Conditions of the Uterus, Cervix, Ovary and Fallopian tubes

Question 1

What forms the upper vagina, cervix, uterus and fallopian tubes?

Answer 1

The paramesonephric (Mullerian) ducts

Question 2

The absence of the Y chromosome and absence of Mullerian inhibiting substance leads to the development of what?

Answer 2

The paramesonephric system with the regression of the mesonephric system

Question 3

At what point in time do the paramesonephric ducts arise?

Answer 3

At 6 weeks gestational and by 9 weeks they fuse in the midline to form the uterovaginal primordium

Question 4

When the septum resolves between the fused paramesonephric ducts its leads to the development of what structures?

Answer 4

A single cervix and uterus

Question 5

Failure of the paramesonephric duct to fuse can lead to which anomalies?

Answer 5

Uterus didelphysis (2 separate uterine bodies with its own cervix, attached Fallopian tubes and vagina); bicronuate uterus with a rudimentary horn; bicorunuate uterus w/ or w/o double cervices

Question 6

Incomplete dissolution of the midline fusion of the paramesonephric duct leads to which anomaly?

Answer 6

Septate uterus

Question 7

Failure of formation of Müllerian ducts can lead to which anomaly?

Answer 7

Unicornate uterus

Question 8

What is Mullerian agenesis?

Answer 8

The complete lack of development of the paramesonephric system; absence of the uterus and mot of the vagina

Question 9

The MC congenital cervical anomalies are the result of what?

Answer 9

Malfusion of the paramesonephric ducts with varying degrees of separation; examples include didelphys cervix and septate cervix

Question 10

What are the characteristics of fibroids?

Answer 10

Spherical, well circumscribed, white firm lesions with a whorled appearance on cut sections; may degenerate and cause pain; may calcify especially if postmenopausal pts

Question 11

What are the signs of a leiomyoma upon a bimanual exam?

Answer 11

Can reveal an enlarged irregularly shaped uterus; if palpated mass moves with the cervix it is suggestive of a fibroid uterus; the degree of enlargement is described in week size used to estimate equivalent gestational size

Question 12

What are the signs of a leiomyoma on an US?

Answer 12

Can help distinguish between adnexal masses and lateral leiomyomas

Question 13

If endometrial cavity is entered for myomectomy future deliveries must be what?

Answer 13

C section

Question 14

If uterine tissue remains after a myomectomy, what may be warranted?

Answer 14

Hysterectomy

Question 15

What percentage of simple hyperplasia without atypia progresses to cancer?

Answer 15

1%

Question 16

What percentage of complex hyperplasia without atypia progresses to cancer?

Answer 16

3%

Question 17

What percentage of simple hyperplasia with atypia progresses to cancer?

Answer 17

9%

Question 18

What percentage of complex hyperplasia with atypia progresses to cancer?

Answer 18

27%

Question 19

What is Turner syndrome?

Answer 19

45 XO, associated with abnormal gonad development; small rudimentary streaked ovaries; develop secondary sexual characteristics but enter menopause shortly after

Question 20

What is complete androgen insensitivity syndrome/testicular feminization?

Answer 20

Lack androgen receptors, phenotypically female, gonads (functioning testes) need to be removed after puberty because of malignant potential

Question 21

What are some congenital anomalies of the ovaries?

Answer 21

Turner syndrome and androgen insensitivity

Question 22

How can DES affect the Fallopian tubes?

Answer 22

May lead to shortened, distorted or clubbed tubes

Question 23

What are the types of benign neoplastic ovarian tumors?

Answer 23

Epithelial, sex cord stromal and germ cell tumors

Question 24

What are the characteristics of epithelial ovarian tumors?

Answer 24

Derived from the mesothelial cells lining the peritoneal cavity and also the lining from the surface of the ovary

Question 25

Mucinous ovarian tumors cytologically resemble what?

Answer 25

The endocervical epithelium

Question 26

Serous ovarian tumors resemble what?

Answer 26

The lining of the Fallopian tubes

Question 27

Sex cord stromal ovarian tumors are derived from what?

Answer 27

From the sex cords stroma of the developing gonad

Question 28

What are the clinical features of benign ovarian tumors?

Answer 28

Often nonspecific and asx; enlarge very slowly, generally pain is mild to intermittent; can be painful if tumor twists on its pedicure (torsion) or rupture of cyst resulting in pain and peritoneal irritation

Question 29

What are some of the methods used to diagnose an ovarian tumor?

Answer 29

Abd and bimanual pelvic exam, US, tumor markers, laparoscopy

Question 30

How can US be used to diagnose benign ovarian tumors?

Answer 30

Looking for simple vs complex nature; can be helpful identifying dermoid cyst (can sometimes see a tooth like calcification)

Question 31

Which tumor marker can be used to dx benign ovarian tumors?

Answer 31

CA 125 serum marker esp in post menopausal women

Question 32

How can laparoscopy be used to diagnose benign ovarian tumors?

Answer 32

Can be helpful in distinguishing between uterine fibroids, ovarian tumors and hydrosalpinx; in general laparotomy is preferable to laparoscopy unless the mass can be removed without rupture

Question 33

How are ovarian neoplasms managed?

Answer 33

No persistent ovarian neoplasm should be assumed to be benign until proved by surgical exploration and path examination; if surgery is warranted collect pelvic washing for cytologic examination and obtain a frozen section for histologic dx; definitive tx depends on pt age and desire for future pregnancy

Question 34

What are the most benign conditions of the Fallopian tubes?

Answer 34

Most are infectious or inflammatory; hydrosalpinx and pyosalpinx

Question 35

What is hydrosalpinx?

Answer 35

Fluid filled tubes from previous infection

Question 36

What is pyrosalpinx?

Answer 36

Purulent filled tube from active infection

Question 37

What is an ovarian torsion?

Answer 37

The complete or partial rotation of the ovary on its ligamentous supports which often results in impedance of its blood supply; one of the MC gynecological emergencies

Question 38

What is an adnexal torsion?

Answer 38

When the ovary and Fallopian tube both twist

Question 39

What is the primary RF for an ovarian torsion?

Answer 39

An ovarian mass >5cm

Question 40

What is the classic presentation of an ovarian torsion?

Answer 40

Acute onset of unilateral pain, nausea and possibly vomiting

Question 41

How is a dx of ovarian torsion made?

Answer 41

US is first line imaging study to ID mass; definitive dx is made by direct visualization

Question 42

What is the tx for an ovarian torsion?

Answer 42

Detorsion and ovarian conservation with an ovarian cystectomy; salpingo-oophorectomy is performed if ovary is necrotic or you suspect malignancy