GYN pathology registry review Flashcards
Diethylstilbestrol (DES) drug
Used to treat threatened miscarriages’ in the 70s
*most commonly associated with T shaped uterus
Arcuate uterus
Normal contour, slight indentation of fundal echo
Bicornuate uterus (bicornis unicollis)
-1 endometrial cavity dividing into 2 at uterine fundus
-Y shaped
-Fundus has concave contour
Subseptate uterus
Normal uterine contour with 2 separate endometrial cavities
Septate uterus
-2 completely separate endometrial cavities
-Uterine contour is concave at the fundus
*most common congenital uterine anomaly
Uterus didelphys
Complete lack of fusion. 2 vaginas, 2 cervices, 2 uteri
Unicornuate uterus
Lack of formation of one duct. Single horn
Congenital uterine malformations result from
Incomplete, abnormal fusion or lack of formation of paired Mullerian ducts
Vaginal atresia
Absent or closed vagina, cannot be distended. ONLY uterus and cervix will be distended with fluid or blood
Hydrometra
Fluid in the uterus
Hematometra
Blood in the uterus
Imperforate hymen
Closed hymen. Everything above it can be distended
Hymen
Small, thin piece of tissue at the opening of the vagina
Adenomyosis
Invasion of endometrial tissue into myometrium, either focal or diffuse
*MRI key to diagnosis
Sonographic appearance of adenomyosis
-Enlarged uterus with diffusely heterogenous myometrium
-Thickened posterior uterus
-Small cystic spaces scattered throughout myometrium
Clinical presentation of adenomyosis
Dysmenorrhea, menometrorrhagia, pelvic pain, dyspareunia, multiparous
Dysmenorrhea
Abnormal/painful menses
Menometrorrhagia
Heavy uterine bleeding
Dyspareunia
Painful intercourse
Leiomyoma (fibroid/myoma)
-Benign, smooth muscle tumor
-Stimulated by estrogen
most common benign gyn tumor, leading cause of hysterectomy and gyn surgery
Clinical presentation of leiomyoma
Dependent on location/size
Abnormal bleeding, pelvic distention, pressure, infertility, urinary frequency
Sonographic appearance of leiomyoma
-Hypoechoic mass with poor through transmission
-Multiple= heterogenous, bulky, enlarged uterus
Intramural leiomyoma
-Within the muscle wall of the uterus
-Will not change contour of uterus but may make it bulky
most common
Subserosal leiomyoma
-Grows under serosal layer
-Distorts outer contour
Submucosal leiomyoma
-Adjacent to endometrium and distorts endometrial contour
-Likely to cause bleeding issues
-Intracavity = pedunculated that project into endometrium
Pedunculated leiomyoma
-Subserosal myoma attached to stalk and grown out
-Resemble adnexal masses
-Possible abdominal distension or pelvic pressure
LeiomyoSARcoma
-Malignant form of fibroids
-Rapidly growing
-Most common in perimenopausal and postmenopausal women
Cervical carcinoma
May present as heterogenous, enlarged cervix with focal mass
*most common female malignancy under age 50
Nabothian Cyst
-Benign retention cyst within cervix that may have septation or debri
-Common, usually incidental finding, asymptomatic
Vaginal gartner duct cyst
Small cyst located along vaginal wall, asymptomatic
Endometrial Hyperplasia
-Increased thickening of endometrium
-Result from unopposed estrogen stimulation
-Most likely diagnosed in postmenopausal women with thickened endo
-Hyperplasia vs. carcinoma (bx to confirm)
Clinical presentation for endometrial hyperplasia
Post menopausal bleeding, abnormal uterine bleeding, hx of PCOS, HRT, or tamoxifen treatment
Sonographic appearance of endometrial hyperplasia
Abnormal thickening of endo, heterogenous with cystic changes
Endometrial carcinoma
-Most common GYN malignancy
-Type of adenocarcinoma
-Linked with nulliparity, obesity, chronic anovulation, estrogen producing ovarian tumors, tamoxifen, unopposed estrogen therapy
Clinical presentation of endometrial carcinoma
PMB, abnormal uterine bleeding, elevated CA-125
Sonographic appearance of endometrial carcinoma
-Abnormal thickening of endo/heterogenous with cystic changes
-Enlarged hetero uterus
-Polypoidal mass within endo with increased vascularity and low resistance flow
Polypoidal mass
A raised lesion that grows outward from the surface of an organ or the lumen of the organ
Endometrial polyps
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
Clinical presentation for endometrial polyps
Intermenstrual bleeding, menometrorrhagia, infertility
*could be asymptomatic
Sonographic appearance for singular endometrial polyp
Focal thickening of endo
Sonographic appearance for multiple polyps
-Diffuse thickening of endometrium
-Echogenic nodules with vascular stalk
-SIS helps nodules easily outlined by fluid
Endometrial atrophy
Thinning of endometrium in POSTmenopausal patients
*most common cause of PMB
Clinical presentation for endometrial atrophy
Post menopausal bleeding
Sonographic appearance for endometrial atrophy
Thin endo < equal to 4mm with possible intracavitary fluid
Asherman syndrome
Adhesions or synechiae within the uterine cavity as a result of scar formation after surgery (D&C)
Clinical presentation for asherman syndrome
Ammenorrhea or hypomenorrhea, hx of miscarriages or surgery
Sonographic appearance of asherman syndrome
-Thin endo with echogenic regions/scarring
-SIS webb like/stringy appearance and visualization of the synechiea
Saline infused Sonohysterography (SIS)
A procedure that uses ultrasound and sterile fluid to create images of the uterus and uterine cavity
Polycystic Ovarian Disease (PCOD/PCOS)
-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
Stein-Leventhal syndrome (PCOS)
Obesity, hirsutism, amenorrhea
Hisutism
The growth of excessive male-pattern hair in women after puberty
Clinical appearance for PCOD
PCOS-obesity, hirsutism, amenorrhea, hypomenorrhea, infertility
Sonographic appearance for PCOD (PCOS)
-Bilaterally enlarged ovaries with multiple small follicles along periphery (string of pearls)
-Secondary endometrial hyperplasia
Endometriosis
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
Endometriomas
-Blood filled cysts AKA chocolate cysts
-Most common location = ovaries
Clinical presentation of endometriosis
Dysmenorrhea, dyspareunia, chronic pelvic pain, painful bowel movements, infertility, nulliparity, REPRODUCTIVE age patients
Sonographic appearance of endometriosis
Cystic mass with low level echoes, anechoic or complex with posterior enhancement, may have fluid
Functional infertility
Hormone related… PCOS
Physical infertility
Damages or blockages endometriosis, polyps, chronic PID
Clinical appearance of benign focal
Asymptomatic or cause cramping due to size or rupture
Sonographic appearance of simple benign focal
Anechoic, thin, smooth walls with posterior enhancement
Sonographic appearance of hemorrhagic focal
Complex or echogenic with posterior enhancement
Follicular cysts
Graafian follicle that fails to rupture and continues to enlarge > 3cm
(may be caused by hyperstimulation from infertility treatment)
*most common adnexal mass
Corpus luteal cyst
Hemorrhagic “lacy” appearance
*most common adnexal mass in pregnancy
Paraovarian cyst
Located adjacent or next to ovary. Typically <2cm and asymptomatic. NOT physiologic
Thecal lutein cyst
-Found ONLY with elevated levels of hCG (>100,000)
-May coincided with gestational trophoblastic disease or multiple gestations
Ovarian hyperstimulation syndrome (OHSS)
Caused by hCG found in infertility treatments
Clinical presentation of thecal lutein cyst
Nausea and vomiting, high hCG, possible pain
Sonographic appearance of thecal lutein cyst
Bilaterally enlarged multiloculate ovarian cyst “grape clusters”, no normal ovarian parenchyma
Cystic teratoma (dermoid)
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
Most common complication of cystic teratoma/dermoid
Ovarian torsion
3 layers of dermoid composition
ectoderm, mesoderm, endoderm
Clinical presentation of cystic teratoma (dermoid)
Asymptomatic, palpable mass
Sonographic appearance of cystic teratoma (dermoid)
Complex, cystic, solid mass
Tip of the iceberg (dermoid)
Posterior shadowing
Dermoid plug
Poor thru transmission
Dermoid mesh
Produce by hair, numerous, linear echoes
Clinical presentation of benign ovarian tumors seen in middle aged and PM women
Depends on estrogen producing or not, abnormal bleeding, complications of Meigs
Sonographic appearance of benign ovarian tumors seen in middle aged and PM women
Hypoechoic with poor thru transmission. Some are more complex or have calcification. Secondary endometrial hyperplasia
Fibroma
NOT associated with estrogen production. NOT related to thick endo or abnormal bleeding
*most common solid benign tumor
*most likely associated with abnormal bleeding
Sonographic appearance of fibroma
Solid, hypoechoic mass with poor through transmission
Meigs syndrome
Ascites and pleural effusion in the presence of a benign ovarian tumor
Brenner tumor
NO estrogen production
Transitional cell tumor that are small, solid and unilateral with calcifications
Fibroma and Brenner tumors
NO estrogen producing = NO bleeding or endometrial thickening
Thecoma and granulosa cell tumors
ESTROGEN producing
-Sex cord stromal tumors, related to hormone production
Estrogen producing ovarian tumors
Unopposed estrogen stimulation leading to endometrial hyperplasia and possibly carcinoma
Granulosa cell tumor
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
Pediatric granulosa cell tumor
Causes pseudoprecocious puberty (breast development), malignant protentional, unpredictable in appearance (solid, hypoechoic, complex mass)
Thecoma
Most often seen in postmenopausel with PMB, unilateral and hypoechoic
Serous cystadenoma
-Large cystic mass with thin septations (typically bilateral)
-50-70% benign
-Simple=anechoic
*think s=simple
Mucinous cystadenoma
-Large, usually unilateral
-Septations and presence of internal debri
-Mucous=debri filled
*think m=mucous
Clinical presentation of cystadenomas
Asymptomatic or pelvic pressure/swelling to large size
Serous cystadenocarcinoma
Prominent papillary projections (mural wall nodules/irregularities) and thicker septations
*most common ovarian malignancy
Mucinous cystadenocarcinoma
Intraperiotoneal extensions of mucin secreting cells, similar to complex ascites
Clinical presentation of cystadenocarcinoma
Weight loss, pelvic pressure/swelling, abnormal bleeding, GI symptoms, elevated CA-125, acute abdominal pain with torsion or rupture
Sonographic appearance of cystadenocarcinoma
Cystic mass with thick septation and papillary projections with internal vascularity, abnormal decreased resistance flow patterns
Krukenburg tumor
Metastasis from GI tract (stomach/gastric), bilateral ovarian masses and ascites
Krukenburg tumor symptoms
Possible weight loss or pelvic pain, could be asymptomatic
Sertoli-Leydig cell tumor (adroblastoma)
Sex-cord stromal tumor associated with virilization, may be benign or malignant
Virilization
Development of masculine qualities and physical characteristics
Clinical presentation of sertoli-leydig cell tumor`
Abnormal menstruations and hirsutism, women over 30 years old
Dysgerminoma
Most often seen in younger than 30yr old patients, may be found in pregnancy
*most common malignant germ cell tumor
*male version = seminoma
Clinical presentation of dysgerminoma
Elevated hCG levels in non-gravida females, tumor marker serum lactate dehydrogenase
Yolk sac tumor (endodermal sinus tumor)
Rapid growing, present in females less than 20 yr old
*2nd most common malignant germ cell tumor
Clinical presentation of yolk sac tumor (endodermal sinus tumor)
Elevated AFP in non gravida female
Ovarian torsion
-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
Clinical presentation of ovarian torsion
Acute unilateral pain, nausea, vomiting
Sonographic presentation of ovarian torsion
Enlarged heterogenous ovary with diminished or lack of blood flow, hemorrhagic cyst or tumor may be present
Abnormal vascular networks
Low resistance; malignant masses want to grow and invade
Abnormal doppler patterns expected with malignancy
Resistive index (RI) < .40
Elevated velocity >15cm/s
Absence of diastolic notch
Arteriovenous malformation (AVM)
Abnormal connections between arterial and venous channels
*more likely to form post D/C or miscarriage
Mucinous cystadenocarcinoma
Intraperiotoneal extensions of mucin secreting cells, similar to complex ascites
Appearance of PW of AVM
High velocity flow, turbulent and low resistant
Pelvic inflammatory disease (PID)
Infection of the upper genital tract, typically starts from outside and extends internally
*most common initial clinical presentation is vaginitis
Risk factors for PID
Previous hx of PID, post abortion/ surgery, post childbirth, douching, multiple sex partners, early sexual contact
*STD (chlamydia and gonorrhea)
Progressed PID
Can affect uterus, fallopian tubes, possibly ovaries. Eventually causes damage and is chronic if organs are damaged
Acute infection
Active infection/inflammation
*fever and leukocytosis related to active infection
Chronic infection
Damage that is caused by infection
Clinical presentation for acute PID
Hx of STD, fever, chills, pelvic pain/tenderness, purulent vaginal discharge, vaginal bleeding, dyspareunia, leukocytosis
Sonographic appearance for acute PID
Endometritis, pyosalpinx or hydrosalpinx, free fluid in cul de sac, complex adnexa mass
Pyosalpinx
A condition where pus accumulates in a fallopian tube, usually due to a bacterial infection that spreads from the lower genital tract
Clinical presentation of chronic PID
Chronic pelvic/abdominal pain, infertility (adhesions), palpable adnexal mass, irregular menses, vaginal discharge
Sonographic appearance of chronic PID
Hydrosalpinx, adhesions seen as echogenic bands within tube, complex adnexal masses
Stage 1PID
Acute, confined to uterus.
-Evidence of endometritis (thick endo/heterogenous)
Stage 2 PID
Spread into tubes and adnexa, evidence of salpingitis, hydrosalpinx or pyosalpinx. Hyperemia of tube
Hyperemia
Increased blood flow
Stage 3 PID
Severe progression of infection into adnexa. Bilateral complex adnexal masses
*remains chronic
Tubo-ovarian complex/abscess
PID progression to adnexa. Adhesions develop between tubes and ovaries leading to fusion
