CORE - Reproductive Flashcards
Linea terminalis
separates the true and false pelvis
Varicocele measurement
> 2 mm
Most common mets to testis
RCC, prostate
Upper limit of normal epididymis
10 mm
Most common extra-testicular mass (adult)
spermatic cord lipoma
Most common extra-testicular mass (child)
rhabdomyosarcoma
Most common epididymal neoplasm
adenomatoid tumor of the tunica albuginea (benign)
Tunical cyst (or tunica albuginea cyst)
small, anechoic; located eccentrically along the capsule of the testis; often p/w palpable nodule
Bilateral testicular masses DDx
lymphoma, mets, sarcoid, adrenal rests
T2 hypointense lesion in prostate DDx
prostate cancer, hemorrhage, prostatitis
Chorioadenoma destruens
complete mole that invades the myometrium
Fetal cystic pelvic mass with a “daughter cyst”
pathognomonic for an ovarian cyst
Prosencephalon
forebrain
Rhombencephalon
hindbrain
Progression of incompetent cervix shape
T => Y => V => U
Pediatric ovarian neoplasms
GCTs are most common regardless of age (also most common amongst malignant ovarian tumors)
Serous cystadenoma (ovary) - unilocular or multilocular?
unilocular, often bilateral
Mucinous cystadenoma (ovary) - unilocular or multilocular?
multilocular, unilateral; assoc. with smoking
Fetal ventriculomegaly
> 10 mm across the atria of the ventricles, or >3 mm of separation between choroid plexus and medial wall of the lateral ventricle
Uterus-cervix ratio (by age)
0.5 at birth (cervix 2x as large), 1.0 at puberty, 2.0 in adults
Turner syndrome (GU findings)
streak ovaries, 0.5 uterus-to-cervix ratio, horseshoe kidney
Mullerian ducts
forms uterus, fallopian tubes, and upper 2/3 of vagina
Urogenital sinus
forms lower 1/3 of vagina and prostate
Wolffian ducts
forms seminal vesicles, epididymis, and vas deferens
Mayer-Rokitansky-Kuster-Hauser syndrome
Mullerian agenesis
Mullerian agenesis (3 features)
rudimentary uterus, vaginal atresia, normal ovaries; assoc. with renal agenesis or ectopia
Unicollis vs. bicollis bicornuate uterus
refers to number of cervices (1 or 2)
Stuff that can be shown on HSG
adenomyosis, Asherman syndrome, salpingitis isthmica nodosa, uterine anomalies, tubal sclerosing devices
Contraindications to HSG
active infection (PID), contrast allergy, active bleeding, pregnancy
Ideal timing of HSG (menstrual cycle)
days 7-10
Asherman syndrome
a.k.a. intrauterine adhesions; due to prior infection, D&C, or pregnancy
Venetian blind sign
uterine fibroid
MRI characteristic of fibroids associated with a better IR treatment prognosis
increased T2 signal, enhancing
Fibroid degeneration types
hyaline (most common), red/carneous (pregnancy), myxoid, cystic
Fibroid with peripheral rim of high T1 signal
red/carneous type of degeneration; during pregnancy
Fibroid with high T2 signal
myxoid type of degeneration
Fibroid with low T2 signal
hyaline type of degeneration (most common)
Rapidly enlarging fibroid
suspicious for malignant transformation (leiomyosarcoma); may also see areas of necrosis
Thickened junctional zone with scattered T2 bright foci
adenomyosis (foci represent cystic change)
Endometrial thickening + ovarian mass
granulosa-theca cell tumor, or endometroid carcinoma (ovary) + endometrial cancer
Endometrial thickness necessitating biopsy
> 5 mm + PMB, or >8 mm (no PMB)
Syndrome associated with increased risk of endometrial cancer
HNPCC (30-50x)
Tamoxifen changes (uterus)
subendometrial cysts, endometrial polyps; increased risk of endometrial cancer
Endometrial fluid in a post-menopausal patient
cervical stenosis or an obstructing mass
Work-up for post-menopausal uterine bleeding
US => if endometrium is too thick => biopsy => if concern for higher stage disease => MRI for extent
Enhancement of endometrial cancer
homogeneous, but LESS than the adjacent myometrium; mildly T2 hyperintense, restricts on DWI
Critical stage for endometrial cancer
stage 2 (cervical stromal invasion); change to pre-operative radiation and from TAH => radical hysterectomy
Most important MR sequence for staging of endometrial cancer
post-gad
Critical stage for cervical cancer
stage 2B (parametrial invasion = disruption of T2 hypo ring); change from surgical resection to chemoradiation
Phase of menstrual cycle assoc. with trilaminar appearance of the endometrium
late proliferative (days 10-14)
Most common cancer of vagina
squamous cell carcinoma (related to HPV)
Met to anterior wall of upper 1/3 of the vagina
from upper genitourinary tract (90%)
Met to posterior wall of lower 1/3 of the vagina
from GI tract (90%)
Cyst in anterior-lateral wall of upper vagina
Gartner duct cyst; due to incomplete regression of Wolffian ducts
Cyst below pubic symphysis near anus (females)
Bartholin cyst (‘B’ for Butthole and Below pubic symphysis)
Cyst below pubic symphysis between urethra and vagina canal
Skene gland cyst; may cause recurrent UTI or urethral obstruction
Segments of fallopian tube
from medial to lateral: intersitium»_space; isthmus»_space; ampulla»_space; infundibulum
Ovaries with multiple large cysts
theca-lutein cysts due to increased hCG; multiple, bilateral
Causes of theca-lutein cysts
multiple gestations, molar pregnancy, clomiphene or gonadotropins
Ovarian hyperstimulation syndrome
due to fertility treatment; abdominal pain, ovary >5 cm, ascites or hydrothorax; may see theca-lutein cysts
Maximum ovarian volume in a post-menopausal patient
6 cc
Ovarian simple cyst - indication for annual US follow-up
> 5 cm in pre-menopause, >1 cm in post-menopause
Ovarian simple cyst - indication for MRI or surgical evaluation
> 7 cm in pre or post-menopause
Physiologic cyst (ovary)
simple cyst <3 cm; represents a normal follicle (or corpus luteum)
Follicular cyst (ovary)
simple cyst >3 cm; follicle that did not undergo ovulation; resolves in 2-3 cycles usually
Corpus luteum cyst (ovary)
when corpus luteum fails to regress
Hemorrhagic cyst (ovary)
hemorrhage into a functional cyst (most commonly a corpus luteum cyst); resolves in 2-3 cycles usually
Most common location for ectopic pregnancy
tubal (ampullary segment most commonly)
Ovarian cyst with internal echoes and echogenic foci along wall
endometrioma
Malignant transformation in ovaries + risk factors
endometrioma => clear cell or endometroid, mature cystic teratoma => SCC; risk factors for both are size and age
Decidualized endometrioma
solid nodule with internal flow in an endometrioma; seen in pregnancy; mimic for malignant degeneration
MRI characteristics of endometrioma vs. teratoma
endometrioma is T1 bright, T2 dark (“shading”); teratoma is T1/T2 bright (dark on fat sat)
Hemorrhagic cyst in a 70 y/o
cancer until proven otherwise (old people shouldn’t have cysts to hemorrhage into)
Ovarian cysts that resolve in 2-3 cycles (typically)
follicular cysts, hemorrhagic cysts
PCOS numbers
> 12 follicles per ovary, each <9 mm, ovarian volume >10 cc
Most common type of ovarian malignancy
serous cystadenocarcinoma
Cystic ovarian mass with papillary projections
malignancy (serous > mucinous)
Endometroid carcinoma of the ovary
2nd most common ovarian malignancy; large solid and cystic mass; may arise from an endometrioma; 25% also have endometrial cancer; 15% bilateral
B.F.M. (adult)
ovarian masses (serous or mucinous), desmoid, sarcoma
T1/T2 dark ovarian mass (no calcification)
fibroma/fibrothecoma (benign); middle-aged women
T2 dark ovarian mass with calcification
Brenner tumor (benign); 50-70 y/o
Meigs syndrome
benign ovarian tumor (fibroma most commonly), ascites, pleural effusion; treatment is resection only
Ovarian fibromatosis
tumor-like enlargement of ovaries due to fibrosis (T1/T2 dark); assoc. with omental fibrosis and sclerosing mesenteritis
Ovarian transitional cell carcinoma
a.k.a. Brenner tumor
Bilateral solid ovarian masses
consider mets
Ovarian size suggestive of torsion
> 4 cm (unilateral)
Pelvic inflammatory disease
hydrosalpinx, thickened tube, +/- internal debris; may progress to TOA
Paraovarian cyst
congenital, remnant of Wolffian duct; separate from ovary; followed if >5 cm
Most common side for ovarian vein thrombophlebitis
right (80%); typically postpartum; may cause PE; treatment with antibiotics + heparin
Peritoneal inclusion cyst
adhesions (prior surgery or inflammatory disease) encapsulate an ovary => secretions result in cystic collection