Module 4: Gynae/ Obs / Breast Flashcards
how does a uterus change shape over time
infant - larger than expect. large cervix
prepuberyty - elongates
puberty - pear
Tuners syndrome gonads
Streaky ovaries and pre-puberty uterus
mullerian ducts make
uterus and upper 2/3 of the vagina
fallopian tubes
what makes the bottom 1/3 f the vagina
the urogenital sinsus
Urogenital sinus makes
Prostate
Lower 1/3 of the vagina
uterus cleavage happens in what direction
bottom to top
three types of uterine failure
failire to form
fail to fuse
fail to cleave
Uterus didelphys is what
seperate uterus . fail to fuse.
vaginal ax of uterus didelphys
vaginal septa
feature of septate uterus
septum remains between the two uterine cavities
mullerian agenesis is called what syndrome
Mayer Rokitansky Kuster Hauser Syndrome
Features of mullerian agenesis
vaginal atresia
absent uterus / abnormal
normal ovaries
(often have kidney issues)
mullerian agenesis is a type of what uterine malfunction
failire to form
unicornate uterus is what type
and why is it painful
failure to form
endometrial tissue inside non communicating horn(hemi uterus)
complete uterine duplication is called
Uterus didelphys
DES related anomaly
T shaped ueterus from drug.
and vaginal clear cell carinoma
failure to cleave results in what
thick septate
biconruate vs septate
fundal contour is heart shaped in bicornuate
contraindications to salphyngogram
bleeding
infection
pregnancy
allergy
contraindications to salphyngogram
bleeding (menstruation)
infection
pregnancy
allergy
contraindications to salphyngogram
bleeding (menstruation) do d7.
infection
pregnancy
allergy
appearance of salpingitis isthmica nodosa
nodular scarring of fallopian tubes
features of endometritis
post birth
spectrum of pid
features of endometritis
post birth
spectrum of pid
thickened endometrial cavity
endometritis can progress to having gas and pus and is called
pyometrium
fibroids are made of
smooth muscle
fibroids are made of
smooth muscle
fibroids are made of
smooth muscle
fibroids are made of
smooth muscle
fibroids are made of
smooth muscle
fibroids are made of
smooth muscle
endometritis can progress to having gas and pus and is called
pyometrium
most common location of fibroids
intramural
peripheral popcorn calcifcaiton of uterin fibroid seen on which modality
plain film
fibroids on mri
T1 dark (to intermeidate)
T2 dark
variable enhacnement
what are the 4 tpyes of degeneration of uterine fibroids
Hyaline
Red 9carneous)
Myxoid
Cystic
hyaline degeneration
MRI findings and why
T2 dark
outstrips blood supply.
proteinacious tissue.
T2 dark, no enhacnement
Red (carneous) degeneration of fibroid
MRI and why
peripheral T1 high signal .
occurs in pregnancy, from venous thrombosis.
myxoid degenerative change apperaance on mRI
T2 bright.
what is the feature of a leiomyosarcoma ?
rapid growth and necrosis
what is adenomyosis
endometrial tissue has entered the myometrium layer.
causes enlarged uterus
thickening of the junctional zone of uterus to more than 12mm…
with T2 bright cystic foci…
adenomyosis
post menopausal endometrial thickening
what measuremnt is concerning and require sampling
5mm
what type of tumour will thicken the endometrium and why
Granulosa cell tumours
- oestrogen secreting
Hereditory nonpolyposis colon cancer
what effect does tamoxifen have on the uterus
increases endometrial cancer risk due oestrogen effect on the uterus
depsite being a blocker of estrogen in the breasat
tamoxifen endometrial thickness gets a pass up to
8mm
endometrial fluid in a post menopausal mass means
cervical stenosis or an obstructing mass
cervical cancer - staging for surgery
IIA or below is surgery
IIb cervical cancer (parametrial invasion) get
chemo and radiation
what is the parametrium ?
fibrous band between the supravaginal cervix and bladder
primary vaginal masses
what types of cancer
clear cell adenocarcinoma
rhabdomyosarcoma
most common cancer of the vagina
squamous cell carcinoma
Who gets vaginal celar cell ADENO carcinoma
mothers took DEX
T shaped uterus
Vaginal rhabdomyosarcoma has what age distribution
2- 6
14 - 18
metastatic spread to the upper vagina wall
anterior vs posterior
anterior from genital
posterior from GI tract
nabothian cysts are found where?
Cervix
epithelium plugging of mucous glands
Gartner duct cyxsts are found where
anterior lateral wall of vagina.
due to incomplete regression of the wolfian ducts
skene gland cysts are found where
periurethral glands
ovaries
haemorrage in a cystic mass means it is
benign
Normal vs abnromal ovary size cut off
15ml
post menopause 6ml
dominant follicle can be what size?
2cm
what is an cumulus oophorus?
cells that protrude into a mature dom follice, imminent ovulation
what does clomiphene citrate do?
forces matuation of multiple bilateral ovarian cysts
theca lutein cyst will have what appearance
spoke wheel from multiple large cysts
what causes theca lutein cysts
overstimulation of b-HCG
what are the sequelae of ovarian hyperstimulation syndrome?
theca lutein cysts, ascites, pleural effusion event pericardial effusions.
hypovolaemic shock
why do you do a PET in the first week of the menstrual cycle?
beacuse ovaries can be on HOT depending on cycle
menopause is defined as
1 whole year without menses
postmenoausal ovary abnormal is when its above normal limit orrrrrr
twice the size of the other one
PET ovaries on post menopausal is
ABNORMAL
ovarian cyst rules
under3cm simple - nothing
3-5cm - report but no f/u
>5cm - described and f/u considered
>7cm MRI or surgical referral
get an US if found on ct/mri
what are the ovaria sinister 6
physio follicles
corpora lutea
haemohagic cysts
endometriomas
benign cystic teratomas
polycystic ovaries
a peristent cyst may be called….
a nonfunctioning cyst
normally change after 6 weeks with hormones
ring of fire seen around ovarian lesion
corpus luteum
but could also be ectopic pregnancy
endometriosis triad
infertility
dysmenorrhea
dyspareunia
what will an endometrioma look like
rounded mass
homogenous low level internal echoes
increased through transmission
echogenic foci on wall
endometrioma can (1% ) become what cancer
note need to be like 9cm and older than 45
endometrioid or clear cell carcinoma
what is the most sensitive imaging feature on MRI for the diagnosis of malignany in an endometrioma
enhancing mural nodule
endometrioma on MRI
T1 bright -blood
T2 - dark (iron)
fat sat, won’t suppress (not a teratoma)
hameorrhagic cyst
lacy fishnet appearance
classsic or having bled into it
different apeparance ot an endometrioma
haemorrhagic cyst in early post menopause ladies?
postmenopausal women may ovulate
can follow up in 6 weeks as haemorrhagic cysts should disappear
Dermoids affect what age?
20s to 30s
what does tip of the icerberg sign mean?
US, absorbed by the mass at the top
dermoid on MRI
T1 and fat sat b ehaviour
T1 bright - fat
supress
T2 bright
haemorrhagic cysts and endometriomas dont suppress
Endometrioma on MRI
T1 bright
not suppress on fat sat
T2 dark
dermoids can (1%) turn into what cancer with what risk factors
squamous cell CA
10cm +
older than >50
PCOS on US how many cysts
10 or more
do ovaries have to be enlarged in PCOS
no
where in the ovary are cancers found
within ovary
outside often benign
what measurement is thick counted at for septations
3mm
nodule with flow or mutliple thin or thick speations need to
refer to surgeons
Solid nodules without flow, why do we need an MRI
to ensure not a dermoid plug
if not to surgeons
appearance of serous tumours?
unilocular
few septations
can be bilateral
papillary projections suggest malignancy
mucinous ovarian (cystadencarcinoma) appearance
what can you get from this
large
multiloculated with thin septa
can get pseudomyxoma peritonei
risk factor for mucinous ovarian cystadencarcinoma
smoking
endometroid ovarian cancer
25% will have concomitant
endometrial cancer
(ovary is the met)
ovarian mass and endometrial thickening can be caused by what two conditions
Endometroid cancer
Granulosa Theca Cell Tumour
adult big fucking mass
differentials can be
Ovarian masses
desmoids (gardner syndrome)
sarcomas
ovarian fibroma on US
hypoechoic and solid
MRI findings of ovarian fibroma
T1 and T2 dark
T2 dark rim