uterus and vagina Flashcards
turner syndrome
XO kids. aortic co-arctations, horseshoe kidney, streaky kidneys, cystic hygroma
ovaries from what embryologic remnant
mullerian ducts
mullerian ducts form what in the female GU system?
uterus and upper 2/3 of vagina
upper 2/3 of vagina embryologic remnant
mullerian duct
embryologic remnant that makes the bottom 1/3 of the vagina
urogenital sinus
urogenital sinus forms what in the female GU system?
lower 1/3 of the vagina
what do Wolfian ducts contribute to in the female GU system?
nothing in the female GU system
congenital absence of the uterus (or unicornuate or bicornuate) and upper 2/3 vagina with normal ovaries and fallopian tubes
Mayer-Rokitanksy-Kuster-Hauser syndrome (Mullerian agenesis). has 3 features: 1`) vaginal atresia. 2) absent or rudimentary uterus and 3) normal ovaries
pt with a unicornuate uterus has what % chance of renal anomalies
40% will have renal issues. Usually ipsilateral to the rudimentary horn
who has more infertility issues: patients with a septate uterus or a patient with a bicornuate uterus
the septate uterus will have more infertility issues
T-shaped uterus
DES related anomaly
Mayer-Rokitanksy-Kuster-Hauser syndrome
(Mullerian agenesis). has 3 features: 1`) vaginal atresia. 2) absent or rudimentary uterus and 3) normal ovaries
most common type of leiomyoma
Hyaline T2 dark
type of fibroid that is associated with pregnancy
red (carneous) Peripheral rim of T1 high signal
T2 bright fibroid
myoxoid
risk of malignant transformation of a leiomyoma
0.1%. Super duper low. The typical history will be rapidly enlarging
thickening of the junctional zone >12 mm
adenomyosis
adenomyosis junctional zone thickness
>12 mm
endometrium < 5 mm in a postmenopausal woman
atrophy
endometrium > 5 mm in a postmenopausal woman
might be cancer. get a biopsy.
HNPCC increased risk of endometrial cancer
30-50x increased risk of endometrial cancer
30-50x increased risk of endometrial cancer
HNPCC (Lynch Syndrome)
abnormal endometrial thickness on Tamoxifen
Tamoxifen endometrium gets a pass up to 8mm. At >8mm it gets a biopsy
If there is concern for an endometrial polyp. Next step?
sonohysterogram
endometrial fluid in a premenopausal vs post-menopausal woman
premenopausal -endometrial fluid is normal. Postmenopausal women - endometrial fluid means either cervical stenosis or an obstructing mass (usually cervical stenosis)
how does cervical stenosis in a post menopausal woman manifest?
endometrial fluid - which is abnormal in a post menopausal woman.
cervical cancer stage most likely to have lymph node mets?
IIc
At this stage there is > 50% myometrial invasion - associated with lymph node mets
up to what cervical stage can you do surgery?
up to stage II A (spread beyond the cervix but no parametrial invasion)
what runs inside the parametrium?
uterine artery
cervical cysts
Nabothian cyst
most common cancer of the vagina in adults
Squamous cell carcinoma
most common cancer of the vagina in kids
rhabdomyosarcoma bi-modal age distribution in ages 2-6 and 14-18
met to the anterior wall upper 1/3 of the vagina
from the upper genital tract
met to the posterior wall, lower 1/3 of the vagina
from the GI tract
results of incomplete regression of the wolffian ducts
Gartner duct cyst
cyst located along the anterior lateral wall of the upper vagina
Gartner duct cyst
type of cysts that may compress the urethra
Gartner duct cyst and Skene Gland cyst
Cyst below pubic symphysis near the butt-hole
Bartholin duct cyst
periurethral gland cyst, low and anterior
Skene gland (periurethral)
do you ever biopsy an ovary?
no
who has a better prognosis: perimenopausal or older (70s) patient with endometrial cancer?
at what cervical cancer stage is there parametrial involvement?
2B
Smit sleeve - for radiation oncology
complete mole resulting in a theca lutein cyst
most common for of Mullerian duct anomaly (in females)
septate uterus
will have a muscular and fibrous septae
biopsy
thickened irregular and cystic appearing endometrium. Tamoxifen has proesterogenic effects on the endometrium and associated with increased risk of endometrial hyperplasia, polyps, and carcinoma.
a patient who develops bleeding while taking tamoxifen requires evaluation. >8 mm thick endometrium on tamoxifen –> biopsy
what classic HSG case is associated with TB?
salpingitis isthmica nodosa (SIN)
the following is associated with:
imaging findings are consistent with adenoma malignum, associated with Peutz-Jeghers syndrome and a poor prognosis.
adenoma malignum (mucinous minimal deviation adenocarcinoma) is a rare cervical adenocarcinoma.
normal endometrial thickness
4 mm
lipoleiomyoma
hyperechoic mass with a partially hypoechoic rim
mullerian duct anomalies are associated with:
vertebral body anomalies (20%)
renal anomalies (30-50%)
Mayer-Rokitansky-Küster-Hauser syndrome (MRKH)
Ovaries are present and function normally, but they are often ectopic. Functioning endometrial tissue within rudimentary uteri may result in intraluminal blood or adenomyosis, and these patients may have pelvic pain.
One or both ovaries are ectopic in 40% of cases and may be seen as follows:
- Anterolaterally or far laterally in the pelvis
- Posteriorly to the anterior abdominal wall
- Very high in the pelvis just below the pelvic brim
