Disorders of the female genital tract 2 Uterus and ovaries Flashcards by Rob Mackenzie

What is endometriosis?

Ectopic presence of endometrium stroma/glands in other sites (mostly fallopian tubes/ovaries)

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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

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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

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How is endometriosis investigated?

Laparoscopy

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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)

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What are the usual causes for acute endometritis?

Retained contraceptive products/ instrumentation

Complicated labour

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What is the associated histological findings of acute endometritis?

Neutrophils in the stroma/manifestations of acute inflammation

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What are the main causes of chronic endometritis?

Pelvic inflammatory disease
TB/Chlamydia
Inter uterine contraceptive device infection

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What are the histological findings of chronic endometritis?

Lymphocytes/plasma cels

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What are the symptoms/signs associated with endometritis?

Abdominal pain
Dysuria
Vaginal discharge
Abnormal vaginal bleeds
Pyrexia

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What is the treatment for endometritis?

Analgesia
Antibiotics
Remove cause

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What are endometrial polyps?

Sessile/polypoidal uterine overgrowths that are oestrogen dependent

Occur in 10% women (40-50s)

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What are the symptoms of endometrial polyps

Can be asymptomatic
Inter-menstrual bleeding
postmenopausal bleeding
Dysmenorrhoea
Menorrhagia

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How are endometrial polyps diagnosed?

Ultrasound

Hysteroscopy

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What is the treatment for endometrial polyps?

GnRH agonist/progesterone

Surgical

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What are leiomyomata (uterine fibroids)?

Benign myometrial tumours with oestrogen and progesterone dependent growth

Usually gone after menopause

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What are the main risk factors for leiyomata (uterine fibroids)?

Anything that increase oestrogen production! 
Genetic
Nulliparity (not having kids)
PCOS
Obesity

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What are the main symptoms for leiomyomata? (uterine fibroids)

Asymptomatic (can be)
Menometrorrhagia (painful, heavy bleeds - result in anaemia)
Infertility
Problems with pregnancy

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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

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What is endometrial hyperplasia and whats it caused by?

Excess proliferation of endometrium

Caused by increased oestrogen and reduced progesterone

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What are the risk factors for endometrial hyperplasia?

Obesity
PCOS
Oestrogen producing tumours
Exogenous oestrogen

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How are endometrial hyperplasia categorised?

Non-atypical hyperplasia (low risk of turning malignant)

Atypical hyperplasia (high risk)

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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)