Uterus, Cervix, Ovary and Fallopian tubes (Moulton) Flashcards
Uterus didelphysis
2 separate uterine bodies w their own cervix, attached fallopian tube, and vagina; due to failure of paramesonephric duct to fuse
Incomplete dissolution of the midline fusion of the paramesonephric ducts leads to what?
septate uterus
Diethylstilbestrol (DES)
early maternal exposure to drugs; small T-shaped endometrial cavity; cervical collar deformity
Uterine leiomyomas
“fibroids”; tumors of the smooth muscle cells of the myometrium; most are asymptomatic; most common indication for hysterectomy; increased risk in blacks and nulliparity
Characteristics of uterine leiomyomas
spherical, well-circumscribed, white firm lesions w a whorled appearance on cut sections
What are the three major locations for uterine leiomyomas?
- Subserosal
- Intramural (most common)
- Submucosal - can cause prolonged or heavy menstrual bleeding
What is the first therapeutic option for treatment of leiomyomas?
Combination of oral contraceptive pills (estrogen + progesterone)
Endometrial polyps
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
Nabothian cervical cyst
normal variant; appears opaque w a yellowish or bluish hue
What is the most benign growth of the cervix
Cervical polyp (endocervical polyp is most common compared to an ectocervix polyp)
Cervical polyp
benign growth of the cervix; endocervix - more common; beefy red in color; ectocervix polpys are pale in appearance
Endometrial Hyperplasia risk of progression to cancer
Simple w/o atypia 1%
Complex w/o atypia 3%
Simple w/ atypia 9%
Complex w/ atypia 27%
Endometrial hyperplasia on US
endometrial lining > 4 mm in a post-menopausal female
Adenexa definition
includes the ovaries, fallopian tubes, upper portion of the broad ligament, and mesosalpinx
The 4 types of functional ovarian cysts
- Follicular - lined by granulosa cells; can get large enough to cause pain
- Corpus Luteum - if corpus luteum fails to regress
- Hemorrhagic - more likely to cause symptoms; hemorrhage of corpus luteum cysts after ovulation
- Polycystic ovaries - multiple simple follicles
Epithelial ovarian tumors are derived from what?
mesothelial cells lining the peritoneal cavity and the lining from the surface of the ovary
Mucinous ovarian tumors cytologically resemble what?
the endocervical epithelium (columnar)
Endometrioid ovarian tumors cytologically resemble what?
the endometrium
Serous ovarian tumors cytologically resemble what?
the lining of the fallopian tubes
What is the most common epithelial ovarian tumor?
Serous cystadenoma (75%); histology will show psammoma bodies
Mucinous cystadenoma
can be HUGE, filling entire pelvis and abdomen - “jelly belly”; second most common epithelial ovarian tumor; typically multiloculated
Granulosa-Theca cells ovarian tumors
produce estrogenic components; promote feminizing symptoms - precocious menarche and thelarche
Sertoli-Leydig ovarian tumors
produce androgenic components; promote virilizing effects - hirsutism, temporal baldness, deepening of the voice, clitoromegaly
Most common benign solid ovarian tumor
Fibroma; does NOT secrete sex steroids; Meigs syndrome - ascites and right pleural effusion (hydrothorax)
Benign cystic teratome
most common ovarian neoplasm found in all ages; dermoid cyst; bilateral; all three germ layers; can rupture and lead to chemical peritonitis
Management of ovarian neoplasms in epithelial
in young nulliparous women - cystectomy for ovarian preservation
in older women - hysterectomy w bilateral salpingo-oophorectomy
Hydrosalpinx
fluid-filled tubes from previous infection
Pyosalpinx
purulent-filled tubes from active infection
Two types of ovarian torsion
adnexal torsion - ovary and fallopian tubes both twist
isolated torsion - just the fallopian tube twist (rare)
**gynecologic emergency
What is considered a gynecologic emergency?
ovarian torsion; increased risk if ovarian mass >5 cm
Ovarian torsion
gynecologic emergency; acute onset of unilateral pain, n/v, US is first line imaging; treatment is ovarian cystectomy
