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OBGYN > GYN pathology registry review > Flashcards

GYN pathology registry review Flashcards

1
Q

Diethylstilbestrol (DES) drug

A

Used to treat threatened miscarriages’ in the 70s
*most commonly associated with T shaped uterus

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2
Q

Arcuate uterus

A

Normal contour, slight indentation of fundal echo

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3
Q

Bicornuate uterus (bicornis unicollis)

A

-1 endometrial cavity dividing into 2 at uterine fundus
-Y shaped
-Fundus has concave contour

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4
Q

Subseptate uterus

A

Normal uterine contour with 2 separate endometrial cavities

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5
Q

Septate uterus

A

-2 completely separate endometrial cavities
-Uterine contour is concave at the fundus
*most common congenital uterine anomaly

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6
Q

Uterus didelphys

A

Complete lack of fusion. 2 vaginas, 2 cervices, 2 uteri

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7
Q

Unicornuate uterus

A

Lack of formation of one duct. Single horn

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8
Q

Congenital uterine malformations result from

A

Incomplete, abnormal fusion or lack of formation of paired Mullerian ducts

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9
Q

Vaginal atresia

A

Absent or closed vagina, cannot be distended. ONLY uterus and cervix will be distended with fluid or blood

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10
Q

Hydrometra

A

Fluid in the uterus

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11
Q

Hematometra

A

Blood in the uterus

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12
Q

Imperforate hymen

A

Closed hymen. Everything above it can be distended

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13
Q

Hymen

A

Small, thin piece of tissue at the opening of the vagina

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14
Q

Adenomyosis

A

Invasion of endometrial tissue into myometrium, either focal or diffuse
*MRI key to diagnosis

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15
Q

Sonographic appearance of adenomyosis

A

-Enlarged uterus with diffusely heterogenous myometrium
-Thickened posterior uterus
-Small cystic spaces scattered throughout myometrium

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16
Q

Clinical presentation of adenomyosis

A

Dysmenorrhea, menometrorrhagia, pelvic pain, dyspareunia, multiparous

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17
Q

Dysmenorrhea

A

Abnormal/painful menses

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18
Q

Menometrorrhagia

A

Heavy uterine bleeding

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19
Q

Dyspareunia

A

Painful intercourse

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20
Q

Leiomyoma (fibroid/myoma)

A

-Benign, smooth muscle tumor
-Stimulated by estrogen
most common benign gyn tumor, leading cause of hysterectomy and gyn surgery

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21
Q

Clinical presentation of leiomyoma

A

Dependent on location/size
Abnormal bleeding, pelvic distention, pressure, infertility, urinary frequency

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22
Q

Sonographic appearance of leiomyoma

A

-Hypoechoic mass with poor through transmission
-Multiple= heterogenous, bulky, enlarged uterus

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23
Q

Intramural leiomyoma

A

-Within the muscle wall of the uterus
-Will not change contour of uterus but may make it bulky
most common

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24
Q

Subserosal leiomyoma

A

-Grows under serosal layer
-Distorts outer contour

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25
Q

Submucosal leiomyoma

A

-Adjacent to endometrium and distorts endometrial contour
-Likely to cause bleeding issues
-Intracavity = pedunculated that project into endometrium

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26
Q

Pedunculated leiomyoma

A

-Subserosal myoma attached to stalk and grown out
-Resemble adnexal masses
-Possible abdominal distension or pelvic pressure

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27
Q

LeiomyoSARcoma

A

-Malignant form of fibroids
-Rapidly growing
-Most common in perimenopausal and postmenopausal women

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28
Q

Cervical carcinoma

A

May present as heterogenous, enlarged cervix with focal mass
*most common female malignancy under age 50

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29
Q

Nabothian Cyst

A

-Benign retention cyst within cervix that may have septation or debri
-Common, usually incidental finding, asymptomatic

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30
Q

Vaginal gartner duct cyst

A

Small cyst located along vaginal wall, asymptomatic

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31
Q

Endometrial Hyperplasia

A

-Increased thickening of endometrium
-Result from unopposed estrogen stimulation
-Most likely diagnosed in postmenopausal women with thickened endo
-Hyperplasia vs. carcinoma (bx to confirm)

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32
Q

Clinical presentation for endometrial hyperplasia

A

Post menopausal bleeding, abnormal uterine bleeding, hx of PCOS, HRT, or tamoxifen treatment

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33
Q

Sonographic appearance of endometrial hyperplasia

A

Abnormal thickening of endo, heterogenous with cystic changes

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34
Q

Endometrial carcinoma

A

-Most common GYN malignancy
-Type of adenocarcinoma
-Linked with nulliparity, obesity, chronic anovulation, estrogen producing ovarian tumors, tamoxifen, unopposed estrogen therapy

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35
Q

Clinical presentation of endometrial carcinoma

A

PMB, abnormal uterine bleeding, elevated CA-125

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36
Q

Sonographic appearance of endometrial carcinoma

A

-Abnormal thickening of endo/heterogenous with cystic changes
-Enlarged hetero uterus
-Polypoidal mass within endo with increased vascularity and low resistance flow

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37
Q

Polypoidal mass

A

A raised lesion that grows outward from the surface of an organ or the lumen of the organ

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38
Q

Endometrial polyps

A

Small nodules of hyperplastic endometrial tissues
-local or diffuse thickening of endometrium (sonohysterography for best visual)
*most likely reason for abnormal bleeding/thick endo in REPRODUCTIVE years

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39
Q

Clinical presentation for endometrial polyps

A

Intermenstrual bleeding, menometrorrhagia, infertility
*could be asymptomatic

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40
Q

Sonographic appearance for singular endometrial polyp

A

Focal thickening of endo

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41
Q

Sonographic appearance for multiple polyps

A

-Diffuse thickening of endometrium
-Echogenic nodules with vascular stalk
-SIS helps nodules easily outlined by fluid

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42
Q

Endometrial atrophy

A

Thinning of endometrium in POSTmenopausal patients
*most common cause of PMB

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43
Q

Clinical presentation for endometrial atrophy

A

Post menopausal bleeding

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44
Q

Sonographic appearance for endometrial atrophy

A

Thin endo < equal to 4mm with possible intracavitary fluid

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45
Q

Asherman syndrome

A

Adhesions or synechiae within the uterine cavity as a result of scar formation after surgery (D&C)

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46
Q

Clinical presentation for asherman syndrome

A

Ammenorrhea or hypomenorrhea, hx of miscarriages or surgery

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47
Q

Sonographic appearance of asherman syndrome

A

-Thin endo with echogenic regions/scarring
-SIS webb like/stringy appearance and visualization of the synechiea

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48
Q

Saline infused Sonohysterography (SIS)

A

A procedure that uses ultrasound and sterile fluid to create images of the uterus and uterine cavity

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49
Q

Polycystic Ovarian Disease (PCOD/PCOS)

A

-ENDOcrine disorder, hormonal imbalance and chronic anovulation
-Menses unable to function normal, follicles do not mature therefore no ovulation
-related to Stein-Leventhal syndrome
*most common cause of infertility

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50
Q

Stein-Leventhal syndrome (PCOS)

A

Obesity, hirsutism, amenorrhea

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51
Q

Hisutism

A

The growth of excessive male-pattern hair in women after puberty

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52
Q

Clinical appearance for PCOD

A

PCOS-obesity, hirsutism, amenorrhea, hypomenorrhea, infertility

53
Q

Sonographic appearance for PCOD (PCOS)

A

-Bilaterally enlarged ovaries with multiple small follicles along periphery (string of pearls)
-Secondary endometrial hyperplasia

54
Q

Endometriosis

A

Ectopic endometrial tissue outside the uterus into the adnexa. Endometrial implants attach anywhere in pelvic/abdomen and localize forming blood filled cysts
-Infertility due to damage and scaring of tubes/ovaries

55
Q

Endometriomas

A

-Blood filled cysts AKA chocolate cysts
-Most common location = ovaries

56
Q

Clinical presentation of endometriosis

A

Dysmenorrhea, dyspareunia, chronic pelvic pain, painful bowel movements, infertility, nulliparity, REPRODUCTIVE age patients

57
Q

Sonographic appearance of endometriosis

A

Cystic mass with low level echoes, anechoic or complex with posterior enhancement, may have fluid

58
Q

Functional infertility

A

Hormone related… PCOS

59
Q

Physical infertility

A

Damages or blockages endometriosis, polyps, chronic PID

60
Q

Clinical appearance of benign focal

A

Asymptomatic or cause cramping due to size or rupture

61
Q

Sonographic appearance of simple benign focal

A

Anechoic, thin, smooth walls with posterior enhancement

62
Q

Sonographic appearance of hemorrhagic focal

A

Complex or echogenic with posterior enhancement

63
Q

Follicular cysts

A

Graafian follicle that fails to rupture and continues to enlarge > 3cm
(may be caused by hyperstimulation from infertility treatment)
*most common adnexal mass

64
Q

Corpus luteal cyst

A

Hemorrhagic “lacy” appearance
*most common adnexal mass in pregnancy

65
Q

Paraovarian cyst

A

Located adjacent or next to ovary. Typically <2cm and asymptomatic. NOT physiologic

66
Q

Thecal lutein cyst

A

-Found ONLY with elevated levels of hCG (>100,000)
-May coincided with gestational trophoblastic disease or multiple gestations

67
Q

Ovarian hyperstimulation syndrome (OHSS)

A

Caused by hCG found in infertility treatments

68
Q

Clinical presentation of thecal lutein cyst

A

Nausea and vomiting, high hCG, possible pain

69
Q

Sonographic appearance of thecal lutein cyst

A

Bilaterally enlarged multiloculate ovarian cyst “grape clusters”, no normal ovarian parenchyma

70
Q

Cystic teratoma (dermoid)

A

Germ cell tumor often seen in REPRODUCTIVE age. Retained of unfertilized ovum composed of 3 layers, may include tissues such as hair, teeth, fat, ect
*most common benign ovarian tumor

71
Q

Most common complication of cystic teratoma/dermoid

A

Ovarian torsion

72
Q

3 layers of dermoid composition

A

ectoderm, mesoderm, endoderm

73
Q

Clinical presentation of cystic teratoma (dermoid)

A

Asymptomatic, palpable mass

74
Q

Sonographic appearance of cystic teratoma (dermoid)

A

Complex, cystic, solid mass

75
Q

Tip of the iceberg (dermoid)

A

Posterior shadowing

76
Q

Dermoid plug

A

Poor thru transmission

77
Q

Dermoid mesh

A

Produce by hair, numerous, linear echoes

78
Q

Clinical presentation of benign ovarian tumors seen in middle aged and PM women

A

Depends on estrogen producing or not, abnormal bleeding, complications of Meigs

79
Q

Sonographic appearance of benign ovarian tumors seen in middle aged and PM women

A

Hypoechoic with poor thru transmission. Some are more complex or have calcification. Secondary endometrial hyperplasia

80
Q

Fibroma

A

NOT associated with estrogen production. NOT related to thick endo or abnormal bleeding
*most common solid benign tumor
*most likely associated with abnormal bleeding

81
Q

Sonographic appearance of fibroma

A

Solid, hypoechoic mass with poor through transmission

82
Q

Meigs syndrome

A

Ascites and pleural effusion in the presence of a benign ovarian tumor

83
Q

Brenner tumor

A

NO estrogen production
Transitional cell tumor that are small, solid and unilateral with calcifications

84
Q

Fibroma and Brenner tumors

A

NO estrogen producing = NO bleeding or endometrial thickening

85
Q

Thecoma and granulosa cell tumors

A

ESTROGEN producing
-Sex cord stromal tumors, related to hormone production

86
Q

Estrogen producing ovarian tumors

A

Unopposed estrogen stimulation leading to endometrial hyperplasia and possibly carcinoma

87
Q

Granulosa cell tumor

A

Unilateral and typically postmenopausel, 10-15% chance of developing endometrial carcinoma due to consistent estrogen production
-Grows larger and faster than thecoma
*most common estrogenic tumor

88
Q

Pediatric granulosa cell tumor

A

Causes pseudoprecocious puberty (breast development), malignant protentional, unpredictable in appearance (solid, hypoechoic, complex mass)

89
Q

Thecoma

A

Most often seen in postmenopausel with PMB, unilateral and hypoechoic

90
Q

Serous cystadenoma

A

-Large cystic mass with thin septations (typically bilateral)
-50-70% benign
-Simple=anechoic
*think s=simple

91
Q

Mucinous cystadenoma

A

-Large, usually unilateral
-Septations and presence of internal debri
-Mucous=debri filled
*think m=mucous

92
Q

Clinical presentation of cystadenomas

A

Asymptomatic or pelvic pressure/swelling to large size

93
Q

Serous cystadenocarcinoma

A

Prominent papillary projections (mural wall nodules/irregularities) and thicker septations
*most common ovarian malignancy

94
Q

Mucinous cystadenocarcinoma

A

Intraperiotoneal extensions of mucin secreting cells, similar to complex ascites

95
Q

Clinical presentation of cystadenocarcinoma

A

Weight loss, pelvic pressure/swelling, abnormal bleeding, GI symptoms, elevated CA-125, acute abdominal pain with torsion or rupture

96
Q

Sonographic appearance of cystadenocarcinoma

A

Cystic mass with thick septation and papillary projections with internal vascularity, abnormal decreased resistance flow patterns

97
Q

Krukenburg tumor

A

Metastasis from GI tract (stomach/gastric), bilateral ovarian masses and ascites

98
Q

Krukenburg tumor symptoms

A

Possible weight loss or pelvic pain, could be asymptomatic

99
Q

Sertoli-Leydig cell tumor (adroblastoma)

A

Sex-cord stromal tumor associated with virilization, may be benign or malignant

100
Q

Virilization

A

Development of masculine qualities and physical characteristics

101
Q

Clinical presentation of sertoli-leydig cell tumor`

A

Abnormal menstruations and hirsutism, women over 30 years old

102
Q

Dysgerminoma

A

Most often seen in younger than 30yr old patients, may be found in pregnancy
*most common malignant germ cell tumor
*male version = seminoma

103
Q

Clinical presentation of dysgerminoma

A

Elevated hCG levels in non-gravida females, tumor marker serum lactate dehydrogenase

104
Q

Yolk sac tumor (endodermal sinus tumor)

A

Rapid growing, present in females less than 20 yr old
*2nd most common malignant germ cell tumor

105
Q

Clinical presentation of yolk sac tumor (endodermal sinus tumor)

A

Elevated AFP in non gravida female

106
Q

Ovarian torsion

A

-Result from ovary twisting on its mesenteric connection and cutting off blood supply
-Can be complete or partial
-Usually caused by ovarian mass or cyst
*most commonly on right side

107
Q

Clinical presentation of ovarian torsion

A

Acute unilateral pain, nausea, vomiting

108
Q

Sonographic presentation of ovarian torsion

A

Enlarged heterogenous ovary with diminished or lack of blood flow, hemorrhagic cyst or tumor may be present

109
Q

Abnormal vascular networks

A

Low resistance; malignant masses want to grow and invade

110
Q

Abnormal doppler patterns expected with malignancy

A

Resistive index (RI) < .40
Elevated velocity >15cm/s
Absence of diastolic notch

111
Q

Arteriovenous malformation (AVM)

A

Abnormal connections between arterial and venous channels
*more likely to form post D/C or miscarriage

112
Q

Mucinous cystadenocarcinoma

A

Intraperiotoneal extensions of mucin secreting cells, similar to complex ascites

113
Q

Appearance of PW of AVM

A

High velocity flow, turbulent and low resistant

114
Q

Pelvic inflammatory disease (PID)

A

Infection of the upper genital tract, typically starts from outside and extends internally
*most common initial clinical presentation is vaginitis

115
Q

Risk factors for PID

A

Previous hx of PID, post abortion/ surgery, post childbirth, douching, multiple sex partners, early sexual contact
*STD (chlamydia and gonorrhea)

116
Q

Progressed PID

A

Can affect uterus, fallopian tubes, possibly ovaries. Eventually causes damage and is chronic if organs are damaged

117
Q

Acute infection

A

Active infection/inflammation
*fever and leukocytosis related to active infection

118
Q

Chronic infection

A

Damage that is caused by infection

119
Q

Clinical presentation for acute PID

A

Hx of STD, fever, chills, pelvic pain/tenderness, purulent vaginal discharge, vaginal bleeding, dyspareunia, leukocytosis

120
Q

Sonographic appearance for acute PID

A

Endometritis, pyosalpinx or hydrosalpinx, free fluid in cul de sac, complex adnexa mass

121
Q

Pyosalpinx

A

A condition where pus accumulates in a fallopian tube, usually due to a bacterial infection that spreads from the lower genital tract

122
Q

Clinical presentation of chronic PID

A

Chronic pelvic/abdominal pain, infertility (adhesions), palpable adnexal mass, irregular menses, vaginal discharge

123
Q

Sonographic appearance of chronic PID

A

Hydrosalpinx, adhesions seen as echogenic bands within tube, complex adnexal masses

124
Q

Stage 1PID

A

Acute, confined to uterus.
-Evidence of endometritis (thick endo/heterogenous)

125
Q

Stage 2 PID

A

Spread into tubes and adnexa, evidence of salpingitis, hydrosalpinx or pyosalpinx. Hyperemia of tube

126
Q

Hyperemia

A

Increased blood flow

127
Q

Stage 3 PID

A

Severe progression of infection into adnexa. Bilateral complex adnexal masses
*remains chronic

128
Q

Tubo-ovarian complex/abscess

A

PID progression to adnexa. Adhesions develop between tubes and ovaries leading to fusion

OBGYN (17 decks)

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