Module 1 : Uterine Pathology Flashcards
mullarian duct abnormalities
- arrested development
- failure of fusion
- failure of resorption
type of arrested development
- unicornuate uterus
unicornuate uterus characteristics
- deviation of the fundal endometrium to the left or the right
- banana shaped uterus
- highest association of renal anomalies arising on the CONTRALATERAL SIDE
two types of failure of fusion
- bicornuate uterus
- uterine didelphys
bicornuate uterus characteristics
- two uterine bodies one cervix one vagina
- indent on outer contour of uterus
uterine didelphys characteristics
- two of everything
two types of failure of resorption
- septate
- sub septate
+ most unfavourable outcomes in pregnancy (embryo implants in the separation) but can be surgically fixed
septate uterus characteristics
- > 1cm indentation on inner contour of uterus
sub septate uterus characteristics
- < 1cm indentation on inner contour of uterus
MRKH syndrome
- distal vagina present
- complete agenisis of the uterus and cervix
what is a prolapsed uterus
- descent of the uterus down the vagina
- caused from weak pelvic floor muscles
- clinical diagnosis not sonographic
what is Asherman’s syndrome and what does it cause
- endometrial lining is replaced by fibrous lesions
- a scar in the endometrium
- causes loss of menstruation and infertility
causes of Asherman’s syndrome
- secondary to D&C, multiple abortions, or infection
appearance of Asherman’s syndrome
- thick or thin endo
AV malformations of the uterus charateristics
- rare
- anastomosis of artery and vein
- causes = congenital, trauma or surgery
- symptoms = menorrhagia
- sonographic appearance = difficult to see without color
neoplastic definition
- multiplication of abnormal cells, malignant or benign
non neoplastic definition
- multiplication of normal cells
types of non neoplastic conditions
- endometrial hyperplasia
- endometrial polyps
- adenomyosis
- uterine varices
- endometritis
cause of endometrial hyperplasia
- unopposed estrogen stimulation from ovarian dysfunction
when does endometrial hyperplasia occur
- immediately after menarche and also before menopause
symptoms of endometrial hyperplasia
- irregular bleeding
sonographic appearance of endometrial hyperplasia
- thick ( >14mm) hyperechoic endo
- involving most of endo or focal
DDX of endometrial hyperplasia
- endometrial cancer
- polyps
thickness of endo in the secretory phase
7-14mm
thickness of endo in the proliferative phase
4-8mm
thickness of endo int he post menopausal phase
> 5mm investigative
+ EV
+ hysterosonogram
+ endo cancer
endo polyps characteristics
- endometrial growth extending into the canal from a stalk
- may protrude in to the cervix if it has a long stalk
- may cause bleeding or be asymptomatic
sonographic appearance of polyp
- thick hyperechoic endometrium
DDX of polyps
- endo cancer
- endo hyperplasia
what is adenomyosis
- extension of endo tissue beyond the endometrium into the myometrium
- form of endometriosis
- usually occurs in posterior wall of uterus
- can cause pain and abnormal bleeding
sonographic appearance of adenomyosis
- slight diffuse uterine enlargement
- hypo echoic or cystic lesions within myometrium
- focal lesions
- look like fibroid or polyp
- unequal myo thickness
- endo not in centre of uterus
Venetian blind appearance
- multiple shadowing lines in the posterior aspect of uterus myometrium demonstrating adenomyosis
prominent arcuate vessels & varices
- dilated vessels around the uterus
- increase after pregnant
- use color to distinguish between ovaries
what is endometritis
- inflammation of endo
- can occur postpartum or with PID
sonographic appearance of endometritis
- normal endo
- irregular endo
- fluid filled cavity or GAS BUBBLES from micro organisms
- usually patient on anti bionics or febrile
two types of benign uterine neoplasia
- leiomyoma (fibroid)
- lipoleiomyoma
what is a leiomyoma
- benign neoplastic mass of fibromuscular tissue
- MOST COMMON TUMOR IN FEMALE PELVIS
- increase as older and African Americans
what are fibroids influenced by
- increase in estrogen
+ pregnant
+ menopause
symptoms of fibroids
- menorrhagia
- pain or pressure
- palpable mass
- infertility
3 classifications of fibroids
- intramural
- submucosal
- subserosal
intramural fibroid characteristics
- confined to myometrium (muscle)
- most common
submucosal fibroid characteristics
- projecting into the uterine cavity
- can be pedunculated (have a stalk)
- can cause bleeding
subserosal fibroid characteristics
- project from perimetrium
- can be pedunculated
- can be found in broad ligament
+ SOME FOUND UP NEAR BELLY BUTTON (REASON WHY WE SWEEP UP THAT FAR)
sonographic appearance of fibroids
- hypo echoic with high attenuation
- enlarged uterus with irregular contour
- calcification in older women
- can be complex with necrosis
fibroids with pregnancy
- enlarge with increase estrogen
- rapidly growing may result in lack of blood supply and necrosis
- large fibroid near cervix would inhibit delivery
lipoleiomyoma
- lipocytes (fat) and fibromuscular tissue
- uncommon
sonographic appearance of lipleiomyoma
- very hyperechoic and attenuating
- appear similar to a dermoid
2 malignant uterine neoplasias
- leiomyosarcoma
- endometrial cancer
leiomyosarcoma characteristics
- rare
- could arise form preexisting fibroid
- symptoms are same for fibroid
sonographic appearance of leiomysarcoma
- degenerating fibroid appearance
- may see local invasion of surrounding organs or hepatic metastases
endometrial carcinoma
- most commonly occurring in post menopausal women
- symptoms = POST MENOPAUSAL BLEEDING
stages of endo cancer
stage 1 = confined to uterus
stage 2 = confined to uterus
stage 3 = spread beyond uterus yet confined to pelvis
stage 4 = distal metastasis
increased risk for endo cancer
- strong association with estrogen therapy
- obesity
- hypertension
- diabetes
- PCOS
- granulosa cell tutors of ovary
sonographic appearance of endo cancer
- thick echogenic endo
- difficult to distinguish from hyperplasia or polyps
tamoxifen
- non steroidal anti estrogen hormonal drug
- used in treating breast cancer
- estrogen antagonist to uterus resulting in stimulation of endo
- increases risk of endo cancer by 1% but benefit of breast cancer treatment outweighs risk
- sonographic appearance = heterogenous bizarre endo
