Conditions Of The Uterus, Cervix, Ovary, & Fallopian Tubes

Question 1

Exogenous estrogens administered without progesterone to someone with a uterus may lead to _____ _____ which is a precursor to endometrial cancer

Answer 1

Endometrial hyperplasia

Question 2

Theca-lutein ovarian cysts are functional cysts that may develop in patients with high serum levels of hCG, such as those undergoing ovulation induction. Characteristically, they regress when?

Answer 2

When gonadotropin levels fall

Question 3

Luteomas of pregnancy are functional ovarian cysts caused by hyperplastic reactions of the ovarian theca cells secondary to prolonged hCG stimulation during pregnancy. Is surgical resection indicated for this type of cyst?

Answer 3

No — they usually regress spontaneously postpartum

Question 4

Most common epithelial ovarian tumor

Answer 4

Serous cystadenoma

Question 5

Most common benign solid ovarian tumor

Answer 5

Fibroma (sex cord stromal ovarian tumor)

Question 6

The upper vagina, cervix, uterus, and fallopian tubes are formed from the fusion of the _____ ducts by week 9 of gestation, as long as Y chromosome is absent

Answer 6

Paramesonephric (mullerian)

Question 7

Condition characterized by 2 separate uterine bodies, each with its own cervix, attached fallopian tube, and vagina

Answer 7

Uterus didelphys

Question 8

Most common neoplasm of the uterus, affecting >70% of women by the fifth decade

Answer 8

Uterine leiomyomas (fibroids)

[most are asymptomatic, but some may present with excess uterine bleeding, pelvic pressure, pelvic pain, and infertility; Most are intramural; most common indication for a hysterectomy]

Question 9

Medical treatment for benign uterine fibroids

Answer 9

Combination OCPs (usually first-line)

Progesterone-only therapies — Depo, Mirena

GnRH agonists (Depo-Lupron)

Question 10

Surgical tx of leiomyomas

Answer 10

Myomectomy

Endometrial ablation

Uterine artery embolization

Hysterectomy is definitive therapy

Question 11

Normal cervical variant in which cyst appears opaque with yellowish or bluish hue, resulting from squamous metaplasia in which layer of superficial squamous cells entrap a layer of columnar cells beneath its surface

Answer 11

Nabothian cervical cyst

Question 12

Most common benign growths on cervix

Answer 12

Ectocervical and endocervical polyps (endocervical more common)

Usually asymptomatic but can cause coital bleeding or menorrhagia

Question 13

Conditions associated with endometrial hyperplasia

Answer 13

PCOS and anovulation

Granulosa theca cell tumors (estrogen-producing)

Obesity (secondary to peripheral conversion of androgens to estrogens in adipose cells)

Exogenous estrogens without progesterone

Tamoxifen

[sx include intermenstrual, heavy, or prolonged bleeding that is unexplained]

Question 14

Dx and tx of endometrial hyperplasia

Answer 14

Dx: sample the endometrium; US reveals endometrial lining >4 mm in a postmenopausal female

Tx: simple and complex hyperplasia WITHOUT atypia is treated with progestin and then resampled in 3 months. Simple and complex hyperplasia WITH atypia is best treated with a hysterectomy

Question 15

Types of functional ovarian cysts

Answer 15

Follicular cysts

Corpus luteum cysts

Hemorrhagic cysts

Polycystic ovaries

Question 16

Treatment for serous cystadenomas

Answer 16

Surgical (cystectomy vs. oopherectomy vs. hysterectomy with b/l oopherectomy)

Question 17

Mucinous cystadenomas are associated with mucoceles of the _____, and rarely can lead to _____ _____

Answer 17

Appendix; pseudomyxoma peritonei

Question 18

Small, smooth, solid, usually benign ovarian neoplasm with a large fibrotic component that encases epithelioid cells that resemble transitional cells of the bladder

Answer 18

Brenner tumor

Question 19

Condition characterized by ascites and right pleural effusion (hydrothorax) in association with an ovarian fibroma

Answer 19

Meigs syndrome

Question 20

Most common ovarian neoplasm found in women of all ages

Answer 20

Benign cystic teratoma (dermoid cyst)

[typically occur in reproductive years]

Question 21

Diagnosis of benign ovarian tumors

Answer 21

Abdominal and bimanual pelvic exam

US — especially helpful in identifying dermoid cysts

Tumor markers — CA 125 especially in postmenopausal women

Laparoscopy

Question 22

Management of ovarian epithelial neoplasms

Answer 22

Usually managed with u/l salpingo-oopherectomy

If it is mucinous cystadenoma, perform appendectomy

If young nulliparous pts, may perform cystectomy for ovarian preservation

In older women, a total abdominal hysterectomy with bilateral salpingo-oopherectomy is appropriate

Question 23

Management of sex cord stromal ovarian neoplasms

Answer 23

Generally tx by u/l salpingo-oopherectomy when future pregnancies are desired

Question 24

Management of germ cell tumors of the ovary

Answer 24

Can be tx by ovarian cystectomy

Carefully evaluate other ovary since they are b/l in approx. 15-20% of cases

Copiously irrigate pelvis to avoid chemical peritonitis

Question 25

Types of ovarian torsion

Answer 25

Adnexal torsion — ovary and fallopian tube both twist

Isolated torsion — just the fallopian tube or fallopian tube cysts twist

Question 26

Primary risk factor for ovarian torsion

Answer 26

Ovarian mass >5 cm

Question 27

Classic presentation and dx of ovarian torsion

Answer 27

Presents with acute onset of u/l pain; nausea and possibly vomiting

Dx: ultrasound is first line imaging study to identify mass; definitive dx made by direct visualization

Question 28

Tx for ovarian torsion

Answer 28

Detorsion and ovarian conservation with an ovarian cystectomy

Salpingo-oopherectomy is performed if ovary is necrotic or you suspect a malignancy