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Flashcards in pathology of the uterus Deck (189):
0

What is a Gartner's duct cyst?

Vaginal mass

remnant of mesonephirc duct

not in cervix, just in the vagina

1

What kind of mass is missed more than any other?

vaginal masses

2

If you had stool coming out of the vagina what would you find?

a vaginal/rectal fistula

3

What is the most common congenital abnormality of the female genital tract?

imperforate hymen

4

What does an obstruction of the uterus and/or vagina result in?

hydrometra (fluid)

hematometria (blood)

pyometra (pus)

5

what are the two solid cancers of the vagina?

vaginal adenocarcinoma

rhabdomyosarcoma

6

Are vaginal solid masses common?

no, they are rare

7

If you do see a soild mass in the vagina what might you see in the tissue?

solid mass occasionally with areas of necrosis

8

What kind of scan would you do if the Dr. thinks there is a vaginal mass?

translabial/trans peritoneal

9

Why is sonography used if a solid vaginal mass is found?

for staging

10

What is a vaginal cuff?

seen in hysterectomy patients

11

What is the size of a vaginal cuff?

< 2.1 cm

12

What would nodular areas in the vaginal cuff be from?

postirradiation fibrosis

13

Why would you scan the vaginal cuff?

suspicion for malignancy, especially in a patient who has previous history of cancer

14

what are adhesions?

scar tissue

adhere things that shouldn't be adhered together

15

What is the smallest amount of fluid in the pouch of douglas that can be detected by US?

5mL

16

What are pathologic fluid collection associated with?

ascites

blood resulting from ruptured ectopic pregnancy

hemorrhagic cyst

pus resulting from infection

17

Besides fluid, what else can occur in the pelvic cul-de-sac?

pelvic abscesses

hematomas

18

Are nebothian cysts benign or malignant?

benign

19

What is another name for nabothian cyst?

retention cyst

chornic cervicitis

20

What are the symptoms of nabothian cysts?

asymptomatic

21

How might cervical polyps clinically present?

with irregular bleeding

22

What does pedunculated mean?

projecting out of the cervix, or broad based

23

Will you always see cervical polyps?

maybe, depends on location

24

What kind of cervical myomas occur in the cervix?

small percentage of leiomyomas occur in the cervix

25

What are the symptoms of cervical myomas?

when small: asymptomatic

as mass enlarges: bladder or bowel obstruction may result

26

What is cervical stenosis?

an acquired condition

obstruction of cervical canal at internal or external os

27

What causes cervical stenosis?

radiation therapy

previous cone biopsy

postmenopausal cervical atrophy

chronic infection

laser or cryosurgery

cervical carcinoma





28

do menopausal patients have symptoms from cervical stenosis?

no

can cause a distended uterus from fluid

29

What are the symptoms of cervical stenosis of premenopausal women?

abnormal bleeding

oligomenorrhea

amenorrhea

cramping

dysmenorrhea

infertility


30

What is cervical Ca (carcinoma)?

squamous cell carcinma

31

What is the most common type of cervical Ca?

squamous cell carcinoma

32

What are the precursors of Cervical Ca?

cervical dysplasias

33

how are cervical dysplasias classified?

mild

moderate

severe

34

what is carcinoma in situ?

all of the cancer is localized...no evidence of spread

pre-stage I

35

When is cervical Ca called carcinoma in situ?

when full thickness of epithelium composed of undifferentiated neoplastic cells

36

What helps detect cervical ca?

Pap smears

most early lesions are asymptomatic

37

Which is more common cervical ca or endometrial ca?

endometrial

38

Who does cervical ca affect the most?

women of menstrual age

39

What is a clinical sign of cervical ca?

vaginal discharge or bleeding

40

What are the sonographic findings of cervical ca?

retrovesical mass

obstruction of ureters

invasion of bladder

41

how do you do a translabial or trasperineal sonogram?

5-7.5 MHz sector or curvilinear transducer

covered with a sterile probe cover

applied to vestibule of vagina - sagittal plane

42

What are the most common uterine calcificatons?

myomas

43

What arteries in the pelvis calcify?

arcuate arteries in the periphery of the uterus

44

What pelvic structure can mimic a "mass" on a physical exam?

the uterus

45

What is the size and shape of the uterus related to?

age

hormonal status

parity

46

What reasons would you have for an enlarged uterus?

pregnancy

postpartum

leiomyoma (fibroid)

adenomyosis

bicornuate or didelphic uterus

47

What are the uterine tumors?

leiomyoma benign

carcinoma (malignant)

48

What would an intrauterine pregnancy give you?

thickened endometrium

49

what does endometrial hyperplasia cause?

thickened endometrium

50

What does trophoblastic disease, endometritis and adhesions cause?

thickened endometrium

51

Polyps, inflammatory disease and endometrial carcinoma with do what to the endometrium?

thicken it

52

When an abortion is done, what would cause a thickened endometrium?

retained products of conception or an incomplete abortion

53

What is trophoblasitc disease?

when placenta is left in the endometrium after a pregnancy

54

What is inflammatory disease?

pus in the endometrium

55

Why might you find fluid in the endometrium?

endometritis

retained products of conception

pelvic inflammatory diesease

cervical obstruction

56

What mighth cause endometrial shadowing?

gas (abscess)

intrauterine device

calcified myomas or vessels

retained products of conception

57

what are the most common gynecological tumors?

leiomyomas

myomas

fibroids

all the same thing

58

What are 20%-30% of women over age 30 at risk for?

Leiomyomas

myomas

fibroids

more common in african american women

59

What does a leiomyoma look like?

spindle shaped

smooth muscle cells in a whorl like pattern

various amounts of fibrous connective tissue

60

Are leiomyomas hormonally influenced?

yes - grow with hormones

tend to shrink after menopause and become calcified

61

when does degeneration occur to leiomyomas?

when it outgrows its blood supply = calcification

62

What are the clinical indications of leiomyomas?

enlarged uterus

profuse and prolonged bleeding

pain

63

What are the different types of fibroids?

submucosal

intramural

subserosal

64

What is an intramural (aka: interstitial) fibroid?

within myometrium

most common type

may enlarge to cause pressure on adjacent organs

infertility or recurrent pregnancy loss

65

what is a subserosal fibroid?

arise from myometrium and project exophytically

may enlarge to cause pressure on adjacent organs

66

What are fibroids dependent on?

estrogen

67

What is suspicious in an postmenopausal woman when it comes to fibroids?

rapid increase in myoma size is suspicious for neoplasm

if not on hormone replacement therapy

68

What are pedunculated fibroids?

a fibroid on a stalk outside of the uterus

69

Which fibroid is the most common?

intraamural/interstital

70

How do you treat fibroids in the case of infertility?

it has to be subucosal.

surgery by myomectomy

71

in cases of menorrhagia, how is a fibroid treated?

hormonal suppression (least invasive)

endometrial ablation

uterine artery embolization (UAE)

high intensity focused ultrasound (HIFU)

72

What is the most common cause of uterine calcifications?

myomas

73

What is Monckebergs's arteriosclerosis?

calcium deposits are found in the tunica media of the walls of arteries

74

What is adenomyosis?

benign disease

is ectopic ocurrence of endometrial tissue within myometrium

more common in posterior aspect

75

How does an adenomyosis look on US?

presents as a bulky enlarged uterus without a focal mass

76

Is adenomyosis diffuse or focal?

both

77

What is another name for adenomyosis?

adenomyoma - referring to isolated implants that typically cause reactive hypertrophy of surrounding myometrium

78

What are the symptoms of 60% of women with adenomyosis?

hypermenorrhagia

menorrhagia

metrorrhea (irregular, acyclic bleeding)

79

What is the most common presentation on US of extensive andenomyosis?

diffuse uterine enlargement

thickening of posterior myometrium

indistinct border between endometrium and myometrium

myometrial cysts

80

What are adenomyomas?

hemorrhage in islands of endometrial tissue appears as small hypoechoic myometrial cysts

looks like Swiss cheese or honeycomb pattern

81

What are arteriovenous malformations?

a connection between and artery and vein that is abnormal

no capillaries...direct connection

venous and arterial flow in one vessel

82

What is Uterine arteriovenous malformations (AVMs)?

consist of vascular plexus of arteries and veins without intervening capillary network

83

What does teratogenic mean?

aquired

84

How does one get AVM?

congenital or teratogenic

due to pelvic trauma, surgery or gestational trophoblastic neoplasia

85

What clinical symptoms would a woman with AVM have?

women of childbearing years have metrorrhagia with blood loss and anemia

86

if an AVM is cut into during a dilation and curettage (D&C)what can happen?

life threatening, catastrophic hemorrhaging

87

What are sonographic findings of AVM?

serpiginous (creeping or crawling) anechoic structures seen within the pelvis

88

What does spectral doppler show with an AVM?

high velocity, low resistance

arterial flow coupled with venous flow

89

What is a uterine leiomyosarcoma?

rare, solid tumor arising from myometrium or endometrium

90

Where is a leiomyosarcoma commonly found?

in fundus of the uterus

91

What is the most common age for uterine leiomyosarcoma?

40-60 years old

92

What is the sonographic finding for leiomyosarcoma?

may resemble myomas or endometrial carcinoma with features of solid or mixed-solid and cystic texture

93

What is the cervical canal?

from the internal os to the external os

94

What benign condition arises from hyperplastic protrusion of epithelium of endocervix or ectocervix?

Cervical Polyps

95

What is the most likely factor for cervical polyps?

chronic inflammation

96

What are the two most likely ways you would find/describe cervical polyps?

Pedunculated (projecting out of the cervix)

broad based

Depending on location may or may not be seen

97

Who are most likely to develop cervical polyps?

women in late middle age

98

what enhances visualization of of cervical myomas?

fluid infusion with sonoysterography

99

How does sonography assist with a Pedunculated cervical myoma?

by determining the location and thickness of the stalk

It's possible it may prolapse into the vagina

100

If you have already scanned translabial in the sagittal plane, what do you do for your second plane?

rotation of transducer obliquely in counterclockwise direction shows coronal images

101

When does fibrosis occur with a leiomyoma?

after atrophic or degenerative changes

102

how does a leiomyoma clinically present?

uterine irregularity and enlargement

pelvic pressure and pain

irregular bleeding (menometrorrhagia)

heavy bleeding (menorrhagia)

may contribute to infertility

103

What is a less common cause of uterine calcifications?

arcuate artery calcification in periphery of uterus

104

What can indicate underlying disease like diabetes mellitus, hypertension or chronic renal failure?

Calcifications in the the tunica media of arteries

105

What is the landmark for the long axis of the uterus?

endometrium

106

what percentage of patient with adenomyosis also suffer from dysmenorrhea?

25%

107

What two uterine conditions often appear together?

fibroids and andomyosis

108

On US how do adenomyomas present?

fluid nature of lesions produce increased posterior acoustic enhancement rather than the degree of attenuation normally seen posterior to uterus.

109

do you typically find arteriovenous malformations usually involve the myometrium or the endometrium?

These are rare

usually myometrium

110

How do uterine AVM's appear on US?

can be subtle like:

myometrial inhomogeneity

tubular spaces within myometrium

intramural uterine mass

endometrial or cervical mass

prominent parametrial vessels

111

Why would you use color doppler on an AVM?

to show blood flow within anechoic structures

may be florid-colored mosaic pattern with apparent flow reversals and areas of color aliasing

112

What does spectral doppler show in an AVM?

High-velocity/ low resistance arterial flow COUPLED with high velocity venous flow with arterial component

113

What is a sarcoma botryoides?

type of uterine leiomyosarcoma

very rare condition in children characterized by grapelike clusters of tumor mass

114

When would concern about development of malignancy occur for solid uterine masses?

When a solid uterine mass rapidly enlarges in a perimenopausal or postmenopausal patient.

115

What are some endometrial pathologies that can cause abnormal bleeding, especially in the postmenopausal patient?

hyperplasia

polyps

carcinoma

116

When a patient is receiving tamoxifen therapy for breast cancer, what other disorder can that cause?

disorders of the endometrium

117

How is tamoxifen used to treat some forms of breast cancer?

tamoxifen is a partial estrogen receptor antagonist used in postmenopausal women with estrogen receptor positive breast cancer.

118

What is a sonohysterography?

saline infused sonography [SIS]

119

What is sonohysterography used for?

valuable for further evaluating abnormally thickened endometrium

by distending endometrial cavity with saline, endometrial growths and abnormalities can be distinguished

120

In premenopausal women when is a sonohysterography performed?

mid-menstrual cycle

usually between days 6-10

121

When is a sonohysterography not performed?

when the patient has acute pelvic inflammatory disease

122

When doing a sonohysterography, when would you give a patient prophylactic antibiotics?

given with chronic pelvic inflammatory disease

women with hx of mitral valve prolapse

cardiac disorders

123

What is endometrial hyperplasia?

occurs when the endometrium becomes too thick

124

When does endometrial hyperplasia occur?

follows prolonged unopposed estrogen stimulation

125

What could be a precursor of endometrial cancer?

endometrial hyperplasia

126

What is the most common cause of of pre and post menopausal abnormal bleeding in women?

endometrial hyperplasia

127

What does an atrophic endometrium measure?

thin- measures <5mm

128

What are the measurements for endometrial thickness with hyperplasia?

Premenopausal >14mm

asymptomatic postmenopausal >8mm

symptomatic postmenopausal >5mm

129

If the uterus is present, what is associated with increased risk for enometrial hyperplasia or carcinoma?

unopposed estrogen - Premarin

130

What produces endometrial atrophy after 3-6 months?

continuous/combined estrogen and progesterone (Premarin and Provera)

131

If you take continuous/combined estrogen and progesterone like Premarin and Provera, are you at risk endometrial ca?

usually no risk

132

What symptoms do women if they have sequential estrogen and progesterone (Premarin first half, Provera second half)

women have predictable withdrawal bleeding at the end of each month

133

What are the benefits of estrogen?

alleviates menopausal symptoms

reduces risk of osteoporosis, vertebral and hip fractures

reduces risk of heart attacks, strokes

134

what are the benefits of progesterone?

produces endometrial atrophy

reduces risk of endometrial hyperplasia and Ca.

135

What are the negative effects of estrogen?

increases risk of endometrial hyperplasia and cancer

136

What are the negative effects of progesterone?

increases risk of breast cancer

causes irritability, depression, breast tenderness

137

What are enodmetrial polyps?

histologically: polyps are overgrowths of endometrial tissue covered by epithelium

138

How do patients with endometrial polyps present?

my be asymptomatic

may have uterine bleeding

139

During what phase of the month would endometrial polyps appear?

toward the end of the luteal phase

140

What would the endometrium look like if there were endometrial polyps?

represented by a hypoechoic or isoechoic region within hyperechoic endometrium

initally may appear as nonspecific echogenic endometrial thickening

141

What can sonographically appear as diffuse or focal, round echogenic mass within the endometrial cavity?

endometrial polyps

should see a feeding artery to the polyp

142

What is endometritis?

an infection within the endometrium of the uterus

143

What may be an indication of endometritis?

endometrial thickening

fluid

144

When does endometritis most often occur?

in association with PID

postpartum state

following instrumentation of uterus

145

In patients with a pelvic infection, what is a conduit for infectious spread to tubes and adnexa?

the uterus

146

When might postpartum patients develop endometritis?

after prolonged labor

vaginitis

PROM

retained products of conception

147

What are the clinical symptoms of endometritis?

patient has intense pelvic pain

148

How does endometritis appear sonographically?

endometrium appears prominent, irregular or both with small amount of endometrial fluid

149

What would you find in the cul-de-sac of a patient with endometritis?

pus or echogenic particles/debris

150

On US with a patient with endometritis, what might the ovaries look like?

enlarged ovaries with multiple cysts and indistinct margins seen secondary to periovarian inflammation

151

In a patient with endometritis how do the Fallopian tubes appear sonographically?

dilation of Fallopian tubes show fluid filled tubular shapes

folded configuration

well defined echogenic walls

152

What is a thickened tubal wall, 5mm or more, indicative of?

acute endometritis disease

153

How do you tell the difference between bowel and infected Fallopian tubes?

gentle compression on pelvic wall to look for peristalsis or movement in bowel lumen

154

What is a tubo-ovarian complex?

as infection worsens, periovarian adhesions may form and fuse inflamed tube and ovary

155

How does a tubo-ovarian abscess appear?

appears as complex multiloculated mass with septations

irregular shaggy margins

scattered internal echoes

156

What are some clinical signs of endometritis?

low back pain and fever

lower abd pain

dysmenorrhea

menorrhagia

sterility

constipation

157

What is synechiae?

endometrial adhesions (asherman's syndrome)

158

When might you find synechiae?

found in women with posttraumatic or postsurgical histories

includes uterine curettage

159

What conditions might synechiae cause?

infertility

recurrent pregnancy loss

160

How does synechiae appear sonographically?

bright echoes within endometrial cavity

in a gravid uterus: appear as hyperechoic band traversing uterus from anterior to posterior

161

During what phase is synechiae best seen?

secretory phase when endometrium is more hyperechoic

typically need fluid distending the endometrial cavity to diagnose

162

What is the most common gynecologic malignancy in North America?

Endometrial Carcinoma

163

What stage of life do you see the most endometrial carcinoma?

postmenopausal patients

164

what is the most common clinical presentation of endometrial carcinoma?

uterine bleeding

165

What percentage of postmenopausal women with uterine bleeding have endometrial carcinoma?

10%

166

What are the risk factors for endometrial carcinoma?

replacement estrogen therapy

Premenopausal women:

anovulatory cycles

obesity

167

What is the earliest change of endometrial carcinoma?

thickened endometrium

168

How can a transvaginal examination be helpful in screening for early changes of endometrial hyperplasia or carcinoma?

by accurately measuring endometrial thickness

169

Sonographically, thickened endometrium (>4 to 5mm) must be considered ______ until proved otherwise.

cancer

170

what is clear evidence for endometrial carcinoma?

demonstration of myometrial invasion

171

How does TV scanning demonstrate myometrial invasion?

thickening and irregularity of central endometrial interface

with echogenic or hypoechoic patterns

combined with infiltration of hyperdense structures in mymetrium

172

A sonographic finding of enlarged uterus with irregular areas of low-level echoes would be consistent with what?

endometrial carcinoma

173

if endometrail carcinoma obstructs the endometrial canal, what could the result be?

hydrometra

hematometra

174

What does the intactness of subendometrial halo (inner layer of myometrium) usually indicate?

superficial invasion (as relates to endometrial carcinoma)

175

What does obliteration of subendometrial halo indicate?

deep invasion of myometrium (as it relates to endometrial carcinoma)

176

When do SMALL endometrial fluid collections occur?

small fluid collections also occur with:

ectopic pregnancy

endometritis

degenerating myomas

recent abortion

177

obstruction of _____________ results in accumulation of secretions, blood, or both in uterus..

cervical os

178

before menstruation, accumulation of secretions is referred to as what?

hydrometrocolpos

179

Following menstruation, hematometrocolpos results from what?

presence of retain menstrual blood

180

When a patient has a large collection of endometrial fluid and a fever, what does that suggest?

infection of blood collection

lab results would show elevated wbc count

181

What would a patient with large endometrial fluid collections typically complain about?

abd pain

has enlarged abd mass

182

When is pyometra more likely to occur?

with uterine cancer

183

What might an abnormal development of vagina or uterus result in?

cystic uterine or vaginal collection of mucus in children

when menstruation begins collection consists of blood

184

how do large collections of fluid present sonographically?

centrally cystic

round

moderately enlarged uterus

may contain echogenic material if pus or blood present

185

What are the two most commonly used IUCD's?

Paraguard (t-shaped flexible plastic wrapped in copper)

Mirena (t-shaped flexible plastic that releases low amts of progestin)

186

What is a copper-releasing IUD?

ParaGard

remain in uterus up to 10 years

copper ions are toxic to sperm

187

What is a progestin-releasing IUD?

Mirena

remain in uterus up to 5 years

levonorgestrel impairs sperm motility and viability

188

what is hypertrophy?

excessive development of an organ or part

increase in by by thickening of muscle fibers