Uterine and ovarian pathology

Question 1

what is endometriosis?

Answer 1

ectopic endometrium which causes bleeding into tissues which leads to fibrosis

Question 2

what is the symptoms of those with endometriosis?

Answer 2

25% are asymptomatic, dysmenorrhoea, dyspareunia, pelvic pain, sub fertility, pain on passing stool and dysuria

Question 3

what is linked with endometriosis?

Answer 3

ectopic pregnancy, ovarian cancer and IBD

Question 4

what are some treatments of endometriosis?

Answer 4

medical treatments include

• COCP
• GnRH agonists/antagonists
• progesterone antagonists

Surgical treatments

• ablation
• tah-bso

Question 5

what is endometritis?

Answer 5

inflammation of the endometrium caused by foreign bodies, chronic retained products and infection

Question 6

what are the symptoms of endometritis?

Answer 6

abdominal/pelvic pain, pyrexia, discharge, dysuria and abnormal vaginal bleeding

Question 7

how to treat endometritis?

Answer 7

analgesia, abx and remove cause

Question 8

how to diagnose endometritis?

Answer 8

biochemistry/microbiology, USS

Question 9

what are endometrial polyps?

Answer 9

Sessile/polypoid E2-dependent uterine overgrowths

Question 10

what are the symptoms of endometrial polyps?

Answer 10

often asymptomatic, intermenstrual/post menopausal bleeding, menorrhagia, dysmenorrhoea

Question 11

how to diagnose endometrial polyps?

Answer 11

USS, Hysteroscopy

Question 12

how to treat endometrial polyps?

Answer 12

medical

P4/GnRH agonists, surgical curettage

Question 13

what is leiomyoma?

Answer 13

uterine fibroids, benign myometrial tumours with E2/P4- dependent growth

Question 14

what are the risk factors for leiomyoma?

Answer 14

genetics
nulliparity,
obesity,
PCOS,
HTN

Question 15

what are the symptoms of leiomyoma?

Answer 15

often asymptomatic,
menorrhagia (iron deficient anaemia),
sub fertility/pregnancy problems

Question 16

how do you diagnose leiomyoma?

Answer 16

Bimanual examination

USS

Question 17

what is the treatment for leiomyoma?

Answer 17

medical

• IUS
• NSAIDs
• OCP
• P4
• FE2+

non-medical

• Artery embolisation
• Ablation
• TAH

Question 18

what is the prognosis for leiomyoma?

Answer 18

• menopausal regression

- malignancy risk 0.01%

Question 19

what is endometrial hyperplasia?

Answer 19

excessive endometrial proliferation

Question 20

what is the risk factors for endometrial hyperplasia? 6

Answer 20

• obesity
• exogenous E2
• PCOS
• E2-producing tumours
• tamoxifen
• HNPCC (PTEN Mutations)

Question 21

what are the types of endometrial hyperplasia?

Answer 21

• simple non-atypical, simple atypical

- complex non-atypical, complex atypical

Question 22

what are the symptoms of endometrial hyperplasia?

Answer 22

abnormal bleeding - IMB/PCB/PMB

Question 23

how do you diagnose endometrial hyperplasia?

Answer 23

USS, Hysteroscopy +/- biopsy

Question 24

how do you treat endometrial hyperplasia?

Answer 24

?medical 
-IUS
-P4
surgical 
-TAH

Question 25

what is the prognosis endometrial hyperplasia?

Answer 25

endometrial adenocarcinoma | regression

Question 26

what is the malignant progression of hyperplasia?

Answer 26

1. normal 2. Non-atypical hyperplasia 3. atypical hyperplasia 4. endometrioid adenocarcinoma

Question 27

what is the most common cancer of the female genital tract?

Answer 27

endometrial adenocarcinoma

Question 28

what is the prognosis of endometrial adenocarcinoma?

Answer 28

stage 1 = 90% 5yr survival | stage 2-3 = <50%

Question 29

what is the treatments of endometrial adenocarcinoma?

Answer 29

medical (P4) surgery (TAH-BSO) adjuvant therapy (chemo-/radiotherapy)

Question 30

what are the symptoms of endometrial adenocarcinoma?

Answer 30

PMB/IMB pain if late

Question 31

What is Polycystic ovary syndrome?

Answer 31

Endocrine disorder; hyperandrogenism, menstrual abnormalities, polycystic ovaries

Question 32

what are the links to PCOS?

Answer 32

infertility, endometrial hyperplasia/adenocarcinoma

Question 33

what are the treatments of pcos?

Answer 33

Lifestyle (weight loss) medical (metformin, OCP, Clomiphene) surgical (ovarian drilling)

Question 34

what are the diagnosis criteria for PCOS?

Answer 34

rotterdam criteria 2/3 of polycystic ovaries hyperandrogenism (hirsuitism/biochemical) irregular periods >35days

Question 35

what tests are done to diagnose for PCOS?

Answer 35

USS fasting biochemical screen (low FSH, High LH, testosterone, DHEAS) OGTT

Question 36

what are the origin of ovarian neoplasms?

Answer 36

surface epithelial tumours sex-cord stromal tumours germ cell tumours

Question 37

what are the 3 major carcinoma histologic types of epithelial tumours?

Answer 37

Serous (tubal) Mucinous (endocervical) Endometrioid (endometrium)

Question 38

what is serous cystuadenocarcinoma characterised by?

Answer 38

characterised by complex, branching and glands incorporating slit-like spaces

Question 39

what % of ovarian tumours are germ cell tumours?

Answer 39

15-20% of all ovarian tumours

Question 40

what are the risk factors for ovarian cancer?

Answer 40

``` FH older age PMH breast cancer smoking, E2-only HRT Lynch 2 syndrome, obesity nulliparity ```

Question 41

what are the protective factors for ovarian cancer?

Answer 41

OCP Breastfeeding Hysterectomy

Question 42

what are the symptoms of ovarian cancer?

Answer 42

non-specific symptoms; pain, bloating, weight loss, PV bleeding, urinary frequency, anorexia

Question 43

what is the prognosis of ovarian cancer?

Answer 43

overall 5 years 43% survival