Pelvic Masses

Question 1

List the Benign uterine masses?

Answer 1

Uterine fibroids
Adenomyosis
Nabothian cyst
Cervical polyp
Endometrial polyps

Question 2

What is a Uterine Fibroid?

Answer 2

It is a benign tumor of uterine smooth muscle

Question 3

When do uterine fibroids regress and why?

Answer 3

• After Menopause
  -Because of the reduction in estrogen levels

Question 4

What are the risk factors for uterine Fibroids?(7)

Answer 4

-Age
-Early menarche
-Family history/Genetics
-Obesity/overweight/high BMI
-Hormonal Contraceptives
- Black
-Smoking

Question 5

What are the types of fibroid?

Answer 5

-Submucosa
-Subserosa
-Intramural

Question 6

Describe how to classify Fibroids?

Answer 6

REFER

Question 7

What are the secondary changes a fibroid undergoes?

Answer 7

-Degeneration

-Hyaline
-Cystic
-Calcification
-Infection and abscess
-Necrobiosis
-Sarcomatous Change

Question 8

What is Hyaline degeneration?

Answer 8

• Smooth muscles replaced by fibrous connective tissues
  -Scattered islands of muscle cells are found intact in broad expanses of hyaline degeneration.

Question 9

Describe a cystic degeneration?

Answer 9

An extension of hyaline degeneration with liquefaction of some areas of the fibroid and cyst formation.

Question 10

Describe Calcification Degeneration?

Answer 10

Usually occurs after menopause/age occurs when there reduced blood flow to the fibroid which causes ischemia and tissue death and as result calcification occurs as part of the healing process.

Question 11

Which fibroids usually undergo Infection and abscess formation? What does it usually follow?

Answer 11

-Submucous Fibroid
-Following a septic abortion or tumor

Question 12

Which type of Fibroid does necrobiosis affect?

Answer 12

Pedunculated Subserous Fibroids

Question 13

Describe red generation/Carneous Degeneration?

Answer 13

This a type of degeneration occurs normally during pregnancy via a couple of mechanism.
-As the uterus gets bigger there is venous obstruction and this leads to a hemorrhagic infarction resulting in ischemia and necrosis of the fibroid. The necrotic tissue triggers an inflammatory reaction and starts to look like an infection.
-this results in pain, fever.

Question 14

What happens in a sarcomatous change during degeneration?

Answer 14

Malignant change in fibroids

Question 15

What is the clinical presentation of uterine fibroids?

Answer 15

Abnormal vaginal bleeding
Slight Dysmenorrhea
Dyspareunia
Pelvic pain(though not a significant factor)
Pressure symptoms-Constipation, urgency, frequency

Question 16

What investigations are done for someone suspected of having a Fibroid?

Answer 16

Bloods
FBC
Urine - pregnancy test
Imaging
Pelvic ultrasound (transvaginal vs transabdominal)
Hysteroscopy
Hysterosalpingography
MRI –provide detailed image (size, location and number)

Question 17

What is the definitive management for Fibroids?

Answer 17

Myomectomy
Hysterectomy
Uterine artery embolism

Question 18

What symptomatic management is given to treat fibroids?

Answer 18

NSAIDs
Antifibrinolytics- Tranexamic acid
Hormonal therapies
Combined oral contraceptives
Progestin-releasing intrauterine device
Gonadotropin-releasing hormone agonists (Leuprolide, goserelin

Question 19

When is a myomectomy considered?

Answer 19

When fertility is a concern.

Question 20

What are the complications of a Fibroid?(7)

Answer 20

Myomectomy
Hysterectomy
Uterine artery embolism

Question 21

What is adenomyosis?

Answer 21

-Benign disease characterized by occurrence of endometrial tissue within the myometrium due to invasion of the endothelial basal layer.
-Characterized by invasion of endometrial glands and stroma into the myometrium.

Question 22

What are the risk factors for Adenomyosis?(4)

Answer 22

Obesity
Family history
Child birth
Prior uterine surgery

Question 23

What is the clinical presentation of Adenomyosis?(8)

Answer 23

Dyspareunia
Chronic pelvic pain
Dysmenorrhea
Abnormal uterine bleeding
Spotting in between periods
Heavy menstrual bleeding
Globular, uniformly enlarged uterus that is soft but tender on palpation
Bloating

Question 24

What investigations are done for Adenomyosis?

Answer 24

Abdominal/transvaginal ultrasound
Magnetic Resonance Imaging
Computed Tomography

Question 25

What is the definitive treatment for Adenomyosis?

Answer 25

Hysterectomy

Question 26

What is the symptomatic treatment done for Adenomyosis?

Answer 26

Non steroidal anti-inflammatory drug Hormonal treatment (oral contraceptives)

Question 27

Differentiate Endometriosis and Adenomyosis?

Answer 27

REFER TO NOTES?

Question 28

What is a Nabothian cyst?

Answer 28

It is a mucus filled sac on the surface of the cervix?

Question 29

What is the cause of the nabothian cyst?

Answer 29

It occurs when the stratified squamous epithelium of the ectocervix grow over the simple columnar epithelium of the endocervix.

Question 30

What is the clinical presentation of a Nabothian Cyst?

Answer 30

-Typically Asymptomatic -Can cause pain and vaginal fullness

Question 31

Treatment for Nabothian Cyst?

Answer 31

-They frequently resolve so don’t usually require treatment. -Treatment involves ablation with electrocautery -Sims cryotherapy may be used

Question 32

What is a cervical Polyp?

Answer 32

It is a benign lesion of hyperplastic cervical epithelium

Question 33

What is the cause of cervical polyps?

Answer 33

Unknown but usually associated with abnormal response to estrogen and cervical infections.

Question 34

What is clinical presentation of a cervical polyp?

Answer 34

Heavy menstrual bleeding Postcoital bleeding Intermenstrual Bleeding Post Menopausal bleeding Foul smelling vaginal discharge because of infections

Question 35

What investigations are done in A cervical polyp?

Answer 35

-Biopsy -Speculum

Question 36

What is an Endometrial Polyp?

Answer 36

-It is an overgrowth of localized endometrial tissue .

Question 37

What is the treatment for a cervical polyp?

Answer 37

Surgical removal -Polypectomy

Question 38

What is endometrial polyps a common cause for?

Answer 38

bleeding in both premenopausal and post menopausal patients

Question 39

What are the 2 types of endometrial polyps?

Answer 39

-Pedunculated Polys -Sessile Polyps

Question 40

What are the risk factors for Endometrial Polyps?

Answer 40

Obesity History of cervical polyps Tamoxifen or hormone replacement therapy

Question 41

What are the clinical features of endometrial polyps?

Answer 41

Irregular menstrual periods. Heavy menstrual bleeding PV bleeding after menopause Dysmenorrhea

Question 42

What investigations are done for an endometrial Polyp?

Answer 42

Hysteroscopy Transvaginal ultrasound Biopsy

Question 43

What investigations are done for endometrial polyp?

Answer 43

Curettage (with or without hysteroscopy) If cancerous do hysterectomy

Question 44

What are the two types of fallopian tube benign tumors?

Answer 44

-Adenomatoid Tumor -Serous Papilloma

Question 45

Where can an adenomatoid tumor be found?

Answer 45

-Can be found in uterus, fallopian tube and ovarian hilus

Question 46

What are adenomatoid tumors associated with?

Answer 46

-leiomyomas and adenomyosis.

Question 47

What are adenomatoid tumors?

Answer 47

benign tumors of mesothelial origin.

Question 48

How are they diagnosed and why?

Answer 48

Histologically as it is difficult to differentiate between a leiomyoma

Question 49

What are the differentials for an adenomatoid tumor?

Answer 49

Lymphangioma Adenomyoma Mesothelial cells - simple squamoepithelium found on coelemic (cavity in the body that contain internal organs)

Question 50

Where can serous papilloma be located?

Answer 50

-Intramural and Fimbria

Question 51

Clinical Features of serous papilloma?

Answer 51

Abnormal vaginal bleeding Abdominal Pain