Uterine & Ovarian Disorders Flashcards
Define endometritis and how it presents clinically
- Inflammation of endometrium
- acute: retained POC/placenta, complicated labour, neutrophils
- chronic: pelvic inflammatory disease, TB, retained gestational tissue, lymphocytes/plasma cells
- abdo/pelvic pain, discharge, dysuria, abnormal vaginal bleeding, pyrexia
Describe endometrial polyps
- intermenstrual bleeding/ menorrhagia/dysmenorrhoea
- sessile/polypoid E2 dependant uterine overgrowths
Describe Leiomyomata, risk factors and how it presents clinically
- Benign myometrial tumours with E2/P4 dependant growth
- genetics, no children, obesity, PCOS
- menometrorrhagia (iron def anaemia), subfertility/pregnancy problems, uterine fibroids
Describe the malignant progression of hyperplasia
- Overgrowth of whole endometrium with simple tubular glands
- Varied size, shape, may be dilated
- Inc gland:stroma
- Complex patterns of proliferating glands with nuclear atypia
- Normal-> non-atypical hyperplasia-> atypical hyperplasia-> endometroid carcinoma
What is the most common cancer of the female genitalia?
Endometrial carcinoma
Describe polycystic ovary syndrome
- Complex endocrine disorder, hyperandrogenism, menstrual abnormalities, polycystic ovaries
- infertility, endometrial hyperplasia, adenocarcinoma
- Rotterdam criteria must have at least 2/3
- related to diabetes
Where do ovarian neoplasms originate?
- sex cord stromal tumours= granolas cell, thecomas, fibrothecomas, Sertoli-leydig
- surface epithelial stromal tumours= serous, mucinous, endometroid, transitional cell
- germ cell tumours: yolk sac tumours, teratomas, dysgerminomas
Define endometriosis and how it presents clinically
- Ectopic endometrium= bleeding into tissues=fibrosis
- Pelvic pain, pain on passing stools, dysuria, sub fertility, dysmenorrhoea, dyspareunia
- Ectopic pregnancy, IBD, ovarian cancer
Describe endometrial hyperplasia, its risk factors and how it presents clinically
- Excessive endometrial proliferation (inc E2, dec P4)
- Obesity, exogenous E2, PCOS, E2 producing tumours, tamoxifen
- Abnormal bleeding
What can endometrial hyperplasia lead to?
- Endometrial adenocarcinoma
- Regression
What are the 2 types of gonadal failure?
- Hypergonadotrophic hypogonadism: primary failure of gonads, Congenital: turner syndrome, Acquired: infections, surgery, chemo, drugs/toxins
- Hypogonadotrophic hypogonadism: pituitary failure leads to secondary failure, Sheehan’s syndrome, pituitary tumours, brain injury, empty sella syndrome, PCOS, delayed puberty, +/- sex hormone levels
What is the most common group of ovarian neoplasms?
- Epithelial tumours
- Serous (tubal), mucinous (endocervical), endometroid (endometrium)
What are the names of malignant epithelial and benign ovarian tumours?
- M= cystadenocarcinoma
- B= cystic-cystadenomas, fibrous-adenofibroma, cystic & fibrous- cystadenofibromas
Describe germ cell tumours
- Germinomatous: dysgerminomas-malignant, respond to chemo
- Non-Germinomatous: teratomas-multi-cell layers, mature=benign, immature=malignant
- Yolk sac tumours: malignant, differentiation towards extra embryonic yolk sac
- Choriocarcinomas: malignant, unresponsive, differentiation towards placenta
Describe sex cord stromal tumours
- Rare
- Arise from ovarian stroma derived from sex cord of embryonic gonad
- Thecoma/fibroma/fibrothecoma: Benign, comprised of spindle cells, produce E2, Meig’s syndrome-ovarian tumour
- Granulosa cell tumour: low grade malignant, produces E2
- Sertoli-leydig cell tumour: produces androgens, some malignant
