Uterine Pathology Flashcards
Leiomyoma Prevalence, age, ethnicity
· Most common tumor of the female pelvis
· Occurs in 20-30% of women of reproductive age
• Occurs at a greater rate in Afracan Amercians
Symptoms of leiomyoma
- Menorrhagia
- Spotting
- Increased abdominal girth
- Pain
- Urinary frequency/uregency
- Lower back pain
- Leg discomfort/swelling
Leiomyoma (Fibroids) History
More common with a family history (40% greater chance)
Leiomyoma etiology
- No known cause of fibroids
* Arise after menache and regress after menopause, ESTROGEN is a promoter of growth
Locations of leiomyoma
- Intramural
- Submucous
- Subserosal
Leiomyoma types
- Pedunculated
- Submucosal
- Subserosal
- Calcified
Sonographic findings leiomyoma
Heterogenous myometrium
• Irregular endometrial stripe
• Hypoechoic areas within the myometrium
• Whorled internal architecture of a mass
• Calcifications
• Posterior bladder contour changes
Leiomyoma treatment
- 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
Endometrial Hyperplasia Prevalence
• More common in post-menopausal women
Endometrial Hyperplasia Symptoms
• Most common cause of abnormal uterine bleeding
Endometrial Hyperplasia Etiology
• Excessive growth of the endometrium
Endometrial Hyperplasia Causes
- High estrogen levels
- Hormone repacement therapy
- Tamoxifen
- Diabetes
- Obesity
- PCOD/Anovulatory cycles
Endometrial Hyperplasia sonographic findings
- 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
Endometrial Hyperplasia Treatment
- Hysteroscopy
- D and C
- Porgesterone IUD
- Progesterone orally
- Hysterectomy
Asherman’s Syndrome Symptoms
- Fertility problems
- Recurrent pregnancy losses
- Normal to absent menses
Asherman’s Syndrome Etiology
Adhesions of the endometrium
Asherman’s Syndrome Causes
- Trauma
- Surgery
- Cesarean section
- D and C
Asherman’s Syndrome Sonographic appearance
- 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
Gartner’s Duct Cyst Symptoms
• Most commonly asymptomtic and found on routine plevic exams
If large, can cause symptoms :
• Pressure symptoms
• Dyspareunia
Gartner’s Duct Cyst etiology
- Common lesion of the vagina
* Caused by remnant of mesonephric duct (embryonic urogenital structure)
Gartner’s Duct Cyst sonographic appearance
- can delineate the location of the cyst in anterolateral vaginal wall
- Appears as an anechoic or complex mass
- Well defined margins
- Good sound transmission
Gartner’s Duct Cyst treatment
- Do not require follow up if asymptomatic
* If symptomatic: drainage and removal to aid symptoms
Inflammatory Process of Fallopian tubes Symptoms
- Fever
- Pain
- Elevated WBC
Inflammatory Process of Fallopian tubes Types
- PID
- Pyosalpinx
- Tubo-Ovarian abscess
- Non Gynecological abscesses
Abscess Symptoms
- Fever
- Tenderness/pain
- Swelling at surgery site (Postoperatively)
- Chills
- General malaise
- Weakness
Abscess Etiology
• Infectious process involving the tubes, ovaries, appendix, bowel, peritoneum or bowel perforation
Abscess sonographic appearance
- 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
Abscess other tests
- Increased white blood cells
- Sepsis
- Possible posutive bacterial cultures
- CT is a very accurate method of diagnosing infectious disease within the pelvis
Hematoma symptoms
- Possible palpable mass
- Hypertension
- Decreased Renal Function
Hematoma Etiology
Collection of blood due to trauma or a disease process
Hematoma Causes
- Ectopic pregnancy
- Cyst rupture
- Postoperative bleeding due to renal transplant, surgery or trauma
Hematoma sonographic appearance
- 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
Hematoma other tests
Decreased hematocrit level
Leiomyosarcoma prevalence
- 3% of uterine tumors
* 1% of uterine malignancies
Leiomyosarcoma Risk factors
- Nulliparity
- 50 years and older
- Obesity
- Pelvic Radiation
- Tamoxifen exposure
Leiomyosarcoma symptoms
- Abnormal vaginal bleeding
- Palpable pelvic mass
- Pelvic/abdominal pain
Leiomyosarcoma Etiology
- Dervived from the smooth muscle of the wall of the uterus
* Agressives and poor prognosis (Mets common)
Leiomyosarcoma sonographic appearance
- Usually intramural
- Rapidly growing heterogenous mass
- Acoustic enhancement (due to increased vascularity)
- Increased intra-tumoral flow
- Anechoic or complex areas due to tumor liquefaction
Leiomyosarcoma Treatment
- Total hysterectomy
- Peritoneal washing
- Nodule Sampling
- Radiotherapy
Leiomyosarcoma other tests
- CT
* MRI
Leiomyosarcoma Differential Diagnosis
• Other uterine sarcomas, endometrial adenocarcino, adenomyomas, GI and bladder carcinomas
Endometrial Carcinoma prevalence
- Most common gynecologic cancer
- Most common in 6th-7th decade of life
- Most common in white women
Endometrial Carcinoma risk factors
- Obesity
- Nulliparity
- Late Meonpause
- Adenomatous polyps
- Family history
- Unopposed Estrogen
Endometrial Carcinoma predisposing factors
- Herediatry colon cancer
* Breast cancer (tamoxifen treatment)
Endometrial Carcinoma Decreased risk
- Oral contraceptives
* Smoking
Endometrial Carcinoma Symptoms
- Bleeding
- Pain
- Uterine distention
Endometrial Carcinoma Etiology
• Histologically, 80% of endometrial carcinomas are of the endometrioid typ
Endometrial Carcinoma Stage 1/2
• Confined to the uterus
Endometrial Carcinoma Stage 3/4
- Extends beyond the uerus
- Bladder/rectum infiltration
- Adjacent mass
- Ureteral obstruction
Endometrial Carcinoma Sonographic appearance
- 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
Endometrial Carcinoma Treatments
- Total hysterectomy (Uterus, Ovaries, Tubes)
- Lymphadenectomy (higher grade cancer)
- Radiation and chemo
Endometrial Carcinoma Other treats
• MRI/CT (can help identify lymphadenopathy and metastic disease)
Endometrial Carcinoma DD
- Endometrial hyperplasia
- Endometral polyps
- Leiomyoma
- Cervical Cancer
Carcinoma of the Cervix Prevalence
- Second most common gynecologic malignancy
* Occurs 3rd-4th decade of life
Cervical Carcinoma risk factors
- Human papilloma virus infection
- Early sexual activity
- Multiple partners
- Low socioeconomic status
- Smoking
- Oral contraceptives
- Weak immune system
- DES exposure
Cervical cancer symptoms
- Often asymptomatic in early stages
- Abnormal vginal discharge
- Post-coital bleeding
- Bladder irritability
- Low black pain
- Ureteral obstruction
Cervical cancer stage 1/2
- Normal size and echogenicity
* Hematometra due to cerrvical stenosis
Cervical cancer stage 3/4
- Bulky cervix
- Bladder invasion
- Hydronephrosis
- Liver metastasis
- Nodeformation aorund aorta and IVC
Cervical cancer treatments
• Cone biopsy to preserve fertility • Radiotherapy Extra cervical spread • Surgery • Radiotherapy/chemo
Cervical cancer other tests
• Pap Test (Papanicolau smear)
Invasive mole prevalence
- Reproductive Age (Complication of pregnancy)
* More common in women over 40
Invasive mole symptoms
- Persistent heavy bleeding
* Elevated HCG
Invasive mole risk factors
• History of multiple molar pregnancies
invasive mole is a type of what?
PTN (Persitent Trophoblastic Neoplasia)
Invasive mole etiology
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
what are types of PTN
- Invasive Mole
- Choriocarcinoma
- Placental Site Trophoblastic Tumor
- Epitheliod Trophoblastic Tumor
Invasive mole sonographic appearance
- 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
Invasive mole treatment
- Methotrexate
- Multidrug chemotherapy
- Avoiding pregnancy for 1 year
- Monitoring hCG (at some sites)
Invasive Mole other tests
• Serum beta HCG is used as a tumor marker
Choriocarcinoma prevalence
- Reproductive Age (Complication of pregnancy)
* More common in women over 40
Choriocarcinoma risk factors
- Complete or partial mole
- Normal pregnancy
- Still birth
- Spontaneous abortion
- Ectopic pregnancy
- History of multiple molara pregnancies
Choriocarcinoma symptoms
- Cough
- Hemopysis
- Neurologic disturbances or hemorrhage
Choriocarcinoma etiology
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
Choriocarcinoma sonographic appearance
- Focal, hemorrhagic nodule within the endometrium
- Secondary masses to cervix or vagina
- Mets to liver
Choriocarcinoma treatment
- Chemo (Methotrexate)
- Avoiding pregnancy for 1 year
- Monitoring hCG (at some sites)
Choriocarcinoma DD
- Incomplete Abortion
- Hydropic degneration of the placenta
- Dermoids
- Adenomyosis
- Ovarian tumors
- Cystic paipillary Adenomas
Choriocarcinoma other tests
- CT
- MRI
- High levels of Beta HCG
