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OBGYN Ultrasound > Uterine Pathology > Flashcards

Uterine Pathology Flashcards

1
Q

Leiomyoma Prevalence, age, ethnicity

A

· Most common tumor of the female pelvis
· Occurs in 20-30% of women of reproductive age
• Occurs at a greater rate in Afracan Amercians

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2
Q

Symptoms of leiomyoma

A
  • Menorrhagia
  • Spotting
  • Increased abdominal girth
  • Pain
  • Urinary frequency/uregency
  • Lower back pain
  • Leg discomfort/swelling
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3
Q

Leiomyoma (Fibroids) History

A

More common with a family history (40% greater chance)

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4
Q

Leiomyoma etiology

A
  • No known cause of fibroids

* Arise after menache and regress after menopause, ESTROGEN is a promoter of growth

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5
Q

Locations of leiomyoma

A
  • Intramural
  • Submucous
  • Subserosal
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6
Q

Leiomyoma types

A
  • Pedunculated
  • Submucosal
  • Subserosal
  • Calcified
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7
Q

Sonographic findings leiomyoma

A

Heterogenous myometrium
• Irregular endometrial stripe
• Hypoechoic areas within the myometrium
• Whorled internal architecture of a mass
• Calcifications
• Posterior bladder contour changes

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8
Q

Leiomyoma treatment

A
  • If patient is asymptomatic: routine follow ups
  • Oral contraceptive to reduce or eliminate symptoms
  • Myomectomy if myoma is large and patient wishes to become pregnant
  • Uterine artery embolization
  • Hysterectomy
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9
Q

Endometrial Hyperplasia Prevalence

A

• More common in post-menopausal women

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10
Q

Endometrial Hyperplasia Symptoms

A

• Most common cause of abnormal uterine bleeding

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11
Q

Endometrial Hyperplasia Etiology

A

• Excessive growth of the endometrium

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12
Q

Endometrial Hyperplasia Causes

A
  • High estrogen levels
  • Hormone repacement therapy
  • Tamoxifen
  • Diabetes
  • Obesity
  • PCOD/Anovulatory cycles
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13
Q

Endometrial Hyperplasia sonographic findings

A
  • Thickened endometrium
  • Homogenous, heterogenic endometrium with small cystic areas (Dilated cystic galnds)
  • Nonspecific on sonography therefore a bipsoy or D and C is necessary to confirm diagnosis
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14
Q

Endometrial Hyperplasia Treatment

A
  • Hysteroscopy
  • D and C
  • Porgesterone IUD
  • Progesterone orally
  • Hysterectomy
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15
Q

Asherman’s Syndrome Symptoms

A
  • Fertility problems
  • Recurrent pregnancy losses
  • Normal to absent menses
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16
Q

Asherman’s Syndrome Etiology

A

Adhesions of the endometrium

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17
Q

Asherman’s Syndrome Causes

A
  • Trauma
  • Surgery
  • Cesarean section
  • D and C
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18
Q

Asherman’s Syndrome Sonographic appearance

A
  • 2D imaging: Normal or hypoechoic bridgelike bands
  • Sonohystogram: Bridgining tissue bands. Cavity distortion, thin, free-floating membranes; lack of distension in the prsence of thick membranes
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19
Q

Gartner’s Duct Cyst Symptoms

A

• Most commonly asymptomtic and found on routine plevic exams
If large, can cause symptoms :
• Pressure symptoms
• Dyspareunia

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20
Q

Gartner’s Duct Cyst etiology

A
  • Common lesion of the vagina

* Caused by remnant of mesonephric duct (embryonic urogenital structure)

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21
Q

Gartner’s Duct Cyst sonographic appearance

A
  • can delineate the location of the cyst in anterolateral vaginal wall
  • Appears as an anechoic or complex mass
  • Well defined margins
  • Good sound transmission
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22
Q

Gartner’s Duct Cyst treatment

A
  • Do not require follow up if asymptomatic

* If symptomatic: drainage and removal to aid symptoms

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23
Q

Inflammatory Process of Fallopian tubes Symptoms

A
  • Fever
  • Pain
  • Elevated WBC
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24
Q

Inflammatory Process of Fallopian tubes Types

A
  • PID
  • Pyosalpinx
  • Tubo-Ovarian abscess
  • Non Gynecological abscesses
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25
Q

Abscess Symptoms

A
  • Fever
  • Tenderness/pain
  • Swelling at surgery site (Postoperatively)
  • Chills
  • General malaise
  • Weakness
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26
Q

Abscess Etiology

A

• Infectious process involving the tubes, ovaries, appendix, bowel, peritoneum or bowel perforation

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27
Q

Abscess sonographic appearance

A
  • Difficult to image due to gas bubbles
  • May be loculated and within the pelvis and paracolic gutters or extend out of the pelvis
  • Fluid collects in upper and right upper quadrant (surronding the kidneys)
  • May have fluid levels within the mass
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28
Q

Abscess other tests

A
  • Increased white blood cells
  • Sepsis
  • Possible posutive bacterial cultures
  • CT is a very accurate method of diagnosing infectious disease within the pelvis
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29
Q

Hematoma symptoms

A
  • Possible palpable mass
  • Hypertension
  • Decreased Renal Function
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30
Q

Hematoma Etiology

A

Collection of blood due to trauma or a disease process

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31
Q

Hematoma Causes

A
  • Ectopic pregnancy
  • Cyst rupture
  • Postoperative bleeding due to renal transplant, surgery or trauma
32
Q

Hematoma sonographic appearance

A
  • Well defined, walled off mass
  • Complex appearance, ranging from swirling mobile mass cotents to partilly solid and anechoic to totally anechoic
  • Appearance varies depending on the age of the hematoma
33
Q

Hematoma other tests

A

Decreased hematocrit level

34
Q

Leiomyosarcoma prevalence

A
  • 3% of uterine tumors

* 1% of uterine malignancies

35
Q

Leiomyosarcoma Risk factors

A
  • Nulliparity
  • 50 years and older
  • Obesity
  • Pelvic Radiation
  • Tamoxifen exposure
36
Q

Leiomyosarcoma symptoms

A
  • Abnormal vaginal bleeding
  • Palpable pelvic mass
  • Pelvic/abdominal pain
37
Q

Leiomyosarcoma Etiology

A
  • Dervived from the smooth muscle of the wall of the uterus

* Agressives and poor prognosis (Mets common)

38
Q

Leiomyosarcoma sonographic appearance

A
  • Usually intramural
  • Rapidly growing heterogenous mass
  • Acoustic enhancement (due to increased vascularity)
  • Increased intra-tumoral flow
  • Anechoic or complex areas due to tumor liquefaction
39
Q

Leiomyosarcoma Treatment

A
  • Total hysterectomy
  • Peritoneal washing
  • Nodule Sampling
  • Radiotherapy
40
Q

Leiomyosarcoma other tests

A
  • CT

* MRI

41
Q

Leiomyosarcoma Differential Diagnosis

A

• Other uterine sarcomas, endometrial adenocarcino, adenomyomas, GI and bladder carcinomas

42
Q

Endometrial Carcinoma prevalence

A
  • Most common gynecologic cancer
  • Most common in 6th-7th decade of life
  • Most common in white women
43
Q

Endometrial Carcinoma risk factors

A
  • Obesity
  • Nulliparity
  • Late Meonpause
  • Adenomatous polyps
  • Family history
  • Unopposed Estrogen
44
Q

Endometrial Carcinoma predisposing factors

A
  • Herediatry colon cancer

* Breast cancer (tamoxifen treatment)

45
Q

Endometrial Carcinoma Decreased risk

A
  • Oral contraceptives

* Smoking

46
Q

Endometrial Carcinoma Symptoms

A
  • Bleeding
  • Pain
  • Uterine distention
47
Q

Endometrial Carcinoma Etiology

A

• Histologically, 80% of endometrial carcinomas are of the endometrioid typ

48
Q

Endometrial Carcinoma Stage 1/2

A

• Confined to the uterus

49
Q

Endometrial Carcinoma Stage 3/4

A
  • Extends beyond the uerus
  • Bladder/rectum infiltration
  • Adjacent mass
  • Ureteral obstruction
50
Q

Endometrial Carcinoma Sonographic appearance

A
  • Heterogenous, echo-texture with irregular or poorly defined margins
  • Cystic changes within the endometrium
  • May cause hydrometra or hematometra
  • Enlargment with lobular contour of the uterus and mixed echogencity is more indicitive of an advanced disase stage
51
Q

Endometrial Carcinoma Treatments

A
  • Total hysterectomy (Uterus, Ovaries, Tubes)
  • Lymphadenectomy (higher grade cancer)
  • Radiation and chemo
52
Q

Endometrial Carcinoma Other treats

A

• MRI/CT (can help identify lymphadenopathy and metastic disease)

53
Q

Endometrial Carcinoma DD

A
  • Endometrial hyperplasia
  • Endometral polyps
  • Leiomyoma
  • Cervical Cancer
54
Q

Carcinoma of the Cervix Prevalence

A
  • Second most common gynecologic malignancy

* Occurs 3rd-4th decade of life

55
Q

Cervical Carcinoma risk factors

A
  • Human papilloma virus infection
  • Early sexual activity
  • Multiple partners
  • Low socioeconomic status
  • Smoking
  • Oral contraceptives
  • Weak immune system
  • DES exposure
56
Q

Cervical cancer symptoms

A
  • Often asymptomatic in early stages
  • Abnormal vginal discharge
  • Post-coital bleeding
  • Bladder irritability
  • Low black pain
  • Ureteral obstruction
57
Q

Cervical cancer stage 1/2

A
  • Normal size and echogenicity

* Hematometra due to cerrvical stenosis

58
Q

Cervical cancer stage 3/4

A
  • Bulky cervix
  • Bladder invasion
  • Hydronephrosis
  • Liver metastasis
  • Nodeformation aorund aorta and IVC
59
Q

Cervical cancer treatments

A 
• Cone biopsy to preserve fertility 
• Radiotherapy 
 Extra cervical spread 
• Surgery 
• Radiotherapy/chemo
60
Q

Cervical cancer other tests

A

• Pap Test (Papanicolau smear)

61
Q

Invasive mole prevalence

A
  • Reproductive Age (Complication of pregnancy)

* More common in women over 40

62
Q

Invasive mole symptoms

A
  • Persistent heavy bleeding

* Elevated HCG

63
Q

Invasive mole risk factors

A

• History of multiple molar pregnancies

64
Q

invasive mole is a type of what?

A

PTN (Persitent Trophoblastic Neoplasia)

65
Q

Invasive mole etiology

A

80-90% of cases
• Complication of pregnancy
• Pathology occurs when an abnormal ovum (inactive maternal chromosomes or absent chromosomes) is fertilized by a normal hapoloid sperm
• No fetus (embryo demises early)
• Proliferation of trophoblasts and presence of chorionic villi within the endometrium and myometrium

66
Q

what are types of PTN

A
  • Invasive Mole
  • Choriocarcinoma
  • Placental Site Trophoblastic Tumor
  • Epitheliod Trophoblastic Tumor
67
Q

Invasive mole sonographic appearance

A
  • Heterogenous wiith hypoechoic areas representing hemorrhage or vascular lakes
  • Doppler/colour doppler can be used to evaulate the extent of tumor an response to chem
68
Q

Invasive mole treatment

A
  • Methotrexate
  • Multidrug chemotherapy
  • Avoiding pregnancy for 1 year
  • Monitoring hCG (at some sites)
69
Q

Invasive Mole other tests

A

• Serum beta HCG is used as a tumor marker

70
Q

Choriocarcinoma prevalence

A
  • Reproductive Age (Complication of pregnancy)

* More common in women over 40

71
Q

Choriocarcinoma risk factors

A
  • Complete or partial mole
  • Normal pregnancy
  • Still birth
  • Spontaneous abortion
  • Ectopic pregnancy
  • History of multiple molara pregnancies
72
Q

Choriocarcinoma symptoms

A
  • Cough
  • Hemopysis
  • Neurologic disturbances or hemorrhage
73
Q

Choriocarcinoma etiology

A 
Rare subtype of PTN 
• Complication of pregnancy 
• Pathology occurs when an abnormal ovum (inactive maternal chromosomes or absent chromosomes) is fertilized by a normal hapoloid sperm 
• No fetus (embryo demises early)
•  Abnormal, proliferating trophoblast 
• Absence of chorionic villi
74
Q

Choriocarcinoma sonographic appearance

A
  • Focal, hemorrhagic nodule within the endometrium
  • Secondary masses to cervix or vagina
  • Mets to liver
75
Q

Choriocarcinoma treatment

A
  • Chemo (Methotrexate)
  • Avoiding pregnancy for 1 year
  • Monitoring hCG (at some sites)
76
Q

Choriocarcinoma DD

A
  • Incomplete Abortion
  • Hydropic degneration of the placenta
  • Dermoids
  • Adenomyosis
  • Ovarian tumors
  • Cystic paipillary Adenomas
77
Q

Choriocarcinoma other tests

A
  • CT
  • MRI
  • High levels of Beta HCG

OBGYN Ultrasound (5 decks)

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