Lecture 9: Benign Conditions of Uterus, Cervix, Ovary and FT's Flashcards
Most common congenital cervical anomalies are a result of what?
Malfusion of the paramesonephric ducts
What is a uterus didelphysis?
2 separate uterine bodies w/ its own cervix, attached fallopian tube and vagina
A small T-shaped endometrial cavity or cervical collar deformity have historically been seen w/ exposure to what?
DES
What is the most common neoplasm of the uterus and what does it arise from?
- Uterine leiomyomas “fibroids”
- Benign tumors derived from local proliferation of smooth muscle cells of myometrium
Uterine leiomyomas “fibroids” are generally asymptomatic, but if symptomatic, what sx’s are seen and this is the most common indication for what?
- Excessive uterine bleeding, pelvic pressure, pain and infertility
- Most common indication for hysterectomy
What are 4 risk factors for developing uterine leiomyomas “fibroids?”
- ↑ age during reproductive years
- African American women have 2-3 fold ↑ risk
- Nulliparity
- Family hx
What are the gross characteristics of uterine fibroids?
Spherical, well-circumscribed, white firm lesions w/ a whorled appearance of cut sections
What is the most common subtype of uterine fibroids; arise where?
INTRAMURAL arising within myometrium
What is the most common presenting sx of uterine leiomyomas “fibroids?”
Prolonged or heavy bleeding
What are some of the signs of a uterine fibroid on bimanual exam; how is the degree of enlargement characterized?
- Enlarged, irregularly shaped uterus
- If palpated mass moves with the cervix it is suggestive of a fibroid uterus
- Degree of enlargement is described in “week size” used to estimate equivalent gestational size
What is the typically the first theapeutic option for treatment of uterine leiomyomas?
Combination (estogen + progesterone) –> OCP’s and rings
When are GnRH agonist such as Depo-Lupon used as therapy for uterine leiomyomas?
Used to ↓ fibroid size; usually used to alter route of surgery
What is uterine artery embolization used for treatment of fibroids?
Microspheres/polyvinyl alcohol particles are introduced into the uterine a. and occlude the artery feeding the fibroid –> necrosis of the fibroid
What may be seen on ultrasound with endometrial polyps; which type of imaging allows for better detection?
- Focal thickening of the endometrial stripe
- Saline hysterosonography and hysteroscopy allow for better detection
How are endometrial polyps managed clinically?
Need to remove via hysteroscopy since endometrial hyperplasia and carcinoma may also present as polyps
How do endocervical polyps differ from ectocervical polyps; which is most common?
- Endocervical = more common; beefy red in color; arise from endocervical canal
- Ectocervical = less common; pale in appearance
Common symptoms of endometrial hyperplasia?
Intermenstrual, heavy or prolonged bleeding that is unexplained
Which finding of the endometrium on ultrasound in a post-menopausal woman warrants biopsy?
Endometrial lining ≥4 mm
What is the treatment for simple and complex endometrial hyperplasia without and with atypia?
- Without atypia treat w/ progestin and resample in 3 months
- With atypia is best treated with a hysterectomy
Which functional cyst of the ovary is more likely to cause symptoms?
Hemorrhagic cysts
Are theca-lutein cysts (bi-/unilateral) and what are distinguishing characteristics?
- Usually bilateral and can become large (>30 cm)
- May develop in pt’s w/ high serum hCG; regress when gonadotropin levels fall
Functional ovarian cysts, luteomas of pregnancy, are caused by what?
Hyperplastic rxn of the ovarian theca cells; 2’ to prolonged hCG stimulation during pregnancy
Malignant serous cystadenocarcinomas will often have what histologic finding?
Psammoma bodies
What is the most common type of epithelial ovarian tumor?
Serous
Which type of epithelial ovarian tumor can attain a huge size, sometime filling the entire pelvis and abdomen?
Mucinous cystadenoma
What are signs/sx’s associated with granulosa-theca cell ovarian tumors?
- Feminizing signs
- Precocious menarche and thelarche
- Premenarchal uterine bleeding during infancy and childhood
- Menorrhagia, endometrial hyperplasia and cancer
- Breast tenderness, fluid retention, and postmenopausal bleeding
Sertoli-leydig ovarian tumors produce what sign/sx’s?
- Hirsutism + temporal blindness + deepening of voice
- Clitoromegaly
- Defemenizing of the female body habitus —> muscular build
What is the most common benign solid ovarian tumor?
Fibroma (sex cord-stromal tumor)
On occasion, ovarian fibromas can be associated with what syndrome?
- Meigs syndrome
- Ascites + right pleural effusion (hydrothorax) + ovarian fibroma
What is the most common ovarain neoplasm found in women of all ages?
Germ cell tumor –> Cystic Teratoma
Rokintanksy’s protuberance is seen with what type of ovarian tumor?
Cystic teratoma (germ cell tumor)
Benign ovarian tumors are often asymptomatic, but can be painful in what situations?
- If tumor twists on its pedicle (torsion)
- Rupture of the cyst –> pain + peritoneal inflammation; can occur spontaneously, with trauma, during bimanual exam, or with intercourse
Which is preferable for diagnosis of benign ovarian tumors, laparotomy or laparoscopy?
Laparotomy is preferable unless the mass can be removed without rupture
Can a persistent ovarian neoplasm be assumed benign?
No, must be proven by surgical exploration and pathologic exam
If surgery is warranted for ovarian neoplasm what 2 things must be done?
- Collect pelvic washings for cytologic examination
- Obtain frozen section for histologic diagnosis
How are benign epithelial ovarian tumors typically managed; what if the diagnosis is a mucinous type?
- Typically managed w/ unilateral salpingo-oophorectomy
- If mucinous, perform an appendectomy 2’ to possibe coexistence of an appendiceal mucocele
What is appropriate management of epithelial ovarian neoplasm in young nulliparous patients vs. older women?
- Young = may perform a cystectomy for ovarian preservation
- Older = total abdominal hysterectomy w/ bilateral salpingo-oophrectomy is appropriate
What is appropriate management and steps for benign mature cystic teratomas “dermoid?”
- Can be tx w/ ovarian cystectomy
- Carefully evaluate other ovary since they are bilateral in 15-20% of cases
- Copiously irrigate pelvis to avoid chemical peritonitis
What is hydrosalpinx vs. pyosalpinx?
- Hydrosalpinx = fluid filled FT’s from previous infection
- Pyosalpinx = purulent filld tube from active infection
What is the primary risk factor for ovarian torsion?
Ovarian mass ≥5 cm
What is the classic presentation for ovarian torsion?
- ACUTE onset of unilateral pain
- Nausea and possibly vomiting
How is diagnosis of ovarian torsion made?
- US is first line imaging study to identify mass
- Definitive dx is made by direct visualization
What is treatment for ovarian torsion; how does this change if ovary is necrotic or you suspect malignancy?
- Detorsion and ovarian conservation w/ an ovarian cystectomy
- Salpingo-oophorectomy is performed if ovary is necrotic or you suspect malignancy
