Benign Conditions of the Uterus, Cervix, Ovary & Fallopian Tubes Flashcards
(53 cards)
What comes from the paramesonephric (Mullerian) ducts?
Absence of which “inhibiting substance” leads to the development of the paramesonephric system with regression of mesonephric system?
Upper vagina, cervix, uterus and fallopian tubes.
Absence of the Mullerian inhibiting substance and absence of Y chromosome.
What causes uterus didelphysis? What is it?
Failure of the paramesonephric duct to fuse. It results in 2 separate uterine bodies with its own cervix, fallopian tubes and vagina.
What causes a septate uterus?
Incomplete dissolution of the midline fusion of the paramesonephric ducts.
What causes unicornate uterus?
Failure of formation of the Mullerian ducts
What is Mullerian agenesis AKA?
What is it?
Meyer-Rokitansky-Kuster-Hauser syndrome
The complete lack of development of the paramesonephric system - absence of uterus and most of vagina.
The most common congenital cervical anomalies are the result of what?
Malfusion of the paramesonephric ducts with varying degrees of separation.
- didelphys cervix
- septate cervix
Most of the time, how do uterine and cervical anomalies occur?
What drug is implicated in some anomalies?
They occur spontaneously.
Early maternal exposure to DES: small T-shaped endometrial cavity, cervical collar deformity
Most common neoplasm of the uterus:
What age is most common?
What is the most common presentation?
It is the most common indication for what procedure?
What happens to them during pregnancy? What might happen in post-menopausal women?
What are some risk factors?
Fibroids: benign tumors from localized SM cells of the myometrium.
> 70% of women have them by 5th decade. Rarely form before menarch or enlarge after menopause.
Most are asymptomatic. Symptomatic fibroids can cause bleeding, pelvic pain and infertility.
Hysterectomy
40% will enlarge in pregnancy. May calcify in post-menopausal women.
Increasing age during reproductive years, AA 2-3x risk, nulliparity, FH
Subserosal fibroids
Intramural fibroids
Submucosal fibroids
Subserosal fibroids: fibroid beneath the uterine serosal surface. May rarely attach to blood supply of the omentum or bowel mesentery and lose uterine connection to become parasitic.
Intramural fibroids: fibroid arises in the myometrium. **Most common.
Submucosal fibroids: fibroid beneath the endometrium. Can become pedunculated and protrude through the cervical os. Prolonged or heavy menses is common.
What are signs of Leiomyoma on bimanual exam?
How is US helpful?
Bimanual exam: can reveal enlarged, irregularly shaped uterus. If the palpated mass moves with the cervix, it is suggestive of fibroid uterus. Degree of enlargement is described in “week size” to estimate equivalent gestational size.
US: it may help distinguish between adnexal masses and lateral leiomyomas.
What is the medical treatment options for Leiomyomas? (3)
Combination therapy (estrogen + progesterone)
- oral contraceptive pills, rings
- usually first option used**
Progesterone-only
-Depo-provera, Mirena intrauterine system
Gonadotropin releasing hormones (GnRH agonists)
- Depo-Lupron
- used as a surgical alternative
What is the definitive surgical treatment of fibroids?
What are 3 other surgical options?
Hysterectomy
Myomectomy: submucosal fibroids. Can be done laparoscopically or robotically.
Endometrial ablation: may cause decreased menstrual flow.
Uterine artery embolization: causes fibroid necrosis and 40-60% shrinkage.
What are some complications of myomectomy? (3)
If the endometrial cavity is entered, future deliveries must be via C-section.
Oftentimes the fibroids will grow back - 25% of patients will need subsequent operations.
If there is inadequate uterine tissue remaining post-myomectomy, a hysterectomy may be indicated.
What is an endometrial polyp?
What are symptoms?
What might be revealed on US? What are better diagnositics? (2)
Are the usually benign or malignant? What is the treatment generally?
Polyps in the endometrium that are soft, friable and protrude into the endometrial cavity.
Menorrhagia, spontaneous or post-menopausal bleeding.
US may reveal focal thickening of the endometrial stripe.
-Saline hysterosonography and hysterography are better.
Most are benign; however, they need to be removed via hysteroscopy since endometrial hyperplasia and carcinoma may also present as polyps.
What is a nabothian cyst?
What do they look like?
What causes it?
A normal finding on the cervix.
Opaque with yellowish or bluish hue. Approx. 3 mm to 3 cm.
Squamous metaplasia in which a layer of superficial squamous epithelial cells entrap a layer of columnar cells beneath, which continue to produce mucus, leading to a cyst.
Where do cervical polyps occur? What are features of each?
Endocervical polyps
- more common
- beefy red in color
- arise in endocervical canal
Ectocervical polyps
- less common
- pale in appearance
What are the symptoms of cervical polyps (endo- and ecto-)?
What is the treatment?
None (common), coital bleeding or menorrhagia.
Removed in office - rarely malignant (<1/1000 will become sarcomas).
What is the major cause of endometrial hyperplasia?
Which underlying processes are associated? (4)
What is it a precursor to?
Persistent unopposed estrogen.
PCOS and anovulatory cycle
Granulosa tumors - estrogen producing tumors
Obesity (peripheral conversion)
Tamoxifen
Precursor to endometrial cancer.
What are the 4 WHO classifications of endometrial hyperplasia? Which is most likely to progress to cancer?
Simple hyperplasia w/o atypia
Complex hyperplasia w/o atypia
Simple hyperplasia w/ atypia
Complex hyperplasia w/ atypia - 27% progress to cancer
What are the symptoms of endometrial hyperplasia?
What is needed to diagnose?
What is the treatment if there is atypia vs. if there is no atypia?
intermenstrual, heavy or prolonged bleeding that is otherwise unexplained.
Endometrial sample. US revelaing >4 mm in post-menopausal women.
Simple and complex with atypia - hysterectomy
Simple and complex w/o atypia - progestin and resample in 3 mo.
What are the 2 congenital abnormalities of the ovaries?
Turner syndrome - 45XO
Complete androgen insensitivity syndrome/testicular feminization (46XY) - lack of androgen receptors, phenotypically female but have functioning testes and need to be removed after puberty due to malignant transformation
What is the classification of a theca-lutein cyst?
What is the size of them and laterality?
They may develop in patients with: (3)
When do they go away?
Functional ovarian cyst
Large (>30 cm) and BL
Patients with high hCG
- pregnancy
- choriocarcinoma or molar pregnancy
- patients undergoing ovulation induction (gonadotropins or clomid)
Regress when gonadotropins (hCG) fall
What is the classification of a luteoma of pregnancy?
What causes it?
What is the appearance?
What is the treatment?
Functional ovarian cyst
Hyperplastic reaction of the ovarian theca cells (secondary to prolonged hCG stimulation during pregnancy)
Reddish-brown nodules
They will regress after delivery - no surgery needed
What is the classification of polycystic ovarian cyst?
What causes it?
What is the classic feature?
What hormones are elevated? (3)
What hormone is low?
Functional ovarian cyst
Chronic anovulation, hyperandrogenism and insulin resistance
Enlarged ovaries - multiple small follicles that are inactive and arrested in mid antral stage
LH, androgens (androstenedione and testosterone), estrogen
Low FSH
