Gynae New Flashcards
What makes up the Mullerian and Wolffian ducts?
Mullerian
Uterus
Falloipan tubes
Upper 2/3 vagina
Wolffian Ducts
Vas deferens
Seminal vesicles
Epididymis
What are the 3 features of Mullerian agenesis (Mayer-Rokitansky Syndrome)
- Vaginal atresia
- Absent or rudimentary uterus (unicornate or bicornate)
- Normal ovaries
Can have renal agenesis or ectopia in 50% of cases
What is a Unicornate uterus?
Where a person has only half of a uterus
What is the significance of a rudimentary horn?
Unicornate uterus can have a communicating or non communicating rudimentary horn
Can put patient at increased risk of miscarriage and phantom belly pain
OPPOSITE SIDE Renal agenesis is associated with Unicornate uterus
Complete uterine duplication (2 cervixes, 2 uterus, 2 upper third vagina)
What is this called?
Uterus didelphys
What is Bicornuate uterus?
What are 2 main types
Bicornate is where uterus has 2 sides rather than one cavity - it will be shaped as a heart
Bicornate unicollis = 1 cervix
Bicornate bicollis = 2 cervixes
Increased risk of fetal loss but less so than septate
Two endometrial canals separated by fibrous septum
What is it?
Septate uterus
Increased risk of infertility and spontaneous abortion
-This is partly due to poor blood supply to septum (poor implantation as a result)
What is arcuate uterus?
Has this any significance?
No clinical significance
This is a smooth concavity at fundus of uterus
Normal variant
Bicornate vs septate summary
Nodular scarring of fallopian tubes involving proximal 2/3
What is this?
What is it associated with?
Salpingitis isthmica Nodosa
-Unknown etiology but possible due to STIs
Associated with infertility and ectopic pregnancy
Uterine AVMs
Name 3 acquired causes
- Multiple pregnancies
- Previous dilatation and curettage
- C sections
- Previous abortions
Multiple intrauterine adhesions
What is this?
What causes it?
Ashermans
Caused by prior injury - infection/surgery
HSG - non filling of uterus OR multiple linear filling defets
MRI - T2 dark bands
Previous GU TB can be a cause
Most common type of fibroid degeneration?
Hyaline most common
Fibroid outgrows blood supply
Migration of endometrial tissue into the myometrium
Bright cytic foci with thick junctional zone on MRI
What is this?
Who is it seen in?
Adenomyosis
Usually seen in multiparous women, especially if history of uterine procedures
-Uterine enlargement (esp posterior wall)
-Spares cervix
MRI - thickening of the junctional zone to >12mm is classic <5mm is normal
The findings of small high T2 signal regions is NORMAL and represents cystic change
Endometrial thickening >5mm in post menopausal lady
What to do?
If <5mm this is normal and probably atrophy
If >4-5mm = could be cancer = needs sampled
Does Tamoxifen increase or decrease risk endometrial cancer?
Increases risk of endometrial cancer
Blocks oestrogen in breast but encourages in pelvis
-Subendometrial cysts can be seen
-Endometrial polyps can also be seen
What type of cancer are Uterine cancers?
They are all adenocarcinoma
Stages of endometrial cancer
Stage 1 - limited to body of uterus
Stage 2 - Invasion of cervical stroma
Stage 3 - Local or regional spread
a-serosa
b-vaginal/parametrium
c-pelvis or para-aortic nodes
Stage 4 - involvement of rectum or bladder or distal mets
Cervical cancer - what type is it?
Staging?
Squamous cell cancer
Related to HPV in 90%
THings to know
Stage IIb = parametrial involvement and therefore only chemo/radiation available. NO SURGERY
Below Stage IIa = surgery
Fibrous band that separates supravaginal cervix from the bladder
Parametrium
Extends between layers of broad ligament
-Uterine artery runs inside the parametrium therefore need for chemo
How to tell if involvement of parametrium?
Normally there is a T2 dark ring around cervix
If this is disrupted = parametrial invasion
Most common cancer of the vagina?
HPV related SCC
Mets Trivia:
-A met to the vagina in the anterior wall upper 1/3 is “always” (90%) upper genital tract.
-A met to the vagina in the posterior wall lower 1/3 is “always” (90%) from the GI tract.
*Clear Cell Adenocarcinoma - can be seen in women whose mothers took synthetic oestrogen (DES) in the 1940’s *
Cyst along the anterior lateral wall of the upper vagina - causing urinary symptoms
Gartner Duct cysts
These can cause mass effect on urethra
Normal ovarian volume pre and post menopausal
Up to 15ml pre
Up to 6ml post
Ectopic vs Corpus luteum cyst on US
Appearance of cystadenocarcinoma on imaging?
Large cystic adnexal mass with significant solid component and septations. Unilocular
Can be bilateral
Mucinous Ovarian Cystadenocarcinoma
3rd most common
Large multiloculated mass. Rare but malignant
Low level echoes present on US (due to mucin)
Can get Pseudomyxoma peritoneii
Associated with smoking
Differentials for BIG pelvic/abdominal mass in Adults
Ascites, pleural effusion, ovarian tumour
What is it?
Meigs Syndrome
Tumour is a benign ovarian fibroma
These tumours are seen in middle ages women
US - hypoechoic
MRI - Low T1, Low T2, peripheral rim of low T2 signal
What are Struma ovarii tumours?
Type of teratoid tumour that contains thyroid tissue
Think of this when mention of hyperthryoid and INTENSELY enhancing solid component in ovarian cystic tumour
Low T2 in the cystic areas due to COLLOID
First trimester US showing uterus filled with a highly vascular mass and snow storm appearance
Complete Hydatiform Mole (fertilization of an egg thats lost its chromosomes)
-No fetus
-Will have marked elevation of HCG
-Diploid karyotype
In second trimester scan = seen as multiple cysts (bunch of grapes)
Placenta Creta
What are types?
This is abnormal insertion of the placenta which invades myometrium
RIsk Factos
-Prior c section
-Placenta praevia
Accreta: placenta attaches to myometrium without invasion
Increta: placenta partially invades myometrium
Percreta: placenta penetrates through myometrium and serosa. Can sometimes invade bowel
Concerning features for DOWNS on US
Cervical Ca
Placenta Variations
This is an additional lobule separate from the main bulk of the placenta. The significance of this variant is the rupture of vessels connecting the two components or retention of the accessory lobe with resultant post-partum haemorrhage.
Circumvallate placenta has a chorionic plate smaller than the basal plate, with associated rolled placental edges. There is known to be an increased risk of placental abruption and haemorrhage with this type of placenta.
A bilobed placenta is a placenta with two evenly sized lobes connected by a thin bridge of placental tissue. This has no known increased risk of morbidity.
