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OB/GYN 303 > Module 1: Uterine Pathology > Flashcards

Module 1: Uterine Pathology Flashcards

1
Q

What forms the fallopian tubes?

A

The unfused cranial ends of the Mullerian ducts.

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2
Q

What does the caudal end of the Mullerian duct form?

A

Uterus, cervix and upper vagina.

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3
Q

What is another name for the Mullerian ducts?

A

Paramesonephric ducts

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4
Q

What forms the vagina?

A

The upper portion is formed by the Mullerian ducts and the lower portion is formed by the urogenital sinus.

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5
Q

What is an imperforate hymen?

A

A sealed hymen that traps menstrual blood due to the incomplete fusion of the Mullerian ducts with the urogenital sinus during the develpment of the vagina.

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6
Q

What is arrested development?

A

When one or both of the Mullerian ducts fails to develop

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7
Q

What are the types of arrested development?

A
  1. Uterine aplasia
  2. Unicornuate uterus
  3. MRKH syndrome
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8
Q

Uterine Aplasia

A

No uterus

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9
Q

Unicornuate Uterus

A

A single horned, banana shaped uterus sometimes with a 2nd, smaller rudimentary horn.

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10
Q

MRKH syndrome

A

Complete agenesis of the vagina and uterus

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11
Q

What is Failure of Fusion?

A

The Mullerian Ducts develop but fail to fuse together.

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12
Q

What are the types of Failure to Fusion?

A
  1. Uterus Didelphys
  2. Uterus Bicornis Bicollis
  3. Uterus Bicornis Unicollis
  4. Uterus Arcutus
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13
Q

Uterus Didelphys

A

Double systems : 2 vag, 2 cvx, 2 ut

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14
Q

Uterus Bicornis Bicollis

A

1 vag, 2 cvx, 2 ut

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15
Q

Uterus Bicornis Unicollis

A

1 vag, 1 cvx, 2 ut

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16
Q

Uterus Arcutus

A

Indentation of < 1 cm at the fundus

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17
Q

What is another name for Uterus Bicornis Unicollis?

A

Bicornuate Uterus

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18
Q

What is the definition of Bicornuate Uterus/Bicornis Unicollis?

A

A serosal indent > 1 cm at fundus.

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19
Q

What is the uterine anomaly most seen on ultrasound?

A

Bicornuate Uterus

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20
Q

What is Incomplete Reabsorption?

A

The mullerian ducts fuse but the septum is not reabsorbed.

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21
Q

What are the two types of incomplete reabsorption?

A
  1. Uterus septus - Complete septum

2. Uterus subseptus - Partial septum

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22
Q

What is a T-shaped uterus?

A

Specific to the embyonic exposure of the drug DES

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23
Q

Asherman’s Syndrome

A

Endometrial lining is replaced by fibrous adhesions causing loss of menstruation and infertility.

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24
Q

What causes Asherman’s Syndrom?

A

D&C, multiple abortions or infection.

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25
Q

What are AV Malformations of the uterus?

A

Arterial Venous malformations that are congential or caused from surgery/trauma

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26
Q

What are the symptoms of AV malformations?

A

Menorrhagia

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27
Q

What is Menorrhagia?

A

Abnormally heavy menstrual periods

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28
Q

What is neoplasia?

A

A multiplication of abnormal cells that can be malignant or benign.

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29
Q

What is Endometrial Hyperplasia?

A

Excessive growth of the endometrium due to high levels of estrogen from ovarian dysfunction.

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30
Q

What does Endometrial Hyperplasia cause?

A

Irregular uterine bleeding

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31
Q

What is the differential diagnosis of Endometrial Hyperplasia?

A

Endometrial cancer or polyps

32
Q

When is the endometrium considered thickened?

A

Premeno = Greater than 14mm

Postmeno = Greater than 5 mm

33
Q

When during the menstrual cycle should a US be done to investigate for endometrial hyperplasia?

A

1st nine days of cycle (when endo shouldn’t be thickened).

34
Q

What is an endometrial polyp?

A

A growth extending into the canal from a stalk (may protrude into cvx) that is asymptomatic or may cause bleeding.

35
Q

How do endometrial polyps appear on US?

A
  • Thick hyperechoic endo

- Colour doppler shows stalk w/ slow flow

36
Q

What is the DDX of endo polyps?

A

Endo cancer or Endo Hyperplasia

37
Q

What is a sonohysteroogram?

A

Saline is injected into the uterus to better visualize the definition and diagnose polyps.

38
Q

What is Synechiae?

A

A scar in the uterus similar to Ascherman’s that can appear as a wavy line in the uterus during pregnancy.

39
Q

What is Adenomyosis?

A

A form of endometriosis where endometrial tissue (glands and stoma) grows within the myometrium of the uterus causing a fuzzy endometrium/myometrium junction, pain and abnormal bleeding.

40
Q

Where does adenomyosis typically occur?

A

In the posterior wall of the uterus

41
Q

How does adenomyosis appear on US?(5)

A
  • Diffuse uterus enlargement
  • Cysts in myometrium
  • No endo/myo interface
  • May look like fibroid/polyp/focal lesion.
  • Endo is not in middle of uterus (myo is unequal thickness).
42
Q

What is the venetian blind appearance?

A

Multiple lines shadowing in the posterior aspect of the uterus in the myometrium (Adenomyosis).

43
Q

What can conditions can appear as small cysts around the lateral edges of the uterus?

A
  1. Prominent arcuate arteries

2. Uterine Varices

44
Q

What is Endometritis?

A

Inflammation of the endometrium that commonly occurs postpartum or with PID

45
Q

What is PID?

A

Pelvic Inflammatory Disease

46
Q

What is the sonographic appearance of Endometritis?

A
  • Normal or irregular endometrium
  • Fluid filled cavity
  • Sparkly gas bubbles
47
Q

What is another name for Fibroid?

48
Q

What is Leiomyoma?

A

Fibroid. A benign uterine neoplasia of fibromuscular tissue.

49
Q

What is the most common tumor in the female pelvis?

A

Leiomyoma (fibroid)

50
Q

How common are leiomyomas?

A

40 % over age 35, more common in african americans

51
Q

What are leimyomas influenced by?

A

Estrogen. (Pregnancy, menopause)

52
Q

What is the malignant form of Leiomyoma?

A

Leiomyosarcoma

53
Q

What are the symptoms of leiomyoma? (4)

A
  • Menorrhagia
  • Pain/pressure
  • Palpable mass on pelvic exam
  • Infertility
54
Q

What is the most common classification of leiomyoma?

A

Intramural

55
Q

What is an intramural leiomyoma?

A

Fibroid in the myometrium

56
Q

What is a submucosal leiomyoma?

A

Fibroid that projects into the uterine cavity that can be pedunculated and cause bleeding.

57
Q

What does pedunculated mean?

A

Something that has a stalk

58
Q

What is a subserosal leiomyoma?

A

Fibroid that projects out from the perimetrium that can be pedunculated or found in the broad ligament

59
Q

What is the appearance of leiomyoma on US? (4)

A
  • Hypoechoic with high attenuation
  • Enlarged uterus w/irregular contour
  • May have calcifications in older women
  • May be complex w/ degeneration and necrosis
60
Q

What classification of leiomyoma is best suited for Ev?

A

Submucosal

61
Q

How does pregnancy effect fibroids? (3)

A
  • Enlarge w/ increased estrogen
  • If they rapidly outgrow their blood supply they will necrose
  • C-section is needed if a large fibroid is near cervix inhibiting delivery.
62
Q

How can you decipher between contractions and a fibroid?

A

A contraction will go away and they are typically on the anterior wall.

63
Q

What is a lipoleiomyoma?

A

An uncommon benign uterine neoplasm of lipocytes (fat) and fibromuscular tissue.

64
Q

How do lipoleiomyomas appear on US?

A

Very hyperechoic and attenuating, appear similar to a dermoid.

65
Q

What is leimyosarcoma?

A

A rare, malignant uterine neoplasm that MAY arise from a pre-existing fibroid although recent info disagrees

66
Q

What are the symptoms of leiomyosarcoma?

A

Same as fibroids

67
Q

What is the appearance of leiomyosarcoma on US? (2)

A
  • Degenerating fibroid appearance

- May see local invasion of surrounding organs or hepatic metastases

68
Q

What accounts for 90% of all uterine malignancies?

A

Endometrial Carcinoma

69
Q

Who does endometrial carcinoma most commonly occur in?

A

Postmenopausal women

70
Q

What are the symptoms of endmetrial carcinoma?

A

Postmenopausal bleeding

71
Q

What are the stages of endometrial carcinoma? (4)

A
  1. Confined to endo
  2. Confined to uterus
  3. Spread and confined to pelvis
  4. Distal metastasis (liver)
72
Q

What conditions have an increased risk for developing Endo CA?

A
  1. Estrogen therapy (HRT)
  2. Obesity
  3. Hypertension
  4. Diabetes
  5. PCOS - Polycystic ovarian syndrome
  6. Granulosa cell tumors of the ovary
73
Q

How does endometrial carcinoma appear on US?

A

Thick endo, difficult to distinguish from hyperplasia or polyps.

74
Q

What is Tamoxifen?

A

A non-steroidal, anti estrogen hormonal drug used to treat breast cancer that stimulates the endo and increases the risk of CA by 1 %

75
Q

What is the sonographic appearance of tamoxifen?

A

A heterogenous, bizarre endometrium.

OB/GYN 303 (21 decks)

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