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OBGYN 2 > M1: Uterine Pathology > Flashcards

M1: Uterine Pathology Flashcards

1
Q

the caudal ends of the Mullerian duct fuse for form which structures

A

the uterus, cervix, upper vagina

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2
Q

the unfused cranial ends of the mullerian ducts form which structures

A

fallopian tubes

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3
Q

review flash cards on mullerian duct abnormalities

A

/

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4
Q

what is a prolapsed uterus

what causes it

A

descent of the uterus down into the vagina

weak pelvic floor muscles

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5
Q

how is a prolapsed uterus diagnosed

A

clinically

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6
Q

what is asherman’s syndrome

A

when the endometrial lining is replaced by fibrous adhesions… it is considered a scar in the uterus

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7
Q

what causes asherman’s syndrome

A

previous D&C, multiple abortions or infection

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8
Q

how does asherman’s syndrome look on US

A

appearances vary… endo can be thick or thin, have cystic areas

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9
Q

what does asherman’s syndrome cause

A

loss of periods and infertility

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10
Q

what are AV malformations of the uterus

A

rare malformations where a uterine vain and artery anastomose

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11
Q

what are the causes of AV malformations of the uterus and what are the symptoms

A

congenital
trauma
surgery

menorrhagia (excessive bleeding during periods)

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12
Q

can you see AV malformations only using 2D scanning?

A

hard to see…. need to use doppler

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13
Q

how will the doppler of an AV malformations appear

A

chaotic flow

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14
Q

what is endometrial hyperplasia

what causes it

A

a large, thick endometrium

excessive estrogen production from ovarian dysfunction

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15
Q

when is it most likely for endometrial hyperplasia to occur

A

immediately after menarche and before menopause (during premenopause)

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16
Q

how will endometrial hyperplasia effect uterine bleeding

A

heavy bleeding… often continuous bleeding

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17
Q

what is the US appearance of endometrial hyperplasia

A

thick, hyperechoic endo

can effect most of the endometrium, or it can be focal or nodular

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18
Q

what is the DDX for endometrial hyperplasia

A

endometrial cancer or polyps

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19
Q

the endo should be smaller than what value

A

14mm

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20
Q

how thick should the endo be in the proliferative and secretory phase

post menopausal thickness?

A

sec: 7-14 mm
pro: 4-8 mm

post m: < 5mm… if > 5mm, investigate for endo cancer

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21
Q

when is the best time for a reproductive female patient to have a pelvic US… why?

A

~ 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

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22
Q

what are endometrial polyps

A

endometrial growths extending into the endo canal from a stalk… if long enough they may protrude into the cervix

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23
Q

what are symptoms of endometrial polyps

A

bleeding, or asymptomatic

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24
Q

how do endometrial polyps appear on US

A

thick, hyperechoic endometrium

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25
Q

what is the DDX for endometrial polyps

A

endo cancer or endo hyperplasia

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26
Q

when are polyps easily missed on US

A

when the endo is thick… can cause polyps to blend in

27
Q

what will colour doppler of an endometrial polyp look

A

will see a stock entering the polyp light up with colour

28
Q

what is a sonohystergram

A

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

29
Q

what is adenomyosis

A

the extension of endometrial tissue, including glands and stroma, beyond the endometrium into the myometrium

30
Q

adenomyosis is a form or what other type of condition

A

endometriosis

31
Q

how does adenomyosis appear on US

A
  • 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)
32
Q

where does adenomyosis usually occur in the uterus

A

the posterior wall of the uterus

33
Q

symptoms of adenomyosis

A

pain and abnormal bleeding

34
Q

where are prominent arcuate vessels found

how can you differentiate them from cysts

A

around the periphery of the uterus.. use colour to R/O cysts

35
Q

where are uterine varices often found

how can you differentiate them from an ovary

A

on the lateral aspect of the uterus… they are enlarges vessels

colour doppler

36
Q

what is endometritis

when does it often occur

A

inflammation of the endo

postpartum or w/ PID

37
Q

how does endometritis appear on US

A
  • normal endo
  • irregular endo
  • fluid filled cavity
  • gas bubbles from microorganisms
38
Q

what are leiomyomas

A

fibriods… benign neoplastic masses of fibromuscular tissue

39
Q

what is the most common type of tumor in the female pelvis

A

leiomyomas… 40% of females over 35

40
Q

leiomyomas are most common in which demographic

A

african american women

41
Q

what can effect the size and growth of leiomyomas

A

hormones, mostly estrogen

effected by pregnancy and menopause

42
Q

what is a maligant leiomyoma called

A

leiomyosarcoma (rare cancer)

43
Q

symptoms of leiomyomas

A

menorrhagia
pain or pressure
palpable mass
infertility

44
Q

what are the 3 classifications for leiomyomas

A

Intramural
submucosal
subserosal

45
Q

describe an intramural leiomyoma

A

confined to the myom

most common

46
Q

describe an submucosal leiomyoma

A

projects into the uterine cavity
can be pedunculated
can cause bleeding

47
Q

describe an subserosal leiomyoma

A

projects from perimetrium
can be pedunculated
can be found in the broad ligament

48
Q

for which type of leiomyoma should you always do a TA before an EV

A

subserosal leiomyoma because it can be high above the fundus

49
Q

what are the US features of a leiomyoma

A
  • hypoechoic w/ lots of attenuation
  • enlarged uterus w/ irregular contour
  • calcifications may be seen in older women
  • can be complex w/ degeneration and necrosis
50
Q

how can fibroids effect pregnancy

A

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

51
Q

what is a lipoleiomyoma

are they common

A

benign tumor made out of fat and fibromuscular tissue

no

52
Q

how to lipoleiomyomas appear on US

A

very hyperechoic and attenuating

appear similar to dermoids

53
Q

what are the 2 malignant uterine neoplasias

A

leiomyosarcoma

endometrial carcinoma

54
Q

what is a leiomyosarcoma

is it common

A

a cancerous fibroid that MAY arise from an existing fibroid…
rare

55
Q

what are the symptoms of a leiomyosarcoma

A

menorrhagia
pain or pressure
palpable mass
infertility

(same as a normal fibroid)

56
Q

what is the US appearance of a leiomyosarcoma

A
  • degenerative fibroid appearance

- may see local invasion of surrounding organs or hepatic mets

57
Q

describe endometrial carcinoma

is what group of women does it most commonly occur?

A

an endometrial cancer that accounts for 90% of all uterine malignancies

in post menopausal women

58
Q

what are the symptoms of endometrial carcinoma

A

postmenopausal bleeding

59
Q

what are the stages of endometrial carcinoma

A
  1. Confined to endometrium
  2. Confined to uterus
  3. Spread beyond the uterus, but confined to the pelvis
  4. Distal mets (i.e. liver)
60
Q

what risk factors are associated with endometrial carcinoma

A
  • estrogen therapy/HRT (strong association)
  • obesity
  • hypertension
  • diabetes
  • polycystic overian syndrome (PCOS)
  • granulosa cell tumors of the ovary
61
Q

what is the US appearance of endometrial carcinoma

A

thick echogenic endometrium that’s difficult to distinguish from hyperplasia or polys

62
Q

what is tamoxifen

what is it used for

A

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

63
Q

what is the risk of using tamoxifen

A

it increases the risk of endo cancer by 1%… but benefit for breast cancer treatment outweighs the risk

64
Q

how will the endo appear when the patient is taking tamoxifen?

A

heterogenous and bizarre

OBGYN 2 (15 decks)

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