Uterus, Cervix, Ovary and Fallopian tubes (Moulton)

Question 1

Uterus didelphysis

Answer 1

2 separate uterine bodies w their own cervix, attached fallopian tube, and vagina; due to failure of paramesonephric duct to fuse

Question 2

Incomplete dissolution of the midline fusion of the paramesonephric ducts leads to what?

Answer 2

septate uterus

Question 3

Diethylstilbestrol (DES)

Answer 3

early maternal exposure to drugs; small T-shaped endometrial cavity; cervical collar deformity

Question 4

Uterine leiomyomas

Answer 4

“fibroids”; tumors of the smooth muscle cells of the myometrium; most are asymptomatic; most common indication for hysterectomy; increased risk in blacks and nulliparity

Question 5

Characteristics of uterine leiomyomas

Answer 5

spherical, well-circumscribed, white firm lesions w a whorled appearance on cut sections

Question 6

What are the three major locations for uterine leiomyomas?

Answer 6

1. Subserosal
2. Intramural (most common)
3. Submucosal - can cause prolonged or heavy menstrual bleeding

Question 7

What is the first therapeutic option for treatment of leiomyomas?

Answer 7

Combination of oral contraceptive pills (estrogen + progesterone)

Question 8

Endometrial polyps

Answer 8

benign hyperplastic masses; soft friable protrusions in the endometrial cavity; US reveals focal thickening of the endometrial stripe; hysteroscopy is preferred for visualization and surgical treatment

Question 9

Nabothian cervical cyst

Answer 9

normal variant; appears opaque w a yellowish or bluish hue

Question 10

What is the most benign growth of the cervix

Answer 10

Cervical polyp (endocervical polyp is most common compared to an ectocervix polyp)

Question 11

Cervical polyp

Answer 11

benign growth of the cervix; endocervix - more common; beefy red in color; ectocervix polpys are pale in appearance

Question 12

Endometrial Hyperplasia risk of progression to cancer

Answer 12

Simple w/o atypia 1%
Complex w/o atypia 3%
Simple w/ atypia 9%
Complex w/ atypia 27%

Question 13

Endometrial hyperplasia on US

Answer 13

endometrial lining > 4 mm in a post-menopausal female

Question 14

Adenexa definition

Answer 14

includes the ovaries, fallopian tubes, upper portion of the broad ligament, and mesosalpinx

Question 15

The 4 types of functional ovarian cysts

Answer 15

1. Follicular - lined by granulosa cells; can get large enough to cause pain
2. Corpus Luteum - if corpus luteum fails to regress
3. Hemorrhagic - more likely to cause symptoms; hemorrhage of corpus luteum cysts after ovulation
4. Polycystic ovaries - multiple simple follicles

Question 16

Epithelial ovarian tumors are derived from what?

Answer 16

mesothelial cells lining the peritoneal cavity and the lining from the surface of the ovary

Question 17

Mucinous ovarian tumors cytologically resemble what?

Answer 17

the endocervical epithelium (columnar)

Question 18

Endometrioid ovarian tumors cytologically resemble what?

Answer 18

the endometrium

Question 19

Serous ovarian tumors cytologically resemble what?

Answer 19

the lining of the fallopian tubes

Question 20

What is the most common epithelial ovarian tumor?

Answer 20

Serous cystadenoma (75%); histology will show psammoma bodies

Question 21

Mucinous cystadenoma

Answer 21

can be HUGE, filling entire pelvis and abdomen - “jelly belly”; second most common epithelial ovarian tumor; typically multiloculated

Question 22

Granulosa-Theca cells ovarian tumors

Answer 22

produce estrogenic components; promote feminizing symptoms - precocious menarche and thelarche

Question 23

Sertoli-Leydig ovarian tumors

Answer 23

produce androgenic components; promote virilizing effects - hirsutism, temporal baldness, deepening of the voice, clitoromegaly

Question 24

Most common benign solid ovarian tumor

Answer 24

Fibroma; does NOT secrete sex steroids; Meigs syndrome - ascites and right pleural effusion (hydrothorax)

Question 25

Benign cystic teratome

Answer 25

most common ovarian neoplasm found in all ages; dermoid cyst; bilateral; all three germ layers; can rupture and lead to chemical peritonitis

Question 26

Management of ovarian neoplasms in epithelial

Answer 26

in young nulliparous women - cystectomy for ovarian preservation
in older women - hysterectomy w bilateral salpingo-oophorectomy

Question 27

Hydrosalpinx

Answer 27

fluid-filled tubes from previous infection

Question 28

Pyosalpinx

Answer 28

purulent-filled tubes from active infection

Question 29

Two types of ovarian torsion

Answer 29

adnexal torsion - ovary and fallopian tubes both twist
isolated torsion - just the fallopian tube twist (rare)
**gynecologic emergency

Question 30

What is considered a gynecologic emergency?

Answer 30

ovarian torsion; increased risk if ovarian mass >5 cm

Question 31

Ovarian torsion

Answer 31

gynecologic emergency; acute onset of unilateral pain, n/v, US is first line imaging; treatment is ovarian cystectomy