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
2
Q
______ are commonly seen in the area of the cervix as small, anechoic, round structures
A
nabothian cysts
3
Q
______ are a result of hyperplasia of the cervical epithelium
A
cervical polyps
4
Q
When ______ occur in the cervix, enlargement may lead to bladder or bowel obstruction
A
leiomyomas
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
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
7
Q
After hysterectomy, sonography of the pelvis demonstrates the vagina ending at the
A
vaginal cuff
8
Q
If the vaginal cuff measurement exceeds 2.1cm, it is suspicious for recurrence of
A
malignancy
9
Q
A cystic mass in the vagina is most commonly a
A
gartners duct cyst
10
Q
Solid masses in the vagina are usually ______
A
malignant
11
Q
_______ are the most gynecologic tumors
A
leiomyomas
12
Q
Fibroid is another name for
A
leiomyoma
13
Q
Leiomyomas arise from the _____ of the uterine wall
A
smooth muscle
14
Q
Leiomyomas are usually hypoechoic due to
A
hyalinization
15
Q
Leiomyomas often increase in size during pregnancy because they are sensitive to
A
estrogen
16
Q
______ is a term describing the development of a mass of albumin in a cell or tissue
A
hyalinization
17
Q
After menopause, if no replacement hormones are used, leiomyomas usually decrease in size due to lack of
A
estrogen
18
Q
List three common clinical symptoms of leiomyomas
A
irregular bleeding, heavier periods, menstrual cramping, enlarged uterus, dysmenorrhea, pelvic pressure
19
Q
Leiomyomas may contribute to _____ by distorting the fallopian or endometrial cavity
A
infertility
20
Q
Leiomyomas are always located in the uterine wall
A
false
21
Q
_____ fibroids are located just under the endometrium and cause irregular or heavy menstrual bleeding
A
submucosal
22
Q
______ fibroids are located within the myometrium and are often asymptomatic until they are quite large
A
intramural
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
24
Q
______ fibroids are the most common type
A
intramural
25
_____ fibroids are most likely to interfere with pregnancy
submucosal
26
______ fibroids are the type most likely to be pedunculated
subserosal
27
A ______ fibroid develops a long stalk and is very mobile
migratory
28
_______ sonography can define smaller fibroids and better outline their precise relationship to the endometrium
transvaginal
29
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
30
_______ is more sensitive in evaluating the location, size and precise number of fibroids
MRI
31
_______ are the most common cause of uterine calcification
myomas
32
______ is a fairly rare malignancy that arises from the smooth muscle of the uterine wall
leiomyosarcoma
33
When the patient is close to the ovulatory stage of her cycle, there is a ______ layer around the endometrium
hypoechoic
34
_______ occurs when the patient is taking estrogen without progesterone
endometrial hyperplasia
35
In premenopausal women, and endometrial thickness of more than _____ is considered abnormal
15mm
36
In post menopausal women who are NOT taking hormones ______ is the upper limit of normal for the endometrial thickness
8mm
37
______ are seen sonographically as solid masses in the endometrial cavity
endometrial polyps
38
_______ 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
39
The first sonographic sign of endometrial cancer is
thickening of the endometrium
40
In patients with post menopausal bleeding, an endometrial thickness of less than 5mm _____ significant endometrial abnormality
excludes
41
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
42
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
43
Tiny fluid collections in the endometrial cavity are common in women during the _____ stage of the menstrual cycle
menstrual
44
Why should the diameter of the fluid collection be subtracted from the endometrial measurement when fluid is present
get a true endometrial thickness measurement
45
Large endometrial fluid collections represent an increased risk for ______
endometrial carcinoma
46
______ is more likely to occur with uterine cancer
pyometra
47
An IUD that appears sonographically as a series of echogenic dotted lines in the uterus is
lippes loop
48
An IUD that appears sonographically as a T shape is a
tatum t
49
An IUD that appears sonographically as a 7 shape is a
copper 7
50
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
51
If the woman becomes pregnant while she has an IUD, the pregnancy has a ______ chance of aborting if te IUD is extracted
50%
52
When coexisting with pregnancy, the IUD is always _____ the fetal membranes
outside
53
A _______ is a pregnancy located outside the uterus
ectopic
54
Uterine arteriovenous malformation (AVM):
involves the myometrium
55
Benign, small cysts located in the area of the cervix caused by clogged cervical glands. Often due to chronic cervicitis
nabothian cysts
56
Nabothian cysts are also called
epithelial inclusion cysts
57
Caused by hyperplasia of the cervical epithelium and are benign. Affects women in late middle age
cervical polyps
58
Cervical polyps may be
predunculated, project out of cervix, or broad-based
59
Cervical polyps appear as a _______ on sonogram
solid mass
60
Rare, small, assymptomatic. Can cause bowel or bladder obstruction
cervical fibroids
61
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
62
Cervical pathology is better visualized with
transvaginal scan
63
Can cervical fibroids hinder delivery if patient is pregnant
yes
64
Generally diagnosed with PAP smear before lesion is large enough to see sonographically. Affects women who are still menstruating
cervical carcinoma
65
What are the symptoms of cervical carcinoma
vaginal discharge and abnormal bleeding
66
Sonographic findings for cervical carcinoma
mass in cervical area (posterior to bladder), hypoechoic and irregular borders
67
Transvaginal scanning for cervical carcinoma is used to evaluate
extent of bladder, ureteral, rectal or vaginal involvement
68
Transrectal scanning for cervical carcinoma is used for
evaluating the size and penetration of the tumor
69
For cervical carcinoma, ________/________ are both superior to CT or MRI for determining details of cervical extension into neighboring structures
transvaginal/transrectal
70
CT/MRI are superior for determining ________ and general staging of cervical cancer
lymph node spread
71
Area left at end of vagina after hysterectomy, blind pouch, masses occasionally recur here
vaginal cuff
72
What is the upper limit of normal for vaginal cuff
2.1cm
73
Caused by occluded gartners duct in the anterior lateral vaginal wall
gartners duct cyst
74
What is the most common cystic mass of the vagina
gartners duct cyst
75
Most solid massed in the vagina are
malignant
76
Cancer arising from the glandular tissue
vaginal adenocarcinoma
77
Cancer arising from muscle tissue
vaginal rhabdomyosarcoma
78
What is the most common gynecological tumor
leiomyoma
79
What is another name for leiomyoma
fibroid
80
Where do leiomyomas arise from
myometrium, premenopausal
81
Symptoms of leiomyomas
irregular bleeding, heavier bleeding, pelvic pressure and increased cramping
82
Clinical findings of leiomyomas
enlarged uterus with irregular contour, often palpable during exam
83
Leiomyomas may lead to
infertility by distorting fallopian tube or endometrial cavity
84
3 types of appearances for leiomyomas
hyalinization, necrosis, calcified
85
Fibroid becomes filled with deposits of albumin, hypoechoic MOST COMMON APPEARANCE
hyalinization
86
When fibroid outgrows its blood supply, begins to die, center becomes liquified, complex appearance
necrosis
87
A necrotis fibroid eventually scars and becomes calcified. 10% of fibroids become calcified, posterior shadowing
calcified
88
Fibroids are sensitive to _______ and may grow during ______
estrogen, pregnancy or other situations involving increased estrogen levels
89
Fibroids often ______ after menopause due to falling levels of estrogen in the blood
shrink
90
5 locations of fibroids
subserosal, pedunculated, migratory, intramural, submucosal
91
Located just below the outer membrane covering of the uterus. Outer surface lumpy. Cause most obvious disturbance of the unterine contour
subserosal
92
Type of subserosal fibroid that is on a stalk
pedunculated
93
Pedunculated fibroid with a particularly long stalk
migratory fibroid
94
Most common type of fibroid. Located within the myometrium but does not disturb the endometrium or serosal layer
intramural
95
Located just deep to the endometrium, disturn the endometrial surface
submucosal
96
Benign invasion of endometrial tissue in the myometrium, thought to be caused by multiple pregnancies
adenomyosis
97
Sonographic appearance of adenomyosis
bulky enlarges heterogenous uterus without focal mass, VENETIAN BLIND SHADOWING
98
Is MRI or US better at diagnosing adenomyosis
MRI
99
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
100
The rapid enlargment of a fibroid in a woman who is perimenopausal or postmenopausal is suspicious of
leiomyosarcoma
101
Normal endometrial thickness menstrual phase
1-3mm
102
Normal endometrial thickness early proliferative phase
4-6mm
103
Normal endometrial thickness ovulatory (late proliferative)
6-8mm
104
Normal endometrial thickness secretory phase
8-14mm
105
Normal endometrial thickness post menopausal NO HRT
8mm no symptoms
106
Normal endometrial thickness postmenopausal on HRT
up to 15mm
107
Caused by unopposed estrogen, precursor to endometrial cancer
endometrial hyperplasia
108
Endometrial hyperplasia endometrium in premenopausal
>14mm
109
Endometrial hyperplasia endometrium in post menopausal (asymptomatic)
>8mm NO HRT
110
Endometrial hyperplasia endometrium in post menopausal with bleeding
>5mm
111
May cause abnormal bleeding, diffuse or focal thickening of endometrium
endometrial polyps
112
Infection/inflammation of the endometrium, usually due to PID. Thickening/irregular contour to endometrium
endometritis
113
Endometrial adhesions, asherman's syndrome, septae/scars caused by instrumental procedures, bright echoes in endometrial cavity
intrauterine synechiae
114
Most common gynecologic malignancy
endometrial carcinoma
115
RI<0.4=
endometrial carcinoma low resistance
116
PI<1=
cutoff (intratumoral neovascularity)
117
Blood in the endometrial canal-anechoic usually resolves after D&C
hematometra
118
Pus in the endometrial canal-has echoes within it associated with malignancy
pyometra
