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OB/Gyn > pathology of the uterus > Flashcards

pathology of the uterus Flashcards

0
Q

What kind of mass is missed more than any other?

A

vaginal masses

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1
Q

What is a Gartner’s duct cyst?

A

Vaginal mass

remnant of mesonephirc duct

not in cervix, just in the vagina

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2
Q

If you had stool coming out of the vagina what would you find?

A

a vaginal/rectal fistula

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3
Q

What is the most common congenital abnormality of the female genital tract?

A

imperforate hymen

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4
Q

What does an obstruction of the uterus and/or vagina result in?

A

hydrometra (fluid)

hematometria (blood)

pyometra (pus)

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5
Q

what are the two solid cancers of the vagina?

A

vaginal adenocarcinoma

rhabdomyosarcoma

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6
Q

Are vaginal solid masses common?

A

no, they are rare

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7
Q

If you do see a soild mass in the vagina what might you see in the tissue?

A

solid mass occasionally with areas of necrosis

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8
Q

What kind of scan would you do if the Dr. thinks there is a vaginal mass?

A

translabial/trans peritoneal

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9
Q

Why is sonography used if a solid vaginal mass is found?

A

for staging

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10
Q

What is a vaginal cuff?

A

seen in hysterectomy patients

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11
Q

What is the size of a vaginal cuff?

A

< 2.1 cm

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12
Q

What would nodular areas in the vaginal cuff be from?

A

postirradiation fibrosis

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13
Q

Why would you scan the vaginal cuff?

A

suspicion for malignancy, especially in a patient who has previous history of cancer

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14
Q

what are adhesions?

A

scar tissue

adhere things that shouldn’t be adhered together

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15
Q

What is the smallest amount of fluid in the pouch of douglas that can be detected by US?

A

5mL

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16
Q

What are pathologic fluid collection associated with?

A

ascites

blood resulting from ruptured ectopic pregnancy

hemorrhagic cyst

pus resulting from infection

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17
Q

Besides fluid, what else can occur in the pelvic cul-de-sac?

A

pelvic abscesses

hematomas

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18
Q

Are nebothian cysts benign or malignant?

A

benign

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19
Q

What is another name for nabothian cyst?

A

retention cyst

chornic cervicitis

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20
Q

What are the symptoms of nabothian cysts?

A

asymptomatic

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21
Q

How might cervical polyps clinically present?

A

with irregular bleeding

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22
Q

What does pedunculated mean?

A

projecting out of the cervix, or broad based

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23
Q

Will you always see cervical polyps?

A

maybe, depends on location

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24
Q

What kind of cervical myomas occur in the cervix?

A

small percentage of leiomyomas occur in the cervix

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25
Q

What are the symptoms of cervical myomas?

A

when small: asymptomatic

as mass enlarges: bladder or bowel obstruction may result

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26
Q

What is cervical stenosis?

A

an acquired condition

obstruction of cervical canal at internal or external os

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27
Q

What causes cervical stenosis?

A

radiation therapy

previous cone biopsy

postmenopausal cervical atrophy

chronic infection

laser or cryosurgery

cervical carcinoma

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28
Q

do menopausal patients have symptoms from cervical stenosis?

A

no

can cause a distended uterus from fluid

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29
Q

What are the symptoms of cervical stenosis of premenopausal women?

A

abnormal bleeding

oligomenorrhea

amenorrhea

cramping

dysmenorrhea

infertility

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30
Q

What is cervical Ca (carcinoma)?

A

squamous cell carcinma

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31
Q

What is the most common type of cervical Ca?

A

squamous cell carcinoma

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32
Q

What are the precursors of Cervical Ca?

A

cervical dysplasias

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33
Q

how are cervical dysplasias classified?

A

mild

moderate

severe

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34
Q

what is carcinoma in situ?

A

all of the cancer is localized…no evidence of spread

pre-stage I

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35
Q

When is cervical Ca called carcinoma in situ?

A

when full thickness of epithelium composed of undifferentiated neoplastic cells

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36
Q

What helps detect cervical ca?

A

Pap smears

most early lesions are asymptomatic

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37
Q

Which is more common cervical ca or endometrial ca?

A

endometrial

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38
Q

Who does cervical ca affect the most?

A

women of menstrual age

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39
Q

What is a clinical sign of cervical ca?

A

vaginal discharge or bleeding

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40
Q

What are the sonographic findings of cervical ca?

A

retrovesical mass

obstruction of ureters

invasion of bladder

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41
Q

how do you do a translabial or trasperineal sonogram?

A

5-7.5 MHz sector or curvilinear transducer

covered with a sterile probe cover

applied to vestibule of vagina - sagittal plane

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42
Q

What are the most common uterine calcificatons?

A

myomas

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43
Q

What arteries in the pelvis calcify?

A

arcuate arteries in the periphery of the uterus

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44
Q

What pelvic structure can mimic a “mass” on a physical exam?

A

the uterus

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45
Q

What is the size and shape of the uterus related to?

A

age

hormonal status

parity

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46
Q

What reasons would you have for an enlarged uterus?

A

pregnancy

postpartum

leiomyoma (fibroid)

adenomyosis

bicornuate or didelphic uterus

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47
Q

What are the uterine tumors?

A

leiomyoma benign

carcinoma (malignant)

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48
Q

What would an intrauterine pregnancy give you?

A

thickened endometrium

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49
Q

what does endometrial hyperplasia cause?

A

thickened endometrium

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50
Q

What does trophoblastic disease, endometritis and adhesions cause?

A

thickened endometrium

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51
Q

Polyps, inflammatory disease and endometrial carcinoma with do what to the endometrium?

A

thicken it

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52
Q

When an abortion is done, what would cause a thickened endometrium?

A

retained products of conception or an incomplete abortion

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53
Q

What is trophoblasitc disease?

A

when placenta is left in the endometrium after a pregnancy

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54
Q

What is inflammatory disease?

A

pus in the endometrium

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55
Q

Why might you find fluid in the endometrium?

A

endometritis

retained products of conception

pelvic inflammatory diesease

cervical obstruction

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56
Q

What mighth cause endometrial shadowing?

A

gas (abscess)

intrauterine device

calcified myomas or vessels

retained products of conception

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57
Q

what are the most common gynecological tumors?

A

leiomyomas

myomas

fibroids

all the same thing

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58
Q

What are 20%-30% of women over age 30 at risk for?

A

Leiomyomas

myomas

fibroids

more common in african american women

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59
Q

What does a leiomyoma look like?

A

spindle shaped

smooth muscle cells in a whorl like pattern

various amounts of fibrous connective tissue

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60
Q

Are leiomyomas hormonally influenced?

A

yes - grow with hormones

tend to shrink after menopause and become calcified

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61
Q

when does degeneration occur to leiomyomas?

A

when it outgrows its blood supply = calcification

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62
Q

What are the clinical indications of leiomyomas?

A

enlarged uterus

profuse and prolonged bleeding

pain

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63
Q

What are the different types of fibroids?

A

submucosal

intramural

subserosal

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64
Q

What is an intramural (aka: interstitial) fibroid?

A

within myometrium

most common type

may enlarge to cause pressure on adjacent organs

infertility or recurrent pregnancy loss

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65
Q

what is a subserosal fibroid?

A

arise from myometrium and project exophytically

may enlarge to cause pressure on adjacent organs

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66
Q

What are fibroids dependent on?

A

estrogen

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67
Q

What is suspicious in an postmenopausal woman when it comes to fibroids?

A

rapid increase in myoma size is suspicious for neoplasm

if not on hormone replacement therapy

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68
Q

What are pedunculated fibroids?

A

a fibroid on a stalk outside of the uterus

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69
Q

Which fibroid is the most common?

A

intraamural/interstital

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70
Q

How do you treat fibroids in the case of infertility?

A

it has to be subucosal.

surgery by myomectomy

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71
Q

in cases of menorrhagia, how is a fibroid treated?

A

hormonal suppression (least invasive)

endometrial ablation

uterine artery embolization (UAE)

high intensity focused ultrasound (HIFU)

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72
Q

What is the most common cause of uterine calcifications?

A

myomas

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73
Q

What is Monckebergs’s arteriosclerosis?

A

calcium deposits are found in the tunica media of the walls of arteries

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74
Q

What is adenomyosis?

A

benign disease

is ectopic ocurrence of endometrial tissue within myometrium

more common in posterior aspect

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75
Q

How does an adenomyosis look on US?

A

presents as a bulky enlarged uterus without a focal mass

76
Q

Is adenomyosis diffuse or focal?

A

both

77
Q

What is another name for adenomyosis?

A

adenomyoma - referring to isolated implants that typically cause reactive hypertrophy of surrounding myometrium

78
Q

What are the symptoms of 60% of women with adenomyosis?

A

hypermenorrhagia

menorrhagia

metrorrhea (irregular, acyclic bleeding)

79
Q

What is the most common presentation on US of extensive andenomyosis?

A

diffuse uterine enlargement

thickening of posterior myometrium

indistinct border between endometrium and myometrium

myometrial cysts

80
Q

What are adenomyomas?

A

hemorrhage in islands of endometrial tissue appears as small hypoechoic myometrial cysts

looks like Swiss cheese or honeycomb pattern

81
Q

What are arteriovenous malformations?

A

a connection between and artery and vein that is abnormal

no capillaries…direct connection

venous and arterial flow in one vessel

82
Q

What is Uterine arteriovenous malformations (AVMs)?

A

consist of vascular plexus of arteries and veins without intervening capillary network

83
Q

What does teratogenic mean?

A

aquired

84
Q

How does one get AVM?

A

congenital or teratogenic

due to pelvic trauma, surgery or gestational trophoblastic neoplasia

85
Q

What clinical symptoms would a woman with AVM have?

A

women of childbearing years have metrorrhagia with blood loss and anemia

86
Q

if an AVM is cut into during a dilation and curettage (D&C)what can happen?

A

life threatening, catastrophic hemorrhaging

87
Q

What are sonographic findings of AVM?

A

serpiginous (creeping or crawling) anechoic structures seen within the pelvis

88
Q

What does spectral doppler show with an AVM?

A

high velocity, low resistance

arterial flow coupled with venous flow

89
Q

What is a uterine leiomyosarcoma?

A

rare, solid tumor arising from myometrium or endometrium

90
Q

Where is a leiomyosarcoma commonly found?

A

in fundus of the uterus

91
Q

What is the most common age for uterine leiomyosarcoma?

A

40-60 years old

92
Q

What is the sonographic finding for leiomyosarcoma?

A

may resemble myomas or endometrial carcinoma with features of solid or mixed-solid and cystic texture

93
Q

What is the cervical canal?

A

from the internal os to the external os

94
Q

What benign condition arises from hyperplastic protrusion of epithelium of endocervix or ectocervix?

A

Cervical Polyps

95
Q

What is the most likely factor for cervical polyps?

A

chronic inflammation

96
Q

What are the two most likely ways you would find/describe cervical polyps?

A

Pedunculated (projecting out of the cervix)

broad based

Depending on location may or may not be seen

97
Q

Who are most likely to develop cervical polyps?

A

women in late middle age

98
Q

what enhances visualization of of cervical myomas?

A

fluid infusion with sonoysterography

99
Q

How does sonography assist with a Pedunculated cervical myoma?

A

by determining the location and thickness of the stalk

It’s possible it may prolapse into the vagina

100
Q

If you have already scanned translabial in the sagittal plane, what do you do for your second plane?

A

rotation of transducer obliquely in counterclockwise direction shows coronal images

101
Q

When does fibrosis occur with a leiomyoma?

A

after atrophic or degenerative changes

102
Q

how does a leiomyoma clinically present?

A

uterine irregularity and enlargement

pelvic pressure and pain

irregular bleeding (menometrorrhagia)

heavy bleeding (menorrhagia)

may contribute to infertility

103
Q

What is a less common cause of uterine calcifications?

A

arcuate artery calcification in periphery of uterus

104
Q

What can indicate underlying disease like diabetes mellitus, hypertension or chronic renal failure?

A

Calcifications in the the tunica media of arteries

105
Q

What is the landmark for the long axis of the uterus?

A

endometrium

106
Q

what percentage of patient with adenomyosis also suffer from dysmenorrhea?

A

25%

107
Q

What two uterine conditions often appear together?

A

fibroids and andomyosis

108
Q

On US how do adenomyomas present?

A

fluid nature of lesions produce increased posterior acoustic enhancement rather than the degree of attenuation normally seen posterior to uterus.

109
Q

do you typically find arteriovenous malformations usually involve the myometrium or the endometrium?

A

These are rare

usually myometrium

110
Q

How do uterine AVM’s appear on US?

A

can be subtle like:

myometrial inhomogeneity

tubular spaces within myometrium

intramural uterine mass

endometrial or cervical mass

prominent parametrial vessels

111
Q

Why would you use color doppler on an AVM?

A

to show blood flow within anechoic structures

may be florid-colored mosaic pattern with apparent flow reversals and areas of color aliasing

112
Q

What does spectral doppler show in an AVM?

A

High-velocity/ low resistance arterial flow COUPLED with high velocity venous flow with arterial component

113
Q

What is a sarcoma botryoides?

A

type of uterine leiomyosarcoma

very rare condition in children characterized by grapelike clusters of tumor mass

114
Q

When would concern about development of malignancy occur for solid uterine masses?

A

When a solid uterine mass rapidly enlarges in a perimenopausal or postmenopausal patient.

115
Q

What are some endometrial pathologies that can cause abnormal bleeding, especially in the postmenopausal patient?

A

hyperplasia

polyps

carcinoma

116
Q

When a patient is receiving tamoxifen therapy for breast cancer, what other disorder can that cause?

A

disorders of the endometrium

117
Q

How is tamoxifen used to treat some forms of breast cancer?

A

tamoxifen is a partial estrogen receptor antagonist used in postmenopausal women with estrogen receptor positive breast cancer.

118
Q

What is a sonohysterography?

A

saline infused sonography [SIS]

119
Q

What is sonohysterography used for?

A

valuable for further evaluating abnormally thickened endometrium

by distending endometrial cavity with saline, endometrial growths and abnormalities can be distinguished

120
Q

In premenopausal women when is a sonohysterography performed?

A

mid-menstrual cycle

usually between days 6-10

121
Q

When is a sonohysterography not performed?

A

when the patient has acute pelvic inflammatory disease

122
Q

When doing a sonohysterography, when would you give a patient prophylactic antibiotics?

A

given with chronic pelvic inflammatory disease

women with hx of mitral valve prolapse

cardiac disorders

123
Q

What is endometrial hyperplasia?

A

occurs when the endometrium becomes too thick

124
Q

When does endometrial hyperplasia occur?

A

follows prolonged unopposed estrogen stimulation

125
Q

What could be a precursor of endometrial cancer?

A

endometrial hyperplasia

126
Q

What is the most common cause of of pre and post menopausal abnormal bleeding in women?

A

endometrial hyperplasia

127
Q

What does an atrophic endometrium measure?

A

thin- measures <5mm

128
Q

What are the measurements for endometrial thickness with hyperplasia?

A

Premenopausal >14mm

asymptomatic postmenopausal >8mm

symptomatic postmenopausal >5mm

129
Q

If the uterus is present, what is associated with increased risk for enometrial hyperplasia or carcinoma?

A

unopposed estrogen - Premarin

130
Q

What produces endometrial atrophy after 3-6 months?

A

continuous/combined estrogen and progesterone (Premarin and Provera)

131
Q

If you take continuous/combined estrogen and progesterone like Premarin and Provera, are you at risk endometrial ca?

A

usually no risk

132
Q

What symptoms do women if they have sequential estrogen and progesterone (Premarin first half, Provera second half)

A

women have predictable withdrawal bleeding at the end of each month

133
Q

What are the benefits of estrogen?

A

alleviates menopausal symptoms

reduces risk of osteoporosis, vertebral and hip fractures

reduces risk of heart attacks, strokes

134
Q

what are the benefits of progesterone?

A

produces endometrial atrophy

reduces risk of endometrial hyperplasia and Ca.

135
Q

What are the negative effects of estrogen?

A

increases risk of endometrial hyperplasia and cancer

136
Q

What are the negative effects of progesterone?

A

increases risk of breast cancer

causes irritability, depression, breast tenderness

137
Q

What are enodmetrial polyps?

A

histologically: polyps are overgrowths of endometrial tissue covered by epithelium

138
Q

How do patients with endometrial polyps present?

A

my be asymptomatic

may have uterine bleeding

139
Q

During what phase of the month would endometrial polyps appear?

A

toward the end of the luteal phase

140
Q

What would the endometrium look like if there were endometrial polyps?

A

represented by a hypoechoic or isoechoic region within hyperechoic endometrium

initally may appear as nonspecific echogenic endometrial thickening

141
Q

What can sonographically appear as diffuse or focal, round echogenic mass within the endometrial cavity?

A

endometrial polyps

should see a feeding artery to the polyp

142
Q

What is endometritis?

A

an infection within the endometrium of the uterus

143
Q

What may be an indication of endometritis?

A

endometrial thickening

fluid

144
Q

When does endometritis most often occur?

A

in association with PID

postpartum state

following instrumentation of uterus

145
Q

In patients with a pelvic infection, what is a conduit for infectious spread to tubes and adnexa?

A

the uterus

146
Q

When might postpartum patients develop endometritis?

A

after prolonged labor

vaginitis

PROM

retained products of conception

147
Q

What are the clinical symptoms of endometritis?

A

patient has intense pelvic pain

148
Q

How does endometritis appear sonographically?

A

endometrium appears prominent, irregular or both with small amount of endometrial fluid

149
Q

What would you find in the cul-de-sac of a patient with endometritis?

A

pus or echogenic particles/debris

150
Q

On US with a patient with endometritis, what might the ovaries look like?

A

enlarged ovaries with multiple cysts and indistinct margins seen secondary to periovarian inflammation

151
Q

In a patient with endometritis how do the Fallopian tubes appear sonographically?

A

dilation of Fallopian tubes show fluid filled tubular shapes

folded configuration

well defined echogenic walls

152
Q

What is a thickened tubal wall, 5mm or more, indicative of?

A

acute endometritis disease

153
Q

How do you tell the difference between bowel and infected Fallopian tubes?

A

gentle compression on pelvic wall to look for peristalsis or movement in bowel lumen

154
Q

What is a tubo-ovarian complex?

A

as infection worsens, periovarian adhesions may form and fuse inflamed tube and ovary

155
Q

How does a tubo-ovarian abscess appear?

A

appears as complex multiloculated mass with septations

irregular shaggy margins

scattered internal echoes

156
Q

What are some clinical signs of endometritis?

A

low back pain and fever

lower abd pain

dysmenorrhea

menorrhagia

sterility

constipation

157
Q

What is synechiae?

A

endometrial adhesions (asherman’s syndrome)

158
Q

When might you find synechiae?

A

found in women with posttraumatic or postsurgical histories

includes uterine curettage

159
Q

What conditions might synechiae cause?

A

infertility

recurrent pregnancy loss

160
Q

How does synechiae appear sonographically?

A

bright echoes within endometrial cavity

in a gravid uterus: appear as hyperechoic band traversing uterus from anterior to posterior

161
Q

During what phase is synechiae best seen?

A

secretory phase when endometrium is more hyperechoic

typically need fluid distending the endometrial cavity to diagnose

162
Q

What is the most common gynecologic malignancy in North America?

A

Endometrial Carcinoma

163
Q

What stage of life do you see the most endometrial carcinoma?

A

postmenopausal patients

164
Q

what is the most common clinical presentation of endometrial carcinoma?

A

uterine bleeding

165
Q

What percentage of postmenopausal women with uterine bleeding have endometrial carcinoma?

A

10%

166
Q

What are the risk factors for endometrial carcinoma?

A

replacement estrogen therapy

Premenopausal women:

anovulatory cycles

obesity

167
Q

What is the earliest change of endometrial carcinoma?

A

thickened endometrium

168
Q

How can a transvaginal examination be helpful in screening for early changes of endometrial hyperplasia or carcinoma?

A

by accurately measuring endometrial thickness

169
Q

Sonographically, thickened endometrium (>4 to 5mm) must be considered ______ until proved otherwise.

A

cancer

170
Q

what is clear evidence for endometrial carcinoma?

A

demonstration of myometrial invasion

171
Q

How does TV scanning demonstrate myometrial invasion?

A

thickening and irregularity of central endometrial interface

with echogenic or hypoechoic patterns

combined with infiltration of hyperdense structures in mymetrium

172
Q

A sonographic finding of enlarged uterus with irregular areas of low-level echoes would be consistent with what?

A

endometrial carcinoma

173
Q

if endometrail carcinoma obstructs the endometrial canal, what could the result be?

A

hydrometra

hematometra

174
Q

What does the intactness of subendometrial halo (inner layer of myometrium) usually indicate?

A

superficial invasion (as relates to endometrial carcinoma)

175
Q

What does obliteration of subendometrial halo indicate?

A

deep invasion of myometrium (as it relates to endometrial carcinoma)

176
Q

When do SMALL endometrial fluid collections occur?

A

small fluid collections also occur with:

ectopic pregnancy

endometritis

degenerating myomas

recent abortion

177
Q

obstruction of _____________ results in accumulation of secretions, blood, or both in uterus..

A

cervical os

178
Q

before menstruation, accumulation of secretions is referred to as what?

A

hydrometrocolpos

179
Q

Following menstruation, hematometrocolpos results from what?

A

presence of retain menstrual blood

180
Q

When a patient has a large collection of endometrial fluid and a fever, what does that suggest?

A

infection of blood collection

lab results would show elevated wbc count

181
Q

What would a patient with large endometrial fluid collections typically complain about?

A

abd pain

has enlarged abd mass

182
Q

When is pyometra more likely to occur?

A

with uterine cancer

183
Q

What might an abnormal development of vagina or uterus result in?

A

cystic uterine or vaginal collection of mucus in children

when menstruation begins collection consists of blood

184
Q

how do large collections of fluid present sonographically?

A

centrally cystic

round

moderately enlarged uterus

may contain echogenic material if pus or blood present

185
Q

What are the two most commonly used IUCD’s?

A

Paraguard (t-shaped flexible plastic wrapped in copper)

Mirena (t-shaped flexible plastic that releases low amts of progestin)

186
Q

What is a copper-releasing IUD?

A

ParaGard

remain in uterus up to 10 years

copper ions are toxic to sperm

187
Q

What is a progestin-releasing IUD?

A

Mirena

remain in uterus up to 5 years

levonorgestrel impairs sperm motility and viability

188
Q

what is hypertrophy?

A

excessive development of an organ or part

increase in by by thickening of muscle fibers

OB/Gyn (14 decks)

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