Repro 8 - Uterine Pathology Flashcards
What is endometriosis?
Endometrial tissue found outside the uterus; usually in the ovary but can be anywhere.
What is an endometrioma?
AKA “chocolate cyst”, it is a result of blood build-up from endometriosis in the ovary.
What are the symptoms of endometriosis?
Severe menstrual-related pain. Painful intercourse. Pain w/ defecation or urination. Blood in stool or urine during menses. Infertility.
Why does Endometriosis cause infertility?
Inflammation and pelvic scarring which leads to adhesions and decreased function of the tubes (and cilia inside of the tubes).
How is the diagnosis for endometriosis made?
Laparoscopy and biopsy.
What are the theories of causes of endometriosis?
Retrograde menstrual flow. Hematologic spread. Lymphatic spread. Direct spread. Metaplasia.
What are the treatments for endometriosis?
OCPs. If not sufficient, use continuous GnRH agonists (leuprolide) to get the patient into a chemical menopause. Or bilateral salpingo-oophorectomy. Danazol.
What is Adenomyosis? What is the only treatment?
Endometrial tissue found within myometrium (instead of spreading out, it invades into the muscular wall of the uterus itself). Only useful treatment is Hysterectomy.
What are the symptoms of adenomyosis?
Tender, boggy, enlarged uterus. Heavy periods. Focal pain on exam. Dyspareunia.
What is the cause of endometrial proliferation And what does it lead to?
Caused by excess unopposed estrogen. Precursor to hyperplasia and endometrial cancer.
What are the symptoms of endometrial proliferation?
Menorrhagia or metrorrhagia after age 35 years. Postmenopausal bleeding (NEVER normal to have this).
What are the risk factors of endometrial proliferation?
Anovulatory cycles. PCOS. Unopposed estrogen (HRT). Granulosa cell tumor.
What is the most common GYN malignancy in the US?
Endometrial cancer.
What is the symptom of endometrial cancer?
Vaginal bleeding.
What are the risk factors for Endometrial cancer?
[HHONDA] Hyperplasia. Hypertension. Obesity. Nulliparity. Diabetes. Anovulatory state.
What are Leiomyoma?
AKA fibroid, they are benign smooth muscle tumor. Monoclonal. Most common tumor in females. Usually presents in a patient w/ multiple tumors w/ well demarcated borders. High recurrence risk. Malignant transformation is rare. They are estrogen sensitive (increase in preg, decrease in menopause).
What are the symptoms of Leiomyoma?
Asymptomatic. Vaginal bleeding. Bulk symptoms (pelvic pressure and discomfort). Miscarriage. Pain if necrosis.
What are the Leiomyomas according to their location and which one is the most common?
Subserosal (reach outside the uterus). Intramural. Submucosal. Intramural are the most common.
What are the treatments for Leiomyomas?
OCPs. Continuous GnRH analog (Leuprolide). Embolization. Ablation. Myomectomy (Scoop them out). Hysterectomy.
What are Leiomyosarcoma?
Arise de novo. They are bulky, irregularly shaped. They grow so fast there are areas of necrosis and hemorrhage. Common in middle aged women, more on blacks. We suspect this disease if the uterus is enlarging rapidly. Very aggressive and tend to reoccur.
When do we use Leuprolide?
Fibroids. Endometriosis. Infertility. Prostate cancer.
What is the most common GYN cancer in the world?
Cervical.
Which of the GYN cancers has the worst prognosis (endometrial, ovarian, cervical)?
Ovarian has the worst prognosis.
What uterine pathology has Excess unopposed estrogen as the main risk factor?
Endometrial hyperplasia, endometrial carcinoma.
