Ch 3b (pathology of uterus + endo) Flashcards
(109 cards)
1
Q
Where is a gartner duct cyst?
A
Simple cyst located in anterolateral wall of vagina
2
Q
Who gets gartner duct cysts?
A
Reproductive aged women
3
Q
What do gartner duct cysts look like?
A
Anechoic fluid filled mass with well defined boarders + good transmission
4
Q
Where are Nabothian/inclusion cysts found?
A
Simple cyst in cervix at the opening of a nabothian duct
5
Q
When are nabothian cysts often found?
A
After pregnancy
6
Q
SF of nabothian cysts?
A
-fluid filled mass in cervical canal
-refractive edge shadowing
-measure 3-30 mm
7
Q
M/c benign neoplasm of the cervix?
A
Cervical polyp
8
Q
Cause of a cervical polyp?
A
Profuse bleeding or discharge
9
Q
Where are cervical polyps located?
A
Attached to cervical wall by a pedicle, can grow to be several cm
10
Q
SF of cervical polyp?
A
-Solid lesion with stalk
-Vascular feeding stalk seen with CD
(no colour in endo normally)
11
Q
What is a cervical myoma?
A
Muscular benign solid mass in cervix
(similar to fibroid/leiomyoma)
12
Q
Symptoms of a cervical myoma?
A
Most asymptomatic
13
Q
SF of cervical myoma?
A
-distorts cervix
-appearance similar to corpus myoma/fibroid
14
Q
What is endometrial hyperplasia?
A
Excessive growth of endo
15
Q
Cause of endo hyperplasia?
A
High hormone levels (estrogen) cause endo thickening
16
Q
Can endo hyperplasia develop into something more serious?
A
Yes, risk for endo cancer. Must monitor closely.
17
Q
SF of endo hyperplasia?
A
-Thick + heterogeneous endo
-Small, anechoic cysts within endo
18
Q
What pathology is the m/c cause of abnormal uterine bleeding?
A
Endo hyperplasia
19
Q
Thickness measurements of endo with endo hyperplasia?
A
-14mm with premenopausal
-10mm when on tamoxifen
-8mm with postmenopausal
20
Q
What is synechiae/asherman syndrome?
A
Scar tissue adhesions develop inside the endo due to trauma of the uterine lining
21
Q
What kind of trauma causes asherman syndrome?
A
-C section
-Dilation + curettage (removal of tissue inside uterus)
22
Q
Risks of asherman syndrome?
A
-Fertility problems
-Recurrent pregnancy loss
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)
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
25
When does uterine dehiscence occur?
Rare complication of C section that can result in maternal + fetal morbidity
26
SF of uterine dehiscence?
-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)
27
What is the m/c tumour of female pelvis?
Leiomyoma/fibroid (they are benign)
28
Cause of leiomyoma?
Unknown, although often arise after menarche and get worse after menopause (estrogen + tamoxifen may cause growth)
29
Location of leiomyoma?
Anywhere in uterus
30
What is a leiomyoma?
Benign tumour composed of smooth muscle cells + fibrous connective tissue
31
SF of leiomyoma?
-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
32
List the 4 locations for a leiomyoma?
intramural: within myometrium
submucosal: below endo
subserosal: below serosa/perimetrium/outer uterus layer
pedunculated: outside uterus with stalk
33
Which location of fibroid is m/c to cause changes to menstrual cycle?
Submucosal fibroid b/c it is within/adjacent to the endo
34
Symptoms of heavy vaginal bleeding with fibroids get worse when they are located where in the uterus?
Worsen the closer the fibroid is to the endo cavity
35
Which location of a fibroid does not affect menstrual bleeding?
Subserosal fibroids, b/c below perimetrium/outer layer
(they can become large and don't affect period)
36
Causes of pelvic abscess?
Infection of tubes, ovaries, appendix, bowel, peritoneum
(often occurs from a procedure, bacteria gets into the pelvic space)
37
Patient symptoms with a pelvic abscess?
-fever
-increased WBC
-tenderness/pain
-swelling at surgery site
38
SF of pelvic abscess?
Varies, often mix of cystic + solid mass. Lots of colour flow.
39
What is a pelvic hematoma?
Collection of blood due to trauma or a disease process within an organ/potential space
40
Cause of pelvic hematoma?
-ectopic pregnancy
-cyst rupture
-postoperative bleeding
-surgery
-trauma
41
SF of hematoma?
-well defined with clear borders
-complex or anechoic
-appearance depends on age of blood
-not a lot of colour flow
42
What is a pelvic lymphocele?
Pocket of lymph fluid resulting from trauma to lymph vessels in pelvis
43
SF of lymphocele?
-septated
-well defined
-complex mass
44
What type of mass can appendicitis result in?
An abscess
45
M/c physical finding of appendicitis?
RLQ pain at mcburney point
46
SF features of the appendix in SAG/TRV?
SAG: blunt ended tubular structure
TRV: bull's eye
47
What is a hysterectomy?
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
SF of a posthysterectomy?
Bowel fills in extra space now
(if removal of ovaries/tubes pt must take medication to receive those hormones)
49
Do PID and endometriosis look similar on u/s?
Yes
50
What clinical presentation do PID + endometriosis mimic in the early stage?
PID: ectopic pregnancy or appendicitis
Endo: bowel disease
51
M/c location for PID to affect?
Fallopian tubes
52
What is PID?
Pelvic inflammatory disease of upper female genital tract from an infection
53
Locations that PID affects?
-endo (endometritis)
-uterine wall (myometritis)
-uterine serosa + broad ligs (parametritis)
-ovary (oophoritis)
-fallopian tube (salpingitis) M/C
54
Typical result of PID is?
Result of STI (chlamydia + gonorrhoeae)
55
Symptoms pt's suffer from with PID?
-chronic pelvic pain
-tubo ovarian abscess
-ectopic preg
-infertility
56
Risk factors that lead to acquiring PID?
-early age for 1st intercourse
-young people
-increased # sexual partners
-frequent sex
(all increase chance of getting STI which can develop into PID)
57
3 stages of PID as the bacteria spreads through the pelvis?
1: endometritis
2: salpingitis
3. tubo-ovarian complex or abscess
58
What is Fitz-Hugh-Curtis syndrome?
-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
M/c symptoms of PID?
-lower abdomen + pelvic pain
-adnexal tenderness
-constant dull pain with movement or sexual activity
-fever
-cervical discharge
-increased WBC
60
Early SF of acute PID?
-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
SF of advanced acute PID?
-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
SF of chronic PID?
-hydrosalpinx (fluid in tube now instead of pus)
63
What is endometriosis?
-Heterotopic (abnormal) growth of the endo glands
-Endo tissue grows outside uterus
64
What does the ectopic tissue adhere to + invade with endometriosis?
Abdominal organs, responds to hormonal influence of ovulatory cycle
65
Can endometriosis lead to adhesion formation + interruption of normal reproduction?
Yes, if chronic it can lead to infertility + severe menstrual cycle pelvic pain
66
What women get endometriosis?
Reproductive aged women b/c directly relates to menstrual cycle hormonal stimulation
67
Treatment of endometriosis?
-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
SF of endometriosis?
-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
Does endometriosis normally become malignant?
No
70
M/s symptom of endometriosis?
Chronic pelvic pain
71
Why does endometriosis go so long before being diagnosed?
B/c doctors think periods normally hurt and they don't further look into it :(
72
What "sign" goes hand in hand with endometriosis?
The sliding sign
73
SF of endometriosis?
-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
What is adenomyosis?
When ectopic endo tissue grows in myometrium of uterus
(considered a variant from endometriosis where it extends deeper than 2.5mm into myometrium)
75
What women m/c get adenomyosis?
Women who have given birth (parous women) in their 30-40s
76
M/s symptoms of adenomyosis?
-abnormal bleeding
-secondary dysmenorrhea (painful period)
-enlarged tender uterus
77
Is the anterior or posterior uterus wall m/c affected with adenomyosis?
Posterior wall m/v involved
78
Difference b/w diffuse + nodular/focal adenomyosis?
Diffuse: entire myometrium affected
Focal: adenomyomas (discrete nodules) produced within myometrium or cervix
79
SF of adenomyosis?
-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
Is adenomyosis m/c focal or diffuse?
Diffuse
81
What do adenomyoma's look like SF?
Like a fibroid, an isoechoic mass
82
What is the m/c gyne malignancy in developed countries vs developing countries?
Developed: endo carcinoma (6%)
Developing: cervical carcinoma
83
Is type 1 or 2 m/c for endo carcinoma?
Type 1 (65-70%)
84
Difference b/w type 1 + type 2 endo carcinoma?
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
4 stages of endo carcinoma?
1 - tumour in uterus
2 - tumour invades cervix
3 - cancer spreads to ovary, etc.
4 - tumour invades bladder/bowel + metastasizes
86
About 80% of endo carcinoma's are what?
Adenocarcinomas
(develop from glandular structure, diagnosed in 6th/7th decade)
87
M/c symptom of adenocarcinoma?
Uterine bleeding
88
SF of endo carcinoma?
-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
What is a subendometrial halo?
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
How can CD suspect myometrial invasion with endo carcinoma?
Normally no endo CD flow, CD indicates invasion of myometrial if there is increase in flow surrounding a lesion
91
What is a leiomyosarcoma?
Rare fast growing malignancy in bones + soft tissues. Develop from myometrium.
92
Symptoms of leiomyosarcoma's?
-vag bleeding
-abdominal pain
-rapid inrease in uterine mass size
93
Risk factors that lead to developing leiomyosarcoma's?
-history of pelvic radiation
-use of tamoxifen
-genetic syndromes
94
How to tell if a benign leiomyoma is developing into a malignant leiomyosarcoma?
If fibroid has increased rapidly in size after menopause
95
SF of leiomyosarcoma?
-rapidly growing heterogeneous uterine mass similar to fibroid
-solid lesion in uterus
-m/c intramural
-CD shows neovascularity at border + within mass
96
Is fallopian tube carcinoma rare + difficult to cure?
Yes
97
M/c symptom of FT carcinoma?
-vag bleeding
-spotting
98
Risk factors of FT carcinoma?
40-60 y/o, breast cancer, chromosomal mutations, infertility, never given birth (nulliparity), family history of ovarian CA, postmenopausal bleeding
99
SF of FT carcinoma?
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
How common is cervical carcinoma worldwide?
4th m/c female malignancy
101
What is the m/c RF for developing cervical carcinoma?
Infection by HPV
102
Where do 85-90% of cervical cancers originate from?
Squamous epithelium cell within cervix (leading to squamous cell carcinoma)
103
What does a pap test look for?
Cervical carcinoma b/c disease is asymptomatic in early stages
104
Who is m/c to getting cervical cancer?
Women under 50 who still have periods
105
SF of cervical carcinoma?
-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
M/c symptom for cervical carcinoma?
Bleeding when not on period
107
4 stages of cervical carcinoma?
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
SF of cervical carcinoma?
-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
What is parametritis?
Inflammation of outer layer of uterus (serous layer) and broad ligament
