M1: Uterine Pathology Flashcards
the caudal ends of the Mullerian duct fuse for form which structures
the uterus, cervix, upper vagina
the unfused cranial ends of the mullerian ducts form which structures
fallopian tubes
review flash cards on mullerian duct abnormalities
/
what is a prolapsed uterus
what causes it
descent of the uterus down into the vagina
weak pelvic floor muscles
how is a prolapsed uterus diagnosed
clinically
what is asherman’s syndrome
when the endometrial lining is replaced by fibrous adhesions… it is considered a scar in the uterus
what causes asherman’s syndrome
previous D&C, multiple abortions or infection
how does asherman’s syndrome look on US
appearances vary… endo can be thick or thin, have cystic areas
what does asherman’s syndrome cause
loss of periods and infertility
what are AV malformations of the uterus
rare malformations where a uterine vain and artery anastomose
what are the causes of AV malformations of the uterus and what are the symptoms
congenital
trauma
surgery
menorrhagia (excessive bleeding during periods)
can you see AV malformations only using 2D scanning?
hard to see…. need to use doppler
how will the doppler of an AV malformations appear
chaotic flow
what is endometrial hyperplasia
what causes it
a large, thick endometrium
excessive estrogen production from ovarian dysfunction
when is it most likely for endometrial hyperplasia to occur
immediately after menarche and before menopause (during premenopause)
how will endometrial hyperplasia effect uterine bleeding
heavy bleeding… often continuous bleeding
what is the US appearance of endometrial hyperplasia
thick, hyperechoic endo
can effect most of the endometrium, or it can be focal or nodular
what is the DDX for endometrial hyperplasia
endometrial cancer or polyps
the endo should be smaller than what value
14mm
how thick should the endo be in the proliferative and secretory phase
post menopausal thickness?
sec: 7-14 mm
pro: 4-8 mm
post m: < 5mm… if > 5mm, investigate for endo cancer
when is the best time for a reproductive female patient to have a pelvic US… why?
~ days 7-9 in their cycle… during the proliferative phase…. so that the endo is thin and its less likely that pathology will be missed
what are endometrial polyps
endometrial growths extending into the endo canal from a stalk… if long enough they may protrude into the cervix
what are symptoms of endometrial polyps
bleeding, or asymptomatic
how do endometrial polyps appear on US
thick, hyperechoic endometrium
what is the DDX for endometrial polyps
endo cancer or endo hyperplasia
when are polyps easily missed on US
when the endo is thick… can cause polyps to blend in
what will colour doppler of an endometrial polyp look
will see a stock entering the polyp light up with colour
what is a sonohystergram
a type of US where a catheter is inserted into the uterus and saline is injected to fill it will fluid to help identify polyps
what is adenomyosis
the extension of endometrial tissue, including glands and stroma, beyond the endometrium into the myometrium
adenomyosis is a form or what other type of condition
endometriosis
how does adenomyosis appear on US
- the junction of the endo and myo is less pronounced
- diffuse uterine enlargement
- hypoechoic or cystic lesions in the myom
- may have focal lesions or look like a fibroid or polyp
- myom of unequal thickness (endo not in the middle of the uterus)
- venetian blind appearance (multiple lines shadowing in the post. aspect of the uterus in the myom)
where does adenomyosis usually occur in the uterus
the posterior wall of the uterus
symptoms of adenomyosis
pain and abnormal bleeding
where are prominent arcuate vessels found
how can you differentiate them from cysts
around the periphery of the uterus.. use colour to R/O cysts
where are uterine varices often found
how can you differentiate them from an ovary
on the lateral aspect of the uterus… they are enlarges vessels
colour doppler
what is endometritis
when does it often occur
inflammation of the endo
postpartum or w/ PID
how does endometritis appear on US
- normal endo
- irregular endo
- fluid filled cavity
- gas bubbles from microorganisms
what are leiomyomas
fibriods… benign neoplastic masses of fibromuscular tissue
what is the most common type of tumor in the female pelvis
leiomyomas… 40% of females over 35
leiomyomas are most common in which demographic
african american women
what can effect the size and growth of leiomyomas
hormones, mostly estrogen
effected by pregnancy and menopause
what is a maligant leiomyoma called
leiomyosarcoma (rare cancer)
symptoms of leiomyomas
menorrhagia
pain or pressure
palpable mass
infertility
what are the 3 classifications for leiomyomas
Intramural
submucosal
subserosal
describe an intramural leiomyoma
confined to the myom
most common
describe an submucosal leiomyoma
projects into the uterine cavity
can be pedunculated
can cause bleeding
describe an subserosal leiomyoma
projects from perimetrium
can be pedunculated
can be found in the broad ligament
for which type of leiomyoma should you always do a TA before an EV
subserosal leiomyoma because it can be high above the fundus
what are the US features of a leiomyoma
- hypoechoic w/ lots of attenuation
- enlarged uterus w/ irregular contour
- calcifications may be seen in older women
- can be complex w/ degeneration and necrosis
how can fibroids effect pregnancy
if they are fast growing they can lead to a lack of adequate blood supply which leads to necrosis…
…if there’s a large fibroid near the cervix it inhibits delivery of the fetus and a C section is needed
what is a lipoleiomyoma
are they common
benign tumor made out of fat and fibromuscular tissue
no
how to lipoleiomyomas appear on US
very hyperechoic and attenuating
appear similar to dermoids
what are the 2 malignant uterine neoplasias
leiomyosarcoma
endometrial carcinoma
what is a leiomyosarcoma
is it common
a cancerous fibroid that MAY arise from an existing fibroid…
rare
what are the symptoms of a leiomyosarcoma
menorrhagia
pain or pressure
palpable mass
infertility
(same as a normal fibroid)
what is the US appearance of a leiomyosarcoma
- degenerative fibroid appearance
- may see local invasion of surrounding organs or hepatic mets
describe endometrial carcinoma
is what group of women does it most commonly occur?
an endometrial cancer that accounts for 90% of all uterine malignancies
in post menopausal women
what are the symptoms of endometrial carcinoma
postmenopausal bleeding
what are the stages of endometrial carcinoma
- Confined to endometrium
- Confined to uterus
- Spread beyond the uterus, but confined to the pelvis
- Distal mets (i.e. liver)
what risk factors are associated with endometrial carcinoma
- estrogen therapy/HRT (strong association)
- obesity
- hypertension
- diabetes
- polycystic overian syndrome (PCOS)
- granulosa cell tumors of the ovary
what is the US appearance of endometrial carcinoma
thick echogenic endometrium that’s difficult to distinguish from hyperplasia or polys
what is tamoxifen
what is it used for
a non-steroidal, anti-estrogen hormonal drug… it opposes estrogen in the uterus and results in the stimulation of the endometrium
used to treat breast cancer
what is the risk of using tamoxifen
it increases the risk of endo cancer by 1%… but benefit for breast cancer treatment outweighs the risk
how will the endo appear when the patient is taking tamoxifen?
heterogenous and bizarre
