GYNE SE2 uterus lesions Flashcards
MC benign lesion of uterus
leiomyoma
other names of leiomyoma
myoma, fibroids, fibromyoma
MC location of myomas
BODY of uterus
5 types of myomas based on position in the uterus
intramural (MC), subserous, submucous – also, broad ligament and intracavitary
all myomas start as ______ type
intramural
knobby contour during PE
subserous myoma (kasi nakakapa mo siya dahil nasa serosa nga)
called parasitic myoma if super laki na
subserous myoma
most troublesome, assoc with bleeding and distortion of uterine cavity
submucous myoma
seen as HUMPS and BUMPS in d and c
submucous myoma
Ddx of broad ligament myoma
adnexal mass
current theory for myoma etiology
SOMATIC MUTATION of myocyte, with contributions from estrogen and progesterone
gross appearance of myoma
gllistening pearl white, smooth muscle in whorled appearance, with PSEUDOcapsule
true or false – more fibrous tissue in histo slide == more atrophy and degeneration
TRUE
fate of myomas depend on _____
BLOOD SUPPLY (less blood supply, more degeneration)
three degrees of degeneration
hyaline, red/carneous/infarction, malignant
mildest and MC degree of degeneration
hyaline
most acute form of degeneration
red/carneous/infarction – CAUSES SEVERE PAIN
malignant degeneration into what type of CA?
leiomyoSARCOMA
three main symptoms of myoma
pressure sx (urinary frequency, constip, hydroureter), pelvic pain (dysme), AUB (menorrhagi)
classic sign of development of leiomyosarcoma
rapid growth of uterine myoma AFTER menopause (cos dapat liliit na siya pag menopause cos la na hormones)
diagnosis for myoma
pelvic exam and ultrasound
diagnostic and therapeutic for SUBMUCOSAL myoma
hysteroscopy
main indication for myomectomy
women who want to get pregnant pa
main indication for hysterectomy
kung cancer talaga, and kung complete na ang reproductive career
most common medical tx to reduce estrogen and progesterone circulating levels
GnRH agonist
advantages of medical tx before surgery
uterine fibroid shrinkage AND induction of amenorrhea
mgt for prolapsed myoma of the cervix
Hysteroscopic resection then Abx coverage
newest modality, ambulatory non surgical technique
transcatheter UTERINE ARTERY embolization
gross appearance of “intravenous leiomyomatosis”
SPAGHETTI tumor (cos smooth muscles invade the venous channels of pelvis and abd peritoneum)
benign dse with multiiple small nodules over the surface of pelvic and abd peritoneum
Leiomyomatosis Peritonealis Disseminata (as in disseminated yung leiomyoma sa peritoneum)
localized overgrowths of endometrial gland and stroma BEYOND the surface of endometrium
endometrial polyps
main symptom of endometrial polyps
wide range of ABNORMAL BLEEDING patterns
MC loction of polyps
FUNDUS of the uterus
appearance of immature endometrium of endometrial polyps
swiss cheese
rate of malignant transformation of polyps
0.50%
benign condition in which numerous small polyps are discovered throughout the endometrial cavity
POLYPOID hyperplasia
diagnostic criteria of endometrial polyps (MUST KNOW)
endometrial glands, endometrial stroma, central vascular channels
management of polyps
remove by hysteroscopy or curettage THEN biopsy (impt)
uterus is distended with blood and is secondary to gynatresia
hematometra
2 MC congenital causes of hematometra
imperforate hymen AND transverse vaginal septum
main ssx of hematometra
primary or secondary amenorrhea, AND cyclic lower abd pain
infection of accumulated blood
pyometra
how to diagnose hematometra
vaginal UTZ or pag dinilate mo cervix may dark brown black blood na lalabas
major determinant of pre-malignant potential of endometrial hyperplasia
degree of cytologic atypia
four classifications of endometrial hyperplasia
simple, complex, atypical simple, atypical complex
swiss cheese hyperplasia
simple hyperplasia
crowded glands with budding and infolding in decreased stroma
complex hyperplasia
hyperplasia type with greatest premalignant potential
atypical complex hyperplasia
main sx of endometrial hyperplasia
abnormal vaginal bleeding
diagnostic and therapeutic for simple and complex hyperplasia
D and C
tx for atypical complex hyperplasia BUT wants kids pa
continuous high dose progestin (megestrol acetate 40 mg tid-qid)
tx for atypical complex hyperplasia AND ayaw na ng kids / old na
hysterectomy
tx for atypical complex hyperplasia AND ayaw na ng kids BUT di kaya ng surgery
LONG TERM high dose progestine (megestrol acetate 40-160mg per day)
MC malignancy of the female genital tract
endometrial cancer
poorer prognosis, older postmenopausal women, with NO HISTORY of endometrial hyperplasia
estrogen INDEPENDENT (the opposite is true for estrogen dependent)
main ssx of endometrial cancer
postmenopausal bleeding AND abnormal premenopausal and perimenopausal bleeding
diagnostic procedure of choice for endo CA
fractional D and C (endocervix first then endometrium)
grading of endo CA is based on ________
percentage of SOLID COMPONENTS in the tumor (less than 6, 6-50, more than 50%)
endo CA with desmoplastic stroma
endometrioid CA
endo CA wherein cells have hobne (?) configuration arranged in papilla with hyalinized stalk
Clear cell CA
uterine papillary serous CA with high rate of extrauterine disease
Serous CA
diagnosed in the presence of progestational stimulation
secretory CA
endo CA with poor prognosis
papillary serous, clear cell, poorly differentiated tumors
LN mets of endo ca goes to
inguinal femoral nodes, paraaortic nodes, and pelvic nodes
three types of hysterectomy for endo ca
supracervical or subtotal, total, radical
two types of surgical techniques for hysterectomy
traditional/open AND minimally invasive
meaning of tahbso and blnd
total abdominal hysterectomy with bilateral salpingo-oophorectomy AND bilateral lymph node dissection
classification of uterine sarcomas is based on _____
presence of either homologous or heterologous tissue
MC uterine sarcoma
leiomyosarcoma (homologous type)
diagnosis of leiomyosarcoma
> 5 mitosis per 10 HPO field with cytologic atypia (benign if 10)
most active single agent against leiomyosarcoma
doxorubicin
