Uterine Pathology Flashcards
1
Q
What is the most common cystic lesion in the vagina
A
Gartner’s Duct Cyst
2
Q
What is a Bartholin’s cyst
A
Fluid-filled lump near the vaginal opening
3
Q
What is the most common congenital lesion or abnormality in the vaginal region
A
Imperforated hymen
4
Q
What are the problems that follow with a fully intact hymen
A
Vaginal opening is completely covered
Problems with menstruation, and release of fluid
5
Q
With a fully intact hymen where does fluid go
A
Fluid will go back into the cervix and/or uterus
6
Q
Inflammation of the vulva
A
Vulvitis
7
Q
Small skin tags (growth) found in vagina that usually are not noticed
A
Vaginal polyp
8
Q
Small pebbly growths that can be felt with a finger
A
Warts
9
Q
What is the cause of genital warts
A
Humanpapilloma virus (HPV) passed during sex
10
Q
HPV is considered a risk-factor for
A
Cancer
11
Q
What is the most common solid lesion/cancer cell
A
Squamous (epithelial) cell carcinoma
12
Q
This sarcoma is most common in children
A
Rhabdomyosarcoma
13
Q
This sarcoma is most common in women over 50 years of age
A
Leiomyoma
14
Q
Common STD that can cause cancer or genital warts
A
HPV (Humanpapilloma virus)
15
Q
What cancers can HPV put people at risk to
A
Cervical, vulva, vagina, penis, anus
16
Q
Unusual kind of skin cancer that arises from glandular cells
A
Paget’s Diseas of the Vuvla
17
Q
Women with Paget’s disease of the vulva will appear
A
Red, velvety area with white islands of tissue on vulva
18
Q
If a women has had a hysterectomy what do you measure?
What is the usual measurement for this?
A
Vaginal cuff
Typically should be 2.1 cm
19
Q
Metra means
A
Uterus
20
Q
T or F:
Cervix is not part of the uterus
A
False
Cervix is part of the uterus, VAGINA is not part of the uterus
21
Q
Abnormal collection of watery-like fluid secretions within the uterine cavity
A
Hydrometra
22
Q
Abnormal fluid (blood) collections in the uterine cavity
A
Hematometra
23
Q
What is the result of hemoatometra
A
Obstruction of the genital tract
24
Q
How will the uterine cavity and cervical canal appear when there is hematometra
A
Uterine cavity and cervical canal are anechoic and distended
25
Dilatation of the vaginal proximal to a congenital obsturction
Hydrocolpos
26
Blood-filled dilated vagina
Hematocolpos
27
What causes hematocolpos
Menstural blood in the setting of an anatomical obstruction, usually with an imperforate hymen
28
Colpos means
Vagina
29
Fluid accumulation invades the vagina and uterus
Hydrometrocolpos
30
What are the main causes of hydrometrocolpos
Intact hymen
Vaginal outflow obstruction and the accumulation of secretions
31
Blood-filled distended uterus and vagina
Hematometrocolpos
32
What are the main causes of hematometrocolpos
Anatomical mechanical obstruction precluding the evacuation of the menstrual blood
Usually postmenarche
33
This is a secondary infection that occurs as a result of hormonal changes in the female's repro tract
Pyometra
34
Pyo means
Pus
35
Pyometra means
Puss in the endometrium
36
What are the other causes of pyometra
Stenosed cervical os
Uterine or cervical malignancy
Treatment with radiotherapy
Fibroid degeneration
Pus
Fluid secretions become mucinous and infectious
37
Congenital uterine anomalies occur in less than
5% of all women
38
Congenital anomalies usually develop in the ____ development of the:
Embryonic development
In the uterus and upper 3rd of the vagina
39
Congenital anaomalies are derived from
Occur during what period of pregnancy
Embryonic mullerian (paramesonephric) ducts
Durng 7-12 weeks of pregnancy
40
The cause anomalies
Improper fusions
41
Rare condition that causes to have only half a uterus
Unicornuate uterus
42
Unicornuate uterus is related to ___ and ___ loss
Infertility and pregnancy loss
43
How does a unicornuate uterus appear sonographically
Uterus long & slender (Cigar-shaped)
Deviated to one side
Renal agenesis (absence) can be present on the contralateral side
Suspected if uterus appears small and positioned more lateral
44
In the unicornuate uterus if the right Fallopian tube is missing affects what other structure
Right kidney may be abnormality or may be missing
45
This uterine pathology is difficult to diagnose because of there being 2 uterine cavities
Didelphys Uterus
46
Didelphys Uterus has complete duplication
Uterus, cervix, and vagina
47
Didelphys uterus are not usually associated with
Fertility problems
48
T or F:
There is no treatment for didelphys uterus
T
49
Di means
2
50
How does a didelphys uterus appear sonographically
2 endometrial echoes
51
What sonographic appearance helps distingush with a bicornuate uterus
External contour of the uterus
52
This pathology is the duplication of the uterus and sometimes cervix
Bicornuate uterus
53
The bicornuate uterus is a ___-lobed uterus that has a ____-spaced cavities
Bi-lobed
Wide-spaced cavities
54
This pathology has recurrent pregnancy loss and preterm labor are common
Bicornuate uterus
55
In the bicornuate uterus the uterus is duplicated but not
Not fully duplicated
56
Most common anomaly of the uterus
Septate uterus
57
How many uterine cavities does a septate uterus have
2
58
Septate uterus has incidence of ____
Infertility
59
Septate uterus is similar to
Didelphys uterus
60
T-shaped uterus/uterine anomaly is caused by
Diethlystilbestrol exposure (DES)
61
DES was give to women from ____'s-____'s
Given for:
1940's-1970's
Treatment of threatened abortion
62
How does a T-shaped uterus uterine anaomaly appear sonographically
Cavity is t-shaped
63
What are the 3 rare etiologies for sexual ambiguity
Male pseudohermaphroditism (46, XY)
Female pseudohermaphroditism (46, XX)
True hermaphroditism (46 XX/46 XY)
64
Type of intersex in which the testis are present but external genitalia are incompletely masculinized
Male pseudohermaphroditism (46, XY)
65
Caused by adrenal hyperplasia, which leads to increased androgen production responsible for masculinization of the external genitalia
Female pseudohermaphronditism (46, XX)
66
This is the most common cause of female virilization
Female pseudohermaphronditism (46, XX)
67
What does a child with female pseudohermaphroditism (46, XX) develop
Characteristics associated with male hormones (hirsutism)
Body hair
Muscle bulk
Deep voice
68
True hermaphroditism is what type of disorder of sex development
Ovotesticular disorder
69
Intersex condition in which an individual is born with both ovarian and testicular tissue
True hermaphroditism
70
In cases of true hermaphroditism this is a rare condition in which cells within the same person have different genetic makeup
Mosaicism
71
All sexual ambiguity rare etiology is considered what type of abnormalities
Chromosomal abnormalities
72
Which pair of chromosomes cause down syndrome
21st pair
73
40% of infertility happens on
Males behalf
74
Pseudo means
False
75
Chromosomal abnormalities can be passed down
Genetically
76
Rare etiology develops during what weeks of pregnancy
7-12 weeks of pregnancy
77
General terms for a variety of situations in which a person is born with repro or sexual anatomy that doesn't fir the boxes of male or female
Intersex
78
46, XX - ______ disorder of sex development is a condition in which person with 2 __ chromosomes, normally found in ___ and result in having a ___ appearance
Testicular disorder, 2 X chromosomes, normaly found in females, results in male appearance
79
What is the role of sonography is causes of sexual ambiguity
May help identify the presence of uterus, vagina, ovaries, and testicles in the neonate or in utero
80
What is the treatment for sexual ambiguity
Surgical correction in infancy
Hormonal replacement therapy
81
Contraception is designed to
Prevent pregnancy
82
What are the hormonal contraceptive methods
Oral
DMPA (Depo-shot)
Implant
Post-coital (PCC)
83
Oral contrapceptives inhibit
Ovulation
84
How is the depot-medrocyprogesterone acetate (DMPA) given
What does it inhibit
Injected every 3 months
Inhibits ovulation
85
How are implants given
What do they inhibit
Inserted under the skin
Inhibits ovulation
86
What is another name for th post-coital hormonal contraceptive (PCC)
Morning after pill
87
What are the barrier intrauterine contraceptives
Diaphragm
Cervical cap
Condoms
88
What are the surgical fertility control
Hysterectomy
Elective abortion
Tubal ligation
89
Intrauterine Contraceptive Device is also known as
IUD
90
What are the types of IUD
Progestaset
Paraguard Copper T
91
What types of IUD's are not on the market
Lippes Loop
Copper 7
Saf-T-Coil
Dalkon shield
92
What is the sonographic appearance of an IUD
Highley reflective
Posterior shadowing
93
The IUD is usually kept in the?
And is inserted in the?
Perforation usually happens?
Endometrium
Uterine cavity (endo) near fundus
Perferation usually happens after insertion
94
Improper insertion of IUD can induce
Cramping and bleeding
95
What are the risks of IUD with pregnancy
Embedding in the endo or superficial layers of the myometrium may lead to?
Spontaneous abortion
Fibrosis
96
What is the abscess formation of IUD's
Unilateral
Commonly arise from bacteria
Can have multiple septations
Appear anechoic to echogenic dependent on the amount of debris in the abscess
97
What are the other 3 risks of having an IUD
Perforation
Lost IUD
PID (Pelvic Inflammatory Disease)
98
Definition of infertility
Not being able to become pregnant after a year (12 months) of trying
99
If a woman can get pregnant but keeps having miscarriages or stillbirths this is called
Infertility
100
What are the most common causes of infertility
Ovulatory disorders
Low levels of gonadotropin releasing hormone (GnRH)
Premature ovarian failure
Polycystic ovarian disease
Tubal disease
Abnormal conception cycle
101
Imbalance of the hormones that cause women to ovulate is called
Ovulatory disorders
102
This is most common cause of anovulatory infertility
Polycystic ovarian disease (PCOS)
103
A common sexually transmitted infection caused by bacteria and is the most common STI
Chlamydia
104
What is an example of abnormal conception cycle
Diminished ovarian reserve (DOR)
105
What is the size of the uterus in diminished ovarian reserve during ovulation
Less than 50% of its size at ovulation
106
Salpi/o means
Fallopian tube
107
Salpingitis
Inflammation of the fallopian tube
108
What scan approach would you use for a pediatric uterus
Only transabdominal scan
109
When does the pediatric uterus increase in size
Increases after age 7
110
T or F:
You should do a transvaginal exam on pediatric even if the doctor tells you to
False!!!!!!
NO!
111
When you need to do both transabdominal and transvaginal which do you start with?
Start with transabdominal, allow patient to empty their bladder, then floow up with an empty bladder for transvaginal scan
112
What is the upper size limit of the vaginal cuff post-hysterectomy
2.1 cm
113
What is the average length of cervix in a normal adult non-pregnant
Where do you measure it from
2-4 cm
Measured from internal os to external os
114
What are the variations that can affect the size of the cervix
Age
Parity
Stage of menstrual cycle
115
What is the most common bengin lesion in the cervix
What does it result from
How long will the cervix measure
Nabothian cysts
Chronic cervicitis
Less than 2 cm
116
What is a cervical polyp
What is it caused by
Abnormal growths on the cervical canal
Caused by chronic cervical inflammation
117
Cervical stenosis means
Narrowing of the cervix
118
Cervical stenosis is ____ & ____
Results from
Acquired & obstruction
Results from chronic infection & previous cone biopsy
119
What is a cone biopsy
Small operation to remove a cone shaped piece of tissue from the cervix
120
Cervical cancer is a type of cancer that occurs in
Occurs in the cells of the cervix
121
The cervix is the lower part of the ___ & connects to the ____
Uterus that connects to the vagina
122
HPV plays a role in causing which type of cancer
Cervical cancer
123
What is the most common type of cervical carcinoma
How do you detect it
Squamous cell carcinoma
Detect through PAP smears
124
What are the 3 types of cervical carcinoma sonographic findings
Retrovesical (Behind the urinary bladder) mass
Obstruction of ureters
Invasion of bladder
125
What are the 3 most common sonographic findings that indiciate uterine abnormality
Uterine enlargement
Thickened endometrium
Contour irregularity
126
What are the 3 MAIN causes of uterine enlargement
Repro age
Post menopause
Pediatric
127
What are the causes of uterine enlargement in the cause of repro age
Pregnancy
Fibroids (Leiomyomas)
128
What is the most common cause of uterine enlargement
Fibroids (Leiomyomas)
129
What are the causes of uterine enlargement in the case of post menopause
Fibroids
Endometrial pathology (Hyperplasia)
130
What is the cause of uterine contour irregularity sonographically?
What are the developmental abnormalities that will cause the contour?
Often due to fibroids (Leiomyomas)
Bicornuate uterus
131
What is the name of a uterine mass
Leiomyoma
132
What are the clinical symptoms of a leiomyoma
Asymptomatic (mostly)
Pelvic pain/fullness
Increased abdominal girth
Enlarged uterus
Menorrhagia
133
What is menorrhagia
Heavy or prolonged menstrual bleeding
134
What are the major uterine fibroid symptoms
Heavy monthly periods
Pelvic pain and pressure
Constipation and bloating
Anemia
Pain during sexual intercourse
Frequent need to urinate
Chewing ice
Infertility
135
What is the sonographic appearance of uterine masses
Classic appearance
Hypoechoic
Homogenous
Well-defined
Uterine contour irregularity
Uterine enlargement
Distortion of endometrium
136
Transvaginal is better to see ____ fibroids
Smaller
137
Transabdominal may be needed to see ____ fibroids
Larger
138
What are the 4 common classifications of leiomyoma?
Where are they usually located?
Which is the most common?
Intramural (Myometrial) - Most common
Subserosal (Perimetrium)
Submucosal (Endometrial)
Pedunculated (Exophytic)
139
This type of leiomyoma grows outside the uterus also known as the perimetrium
Subserosal
140
This type of leiomyoma is pertaining to the growth outward
Is a ____ stalk
Where does this leiomyoma arise from
Pedunculated
Fibrous stalk
Arises from superior fundal region
141
This uterine mass is most likely to be symptomatic (bleeding) and can cause complications during pregnancy
Submucosal
142
What is the rare uterine mass that may obstruct the internal os?
What does it interfere with?
What does it interrupt?
Cervical myoma
Interfere with urinating, cause pain during sexual activity
Interrupt fetal devlivery
143
Broad ligament myoma is very ___
Rare
144
What happens to fibroids during pregnancy
Increase in size due to estrogen & decrease in echogenicity
Large fibroids may complete with placenta for uterine BV's
May result in miscarriage or birth deformities
145
Adenomyosis is also known as
Internal endometriosis
146
What is adenomyosis?
How will it present?
How is it managed?
Endometrial implants lie deep within the endometrium
Present with pelvic cramping & dysmenorrhea
Managed with hormonal therapy or hysterectomy
147
What is the sonographic appearance of adenomyosis
Wall may be hypoechoic, diffusely enlarged, small myometrial cysts
148
What are the main causes of endometrial thickening
Incomplete abortion - Retained product of conception
Gestational trophoblastic disease - When sperm cell fertilizes an empty egg cell or 2 sperm cells fertilize a normal egg
149
For younger women if you see their uterus is hyperechoic and larger than 15 cm you should immediately think
Pregnancy
150
Development of uterine's inner lining tissue outside of the uterus (ectopic endometrium)
Endometriosis
151
Where can you find endometriosis?
Which cavities?
Found on structures within the abdominal and pelvic cavity
Ovaries
Fallopian tubes
Colon
Bladder
152
What are the most common symptoms associated with endometrial abnormalities
Pain
Menstural irregularity with excessive bleeding
153
What are the causes of endometriosis
Retrograde menstruation
Surgical scar implantation
Immune system disorder
154
What are the risk factors of endometriosis
Never giving birth
Starting menses at early age
Having higher levels of estogen
1+ relative with this
Conditions that prevent passage of blood from the body during menstruation
155
What is the sonographic finding for endometriosis
What is the treatment
Mostly hard to see on u/s, must tak tissue sample
Hormones, excision surgery
156
What are 2 types abnormalities under endometrial thickening
Hyperplasia
Carcinoma
157
Overgrowth of the endometrium, the lining of the uterus, that may progress to or coexist with endometrial cancer
Hyperplasia
158
Sonohysterography is the best for imaging
Modality to image endometrium and its cavity
159
Carcinoma in older women is
More critical but more treatable
160
In younger women they can get ___ but can be
Cancer, but can be more difficult to treat
161
Abnormal thickening of the lining of the endometrium
Endometrial hyperplasia
162
What is the most common cause of endometrial hyperplasia
Postmenopausal bleeding
163
Endometrial hyperplasia is indistinguishable from
Carcinoma on U/S
164
In endometrial hyperplasia there is excess ___ without ___
Excess estrogen, without progesterone
165
Endometrial hyperplasia usually occurs after
Menopause, when ovulation stops and progesterone is no longer made
166
Up to ____ of endometrial ___ is believed to be preceded by ____
1/3 of endometrial carcinoma, preceded by hyperplasia
167
This is required for endometrial hyperplasia
Biopsy is required for a definitive diagnosis
168
2 reasons for NORMAL enlargement of the endometrium
Pregnancy
Luteal Phase
169
Risk factors of endometrial hyperplasia
Older age at menopause
Early age when menstruation started
170
Family ___ is important but, ____matters
History, lifestyle
171
Signs and symptoms of endometrial hyperplasia
Bleeding during menstrual period heavier or last longer than usual
Menstrual cycle shorter than 21 days
Any bleeding after menopause
172
When is the best time for U/S to view endometrial hyperplasia
Right after period because menses being shed
173
Endometrial hyperplasia in premenopausal women this measurement in this phase is considered abnormal
>15 mm in secretory phase
174
Hyperplasia can be reliably excluded in patients only when the endometirum measures less than
6mm
175
Postmenopausal endometrial hyperplasia has a thickness greater than ___ -thick
Thickness greater than ___mm is highley suggestive of ___ and ___ is needed
__mm with ___ bleeding should be biopsied as well
>5mm thick
>11mm - Highley suggestive of hyperplasia and biopsy needed
8mm with vaginal bleeding
176
Inflammation of the inner lining of the uterus
Endometritis
177
Endometritis is associated with?
Symptoms?
Most common cause?
PID (Pelvic inflammatory disease), abortion, menstruation, childbirth
Fever, lower abdominal pain, abnormal vaginal bleeding or discharge
Infection after childbirth (Postpartum)
178
What is the sonographic appearance of endometitis
Gas bubbles (Rare)
Endometrial fluid
Irregular
Endometrium appears prominent
179
Localized overgrowth of endometrial glands and stroma
Endometrial polyps
180
Endometrial polyps are ____ or irregular ____
Asymptomatic or irregular bleeding
181
What are the best scans for visualization of endometrial pathology
Transvaginal and sonohysterography
182
What is the sonographic appearance of endometrial polyps
Broad based or penduculated mass
Discrete echogenic mass
183
Leiomyosarcoma meaning
Is extremely ___ and ___
Malignant form of leiomyoma
Rare and aggressive
184
Leiomyosarcoma may arise from
Existing fibroid
185
Leiomyosarcomas are usually happening to women around ages
50-60
186
Most common site of involvement of leiomyosarcoma
Retroperitoneum
187
The leiomyosarcoma cannot be
Differentiated from benign fibroid on U/S
188
What are the symptoms of leiomyosarcoma?
Symptoms indicating infection or inflammation?
Weight loss and vomiting
Fever, elevated WBC count
189
What are the sonographic findings of a leiomyosarcoma
Resemble fibroids
190
What is the most common gynecologic malignancy in U/S?
Incidence increasing with?
Endometrial carcinoma
Hormone replacement therapy and tamoxifen use
191
Endometrial carcinoma are ____ & ___ and __% of cases seen in ____ women
Perimenopausal & Postmenopausal
75% seen in postmenopausal women
192
What is the earliest change associated with endometrial carcinoma
Thickened endometirum
193
Postmenopausal bleeding in endometrial thickness of < ___mm excludes significant ____ ____
<5mm
Excludes significant endometrial abnormalities
194
What are the clinical symptoms of endometrical carcinoma
Bleeding
Large endometrial fluid collection
195
Endometrial carcinoma is indistiguishable from?
Often carcinoma will appear?
Fluid may be seen in the?
Benign hyperplasia on U/S
Appear more irregular and thicker than benign hyperplasia
Seen in endometrial cavity with carcinoma
196
What are the sonographic findings of the endometrial carcinoma
Myometrial invasion
Hypoechoic, echogenic
197
Abnormal development of sexual maturity
What happens in girls and boys with this
Precocious Puberty
G - Ovulation before age 8
B - Sexual maturity before age 9
198
Signs and symptoms of precocious puberty in girls
Early breast growth
Early first period (Menarche)
199
Signs and symptoms of precocious puberty in boys
Enlarged testicles and penis
Facial hair (Usually first on upper lip)
Deepening voice
200
Signs and symptoms of precocious puberty in boys and girls
Pubic or underarm hair
Rapid growth
Acne
Adult body odor
201
Factors that increase a child's risk of precocious puberty
Being girl
Being african-american
Being obese
Being exposed to sex hormones
202
Risk factors of precocious puberty
Increased risk of precocious puberty
Having other medical conditions
Hyperthyroidism
Received radiation therapy of the central nervous system
203
Precocious puberty may be a complication with what type of medical conditions
McCune-Albright Syndrome/Congenital Adrenal Hyperplasia
204
Ovarian artery comes from
Aorta
205
Vaginal, uterine, straight & spiral arteries come from
Internal iliac artery
206
Arcuate artery originates from
Uterine artery
