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UT pathology Flashcards

(63 cards)

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1
Q

How does the uterus develop?

A
  • Paired Mullerian ducts descend into the pelvis at week 13 of fetal life
  • fusion occurs from the inferior (Cx) to the superior (fundus)
  • resorption of the center occurs last
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2
Q

What must be evaluated in all cases of UT anomalies?

A

Urinary tract

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3
Q

Do the ovaries develop from mullerian ducts?

A

No

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4
Q

Are ovaries generally normal in the presence of Mullerian anomalies?

A

Yes

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5
Q

What is the gold standard for evaluating Mullerian anomalies?

A

MRI=gold standard but can be well evaluated with 3D U/S

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6
Q

Name the Mullerian duct anomalies?

A
  1. Failure of formation
  2. Failure of fusion
  3. Failure of dissolution
  4. Failure of dissappearance
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7
Q

Type of failure of formation where there is no vagina, Cx, UT, or tubes?

A

Complete agenesis Failure of formation

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8
Q

Type of failure of formation that has a unicornuate UT, usually with a blind ending UT body associated

A

Partial agenesis Failure of formation

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9
Q

Types of Failure of fusion

A
  1. Uterus Didelphys

2. Bicornuate

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10
Q

2 separate bodies, 2 Cx’s each with their own tube doesn’t share myometrium

A

Uterus Didelphys

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11
Q 
#1 most common Mullerian anomaly,
1 vagina, 1 or 2 CX's and variable lack of fusion in the uterine body
A

Bicornuate

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12
Q

The median septum fails to dissolve after fusion of the 2 separate Mullerian ducts?

A

Failure of dissolution

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13
Q

What are the types of uterus that develop as a result of failure of dissolution and which is the least severe?

A 
Septate UT
Arcuate UT (the least severe)
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14
Q

Also Known as persistent structures of Vestigial remnant

A

Failure of disappearance

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15
Q

1 most common Vestigial remnant

A

Gartner’s duct cyst

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16
Q

Arise from the Caudal remnants of the Wollfian duct= Mesonephric duct

A

Gartner’s duct cyst

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17
Q

Where do Gartner’s duct cysts occur?

A

On the anterolateral wall of vagina

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18
Q

Drug given between 1940-1970 to pregnant women in the mistaken belief that it would decrease the risk of pregnancy loss and complications

A

DES (Diethylstibesteid)

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19
Q

What are the effects of DES exposure?

A
  1. Clear cell carcinoma of the vagina
  2. Cervical cancer
  3. T shaped uterus (infertility)
  4. Intrauterine wall defects-amniotic band syndrome in pregnancy
  5. Poor pregnancy outcome
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20
Q

What are the two congenital vaginal malformations?

A
  1. Mullerian duct anomalies

2. Urogenital sinus malformations

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21
Q

Types of urogenital sinus malformations

A
  1. Vaginal atresia = absence of vagina
  2. Vaginal septa = Transverse septa in vagina
  3. Vaginal duplication = Longitudinal septa
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22
Q

1 most common tumor of the female pelvis, most common in African-American women, usually multiple, Better detected with MRI

A

Leiomyomas = fibroids

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23
Q

What are the symptoms of leiomyomas?

A
  1. Pain- especially when size increases and with infarction
  2. Menorrhagia - fibroids prevent the efficient contraction of the UT during menses
  3. Infertility - repeat spontaneous abortions (especially with submucous)
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24
Q

Locations of leiomyoumas

A
  1. Submucosal
  2. Intramural (interstitial)
  3. Subserosal
  4. Cervical (Uncommon)
  5. Intraligamentus
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25
Under the uterine endometrium, projects into UT cavity, repeated spontaneous abortions because the fertilized egg can't successfully implant on it, may be pedunculated
Submucosal
26
Within the myometrium and the most common location
Intramural (interstitial)
27
Beneath the serosa or perimetrium, may be pedunculated and torse(twist) . . . infarct . . . Pain
Subserosal
28
Between layer of broad ligament
Intraligamentous
29
Sono findings for Leiomyomas
- Well circumscribed , solid mass - May be hypoechoic or echogenic and shadows if calcified - Usually round - Swirled internal architecture
30
Invasion of endometrial glands and stroma into the myometriun - may be diffuse or focal - Oval not round like a fibroid
Adenomyosis
31
Malignant rare tumor of the uterus that develops primarily as a malignancy (not premalignant)
Leiomyosarcoma
32
Sono findings of Leiomyosarcoma
there is no defining feature sonographically or on MRI - these are incidental findings at hystorectomy - suspect it with rapid growth of a solid mass
33
Symptoms of adenomyosis
1. pain 2. Infertility 3. Menometrorrhagia -UT can't contract effectively
34
Sono findings of adenomyosis
- oval mass (focal form) - UT enlarged (> 14cm) - Myometrial cysts (dilated glands that have grown into the myometrium) - asymetric thickening of endometrium - Mottled, inhomogeneous myometrium - "venetian blind" type of shadowing
35
Do sono findings lead to diagnosis of adenomyosis?
No, sono findings are suggestive , MRI=diagnostic
36
2nd most common Gyn malignancy in females
Cervical cancer
37
Cervical cancer is most common in females of what age?
20-30 yrs. old
38
What is the most common symptom for cervical cancer?
Post coital bleeding
39
How is cervical cancer diagnosed and treated?
Diagnosed with pap smear, colposcopy, cone Bx | Treatment= Conization, LEEP, Hystorectomy ( if advanced)
40
What are the risk factors for cervical cancer
1. Early sexual activity 2. Multiple sex partners 3. HPV infection
41
Sono findings for cervical cancer
- Normal if early - Enlarged bulking Cx - May look like a cervical fibroid - Late stage = hydronephrosis (spreads and blocks ureters)
42
Nabothian cysts are
Very common, due to obstruction-dilation of endocervical gland and are of no clinical significance
43
Are nabothian cysts measured or counted?
No
44
Water in the uterus
Hydrometra
45
Causes of hydrometra
- cervical stenosis (lack of estrogen in post menopausal women) - pelvic radiation ( hisstory counts) - cervical mass
46
How do you measure hydrometra?
Anterior and posterior endo linings separately, then add together - Do it at the thickest part, usually near the fundus - 1 good measurement
47
#1 most Gyn malignancy?
Endometrial carcinoma
48
Percentage of post menopausal women with endometrial carcinoma
75-80% of time
49
Symptoms of endometrial carcinoma
- Post menopausal bleeding | - Pre menopausal = intermenstrual bleeding, heavy bleeding
50
Risk factors for endometrial carcinoma
(increased estrogen) 1. Obesity - pre or post menopausal 2. unopposed estrogen replacement 3. Tamoxifen ( antiestrogen effect the breast but stimulate the UT) 4. Estrogen producing tumor of the ovary (Granulosa cell, Thecoma) 5. Family history
51
Where does endometrial carcinoma start?
Tumor starts in the uterine cavity and grows through the myometrium, then into the endometrium
52
Distant mets can occur with
Lymph node involvement
53
Sono findings for endometrial carcinoma
1. Thick irregular endo (>6mm post menopause) 2. Fluid in the UT cavity 3. Really irregular mass in sonohysterography
54
How is endocarcinoma diagnosed?
With EMB= endoBx or with D&C= dilatation & curretage
55
What percentage of endometrial hyperplasia undergo malignant transformation to endometrial carcinoma?
25%
56
What are the symptoms for endometrial hyperplasia?
Same as endocarcinoma 1. Post menopausal bleeding 2. Pre menopausal = intermenstrual bleeding, heavy bleeding
57
What are the risk factors for endometrial hyperplasia?
Same as endocarcinoma 1. Obesity (pre or post menopausal) 2. Unopposed estrogen replacement 3. Tamoxifen 4. Estrogen producing tumor of the ovary (Granulosa cell, Thecoma) 5. Family history
58
How is endometrial hyperplasia diagnosed?
With EMB= endoBx or D&C= dilatation and curretage
59
Localized overgrowth of endometrium , may be pedunculated or broad based?
Endometrial polyps
60
What are the symptoms of endometrial polyps?
- Infertility, repeat spontaneous abortions | - Abnormal UT bleeding/ Post menopausal bleeding
61
Sono findings of endometrial polyps
1. Endo thickening ( may appear as round mass) 2. Blood flow into polyp 3. Echogenic, may have cystic spaces
62
How are endometrial polyps diagnosed?
Sonohysterography = Saline infusion sonohysterography
63
What is sonohysterography ( saline infusion sonohysterography)
Using a thin catheter to instill sterile water/ saline into the uterine cavity while watching with transvaginal U/S

GYN (6 decks)

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