Pelvic Masses Flashcards
List the Benign uterine masses?
Uterine fibroids
Adenomyosis
Nabothian cyst
Cervical polyp
Endometrial polyps
What is a Uterine Fibroid?
It is a benign tumor of uterine smooth muscle
When do uterine fibroids regress and why?
- After Menopause
-Because of the reduction in estrogen levels
What are the risk factors for uterine Fibroids?(7)
-Age
-Early menarche
-Family history/Genetics
-Obesity/overweight/high BMI
-Hormonal Contraceptives
- Black
-Smoking
What are the types of fibroid?
-Submucosa
-Subserosa
-Intramural
Describe how to classify Fibroids?
REFER
What are the secondary changes a fibroid undergoes?
-Degeneration
-Hyaline
-Cystic
-Calcification
-Infection and abscess
-Necrobiosis
-Sarcomatous Change
What is Hyaline degeneration?
- Smooth muscles replaced by fibrous connective tissues
-Scattered islands of muscle cells are found intact in broad expanses of hyaline degeneration.
Describe a cystic degeneration?
An extension of hyaline degeneration with liquefaction of some areas of the fibroid and cyst formation.
Describe Calcification Degeneration?
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.
Which fibroids usually undergo Infection and abscess formation? What does it usually follow?
-Submucous Fibroid
-Following a septic abortion or tumor
Which type of Fibroid does necrobiosis affect?
Pedunculated Subserous Fibroids
Describe red generation/Carneous Degeneration?
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.
What happens in a sarcomatous change during degeneration?
Malignant change in fibroids
What is the clinical presentation of uterine fibroids?
Abnormal vaginal bleeding
Slight Dysmenorrhea
Dyspareunia
Pelvic pain(though not a significant factor)
Pressure symptoms-Constipation, urgency, frequency
What investigations are done for someone suspected of having a Fibroid?
Bloods
FBC
Urine - pregnancy test
Imaging
Pelvic ultrasound (transvaginal vs transabdominal)
Hysteroscopy
Hysterosalpingography
MRI –provide detailed image (size, location and number)
What is the definitive management for Fibroids?
Myomectomy
Hysterectomy
Uterine artery embolism
What symptomatic management is given to treat fibroids?
NSAIDs
Antifibrinolytics- Tranexamic acid
Hormonal therapies
Combined oral contraceptives
Progestin-releasing intrauterine device
Gonadotropin-releasing hormone agonists (Leuprolide, goserelin
When is a myomectomy considered?
When fertility is a concern.
What are the complications of a Fibroid?(7)
Myomectomy
Hysterectomy
Uterine artery embolism
What is adenomyosis?
-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.
What are the risk factors for Adenomyosis?(4)
Obesity
Family history
Child birth
Prior uterine surgery
What is the clinical presentation of Adenomyosis?(8)
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
What investigations are done for Adenomyosis?
Abdominal/transvaginal ultrasound
Magnetic Resonance Imaging
Computed Tomography
What is the definitive treatment for Adenomyosis?
Hysterectomy
What is the symptomatic treatment done for Adenomyosis?
Non steroidal anti-inflammatory drug
Hormonal treatment (oral contraceptives)
Differentiate Endometriosis and Adenomyosis?
REFER TO NOTES?
What is a Nabothian cyst?
It is a mucus filled sac on the surface of the cervix?
What is the cause of the nabothian cyst?
It occurs when the stratified squamous epithelium of the ectocervix grow over the simple columnar epithelium of the endocervix.
What is the clinical presentation of a Nabothian Cyst?
-Typically Asymptomatic
-Can cause pain and vaginal fullness
Treatment for Nabothian Cyst?
-They frequently resolve so don’t usually require treatment.
-Treatment involves ablation with electrocautery
-Sims cryotherapy may be used
What is a cervical Polyp?
It is a benign lesion of hyperplastic cervical epithelium
What is the cause of cervical polyps?
Unknown but usually associated with abnormal response to estrogen and cervical infections.
What is clinical presentation of a cervical polyp?
Heavy menstrual bleeding
Postcoital bleeding
Intermenstrual Bleeding
Post Menopausal bleeding
Foul smelling vaginal discharge because of infections
What investigations are done in A cervical polyp?
-Biopsy
-Speculum
What is an Endometrial Polyp?
-It is an overgrowth of localized endometrial tissue .
What is the treatment for a cervical polyp?
Surgical removal -Polypectomy
What is endometrial polyps a common cause for?
bleeding in both premenopausal and post menopausal patients
What are the 2 types of endometrial polyps?
-Pedunculated Polys
-Sessile Polyps
What are the risk factors for Endometrial Polyps?
Obesity
History of cervical polyps
Tamoxifen or hormone replacement therapy
What are the clinical features of endometrial polyps?
Irregular menstrual periods.
Heavy menstrual bleeding
PV bleeding after menopause
Dysmenorrhea
What investigations are done for an endometrial Polyp?
Hysteroscopy
Transvaginal ultrasound
Biopsy
What investigations are done for endometrial polyp?
Curettage (with or without hysteroscopy)
If cancerous do hysterectomy
What are the two types of fallopian tube benign tumors?
-Adenomatoid Tumor
-Serous Papilloma
Where can an adenomatoid tumor be found?
-Can be found in uterus, fallopian tube and ovarian hilus
What are adenomatoid tumors associated with?
-leiomyomas and adenomyosis.
What are adenomatoid tumors?
benign tumors of mesothelial origin.
How are they diagnosed and why?
Histologically as it is difficult to differentiate between a leiomyoma
What are the differentials for an adenomatoid tumor?
Lymphangioma
Adenomyoma
Mesothelial cells - simple squamoepithelium found on coelemic (cavity in the body that contain internal organs)
Where can serous papilloma be located?
-Intramural and Fimbria
Clinical Features of serous papilloma?
Abnormal vaginal bleeding
Abdominal Pain
