Benign Conditions of the Uterus, Cervix, Ovary, and Fallopian Tubes Flashcards
(64 cards)
the absence of a Y chromosome and absence of the mullerian inhibiting substance leads to the development of what?
the paramesonephric system with the regression of the mesonephric system
when do the paramesonephric ducts arise?
at 6 weeks gestational and by 9 weeks they fuse in midline to form the uterovaginal primordium
Failure of the paramesonephric duct to fuse can lead to:
1.
2.
3.
- uterus didelphysis: 2 separate uterine bodies with its own cervix, attached fallopian tube, and vagina
- Bicornuate uterus with a rudimentary horn
- bicornuate uterus with or without double cervices
Incomplete dissolution of the midline fusion of the paramesonephric ducts leads to:
septate uterus
failure of formation of mullerian ducts can lead to:
unicornate uterus
what is the most common congenital cervical anomalies the result of?
malfusion of the paramesonephric ducts with varying degrees of separation
- didelyphs cervix
- septate cervix
If not spontaneous, what could cause uterine and cervical anomalies?
early maternal exposure to drugs: DES
which can cause small T-shaped endometrial cavity or cervical collar deformity
What are uterine leiomyomas “fibroids”?
benign tumors derived from localized proliferation of smooth muscle cells of the myometrium
what is the most common neoplasm of the uterus?
uterine leiomyomas “fibroids”
what can symptomatic fibroids cause?
excessive uterine bleeding, pelvic pressure, pelvic pain and infertility
what is the most common indication for hysterectomy?
symptomatic fibroids
What are the risk factors for developing fibroids?
increasing age during reproductive years
african american women have a 2-3 fold increase risk
nulliparity
family history
what is the pathogenesis of fibroids?
factors that initiate leiomyomas are unknown
rarely form before menarche or enlarge after menopause: estrogen stimulates the proliferation of smooth muscle cells
what are the characteristics of fibroids?
usually spherical, well circumscribed, white firm lesions with a whorled appearance on cut sections
may degenerate and cause pain
-during pregnancy 5-10% of women with fibroids undergo a painful red or carneous degeneration caused by bleeding into the tumor
may calcify especially in postmenopausal patients
what are the different locations of fibroids?
- *subserosal**
- fibroid beneath the uterine serosal surface
- *intramural**
- fibroid arises within the myometrium ***most common
- *submucosal**
- fibroid beneath the endometrium
- prolonged or heavy menstrual bleeding is common
- *cervical intraligamentous**
-arise between the broad ligaments
women with leiomyoma symptoms may complain of what?
pelvic or lower back pain
pelvic pressure or fullness
severe pain is not common
frequency of urination if fibroid is pressing on bladder
prolonged or heavy bleeding (***most common presenting symptom and mainly associated with submucosal or intramural fibroids which distort the endometrium
increased incidence of infertility (more common with submucosal fibroids)
what are the signs of leiomyomas?
on bimanual examination: can reveal an enlarged, irregularly shaped uterus
if palpated mass moves with the cervix it is suggestive of a fibroid uterus
the degree of enlargement is described in “week size” used to estimate equivalent gestational size
Ultrasound: is often performed and can help distinguish between adnexal masses and lateral leiomyomas
how do you treat leiomyomas? medically
- Combination (estrogen + progesterone): oral contraceptive pills, rings; this is usually first therapeutic option
- progesterone-only therapies: Depo-provera, mirena intrauterine system
- Gonadotropin releasing hormones (GnRH agonist): Depo-Lupron
How do you treat leiomyomas surgically?
myomectomy, endometrial ablation, uterine artery embolization, and hysterectomy (the definitive therapy)
What is important to note about myomectomy?
if endometrial cavity is entered, then future deliveries must be by c-section
often the fibroids will grow back
what are endometrial polyps?
they form from the endometrium to create soft friable protrusion into the endometrial cavity
can cause menorrhagia, spontaneous, or post menopausal bleeding
what might US reveal in a patient with endometrial polyps?
focal thickening of the endometrial stripe
why is it important to remove endometrial polyps with hysteroscopy?
because endometrial hyperplasia and carcinoma may also present as polyps
what are nabothian cervical cysts?
appear opaque with a yellowish or bluish hue
vary in size 3mm to 3 cm
results from squamous metaplasia in which a layer of superficial squamous epithelial cells entrap a layer of columnar cells beneath it’s surface
columnar cells continue to secrete mucus and a mucus retention cyst is formed
