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OB/GYN > Uterine Pathology > Flashcards

Uterine Pathology Flashcards

1
Q

Congenital uterine anomalies are generally well demonstrated with _____ sonography.

A

3D

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2
Q

What modality may be helpful in examining complex uterine anomalies?

A

MRI

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3
Q

What structures develop from the Mullerian ducts? What is another name for the Mullerian ducts?

A
  • uterus, Fallopian tubes, upper vagina

- paramesonephric ducts

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4
Q

What are most uterine and cervical anatomic variants caused by?

A

failure of development of the Mullerian ducts at some stage of development

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5
Q

The ________ should be evaluated in all cases of uterine anomalies.

A

urinary tract

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6
Q

What structure(s) are normally normal in the presence of Mullerian anomalies?

A

ovaries

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7
Q

What are the 4 categories of anomalous internal genitalia development?

A
  1. failure of formation (aplastic, hypoplastic)
  2. failure of fusion (didelphys, bircornuate)
  3. failure of dissolution
  4. failure of structures to disappear (ie: Wolfian ducts)
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8
Q

What does complete agenesis result in? Which category does this fall under?

A
  • results in complete agenesis of vagina, cervix, uterus and Fallopian tubes
  • failure of formation
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9
Q

What is complete agenesis associated with?

A

Mayer-Rokitansky-Kuster-Hauser (MRKH) syndrome

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10
Q

What does partial agenesis result in? Which category does this fall under?

A

a range of anomalies:

  • absence of upper vagina and cervix
  • presence of uterus and Fallopian tubes
  • unicornuate uterus and single fallopian tube
  • failure of formation
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11
Q

What does uterus didelphys consist of?

A
  • complete duplication of uterus, cervix, vagina
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12
Q

What it the most common Mullerian anomaly?

A
  • bicornuate uterus
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13
Q

What does bicornuate uterus consist of?

A
  • single vagina
  • one or two cervices
  • variable lack of fusion of the upper uterine cavity
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14
Q

Name the two variants resulting from failure of fusion.

A
  1. uterus didelphys

2. bicornuate uterus

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15
Q

What does a septate uterus consist of?

A

single vagina, cervix, and uterus with an intrauterine septum

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16
Q

What is the least severe Mullerian duct anomaly?

A

arcuate uterus

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17
Q

What is an arcuate uterus?

A

a septum slightly protruding into the uterine cavity

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18
Q

How does a septate uterus occur (embryologically)?

A

median septum fails to dissolve after fusion of the two separate Mullerian ducts

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19
Q

What are variants result from failure of dissolution?

A
  • septate uterus

- arcuate uterus

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20
Q

What is failure of disappearance?

A

abnormalities resulting from failure of disappearance of structures that do not normally persist

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21
Q

What are the persistent structures in failure of disappearance sometimes referred to as?

A

vestigial remnants

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22
Q

What is the most common example of failure of disappearance?

A

Gartner’s duct cyst

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23
Q

Where does a Gartner’s duct cyst occur? Where does it arise from?

A

occurs on the anterolateral wall of the vagina

arises from the caudal remnants of the mesonephric (Wollfian) duct

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24
Q

What is DES syndrome and who do we see it in? What does DES stand for?

A
  • daughters of women who received DES from late 1940’s to the early 1970’s for TAB have increased risk of certain genital abnormalities
  • diethylstilbestrol
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25
Q

What is in utero exposure associated with?

A

associated with:

  • vaginal epithelial changes
  • poor pregnancy outcome
  • increased risk of cervical carcinoma and breast carcinoma
  • T-shaped uterus
  • constricting bands in the uterus and intrauterine wall defects
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26
Q

What are vaginal anomalies the result of?

A

Mullerian duct and/or urogenital sinus malformations

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27
Q

What is vaginal atresia?

A

the congenital absence of the vagina

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28
Q

What is vaginal septa?

A

the presence of transverse separations within the vagina

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29
Q

What is vaginal duplication?

A

the presence of two complete vaginas

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30
Q

What other organ should be checked with any Mullerian duct anomaly? Why?

A

kidneys— uterine malformations are associated with increased incidence of renal abnormalities (agenesis, duplication, ectopic kidney)

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31
Q

In who are fibroids more common?

A

black, nulliparous women

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32
Q

Leiomyomas are usually found in the __________, but can also be found in the ______ and ________.

A
  • uterine corpus
  • cervix
  • broad ligament
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33
Q

Lipoleiomyomas are ______ and appear _______ due to the presence of _____.

A

rare
hyperechoic
fat

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34
Q

Describe the location of submucous/submucosal fibroids.

A
  • beneath the endometrial cavity

- often project into uterine cavity

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35
Q

Which type of fibroid is the most common to produce symptoms?

A

submucous/submucosal fibroids

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36
Q

Describe the location of subserous/subserosal fibroids.

A

beneath the perimetrium

37
Q

Describe the location of intraligamentous fibroids.

A

between the layers of the broad ligament

38
Q

Describe the location of cervical fibroids. Are they common or uncommon?

A

in the cervix; uncommon

39
Q

Describe pedunculated fibroids. Which types do these occur with and what else can happen to them?

A
  • on a pedicle or stalk
  • only occurs with submucous and subserous
  • torsion may occur with these
40
Q

Myomas are often ___________.

A

asymptomatic

41
Q

When symptoms are present in myomas, what may they include?

A
  • heavy periods (menometrorrhagia) – especially submucosal
  • frequent urination
  • enlarged uterus
  • increasing pain with degenerative changes
  • infertility or spontaneous abortions
  • alteration in normal menstrual flow
42
Q

What are the common sonographic findings of myomas?

A
  • well circumscribed hypoechoic mass
  • lobulated uterine contour
  • shadowing (with increased attenuation and with calcific degeneration)
  • whorled internal architexture
  • displacement of endometrial echoes
  • extrinsic compression of posterior bladder wall
  • pedunculated fibroid may appear as a hypoechoic adnexal mass
43
Q

What is leiomyosarcoma?

A

extremely rare malignancy arising from myometrium

44
Q

What is the typical sonographic appearance of a leiomyosarcoma?

A
  • single large hypoechoic solid uterine mass

- may be indistinguishable from a fibroid

45
Q

What is the only clue in distinguishing a leiomyosarcoma from a fibroid?

A

the relatively rapid growth of the mass in a post-menopausal woman

46
Q

What is adenomyosis?

A
  • benign invasion of endometrial glands and stroma into myometrium
  • can be diffuse or focal
47
Q

Where does adenomyosis most commonly affect?

A

posterior myometrium

48
Q

Adenomyosis is suspected in those with what 3 things? (ie: age, symptoms, etc)

A
  • parous women
  • ages 40-50 years
  • with dysmenorrhea and irregular bleeding
49
Q

What are the sonographic findings of adenomyosis?

A
  • enlarged uterus with normal contours
  • asymmetric thickening of the anterior or posterior uterine wall
  • myometrial cysts (2-6mm in diameter)
  • mottled inhomogeneous myometrium
  • “Venetian blind” type shadowing (!!!)
50
Q

What is the second most common GYN malignancy?

A

cervical cancer

51
Q

What ages is cervical cancer most commonly seen?

A

ages 20-30

52
Q

What is the most common symptom of cervical cancer?

A

post-coital vaginal bleeding

53
Q

How is cervical cancer diagnosed?

A

via:

  • pap smear
  • colposcopy
  • cone biopsy
54
Q

How is cervical cancer treated?

A

surgically:

  • LEEP
  • conization
  • hysterectomy if advanced
55
Q

What are the risk factors for cervical cancer?

A
  • HPV infection
  • early sexual activity
  • multiple sex partners
  • smoking
  • OCP use
56
Q

What are the sonographic findings of cervical cancer?

A
  • normal appearance early in disease
  • enlarged or bulky cervix
  • may appear similar to cervical myopia
  • hydronephrosis (from clamping of ureters)
  • involvement of other pelvic organs
57
Q

What is a nabothian cyst?

A
  • mucus retention cyst due to obstructed and dilated endocervical glands
  • common
  • benign
  • no clinical significance
58
Q

Describe the sonographic findings of a nabothian cyst.

A
  • small, well circumscribed, anechoic structure
  • located within cervical wall
  • posterior acoustic enhancement
59
Q

What is hydrometra?

A

collection of serous fluid within the endometrial cavity

60
Q

What may hydrometra be secondary to?

A
  • cervical stenosis (especially in post-menopausal patients)
  • endometrial ablation
  • pelvic radiation therapy
61
Q

What is uterine arteriovenous malformation (AVM) caused by?

A
  • may be congenital

- more commonly acquired after surgical procedure or uterine trauma

62
Q

What is uterine arteriovenous malformation associated with? How is it treated?

A
  • associated with heavy vaginal bleeding

- treated with embolization of feeding vessels

63
Q

What are the sonographic findings of uterine arteriovenous malformation?

A
  • hypoechoic myometrial abnormality
  • abundant flow on color Doppler
  • low resistance, high velocity flow on spectral Doppler
64
Q

What is the most commonly encountered gynecologic malignancy? Who most often does this occur in and how do they present?

A
  • endometrial carcinoma
  • postmenopausal women (75-80%)
  • present with early postmenopausal bleeding
65
Q

A relationship exists between increased _________ and development of endometrial cancer.

A

estrogen

66
Q

What are the risk factors for endometrial carcinoma (5)?

A
  • obesity and anovulatory cycles in premenopausal women
  • postmenopausal, with an increased risk if on estrogen replacement therapy
  • history of atypical hyperplasia of endometrium
  • history of Tamoxifen therapy
  • strong family history of uterine cancer
67
Q

Describe the spread of endometrial carcinoma.

A
  • begins in uterine cavity
  • invades and spreads through myometrium, cervix and into the adnexa
  • distant mets may occur if pelvic lymphatic system is affected
68
Q

What are the clinical signs of endometrial carcinoma? (3)

A
  • postmenopausal bleeding
  • hypermenorrhea, intermenstrual flow in patients still having periods
  • pain as a result of uterine distention
69
Q

What are the sonographic findings of endometrial carcinoma? (4)

A
  • alteration in size, shape and sonographic texture of uterine parenchyma
  • increased uterine size
  • inhomogeneity and thickening of endometrial echoes (>4-5mm), especially in postmenopausal women (varies with patient’s hormone status)
  • fluid in endometrial cavity
70
Q

What is endometrial hyperplasia?

A
  • proliferation of endometrial glandular tissue

- may be diffuse or focal

71
Q

What percentage of patients with atypical hyperplasia will undergo malignant change, progressing to endometrial carcinoma?

A

25%

72
Q

What is endometrial hyperplasia a common cause of?

A

bleeding in peri-menopausal patients

73
Q

What may endometrial hyperplasia be caused by in both peri- and postmenopausal women?

A

unopposed estrogen hormone replacement therapy

74
Q

Name 4 other causes of endometrial hyperplasia.

A
  1. persistent anovulatory cycles
  2. PCOS
  3. obesity
  4. estrogen producing tumors of the ovary (ie granulose cell tumor and thecomas)
75
Q

The clinical signs of endometrial hyperplasia are similar to those in patients with _______________.

A

endometrial carcinoma

76
Q

When should sonography be before to evaluate endometrial hyperplasia?

A

at the beginning of the hormone cycle (immediately following menses)

77
Q

What are the sonographic findings of endometrial hyperplasia? (6)

A
  • smooth borders
  • more homogeneous texture, but possibly cystic changes
  • premenopausal women EC > 14mm
  • patient on Tamoxifen EC > 10mm
  • postmenopausal women on estrogen only EC > 5mm
  • postmenopausal women in estrogen phase, EC can be up to 8mm, then in progesterone phase, EC decreases
78
Q

What are endometrial polyps?

A

localized overgrowths of endometrial tissue

79
Q

Name the 3 types of polyps in regards to their stalks.

A
  • pedunculated
  • broad-based
  • thin stalk
80
Q

Occasionally, a polyp will have a long stalk and _______ into the ______ or ______.

A

prolapse into the cervix or vagina

81
Q

What method is ideal for demonstrating polyp size and location?

A

sonohysterography

82
Q

What are the clinical signs of endometrial polyps? (5)

A
  • usually asymptomatic
  • infertility
  • abnormal uterine bleeding
  • usually discovered incidentally in D&C
  • occasionally causes postmenopausal bleeding
83
Q

What are the sonographic findings of endometrial polyps? (3)

A
  • non-specific thickened endometrium, usually focal but occasionally diffuse
  • discrete mass in the endometrium (focal, round and echogenic)
  • possibly vascular stalk demonstrated with color Doppler
84
Q

What may endometrial polyps be indistinguishable from?

A

endometrial hyperplasia

85
Q

What is saline infusion sonohysterography (SIS)? What is another name for it?

A

technique of introducing saline into the endometrial cavity to evaluate endometrium sonographically

AKA hysterosonography

86
Q

What are the indications for SIS? (5)

A
  • infertility and habitual abortion
  • congenital anomalies and/or anatomic variants of the uterine cavity
  • pre- and post-operative evaluation of uterine cavity (especially with regard to myxomas, polyps and cysts)
  • suspected uterine cavity synechiae (ie: scarring associated with Ashermann’s syndrome)
  • further evaluation of abnormalities detected sonographically
87
Q

During a SIS, fluid accumulating in the posterior cul-de-sac ensures what? Images should be obtain in ____ plane(s).

A
  • at least one patent fallopian tube

- images obtained in 2 planes

88
Q

Preliminary tv imaging is performed prior to SIS to evaluate the ______, ______, ______, and ______. The ________ is cleansed and the catheter is placed into the ______ and sterile saline is infused.

A
  • uterus
  • endometrium
  • ovaries
  • adnexae
  • external os
  • cervix

OB/GYN (6 decks)

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