Uterine pathology Flashcards
The Müllerian ducts fuse to form the
Uterus, cervix and upper vagina
Which ends of the Müllerian ducts fuse
Caudal
The infused ends of the Müllerian ducts form the
Fallopian tubes
What is a unicornate
Form of arrested development
Deviation of the fundal endometrium to the Lt or Rt
Banana shaped uterus
What Müllerian duct abnormality has the highest association of renal anormialites arising on the contralateral side
Unicornuate
Bicornuate uterus and uterine didelphys is a form of what mullarian duct abnormality
Failure of fusion
What are the forms of Müllerian duct abnormalities that are from failure of resorption
Septations >1cm indictation
Subseptate
What is a prolapsed uterus
The decent the uterus down the vagina
Caused by weak pelvic floor muscles
Is a prolapsed uterus diagnosed sonographically
No
What is asherman’s syndrome
When the endometrial lining is replaced by fibrous adhesions
It is considered a scar in the endometrium
Occurs after a D&C, multiple abortions or infections
Can asherman’s syndrome vary in appearance of a thick to thin endometrium
Yes
What does asherman’s syndrome cause
Loss of menstruation and infertility
are AV malformations of the uterus common or rare
Rare
What is the cause of AV malformations of the uterus and what are the symptoms
Congenital
From trauma or surgery
- menorrhagia
What is the sonographic apperance of AV malformations of the uterus
Difficult to assess until the use of colour Doppler
What is neoplasia
Multiplication of abnormal cells, can be malignant or benign
What are non neoplasticism conditions
Endometrial hyperplasia Endometrial polyps Adenomyosis Uterine varices Endometritis
What is endometrial hyperplasia
Unopposed estrogen stimulation from ovarian dysfunction
Occurs immediately after menarche and also before menopause (premenopausal)
What can endometrial hyperplasia cause
Irregular uterine bleeding
What is the sonographic appearance of endometrial hyperplasia
Thick hyperechoic endometrium
Can Involve most, focal or modular parts of the endometrium
What is a DDX of endometrial hyperplasia
Endometrial CA or polyps
What are endometrial polyps
Endometrial growth extending into the canal from a stalk
What can endometrial polyps protrude into and what can it cause
Into the cervix if it has a long stalk
Bleeding or be asymptomatic
What type of test is done to see endometrial polyps
Sonohysterogram
What is adenomyosis
Extension of endometrial tissue (glands and storma) beyond the endometrium into the myometrium
What is adenomyosis a form of
Endometriosis because it is an ectopically placed endometrium into the myometrium and causes the endo/myometrium junction to be less pronounced (fuzzy) or jagged.
Where does adenomyosis typically occur in the uterus
Posterior wall
What can adenomyosis cause
Pain
Abnormal bleeding
What is the sonographic appearance of adenomyosis
Slight diffuse uterine enlargement
Hypoechoic or cystic lesions within the myometrium
May have focal lesions
May look like a fibroid or polyp
Myometrium of unequal thickness
~endometrium is not in the centre of the uterus
What is adenomyosis appearance often described as
Venetian blind
~which is multiple lines shadowing in the posterior aspect of the uterus in the myometrium
Where are uterine varices typically found on
The lateral aspect of the uterus, colour Doppler will help differentiate from an ovary
What is endometritis
Inflammation of the endometrium
When does endometritis often occur
Postpartum
Or
PID
What is the sonographic appearance of endometritis
Normal endometrium
Irregular endometrium
Fluid filled cavity to it can demonstrate gas bubbles from micro-organisms
Leiomyoma and lipoleiomyoma are
Benign uterine neoplasia
What is leiomyoma
Aka fibroids
A benign neoplasticism mass of fibromuscular tissue
Most common tumor in the female pelvis
And most commonly found in African American women
Leiomyoma are influenced by
Increase in estrogen
~like pregnancy or menopause
If leiomyoma is malignant what is called and is it common or rare
Leiomyosarcoma and it is rare
What are symptoms from leiomyoma
Menorrhagia Pain Pressure Palpable mass on pelvic exam Infertility
What are classifications of leiomyoma
Intramural
Submucosal
Sub serosal
Where are intramural fibroids
Confined in the myometrium
Most common
Where are submucosal fibroids
Project into the uterine cavity
Can be pedunculated
Can cause bleeding
Where are subserosal fibroids
Project from perimetrium
Can be pedunculated
Can be found in the broad ligament
What are the sonographic appearances of fibroids
Hypoechoic with high attenuation
Enlarged uterus with irregular contour
Calcifications may be present in older women
May be complex looking with degeneration and necrosis
Why can fibroids look necrotic
Because they have outgrown their blood supply
What happens to fibroids with pregnancy
Enlarge from the increase in estrogen
Because of rapid growth it may result in necrosis from lack of adequate blood supply
Large fibroids near cervix can inhibit delivery of the fetus
~c-section would become necessary
Where are fibroids typically located in the uterus
Lateral aspect
What are lipoleiomyoma and are they common
Lipocystes (fat) and fibromuscular tissue
They are uncommon
What is the sonographic appearance of lipoleiomyoma
Very hyperechoic and attenuating
Appear similar to dermoid
Leiomyosarcoma and endometrial carcinoma are
Malignant uterine neoplasias
What is leiomyosarcoma
Rare
May arise from pre-exisiting fibroid
Has the same symptoms as fibroids
What is the sonographic appearance of leiomyosarcoma
Degenerating fibroid appearance
May see local invasion of surrounding organs or hepatic metastasis
What is endometrial ca
Makes up 90% of all uterine malignancies
Most common in postmenopausal women
What is the symptom of endometrial ca
Postmenopausal bleeding
How many stages are there of endometrial ca
4
What is stage 1 endometrial ca
Confined to the endometrium
What is stage 2 endometrial ca
Confined to the uterus
What is stage 3 endometrial ca
Spread beyond the uterus but still within the pelvis
What is stage 4 endometrial ca
Distal metastasis (i.e liver)
What are the risk factors associated with developing endometrial ca
Strong association with estrogen therapy (HRT) obesity Hypertension Diabetes PCOS Granulosa cell tumour of the ovary
What is the sonographic appearance of endometrial ca
Thick echogenic endometrium
Ifficulty distinguishing from hyperplasia or polyps
What is tamoxifen
A non-steroidal anti-estrogen hormonal drug
Used in the treatment of breast ca
An estrogen antagonist to the uterus resulting in simulation of the endometrium
What does tamoxifen increase the risk for
Developing endometrial ca by 1% but the benefit for breast cancer outweighs the risk for uterine ca
What is the sonographic appearance of the endometrium when a patient is on tamoxifen
Heterogenous and bizarre
