosal
______ fibroids are located within the myometrium and are often asymptomatic until they are quite large
intramural
______ fibroids are located in the outer layers of the uterine wall and often appear to be outside the uterus on sonography
subserosal
______ fibroids are the most common type
intramural
_____ fibroids are most likely to interfere with pregnancy
submucosal
______ fibroids are the type most likely to be pedunculated
subserosal
A ______ fibroid develops a long stalk and is very mobile
migratory
_______ sonography can define smaller fibroids and better outline their precise relationship to the endometrium
transvaginal
Mrs. Tuttle went to the doctor complaining of post menopausal vaginal bleeding. She stopped menstruating 2 years ago, but recently started bleeding again. She does not take any replacement hormones. Her doctor ordered a transvaginal sonogram which revealed an endometrial measurement of 7mm. Why was enometrial biopsy the next step
To test for endoemtrial hyperplasia versus endometrial carcinoma versus endometrial polyps
_______ is more sensitive in evaluating the location, size and precise number of fibroids
MRI
_______ are the most common cause of uterine calcification
myomas
______ is a fairly rare malignancy that arises from the smooth muscle of the uterine wall
leiomyosarcoma
When the patient is close to the ovulatory stage of her cycle, there is a ______ layer around the endometrium
hypoechoic
_______ occurs when the patient is taking estrogen without progesterone
endometrial hyperplasia
In premenopausal women, and endometrial thickness of more than _____ is considered abnormal
15mm
In post menopausal women who are NOT taking hormones ______ is the upper limit of normal for the endometrial thickness
8mm
______ are seen sonographically as solid masses in the endometrial cavity
endometrial polyps
_______ develop due to the opposing walls of the endometrium scarring together. They occur when women who have had D & C or spontaneous abortion
uterine synechiae
The first sonographic sign of endometrial cancer is
thickening of the endometrium
In patients with post menopausal bleeding, an endometrial thickness of less than 5mm _____ significant endometrial abnormality
excludes
Mrs. Johnson was experiencing post menopausal bleeding and had recently developed low abdominal pain. Transvaginal sonography of the pelvis revealed a thickened, irregular endometrium with extension of echogenic structures into the myometrium. What was the likely diagnosis
endometrial carcinoma
The sonographer performed doppler of the uterine artery during Mrs. Johnson’s sonogram, and measured the RI. The RI value was 0.2. Is this consistent with diagnosis of enometrial carcinoma
Yes, >0.5 is normal in post menopausal women
Tiny fluid collections in the endometrial cavity are common in women during the _____ stage of the menstrual cycle
menstrual
Why should the diameter of the fluid collection be subtracted from the endometrial measurement when fluid is present
get a true endometrial thickness measurement
Large endometrial fluid collections represent an increased risk for ______
endometrial carcinoma
______ is more likely to occur with uterine cancer
pyometra
An IUD that appears sonographically as a series of echogenic dotted lines in the uterus is
lippes loop
An IUD that appears sonographically as a T shape is a
tatum t
An IUD that appears sonographically as a 7 shape is a
copper 7
The ________ was an IUD that was shaped like a disc with hooks around its periphery. It has been removed from the market, so is very rarely seen
dacron shield
If the woman becomes pregnant while she has an IUD, the pregnancy has a ______ chance of aborting if te IUD is extracted
50%
When coexisting with pregnancy, the IUD is always _____ the fetal membranes
outside
A _______ is a pregnancy located outside the uterus
ectopic
Uterine arteriovenous malformation (AVM):
involves the myometrium
Benign, small cysts located in the area of the cervix caused by clogged cervical glands. Often due to chronic cervicitis
nabothian cysts
Nabothian cysts are also called
epithelial inclusion cysts
Caused by hyperplasia of the cervical epithelium and are benign. Affects women in late middle age
cervical polyps
Cervical polyps may be
predunculated, project out of cervix, or broad-based
Cervical polyps appear as a _______ on sonogram
solid mass
Rare, small, assymptomatic. Can cause bowel or bladder obstruction
cervical fibroids
Obstruction of the cervix at the internal or external os. Post menopuasal patients are asyptomatic but will have fluid filled uterus on sonogram. Premenstrual patients will have oligomenorrhea or amenorrhea with cramping or dysmenorrhea
cervical stenosis
Cervical pathology is better visualized with
transvaginal scan
Can cervical fibroids hinder delivery if patient is pregnant
yes
Generally diagnosed with PAP smear before lesion is large enough to see sonographically. Affects women who are still menstruating
cervical carcinoma
What are the symptoms of cervical carcinoma
vaginal discharge and abnormal bleeding
Sonographic findings for cervical carcinoma
mass in cervical area (posterior to bladder), hypoechoic and irregular borders
Transvaginal scanning for cervical carcinoma is used to evaluate
extent of bladder, ureteral, rectal or vaginal involvement
Transrectal scanning for cervical carcinoma is used for
evaluating the size and penetration of the tumor
For cervical carcinoma, ________/________ are both superior to CT or MRI for determining details of cervical extension into neighboring structures
transvaginal/transrectal
CT/MRI are superior for determining ________ and general staging of cervical cancer
lymph node spread
Area left at end of vagina after hysterectomy, blind pouch, masses occasionally recur here
vaginal cuff
What is the upper limit of normal for vaginal cuff
2.1cm
Caused by occluded gartners duct in the anterior lateral vaginal wall
gartners duct cyst
What is the most common cystic mass of the vagina
gartners duct cyst
Most solid massed in the vagina are
malignant
Cancer arising from the glandular tissue
vaginal adenocarcinoma
Cancer arising from muscle tissue
vaginal rhabdomyosarcoma
What is the most common gynecological tumor
leiomyoma
What is another name for leiomyoma
fibroid
Where do leiomyomas arise from
myometrium, premenopausal
Symptoms of leiomyomas
irregular bleeding, heavier bleeding, pelvic pressure and increased cramping
Clinical findings of leiomyomas
enlarged uterus with irregular contour, often palpable during exam
Leiomyomas may lead to
infertility by distorting fallopian tube or endometrial cavity
3 types of appearances for leiomyomas
hyalinization, necrosis, calcified
Fibroid becomes filled with deposits of albumin, hypoechoic MOST COMMON APPEARANCE
hyalinization
When fibroid outgrows its blood supply, begins to die, center becomes liquified, complex appearance
necrosis
A necrotis fibroid eventually scars and becomes calcified. 10% of fibroids become calcified, posterior shadowing
calcified
Fibroids are sensitive to _______ and may grow during ______
estrogen, pregnancy or other situations involving increased estrogen levels
Fibroids often ______ after menopause due to falling levels of estrogen in the blood
shrink
5 locations of fibroids
subserosal, pedunculated, migratory, intramural, submucosal
Located just below the outer membrane covering of the uterus. Outer surface lumpy. Cause most obvious disturbance of the unterine contour
subserosal
Type of subserosal fibroid that is on a stalk
pedunculated
Pedunculated fibroid with a particularly long stalk
migratory fibroid
Most common type of fibroid. Located within the myometrium but does not disturb the endometrium or serosal layer
intramural
Located just deep to the endometrium, disturn the endometrial surface
submucosal
Benign invasion of endometrial tissue in the myometrium, thought to be caused by multiple pregnancies
adenomyosis
Sonographic appearance of adenomyosis
bulky enlarges heterogenous uterus without focal mass, VENETIAN BLIND SHADOWING
Is MRI or US better at diagnosing adenomyosis
MRI
RARE uterine solid tumor arises from the smooth muscle of the myometrium or endometrium, less than 1% of uterine malignancies, most common 40-60 years
leiomyosarcoma
The rapid enlargment of a fibroid in a woman who is perimenopausal or postmenopausal is suspicious of
leiomyosarcoma
Normal endometrial thickness menstrual phase
1-3mm
Normal endometrial thickness early proliferative phase
4-6mm
Normal endometrial thickness ovulatory (late proliferative)
6-8mm
Normal endometrial thickness secretory phase
8-14mm
Normal endometrial thickness post menopausal NO HRT
8mm no symptoms
Normal endometrial thickness postmenopausal on HRT
up to 15mm
Caused by unopposed estrogen, precursor to endometrial cancer
endometrial hyperplasia
Endometrial hyperplasia endometrium in premenopausal
> 14mm
Endometrial hyperplasia endometrium in post menopausal (asymptomatic)
> 8mm NO HRT
Endometrial hyperplasia endometrium in post menopausal with bleeding
> 5mm
May cause abnormal bleeding, diffuse or focal thickening of endometrium
endometrial polyps
Infection/inflammation of the endometrium, usually due to PID. Thickening/irregular contour to endometrium
endometritis
Endometrial adhesions, asherman’s syndrome, septae/scars caused by instrumental procedures, bright echoes in endometrial cavity
intrauterine synechiae
Most common gynecologic malignancy
endometrial carcinoma
RI<0.4=
endometrial carcinoma low resistance
PI<1=
cutoff (intratumoral neovascularity)
Blood in the endometrial canal-anechoic usually resolves after D&C
hematometra
Pus in the endometrial canal-has echoes within it associated with malignancy
pyometra
