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2nd Year GYN > Chapter 41: Pathology of the Uterus > Flashcards

Chapter 41: Pathology of the Uterus Flashcards

1
Q

What are the most common cystic lesions of the vagina?

A

Gartner’s duct cyst

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2
Q

What is the most common congenital abnormality of the female genital tract?

A

imperforate hymen resulting in obstruction

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3
Q

Obstructin of the uterus and vagina may result in:

A

accumulation of fluid (hydroculpos/hydrometra), blood (hematocolpos/hematometra), pus (pyocolpos/pyometra)

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4
Q

The upper size limit of a normal vaginal cuff is

A

2.1cm

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5
Q

How long does the cervix measure?

A

2-4cm

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6
Q

Most common presence of of the cervix is

A

nabothian cyst AKA epithelial inclusion cysts

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7
Q

How may polyps appear in the cervix?

A

pedunculated (projecting out of the cervix) or broad based

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8
Q

Who is more likely to develop cervical polyps?

A

late middle age

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9
Q

Leiomyoma AKA

A

fibroid

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10
Q

What is cervical stenosis

A

acquired condition with obstruction of the cervial canal at the internal or external os (may be asymptomatic but produce a distended fluid filled uterus)

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11
Q

What is the most common kind of cervical cancer?

A

squamous cell

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12
Q

What are precursors to squamous cell carcinomas?

A

cervical dysplasias classified as mild, moderate or severe

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13
Q

The uterine position changes with

A

degree of bladder and rectal distention

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14
Q

What are the most common gynecologic tumors?

A

leiomyomas or myomas or fibroids …occur in 20-30% of women over 30

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15
Q

T/F: fibroids are more common in white women?

A

false, african american women

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16
Q

Fibroids are composed of what?

A

spindle-shaped smooth muscle cells arranged in a whorl-like pattern

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17
Q

Tumor fibroids consist of what?

A

nodules or myometrial tissue and are usually multiple

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18
Q

The fibroid is encapsulated with

A

a pseudo capsule and separates easily from the surrounding myometrium

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19
Q

What may take place with degeneration of fibroids

A

liquefaction, necrosis, hemorrhage, and calcification

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20
Q

What is hyalinization?

A

development of an albuminoid mass in a cell or tissue..occurs most often, making the fibroid appear more lucent or hypoechoic than myometrium

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21
Q

What percent of fibroids contain calcification?

A

10%

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22
Q

What percent of fibroids have areas of hemorage?

A

10%

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23
Q

Fibroids are ______dependent

A

estrogen, may increase in size in pregnancy, though 50% don’t change in size

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24
Q

Do fibroids regularly develop in postmenopausal women?

A

no, most stabilize or decrease in size following menopause bc of lack of estrogen, unless the women is undergoing hormone replacement therapy

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25
Q

A rapid increase in fibroid size, esp in postmenopausal pt. should raise possibility of

A

sarcomatous change

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26
Q

What has been reported to cause growth in fibroids?

A

tamoxifen

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27
Q

How do fibroids present clinically?

A

cause uterine irregularity and enlargement with sensation of pelvic pressure and pain..patterns of irregular menstrual bleeding , heavy bleeding, or heavy and irregular bleeding

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28
Q

where are fibroids located to interfere with a normal vaginal delivery?

A

LOWER UTERINE SEGAMENT

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29
Q

what type of fibroid is most likely to cause irregular uterine bleeding?

A

submucosal fibroid

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30
Q

The submucosal fibroid is found to _______ or _______ the endometrial cavity and may erode into ?

A

deform or displace; endometrial cavity

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31
Q

Why is it important to diagnose submucosal fibroids?

A

because they are a well established cause of dysfunctional uterine bleeding, infertility and spontaneous abortion

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32
Q

The intramural fibroid is confined to?

A

myometrium and is the most common type

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33
Q

Subserosal fibroid project from the?

A

serosal surface of the uterus

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34
Q

what is the appearance of the subserosal fibroid?

A

becomes pedunculated and appear as an extrauterine mass

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35
Q

Uncommonly, a pedunculated fibroid develops?

A

a long stalk and is migratory

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36
Q

Fibroid can implant into the blood supply of ?

A

broad ligament, omentum or bowel mesentery

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37
Q

T or F ; fibroids have variable sonographic appearances

A

True

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38
Q

What is the earliest sonographic finding of fibroids?

A

uterine enlargement or irregular uterine wall contour with heterogenous myometrial texture pattern

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39
Q

What should you look for along the interface between the uterus and the bladder?

A

contour distortions

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40
Q

Sonographically discrete fibroids look?

A

hypoechoic but can be hyperechoic if they contain dense fibrous tissue

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41
Q

fibroids can look hyperechoic if they contain

A

dense fibrous tissue

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42
Q

fibroids that demonstrate an area of acoustic attenuation without a discrete mass make it hard to?

A

estimate the size

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43
Q

The uterus and adnexa may be difficult to image because of shadowing due to?

A

extensive calcification

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44
Q

what is the size of a fibroid?

A

.5cm

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45
Q

How can fibroids be detected

A

endovaginal sonogram

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46
Q

What do larger fibroids cause? and how are they better visualized?

A

heterogenous uterine enlargement and are better outlined transabdominally

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47
Q

What should you note when describing a fibroid?

A

texture, size and location

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48
Q

What is the most common cause of uterine calcification?

A

fibroids

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49
Q

what is the less common cause of uterine calcification

A

arcuate artery calcification in the periphery of the uterus

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50
Q

Calcifications may occur sonographically as?

A

focal areas of increased echogenicity with shadowing or as a curvilinear echogenic rim

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51
Q

what are some uterus fibroid treatments

A
  • hormonal suppression
  • endometrial ablation
  • uterine artery embolization
  • high intensity focused ultrasound
52
Q

what is endometrial ablation?

A

uses radiofrequency microwaves. freezing or heating to ablate or remove the endometrium

53
Q

what is uterine artery embolization?

A

uses small plastic particles injected into the blood supply to the myoma

54
Q

What is high intensity focused ultrasound?

A

involves the application of therapeutic sound waves to the uterus and fibroid

55
Q

What is the least common cause of uterine calcification?

A

arcuate artery calcification in the periphery of the uterus

56
Q

what is adenomyosis?

A

ectopic occurrence of nest of endometrial tissue within the myometrium and is more extensive in the posterior wall

57
Q

The tissue penetration of adenomyosis usually reaches a depth of?

A

2.5 mm from the basal layer of the endometrium

58
Q

Because this ectopic tissue arises fro the ________ _________ component of the endometrium, it does not bleed in response to_________.

A

stratum basalis; cyclical hormone stimulation

59
Q

what are the classifications of adenomyosis?

A

diffuse and focal forms

60
Q

what is the more common form of classification of adenomyosis?

A

diffuse adenomyosis

61
Q

focal adenmyosis is sometimes called?

A

adenomyoma

62
Q

Adenomyosis represents a reactive hypertrophy of the _______ _______, which produces uterine ___________ but never to extend seen with________

A

myometrial muscle, enlargement, fibroids

63
Q

focal adenomyosis lacks sonographically?

A

a hypoechoic border that is seen with fibroids

64
Q

T or F: clinically, both adenomyosis and endometriosis are identical with respect to structure and function, but are usually regarded as separate and distince processes

A

True

65
Q

Patients with adenomyosis are often?

A

multiparous and older than patients with endometriosis

66
Q

A patient with adenomyosis presents with?

A

heavy, painful abnormal menses. three times normal size, globular in contour, boggy and somewhat tender

67
Q

On a physical examination of adenomyosis the uterus is found to range from normal to?

A

three times normal size

68
Q

______% of women with adenomyosis experience ______ or ________.

A

60%, menorrhagia, or metrorrhea

69
Q

approximately 25% of patients with adenomyosis also suffer from?

A

dysmenorrhea

70
Q

The most common finding of extensive adenomyosis is?

A

diffuse uterine enlargement

71
Q

what appears as small hypoechoic myometrial cyst?

A

hemorrhage in the islands of the endometrial tissue

72
Q

With the involved area being slightly more anechoic than the normal myometrium, there may be?

A

thickening of the posterior myometrium

73
Q

what has been described as a swiss cheese or honeycomb patter?

A

hemorrhage in the islands of endometrial tissue (adenomyosis)

74
Q

How do localized adenomas appear endovaginally?

A

inhomogenous, circumscribed areas in the myometrium , having indistinct margins and ontaining anechoic cavity

75
Q

What is the best technique for presurgical diagnosis of adenomyosis

A

adenomyosis

76
Q

Uterine arteriovenous malformations consist of what?

A

a vascular plexus of arteries and veins without an intervening capillary network

77
Q

Most AVMS are teratogenic (acquired) due to

A

pelvic trauma, surgery, and gestational trophoblastic neoplasia

78
Q

Leiomyosarcomas are rare, accounting for

A

1% of uterine malignancies

79
Q

Leiomyosarcomas originate from the

A

myometrium or endometrial lining, are highly aggressive, and have a poor prognosis

80
Q

What is the endometrial canal is the landmark for the ID’ing of the

A

long axis of the uterus

81
Q

An abnormally thick endometrium results form a variety of conditions:

A
  • early intrauterine pregnancy
  • gestational trophoblastic disease
  • endometrial hyperplasia
  • secretory endometrium
  • estrogen replacement therapy
  • Polyps
  • endometrial carcinoma
82
Q

Disorders of the endometrium may occur in menopausal patients with

A

breast cancer who are receiving tamoxifen therapy

83
Q

Patients with endometrial polyps usually are

A

asymptomatic, but some might be the cause of uterine bleeding

84
Q

What are polyps histologically?

A

overgrowth of endometrial tissue covered by epithelium

85
Q

Approximately __% of endometrial polyps are multiple

A

20%

86
Q

In postmenopausal women, especially those being investigated for bleeding, the major differential considerations other than endometrial polyps are:

A
  • hyperplasia
  • submucosal fibroids
  • less commonly endometrial carcinoma
87
Q

What is the most common cause of abnormal uterine bleeding in both premenopausal and postmenopausal women?

A

endometrial hyperplasia

88
Q

What does hyperplasia develop from?

A

unopposed estrogen stimulation

89
Q

In premenopausal women, if the endometrium measures more than 14mm, ________ is suggested

A

hyperplasia

90
Q

In asymptomatic postmenopausal women with endometrial hyperplasia, ___mm is the upper limit of normal

A

8mm

91
Q

After progesterone is added, endometrial thickness will _____/

A

decrease

92
Q

When should a woman using sequential hormones be studied for endometrial thickness, ideally?

A

at the beginning or end of hormone cycle

93
Q

Hyperplasia is less common when?

A

during reproductive years

94
Q

During reproductive years, hyperplasia of the endometrium may occur when?

A
  • persistent anovulatory cycles
  • polycystic ovarian disease
  • obese women with increased production of endogenous estrogens
95
Q

What is necessary for endometrial hyperplasia diagnosis?

A

endometrial biopsy

96
Q

Describe endometrial hyperplasia

A
  • endo is usually diffusely thick and echogenic with well-defined margins
  • focal/asymmetrical thickening can occur
  • small cysts representing dilated cystic glands may be seen within the endometrium
97
Q

Endometrial polyps typically cause what?

A

diffuse or focal endometrial thickening

98
Q

Endometrial polyps are more frequently seen in who?

A

perimenopausal and postmenopausal women

99
Q

In menstruating women, endometrial polyps may be associated with

A

menometrorrhagia or infertility

100
Q

Sonographically, polyps may initialy appear as

A

nonspecific echogenic endometrial thickening:

  • polyp may be diffuse or focal and may also appear as a round echogenic mass within the endometrial cavity
  • feeding artery may be seen in pedicle
  • individual polyps are better visualized when outlined by intracavitary fluid
101
Q

Endometrial thickening or fluid may indicate

A

endometritis

102
Q

What is endometritis?

A

an infection within the endometrium of the uterus

103
Q

Endometritis occurs most often in association with

A
  • PID
  • postpartum state
  • following instrumentation invasion
104
Q

Postpartum patients may dev. endometritis when?

A
  • after prolonged labor
  • vaginitis
  • premature rupture of membranes
  • retained products of conception
105
Q

Sonographically, how does the endometrium appear with endometritis?

A

prominent, irregular or both, with a small amount of endometrial fluid

106
Q

What can be found in women with posttraumatic or postsurgical histories (including uterine curettage)

A

intrauterine syncheiae

107
Q

How does syncheiae appear sonographically?

A

bright echoes within the endometrial cavity, but diagnosis is difficult unless fluid is distending the endometrial cavity

108
Q

What is the most common gynecological malignancy in North America, with an increase in incidences

A

endometrial carcinoma

109
Q

Most endometrial malignancies are ______ occurring in postmenopausal patients

A

adenocarcinomas

110
Q

What is the most common clinical presentation of endometrial carcinoma?

A

uterine bleeding

111
Q

There is a strong association with endometrial carcinoma and

A

replacement estrogen therapy, also in the premenopausal woman, anovulatory cycles and obesity are also considered risk factors

112
Q

The earliest change of endometrial carcinoma is a

A

thickened endometrium

113
Q

What are correlated with more advanced stages of endometrial carcinoma?

A

enlargement with lobular contour of uterus and mixed echogenicity

114
Q

What is a good way to screen for early changes of endometrial hyperplasia or carcinoma?

A

TV

115
Q

Endometrial carcinoma may obstruct the endometrial canal, resulting in

A

hydrometra or hematometra

116
Q

What is tamoxifen?

A

a nonsteroidal antiestrogen compound used for menopause therapy

117
Q

What has been reported in patients on tamoxifen therapy?

A

increased risk of endometrial carcinoma, hyperplasia, and polyps

118
Q

Small endometrial fluid collections occur when?

A

with ectopic pregnancies

  • endometritis
  • degenerating fibroids
  • recent abortion
119
Q

Before menstruation, the accumulation of secretions is

A

hydrometrocolpos

120
Q

Following menstruation, the presence of retained menstrual blood results in

A

hematometrocolpos

121
Q

Patients with large endometria fluid collections complain of

A

abdominal pain and have a globular abdominal mass..typically little or no vaginal bleeding

122
Q

Presence of fever along with large endometria fluid collections suggest

A

infection of blood collection

123
Q

What is likely to occur with uterine cancer?

A

pyometra

124
Q

Sonography can demonstrate _______, ________,_________ of an IUD

A

malposition, perforation, incomplete removal

125
Q

Eccentric position of an IUD from midline suggest

A

myometrial penetration

126
Q

What is highly recommended for all IUD localization exams?

A

3D scanning

2nd Year GYN (9 decks)

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