Pathology of Uterine Structures Ch 43 Flashcards
(148 cards)
1
Q
Most common congenital abnormality of female genital tract is
A
imperforate hymen resulting in obstruction.
2
Q
Obstruction of uterus and/or vagina may result in:
A
- hydrometra
- hematometra
- pyometra
3
Q
Hydrometra
A
accumulation of fluid
4
Q
Hematometra
A
accumulation of blood
5
Q
Pyometra
A
accumulation of pus
6
Q
Solid masses are
A
rare in vagina
7
Q
Most common vaginal masses are
A
adenocarcinoma and rhabdomyosarcoma
8
Q
Solid mass with possible areas of
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necrosis
9
Q
adenocarcinoma and rhabdomyosarcoma are best seen with
A
translabial scanning approach
10
Q
Vaginal cuff seen in
A
post-surgical hysterectomy patients.
11
Q
Upper size limit of normal vaginal cuff is
A
2.1 cm.
12
Q
If cuff is larger or contains well-defined mass or areas of high echogenicity,
A
it should be regarded with suspicion for malignancy, especially in patient who
has previous history of cancer.
13
Q
Nodular areas in vaginal cuff may be due to
A
postirradiation fibrosis.
14
Q
Rectouterine Recess (Posterior Cul-De-Sac) AKA
A
Pouch of Douglas
15
Q
Rectouterine Recess (Posterior Cul-De-Sac) frequent site for
A
intraperitoneal fluid collections
16
Q
Fluid in cul-de-sac is a
A
normal finding in asymptomatic women and can be seen
during all phases of menstrual cycle.
17
Q
Pathologic fluid collections may be associated with
A
ascites, blood resulting from
ruptured ectopic pregnancy, hemorrhagic cyst, or pus resulting from infection.
18
Q
Pelvic abscesses and hematomas can also occur in the
A
cul-de-sac.
19
Q
Benign Cervical Pathology
A
- Nabothian cysts
- cervical polyps
- Leiomyoma (Fibroid)
- Cervical Stenosis
20
Q
Cervical polyps arises from
A
hyperplastic protrusion of epithelium of endocervix or ectocervix
21
Q
Cervical polyps may be
A
pedunculated, projecting from cervix, or broad-based
22
Q
Cervical polyps ultrasound does not
A
always detect
23
Q
cervical polyps more prevalent in
A
late middle-aged women
24
Q
Leiomyoma (Fibroid) small percentage occur in
A
cervix
25
U/S may assist in determining
location, size, etc.
26
Sonohysterography with leiomyoma (fibroid) may enhance
visualization
27
Cervical Stenosis
a cquired condition
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cervical stenosis obstruction of cervical canal at internal or external os resulting from
- Radiation therapy
- Previous cone biopsy
- Postmenopausal cervical atrophy
- Chronic infection
- Laser or cryosurgery
- Cervical carcinoma
29
intracavitary fluid collections can be
readily seen on ultrasound and may be indirect indicator of cervical stenosis.
30
Menopausal patient with cervical stenosis may be
asymptomatic even though stenosis can produce a distended, fluid-filled uterus
31
Premenopausal patients with cervical stenosis may experience
abnormal bleeding, oligomenorrhea,
amenorrhea, cramping, dysmenorrhea, or
infertility.
32
Squamous cell carcinoma is the most common type of
cervical cancer.
33
Cervical Carcinoma precursors are
cervical dysplasias (mild, moderate, severe)
34
When full thickness of epithelium composed of undifferentiated neoplastic cells, lesion referred to as
carcinoma in situ
35
Detection of these abnormalities attributed to screening with
Papanicolaou (Pap) smears because most early lesions are asymptomatic
36
Advanced cervical cancer usually evident
clinically
37
cervical carcinomas affects
women of menstrual age
38
Clinical findings of cervical carcinoma
vaginal discharge or bleeding
39
Sonographic findings of cervical carcinoma
retrovesical mass, obstruction of ureters, invasion of bladder
40
Translabial or Transperineal Sonography
- 5.0- to 7.5-MHz sector or curvilinear transducer is covered with sterile
probe cover and applied to vestibule of vagina in sagittal plane.
- Partial bladder filling may assist visualization of cervical area.
- Sagittal and Transverse
- Positioning patient with hips elevated, as in transvaginal approach, helps
displace pelvic gas and identify anatomy.
41
normal variations of uterus
- Bicornuate
- Didelphic
- Septate
- Arcuate
- Unicornuate
42
most common normal variations of uterus is
- Bicornuate
- Didelphic
- Septate
43
Leiomyomas (Fibroids) occurring in
about 20-30% of women over the age
of 30.
44
Leiomyomas (Fibroids) more prevalent in
African American women.
45
Leiomyomas (Fibroids) variable amounts of
fibrous connective tissue
46
47
degeneration occurs when a fibroid
outgrows their blood supply, calcifications may be seen
48
Clinical Findings of fibroids
enlarged uterus, patterns of irregular bleeding or heavy menstrual bleeding, pain, sensation of pelvic pressure
49
fibroids may contribute to infertility by
distorting fallopian tube or endo cavity
50
Most Common gynecological tumor,
Leiomyomas (Fibroids)
51
Myomas are
estrogen-dependent
52
fibroids may
increase in size during pregnancy.
53
fibroids rarely develop in
postmenopausal women; most stabilize or decrease in size following
menopause because of lack of estrogen stimulation
54
fibroids may increase in size for patients
undergoing hormone replacement therapy
55
fibroids rapid increase in fibroid size may be
suspicious for neoplasm, especially in postmenopausal women
56
Uterine Locations of Myomas
- Submucosal
- Intramural
- Subserosal
- Pedunculated
- Intracavitary
57
Submucosal
displacing or distorting endometrial cavity with subsequent irregular or heavy menstrual bleeding
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Intramural
confined to myometrium; most common type
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Subserosal
projecting from peritoneal surface of uterus, may enlarge and cause pressure on adjacent organs
60
Pedunculated
can appear as extrauterine masses with stalk arising from uterus
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Intracavitary
usually pedunculated and confined to endometrium
62
In cases of infertility and submucosal myomas,
myomectomy (surgical removal
of fibroid) is often the preferred treatment.
63
In cases of menorrhagia, possible treatments of fibroids are
- Least invasive treatment is hormonal suppression to stop the bleeding
- Endometrial ablation
- Uterine artery embolization (UAE)
- High intensity focused ultrasound (HIFU)
64
most common cause of uterine calcifications.
fibroids
65
Less common uterine calcifications
arcuate artery calcification at periphery of
uterus
66
uterine calcifications are thought to occur as
consequence of calcific sclerosis within these vessels
67
uterine calcifications can indicate
underlying disease, such as diabetes mellitus,
hypertension, or chronic renal failure
68
Adenomyosis is the
ectopic occurrence of endometrial tissue within myometrium; more common in posterior aspect
69
Adenomyosis is
- Benign disease
- Diffuse or focal
70
Adenomyosis sonographically presents as
- bulky enlarged uterus without focal mass
- heterogeneous uterus
- thickening of posterior myometrium
- myometrial cysts
71
Hemorrhage in islands of endometrial tissue appears as
small hypoechoic myometrial cysts.
72
73
Fluid nature of lesions produces
increased posterior acoustic enhancement rather than the degree of attenuation normally seen posterior to uterus.
74
Focal adenomyosis sometimes called
adenomyoma, referring to isolated implants that typically cause reactive
hypertrophy of surrounding myometrium
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implants produce
diffuse uterine enlargement
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estimated 60% women with adenomyosis experience
- Abnormal excessive uterine bleeding (hypermenorrhea)
- Prolonged/profuse uterine bleeding (menorrhagia)
- Irregular, acyclic bleeding (metrorrhea)
77
Approximately 25% of patients with adenomyosis also suffer from
pelvic pain during menstruation
(dysmenorrhea).
78
Uterine arteriovenous malformations
(AVMs) consist of
vascular plexus of arteries and veins.
79
Arteriovenous Malformations
Rare; usually involving myometrium and
rarely endometrium
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Arteriovenous Malformations are
Congenital or acquired due to pelvic trauma,
surgery, or gestational trophoblastic
neoplasia
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Clinically Arteriovenous Malformations women of childbearing years have
metrorrhagia with blood loss and anemia.
82
Arteriovenous Malformations diagnosis critical because
dilation and curettage may lead to catastrophic hemorrhaging.
83
Arteriovenous Malformations:
Sonographic Findings
- Tortuous, anechoic structures seen within the pelvis.
- Uterine AVMs may appear as subtle myometrial inhomogeneity, tubular spaces within myometrium, intramural uterine mass, endometrial or cervical mass, and sometimes as prominent parametrial vessels.
- Color Doppler is diagnostic to show blood flow within anechoic structures.
- May be florid-colored mosaic pattern with apparent flow reversals and areas of color aliasing.
- Spectral Doppler shows high-velocity, low-resistance arterial flow coupled with high-velocity venous flow with arterial component.
84
Uterine Leiomyosarcoma
Rare, solid tumor arising from myometrium or endometrium
85
Uterine Leiomyosarcoma commonly in
fundus of uterus
86
Uterine Leiomyosarcoma most common in
women 40 to 60 years of age
87
Uterine Leiomyosarcoma has
Rapid growth
88
Sarcoma botryoides:
very rare condition in children characterized by grapelike clusters of tumor mass
89
Uterine Leiomyosarcoma: Sonographic Findings
- Leiomyosarcoma may resemble myomas or
endometrial carcinoma with features of solid
or mixed-solid and cystic texture.
- Clinically, rapid enlargement of solid uterine
mass in perimenopausal or postmenopausal
patient raises concern about development of
malignancy.
90
Tamoxifen is a
partial estrogen receptor antagonist used in postmenopausal women with estrogen
receptor positive breast cancer.
91
Abnormally thick endometrium could result
from:
- Early intrauterine pregnancy
- Gestational trophoblastic disease
- Endometrial hyperplasia
- Secretory endometrium
- Estrogen replacement therapy
- Polyps
- Endometrial carcinoma
92
Many endometrial pathologies, such as
hyperplasia, polyps and carcinoma, can cause
abnormal bleeding, especially in
postmenopausal patient.
93
Endometrial canal is landmark for
identification of long axis of uterus.
94
Echogenicity of endometrial tissue compared with
homogeneous, medium-level echogenicity of middle layer of myometrium.
95
Fluid, if present, should not be
included in endometrial measurements.
96
Disorders of endometrium may also occur in
menopausal patients with breast cancer receiving tamoxifen therapy.
97
Endometrial Hyperplasia follows
prolonged estrogenic stimulation
98
Endometrial Hyperplasia May be precursor
of endometrial cancer
99
Endometrial Hyperplasia Sonographic findings:
abnormal thickening of
endometrium
100
Endometrial Hyperplasia majority of women with postmenopausal uterine bleeding are
experiencing endometrial atrophy.
101
Endometrial Hyperplasia on transvaginal sonography,
atrophic endometrium
is thin, measuring <5 mm.
102
If postmenopausal patient has irregular bleeding and thickened endometrium,
may warrant sonohysterography procedure and/or endometrial biopsy
103
Patients with endometrial polyps may be
asymptomatic or present with uterine bleeding.
104
Histologically, polyps are overgrowths of
endometrial tissue covered by epithelium.
105
Endometrial Polyps may be
pedunculated, broad-based, or have a thin stalk.
106
Endometrial Polyps typically cause
diffuse or focal endometrial thickening; more frequently seen in perimenopausal and postmenopausal women.
107
Endometrial Polyps in menstruating women, may be associated with
menometrorrhagia or infertility.
108
Endometrial Polyps: Sonographic Findings
- Represented by hypoechoic or isoechoic
region within hyperechoic endometrium
- Initially may appear as nonspecific
echogenic endometrial thickening
- May be diffuse or focal and may also
appear as round echogenic mass within
endometrial cavity
109
Endometritis is
an infection within endometrium of the uterus.
110
Endometrial thickening or fluid may indicate
endometritis.
111
Endometritis it occurs most often in association
with PID, in postpartum state, or
following instrumentation of uterus, and may be seen with an IUD.
112
With a pelvic infection,
uterus is conduit for infectious spread to
tubes and adnexa.
113
Clinically endometritis patient has
intense pelvic pain; low back pain and fever;
dysmenorrhea; menorrhagia; sterility; constipation
114
Endometritis: Sonographic Findings
- Endometrium appears prominent, irregular, or both, with small amount of endometrial fluid.
- Pus may be demonstrated in cul-de-sac as echogenic particles or debris.
- Enlarged ovaries with multiple cysts and indistinct margins may be seen secondary to periovarian inflammation.
115
Common condition in which functioning
endometrial tissue is present outside the uterus.
116
Ectopic tissue can be found almost anywhere in pelvis, including
- ovary
- fallopian tube
- broad ligament
- external surface of uteru
- scattered over peritoneum
- cul-de-sac
- bladder
117
Endometrial tissue cyclically
bleeds and proliferates.
118
Endometriosis rarely diagnosed by
sonography
119
Intrauterine synechiae
(endometrial adhesions, seen with Asherman’s syndrome)
120
Synechiae found in women with
posttraumatic or postsurgical histories
121
Synechiae includes
uterine curettage and may be cause of infertility or recurrent pregnancy loss
122
synechiae sono findings -
- Bright echoes within endometrial cavity
- Diagnosis difficult unless fluid distending endometrial cavity
- Is best seen during secretory phase when endometrium more hyperechoic
- more easily seen in gravid uterus where they appear as hyperechoic band traversing uterus
from anterior to posterior
123
demonstration of
myometrial invasion clear evidence for endometrial carcinoma
124
TVS demonstrates
myometrial invasion as thickening and irregularity of central endometrial interface with echogenic or hypoechoic patterns combined with infiltration of hyperdense structures in myometrium.
125
endometrial carcinoma may
obstruct endometrial canal, resulting in hydrometra or hematometra
126
endometrial carcinoma intactness of subendometrial halo (inner layer of myometrium) usually indicates
superficial invasion.
127
endometrial carcinoma obliteration of halo indicative of
deep invasion
128
estrogen stimulation associated with
estrogen stimulation
129
endometrial carcinoma has
secondary effects on endometrium
130
endometrial carcinoma clinical
postmenopausal bleeding
131
endometrial carcinoma sonographic findings
- Prominent endometrial complex; enlarged uterus with irregular areas of low-level echoes
132
Small fluid collections can occur
with ectopic pregnancy, endometritis,
degenerating myomas, and recent
abortion.
133
Large fluid collections should be
regarded with suspicion
134
Before menstruation,
accumulation of secretions referred to as hydrometrocolpos.
135
Following menstruation,
hematometrocolpos results from presence of
retained menstrual blood.
136
Pyometra more likely to occur with
uterine cancer.
137
Large Endometrial Fluid Collections Clinical Findings:
- Abdominal pain with possible enlarged abdominal mass
- May or may not have vaginal bleeding
- Presence of fever suggests infection
- Lab results show elevated WBC
138
Large Endometrial Fluid Collections Sonographic Findings
- Large endometrial cavity fluid collection is that of centrally cystic, round, moderately enlarged uterus
- May contain echogenic material if pus or blood present
139
IUD sonographically
Appear as highly echogenic linear structure within endo canal
140
Beneficial Effects of Hormones Estrogen
- Alleviates menopausal symptoms (hot flashes, night sweats, painful intercourse)
- Reduces risk of osteoporosis, vertebral and
hip fractures
- Reduces risk of heart attacks, strokes
141
Beneficial Effects of Hormones Progesterone
- Produces endometrial atrophy
- Reduces risk of endometrial
hyperplasia/cancer
142
Negative Effects of Hormones Estrogen
- Increases risk of endometrial hyperplasia/cancer
143
Negative Effects of Hormones Progesterone
- Increases risk of breast cancer
- Causes irritability, depression, breast tenderness in some women
144
Differential Diagnoses Enlarged Uterus
- Pregnancy
- Postpartum
- Leiomyoma
- Adenomyosis
- Bicornuate or didelphic uterus
145
Differential Diagnoses Uterine Tumor
- Leiomyoma
- Carcinoma
146
Differential Diagnoses Endometrial Fluid
- Endometritis
- Retained products of conception
- Pelvic inflammatory disease
- Cervical obstruction
147
Differential Diagnoses Endometrial Shadowing
- Gas (abscess)
- Intrauterine device
- Calcified myomas or vessels
- Retained products of conception
148
Differential Diagnoses Thickened Endometrium
- Early intrauterine pregnancy
- Endometrial hyperplasia
- Retained products of conception or incomplete abortion
- Trophoblastic disease
- Endometritis
- Adhesions
- Polyps
- Inflammatory disease
- Endometrial carcinoma
