Uterus/adnexa Flashcards
What is the position of the uterus on this image?
Anteverted retroflexed
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Version (think vagina): angle b/w cervical axis & vagina.
- In this case, the cervix is angled forward relative to the vagina = anteverted.
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Flexion (think fundus): angle b/w the uterine body/fundus & cervix at the isthmus.
- In this case, the body/fundus is directed posteriorly, so retroflexed.
- What are the most common GU & non-GU sites for DIE?
- GU: uterosacral ligament.
- Non-GU: rectosigmoid colon.
What structures do the Mullerian ducts form? …and not?
Form: uterus, fallopian tubes, upper 2/3 vagina
Do not form: ovaries
What structure forms the lower 1/3 vagina?
Urogenital sinus
In what direction does fetal uterine cleavage occur?
From bottom to top.
Hence, septae are formed, often extending from the top and only partially to the bottom.
What is Mayer-Rokitansky-Kuster-Hauser syndrome?
3 features:
- Vaginal atresia.
- Absent or rudimentary uterus: unicornuate or bicornuate.
- Normal ovaries (so clearly this is a Mullerian issue).
- The kidneys have issues (agenesis, ectopia) in 50% of cases.
What is the issue you need to look out for w/unicornuate uterus?
- 40% will have issues w/the ipsilateral kidney: agenesis.
Uterus didelphys:
- What are the 3 features?
- What is the prevalence of a vaginal septum?
- Didelphys, so two: uteri, cervixes & upper vaginas.
- 75% will have a septum.
Bicornuate uterus:
- In what % is a vaginal septum present?
- Name the 2 types.
- 25% (so less than didelphys, which is 75%).
- Unicollis or bicollis: 1 or 2 cervixes.
What type of cancer is associated w/a T-shaped uterus?
Vaginal clear cell.
From DES exposure.
Septate uterus:
- In what 2 ways, morphologically, is this different from bicornuate?
- What is an imaging pitfall with these and HSG?
- Has a convex fundus (bicornuate has a cleft >1cm); has a fibrous or muscular septum (bicornuate has a myometrial septum).
- On HSG can look like a bicornuate or unicornuate or didelphys, so need MRI.
Is arcuate uterus associated w/infertility or obstetric complications?
NO! Neither.
HSGs:
- Best time to perform & reason?
- 4 contraindications?
- 3 phases of the menstrual cycle & days?
- Proliferative phase of cycle, i.e., day 7-10 (7-14 technically).
- PID, pregnancy, contrast allergy, active bleeding (day 0-7).
- 3 phases:
- Menstrual: 0-7
- Proliferative: 7-14
- Secretory: 14-28
Malignant transformation is a rare complication of endometriosis.
- What is the rate of xsformation?
- What is the most common malignant neoplasm arising from endometriosis?
- 1%
- Endometrioid carcinoma