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6. REPRODUCTIVE > 3. Masses and Tumors of the Uterus and Vagene > Flashcards

3. Masses and Tumors of the Uterus and Vagene Flashcards

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1
Q

most common uterine mass.

A

Fibroids (Uterine Leiomyoma)

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2
Q

Fibroids (Uterine Leiomyoma) prefers:

A

estrogen + reproductive age (rare in prepubertal)

= Grows rapidly during pregnancy - Involute with menopause

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3
Q

Uterine fibroid locations

A

Submucosal (lease common)
Intramural (MOST common)
Subserosal

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4
Q

Most common Uterine fibroid type

A

Hyaline (Classic)

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5
Q

Uterine Fibroid

Dark T1/T2 + Homogeneous enhancment

A

Hyaline Fibroid

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6
Q

Uterine Fibroid

Dark T1
Bright T2
T1+C: Homogeneous Enhancement

A

Hypercellular fibroid

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7
Q

Uterine Fibroid

Bright T1/T2
May be RIm enhancement

A

Lipoleiomyoma

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8
Q

Uterine Fibroid
Densely packed smooth muscle (without much
connective tissue). Respond well to embolization

A

Hypercellular

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9
Q

Rare fat containing subtype (maybe the result of degeneration).

A

Lipoleiomyoma

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10
Q

4 types of Fibrdoid Degeneration

A

Hyaline (Classic) Degeneration
Red (Carneus) Degeneration
Myxoid Degeneration
Cystic Degeneration

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11
Q

Dark T1/T2
No enhancement

A

Hyaline

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12
Q

Fibroid Degeneration

Most common type.
The fibroid outgrows its blood supply, and you end up getting the accumulation of proteinaceous tissue.

A

Hyaline (Classic) Degeneration

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13
Q

Fibroid Degeneration

Pregnancy
by venous thrombosis.

peripheral rim of T1 high signal.

A

Red (Carneus)

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14
Q

Fibroid Degeneration

Uncommon
Dark T1
Bright T2

A
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15
Q

The risk of malignant transformation to a leiomyosarcoma is super low (0.1%). These look like a fibroid, but rapidly enlarge. Areas of necrosis are often seen.

A

uterine Leiomyosarcoma

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16
Q

This is endometrial tissue that has migrated into the
myometrium.

A

Adenomyosis

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17
Q

Adenomyosis is common in what female population?

A

Multipara + reproductive age + Hx of uterine procedures (CS/D&C)

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18
Q
A

Adenomyosis

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19
Q
A

Adenomyosis

Focal or diffuse thickening of the junctional zone of the uterus to more than 12 mm (normal is < 5 mm)

small high T2 signal regions corresponding to regions of cystic change

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20
Q

Adenomyosis favors this location

A

Posterior wall
Spares the cervix

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21
Q

marked enlargement of the uterus, with preservation of the overall contour.

A

Adenomyosis

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22
Q

Uterine anatomy in T2

A
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23
Q

When is it normal to NOT see the 3 zone pattern of the Uterus on MRI?

A

A. Younglings - Premenarchal
B. Old - Postmenopausal
C. During pregnancy
D. After pregnancy

Young Old Pregnant Postpartum

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24
Q
A
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25
26
27
28
Normal Trilaminar Appearance
Thin Bright Center Dark Middle SoundingEchogenic LAyer ~ 4 - 12 mm
29
Common causes of Abnormal uterine bleeding
Submucosal fibroid Polyps Atrophy Ca
30
Causes of AUB you have to worry in elderly =
Atrophy Cancer
31
Focal or generalized thickening in post menopausal women greater than 5mm should get sampled if its > __ mm.
More than 5 mm
32
Premenaupausal endometrium can get very thick and can be normal
upt to 20 mm
33
Postmenopausal bleeding + < 5mm endometrium =
Probably Atrophy
34
Postmenopausal bleeding + > 5mm endometroium =
Hypertrophy vs Cancers GET BIOPSY!
35
What Ovarian tumor can thicken the endometrium?
Estrogen secreting tumors - Granulosa Cell tumors
36
What Colon CA increases the risk of endometrial CA? by how much?
Hereditary Non-Polyposis Colon Cancer (HNPCC) - 30-50x
37
Basically all uterine cancers are _______, EXCEPT _____
Adenocarcinoma (90%) Except leiomyosarcoma (looks like a giant fucking fibroid
38
STEPS First Step Postmenopausal Bleeder = Too Thick (>4-5mm) = The extent of local disease = Distal mets =
First Step Postmenopausal Bleeder = Ultrasound Too Thick (>4-5mm) = Biopsy Extent of local disease = MRI Distal mets = PET CT
39
There are 3 basic sequences you need to know in Endometrial Cancer Evaluation in MRI
1. Diffusion 2. T2 3. Post Contrast T1
40
Key MRI Findings for Endometrial Cancer
1. Myometrial invation 2. Cervical Stromal invation
41
What is the diffusion sequence in Endometral CA good for?
Tumor restriction (shown on ADC) "Drop Mets" into the vagina Lymph nodes
42
Endometrial CA on T2 tend to give what signal?
Intermediate (Brighter than dark junctional zone)
43
The Myometrium on post contrast MRI should enhance homogeneously. Endometrial CA enhancement =
Tumor enhancement < adjacent myometrium
44
Endometrial CA Intermediate T2 Mildly enhancing on T1+C compared to myometrium
45
Normal T2 Cervix vs Abnormal T2 Ca invading the Cervix
46
Who Gets Nodal Mets ?
Deeper and Bigger Superficial tumor = 5% risk Deep myometrial Invation = ~45%
47
Cervical Invasion risk Tumor < 2cm = % Tumor > 4 cm = %
< 2cm = 5% > 4cm = 35%
48
Best study for nodal metastasis?
PET CT
49
The single most important morphologic prognostic factor in endometrial Ca?
"Extension of the tumor into the myometrium"
50
Stage 2 disease is defined as =
Cervical Stroma invasion
51
Diagnostic key in endometrail Ca detection?
Post contrast imaging (2-3 mins post injection - cervix does not enhance quickly, outer/inner fibrous stroma - gradual enhancement) Normal cervical stromal enhancement? = you have excluded cervical invasion
52
: This is a SERM (acts like estrogen in the pelvis, blocks the estrogen effects on the breast). It’s used for breast cancer, but marginally increases the risk of endometrial cancer (1% per year).
Tamoxifen
53
Tamoxifen will cause:
Subendometrial cysts Endometrial polyps
54
Normally, post menopausal endometrial tissue shouldn’t be thicker than 4mm, but on Tamoxifen the endometrium is often thick - about
12mm at 5 years
55
tamoxifen + thickened endometrium =
If post menopausal + bleeding = biopsy IF asymptomatic = No routine screening
56
Endometrial polyps
57
How do you assess endometrial Polyps?
Saline infused into the uterus (sonohysterography)
58
When should you perform sonohysterography?
Early prolipherative phase (4-6) when the endometrium is at its thinnest
59
Cevical Ca is usually
Squamous Cell related to HPV
60
Cervcial Ca Stage: Parametrial Invasion
Stage II
61
Cervical Ca treated with surgery
Stage IIa or below
62
When do you do chemo/radiation on Cercvical Cancer?
Parametrial Invasion (Stage IIb) or Involvement of the lower 1/3 of the vagina
63
What is this parametrium ?
a fibrous band that separates the supravaginal cervix from the bladder. It extends between the layers of the broad ligament.
64
why is the parametrium important?
The UTERINE artery runs inside the parametrium, hence the need for chemo - once invaded.
65
How do you tell if tha parametrium is invaded on MRI?
Normally the cervix has a T2 dark ring. That thing should be intact. If the tumor goes through that thing, you gotta call it invaded.
66
endometrial fluid + premenopausal =
common finding
67
endometrial fluid + menopausal =
Cervical stenosis or obstructing mass usually cervical stenosis
68
The most common cancer of the vagina (85%).
Squamous Cell Carcinoma Associated with HPV. Just like the cervix
69
This is the zebra cancer seen in women whose mothers took DES (a synthetic estrogen thought to prevent miscarriage).
Clear Cell Adenocarcinoma
70
Most common Vaginal tumor + children
Vaginal Rhabdomyosarcoma Ages (2-6, and 14-18)
71
When you see a solid T2 bright enhancing mass in the vaginal/lower uterus of a child =
Vaginal Rhabdomyosarcoma
72
A met to the vagina in the anterior wall upper 1/3 is “always” (90%)
Upper Genital tract
73
Amettothevaginaintheposteriorwalllower1/3is “always”(90%)
GI tract
74
These are usually on the cervix and you see them all the time. They are the result of inflammation causing epithelium plugging of mucous glands.
Nabothian Cyst
75
These are the result of incomplete regression of the Wolffian ducts along the anterior lateral wall of the vagina. Can cause mass effect on the urethra
Gartner Ducts Cysts
76
The cystic vaginal/cervical masses:
77
Cysts in these periurethral glands, can cause recurrent UTIs and urethral obstruction.
Bartholin Cysts

6. REPRODUCTIVE (17 decks)

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