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GYN > UT pathology > Flashcards

UT pathology Flashcards

1
Q

How does the uterus develop?

A
  • Paired Mullerian ducts descend into the pelvis at week 13 of fetal life
  • fusion occurs from the inferior (Cx) to the superior (fundus)
  • resorption of the center occurs last
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2
Q

What must be evaluated in all cases of UT anomalies?

A

Urinary tract

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3
Q

Do the ovaries develop from mullerian ducts?

A

No

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4
Q

Are ovaries generally normal in the presence of Mullerian anomalies?

A

Yes

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5
Q

What is the gold standard for evaluating Mullerian anomalies?

A

MRI=gold standard but can be well evaluated with 3D U/S

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6
Q

Name the Mullerian duct anomalies?

A
  1. Failure of formation
  2. Failure of fusion
  3. Failure of dissolution
  4. Failure of dissappearance
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7
Q

Type of failure of formation where there is no vagina, Cx, UT, or tubes?

A

Complete agenesis Failure of formation

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8
Q

Type of failure of formation that has a unicornuate UT, usually with a blind ending UT body associated

A

Partial agenesis Failure of formation

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9
Q

Types of Failure of fusion

A
  1. Uterus Didelphys

2. Bicornuate

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10
Q

2 separate bodies, 2 Cx’s each with their own tube doesn’t share myometrium

A

Uterus Didelphys

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11
Q 
#1 most common Mullerian anomaly,
1 vagina, 1 or 2 CX's and variable lack of fusion in the uterine body
A

Bicornuate

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12
Q

The median septum fails to dissolve after fusion of the 2 separate Mullerian ducts?

A

Failure of dissolution

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13
Q

What are the types of uterus that develop as a result of failure of dissolution and which is the least severe?

A 
Septate UT
Arcuate UT (the least severe)
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14
Q

Also Known as persistent structures of Vestigial remnant

A

Failure of disappearance

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15
Q

1 most common Vestigial remnant

A

Gartner’s duct cyst

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16
Q

Arise from the Caudal remnants of the Wollfian duct= Mesonephric duct

A

Gartner’s duct cyst

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17
Q

Where do Gartner’s duct cysts occur?

A

On the anterolateral wall of vagina

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18
Q

Drug given between 1940-1970 to pregnant women in the mistaken belief that it would decrease the risk of pregnancy loss and complications

A

DES (Diethylstibesteid)

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19
Q

What are the effects of DES exposure?

A
  1. Clear cell carcinoma of the vagina
  2. Cervical cancer
  3. T shaped uterus (infertility)
  4. Intrauterine wall defects-amniotic band syndrome in pregnancy
  5. Poor pregnancy outcome
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20
Q

What are the two congenital vaginal malformations?

A
  1. Mullerian duct anomalies

2. Urogenital sinus malformations

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21
Q

Types of urogenital sinus malformations

A
  1. Vaginal atresia = absence of vagina
  2. Vaginal septa = Transverse septa in vagina
  3. Vaginal duplication = Longitudinal septa
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22
Q

1 most common tumor of the female pelvis, most common in African-American women, usually multiple, Better detected with MRI

A

Leiomyomas = fibroids

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23
Q

What are the symptoms of leiomyomas?

A
  1. Pain- especially when size increases and with infarction
  2. Menorrhagia - fibroids prevent the efficient contraction of the UT during menses
  3. Infertility - repeat spontaneous abortions (especially with submucous)
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24
Q

Locations of leiomyoumas

A
  1. Submucosal
  2. Intramural (interstitial)
  3. Subserosal
  4. Cervical (Uncommon)
  5. Intraligamentus
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25
Q

Under the uterine endometrium, projects into UT cavity, repeated spontaneous abortions because the fertilized egg can’t successfully implant on it, may be pedunculated

A

Submucosal

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26
Q

Within the myometrium and the most common location

A

Intramural (interstitial)

27
Q

Beneath the serosa or perimetrium, may be pedunculated and torse(twist) . . . infarct . . . Pain

A

Subserosal

28
Q

Between layer of broad ligament

A

Intraligamentous

29
Q

Sono findings for Leiomyomas

A
  • Well circumscribed , solid mass
  • May be hypoechoic or echogenic and shadows if calcified
  • Usually round
  • Swirled internal architecture
30
Q

Invasion of endometrial glands and stroma into the myometriun

  • may be diffuse or focal
  • Oval not round like a fibroid
A

Adenomyosis

31
Q

Malignant rare tumor of the uterus that develops primarily as a malignancy (not premalignant)

A

Leiomyosarcoma

32
Q

Sono findings of Leiomyosarcoma

A

there is no defining feature sonographically or on MRI

  • these are incidental findings at hystorectomy
  • suspect it with rapid growth of a solid mass
33
Q

Symptoms of adenomyosis

A
  1. pain
  2. Infertility
  3. Menometrorrhagia -UT can’t contract effectively
34
Q

Sono findings of adenomyosis

A
  • oval mass (focal form)
  • UT enlarged (> 14cm)
  • Myometrial cysts (dilated glands that have grown into the myometrium)
  • asymetric thickening of endometrium
  • Mottled, inhomogeneous myometrium
  • “venetian blind” type of shadowing
35
Q

Do sono findings lead to diagnosis of adenomyosis?

A

No, sono findings are suggestive , MRI=diagnostic

36
Q

2nd most common Gyn malignancy in females

A

Cervical cancer

37
Q

Cervical cancer is most common in females of what age?

A

20-30 yrs. old

38
Q

What is the most common symptom for cervical cancer?

A

Post coital bleeding

39
Q

How is cervical cancer diagnosed and treated?

A

Diagnosed with pap smear, colposcopy, cone Bx

Treatment= Conization, LEEP, Hystorectomy ( if advanced)

40
Q

What are the risk factors for cervical cancer

A
  1. Early sexual activity
  2. Multiple sex partners
  3. HPV infection
41
Q

Sono findings for cervical cancer

A
  • Normal if early
  • Enlarged bulking Cx
  • May look like a cervical fibroid
  • Late stage = hydronephrosis (spreads and blocks ureters)
42
Q

Nabothian cysts are

A

Very common, due to obstruction-dilation of endocervical gland and are of no clinical significance

43
Q

Are nabothian cysts measured or counted?

A

No

44
Q

Water in the uterus

A

Hydrometra

45
Q

Causes of hydrometra

A
  • cervical stenosis (lack of estrogen in post menopausal women)
  • pelvic radiation ( hisstory counts)
  • cervical mass
46
Q

How do you measure hydrometra?

A

Anterior and posterior endo linings separately, then add together

  • Do it at the thickest part, usually near the fundus
  • 1 good measurement
47
Q

1 most Gyn malignancy?

A

Endometrial carcinoma

48
Q

Percentage of post menopausal women with endometrial carcinoma

A

75-80% of time

49
Q

Symptoms of endometrial carcinoma

A
  • Post menopausal bleeding

- Pre menopausal = intermenstrual bleeding, heavy bleeding

50
Q

Risk factors for endometrial carcinoma

A

(increased estrogen)

  1. Obesity - pre or post menopausal
  2. unopposed estrogen replacement
  3. Tamoxifen ( antiestrogen effect the breast but stimulate the UT)
  4. Estrogen producing tumor of the ovary (Granulosa cell, Thecoma)
  5. Family history
51
Q

Where does endometrial carcinoma start?

A

Tumor starts in the uterine cavity and grows through the myometrium, then into the endometrium

52
Q

Distant mets can occur with

A

Lymph node involvement

53
Q

Sono findings for endometrial carcinoma

A
  1. Thick irregular endo (>6mm post menopause)
  2. Fluid in the UT cavity
  3. Really irregular mass in sonohysterography
54
Q

How is endocarcinoma diagnosed?

A

With EMB= endoBx or with D&C= dilatation & curretage

55
Q

What percentage of endometrial hyperplasia undergo malignant transformation to endometrial carcinoma?

A

25%

56
Q

What are the symptoms for endometrial hyperplasia?

A

Same as endocarcinoma

  1. Post menopausal bleeding
  2. Pre menopausal = intermenstrual bleeding, heavy bleeding
57
Q

What are the risk factors for endometrial hyperplasia?

A

Same as endocarcinoma

  1. Obesity (pre or post menopausal)
  2. Unopposed estrogen replacement
  3. Tamoxifen
  4. Estrogen producing tumor of the ovary (Granulosa cell, Thecoma)
  5. Family history
58
Q

How is endometrial hyperplasia diagnosed?

A

With EMB= endoBx or D&C= dilatation and curretage

59
Q

Localized overgrowth of endometrium , may be pedunculated or broad based?

A

Endometrial polyps

60
Q

What are the symptoms of endometrial polyps?

A
  • Infertility, repeat spontaneous abortions

- Abnormal UT bleeding/ Post menopausal bleeding

61
Q

Sono findings of endometrial polyps

A
  1. Endo thickening ( may appear as round mass)
  2. Blood flow into polyp
  3. Echogenic, may have cystic spaces
62
Q

How are endometrial polyps diagnosed?

A

Sonohysterography = Saline infusion sonohysterography

63
Q

What is sonohysterography ( saline infusion sonohysterography)

A

Using a thin catheter to instill sterile water/ saline into the uterine cavity while watching with transvaginal U/S

GYN (6 decks)

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