Conditions of the Uterus, Cervix, Ovary and Fallopian tubes Flashcards
What forms the upper vagina, cervix, uterus and fallopian tubes?
The paramesonephric (Mullerian) ducts
The absence of the Y chromosome and absence of Mullerian inhibiting substance leads to the development of what?
The paramesonephric system with the regression of the mesonephric system
At what point in time do the paramesonephric ducts arise?
At 6 weeks gestational and by 9 weeks they fuse in the midline to form the uterovaginal primordium
When the septum resolves between the fused paramesonephric ducts its leads to the development of what structures?
A single cervix and uterus
Failure of the paramesonephric duct to fuse can lead to which anomalies?
Uterus didelphysis (2 separate uterine bodies with its own cervix, attached Fallopian tubes and vagina); bicronuate uterus with a rudimentary horn; bicorunuate uterus w/ or w/o double cervices
Incomplete dissolution of the midline fusion of the paramesonephric duct leads to which anomaly?
Septate uterus
Failure of formation of Müllerian ducts can lead to which anomaly?
Unicornate uterus
What is Mullerian agenesis?
The complete lack of development of the paramesonephric system; absence of the uterus and mot of the vagina
The MC congenital cervical anomalies are the result of what?
Malfusion of the paramesonephric ducts with varying degrees of separation; examples include didelphys cervix and septate cervix
What are the characteristics of fibroids?
Spherical, well circumscribed, white firm lesions with a whorled appearance on cut sections; may degenerate and cause pain; may calcify especially if postmenopausal pts
What are the signs of a leiomyoma upon a bimanual exam?
Can reveal an enlarged irregularly shaped uterus; if palpated mass moves with the cervix it is suggestive of a fibroid uterus; the degree of enlargement is described in week size used to estimate equivalent gestational size
What are the signs of a leiomyoma on an US?
Can help distinguish between adnexal masses and lateral leiomyomas
If endometrial cavity is entered for myomectomy future deliveries must be what?
C section
If uterine tissue remains after a myomectomy, what may be warranted?
Hysterectomy
What percentage of simple hyperplasia without atypia progresses to cancer?
1%
What percentage of complex hyperplasia without atypia progresses to cancer?
3%
What percentage of simple hyperplasia with atypia progresses to cancer?
9%
What percentage of complex hyperplasia with atypia progresses to cancer?
27%
What is Turner syndrome?
45 XO, associated with abnormal gonad development; small rudimentary streaked ovaries; develop secondary sexual characteristics but enter menopause shortly after
What is complete androgen insensitivity syndrome/testicular feminization?
Lack androgen receptors, phenotypically female, gonads (functioning testes) need to be removed after puberty because of malignant potential
What are some congenital anomalies of the ovaries?
Turner syndrome and androgen insensitivity
How can DES affect the Fallopian tubes?
May lead to shortened, distorted or clubbed tubes
What are the types of benign neoplastic ovarian tumors?
Epithelial, sex cord stromal and germ cell tumors
What are the characteristics of epithelial ovarian tumors?
Derived from the mesothelial cells lining the peritoneal cavity and also the lining from the surface of the ovary
Mucinous ovarian tumors cytologically resemble what?
The endocervical epithelium
Serous ovarian tumors resemble what?
The lining of the Fallopian tubes
Sex cord stromal ovarian tumors are derived from what?
From the sex cords stroma of the developing gonad
What are the clinical features of benign ovarian tumors?
Often nonspecific and asx; enlarge very slowly, generally pain is mild to intermittent; can be painful if tumor twists on its pedicure (torsion) or rupture of cyst resulting in pain and peritoneal irritation
What are some of the methods used to diagnose an ovarian tumor?
Abd and bimanual pelvic exam, US, tumor markers, laparoscopy
How can US be used to diagnose benign ovarian tumors?
Looking for simple vs complex nature; can be helpful identifying dermoid cyst (can sometimes see a tooth like calcification)
Which tumor marker can be used to dx benign ovarian tumors?
CA 125 serum marker esp in post menopausal women
How can laparoscopy be used to diagnose benign ovarian tumors?
Can be helpful in distinguishing between uterine fibroids, ovarian tumors and hydrosalpinx; in general laparotomy is preferable to laparoscopy unless the mass can be removed without rupture
How are ovarian neoplasms managed?
No persistent ovarian neoplasm should be assumed to be benign until proved by surgical exploration and path examination; if surgery is warranted collect pelvic washing for cytologic examination and obtain a frozen section for histologic dx; definitive tx depends on pt age and desire for future pregnancy
What are the most benign conditions of the Fallopian tubes?
Most are infectious or inflammatory; hydrosalpinx and pyosalpinx
What is hydrosalpinx?
Fluid filled tubes from previous infection
What is pyrosalpinx?
Purulent filled tube from active infection
What is an ovarian torsion?
The complete or partial rotation of the ovary on its ligamentous supports which often results in impedance of its blood supply; one of the MC gynecological emergencies
What is an adnexal torsion?
When the ovary and Fallopian tube both twist
What is the primary RF for an ovarian torsion?
An ovarian mass >5cm
What is the classic presentation of an ovarian torsion?
Acute onset of unilateral pain, nausea and possibly vomiting
How is a dx of ovarian torsion made?
US is first line imaging study to ID mass; definitive dx is made by direct visualization
What is the tx for an ovarian torsion?
Detorsion and ovarian conservation with an ovarian cystectomy; salpingo-oophorectomy is performed if ovary is necrotic or you suspect malignancy
