M1: Uterine Pathology

Question 1

the caudal ends of the Mullerian duct fuse for form which structures

Answer 1

the uterus, cervix, upper vagina

Question 2

the unfused cranial ends of the mullerian ducts form which structures

Answer 2

fallopian tubes

Question 3

review flash cards on mullerian duct abnormalities

Answer 3

/

Question 4

what is a prolapsed uterus

what causes it

Answer 4

descent of the uterus down into the vagina

weak pelvic floor muscles

Question 5

how is a prolapsed uterus diagnosed

Answer 5

clinically

Question 6

what is asherman’s syndrome

Answer 6

when the endometrial lining is replaced by fibrous adhesions… it is considered a scar in the uterus

Question 7

what causes asherman’s syndrome

Answer 7

previous D&C, multiple abortions or infection

Question 8

how does asherman’s syndrome look on US

Answer 8

appearances vary… endo can be thick or thin, have cystic areas

Question 9

what does asherman’s syndrome cause

Answer 9

loss of periods and infertility

Question 10

what are AV malformations of the uterus

Answer 10

rare malformations where a uterine vain and artery anastomose

Question 11

what are the causes of AV malformations of the uterus and what are the symptoms

Answer 11

congenital
trauma
surgery

menorrhagia (excessive bleeding during periods)

Question 12

can you see AV malformations only using 2D scanning?

Answer 12

hard to see…. need to use doppler

Question 13

how will the doppler of an AV malformations appear

Answer 13

chaotic flow

Question 14

what is endometrial hyperplasia

what causes it

Answer 14

a large, thick endometrium

excessive estrogen production from ovarian dysfunction

Question 15

when is it most likely for endometrial hyperplasia to occur

Answer 15

immediately after menarche and before menopause (during premenopause)

Question 16

how will endometrial hyperplasia effect uterine bleeding

Answer 16

heavy bleeding… often continuous bleeding

Question 17

what is the US appearance of endometrial hyperplasia

Answer 17

thick, hyperechoic endo

can effect most of the endometrium, or it can be focal or nodular

Question 18

what is the DDX for endometrial hyperplasia

Answer 18

endometrial cancer or polyps

Question 19

the endo should be smaller than what value

Answer 19

14mm

Question 20

how thick should the endo be in the proliferative and secretory phase

post menopausal thickness?

Answer 20

sec: 7-14 mm
pro: 4-8 mm

post m: < 5mm… if > 5mm, investigate for endo cancer

Question 21

when is the best time for a reproductive female patient to have a pelvic US… why?

Answer 21

~ days 7-9 in their cycle… during the proliferative phase…. so that the endo is thin and its less likely that pathology will be missed

Question 22

what are endometrial polyps

Answer 22

endometrial growths extending into the endo canal from a stalk… if long enough they may protrude into the cervix

Question 23

what are symptoms of endometrial polyps

Answer 23

bleeding, or asymptomatic

Question 24

how do endometrial polyps appear on US

Answer 24

thick, hyperechoic endometrium

Question 25

what is the DDX for endometrial polyps

Answer 25

endo cancer or endo hyperplasia

Question 26

when are polyps easily missed on US

Answer 26

when the endo is thick... can cause polyps to blend in

Question 27

what will colour doppler of an endometrial polyp look

Answer 27

will see a stock entering the polyp light up with colour

Question 28

what is a sonohystergram

Answer 28

a type of US where a catheter is inserted into the uterus and saline is injected to fill it will fluid to help identify polyps

Question 29

what is adenomyosis

Answer 29

the extension of endometrial tissue, including glands and stroma, beyond the endometrium into the myometrium

Question 30

adenomyosis is a form or what other type of condition

Answer 30

endometriosis

Question 31

how does adenomyosis appear on US

Answer 31

- the junction of the endo and myo is less pronounced - diffuse uterine enlargement - hypoechoic or cystic lesions in the myom - may have focal lesions or look like a fibroid or polyp - myom of unequal thickness (endo not in the middle of the uterus) - venetian blind appearance (multiple lines shadowing in the post. aspect of the uterus in the myom)

Question 32

where does adenomyosis usually occur in the uterus

Answer 32

the posterior wall of the uterus

Question 33

symptoms of adenomyosis

Answer 33

pain and abnormal bleeding

Question 34

where are prominent arcuate vessels found how can you differentiate them from cysts

Answer 34

around the periphery of the uterus.. use colour to R/O cysts

Question 35

where are uterine varices often found how can you differentiate them from an ovary

Answer 35

on the lateral aspect of the uterus... they are enlarges vessels colour doppler

Question 36

what is endometritis when does it often occur

Answer 36

inflammation of the endo postpartum or w/ PID

Question 37

how does endometritis appear on US

Answer 37

- normal endo - irregular endo - fluid filled cavity - gas bubbles from microorganisms

Question 38

what are leiomyomas

Answer 38

fibriods... benign neoplastic masses of fibromuscular tissue

Question 39

what is the most common type of tumor in the female pelvis

Answer 39

leiomyomas... 40% of females over 35

Question 40

leiomyomas are most common in which demographic

Answer 40

african american women

Question 41

what can effect the size and growth of leiomyomas

Answer 41

hormones, mostly estrogen effected by pregnancy and menopause

Question 42

what is a maligant leiomyoma called

Answer 42

leiomyosarcoma (rare cancer)

Question 43

symptoms of leiomyomas

Answer 43

menorrhagia pain or pressure palpable mass infertility

Question 44

what are the 3 classifications for leiomyomas

Answer 44

Intramural submucosal subserosal

Question 45

describe an intramural leiomyoma

Answer 45

confined to the myom | most common

Question 46

describe an submucosal leiomyoma

Answer 46

projects into the uterine cavity can be pedunculated can cause bleeding

Question 47

describe an subserosal leiomyoma

Answer 47

projects from perimetrium can be pedunculated can be found in the broad ligament

Question 48

for which type of leiomyoma should you always do a TA before an EV

Answer 48

subserosal leiomyoma because it can be high above the fundus

Question 49

what are the US features of a leiomyoma

Answer 49

- hypoechoic w/ lots of attenuation - enlarged uterus w/ irregular contour - calcifications may be seen in older women - can be complex w/ degeneration and necrosis

Question 50

how can fibroids effect pregnancy

Answer 50

if they are fast growing they can lead to a lack of adequate blood supply which leads to necrosis... ...if there's a large fibroid near the cervix it inhibits delivery of the fetus and a C section is needed

Question 51

what is a lipoleiomyoma are they common

Answer 51

benign tumor made out of fat and fibromuscular tissue no

Question 52

how to lipoleiomyomas appear on US

Answer 52

very hyperechoic and attenuating | appear similar to dermoids

Question 53

what are the 2 malignant uterine neoplasias

Answer 53

leiomyosarcoma | endometrial carcinoma

Question 54

what is a leiomyosarcoma is it common

Answer 54

a cancerous fibroid that MAY arise from an existing fibroid... rare

Question 55

what are the symptoms of a leiomyosarcoma

Answer 55

menorrhagia pain or pressure palpable mass infertility (same as a normal fibroid)

Question 56

what is the US appearance of a leiomyosarcoma

Answer 56

- degenerative fibroid appearance | - may see local invasion of surrounding organs or hepatic mets

Question 57

describe endometrial carcinoma is what group of women does it most commonly occur?

Answer 57

an endometrial cancer that accounts for 90% of all uterine malignancies in post menopausal women

Question 58

what are the symptoms of endometrial carcinoma

Answer 58

postmenopausal bleeding

Question 59

what are the stages of endometrial carcinoma

Answer 59

1. Confined to endometrium 2. Confined to uterus 3. Spread beyond the uterus, but confined to the pelvis 4. Distal mets (i.e. liver)

Question 60

what risk factors are associated with endometrial carcinoma

Answer 60

- estrogen therapy/HRT (strong association) - obesity - hypertension - diabetes - polycystic overian syndrome (PCOS) - granulosa cell tumors of the ovary

Question 61

what is the US appearance of endometrial carcinoma

Answer 61

thick echogenic endometrium that's difficult to distinguish from hyperplasia or polys

Question 62

what is tamoxifen | what is it used for

Answer 62

a non-steroidal, anti-estrogen hormonal drug... it opposes estrogen in the uterus and results in the stimulation of the endometrium used to treat breast cancer

Question 63

what is the risk of using tamoxifen

Answer 63

it increases the risk of endo cancer by 1%... but benefit for breast cancer treatment outweighs the risk

Question 64

how will the endo appear when the patient is taking tamoxifen?

Answer 64

heterogenous and bizarre