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MIDS 137 > Ch 3b (pathology of uterus + endo) > Flashcards

Ch 3b (pathology of uterus + endo) Flashcards

1
Q

Where is a gartner duct cyst?

A

Simple cyst located in anterolateral wall of vagina

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2
Q

Who gets gartner duct cysts?

A

Reproductive aged women

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3
Q

What do gartner duct cysts look like?

A

Anechoic fluid filled mass with well defined boarders + good transmission

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4
Q

Where are Nabothian/inclusion cysts found?

A

Simple cyst in cervix at the opening of a nabothian duct

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5
Q

When are nabothian cysts often found?

A

After pregnancy

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6
Q

SF of nabothian cysts?

A

-fluid filled mass in cervical canal
-refractive edge shadowing
-measure 3-30 mm

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7
Q

M/c benign neoplasm of the cervix?

A

Cervical polyp

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8
Q

Cause of a cervical polyp?

A

Profuse bleeding or discharge

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9
Q

Where are cervical polyps located?

A

Attached to cervical wall by a pedicle, can grow to be several cm

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10
Q

SF of cervical polyp?

A

-Solid lesion with stalk
-Vascular feeding stalk seen with CD

(no colour in endo normally)

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11
Q

What is a cervical myoma?

A

Muscular benign solid mass in cervix

(similar to fibroid/leiomyoma)

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12
Q

Symptoms of a cervical myoma?

A

Most asymptomatic

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13
Q

SF of cervical myoma?

A

-distorts cervix
-appearance similar to corpus myoma/fibroid

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14
Q

What is endometrial hyperplasia?

A

Excessive growth of endo

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15
Q

Cause of endo hyperplasia?

A

High hormone levels (estrogen) cause endo thickening

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16
Q

Can endo hyperplasia develop into something more serious?

A

Yes, risk for endo cancer. Must monitor closely.

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17
Q

SF of endo hyperplasia?

A

-Thick + heterogeneous endo
-Small, anechoic cysts within endo

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18
Q

What pathology is the m/c cause of abnormal uterine bleeding?

A

Endo hyperplasia

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19
Q

Thickness measurements of endo with endo hyperplasia?

A

-14mm with premenopausal
-10mm when on tamoxifen
-8mm with postmenopausal

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20
Q

What is synechiae/asherman syndrome?

A

Scar tissue adhesions develop inside the endo due to trauma of the uterine lining

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21
Q

What kind of trauma causes asherman syndrome?

A

-C section
-Dilation + curettage (removal of tissue inside uterus)

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22
Q

Risks of asherman syndrome?

A

-Fertility problems
-Recurrent pregnancy loss

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23
Q

What specific type of u/s exam is best used to identify synechiae/asherman syndrome + why?

A

Sonohysterography b/c scar tissue/adhesions are isoechoic to the endo. The anechoic fluid helps visualize the scar tissue.

(look like an isoechoic line in endo)

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24
Q

What is uterine dehiscence?

A

-When the C section scar ruptures, especially if pregnant
-Endo + myometrium layers open but the outer perimetrium stays in tact

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25
Q

When does uterine dehiscence occur?

A

Rare complication of C section that can result in maternal + fetal morbidity

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26
Q

SF of uterine dehiscence?

A

-Scar seen on anterior section uterus at the internal os of cervix
-Scar appears abnoramlly thin + hypoechoic
-Bulges outwards
-M/c seen in pregnancy

(Image lower uterine segment with EV)

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27
Q

What is the m/c tumour of female pelvis?

A

Leiomyoma/fibroid (they are benign)

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28
Q

Cause of leiomyoma?

A

Unknown, although often arise after menarche and get worse after menopause (estrogen + tamoxifen may cause growth)

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29
Q

Location of leiomyoma?

A

Anywhere in uterus

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30
Q

What is a leiomyoma?

A

Benign tumour composed of smooth muscle cells + fibrous connective tissue

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31
Q

SF of leiomyoma?

A

-single or multiple
-variable in size
-calcific degeneration occurs m/c after menopause
-degeneration occurs when it outgrows blood supply
-clusters of bright reflectors with acoustic shadowing seen with calcific degeneration

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32
Q

List the 4 locations for a leiomyoma?

A

intramural: within myometrium
submucosal: below endo
subserosal: below serosa/perimetrium/outer uterus layer
pedunculated: outside uterus with stalk

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33
Q

Which location of fibroid is m/c to cause changes to menstrual cycle?

A

Submucosal fibroid b/c it is within/adjacent to the endo

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34
Q

Symptoms of heavy vaginal bleeding with fibroids get worse when they are located where in the uterus?

A

Worsen the closer the fibroid is to the endo cavity

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35
Q

Which location of a fibroid does not affect menstrual bleeding?

A

Subserosal fibroids, b/c below perimetrium/outer layer
(they can become large and don’t affect period)

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36
Q

Causes of pelvic abscess?

A

Infection of tubes, ovaries, appendix, bowel, peritoneum

(often occurs from a procedure, bacteria gets into the pelvic space)

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37
Q

Patient symptoms with a pelvic abscess?

A

-fever
-increased WBC
-tenderness/pain
-swelling at surgery site

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38
Q

SF of pelvic abscess?

A

Varies, often mix of cystic + solid mass. Lots of colour flow.

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39
Q

What is a pelvic hematoma?

A

Collection of blood due to trauma or a disease process within an organ/potential space

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40
Q

Cause of pelvic hematoma?

A

-ectopic pregnancy
-cyst rupture
-postoperative bleeding
-surgery
-trauma

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41
Q

SF of hematoma?

A

-well defined with clear borders
-complex or anechoic
-appearance depends on age of blood
-not a lot of colour flow

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42
Q

What is a pelvic lymphocele?

A

Pocket of lymph fluid resulting from trauma to lymph vessels in pelvis

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43
Q

SF of lymphocele?

A

-septated
-well defined
-complex mass

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44
Q

What type of mass can appendicitis result in?

A

An abscess

45
Q

M/c physical finding of appendicitis?

A

RLQ pain at mcburney point

46
Q

SF features of the appendix in SAG/TRV?

A

SAG: blunt ended tubular structure
TRV: bull’s eye

47
Q

What is a hysterectomy?

A

Removal uterus

Partial: just uterus
Total: uterus + cervix
Radical: removes everything (tubes, cervix, ovaries, upper vag, uterus)

(left over structures are given the term “cuff”)

48
Q

SF of a posthysterectomy?

A

Bowel fills in extra space now

(if removal of ovaries/tubes pt must take medication to receive those hormones)

49
Q

Do PID and endometriosis look similar on u/s?

A

Yes

50
Q

What clinical presentation do PID + endometriosis mimic in the early stage?

A

PID: ectopic pregnancy or appendicitis
Endo: bowel disease

51
Q

M/c location for PID to affect?

A

Fallopian tubes

52
Q

What is PID?

A

Pelvic inflammatory disease of upper female genital tract from an infection

53
Q

Locations that PID affects?

A

-endo (endometritis)
-uterine wall (myometritis)
-uterine serosa + broad ligs (parametritis)
-ovary (oophoritis)
-fallopian tube (salpingitis) M/C

54
Q

Typical result of PID is?

A

Result of STI (chlamydia + gonorrhoeae)

55
Q

Symptoms pt’s suffer from with PID?

A

-chronic pelvic pain
-tubo ovarian abscess
-ectopic preg
-infertility

56
Q

Risk factors that lead to acquiring PID?

A

-early age for 1st intercourse
-young people
-increased # sexual partners
-frequent sex

(all increase chance of getting STI which can develop into PID)

57
Q

3 stages of PID as the bacteria spreads through the pelvis?

A

1: endometritis
2: salpingitis
3. tubo-ovarian complex or abscess

58
Q

What is Fitz-Hugh-Curtis syndrome?

A

-When PID migrates into RUQ causing perihepatitis (inflamed liver)
-Bacteria causes adhesion b/w chest + RUQ. Normal diaphragm slides easily, should not be adhered + cause pain.

59
Q

M/c symptoms of PID?

A

-lower abdomen + pelvic pain
-adnexal tenderness
-constant dull pain with movement or sexual activity
-fever
-cervical discharge
-increased WBC

60
Q

Early SF of acute PID?

A

-enlarged uterus
-myometrial/endo blurred
-thick + heterogeneous endo with possible fluid
-fluid in posterior cul de sac
-not distinct borders of pelvic organs
-fallopian tubes may be seen due to pus

61
Q

SF of advanced acute PID?

A

-ovarian enlargement + adhesions
-tubo ovarian abscess (ovary + tube are adhered together creating complex mass with cystic/solid components)
-findings m/c bilateral b/c bacteria is going through entire pelvis

(m/c abscesses begin developing now)

62
Q

SF of chronic PID?

A

-hydrosalpinx (fluid in tube now instead of pus)

63
Q

What is endometriosis?

A

-Heterotopic (abnormal) growth of the endo glands
-Endo tissue grows outside uterus

64
Q

What does the ectopic tissue adhere to + invade with endometriosis?

A

Abdominal organs, responds to hormonal influence of ovulatory cycle

65
Q

Can endometriosis lead to adhesion formation + interruption of normal reproduction?

A

Yes, if chronic it can lead to infertility + severe menstrual cycle pelvic pain

66
Q

What women get endometriosis?

A

Reproductive aged women b/c directly relates to menstrual cycle hormonal stimulation

67
Q

Treatment of endometriosis?

A

-Removing affected tissue
-Postmenopausal women will have reduced symptoms b/c no more hormones
-Having ovaries removed will stop hormone production + reduce symptoms

(When endo tissue grows outside the uterus it forms endo implants. When the endo tissue moves + specifically affects the ovary it forms an endometrioma)

68
Q

SF of endometriosis?

A

-diffuse or focal
-chocolate cyst/endometrioma which is old blood from repeated episodes of hormonally stimulated endo shedding
-endometriomas measure b/w 5-10cm

69
Q

Does endometriosis normally become malignant?

A

No

70
Q

M/s symptom of endometriosis?

A

Chronic pelvic pain

71
Q

Why does endometriosis go so long before being diagnosed?

A

B/c doctors think periods normally hurt and they don’t further look into it :(

72
Q

What “sign” goes hand in hand with endometriosis?

A

The sliding sign

73
Q

SF of endometriosis?

A

-normal uterus
-lesions on peritoneal surface (endo implants) + within ovary (endometriomas)
-endo implants vary in appearance, but can look hypoechoic + speculated
-if lesions are not sliding + are adhered to bowel, think endometriosis
-rectal/bowel lesions present

74
Q

What is adenomyosis?

A

When ectopic endo tissue grows in myometrium of uterus

(considered a variant from endometriosis where it extends deeper than 2.5mm into myometrium)

75
Q

What women m/c get adenomyosis?

A

Women who have given birth (parous women) in their 30-40s

76
Q

M/s symptoms of adenomyosis?

A

-abnormal bleeding
-secondary dysmenorrhea (painful period)
-enlarged tender uterus

77
Q

Is the anterior or posterior uterus wall m/c affected with adenomyosis?

A

Posterior wall m/v involved

78
Q

Difference b/w diffuse + nodular/focal adenomyosis?

A

Diffuse: entire myometrium affected
Focal: adenomyomas (discrete nodules) produced within myometrium or cervix

79
Q

SF of adenomyosis?

A

-asymmetric enlarged uterus
-thick posterior myometrium, normal anterior
-abnormal echogenicity of myometrium
-heterogeneous
-anechoic/cystic regions in myometrium
-streaky appearance due to small cysts
-poor visualization b/w endo + myo layers

80
Q

Is adenomyosis m/c focal or diffuse?

A

Diffuse

81
Q

What do adenomyoma’s look like SF?

A

Like a fibroid, an isoechoic mass

82
Q

What is the m/c gyne malignancy in developed countries vs developing countries?

A

Developed: endo carcinoma (6%)
Developing: cervical carcinoma

83
Q

Is type 1 or 2 m/c for endo carcinoma?

A

Type 1 (65-70%)

84
Q

Difference b/w type 1 + type 2 endo carcinoma?

A

1: Low grade, RF of obesity + increased estrogen levels. M/c.
2: High grade, atrophic endo, poorer prognosis. RF of lower BMI, nonwhite race, older age.

85
Q

4 stages of endo carcinoma?

A

1 - tumour in uterus
2 - tumour invades cervix
3 - cancer spreads to ovary, etc.
4 - tumour invades bladder/bowel + metastasizes

86
Q

About 80% of endo carcinoma’s are what?

A

Adenocarcinomas
(develop from glandular structure, diagnosed in 6th/7th decade)

87
Q

M/c symptom of adenocarcinoma?

A

Uterine bleeding

88
Q

SF of endo carcinoma?

A

-m/c thick endo (over 5mm in postmenopausal women not on hormone replacement therapy)
-obstruction causing hydrometra (watery fluid in uterus) or hematometra (blood in uterus)
-uterine enlargement with lobular contours + mixed echogenicity
-small hyperechoic endo lesions (either sm lesions with minimal vascularity or lg lesions with lots of vascularity)
-cancer invades myometrium making it hard to see boarders of endo

89
Q

What is a subendometrial halo?

A

Hypoechoic stripe at inner part of myometrium, bordering the endo

(if halo is intact it means EC only superficial, if halo disrupted it means EC invaded deep myometrial)

90
Q

How can CD suspect myometrial invasion with endo carcinoma?

A

Normally no endo CD flow, CD indicates invasion of myometrial if there is increase in flow surrounding a lesion

91
Q

What is a leiomyosarcoma?

A

Rare fast growing malignancy in bones + soft tissues. Develop from myometrium.

92
Q

Symptoms of leiomyosarcoma’s?

A

-vag bleeding
-abdominal pain
-rapid inrease in uterine mass size

93
Q

Risk factors that lead to developing leiomyosarcoma’s?

A

-history of pelvic radiation
-use of tamoxifen
-genetic syndromes

94
Q

How to tell if a benign leiomyoma is developing into a malignant leiomyosarcoma?

A

If fibroid has increased rapidly in size after menopause

95
Q

SF of leiomyosarcoma?

A

-rapidly growing heterogeneous uterine mass similar to fibroid
-solid lesion in uterus
-m/c intramural
-CD shows neovascularity at border + within mass

96
Q

Is fallopian tube carcinoma rare + difficult to cure?

A

Yes

97
Q

M/c symptom of FT carcinoma?

A

-vag bleeding
-spotting

98
Q

Risk factors of FT carcinoma?

A

40-60 y/o, breast cancer, chromosomal mutations, infertility, never given birth (nulliparity), family history of ovarian CA, postmenopausal bleeding

99
Q

SF of FT carcinoma?

A

Varied appearances:
-ill defined/sausage shaped solid mass
-cystic mass with mural nodules
-hydrosalpinx (b/c tubal blockage)
-multilobular mass with cogwheel sign

-pelvic ascites
-uterine fluid collection
-hydrosalpinx

100
Q

How common is cervical carcinoma worldwide?

A

4th m/c female malignancy

101
Q

What is the m/c RF for developing cervical carcinoma?

A

Infection by HPV

102
Q

Where do 85-90% of cervical cancers originate from?

A

Squamous epithelium cell within cervix (leading to squamous cell carcinoma)

103
Q

What does a pap test look for?

A

Cervical carcinoma b/c disease is asymptomatic in early stages

104
Q

Who is m/c to getting cervical cancer?

A

Women under 50 who still have periods

105
Q

SF of cervical carcinoma?

A

-first confined to cervix only
-then ulcerating mass with bulky expansion of cervix develops
-lesion can extend into parametrium (b/w cervix + bladder), bladder + rectum

106
Q

M/c symptom for cervical carcinoma?

A

Bleeding when not on period

107
Q

4 stages of cervical carcinoma?

A

1 - tumour in cervix
2 - spreads beyond cervix into vag, etc
3 - extends into pelvic wall or obstructs ureter, goes towards bowel, bladder, ureter, etc
4 - extends beyond true pelvis or involves bladder/rectum. Metastasizes.

108
Q

SF of cervical carcinoma?

A

-cervix looks normal in early stages
-advanced stage shows bulky cervix + irregular borders
-cervical mass
-invasion of bladder
-hydronephrosis
-metastasis to liver
-para aortic node formation

109
Q

What is parametritis?

A

Inflammation of outer layer of uterus (serous layer) and broad ligament

MIDS 137 (14 decks)

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