Gynae Flashcards
Turner syndrome
XO
Aortic coactation
horseshoe kidney
Pre puberty uterus and streaky ovaries
Re SIN- Salpingitis Isthmica Nodosa
What is it?
Aetiology?
Symptoms?
This is a nodular scarring of the fallopian tubes involving the proximal 2/3 of the tube.
Unknown aetiology, post infectious/inflam
Associated with infertility and ectopic pregnancy
Re uterine AVM:
Causes
Doppler?
Acquired after D&C, Abortion, C section, multiple pregnancies
Doppler: Serpingous , tubular anechoic structures within the myometrium with high velocity colour doppler flow.
Intrauterine adhesions/ Ashermans
- What is it?
- HSG?
This is scarring in the uterus secondary to injury : prior D&C, surgery, pregnancy, and infection (GU TB).
- Non filing of the uterus,
- Multiple irregular linear filling defect with inability to distend the endometrium.
Can result in infertility
MRI appearances of Ashermans
Bands of T2 dark .
Fibroid/ uterine leiomyoma
Location?
Locations: Intramural, subserosal, submucosal
Fibroid appearance:
Can look like anything…
USS: Hypoechoic, with peripheral blood flow in a Venetian band pattern
CT: Peripheral calcification- popcorn on X ray
MRI: T1 and T2 dark with variable enhancement.
What are the 4 types of degeneration?
- Hyaline: most common- T2 dark, no enhancement post Gd
- Red (carneus): During pregnancy. Cause of venous thrombosis. Peripheral rim of T1 high signal- T2 variable
- Myxoid: Uncommon, T1 dark, T2 bright, minimal enhancement
- Cystic: Uncommon
This type of fibroid degeneration happens during pregnancy and is a common cause of venous thrombosis:
Red degeneration
Typical appearance of fibroid red degeneration :
Peripheral rim of T1 high signal- T2 variable
Name the degeneration:
1) T2 dark:
2) T1 bright rim
3) T2 bright
1) T2 dark: Hyaline
2) T1 bright rim: Red
3) T2 bright: Myxoid
Re adenomyosis:
- Define it
- RF?
This is endometrial tissue that has migrated into myometrium.
Mostly seen in multiparous women of reproductive age
RF: History of uterine procedures: C section, D&C
Most common location for adenomyosis:
Usually at the posterior wall but sparring the cervix.
Causes marked enlargement of the uterus with preservation of the overall contour.
Appearances of the adenomyosis:
Thickening of the junctional zone of uterus >12mm (normal <5mm). The thickening can be focal or diffuse
- Small high T2 signal regions –> cystic changes is a classic findings.
HSG: small diverticula extending from endometrial cavity into myometrium.
When would you sample endometrium in post menopausal women?
> 5MM
Which group of patients with colorectal cancer would have an increased risk of endometrial cancer?
Hereditary Non Polyposis of Colon Cancer HNPCC
Which group of tumours will thicken the endometrium?
Oestrogen secreting tumours- Granulosa Cell tumours of the ovary.
What is the effect of tamoxifen on endometrium?
This is a SERM- acts like oestrogen in the pelvis- it blocks the effect of oestrogen on the breast. But increases the risk of endometrial cancer.
Endometrial cysts and polyps.
What is the upper limit of normal for endometrial thickness for women on tamoxifen
8mm
What are the two causes of endometrial fluid in post menopausal women?
- Cervical stenosis
2. Obstructing mass
What type of cancer is cervical cancer?
Squamous cell related to HPV.
Staging of cervical cancer: FIGO
I: confined to uterus/ cervix
IIa: Spread beyond the cervix ( to upper 2/3 of vagina), but NO parametrial invasion- surgery
IIb: Parametrial involvement but DOES NOT extend to pelvic side wall- Chemo/ radiation
IIIa: invasion into lower 1/3 of vagina
IIIb: Pelvic side wall invasion +/- hydronephrosis.
IV: distant metastases.
Management of cervical cancer:
IIa or below: surgery
IIb: Parametrial invasion or involvement of the lower 1/3 of vagina : chemo/ radiation
What is parametrium?
This is a fibrous band that separates the supravaginal cervix from the bladder. It extends between the layers of broad ligament.
The uterine artery runs inside the parametrium- hence the need for chemo-once invaded.