Benign Tumour Flashcards Preview

Gynaecology > Benign Tumour > Flashcards

Flashcards in Benign Tumour Deck (37):

What are fibroids also known as?

*Uterine leiomyomas


What are fibroids?

Benign tumours of the smooth muscle cells of the myometrium


What is the cause of fibroids?

*Oestrogen and progesterone dependent


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

More likely:
*increasing age during reproductive years
*Black/asian ethnicity
*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


How common are fibroids?

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


What can fibroids be like? Size Placement?

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


Where do intramural fibroids grow?

Within the myometrium


Where do subserous fibroids grow?

Grow from the outside wall of the uterus into the pelvis


Where do submucous fibroids grow?

Grow from the inner wall into the cavity of the uterus


What are the symptoms of firbroids?

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

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


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


What investigations should be done to confirm fibroids?

*Pregnancy test
*MRI if USS not definitive


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


When is treatment of fibroids appropriate?

*Only if symptomatic and patient wants treatment


What is the pharmological management of fibroids?

>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


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


What happens to fibroids with menopause?

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


What are the types of ovarian cyst?

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


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


What happens to a follicular cyst?

*commonly regress after several menstrual cycles


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


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

*intraperitoneal bleeding


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


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

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


What types of benign epithelial ovarian tumours are there?

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


How does mucinous cystadenoma ovarian cysts present?

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


What is the usual presentation of of ovarian cysts?

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


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

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


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


What are the complications of an ovarian cyst?

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


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


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

Patient on tamoxifen for breast carcinoma


What are the presenting features of intrauterine polyps?

*intermenstrual bleeding
*very occasionally prolapse through the cervix


What is Adenomyosis?

Presence of endometrium and underlying stroma within the myometrium


What are the clinical presentation of adenomyosis?

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


Treatment of adenomyosis?

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


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)