Repro 8 - Uterine Pathology

Question 1

What is endometriosis?

Answer 1

Endometrial tissue found outside the uterus; usually in the ovary but can be anywhere.

Question 2

What is an endometrioma?

Answer 2

AKA “chocolate cyst”, it is a result of blood build-up from endometriosis in the ovary.

Question 3

What are the symptoms of endometriosis?

Answer 3

Severe menstrual-related pain. Painful intercourse. Pain w/ defecation or urination. Blood in stool or urine during menses. Infertility.

Question 4

Why does Endometriosis cause infertility?

Answer 4

Inflammation and pelvic scarring which leads to adhesions and decreased function of the tubes (and cilia inside of the tubes).

Question 5

How is the diagnosis for endometriosis made?

Answer 5

Laparoscopy and biopsy.

Question 6

What are the theories of causes of endometriosis?

Answer 6

Retrograde menstrual flow. Hematologic spread. Lymphatic spread. Direct spread. Metaplasia.

Question 7

What are the treatments for endometriosis?

Answer 7

OCPs. If not sufficient, use continuous GnRH agonists (leuprolide) to get the patient into a chemical menopause. Or bilateral salpingo-oophorectomy. Danazol.

Question 8

What is Adenomyosis? What is the only treatment?

Answer 8

Endometrial tissue found within myometrium (instead of spreading out, it invades into the muscular wall of the uterus itself). Only useful treatment is Hysterectomy.

Question 9

What are the symptoms of adenomyosis?

Answer 9

Tender, boggy, enlarged uterus. Heavy periods. Focal pain on exam. Dyspareunia.

Question 10

What is the cause of endometrial proliferation And what does it lead to?

Answer 10

Caused by excess unopposed estrogen. Precursor to hyperplasia and endometrial cancer.

Question 11

What are the symptoms of endometrial proliferation?

Answer 11

Menorrhagia or metrorrhagia after age 35 years. Postmenopausal bleeding (NEVER normal to have this).

Question 12

What are the risk factors of endometrial proliferation?

Answer 12

Anovulatory cycles. PCOS. Unopposed estrogen (HRT). Granulosa cell tumor.

Question 13

What is the most common GYN malignancy in the US?

Answer 13

Endometrial cancer.

Question 14

What is the symptom of endometrial cancer?

Answer 14

Vaginal bleeding.

Question 15

What are the risk factors for Endometrial cancer?

Answer 15

[HHONDA] Hyperplasia. Hypertension. Obesity. Nulliparity. Diabetes. Anovulatory state.

Question 16

What are Leiomyoma?

Answer 16

AKA fibroid, they are benign smooth muscle tumor. Monoclonal. Most common tumor in females. Usually presents in a patient w/ multiple tumors w/ well demarcated borders. High recurrence risk. Malignant transformation is rare. They are estrogen sensitive (increase in preg, decrease in menopause).

Question 17

What are the symptoms of Leiomyoma?

Answer 17

Asymptomatic. Vaginal bleeding. Bulk symptoms (pelvic pressure and discomfort). Miscarriage. Pain if necrosis.

Question 18

What are the Leiomyomas according to their location and which one is the most common?

Answer 18

Subserosal (reach outside the uterus). Intramural. Submucosal. Intramural are the most common.

Question 19

What are the treatments for Leiomyomas?

Answer 19

OCPs. Continuous GnRH analog (Leuprolide). Embolization. Ablation. Myomectomy (Scoop them out). Hysterectomy.

Question 20

What are Leiomyosarcoma?

Answer 20

Arise de novo. They are bulky, irregularly shaped. They grow so fast there are areas of necrosis and hemorrhage. Common in middle aged women, more on blacks. We suspect this disease if the uterus is enlarging rapidly. Very aggressive and tend to reoccur.

Question 21

When do we use Leuprolide?

Answer 21

Fibroids. Endometriosis. Infertility. Prostate cancer.

Question 22

What is the most common GYN cancer in the world?

Answer 22

Cervical.

Question 23

Which of the GYN cancers has the worst prognosis (endometrial, ovarian, cervical)?

Answer 23

Ovarian has the worst prognosis.

Question 24

What uterine pathology has Excess unopposed estrogen as the main risk factor?

Answer 24

Endometrial hyperplasia, endometrial carcinoma.

Question 25

What uterine pathology has menorrhagia w/ an enlarged uterus and no pelvic pain?

Answer 25

Leiomyoma.

Question 26

What uterine pathology has pelvic pain that presents only during menstruation?

Answer 26

Endometriosis.

Question 27

What uterine pathology is diagnosed by endometrial biopsy in clinic?

Answer 27

Endometrial hyperplasia, endometrial carcinoma.

Question 28

What uterine pathology has definitive diagnosis and treatment by laparoscopy?

Answer 28

Endometriosis.

Question 29

What uterine pathology has menstruating tissue within the myometrium?

Answer 29

Adenomyosis.

Question 30

What uterine pathology has Malignant tumor of the uterine smooth muscle?

Answer 30

Leiomyosarcoma.

Question 31

How does the dosing of leuprolide affect its physiological impact?

Answer 31

Pulsatile dosing: GnRH agonist. Continuous dosing: GnRH antagonist.

Question 32

RFF: Most common tumor in women.

Answer 32

Leiomyoma.

Question 33

RFF: Most common gynecologic malignancy in the USA.

Answer 33

Endometrial carcinoma.

Question 34

RFF: Most common gynecological malignancy in the world.

Answer 34

Cervical cancer.

Question 35

RFF: Chocolate cyst of the ovary.

Answer 35

Endometriosis.