Reproductive Flashcards
Ovarian oestrogen secreting tumours?
Ovarian thecoma
Ovarian granulosa cell tumours
What do testicular epidermoid cysts looks like on USS
Round hypoechoic mass
Onion skin layering
What is struma ovarii?
Mature teratoma containing mostly thyroid tissue
What are the radiological features of molar pregnancy?
1st trimester: Intrauterine mass with snowstorm appearance on USS.
2nd trimester: Bunch of grapes on USS.
+/- fetal parts
What is Meigs syndrome?
Ovarian fibroma
Ascites
Pleural effusion
What is Ovarian hyperstimulation syndrome?
Complication of controlled ovarian stimulation.
Ascites, pleural effusions, and intravascular fluid depletion.
Theca lutein cysts.
What is a Brenner tumour?
Benign epithelial tumour of the ovaries.
Appear fibrous and have calcification
Which uterine developmental abnormality has the highest risk of fertility issues?
Septate uterus (flat fundus Vs heart shaped fundus of bicornuate/Didelphis)
What is Salpingitis Ithmica Nodosa (SIN)
Nodular scarring of the fallopian tube. Basically it’s diverticulosis of the fallopian tubes secondary to inflammation/infection.
High association with infertility and ectopic pregnancy
What is Ashermans syndrome?
Intrauterine adhesions. Secondary to prior surgery, infection, or pregnancy.
Clinically can result in infertility.
Classic imaging features of adenomyosis?
Thickening of the junctional zone >12mm
Can have high T2 signal in junctional zone or myometrium (cystic change)
What is the main malignant cancer of the uterus?
Adenocarcinoma
Rarely leiomyosarcoma (fibroid malignant transformation.)
How does endometrial cancer typically enhance?
Typically enhances less than the myometrium
What are the USS imaging appearances of endometrial polyps?
Hyperechoic
Single feeding vessel on Doppler
What is the most common type of cervical and vaginal cancer, and what condition increases the risk of developing it?
Squamous cell
Related to HPV
Where are Bartholin cysts typically found?
BARTHOLIN cysts are cysts of the mucin secreting glands and found BELOW the pubic symphysis.
Can become infected.
Where are Nabothian cysts found?
By the cervix
Where are Gartner cysts found?
Anterior, lateral, or upper vagina
What are the simple ovarian cyst follow up criteria?
Pre menopausal:
<3cm - normal
3-5cm - report presence, no follow up
>5cm - follow up in 3-12 months based on suspicion
Postmenopausal:
<1cm - normal
1-3cm - report presence, no follow up
>3cm - follow up in 3-12 months based on suspicion
What are the USS appearances of haemorrhagic cyst?
Lacy fishnet appearance
Absent Doppler flow
What is the most common ovarian neoplasm is patients<20y.
Ovarian teratoma
What are the USS features of a dermoid cyst?
Fat containing cystic mass with a hyperechoic mural module (Rokitanski nodule)
What cancer can endometriomas turn into?
Clear cell and endometroid ovarian cancer.
Will look like a solid nodule with blood flow in a endometrioma.
What cancer can teratomas turn into?
Squamous cell cancer
Most common type of ovarian cancer?
Serious ovarian cystadenoma/adenocarcinoma
What is an endometroid ovarian cancer?
Second most common ovarian cancer.
Associated with endometriosis.
Can grow within endometriomas.
Bilateral in 25-40% of cases.
What is a Krukenberg tumour?
GI metastasis to the ovary
What is a choriocarcinoma?
Highly aggressive, highly vascular malignancy of the testes, uterus or ovary.
Highly elevated bHcg
Haematogenous spread, usually to lungs.
Isolated orchitis usually occurs from what infections?
Mumps
TB
What nodes do testicular cancers metastasize to?
Retroperitoneal nodes at level of renal hilum.
What are the most common testicular tumors?
Germ cell tumour (90%):
- Seminoma (50%)
- Non Seminoma (50%) (Teratoma, yolk sac, mixed germ cell)
(Non germ cell i.e. Sertoli and leydig cell are 10%).
Typical USS appearance of Seminoma?
Hypoechoic, homogeneous, microcalc
Classically replace the whole testicle.
Non Seminoma tumour typical USS appearance?
Heterogeneous with cystic spaces and calcifications
Most common testicular tumour in >60y?
Testicular lymphoma
What condition is Sertoli tumours associated with?
Peutz-Jeghers Syndrome
What testicular tumors elevate BhCG?
Seminoma
Choriocarcinoma
What testicular tumors elevate AFP?
Mixed germ cell
Yolk sac
What is Zinner syndrome?
Wolffian duct anomalies:
- unilateral renal agenesis
- ipsilateral seminal vesicle cyst
- ejaculatory duct obstruction
Classical presentation of adrenal rests?
Bilateral solid testicular masses and congenital adrenal hyperplasia.
How does testicular sarcoidosis classically present?
Bilateral multiple testicular AND epididymal masses.
Where are seminal vesicle cysts typically and what are they associated with?
Lateral to bladder
Aquired - Polycystic kidney disease
Congenital - Renal agenesis + ejaculatory duct obstruction = Zinner syndrome
What does Uterine AVM look like on USS?
Tubular anechoic structures in myometrium.
High velocity colour on Doppler flow.
How do you define a cystocele?
Bladder prolapse into the vagina.
Bladder decent >1cm below pubococcygeal line.
What are the 4 types of fibroid degeneration?
Hyaline - fibroid outstrips blood supply
Red - venous thrombosis ( in pregnancy)
Myxoid
Cystic
What are the MRI appearances of uterine fibroids?
Classic fibroid
T1 Dark
T2 Dark
C Homogeneous
What are MRI appearance of hyper cellular fibroid?
T1 Dark
T2 Bright
C Homogeneous
Respond well to embolisation
How do fibroids undergo malignant transformation?
Leiomyosarcoma
Look like a fibroid but rapidly enlarge with areas of necrosis
What is the upper limit for endometrial thickness in postmenopausal women?
4-5mm
>5mm should get a biopsy
What is the upper limit of normal for endometrial thickness in women on Tamoxifen?
12mm
How does Tamoxifen affect the endometrium?
Sub endometrial cysts
Endometrial polyps
What is the difference between cervical cancer stage 2a and 2b?
2a spread beyond the cervix, NO parametrial invasion - Surgery
2b spread beyond the cervix, WITH parametrial involvement - Chemo radiotherapy
What tumours metastasise to the anterior upper wall of the vagina?
Upper genital tract tumours (90%)
(Posterior wall is GI tract tumours)
What tumours metastasise to the posterior lower wall of the vagina?
GI tract tumours (90%)
(Anterior wall is upper genital tract tumours)
Where are Skene gland cysts found?
Paraurethral
Can cause recurrent UTI and urethral obstruction.
What are theca lutein cysts?
Multilocular cyst related to ovarian hyper stimulation.
Typical spoke wheel appearance.
Seen in molar and multiple pregnancies
How can you differentiate corpus luteum cyst from ectopic pregnancy?
Ectopic - thick echogenic rim, ring of fire, separate from ovary
Corpus luteum - thin echogenic rim, ring of fire, moves with ovary
How can you differentiate Brenner tumour from fibroma?
Both are fibrous
Brenner tumours have calc in 80%
Fibromas no calc
What are the causes of hydrosalpinx?
PID
Tubal cancer
Torsion
Endometriosis
Hysterectomy
What is a peritoneal inclusion cyst?
Occurs when adhesions envelope an ovary.
Adhesions cannot absorb the normal secretions of the ovary and so they collect and form a cyst.
Risk factors include:
PID
Endometriosis
Surgery
What is the Gleason grade Vs Gleason score?
Gleason grade is the histological pattern, 1-5. Higher grade is worst.
Gleason score is the total of the two most common histological patterns. 3+4, or 4+3. The first number is the most common pattern in the sample
What does J shaped/hockey stick ureter signify in regards to the prostate?
Enlarged prostate - BPH
Most common bilateral testicular malignancy?
Testicular lymphoma
How is the UK breast screening programme work?
All women aged 50 up to 71 are invited for breast screening every 3 years.
What day of the hormone cycle is MRI and Mammography best performed?
Follicular phase - day 7-14
What does involution of fibroadenomas look like on mammography?
Course “pop corn” like calcification.
How can you differentiate Phyllodes tumour from fibroadenomas?
Age, growth, mets.
Middle age to older women (fibroadenoma in young women).
Rapid growth.
Haematogenous mets (lung/bone).
Most common metastases to the breasts?
Lymphoma
