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Flashcards in Benign Tumour Deck (37):
1

What are fibroids also known as?

*Uterine leiomyomas

2

What are fibroids?

Benign tumours of the smooth muscle cells of the myometrium

3

What is the cause of fibroids?

*Oestrogen and progesterone dependent

4

What makes it more likely of having fibroids? Less likely?

More likely:
*increasing age during reproductive years
*Black/asian ethnicity
*Obesity
*Those who had early menarche <11
i.e. factors that increase lifetime exposure to oestrogen and progesterone

Less likely:
*parous women
*COCP or Depo takers

5

How common are fibroids?

By age 50 70% white women and 80% of black women have had at least one fibroid

6

What can fibroids be like? Size Placement?

*single or multiple
*few mm to massive tumours
*Intramural, subserosal or submucosal
*majority are intramural

7

Where do intramural fibroids grow?

Within the myometrium

8

Where do subserous fibroids grow?

Grow from the outside wall of the uterus into the pelvis

9

Where do submucous fibroids grow?

Grow from the inner wall into the cavity of the uterus

10

What are the symptoms of firbroids?

*50% are asymptomatic
*present aged 30-50years old
*prolonged periods
*menorrhagia (30%) = iron deficiency anaemia
*erratic bleeding
*Dysmenorrhoea
*bloating

Pelvic Pressure:
>pelvic pain
>constipation
>urinary symptoms -frequency, retention, hydronephrosis
>Infertility -due to pressing on tubal ostia

11

What signs may be present on examination of someone with fibroids?

*solid mass palpable on pelvic or even abdo examination
*knobbly enlargement of the uterus

12

What investigations should be done to confirm fibroids?

*Pregnancy test
*FBC
*TVUSS
*MRI if USS not definitive

13

What is the cause of fibroid degeneration? What can this result in?

*Normally the result of inadequate blood supply
*'red degeneration' characterised by pain and uterine tenderness

14

When is treatment of fibroids appropriate?

*Only if symptomatic and patient wants treatment

15

What is the pharmological management of fibroids?

*Pharmacological
>Tranexamic Acid 3-4 times a day for the duration of each period
>NSAIDs during periods =reduce pain and high levels of prostaglandin in lining of womb
>COCP or LNG-IUS or progesterone only tablets/depo
>GnRH agonists to reduce size

16

When is surgical management of fibroids indicated? What is the surgical management of fibroids?

*indicated when enlarged uterus, pressure symptoms present, and pharmacological management doesn't work
>Myomectomy =in patients who wish to maintain reproductivity
>Hysteroscopic endometrial ablation =women presenting with menorrhagia
>Total hysterectomy =use to be the mainstay of treatment for many years
>Uterine artery embolisation

17

What happens to fibroids with menopause?

*They typically regress as they are oestrogen dependent
*symptoms resolves with regression

18

What are the types of ovarian cyst?

*Physiological
*Benign germ cell tumour
*Benign epithelial tumour
*Benign sex cord stromal tumour

19

What are physiological (functional) follicular cysts? How common?

*Commonest type of ovarian cyst
*Due to non-rupture of the dominant follicle or failure of atresia in a non-dominant follicle

20

What happens to a follicular cyst?

*commonly regress after several menstrual cycles

21

What is a corpus luteum cyst?

*Also a phsyiological cyst
*if pregnancy doesn't occur the corpus luteum usually breaks down
*if the corpus luteum doesn't break down it may fill with blood or fluid forming a cyst

22

What is a corpus luteum cyst more likely to present with than a follicular cyst?

*intraperitoneal bleeding

23

What is a dermoid ovarian cyst?

*also called a cystic teratoma
*Usually lined with epithelial tissue and hence may contain skin appendages, hair and teeth
*It is a benign germ cell tumour

24

How does a dermoid ovarian cyst usually present? Increased risk of?

*usually asymptomatic
*median age 30years old
*Torsion is more likely

25

What types of benign epithelial ovarian tumours are there?

Arise from ovarian surface epithelium:
>Serous cystadenoma
>Mucinous cystadenoma

26

How does mucinous cystadenoma ovarian cysts present?

*Typically large and may become massive
*if it ruptures, may become pseudomyxoma peritonei

27

What is the usual presentation of of ovarian cysts?

*asymptomatic
*dull ache in lower abdomen
*Dyspareunia
*pressure effects -urinary frequency
(If torsion or rupture =severe pain and fever)

28

What investigations should be done if an ovarian cyst is suspected?

*pregnancy test
*FBC (Infection/haemorrage)
*Urinalysis
*Pelvic USS -TVUS
*Can do CT/MRI
*Fine needle aspiration + cytology may be used to confirm benign

29

What is the management of ovarian cysts?

*simple cysts usually do not require any treatment
*depending on size
*watchful waiting for 2-3months
*cysts with 50-70mm should have yearly USS
*Persistent simple cysts larger than 5-10cm should be considered for surgical removal

30

What are the complications of an ovarian cyst?

*Torsion
*Haemorrhage
*Rupture of an ovarian cyst
*Infertility (however surgical intervention may increase this risk)

31

What is an intrauterine polyp? Common in who?

Small, benign tumours that grow into the uterin cavity
*most are endometrial in origin but some form from submucous fibroids
*common in 40-50year olds when oestrogen levels are high

32

When are intra-uterine polyps found in post-menopausal woman?

Patient on tamoxifen for breast carcinoma

33

What are the presenting features of intrauterine polyps?

*asymptomatic
*menorrhagia
*intermenstrual bleeding
*very occasionally prolapse through the cervix

34

What is Adenomyosis?

Presence of endometrium and underlying stroma within the myometrium

35

What are the clinical presentation of adenomyosis?

*Asymptomatic
*Painful, regular heavy menstruation
*Examination:
>Uterus mildly enlarged and tender

36

Treatment of adenomyosis?

*progesterone IUS
*COCP with or without NSAIDs
*Trial of GnRH analogue therapy then hysterectomy

37

What is endometritis? Why does it happend?

*inflammation of the endometrium
*Occurs secondary to STI, complication of surgery (C-section) and intrauterine procedures (surgical termination or become of foreigh tissue (IUDs and retained products of conception)