Uterine Pathology

Question 1

• BENIGN muscular tumors aka: myomas, fibromyomas & fibroids
• M/C SOLID mass occurring during pregnancy
• Occur 20% white, & 50% black women older than 30 yrs
• Usually multiple & can occur anywhere in UT (m/c) or in CX or broad ligament
• Degeneration occurs when mass outgrows blood supply
• Usually NO clinical symptoms, but if present they include:
▪ Heavy periods, enlarged UT, pelvic pain due to degeneration, torsion or infection
• Sono: appearance varies
▪ Well circumscribed, HYPO masses w/ ↑ attenuation in mass, or calcifications
▪ Distortion of UT contour or compression of posterior bladder wall
• Rarely can become Malignant- clue is rapid growth in postmenopausal women

Answer 1

Leiomyomas (Fibroids)

Question 2

arise from stalk

Answer 2

pedunculate

Question 3

outside the uterus

Answer 3

exophytic

Question 4

with in the myometrium

Answer 4

intramural

Question 5

directly beneath the endo frequently projecting into UT cavity produces symptoms

Answer 5

Submucosal

Question 6

lying close to outer peritoneal surface of uterus

Answer 6

Subserous

Question 7

with in the broad ligament

Answer 7

Interligamentous

Question 8

• BENIGN diffuse infiltration of endometrial glands & stroma into myometrium (usually extensive on POSTERIOR wall)
• Suspected in 40-50 yr w/ painful & irregular bleeding
• Sono: ↑ UT w/ normal contour, areas of ↓ echogenicity in myometrium w/ possible cysts & posterior myometrium thickening

Answer 8

Adenomyosis

Question 9

• Found in CX due to obstructed & dilated endocervical glands
• Sono: sm., anechoic structures w/ post. acoustic enhancement

Answer 9

Nabothian cysts

Question 10

• M/C type of GYN malignancy, w/ 75-80% in postmenopausal women who present w/ bleeding
• Risk factors include:
▪ Obesity & anovulatory cycles in PRE-menopausal women
▪ Postmenopausal women on estrogen therapy or TAMOXIFEN
▪ Family history of UT cancer or atypical hyperplasia
• Tumor mass grow into myometrium & can spread to CX, OV fallopian tubes & adnexa. If lymphatic infiltrated, can cause distant metastases.
• Clinical signs: postmenopausal bleeding, HYPERmenorrhea (in pt. still having periods) & PAIN
• Sono: ↑ UT size, altered shape & echotexture, inhomogeneous & thickened endo > 5 mm & fluid in endo cavity

Answer 10

Endometrial carcinoma

Question 11

• Proliferation of endometrial glandular tissue
• 25% of atypical hyperplasia progresses to endo CA
• Common cause of abnormal bleeding in PERI & POST meno women
• Causes include:
▪ Unopposed estrogen HRT
▪ PCOD, obesity, estrogen producing tumors, & persistent anovulatory cycles
• Clinical signs similar to endo CA therefore do D&C for diagnosis
• Sono: should be done immediately post menstrual
▪ Homogeneous texture w/ possible cystic chg., smooth borders
▪ PREmenopausal women endo > 14 mm
▪ Postmenopausal women endo up to 8 mm
▪ Postmenopausal women on estrogen only endo 5 mm

Answer 11

Endometrial hyperplasia

Question 12

• Localized overgrowth of endometrial tissue
• Can be pedunculated, broad-based, or have a thin stalk
• Color Doppler can reveal a feeding artery in the stalk or pedicle
• Clinical signs: usually asymptomatic but can cause infertility, abnormal bleeding or discovered incidentally during D&C
• Sono: - best imaging is hysterography
o discrete mass, focal, rd. or echogenic discovered in thickened endo w/ possible vascular stalk (color Doppler)
o D/D – endometrial hyperplasia

Answer 12

Endometrial polyps

Question 13

• Sterile saline injected into UT for detection of abnormal endo
• Indications for procedure:
▪ Infertility & habitual abortion
▪ Congenital abnormalities / anatomic variants of UT
▪ Pre- & post-operative evaluation of UT w/ regard cysts, myomas & polyps
▪ Suspected UT synechiae (i.e. scarring assoc. w/ Asherman’s syndrome)

Answer 13

Saline infusion sonohysterography (SIS)