Uterine Pathology Flashcards
The caudal ends of the Müllerian ducts fuse to form what? 3
- Uterus
- Cervix
- Upper vagina
The unfused ends of the Müllerian ducts form what?
Fallopian tubes
What are the three types of Müllerian duct abnormalities?
- Arrested development
- Failure of fusion
- Failure of resporption
What are examples of arrested development 6
- Double uterus
- Uterus duplex bicornis
- Uterus bicornuate
- Uterus unicornuate
- Complete septate uterus
- Subseptate uterus
Label the images
What is a prolapsed uterus?
The descent of the uterus down the vagina
What is a prolapsed uterus usually due to?
Weak pelvic floor muscles
What happens to the endometrium with asherman’s syndrome?
Endometrial lining is replaced by fibrous adhesions
Asherman’s syndrome is considered a ____ in the endometrium? (what does it look like?)
Scar
What might cause Asherman’s syndromes ? 3
- A second D and C
- Multiple abortions
- Infections
Endometrium in Ahserman’s syndrome varies in appearance how?
Thick to thin endometrium
Asherman’s syndrome may cause what symptoms?3
- Loss of menstruation
- Infertility
- Recurrent pregnancy loss
What is synechie a form of?
Ahserman’s
What causes synechie? 3
- A scar on the uterine lining from prior D and C,
- C sections
- Abortions
When would we commonly see synechiae? (What type of scan?)
Obstetrical scanning
What is the DDX for Synechiae?
Amniotic band
What is this a image of ?
Synechiae
What are Arteriovenous malformations?
Abnormal connection between veins and arteries
What are some causes of Arteriovenous malformation? 2
- Congenital - rare
- Trauma or surgery - common
What is a symptom of Arteriovenous malformations?
Menorrhagia
What is the sonographic appearance of Arteriovenous malformation?
Difficult to see until you use colour doppler
What does this image demonstrate?
Arteriovenous malformation
Label the image
- Menstrual
- Proliferative
- Secretory
How thick is the endometrial during the Proliferative phase?
4-8 mm
How thick is the endometrial during the Secretory phase?
7-14 mm
How thick is the endometrial during the Post menopausal phase?
Typically 1-3 mm
What is neoplasia?
Multiplication of abnormal cells, can be malignant or benign
What are some non neoplasticism conditions? 5
- Endometrial hyperplasia
- Endometrial polyps
- Adenomyosis
- Uterine varicella s
- Endometritis
Endometrial hyperplasia happens as a result of what?
Unopposed estrogen stimulation from ovarian dysfunction
When does endometrial hyperplasia occur?
Immediately after menarche or before menopause
What does Endometrial hyperplasia cause?
Irregular uterine bleeding
What is the sonographic appearance of Endometrial hyperplasia? 2
- Thick hyperechoic endometrium
- Most of the endometrium can be focal or nodular
What is the DDX for endometrial hyperplasia?
Endometrial calcification or polyps
What does this image demonstrate?
Hyperplasia
What is endometrial polyps?
Endometrial growths extending into the canal from a stalk
Endometrial polyps May protrude into what?
Cervix if the stalk is long enough
Endometrial polyps may cause what?
Bleeding
Patients with endometrial polyps may be asymptomatic or symptomatic?
Asymptomatic
What is the sonographic appearance of the endometrium with endometrial polyps?
Thick endometrium
What do we look for when doing colour ultrasound of endometrial polyps?
Vessels with colour doppler
What is the DDX for Endometrial polyps? 2
- Endometrial cancer
- Endometrial hyperplasia
What is a hysterosonogram?
When saline is administered into the endometrial canal by a gynaecologist for better visualization of the canal
What does this image demonstrate?
Endometrial polyps
What does this image demonstrate?
Hysterosonogram
What is Adenomyosis?
Extension of endometrial tissue (glands and stroma) beyond the endometrium into the myometrium
Adenomyosis is a form of what?
Endometiosis
Adenomyosis is ectopically placed endometrium where?
Into the myometrium
Adenomyosis can cause what? (s/s) 2
Pain and abnormal bleeding
What is the sonographic appearance of Adenomyosis? 5
- slight diffuse uterine enlargement
- Anterior/ posterior wall myometirum asymmetry
- Endometrium/ myometrium junction is less pronounced (fuzzy) or jagged
- Hypoechoic or cystic lesions within the myometrium
- May have focal lesions (look like a fibroid or polyp)
What does this image demonstrate?
Adenomyosis
What does this image demonstrate?
Adenomyosis
What is this image of? And what can it be described as?
- Adenomyosis
- Venetian blind
What does this image demonstrate?
Prominent arcuate vessels
What does this image demonstrate?
Prominent arcuate vessels
What does this image demonstrate?
Uterine varices
What is endometritis?
Bacterial infection/ inflammation of the endometrium
With endometritis, what does the endometrium have the potential to do?
Extending into surrounding tissues
When does endometritis usually occur? 2
Postpartum or with pelvic inflammatory disease
What is the sonographic appearance of endometritis? 3
- Normal endometrium
- Irregular endometrium
- Fluid filled cavity or demonstrate gas bubbles from micro- organisms
What does this image demonstrate?
Endometritis
What does this image demonstrate?
Endometritis
What are two types of benign uterine neoplasia?
- Leiomyoma
- Lipoleiomyoma
What is leiomyoma?
Benign neoplasticism mass of fibromuscular tissue
What are other ways to refer to leiomyoma? 4
- Myoma
- Leiomyomata
- Fibromyoma
- Fibroids
What is the most common tumor in the female pelvis?
Leiomyoma
Which demographic of individuals are most likely to have leiomyoma?
- 40% of females over 35 years of age
Leiomyoma is most common in which race of women?
African American
What is leiomyoma influenced by?
Increase of estrogen which occurs in pregnancy and menopause
IF leiomyoma is malignant it is called what?
Leiomyosarcoma
How common is leiomyosarcoma?
Rare
What are some symptoms of leiomyoma? 6
- Size and location determine symptoms
- May be asymptomatic
- Menorrhagia
- Pain or pressure
- Urinary frequency/ urgency
- Infertility
What are some sonographic features of fibroids? 3
- Hypoechoic with high attenuation
- Overall enlarged uterus with an irregular contour
- May be complex looking with cystic degeneration and necrosis
In terms of fibroids, what might occur in older women?
Calcifications
Label the image
What is a parasitic myoma?
Term used when the blood supply of a leiomyoma comes from other organs
Parasitic myomas typically only happens with what? (location) 3
- Large posterior
- Fundal tumours
- Pedunculated ones
What is the etiology of parasitic myoma? (what is thought to cause it)
Thought to be pressure necrosis and revascularization during healing of bowel wall
Fibroids with pregnancy do what with increased estrogen?
Enlarge
Fibroids with pregnancy rapidly growing may result in what?
Lack of adequate blood supply resulting in necrosis
If there was a large fibroid near cervix what would happen during pregnancy?
It would inhibit delivery of the fetus
Mucosal fibroid can inhibit what?
Implantation
Large serosal fibroids may block what?
Fallopian tubes
What is a myomectomy in terms of fertility?
Surgery to remove to fibroid can assist in fertility but has risk associated with it
In terms of fibroids and fertility, Uterine artery embolization is what?
Where embolic agents are injected into the uterine arteries, cutting off blood flow to the fibroid, causing them to shrink
What is the sonographic appearance of Adenomyosis? 6
- Irregular endometrial margins
- Varied shape
- Diffuse
- No calcifications
- Multiple attenuating focal areas
- Vascularization across hypertrophied myometrium
What is the sonographic appearance of leiomyoma? 6
- May intrude into endometrium
- Rounded to Lobulated
- Mass like
- Calcifications
- Edge shadowing with attenuation
- Vascularity around the periphery
Lipoleiomyoma is what?
Lipcytes and fibromuscular tissues
How common are Lipoleiomyoma?
Uncommon
What is the sonographic appearance of Lipoleiomyoma?
Very hyperechoic and attenuating
What are two types of malignant uterine neoplasia?
- Leiomyosarcoma
- Endometrial carcinoma
How common is leiomyosarcoma?
Rare
Leiomysarcoma may arise from what?
Pre-existing fibroid
What are the symptoms of leiomyosarcoma? 3.
- Abnormal vaginal bleeding
- Palpable pelvic mass
- Pelvic or abdominal pain
What suggests a leiomyosarcoma?
A rapid increase in size of uterine tumor after menopause
What is the sonographic appearance of a leiomyosarcoma? 3
- Degenerating fibroid appearance
- Vascularity at the border and typically within
- May see local invasion of surrounding organs or hepatic metastases
What does this image demonstrate?
Leiomyosarcoma
_____ of all uterine malignancies are endometrial carcinomas
90%
What is the most commonly occurring cancer in post menopausal women?
Endometrial carcinoma
What is the symptoms of endometrial carcinomas?
Postmenopausal bleeding
What are the 4 stages of endometrial carcinoma?
- Confined to endometrium
- Confined to uterus
- Spread beyond uterus, yet confined to pelvis
- Distal metastasis
What increases the risk for endometrial carcinoma? 6
- Strong association with estrogen therapy
- Obesity
- Hypertension
- Diabetes
- Polycystic ovarian syndrome
- Granulosa cell tumours of the ovary
What is the sonographic appearance of endometrial carcinoma? 2
- Thick echogenic endometrium
- Difficult to distinguish from hyperplasia or polyps
What is this ?
Endometrial carcinoma
What is tamoxifen?
Non steroidal anti-estrogen Hormonal drug
What is tamoxifen used for?
In treatment of breast cancer
Tamoxifen is a estrogen antagonist to what?
The uterus resulting in stimulation of the endometrium
Tamoxifen increases the risk of endometrial cancer by how much? But what is the benefit?
- 1%
- But benefit for breast cancer treatment outweighs the risk for a uterine cancer
What is the sonographic appearance of tamoxifen?
Heterogenous bizarre endometrium
What doe this image demonstrate?
Tamoxifen therapy
