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Repro II > Benign conditions of the uterus, cervix, ovarian tube, and fallopian tube > Flashcards

Benign conditions of the uterus, cervix, ovarian tube, and fallopian tube Flashcards

1
Q

Failure of the paramesonephric duct to fuse

A

Uterus didelphysis - 2 separate uterine bodies with its own cervix, attached fallopian tube & vagina

Bicornuate uterus w/ a rudimentary horn

Bicornuate uterus with or without double cervices

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2
Q

Incomplete dissolution of the midline fusion of the paramesonephric ducts leads to:

A

Incomplete dissolution of the midline fusion of the paramesonephric ducts leads to:

Septate uterus

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3
Q

Failure of formation of mullerian ducts can be lead to

A

Failure of formation of mullerian ducts can be lead to a unicornate uterus

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4
Q

Absence of the uterus and most of the vagina

A

Mullerian agenesis (Meyer-Rokitansky-Kuster-Hauser syndrome)

The complete lack of development of the paramesonephric system:

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5
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A
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6
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7
Q

the most common congenital cervical anomalies are

A

he most common congenital cervical anomalies are the result of malfusion of the paramesonephric ducts with varying degrees of separation

 Didelphys cervix

 Septate cervix

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8
Q

Small T-shaped endometrial cavity

A

Diethylstilbestrol(DES): Small T-shaped endometrial cavity

Cervical collar deformity

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9
Q

FIBROIDS: what are they, when do they appear, how many women get them, ethnic prepoderance, threat of malignancy

A
  1. Benign tumors derived from localized proliferation of smooth muscle cells of the myometrium
    1. Most common neoplasm of the uterus
    2. >70% of women will have leiomyomas by fifth decade
    3. Rarely malignant (sarcomatous change occurs in < 1 per 1000)
    4. African American women have a 2-3 fold increase risk
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10
Q

FIBROIDS: Symptomas, worst case scenario, RISK FACTORS for developing fibroids

A

MOST ARE ASYMPTOMATIC: Symptomatic fibroids can cause:

excessive uterine bleeding, pelvic pressure, pelvic pain & infertility (Most common indication for hysterectomy)

RISK FACTORS for developing fibroids

Increasing age during reproductive years

African American women have a 2-3 fold increase risk

Nulliparity

Family history

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11
Q

what causes fibrinoids? when are they likely to enlarge? how do they subsequently behave?

A

Factors that initiate leiomyomas are unknown but rarely form before menarche or enlarge after menopause, and estrogen stimulates the proliferation of smooth mm cells

40% of fibroids enlarge during pregnancy 

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

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12
Q

where do fibrinoids occur?

A

SUBSEROSAL Fibroid beneath the uterine serosal surface; Can rarely attach to the blood supply of the omentum or bowel mesentery & lose uterine connection thus becoming a parasitic fibroid

INTRAMURAL Fibroid arises within the myometrium, most common

SUBMUCOSAL Fibroid beneath the endometrium, Can be pedunculated and come through the cervical os • Prolonged or heavy menstrual bleeding is common

CERVICAL

INTRALIGAMENTOUS fibrinoids arise between the broad ligaments

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13
Q
  1. ratio of fibrinoids that are symptomatic to those that arent
  2. symptoms
  3. potential emergencies
  4. most common symptoms: what the most common locations
A
  1. 80% of fibrinoids are asymptomatic
  2. increased pelvic fullness/pressure
  3. pelvic/back pain
  4. pelvic pain is uncommon
  5. increased urinary frequency
  6. if it undergoes torsion it will cause pain an acute infarction “red infarction”
  7. prolonged bleeding/heavy bleeding: most commonly due to intramural or subserosal distortions
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14
Q

conception and fibrinoids

A

increased incidence of infertility associated with them, most in the subserosal location

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15
Q

LEIOMYOMA SIGNS

A

Bimanual examination LEIOMYOMA SIGNS

  1. Can reveal an enlarged, irregularly shaped uterus
  2. If palpated mass moves with the cervix, it is suggestive of a fibroid uterus
  3. The degree of enlargement is described in (“week size”) used to estimate equivalent gestational size

ULTRASOUND

  1. Is often performed & can help distinguish between adnexal masses and lateral leiomyomas
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16
Q

DIFFERENTIAL DIAGNOSIS for fibrinoid neoplasm

A

DIFFERENTIAL DIAGNOSIS:

Ovarian neoplasms

Tubo-ovarian inflammatory mass

Pelvic kidney

Bowel mass

Colon cancer

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17
Q

medical treatment for leiomyoma (three)

A
  1. Combination (Estrogen + Progesterone): Oral contraceptive pills, rings, usually first therapeutic option
  2. Progesterone- only therapies: Depo-Provera, Mirena Intrauterine system
  3. Gonadotropin releasing hormones (GnRH agonist)
    1. Depo-Lupron
      1. Can decrease fibroid size up to 40% in 3 months
      2. Usually used to alter route of surgery
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18
Q

procedures to remove the leiomyoma

A

SURGICAL

Hysterectomy: Is the definitive therapy

Hysteroscopic myomectomy (submucosal fibroids)

L_aparoscopic or robotic myomectomy_ (pedunculated, subserosal & some intramural fibroids)

Endometrial ablation: 70% of women have decrease in menstrual flow

Uterine artery embolization: Procedure where microspheres/ polyvinyl alcohol particles are introduced into the uterine artery & occlude the artery feeding the fibroid–> Leads to necrosis of the fibroid.–>Fibroids often shrink 40-60%

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19
Q

myomectomy and future delivery

A

if pt opts for myomectomy, future delivery will have to be via casaerian section. 25% of fibrinoids will grow back, at which point hysterectomy will be warrented.

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20
Q

Nabothian cyst

A

nabothrian cervical cyst: occurs when squamous metaplasia occurs over columnar cells, which continue to secrete mucous despite being entrapped by squamous proliferation—–> results in an inclusion cyst

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21
Q

most common benign growths on the cervix: symptoms, incidence, appearance

A
  1. cerivcal polyps
  2. symptoms: none, bleeding, menorrhagia
  3. incidence < 1/1000
  4. endocervical polyps: beefy red, more common
  5. ectocervical polyps: pale, less common
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22
Q

endometrial hyperplasia: what it is, why it is important, and what the RFs for it

A
  1. overproliferation of endometrium caused by constant, unopposed estrogen.
  2. precursor to endometrial cancer
  3. RFs:
  4. tomoxifen
  5. PCOS
  6. anovulation
  7. obesity (adipocyte conversion of estrogen from androgens)
  8. exogenous estrogen
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23
Q

endometrial hyerplasia classification (WHO)

A
  1. simple hyperplasia without atypia: 1%
  2. complex hyperplasia without atypia: 3%
  3. simple hyperplasia with atypia: 9%
  4. complex hyperplasia with atypia: 27%
24
Q

heavy or prolonged bleeding that is unexplained and in-between menstrual cycles. how would you diagnose this and treat it?

A

endometrial hyperplasia

diagnose with in office endomyocardial biopsy. can use US to establish endometrium that is = or > 4 mm

complex/simple hyperplasia WITHOUT atypia: treat with progestin and re-check 3 months

complex/simple hyperplasia WITH atypia: best treated with hysterectomy

25
Q

streak ovaries

A

turner sydrome

26
Q

Complete Androgen Insensitivity Syndrome/Testicular feminization (46XY)

A

Complete Androgen Insensitivity Syndrome/Testicular feminization (46XY)

 Lack androgen receptors

 Phenotypically female

 Gonads (functioning testes) need to remove after puberty because of malignant potential

27
Q

FALLOPIAN TUBE congenital anomalies

A

FALLOPIAN TUBES: Anomalies are rare

DES (diethylstilbestrol) may lead to shortened, distorted or clubbed tubes

28
Q

Benign conditions of the ovaries

A

Functional cysts/Benign neoplastic cysts

Functional cysts:

  • Follicular
  • luetein
  • hemorrhagic
  • polycystic ovaries

benign neoplastic cyst:

  • EPITHELIAL
    • Serous cystadenoma
    • Mucinous cystadenoma
  • SEX-CORD STROMAL
    • Fibromas
    • Granulosa-theca cell
    • Sertoli-Leydig
  • GERM CELL
    • Mature cystic teratoma /Dermoid
29
Q

SEX-CORD STROMA

A

Benign neoplastic cysts: SEX-CORD STROMAL

  1. Fibromas
  2. Granulosa-theca cell
  3. Sertoli-Leydig
30
Q

EPITHELIAL

A

Benign neoplastic cyst: EPITHELIAL

  1. Serous cystadenoma
  2. Mucinous cystadenoma
31
Q

GERM CELL

A

Benign neoplastic cyst: GERM CELL

  1. Mature cystic teratoma /Dermoid
32
Q

Functional cysts

A

Functional cyst: Follicular, Lutein cyst, Hemorrhagic cyst , Polycystic ovaries

33
Q

Follicular cysts

A
  1. Follicular Cysts:
    1. lined by one or more layers of granulosa cells
    2. develops when an ovarian follicle fails to rupture
    3. Is clinically significant if it gets large enough to cause pain
34
Q

Corpus Luteum Cysts

A

Corpus Luteum Cysts

may develop if the corpus luteum becomes cystic, larger than 3 cm and fails to regress normally after 14 days

35
Q

Hemorrhagic cysts

A

Hemorrhagic cysts

  1. more likely to cause symptoms
  2. caused by hemorrhage in the corpus luteum cyst 2-3 days after ovulation
36
Q

theca lutein cysts

A

usually bilateral, typically regress when gonadotropins fall

appear typically when female is exposed to high levels of hCG: pregnancy, choriocarcinoma, molar pegnancy, ovulation-induction

37
Q

reddish brown enometrial growths that appear during pregnancy

A

functional enometrial cysts. typically regress post partum, no treatment required. secondary to hCG exposure during pregnancy

38
Q

PCOS

A

LH secretion –> thecal cells stimulated to release androstenedione and testosterone –> peripheral conversion to estrogen –> suppression of FSH –> anovulation

associated with hyperandrogenism, insulin resistance, and anovulation

39
Q

cysts in PCOS

A

multiple small cysts arrested mid-antral stage

40
Q

Clinical features of ovarian follicular cysts, diagnosis and management

A

CLINICAL FEATURES:

  1. Ovarian follicular cysts usually asymptomatic, simple. Generally less then 8cm in size. Usually regress during subsequent cycle. Can become large & undergo torsion

DIAGNOSIS:

  1. Bimanual exam reveals and enlarged, mobile, unilateral cyst, Ultrasound

MANAGEMENT:

  1. If asymptomatic & premenopausal: place on OCP’s (suppress gonadotropin levels and prevent development of other cysts) & repeat u/s
  2. If symptomatic & premenopausal, rule out: Ectopic pregnancy, torsion, tubo ovarian abscess
41
Q

Serious ovarian tumor: numbers, what it resmbles, tx, histo

A

the most common epithelial ovarian tumor (75%); resembles fallopian tube epithelia.

  1. 10% bilateral
  2. 70% benign
  3. 5-10% borderline
  4. 20-25% malignant

Treatment: Surgical (cystectomy vs oophorectomy vs hyst with bilateral oophorectomy), depending on desire to maintain fertility

Histologically: psammoma bodies, more common in malignant serous cystadenocarcinomas

42
Q

ovarian mucinous cystadenoma

A

Can attain a huge size filling the entire pelvis & abdomen

  1. Second most common epithelial tumor at 20%
  2. Bilateral 10%
  3. 85% are benign
  4. 15% malignant

Associated with a mucocele of the appendix

 Rarely can lead to Pseudomyxoma peritonei: Condition in which numerous benign implants are seeded onto the surface of the bowel & other peritoneal surfaces producing large quantities of mucus

43
Q

Brenner tumor

A
  1. Small smooth solid ovarian neoplasm
  2. Usually benign
  3. rarely malignant
  4. Usually benign with large fibrotic component that encases epithelioid cells that resemble transitional cells of the bladder
    1. 33% of cases these tumors are associate with mucinous epithelial elements
44
Q

These tumors derive from the sex cords stroma

A
  1. include: granulosa-theca cell tumors, sertoli leydig cell tumors, fibromas
  2. if the developing tissue is feminine
    1. ​the tumor becomes a granulosa or theca or more commonly granulosa-theca tumor
  3. if it is masculine
    1. ​sertoli-leydig.
45
Q

Granulosa theca cell tumor symptoms, age group, potential for malignancy, signs, etc

A
  1. GRANULOSA-THECA CELL
    1. Can occur in any age group
    2. Produce estrogenic components
    3. Low malignant potential: These cells promote feminizing signs & symptoms
  2. Precocious Menarche and Thelarche
  3. Pre-menarchal uterine bleeding during infancy & childhood
  4. menorrhagia (PAIN)
  5. _endometrial hyperplasia & endometrial cance_r
    1. 5% of these tumors have an associated endometrial cancer breast tenderness, fluid retention, postmenopausal bleeding
46
Q

Sertoli Leydig tumors

A
  1. less frequent than granuloca-theca cell tumors
  2. virilizing; produce androgenic components;
    1. low malignancy potential
    2. hirsutism
    3. clitomegaly
    4. balding
    5. deepening of the voice
47
Q

forms a solid, encapsulated, smooth-surfaced tumor made up of interlacing bundles of fibrocytes

A

Fibroma: forms a solid, encapsulated, smooth-surfaced tumor made up of interlacing bundles of fibrocytes

Most common benign solid ovarian tumor

Unlike other stromal tumors: it does not secrete sex steroids

On occasion, fibromas are associated with ascites secondary to transudation of fluid from the ovarian tissue

Meigs syndrome: ascites + right pleural effusion (hydrothorax) in association with an ovarian fibroma

flow of ascitic fluid through the transdiaphragmatic lymphatics into the right pleural cavity leads to Meigs’ syndrome

48
Q
  1. most common tumor in women of all ages is the ________,
  2. these make up about 60% of ovarian neoplasms in infants & children
  3. these make up roughly 1/2 of all tumors seens in children and adolescents
A
  1. dermatoid cyst (a germ cell tumor)
  2. germ cell tumors
  3. dermatoid cyst
49
Q

Most common ovarian neoplasm found in women of all ages, occurs largely during what period, and the median age is

A

Most common ovarian neoplasm found in women of all ages

the benign cystic teratoma (dermoid cyst): 80% occur during the reproductive years, median age is 30 years old

50
Q

Rokintanksy’s protuberance

A

Characteristic macroscopic appearance of a dermatoid cyst:

 Multicystic mass

 Hair, teeth, mixed into sebaceous thick material

Rokintanksy’s protuberance: solid prominence located at the junction between the teratoma & normal ovarian tissue

 Rupture can lead to chemical peritonitis

51
Q

DIAGNOSIS of benign ovarian tumors

A
  1. Abdominal & Bimanual pelvic exam
  2. Ultrasonography
    1. Look for simple vs. complex nature
    2. US helpful identifying a dermoid cyst: can sometimes see a tooth-like calcification
  3. CA 125 serum marker: especially in post menopausal women
  4. Laparscopy if mass can be removed without rupture
  5. Laparotomy if mass can rupture
  6. Laparoscopy helpful in distinguishing between uterine fibroids, ovarian tumors, & hydrosalpinx
52
Q

Management of benign ovarian tumors

A
  1. all persistant neoplasms should be considered malginant until proven benign
    1. pelvic washings for cytology
    2. frozen section for histo analysis
    3. defintive tx based on age and desire for pregnancies
53
Q

Management of EPITHELIAL benign ovarian tumors

A

Usually managed with unilateral salpingo-oophorectomy

 If mucinous cystadenoma tumor is diagnosed: perform an appendectomy secondary to possible coexistence of an appendiceal mucocele

 In young: nulliparous patients may perform a cystectomy for ovarian preservation

 In older women: total abdominal hysterectomy with bilateral salpingo-oophorectomy is appropriate

54
Q

management of ovarian neoplasms in SEX CORD- STROMAL

A

management of ovarian neoplasms in SEX CORD- STROMAL

STROMAL cell tumors: generally treated by unilateral salpingo-oophorectomy when future pregnancies are a consideration

FIBROMAS: Even with MEIGS syndrome are almost always benign; remove ovary or treat by resection of the ovary in a young woman who desires future fertility.

55
Q

management of ovarian neoplasms in GERM CELL TUMORS

A

management of ovarian neoplasms in GERM CELL TUMORS

 Benign Mature cystic teratomas “Dermoid”

 tx by ovarian cystectomy

 Carefully evaluate other ovary since they are bilateral in approximately 15-20% of cases

 Rare recurrence after surgical resection

 Copiously irrigate pelvis to avoid chemical peritoniti

56
Q

ovarian torsion: definition, what it can cause, types of torsion

A

complete or partial rotation of ovary on its ligamentous supports

often results in impedance of it’s blood supply

Adnexal torsion: when the ovary & fallopian tube both twists

Isolated torsion: just the fallopian tube or fallopian tube cysts

ovarian torsions are one of the most common gynecologic emergencies

Primary risk factor for ovarian torsion is an ovarian mass >5 cm

57
Q

Classic presentation of ovarian torsion

A

Classic presentation:

 Acute onset of unilateral pain

 Nausea & possibly vomiting

Diagnosis:

 Ultrasound is first line imaging study to identify mass

 Definitive diagnosis is made by direct visualization

Detorsion & ovarian conservation with an ovarian cystectomy

Salpingo-oophorectomy is performed if ovary is necrotic or you suspect a malignancy

Repro II (5 decks)

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