Disorders of the female genital tract 2 Uterus and ovaries Flashcards
What is endometriosis?
Ectopic presence of endometrium stroma/glands in other sites (mostly fallopian tubes/ovaries)
What are the clinical characteristics of endometriosis?
Stroma/glands are subject to hormone induced haemorrhagic breakdown -
- dysmenorrhea
- pain with sex (fibrosis), -pelvic pain
- infertility
- pain passing stool
- dysuria
What is the pathogenesis of endometriosis?
Ectopic endometrium (regurgitation of menses through fallopian tube and to other places) -> haemorrhage (subject to same hormone-induced changes in endometrium -> fibrosis
How is endometriosis investigated?
Laparoscopy
What is the treatment of endometriosis?
- Oral contraceptive pill
- GnRH agonist/antagonist
- Progesterone antagonist
- Surgery (Want to be fertile - remove ectopic sites; hysterectomy if not)
What are the usual causes for acute endometritis?
Retained contraceptive products/ instrumentation
Complicated labour
What is the associated histological findings of acute endometritis?
Neutrophils in the stroma/manifestations of acute inflammation
What are the main causes of chronic endometritis?
- Pelvic inflammatory disease
- TB/Chlamydia
- Inter uterine contraceptive device infection
What are the histological findings of chronic endometritis?
Lymphocytes/plasma cels
What are the symptoms/signs associated with endometritis?
- Abdominal pain
- Dysuria
- Vaginal discharge
- Abnormal vaginal bleeds
- Pyrexia
What is the treatment for endometritis?
Analgesia
Antibiotics
Remove cause
What are endometrial polyps?
Sessile/polypoidal uterine overgrowths that are oestrogen dependent
Occur in 10% women (40-50s)
What are the symptoms of endometrial polyps
- Can be asymptomatic
- Inter-menstrual bleeding
- postmenopausal bleeding
- Dysmenorrhoea
- Menorrhagia
How are endometrial polyps diagnosed?
Ultrasound
Hysteroscopy
What is the treatment for endometrial polyps?
GnRH agonist/progesterone
Surgical
What are leiomyomata (uterine fibroids)?
Benign myometrial tumours with oestrogen and progesterone dependent growth
Usually gone after menopause
What are the main risk factors for leiyomata (uterine fibroids)?
Anything that increase oestrogen production! Genetic Nulliparity (not having kids) PCOS Obesity
What are the main symptoms for leiomyomata? (uterine fibroids)
- Asymptomatic (can be)
- Menometrorrhagia (painful, heavy bleeds - result in anaemia)
- Infertility
- Problems with pregnancy
What is the treatment for leiomyomata (uterine fibroids)?
Dependent on age (regress post menopause)
- IUS
- NSAIDs
- Oral combined contraceptive pill/progesterone
Surgical - artery embolization, ablation, hysterectomy
What is endometrial hyperplasia and whats it caused by?
Excess proliferation of endometrium
Caused by increased oestrogen and reduced progesterone
What are the risk factors for endometrial hyperplasia?
Obesity
PCOS
Oestrogen producing tumours
Exogenous oestrogen
How are endometrial hyperplasia categorised?
Non-atypical hyperplasia (low risk of turning malignant)
Atypical hyperplasia (high risk)
What are the signs of endometrial hyperplasia?
Abnormal bleeding (inter menstrual bleeds, post coital bleeds, post menopausal bleeds)
What are the investigations that should be performed for endometrial hyperplasia?
Ultrasound
Biopsy
What is the treatment for endometrial hyperplasia?
Medical (ICU, progesterone)
Surgical - hysterectomy
What can endometrial hyperplasia progress to?
Endometrial carcinoma (adenocarcinoma) - histological seen as increased gland to storm ratio
What are the two types of endometrial carcinoma?
Type I (endometroid) and type II (serous)
What are the characteristics of type I endometrial carcinoma? Incidence Age Pre-existing state Mutations Oestrogen status Grades
Most common Younger (pre menopause) Endometrial hyperplasia PTEN mutation Oestrogen positive Grade I - 3
What are the characteristics of type II endometrial carcinoma? Incidence Age Pre-existing state Mutations Oestrogen status Grades
Rarer Older post menopausal Endometrial atrophy P53 mutation Oestrogen negative Grade 3
What symptoms are associated with endometrial carcinoma?
Post menopausal bleeding
Intermenstrual bleeding
How are endometrial carcinomas staged?
FIGO staging (1-4)
What is the treatment for endometrial carcinoma?
Progesterone
Hysterectomy
Chemotherapy
What are the 3 cardinal signs of polycystic ovary syndrome? (aka ROTTERDAM CRITERIA)
Hyerandrogenim
Menstrual abnormalities
Polycystic ovaries
Need 2 out of 3 for POS to be diagnosed!
What biochemical markers is POS associated with?
Increased testosterone DHEAS and LH
Reduced FSH
How is POS treated?
- Weight loss (ass with obesity)
- Combined oral contraceptive pill
- Metformin (diabetes meds)
- Ovarian drilling
What is primary gonadal failure? What is it characterised by?
Hypergonadotrophic hypogonadism (PRIMARY FAILURE)
Increased LH and FSH (failure of ovaries despite increased stimulation)
What are the causes of primary gonadal failure?
Congenital - Turners and Klinefelters syndorme
Acquired - infection, surgery, chemotherapy
What are the characteristics of secondary of the gonads? What is it characterised by?
Hypogonadotrophic hypogonadism
- Failure of pit gland/hypothalamus (low LH/FSH)
What are the causes go secondary gonadal failure (hypogonadatrophic hypogonadism)
- Sheeran’s syndrome
- Pit tumours
- Brain injury
- PCOS
What are the presentations of gonadal failure (primary and secondary)
Amenorrhea/absent menarche
- reduced sex hormones
- Delayed puberty
- +/- FSH/LH levels
What is the treatment for gonadal failure?
HRT
What are the three types of ovarian neoplasms?
- Surface epithelium stromal tumours **
- Germ cell tumours
- Sex-cord stromal tumour
What are the three types of epithelial stromal tumours (ovarian neoplasms)?
Mucionous
Serous
Endometrial
Can be benign, borderline or malignant
How are beinign endometrial stromal tumours in the ovary classified if they are more..
- Cystic
- Fibrous
- Both cystic and fibrous
- Cystadenomas
- Adenofribroma
- Cystadenofibromas
What are malignant epithelial tumours known as?
Cystoadenocarcinomas
What are the two types of germs cell tumours?
Germinous e.g. dysgerminomas - oogonia, malignant, responsive to chemo
Non-germinous e.g. teratomas,yolk sac tumours, choriocarcinomas
What are the two types of teratomas?
Mature - multiple structure e.g. hair, teeth (multiple germs layers) - BENIGN
Immature - MALIGNANT - abnormal foetal/embryological tissue
What are yolk sac tumours?
Differentiate into extra embryological yolk sac - malignant, responsive to chemo
What are choricoadenomas
Differentiate toward placenta - malignant but NOT responsive to chemo
What are the sex chord stromal tumours comprised of?
Thecomas/fibromas/fibrothecoma - produce oestrogen, spindle appearance
Granuloma cell tumours - low grade, produces oestrogen
Sertoli (sperm, FSH) -leydig (testosterone, LH) tumours - produces androgens
What are the risk factors of ovarian cancer?
Family history Age Smoking Breast cancer (PMH) Oestrogen only HRT Obesity Pull parity
What are the symptoms of ovarian cancer?
Very non-specific - pain, bloating, weight loss
How is ovarian cancer staged?
FIGO
What is the treatment for ovarian cancer?
Chemo Omentectomy Appendectomy Lympadenectomy Hysterectomy
What are the most common places where mullein metastatic tumours occur?
GI tract
Breast
Melanoma
Kidney/lung (less common)
