Congenital Malformations

Question 1

What is the outcome of arrested development of both Mullerian ducts?

Answer 1

Uterine apalsia

Question 2

What is the outcome of arrested development of one Mullerian ducts?

Answer 2

Uterine unicornis unicollis

Question 3

What is the results of complete failure of fusion of the mullerian ducts?

Answer 3

Uterus didelphys

Question 4

What is the results of partial failure of fusion of the mullerian ducts?

Answer 4

Uterus bicornis bicollis
Uterus bicornis unicollis
Uterus arcuatus

Question 5

What the the result of the failure of resorption of the median septus

Answer 5

Uterus septus

Uterus subseptus

Question 6

What is the result of diethylstylbestrol exposure in utero

Answer 6

T=shaped uterine cavity

Question 7

What are some associated abnormalities with congenital uterine pathology?

Answer 7

• increased risk of spontaneous abortion and obstetric complications
• often associated with congenital renal abnormalities

Question 8

Describe a uterine leiomyomata (fibroid)

Answer 8

○ Benign
○ Smooth muscle and connective tissue
○ Occur in 20-30% of females over the age of 30

Question 9

What are the classifications of fibroids?

Answer 9

Intramural, subserosal, submucosal.
Submucosal and subserosal can be sessile or pedunculated
Pedunculated submucosal can become prolapsed through the cervix and mistaken for a polyp

Question 10

What are symptoms associated with fibroids?

Answer 10

Mass
Abnormal bleeding-  associated with submucosal fibroids
Acute or chronic pelvic pain
Weight gain
Dysmenorrhea
Pressure symptoms

Question 11

What would you suspect if previously asymptomatic fibroids cause acute onset of pain?

Answer 11

necrosis, inflammation or torsion of a pedunculated one.
prolapse of a submucosal fibroid can cause intense cramping pain, discharge and bleeding
can cause pressure on lumbosacral nerves

Question 12

What can happen if fibroids are large?

Answer 12

increased urinary frequency and urgency as large fibroids exert pelvic pressure. compression of ureters can cause hydroutereronephrosis
cul-de-sac mass can cause obstipation, constipation or haemarrhoids due to rectal pressure

Question 13

What are the secondary changes of fibroids?

Answer 13

Hyaline degeneration
Cystic degeneration
Calcification
Grow under the influence of oestrogen
Shrink after menopause

Question 14

Why does necrosis and central ischaemia occur?

Answer 14

As fibroids increase in size, they can outgrow their blood supply. This causes central ischaemia and necrosis, leading to pain.

Question 15

What is a concerning feature of fibroids after menopause?

Answer 15

After menopause, there should be regression in uterine size due to lack of oestrogen. Calcific tumours will remain stable. Increase in size should prompt immediate action due to increased risk of sarcomatous degeneration or misdiagnosis of an evolving ovarian neoplasm.

Question 16

What is the malignant potential of a fibroid?

Answer 16

○ Small malignant potential- 0.2% or less of becoming a leiomyosarcoma
○ Rarely diagnosed preoperatively
○ Post-menopausal enlargement should suggest the possibility of malignant process

Question 17

What is adenomyosis?

Answer 17

Internal endometriosis.
Can be focal or diffuse.
Usually non-specific. There is generally pelvic pain, dysmenorrhea and menorrhagia

Question 18

What is the typical US appearance of adenomyosis?

Answer 18

Most commonly appears as simple, diffuse uterine enlargement with diffuse heterogeneous attenuative changes and/or small myometrial cysts

Question 19

What is a lipoleiomyoma?

Answer 19

Lipomatous uterine tumour. Very rare but benign. Is often a post-operative diagnosis

Question 20

What is the US appearance of a lipoleiomyoma?

Answer 20

Highly echogenic attenuating mass within the myometrium. There is absence of colour flow

Question 21

What is a uterine AVM?

Answer 21

• Unusual
• Diverse presentation
• Acute torrential vaginal haemorrhage
• Use Doppler