GYN Flashcards
salpingitis isthmica nodosa
AUNT MINNI
-nodular scarring prox 2/3 FT
cervical cancer important staging
IIA-beyond cervix but no parametrical invasion=sx
IIB-parametral involvement but no ext to pelvic side wall-crx/rad
parametrium
fibrous band separating supravaginal cerix from bladder. ext btw layers of broad lig
- imp bc uterine a runs inside-CRX > sx once invaded
- invasion? loss of T2 dark ring normally surrounding cervix
org of met to:
- ant wall upper 1/3
- pst wall lower 1/3
- upper genital
- GI
cervical/vaginal cysts
- nabothian
- gartner
- bartholin
- skene-periurethral glands –> recurr UTIs, obstruction
embryologic org: mullerian duct, wolffian duct, UG sinus
- MD-uterus, FT, upper 2/3 vag
- WD-vd, sv, epididymis
- UG sinus-prostate, lower 1/3 bag
arcuate uterus
mild smooth concavity of uterine fundus (instead of normal straight/convex)
critical endometrial stage
2 (cervical stroma invasion)-high risk LN mets
-IA (<50%) –> IB (>50%) also increase risk LN mets
endometrial cancer img
-T1 iso, T2+ish, hypoenh, DW+
cumulus oophorus
collection of cells in mature dominant follicle signaling imminent ovulation)
fertility mds
clomiphene citrate
theca lutein cysts ass
- multifetal pregn
- gestational trophoblastic dx
- ovarian hyperstimulation syndrome
thecae lutein cysts physio
- functional cyst rel to overstep from b-hcg
- large 2-3cm cysts w/ ML/spokewheel app
ovarian hyperstimulation syndrome
- effusions
- ascites
- shock
next step: ovarian cyst on CT and US, size cut off
-CT: 3cm (premeno) & 1cm (post meno) cutoffs for US
US: 7 cm (premeno), 5 cm (post meno)-for 3mo f/u
max ovarian volume in post meno woman
6mL
-8cc at 40 –> 1cc at 70
fibroid types
hyaline-MC
hypercellular-resp well to embo
lipoleiomyoma
img hyaline fibroid
-T1/2 dark, homog enh
img hyper cellular fibroid-
T1-
T2+ (tightly packed SM cells)
-homog enh
img lipoleiomyoma
T1+, T2+, high rim enh
fibroid degeneration types
- none enh (dead tissue), ex: myxoid minimally
1) hyaline (Classic)-fibroid outgrows bs –> accumulation proteinaceous tissue (var, but usually T1/2(-)
2) red (corneous)-venous thrombosis during pregnancy. T1 bright rim (classic)
3) myxoid-uncommon. T1-, T2+, minimal enh
4) cystic degen-uncommon. T1-, T2+, no enh
normal myometrial junctional zone
<5mm
tamoxifen on endom
polyps
HP
cancer
T2 shading
T2 shortening (darkening) of a lesion that is T1 bright
endometrioma cancer risk
- endometroid
- clear cell
next step: ovarian solid nodule w/o flow
- US-r/o dermoid
- if not dermoid-call sx
serous vs mutinous cystadenocarcinoma
- serous-UL (fewer sept), BL, papillary prj, ascites =mets
- mucinous-ML, pseudomyxoma peritonea, pap prj less common
adult big abd mases
ovarian
desmoid
sarcoma
ovarian cancer rfs
-smoking known for mucinous
endometroid ovarian cancer
2nd MC
- BL 15%
- from endometrial cancer (25%) or from endometrioma
order of ovarian cancer incidence
1) serous
2) endometroid
3) mutinous
hydrosalpinx signs
- “cogwheel”=normal longitudinal folds bc thickening
- “string sign-incomplete septae
- “waste sign”-tubular mass w/ indentation of its opposing walls-differentiates hyrdosalpinx from ovarian mass”
ovarian fibroma & fibrothecoma
- benign tumor of middle aged women
- T2- band (vs fibroid)
- no Ca (vs brenner tumor)
Meigs syndrome
- ascites
- pleural eff
- benign ovarian tumor (fibroma mc)
Fibromatosis
tumor like enlargement of ovaries due to ovarian fibrosis
- 25 yo girl
- ass-omental fibrosis, sclerosis peritonitis
- bw for T2 sign=black garland sign
- mx-+/- sx
brenner tumor/ovarian transitional cell carcinoma
- ovarian epithelial tumor 50-70yo
- Ca v common (vs fibroma/fibrothecoma)
struma ovarii
- subtype of ovarian teratoma containing thyroid tissue rel to hyperTh
- img: dark thick colloid in otherwise T2+ cyst
ovarian mets
10%
- colon, gastric, breast, lung, CL ovary
- krukenburg-from GI (usually stomach)
peritoneal inclusion cyst
passive (lad of walls) fluid filled mass that conforms to shape of pelvis and surr ovary
gestational trophoblastic dx types
- complete (70%)-entire placenta, no fetus, diploid karyotype.
- partial (30%-partial placenta, triploidy fetus
img gestational trophoblastic dx
- complete: 1st TM=snowstorm, highly vas. 2nd TM-bunch of grapes (cysts)
- partial: enlarged placenta; mult diff anechoic lesions. +/-fetal parts
- theca lutein cysts
complications gestational trophoblastic dx
- hyperemesis (b-hcg)
- future mole
- invasive (myom)
- chorioCA-myom, parametric, hematog to body
invasive myom appearance
-masses, dilated vess, areas of hem/necr
choriocarcinoma-what, hx, img, rx
- only trophoblasts (no villous)
- myo/parametrium and hematog spread
- v vasular (bleed like stink!)
- b-hcg rise 8-10 wks after evaluation molar pregn
- mx-MTX
endom polyp vs subendo fibroid vs endom cancer
poly:
- hyper or hypoechoic
- acute angles
- stalk w/ central vessel
subendo fibroid: broad base -obtuse angle -MF per vascularity -htpoecho w/ overlying hyperechoi endom
cancer:
- flat, irregular; can be polypoid
- myom invasion
size of nodules in an endometrioma concerning for malignancy
3mm
US dx accuracy of endometrioma
90% (same as MRI)
azzopardi syndrome
testicular Ca not associated with mass, ie: burnt out testicular cancer
classic vs limited testicular microlithiasis
class 5+ Ca in img. Ass with GCT (limited <5, not ass)
theca lutein cysts in setting of molar pregnancy
20-60%
resolve 6-8 wks after involution
-ass w/ increased risk gestation trophoblastic mal
junctional zone invasive endom CA or vs invasive mole vs adenomyosis
disrupted rather than thickened
