Uterine and Ovarian Pathology

Question 1

hematometra

Answer 1

• imperforated hymen
• cervical stenosis
• vagina neoplasm
• pelvic pain, amenorrhea, hypomenorrhea, pelvic mass
• large hypoechoic midline uterine mass, posterior enhancement
• differential: submucosal leiomyoma, endometrioma, retained products of conception

Question 2

leiomyosarcoma

Answer 2

• derived from smooth muscle of the uterus
• rare
• asymptomatic, vaginal bleeding
• heterogeneous uterine mass
• irregular margins
• differential: leiomyoma or endometrial carcinoma

Question 3

granulosa cell tumor

(ovarian)

Answer 3

• hormonal tumor
• increase in estrogen
• palpable mass
• irregular bleeding
• solid, homogeneous adnexal mass, may appear complex, endo thickening
• differential: pedunculated fibroid

Question 4

dysgerminoma

Answer 4

• malignant germ cell neoplasm
• most common ovarian malignancy in childhood
• asymptomatic, precocious puberty, pelvic pain, pelvic mass, associated with AFP and hCG levels, spread to lymphatics
• predominantly solid, homogeneous
• differential: cystadenocarcinoma or metastatic lesion

Question 5

asherman syndrome

Answer 5

• adhesions from a previous deep curettage or endo infection
• asymptomatic
• amenorrhea
• dysmenorrhea
• hypomenorrhea
• inferility
• endocavity difficult to distinguish
• bright echoes within the endocavity
• differential: normal proliferative phase or uterine mass compressing endo

Question 6

carcinoma

(pathology of the cervix)

Answer 6

• epithelial neoplasm
• third most common gynecological malignancy in the US
• asymptomatic, vaginal discharge or bleeding, palpable mass, weight loss, bleeding
• irregular margins, endo fluid, heterogeneous
• differential: leiomyoma, complex cervical cyst, ovarian mass

Question 7

brenner tumor

(ovarian)

Answer 7

• benign tumor arising from fibroepthelial tissue
• estrogenic in nature
• associated with Meigs syndrome
• asymptomatic
• unilateral pelvic pain or fullness
• small, hypoechoic, solid ovarian mass
• well-defined wall margins
• does not have posterior enhancement
• differential: fibroma, pedunculated fibroid, thecoma

Question 8

arteriovenous fistula

Answer 8

• vascular plexus of arteries and veins without an intervening capillary network
• pelvic surgery or trauma
• gestational trophoblastic disease
• malignancy
• menorrhagia, anemia, often diagnosed postabortion
• intramural uterine mass, flow reversal, multiple anechoic structures within myometrium
• differential: adenomyosis, trophblastic gestation, retained products

Question 9

leiomyoma

(fibroid)

Answer 9

• benign neoplasm of the uterine neoplasm of myometrium
• prevalence in african americans
• asymptomatic, menorrhigia, pelvic pain, bleeding, infertility
• well-defined
• anechoic to hyperechoic, heterogeneous when hemorrhagic, low flow velocity, may increase in size with estrogen stimulation

Question 10

cystadenocarcinoma

Answer 10

• epithelial neoplasm
• palpable pelvic mass
• unexplained weight gain
• pelvic pain
• multilocular, complex mass, irregular wall margins, ascities
• differential: cystadenoma, cystic teratoma, tubovarian abscess

Question 11

fibroma

(ovarian)

Answer 11

• rare, benign stromal tumor
• asymptomatic, pelvic pain, menopause, urinary or intestinal disturbance
• solid, hypoechoic adnexal mass
• dense mass
• posterior shadowing
• ascities
• 5-10 cm
• differential: pedunculated fibroid, teratoma, thecoma, brenner tumor

Question 12

adenomyosis

Answer 12

• ectopic endo tissue within the myometrium
• pelvic pain
• uterine enlargement and tenderness
• menorrhagia
• dysmenorrhea
• posterior uterine wall most commonly affected
• endo appears normal
• differential: degenerating fibroid and endo neoplasm

Question 13

thecoma

(ovarian)

Answer 13

• benign stromal tumor
• produces estrogen
• pelvic pain or pressure
• menopause
• hypoechoic mass
• prominent posterior shadowing
• differential: fibroma, teratoma, brenner tumor

Question 14

endometritis

Answer 14

• pelvic inflammatory disease
• retained products of conception
• postprocedural complication
• vaginitis
• pelvic pain, fever, leukocytosis
• normal findings, irregular endo, hypervascular endo and myometrium
• differential: normal uterus, adenomyosis, leiomyoma

Question 15

theca lutein cysts

Answer 15

• associated with high level of hCG
• gestational trophoblastic disease
• hyperstimulation syndrome
• asymptomatic, hyperemesis, abdominal bloating
• multilocular cystic structure
• bilalteral condtion
• differential: cystadenoma or hydrosalpinx

Question 16

uterine carcinoma

Answer 16

• associated with estrogen stimulation
• adenocarcinoma is most common
• risk factors: obesity, diabetes, nulliparity, postmenopause
• abnormal bleeding
• focal irregularity of the endo
• myometrial distortion
• thickened endo
• complex endometrial mass
• differential: endo hyperplasia or endo polyp

Question 17

polyp

Answer 17

• overgrowth of endo tissue
• unresponsive to progesterone
• asymptomatic, abnormal bleeding, infertility
• endo thickening
• round echogenic mass
• color flow demonstrates stalk
• differential: endo carcinoma, endo hyperplasia, submucosal leiomyoma

Question 18

serous cystadenoma

Answer 18

• epithelial neoplasm
• second most common benign tumor of the ovary
• rapid increase of pelvic mass
• pelvic pain
• irregular menses, bloating
• large, smooth walls, may contain debris, unilateral
• differential: hydrosalpinx, theca lutein cysts, hyperstimulation syndrome

Question 19

mucinous cystadenoma

Answer 19

• epithelial neoplasm
• pelvic pain, irregular menses, bloating
• multilocular anechoic mass, smooth margins, may contain debris
• differential: endometrioma, tuboovarian abscess, theca lutein cyst, cystadenocarcinoma

Question 20

submucosal leiomyoma

Answer 20

mass distorting the endo; least common but most likely to cause symptoms

Question 21

Meigs syndrome

Answer 21

combination of pleural effusion, ascites, and an ovarian mass that resolve after surgery

Question 22

polycystic ovarian disease

Answer 22

• endocrine imbalance, imbalance of LH and FSH
• irregular menses, hirsutism, infertility, obesity
• round, enlarged ovaries
• presence of ten or more follicles per ovary
• multiple, small peripheral cysts
• differential: functional cysts

Question 23

What is the most common uterine neoplasm?

Answer 23

intramural leiomyomas

Question 24

ovarian carcinoma

Answer 24

• epithelial or germ cell neoplasm
• risk factors: high-fat diet, infertility, nulliparity, family history
• asymptomatic, vague abdominal pain, palpable pelvic mass, GI symptoms, bloating
• soild, hypoechoic ovarian mass, irregular margins
• differential: endometrioma, metastatic lesion, granulosa cell tumor

Question 25

tamoxifen effect

Answer 25

• side effects of tamoxifen therapy
• asymptomatic
• abnormal bleeding
• normal appearing endo
• thickening of endo
• complex appearance to the endo
• differential: endo hyperplasia, polyp, carcioma, leiomyoma

Question 26

surface epithelial cyst

Answer 26

• arise from the cortex of the ovary
• asymptomatic
• pelvic pain
• small cluster of cysts
• differential: polycystic ovarian disease or cystadenoma

Question 27

nabothian cyst

Answer 27

• obstructed inclusion cyst
• chronic cervicitis
• asymptomatic
• round, anechoic structure, usually < 2cm
• differential: leiomyoma, arcuate vessel, retained products of conception

Question 28

cystic teratoma

(dermoid)

Answer 28

• arise from the wall of a follicle
• germ cell tumor
• contains fat, hair, skin, and teeth
• most common benign tumor of the ovary
• asymptomatic, abdominal pressure, mild pelvic pain, palpable mass
• tip of the ice burg
• complex
• commonly located superior to uterine fundus
• differential: endmetrioma, hemorrhagic cyst, serous cystadenoma, ectopic pregnancy

Question 29

hematocolpos

Answer 29

blood accumulation in the vagina

Question 30

hyperplasia

Answer 30

• unopposed estrogen
• tamoxifen therapy
• polycystic ovarian syndrome
• obesity
• abnormal bleeding
• asymptomatic
• premenopausal endo thickness >14mm
• postmenopausal endo thickness > 5mm
• differential: endo carinoma or endo polyp

Question 31

subserosal leiomyoma

Answer 31

mass found on the serosal surface of the uterus