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OB/GYN I > Ch. 43 Pathology of the Uterus > Flashcards

Ch. 43 Pathology of the Uterus Flashcards

1
Q

_______ develop due to obstructed and dilated transcervical glands. Often seen in middle aged women

A

nabothian cysts

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2
Q

______ are commonly seen in the area of the cervix as small, anechoic, round structures

A

nabothian cysts

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3
Q

______ are a result of hyperplasia of the cervical epithelium

A

cervical polyps

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4
Q

When ______ occur in the cervix, enlargement may lead to bladder or bowel obstruction

A

leiomyomas

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5
Q

______ is an acquired condition where obstruction of the cervix occurs due to scarring from instrumental procedures, childbirth, surgery, cancer or irradiation

A

cervical stenosis

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6
Q

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

A

cervical carcinoma

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7
Q

After hysterectomy, sonography of the pelvis demonstrates the vagina ending at the

A

vaginal cuff

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8
Q

If the vaginal cuff measurement exceeds 2.1cm, it is suspicious for recurrence of

A

malignancy

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9
Q

A cystic mass in the vagina is most commonly a

A

gartners duct cyst

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10
Q

Solid masses in the vagina are usually ______

A

malignant

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11
Q

_______ are the most gynecologic tumors

A

leiomyomas

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12
Q

Fibroid is another name for

A

leiomyoma

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13
Q

Leiomyomas arise from the _____ of the uterine wall

A

smooth muscle

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14
Q

Leiomyomas are usually hypoechoic due to

A

hyalinization

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15
Q

Leiomyomas often increase in size during pregnancy because they are sensitive to

A

estrogen

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16
Q

______ is a term describing the development of a mass of albumin in a cell or tissue

A

hyalinization

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17
Q

After menopause, if no replacement hormones are used, leiomyomas usually decrease in size due to lack of

A

estrogen

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18
Q

List three common clinical symptoms of leiomyomas

A

irregular bleeding, heavier periods, menstrual cramping, enlarged uterus, dysmenorrhea, pelvic pressure

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19
Q

Leiomyomas may contribute to _____ by distorting the fallopian or endometrial cavity

A

infertility

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20
Q

Leiomyomas are always located in the uterine wall

A

false

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21
Q

_____ fibroids are located just under the endometrium and cause irregular or heavy menstrual bleeding

A

submucosal

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22
Q

______ fibroids are located within the myometrium and are often asymptomatic until they are quite large

A

intramural

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23
Q

______ fibroids are located in the outer layers of the uterine wall and often appear to be outside the uterus on sonography

A

subserosal

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24
Q

______ fibroids are the most common type

A

intramural

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25
Q

_____ fibroids are most likely to interfere with pregnancy

A

submucosal

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26
Q

______ fibroids are the type most likely to be pedunculated

A

subserosal

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27
Q

A ______ fibroid develops a long stalk and is very mobile

A

migratory

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28
Q

_______ sonography can define smaller fibroids and better outline their precise relationship to the endometrium

A

transvaginal

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29
Q

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

A

To test for endoemtrial hyperplasia versus endometrial carcinoma versus endometrial polyps

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30
Q

_______ is more sensitive in evaluating the location, size and precise number of fibroids

A

MRI

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31
Q

_______ are the most common cause of uterine calcification

A

myomas

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32
Q

______ is a fairly rare malignancy that arises from the smooth muscle of the uterine wall

A

leiomyosarcoma

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33
Q

When the patient is close to the ovulatory stage of her cycle, there is a ______ layer around the endometrium

A

hypoechoic

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34
Q

_______ occurs when the patient is taking estrogen without progesterone

A

endometrial hyperplasia

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35
Q

In premenopausal women, and endometrial thickness of more than _____ is considered abnormal

A

15mm

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36
Q

In post menopausal women who are NOT taking hormones ______ is the upper limit of normal for the endometrial thickness

A

8mm

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37
Q

______ are seen sonographically as solid masses in the endometrial cavity

A

endometrial polyps

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38
Q

_______ develop due to the opposing walls of the endometrium scarring together. They occur when women who have had D & C or spontaneous abortion

A

uterine synechiae

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39
Q

The first sonographic sign of endometrial cancer is

A

thickening of the endometrium

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40
Q

In patients with post menopausal bleeding, an endometrial thickness of less than 5mm _____ significant endometrial abnormality

A

excludes

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41
Q

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

A

endometrial carcinoma

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42
Q

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

A

Yes, >0.5 is normal in post menopausal women

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43
Q

Tiny fluid collections in the endometrial cavity are common in women during the _____ stage of the menstrual cycle

A

menstrual

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44
Q

Why should the diameter of the fluid collection be subtracted from the endometrial measurement when fluid is present

A

get a true endometrial thickness measurement

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45
Q

Large endometrial fluid collections represent an increased risk for ______

A

endometrial carcinoma

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46
Q

______ is more likely to occur with uterine cancer

A

pyometra

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47
Q

An IUD that appears sonographically as a series of echogenic dotted lines in the uterus is

A

lippes loop

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48
Q

An IUD that appears sonographically as a T shape is a

A

tatum t

49
Q

An IUD that appears sonographically as a 7 shape is a

A

copper 7

50
Q

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

A

dacron shield

51
Q

If the woman becomes pregnant while she has an IUD, the pregnancy has a ______ chance of aborting if te IUD is extracted

A

50%

52
Q

When coexisting with pregnancy, the IUD is always _____ the fetal membranes

A

outside

53
Q

A _______ is a pregnancy located outside the uterus

A

ectopic

54
Q

Uterine arteriovenous malformation (AVM):

A

involves the myometrium

55
Q

Benign, small cysts located in the area of the cervix caused by clogged cervical glands. Often due to chronic cervicitis

A

nabothian cysts

56
Q

Nabothian cysts are also called

A

epithelial inclusion cysts

57
Q

Caused by hyperplasia of the cervical epithelium and are benign. Affects women in late middle age

A

cervical polyps

58
Q

Cervical polyps may be

A

predunculated, project out of cervix, or broad-based

59
Q

Cervical polyps appear as a _______ on sonogram

A

solid mass

60
Q

Rare, small, assymptomatic. Can cause bowel or bladder obstruction

A

cervical fibroids

61
Q

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

A

cervical stenosis

62
Q

Cervical pathology is better visualized with

A

transvaginal scan

63
Q

Can cervical fibroids hinder delivery if patient is pregnant

A

yes

64
Q

Generally diagnosed with PAP smear before lesion is large enough to see sonographically. Affects women who are still menstruating

A

cervical carcinoma

65
Q

What are the symptoms of cervical carcinoma

A

vaginal discharge and abnormal bleeding

66
Q

Sonographic findings for cervical carcinoma

A

mass in cervical area (posterior to bladder), hypoechoic and irregular borders

67
Q

Transvaginal scanning for cervical carcinoma is used to evaluate

A

extent of bladder, ureteral, rectal or vaginal involvement

68
Q

Transrectal scanning for cervical carcinoma is used for

A

evaluating the size and penetration of the tumor

69
Q

For cervical carcinoma, ________/________ are both superior to CT or MRI for determining details of cervical extension into neighboring structures

A

transvaginal/transrectal

70
Q

CT/MRI are superior for determining ________ and general staging of cervical cancer

A

lymph node spread

71
Q

Area left at end of vagina after hysterectomy, blind pouch, masses occasionally recur here

A

vaginal cuff

72
Q

What is the upper limit of normal for vaginal cuff

A

2.1cm

73
Q

Caused by occluded gartners duct in the anterior lateral vaginal wall

A

gartners duct cyst

74
Q

What is the most common cystic mass of the vagina

A

gartners duct cyst

75
Q

Most solid massed in the vagina are

A

malignant

76
Q

Cancer arising from the glandular tissue

A

vaginal adenocarcinoma

77
Q

Cancer arising from muscle tissue

A

vaginal rhabdomyosarcoma

78
Q

What is the most common gynecological tumor

A

leiomyoma

79
Q

What is another name for leiomyoma

A

fibroid

80
Q

Where do leiomyomas arise from

A

myometrium, premenopausal

81
Q

Symptoms of leiomyomas

A

irregular bleeding, heavier bleeding, pelvic pressure and increased cramping

82
Q

Clinical findings of leiomyomas

A

enlarged uterus with irregular contour, often palpable during exam

83
Q

Leiomyomas may lead to

A

infertility by distorting fallopian tube or endometrial cavity

84
Q

3 types of appearances for leiomyomas

A

hyalinization, necrosis, calcified

85
Q

Fibroid becomes filled with deposits of albumin, hypoechoic MOST COMMON APPEARANCE

A

hyalinization

86
Q

When fibroid outgrows its blood supply, begins to die, center becomes liquified, complex appearance

A

necrosis

87
Q

A necrotis fibroid eventually scars and becomes calcified. 10% of fibroids become calcified, posterior shadowing

A

calcified

88
Q

Fibroids are sensitive to _______ and may grow during ______

A

estrogen, pregnancy or other situations involving increased estrogen levels

89
Q

Fibroids often ______ after menopause due to falling levels of estrogen in the blood

A

shrink

90
Q

5 locations of fibroids

A

subserosal, pedunculated, migratory, intramural, submucosal

91
Q

Located just below the outer membrane covering of the uterus. Outer surface lumpy. Cause most obvious disturbance of the unterine contour

A

subserosal

92
Q

Type of subserosal fibroid that is on a stalk

A

pedunculated

93
Q

Pedunculated fibroid with a particularly long stalk

A

migratory fibroid

94
Q

Most common type of fibroid. Located within the myometrium but does not disturb the endometrium or serosal layer

A

intramural

95
Q

Located just deep to the endometrium, disturn the endometrial surface

A

submucosal

96
Q

Benign invasion of endometrial tissue in the myometrium, thought to be caused by multiple pregnancies

A

adenomyosis

97
Q

Sonographic appearance of adenomyosis

A

bulky enlarges heterogenous uterus without focal mass, VENETIAN BLIND SHADOWING

98
Q

Is MRI or US better at diagnosing adenomyosis

A

MRI

99
Q

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

A

leiomyosarcoma

100
Q

The rapid enlargment of a fibroid in a woman who is perimenopausal or postmenopausal is suspicious of

A

leiomyosarcoma

101
Q

Normal endometrial thickness menstrual phase

A

1-3mm

102
Q

Normal endometrial thickness early proliferative phase

A

4-6mm

103
Q

Normal endometrial thickness ovulatory (late proliferative)

A

6-8mm

104
Q

Normal endometrial thickness secretory phase

A

8-14mm

105
Q

Normal endometrial thickness post menopausal NO HRT

A

8mm no symptoms

106
Q

Normal endometrial thickness postmenopausal on HRT

A

up to 15mm

107
Q

Caused by unopposed estrogen, precursor to endometrial cancer

A

endometrial hyperplasia

108
Q

Endometrial hyperplasia endometrium in premenopausal

A

> 14mm

109
Q

Endometrial hyperplasia endometrium in post menopausal (asymptomatic)

A

> 8mm NO HRT

110
Q

Endometrial hyperplasia endometrium in post menopausal with bleeding

A

> 5mm

111
Q

May cause abnormal bleeding, diffuse or focal thickening of endometrium

A

endometrial polyps

112
Q

Infection/inflammation of the endometrium, usually due to PID. Thickening/irregular contour to endometrium

A

endometritis

113
Q

Endometrial adhesions, asherman’s syndrome, septae/scars caused by instrumental procedures, bright echoes in endometrial cavity

A

intrauterine synechiae

114
Q

Most common gynecologic malignancy

A

endometrial carcinoma

115
Q

RI<0.4=

A

endometrial carcinoma low resistance

116
Q

PI<1=

A

cutoff (intratumoral neovascularity)

117
Q

Blood in the endometrial canal-anechoic usually resolves after D&C

A

hematometra

118
Q

Pus in the endometrial canal-has echoes within it associated with malignancy

A

pyometra

OB/GYN I (13 decks)

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