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Obs/Gynae > Pelvic Masses > Flashcards

Pelvic Masses Flashcards

1
Q

List the Benign uterine masses?

A

Uterine fibroids
Adenomyosis
Nabothian cyst
Cervical polyp
Endometrial polyps

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2
Q

What is a Uterine Fibroid?

A

It is a benign tumor of uterine smooth muscle

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3
Q

When do uterine fibroids regress and why?

A
  • After Menopause
    -Because of the reduction in estrogen levels
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4
Q

What are the risk factors for uterine Fibroids?(7)

A

-Age
-Early menarche
-Family history/Genetics
-Obesity/overweight/high BMI
-Hormonal Contraceptives
- Black
-Smoking

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5
Q

What are the types of fibroid?

A

-Submucosa
-Subserosa
-Intramural

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6
Q

Describe how to classify Fibroids?

A

REFER

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7
Q

What are the secondary changes a fibroid undergoes?

A

-Degeneration

-Hyaline
-Cystic
-Calcification
-Infection and abscess
-Necrobiosis
-Sarcomatous Change

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8
Q

What is Hyaline degeneration?

A
  • Smooth muscles replaced by fibrous connective tissues
    -Scattered islands of muscle cells are found intact in broad expanses of hyaline degeneration.
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9
Q

Describe a cystic degeneration?

A

An extension of hyaline degeneration with liquefaction of some areas of the fibroid and cyst formation.

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10
Q

Describe Calcification Degeneration?

A

Usually occurs after menopause/age occurs when there reduced blood flow to the fibroid which causes ischemia and tissue death and as result calcification occurs as part of the healing process.

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11
Q

Which fibroids usually undergo Infection and abscess formation? What does it usually follow?

A

-Submucous Fibroid
-Following a septic abortion or tumor

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12
Q

Which type of Fibroid does necrobiosis affect?

A

Pedunculated Subserous Fibroids

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13
Q

Describe red generation/Carneous Degeneration?

A

This a type of degeneration occurs normally during pregnancy via a couple of mechanism.
-As the uterus gets bigger there is venous obstruction and this leads to a hemorrhagic infarction resulting in ischemia and necrosis of the fibroid. The necrotic tissue triggers an inflammatory reaction and starts to look like an infection.
-this results in pain, fever.

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14
Q

What happens in a sarcomatous change during degeneration?

A

Malignant change in fibroids

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15
Q

What is the clinical presentation of uterine fibroids?

A

Abnormal vaginal bleeding
Slight Dysmenorrhea
Dyspareunia
Pelvic pain(though not a significant factor)
Pressure symptoms-Constipation, urgency, frequency

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16
Q

What investigations are done for someone suspected of having a Fibroid?

A

Bloods
FBC
Urine - pregnancy test
Imaging
Pelvic ultrasound (transvaginal vs transabdominal)
Hysteroscopy
Hysterosalpingography
MRI –provide detailed image (size, location and number)

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17
Q

What is the definitive management for Fibroids?

A

Myomectomy
Hysterectomy
Uterine artery embolism

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18
Q

What symptomatic management is given to treat fibroids?

A

NSAIDs
Antifibrinolytics- Tranexamic acid
Hormonal therapies
Combined oral contraceptives
Progestin-releasing intrauterine device
Gonadotropin-releasing hormone agonists (Leuprolide, goserelin

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19
Q

When is a myomectomy considered?

A

When fertility is a concern.

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20
Q

What are the complications of a Fibroid?(7)

A

Myomectomy
Hysterectomy
Uterine artery embolism

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21
Q

What is adenomyosis?

A

-Benign disease characterized by occurrence of endometrial tissue within the myometrium due to invasion of the endothelial basal layer.
-Characterized by invasion of endometrial glands and stroma into the myometrium.

22
Q

What are the risk factors for Adenomyosis?(4)

A

Obesity
Family history
Child birth
Prior uterine surgery

23
Q

What is the clinical presentation of Adenomyosis?(8)

A

Dyspareunia
Chronic pelvic pain
Dysmenorrhea
Abnormal uterine bleeding
Spotting in between periods
Heavy menstrual bleeding
Globular, uniformly enlarged uterus that is soft but tender on palpation
Bloating

24
Q

What investigations are done for Adenomyosis?

A

Abdominal/transvaginal ultrasound
Magnetic Resonance Imaging
Computed Tomography

25
Q

What is the definitive treatment for Adenomyosis?

A

Hysterectomy

26
Q

What is the symptomatic treatment done for Adenomyosis?

A

Non steroidal anti-inflammatory drug
Hormonal treatment (oral contraceptives)

27
Q

Differentiate Endometriosis and Adenomyosis?

A

REFER TO NOTES?

28
Q

What is a Nabothian cyst?

A

It is a mucus filled sac on the surface of the cervix?

29
Q

What is the cause of the nabothian cyst?

A

It occurs when the stratified squamous epithelium of the ectocervix grow over the simple columnar epithelium of the endocervix.

30
Q

What is the clinical presentation of a Nabothian Cyst?

A

-Typically Asymptomatic
-Can cause pain and vaginal fullness

31
Q

Treatment for Nabothian Cyst?

A

-They frequently resolve so don’t usually require treatment.
-Treatment involves ablation with electrocautery
-Sims cryotherapy may be used

32
Q

What is a cervical Polyp?

A

It is a benign lesion of hyperplastic cervical epithelium

33
Q

What is the cause of cervical polyps?

A

Unknown but usually associated with abnormal response to estrogen and cervical infections.

34
Q

What is clinical presentation of a cervical polyp?

A

Heavy menstrual bleeding
Postcoital bleeding
Intermenstrual Bleeding
Post Menopausal bleeding
Foul smelling vaginal discharge because of infections

35
Q

What investigations are done in A cervical polyp?

A

-Biopsy
-Speculum

36
Q

What is an Endometrial Polyp?

A

-It is an overgrowth of localized endometrial tissue .

37
Q

What is the treatment for a cervical polyp?

A

Surgical removal -Polypectomy

38
Q

What is endometrial polyps a common cause for?

A

bleeding in both premenopausal and post menopausal patients

39
Q

What are the 2 types of endometrial polyps?

A

-Pedunculated Polys
-Sessile Polyps

40
Q

What are the risk factors for Endometrial Polyps?

A

Obesity
History of cervical polyps
Tamoxifen or hormone replacement therapy

41
Q

What are the clinical features of endometrial polyps?

A

Irregular menstrual periods.
Heavy menstrual bleeding
PV bleeding after menopause
Dysmenorrhea

42
Q

What investigations are done for an endometrial Polyp?

A

Hysteroscopy
Transvaginal ultrasound
Biopsy

43
Q

What investigations are done for endometrial polyp?

A

Curettage (with or without hysteroscopy)
If cancerous do hysterectomy

44
Q

What are the two types of fallopian tube benign tumors?

A

-Adenomatoid Tumor
-Serous Papilloma

45
Q

Where can an adenomatoid tumor be found?

A

-Can be found in uterus, fallopian tube and ovarian hilus

46
Q

What are adenomatoid tumors associated with?

A

-leiomyomas and adenomyosis.

47
Q

What are adenomatoid tumors?

A

benign tumors of mesothelial origin.

48
Q

How are they diagnosed and why?

A

Histologically as it is difficult to differentiate between a leiomyoma

49
Q

What are the differentials for an adenomatoid tumor?

A

Lymphangioma
Adenomyoma
Mesothelial cells - simple squamoepithelium found on coelemic (cavity in the body that contain internal organs)

50
Q

Where can serous papilloma be located?

A

-Intramural and Fimbria

51
Q

Clinical Features of serous papilloma?

A

Abnormal vaginal bleeding
Abdominal Pain

Obs/Gynae (16 decks)

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