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Female Pelvis > Pathology of Uterine Structures Ch 43 > Flashcards

Pathology of Uterine Structures Ch 43 Flashcards

1
Q

Most common congenital abnormality of female genital tract is

A

imperforate hymen resulting in obstruction.

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2
Q

Obstruction of uterus and/or vagina may result in:

A
  • hydrometra
  • hematometra
  • pyometra
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3
Q

Hydrometra

A

accumulation of fluid

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4
Q

Hematometra

A

accumulation of blood

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5
Q

Pyometra

A

accumulation of pus

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6
Q

Solid masses are

A

rare in vagina

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7
Q

Most common vaginal masses are

A

adenocarcinoma and rhabdomyosarcoma

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8
Q

Solid mass with possible areas of

A

necrosis

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9
Q

adenocarcinoma and rhabdomyosarcoma are best seen with

A

translabial scanning approach

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10
Q

Vaginal cuff seen in

A

post-surgical hysterectomy patients.

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11
Q

Upper size limit of normal vaginal cuff is

A

2.1 cm.

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12
Q

If cuff is larger or contains well-defined mass or areas of high echogenicity,

A

it should be regarded with suspicion for malignancy, especially in patient who
has previous history of cancer.

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13
Q

Nodular areas in vaginal cuff may be due to

A

postirradiation fibrosis.

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14
Q

Rectouterine Recess (Posterior Cul-De-Sac) AKA

A

Pouch of Douglas

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15
Q

Rectouterine Recess (Posterior Cul-De-Sac) frequent site for

A

intraperitoneal fluid collections

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16
Q

Fluid in cul-de-sac is a

A

normal finding in asymptomatic women and can be seen
during all phases of menstrual cycle.

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17
Q

Pathologic fluid collections may be associated with

A

ascites, blood resulting from
ruptured ectopic pregnancy, hemorrhagic cyst, or pus resulting from infection.

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18
Q

Pelvic abscesses and hematomas can also occur in the

A

cul-de-sac.

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19
Q

Benign Cervical Pathology

A
  • Nabothian cysts
  • cervical polyps
  • Leiomyoma (Fibroid)
  • Cervical Stenosis
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20
Q

Cervical polyps arises from

A

hyperplastic protrusion of epithelium of endocervix or ectocervix

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21
Q

Cervical polyps may be

A

pedunculated, projecting from cervix, or broad-based

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22
Q

Cervical polyps ultrasound does not

A

always detect

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23
Q

cervical polyps more prevalent in

A

late middle-aged women

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24
Q

Leiomyoma (Fibroid) small percentage occur in

A

cervix

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25
Q

U/S may assist in determining

A

location, size, etc.

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26
Q

Sonohysterography with leiomyoma (fibroid) may enhance

A

visualization

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27
Q

Cervical Stenosis

A

a cquired condition

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28
Q

cervical stenosis obstruction of cervical canal at internal or external os resulting from

A
  • Radiation therapy
  • Previous cone biopsy
  • Postmenopausal cervical atrophy
  • Chronic infection
  • Laser or cryosurgery
  • Cervical carcinoma
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29
Q

intracavitary fluid collections can be

A

readily seen on ultrasound and may be indirect indicator of cervical stenosis.

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30
Q

Menopausal patient with cervical stenosis may be

A

asymptomatic even though stenosis can produce a distended, fluid-filled uterus

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31
Q

Premenopausal patients with cervical stenosis may experience

A

abnormal bleeding, oligomenorrhea,
amenorrhea, cramping, dysmenorrhea, or
infertility.

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32
Q

Squamous cell carcinoma is the most common type of

A

cervical cancer.

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33
Q

Cervical Carcinoma precursors are

A

cervical dysplasias (mild, moderate, severe)

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34
Q

When full thickness of epithelium composed of undifferentiated neoplastic cells, lesion referred to as

A

carcinoma in situ

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35
Q

Detection of these abnormalities attributed to screening with

A

Papanicolaou (Pap) smears because most early lesions are asymptomatic

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36
Q

Advanced cervical cancer usually evident

A

clinically

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37
Q

cervical carcinomas affects

A

women of menstrual age

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38
Q

Clinical findings of cervical carcinoma

A

vaginal discharge or bleeding

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39
Q

Sonographic findings of cervical carcinoma

A

retrovesical mass, obstruction of ureters, invasion of bladder

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40
Q

Translabial or Transperineal Sonography

A
  • 5.0- to 7.5-MHz sector or curvilinear transducer is covered with sterile
    probe cover and applied to vestibule of vagina in sagittal plane.
  • Partial bladder filling may assist visualization of cervical area.
  • Sagittal and Transverse
  • Positioning patient with hips elevated, as in transvaginal approach, helps
    displace pelvic gas and identify anatomy.
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41
Q

normal variations of uterus

A
  • Bicornuate
  • Didelphic
  • Septate
  • Arcuate
  • Unicornuate
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42
Q

most common normal variations of uterus is

A
  • Bicornuate
  • Didelphic
  • Septate
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43
Q

Leiomyomas (Fibroids) occurring in

A

about 20-30% of women over the age
of 30.

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44
Q

Leiomyomas (Fibroids) more prevalent in

A

African American women.

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45
Q

Leiomyomas (Fibroids) variable amounts of

A

fibrous connective tissue

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46
Q
A
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47
Q

degeneration occurs when a fibroid

A

outgrows their blood supply, calcifications may be seen

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48
Q

Clinical Findings of fibroids

A

enlarged uterus, patterns of irregular bleeding or heavy menstrual bleeding, pain, sensation of pelvic pressure

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49
Q

fibroids may contribute to infertility by

A

distorting fallopian tube or endo cavity

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50
Q

Most Common gynecological tumor,

A

Leiomyomas (Fibroids)

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51
Q

Myomas are

A

estrogen-dependent

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52
Q

fibroids may

A

increase in size during pregnancy.

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53
Q

fibroids rarely develop in

A

postmenopausal women; most stabilize or decrease in size following
menopause because of lack of estrogen stimulation

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54
Q

fibroids may increase in size for patients

A

undergoing hormone replacement therapy

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55
Q

fibroids rapid increase in fibroid size may be

A

suspicious for neoplasm, especially in postmenopausal women

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56
Q

Uterine Locations of Myomas

A
  • Submucosal
  • Intramural
  • Subserosal
  • Pedunculated
  • Intracavitary
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57
Q

Submucosal

A

displacing or distorting endometrial cavity with subsequent irregular or heavy menstrual bleeding

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58
Q

Intramural

A

confined to myometrium; most common type

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59
Q

Subserosal

A

projecting from peritoneal surface of uterus, may enlarge and cause pressure on adjacent organs

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60
Q

Pedunculated

A

can appear as extrauterine masses with stalk arising from uterus

61
Q

Intracavitary

A

usually pedunculated and confined to endometrium

62
Q

In cases of infertility and submucosal myomas,

A

myomectomy (surgical removal
of fibroid) is often the preferred treatment.

63
Q

In cases of menorrhagia, possible treatments of fibroids are

A
  • Least invasive treatment is hormonal suppression to stop the bleeding
  • Endometrial ablation
  • Uterine artery embolization (UAE)
  • High intensity focused ultrasound (HIFU)
64
Q

most common cause of uterine calcifications.

A

fibroids

65
Q

Less common uterine calcifications

A

arcuate artery calcification at periphery of
uterus

66
Q

uterine calcifications are thought to occur as

A

consequence of calcific sclerosis within these vessels

67
Q

uterine calcifications can indicate

A

underlying disease, such as diabetes mellitus,
hypertension, or chronic renal failure

68
Q

Adenomyosis is the

A

ectopic occurrence of endometrial tissue within myometrium; more common in posterior aspect

69
Q

Adenomyosis is

A
  • Benign disease
  • Diffuse or focal
70
Q

Adenomyosis sonographically presents as

A
  • bulky enlarged uterus without focal mass
  • heterogeneous uterus
  • thickening of posterior myometrium
  • myometrial cysts
71
Q

Hemorrhage in islands of endometrial tissue appears as

A

small hypoechoic myometrial cysts.

72
Q
A
73
Q

Fluid nature of lesions produces

A

increased posterior acoustic enhancement rather than the degree of attenuation normally seen posterior to uterus.

74
Q

Focal adenomyosis sometimes called

A

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

75
Q

implants produce

A

diffuse uterine enlargement

76
Q

estimated 60% women with adenomyosis experience

A
  • Abnormal excessive uterine bleeding (hypermenorrhea)
  • Prolonged/profuse uterine bleeding (menorrhagia)
  • Irregular, acyclic bleeding (metrorrhea)
77
Q

Approximately 25% of patients with adenomyosis also suffer from

A

pelvic pain during menstruation
(dysmenorrhea).

78
Q

Uterine arteriovenous malformations
(AVMs) consist of

A

vascular plexus of arteries and veins.

79
Q

Arteriovenous Malformations

A

Rare; usually involving myometrium and
rarely endometrium

80
Q

Arteriovenous Malformations are

A

Congenital or acquired due to pelvic trauma,
surgery, or gestational trophoblastic
neoplasia

81
Q

Clinically Arteriovenous Malformations women of childbearing years have

A

metrorrhagia with blood loss and anemia.

82
Q

Arteriovenous Malformations diagnosis critical because

A

dilation and curettage may lead to catastrophic hemorrhaging.

83
Q

Arteriovenous Malformations:
Sonographic Findings

A
  • Tortuous, anechoic structures seen within the pelvis.
  • Uterine AVMs may appear as subtle myometrial inhomogeneity, tubular spaces within myometrium, intramural uterine mass, endometrial or cervical mass, and sometimes as prominent parametrial vessels.
  • Color Doppler is diagnostic to show blood flow within anechoic structures.
  • May be florid-colored mosaic pattern with apparent flow reversals and areas of color aliasing.
  • Spectral Doppler shows high-velocity, low-resistance arterial flow coupled with high-velocity venous flow with arterial component.
84
Q

Uterine Leiomyosarcoma

A

Rare, solid tumor arising from myometrium or endometrium

85
Q

Uterine Leiomyosarcoma commonly in

A

fundus of uterus

86
Q

Uterine Leiomyosarcoma most common in

A

women 40 to 60 years of age

87
Q

Uterine Leiomyosarcoma has

A

Rapid growth

88
Q

Sarcoma botryoides:

A

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

89
Q

Uterine Leiomyosarcoma: Sonographic Findings

A
  • Leiomyosarcoma may resemble myomas or
    endometrial carcinoma with features of solid
    or mixed-solid and cystic texture.
  • Clinically, rapid enlargement of solid uterine
    mass in perimenopausal or postmenopausal
    patient raises concern about development of
    malignancy.
90
Q

Tamoxifen is a

A

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

91
Q

Abnormally thick endometrium could result
from:

A
  • Early intrauterine pregnancy
  • Gestational trophoblastic disease
  • Endometrial hyperplasia
  • Secretory endometrium
  • Estrogen replacement therapy
  • Polyps
  • Endometrial carcinoma
92
Q

Many endometrial pathologies, such as
hyperplasia, polyps and carcinoma, can cause

A

abnormal bleeding, especially in
postmenopausal patient.

93
Q

Endometrial canal is landmark for

A

identification of long axis of uterus.

94
Q

Echogenicity of endometrial tissue compared with

A

homogeneous, medium-level echogenicity of middle layer of myometrium.

95
Q

Fluid, if present, should not be

A

included in endometrial measurements.

96
Q

Disorders of endometrium may also occur in

A

menopausal patients with breast cancer receiving tamoxifen therapy.

97
Q

Endometrial Hyperplasia follows

A

prolonged estrogenic stimulation

98
Q

Endometrial Hyperplasia May be precursor

A

of endometrial cancer

99
Q

Endometrial Hyperplasia Sonographic findings:

A

abnormal thickening of
endometrium

100
Q

Endometrial Hyperplasia majority of women with postmenopausal uterine bleeding are

A

experiencing endometrial atrophy.

101
Q

Endometrial Hyperplasia on transvaginal sonography,

A

atrophic endometrium
is thin, measuring <5 mm.

102
Q

If postmenopausal patient has irregular bleeding and thickened endometrium,

A

may warrant sonohysterography procedure and/or endometrial biopsy

103
Q

Patients with endometrial polyps may be

A

asymptomatic or present with uterine bleeding.

104
Q

Histologically, polyps are overgrowths of

A

endometrial tissue covered by epithelium.

105
Q

Endometrial Polyps may be

A

pedunculated, broad-based, or have a thin stalk.

106
Q

Endometrial Polyps typically cause

A

diffuse or focal endometrial thickening; more frequently seen in perimenopausal and postmenopausal women.

107
Q

Endometrial Polyps in menstruating women, may be associated with

A

menometrorrhagia or infertility.

108
Q

Endometrial Polyps: Sonographic Findings

A
  • Represented by hypoechoic or isoechoic
    region within hyperechoic endometrium
  • Initially may appear as nonspecific
    echogenic endometrial thickening
  • May be diffuse or focal and may also
    appear as round echogenic mass within
    endometrial cavity
109
Q

Endometritis is

A

an infection within endometrium of the uterus.

110
Q

Endometrial thickening or fluid may indicate

A

endometritis.

111
Q

Endometritis it occurs most often in association

A

with PID, in postpartum state, or
following instrumentation of uterus, and may be seen with an IUD.

112
Q

With a pelvic infection,

A

uterus is conduit for infectious spread to
tubes and adnexa.

113
Q

Clinically endometritis patient has

A

intense pelvic pain; low back pain and fever;
dysmenorrhea; menorrhagia; sterility; constipation

114
Q

Endometritis: Sonographic Findings

A
  • Endometrium appears prominent, irregular, or both, with small amount of endometrial fluid.
  • Pus may be demonstrated in cul-de-sac as echogenic particles or debris.
  • Enlarged ovaries with multiple cysts and indistinct margins may be seen secondary to periovarian inflammation.
115
Q

Common condition in which functioning

A

endometrial tissue is present outside the uterus.

116
Q

Ectopic tissue can be found almost anywhere in pelvis, including

A
  • ovary
  • fallopian tube
  • broad ligament
  • external surface of uteru
  • scattered over peritoneum
  • cul-de-sac
  • bladder
117
Q

Endometrial tissue cyclically

A

bleeds and proliferates.

118
Q

Endometriosis rarely diagnosed by

A

sonography

119
Q

Intrauterine synechiae

A

(endometrial adhesions, seen with Asherman’s syndrome)

120
Q

Synechiae found in women with

A

posttraumatic or postsurgical histories

121
Q

Synechiae includes

A

uterine curettage and may be cause of infertility or recurrent pregnancy loss

122
Q

synechiae sono findings -

A
  • Bright echoes within endometrial cavity
  • Diagnosis difficult unless fluid distending endometrial cavity
  • Is best seen during secretory phase when endometrium more hyperechoic
  • more easily seen in gravid uterus where they appear as hyperechoic band traversing uterus
    from anterior to posterior
123
Q

demonstration of

A

myometrial invasion clear evidence for endometrial carcinoma

124
Q

TVS demonstrates

A

myometrial invasion as thickening and irregularity of central endometrial interface with echogenic or hypoechoic patterns combined with infiltration of hyperdense structures in myometrium.

125
Q

endometrial carcinoma may

A

obstruct endometrial canal, resulting in hydrometra or hematometra

126
Q

endometrial carcinoma intactness of subendometrial halo (inner layer of myometrium) usually indicates

A

superficial invasion.

127
Q

endometrial carcinoma obliteration of halo indicative of

A

deep invasion

128
Q

estrogen stimulation associated with

A

estrogen stimulation

129
Q

endometrial carcinoma has

A

secondary effects on endometrium

130
Q

endometrial carcinoma clinical

A

postmenopausal bleeding

131
Q

endometrial carcinoma sonographic findings

A
  • Prominent endometrial complex; enlarged uterus with irregular areas of low-level echoes
132
Q

Small fluid collections can occur

A

with ectopic pregnancy, endometritis,
degenerating myomas, and recent
abortion.

133
Q

Large fluid collections should be

A

regarded with suspicion

134
Q

Before menstruation,

A

accumulation of secretions referred to as hydrometrocolpos.

135
Q

Following menstruation,

A

hematometrocolpos results from presence of
retained menstrual blood.

136
Q

Pyometra more likely to occur with

A

uterine cancer.

137
Q

Large Endometrial Fluid Collections Clinical Findings:

A
  • Abdominal pain with possible enlarged abdominal mass
  • May or may not have vaginal bleeding
  • Presence of fever suggests infection
  • Lab results show elevated WBC
138
Q

Large Endometrial Fluid Collections Sonographic Findings

A
  • Large endometrial cavity fluid collection is that of centrally cystic, round, moderately enlarged uterus
  • May contain echogenic material if pus or blood present
139
Q

IUD sonographically

A

Appear as highly echogenic linear structure within endo canal

140
Q

Beneficial Effects of Hormones Estrogen

A
  • Alleviates menopausal symptoms (hot flashes, night sweats, painful intercourse)
  • Reduces risk of osteoporosis, vertebral and
    hip fractures
  • Reduces risk of heart attacks, strokes
141
Q

Beneficial Effects of Hormones Progesterone

A
  • Produces endometrial atrophy
  • Reduces risk of endometrial
    hyperplasia/cancer
142
Q

Negative Effects of Hormones Estrogen

A
  • Increases risk of endometrial hyperplasia/cancer
143
Q

Negative Effects of Hormones Progesterone

A
  • Increases risk of breast cancer
  • Causes irritability, depression, breast tenderness in some women
144
Q

Differential Diagnoses Enlarged Uterus

A
  • Pregnancy
  • Postpartum
  • Leiomyoma
  • Adenomyosis
  • Bicornuate or didelphic uterus
145
Q

Differential Diagnoses Uterine Tumor

A
  • Leiomyoma
  • Carcinoma
146
Q

Differential Diagnoses Endometrial Fluid

A
  • Endometritis
  • Retained products of conception
  • Pelvic inflammatory disease
  • Cervical obstruction
147
Q

Differential Diagnoses Endometrial Shadowing

A
  • Gas (abscess)
  • Intrauterine device
  • Calcified myomas or vessels
  • Retained products of conception
148
Q

Differential Diagnoses Thickened Endometrium

A
  • Early intrauterine pregnancy
  • Endometrial hyperplasia
  • Retained products of conception or incomplete abortion
  • Trophoblastic disease
  • Endometritis
  • Adhesions
  • Polyps
  • Inflammatory disease
  • Endometrial carcinoma

Female Pelvis (5 decks)

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