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OBGYN > Benign Uterine Conditions/Ovarian Cancer > Flashcards

Benign Uterine Conditions/Ovarian Cancer Flashcards

1
Q
A

Bicornuate Uterus

“Heart shaped” uterus

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2
Q
A

DES Uterus

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3
Q

What are the symptoms of a Bicornuate Uterus?

A

Usually asymptomatic

Recurrent miscarriage

Diagnosed upon pregnancy, usually

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4
Q

What is endometriosis?

A

The presence and growth of the glands and stroma of the lining of the uterus in a place it shouldn’t be (aberrant location).

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5
Q
A

Bicornuate Uterus

“Heart Shaped” Uterus

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6
Q

What is the most common benign pelvic tumor?

A

Leiomyomas (fibroids)

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6
Q

What are the types of leiomyomas (fibroids)?

A

Intramural - body of uterus

Submucosal -below the endometrium

Subserosal - beneath the serosa

Broad ligament - within broad ligament

Parasitic - obtains secondary blood supply from nearby organ

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7
Q

What are the three types of histological ovarian cancer?

A

Epithelial

Germ Cell

Stromal - hormonally active

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8
Q

What are the predictors of outcome in ovarian cancer?

A

Early stage of disease

Histologic grade of the cancer

Abe and health of the patient

Minimal residual disease at the completion of surgery

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8
Q

Who do you most often see Adenomyosis in?

A

Parous women

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9
Q

What genetic pathway has no skipped generations?

A

Autosomal Dominant

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9
Q

What is the differential diagnosis for endometrial polyps?

A

Endometrial adenocarcinoma

Endometrial hyperplasia

Submucosal uterine fibroid (more whitish/yellow)

Cervical polyp

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10
Q

What are the side effects of GnRH agonsits?

A

Menopause-like side effects

Decreased bone density

Amenorrhea in 6-8 weeks

75-90% of pts have decreased symptoms or become asymptomatic.

(no effects on sex hormone-binding globulin… won’t decrease libido)

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10
Q

What are commonly used GnRH agonists?

A

Leuprolide acetate (Lupron) - injectable

Nafarelin acetate (Synarel) - intranasal

Goserelin acetate (Zoladex) - sub cut implant

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11
Q

How is adenomyosis diagnosed?

A

Diffuse enlargement of the uterus (2-3x normal size)

Uterus globular and tender right before and during menses

Differences in tenderness and consistency of uterus from one pelvic exam to another

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12
Q

What imaging is used in diagnosing leiomyomas (fibroids)?

A

Ultrasound is most helpful

X-Ray - calcified uterine fibroids

CT/MRI - expensive and cannot distinguish between benign and malignant

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12
Q

What are the symptoms of endometrial polyps?

A

Most asymptomatic

Various abnormal bleeding patterns:

intermenstrual bleeding

postmenopausal bleeding (cancer until proven otherwise)

menorrhagia (less often)

Polyp may protrude through cervical os (hello!)

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13
Q

How often are the ovaries involved in endometriosis?

A

2/3 of patients

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13
Q

How are imaging studies used in diagnosing adenomyosis?

A

Not used often.

Pelvic ultrasound occasionally helpful

MRI more accurate, but not necessary

CT not helpful

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13
Q

What is the best tool for imaging in endometrial polyps?

A

Saline sonohysterogram.

(Ultrasound is possible but difficult, helps rule out fibroids)

Hysteroscopy can give an incidental diagnosis when evaluating another condition

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13
Q

What is the condition of an absent uterus?

A

Mullerian Agenesis

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14
Q

What are uterine fibroids?

A

AKA leiomyomas, or myomas

They are benign tumor of muscle cell origin found in any tissue that contains smooth muscle

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14
Q

Uterine malformation is the result of what?

A

Abnormal development of the Mullerian ducts during embryogenesis

(2-4% incidence)

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15
Q

What are symptoms of endometriosis?

A

Cyclic pelvic pain - extravasation (leaking) of blood and menstrual debris

2nd degree dysmenorrhea - dull ache to severe pain, unilateral/bilateral, may radiate (legs, low back groin)

Pelvic heaviness, swelling/bloating

Dyspareunia (pain with intercourse)

Abnormal bleeding

Cyclic abdominal pain

Intermittent constipation or diarrhea

Urinary frequency or dysuria

Hematuria

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16
Q

What condition presents where the uterine fundus displays a concave contour towards the uterine cavity?

A

Arcuate Uterus (considered normal variant)

Diagnosed by ultrasound (especially 3D)

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17
Q

What are the common symptoms of Uterine Didelphys?

A

Miscarriage (23%)

Menstruation despite placement of tampon

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18
Q

Endometriosis is dependent on what hormone?

A

Estrogen:

low estrogen = low risk

(smokers, people with low body fat, exercise induced amenorrhea)

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19
Q
A

Septate Uterus

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20
Q

What condition presents with a double uterus, two cervices, often two vaginas, and one attached tube and ovary on each side?

A

Uterine Didelphys

(Mullerian ducts develop but fail to fuse)

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21
Q
A

Arcuate Uterus

22
Q

What ages do endometrial polyps usually occur?

A

Peaks durring 40s and 50s

23
Q

What age do leiomyomas generally occur?

A

5th decade of a woman’s life (40s)

25
Q

Where are the majority of endometrial implants located?

A

Dependent areas of the pelvis

(where there is a lot of blood flow)

26
Q

What is the treatment of endometrial polyps?

A

Surgical removal by curettage.

Always send for pathology (malignancy possible - 0.5%)

27
Q

What genetic pathway may appear to skip generations?

A

Dominance with incomplete penetrance.

28
Q

What is the gold standard for diagnosing endometriosis?

A

Direct visualization of lesions with histologic confirmation. (Ultrasound can help rule out other conditions)

29
Q

What are the symptoms of adenomyosis?

A

Mostly asymptomatic.

Can have dysmenorrhea and menorrhagia, ocassionally dyspareunia.

30
Q

What are the symptoms of leiomyomas (fibroids)?

A

Asymptomatic is common

Abnormal bleeding (30%)

  • menorrhagia

Pain (1/3 of patients)

  • from increased myometrial activity, or secondary to edema

Pressure

31
Q

What condition presents with a T-shaped uterus?

A

DES uterus (from exposure to DES)

33
Q

What is the most common gynecologic malignancy?

A

Uterine Cancer

34
Q

What is the goal of cytoreductive surgery on ovarian cancer?

A

No gross macroscopic disease left at the end of surgery.

This could involve the resection of peritoneum, small bowel, colon, spleen, segments of bladder, and stomach.

Alwasy document acurate tumor volume before and after surgery.

36
Q

What are the two types of bases of endometrial polyps?

A

Sessile - broad

Pedunculated - narrow

38
Q

What percentage of breast and ovarian cancer is hereditary?

A

5-10%

39
Q

What condition presents as a “heart shaped” uterus?

A

Bicornate Uterus

(upper part of Mullerian system fails to fuse)

40
Q

What condition presents with a single vagina, single cervix, and single horn of uterus with Fallopian tube? (Ovary is often present on opposite side)

A

Unicornuate Uterus

42
Q

What other treatment is required after surgery with low risk Stage Ia/b, or Grade 1/2 ovarian cancer?

A

Usually surgery alone is sufficient.

43
Q

What age is most common for adenomyosis?

A

35-47

45
Q

Signs of Endometriosis.

A

Fixed retroverted uterus with tenderness and scarring posteriorly (classic sign)

Nodularity in adnexae and/or posterior cul-de-sac

Ovarian enlargement

Visualization of lesions on speculum exam

46
Q

What is the only option for failed medical therapy in endometriosis?

A

Surgical Therapies:

Conservative

Definitive - hysterectomy w/ bilateral salpingo-oophorectomy and removal of all visible implants

47
Q

What condition presents with the outside of the uterus appearing normal, but a septum divides the inner portion of the uterus?

A

Septate Uterus (partial or complete)

49
Q

Pelvic Mass:

Low Risk

A

Premenopausal

Mass

Normal CA-125

Unilateral Lesion

Rassuring Sonography

  • unilocular
  • non-complex (cystic only)
  • no ascites
50
Q

What is the goal of medical therapies for endometriosis?

A

Induction of amenorrhea

(Danazol, GnRH agonists, OBCPs, Progestins)

52
Q

What is the most deadly gynecologic malignancy?

A

Ovarian cancer

53
Q

How common are leiomyomas found in women?

A

Clinically apparent in 25-50% of women

(1:4 white, 1:2 black)

54
Q

How to manage a pelvic mass:

A

Observation - but must always address any symptoms caused by the mass

Sugrery - Laproscopic, Laparotomy, extent depends on presence or absence of cancer

55
Q

What is the treatment of Adenomyosis?

A

None satisfactory.

Occasional relief from GnRH agonists, OBCPs or prostaglandin synthetase inhibitors.

Can become iron deficient - treat!

Hysterectomy is definitive if appropriate for patient.

56
Q

Pelvic Mass:

High Risk

A

Postmenopausal

Mass > 8cm in diameter

Elevated CA-125

Bilateral masses

Symptomatic

Non-reassuring sonography

  • multiloculated
  • complex (solid and cystic)
  • ascites
57
Q

What are the symptoms of a Septate Uterus?

A

Spontaneous abortion

Miscarriage

menstruation, despite placement of tampon

Diagnosed by ultrasound or MRI

58
Q

What would be a worrisome finding of a fibroid?

A

Rapid growth

(leiomyosarcoma possible - 0.3-0.7%)

59
Q

What is the most reliable lab for diagnosing endometrial polyps?

A

FSH levels.

CBC, TSH, and prolactin are also comonly used.

60
Q

How are fibroids (leiomyomas) commonly diagnosed?

A

By physical exam (bimanual)

-enlarged uterus, firm and irregular

Differential:

Pregnancy

Adenomyosis

Ovarian neoplasm

Endometrial hyperplasia, thyroid dysfunction (abnormal bleeding)

61
Q
A

Uterine Didelphys

62
Q

What are the treatments for leiomyomas (fibroids)?

A

Observation - yearly pelvic exam, yearly sonogram if small and asymptomatic

Meds: GnRH agonists (can shrink fibroids)

Myomectomy - surgical removal of fibroid (and uterine reconstruction)

  • Laparotomy
  • Laparoscopy
  • Hysteroscopic

Hysterectomy

63
Q

What is adenomyosis?

A

The growth of endometrial glands and stroma in the uterine myometrium (at least 2.5mm from the basalis layer of the endometrium)

64
Q

What are the symptoms of a Mullarian Agenesis?

A

Malformations of the vagina

Primary amenorrhea

66
Q

What treatment is required other than surgery for Stages Ic and above, and all Grade 3 ovarian cancer?

A

Intraperitoneal Chemotherapy:

Taxane and Platinum Combination

(most are 6 courses)

67
Q

What are the symptoms of Unicornuate Uterus?

A

Often asymptomatic (diagnosed with pregnancy)

68
Q

What are the symptoms of uterine anomalies?

A

Amenorrhea-obstruction

manual obstruction (tampons, intercourse)

Ectopic pregnancy

Recurrent mmiscarriage/infertility

69
Q
A

Unicornuate Uterus

70
Q

What are the symptoms of DES uterus?

A

Pregnancy loss

ectopic pregnancy

infertility

clear cell adenocarcinoma of vagina and cervix

71
Q

What is the most common presentation of adenomyosis?

A

Diffuse involvement of anterior and posterior walls of the uterus.

(5% is focal area)

Spongy appearance

72
Q

How are most ovarian cancers diagnosed?

A

Surgically - through a histologic evaluation.

Symptoms are vague, and 60-75% are diagnosed at stage III or IV

73
Q

What are endometrial polyps?

A

Localized overgrowths of endometrial glands and stroma that project beyond the surface of the endometrium.

OBGYN (4 decks)

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