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Uterine Pathology Flashcards

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1
Q

Congenital uterine anomalies are generally well demonstrated with _____ sonography.

A

3D

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2
Q

What modality may be helpful in examining complex uterine anomalies?

A

MRI

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3
Q

What structures develop from the Mullerian ducts? What is another name for the Mullerian ducts?

A
  • uterus, Fallopian tubes, upper vagina

- paramesonephric ducts

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4
Q

What are most uterine and cervical anatomic variants caused by?

A

failure of development of the Mullerian ducts at some stage of development

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5
Q

The ________ should be evaluated in all cases of uterine anomalies.

A

urinary tract

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6
Q

What structure(s) are normally normal in the presence of Mullerian anomalies?

A

ovaries

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7
Q

What are the 4 categories of anomalous internal genitalia development?

A
  1. failure of formation (aplastic, hypoplastic)
  2. failure of fusion (didelphys, bircornuate)
  3. failure of dissolution
  4. failure of structures to disappear (ie: Wolfian ducts)
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8
Q

What does complete agenesis result in? Which category does this fall under?

A
  • results in complete agenesis of vagina, cervix, uterus and Fallopian tubes
  • failure of formation
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9
Q

What is complete agenesis associated with?

A

Mayer-Rokitansky-Kuster-Hauser (MRKH) syndrome

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10
Q

What does partial agenesis result in? Which category does this fall under?

A

a range of anomalies:

  • absence of upper vagina and cervix
  • presence of uterus and Fallopian tubes
  • unicornuate uterus and single fallopian tube
  • failure of formation
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11
Q

What does uterus didelphys consist of?

A
  • complete duplication of uterus, cervix, vagina
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12
Q

What it the most common Mullerian anomaly?

A
  • bicornuate uterus
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13
Q

What does bicornuate uterus consist of?

A
  • single vagina
  • one or two cervices
  • variable lack of fusion of the upper uterine cavity
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14
Q

Name the two variants resulting from failure of fusion.

A
  1. uterus didelphys

2. bicornuate uterus

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15
Q

What does a septate uterus consist of?

A

single vagina, cervix, and uterus with an intrauterine septum

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16
Q

What is the least severe Mullerian duct anomaly?

A

arcuate uterus

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17
Q

What is an arcuate uterus?

A

a septum slightly protruding into the uterine cavity

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18
Q

How does a septate uterus occur (embryologically)?

A

median septum fails to dissolve after fusion of the two separate Mullerian ducts

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19
Q

What are variants result from failure of dissolution?

A
  • septate uterus

- arcuate uterus

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20
Q

What is failure of disappearance?

A

abnormalities resulting from failure of disappearance of structures that do not normally persist

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21
Q

What are the persistent structures in failure of disappearance sometimes referred to as?

A

vestigial remnants

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22
Q

What is the most common example of failure of disappearance?

A

Gartner’s duct cyst

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23
Q

Where does a Gartner’s duct cyst occur? Where does it arise from?

A

occurs on the anterolateral wall of the vagina

arises from the caudal remnants of the mesonephric (Wollfian) duct

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24
Q

What is DES syndrome and who do we see it in? What does DES stand for?

A
  • daughters of women who received DES from late 1940’s to the early 1970’s for TAB have increased risk of certain genital abnormalities
  • diethylstilbestrol
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25
What is in utero exposure associated with?
associated with: - vaginal epithelial changes - poor pregnancy outcome - increased risk of cervical carcinoma and breast carcinoma - T-shaped uterus - constricting bands in the uterus and intrauterine wall defects
26
What are vaginal anomalies the result of?
Mullerian duct and/or urogenital sinus malformations
27
What is vaginal atresia?
the congenital absence of the vagina
28
What is vaginal septa?
the presence of transverse separations within the vagina
29
What is vaginal duplication?
the presence of two complete vaginas
30
What other organ should be checked with any Mullerian duct anomaly? Why?
kidneys--- uterine malformations are associated with increased incidence of renal abnormalities (agenesis, duplication, ectopic kidney)
31
In who are fibroids more common?
black, nulliparous women
32
Leiomyomas are usually found in the __________, but can also be found in the ______ and ________.
- uterine corpus - cervix - broad ligament
33
Lipoleiomyomas are ______ and appear _______ due to the presence of _____.
rare hyperechoic fat
34
Describe the location of submucous/submucosal fibroids.
- beneath the endometrial cavity | - often project into uterine cavity
35
Which type of fibroid is the most common to produce symptoms?
submucous/submucosal fibroids
36
Describe the location of subserous/subserosal fibroids.
beneath the perimetrium
37
Describe the location of intraligamentous fibroids.
between the layers of the broad ligament
38
Describe the location of cervical fibroids. Are they common or uncommon?
in the cervix; uncommon
39
Describe pedunculated fibroids. Which types do these occur with and what else can happen to them?
- on a pedicle or stalk - only occurs with submucous and subserous - torsion may occur with these
40
Myomas are often ___________.
asymptomatic
41
When symptoms are present in myomas, what may they include?
- heavy periods (menometrorrhagia) -- especially submucosal - frequent urination - enlarged uterus - increasing pain with degenerative changes - infertility or spontaneous abortions - alteration in normal menstrual flow
42
What are the common sonographic findings of myomas?
- well circumscribed hypoechoic mass - lobulated uterine contour - shadowing (with increased attenuation and with calcific degeneration) - whorled internal architexture - displacement of endometrial echoes - extrinsic compression of posterior bladder wall - pedunculated fibroid may appear as a hypoechoic adnexal mass
43
What is leiomyosarcoma?
extremely rare malignancy arising from myometrium
44
What is the typical sonographic appearance of a leiomyosarcoma?
- single large hypoechoic solid uterine mass | - may be indistinguishable from a fibroid
45
What is the only clue in distinguishing a leiomyosarcoma from a fibroid?
the relatively rapid growth of the mass in a post-menopausal woman
46
What is adenomyosis?
- benign invasion of endometrial glands and stroma into myometrium - can be diffuse or focal
47
Where does adenomyosis most commonly affect?
posterior myometrium
48
Adenomyosis is suspected in those with what 3 things? (ie: age, symptoms, etc)
- parous women - ages 40-50 years - with dysmenorrhea and irregular bleeding
49
What are the sonographic findings of adenomyosis?
- enlarged uterus with normal contours - asymmetric thickening of the anterior or posterior uterine wall - myometrial cysts (2-6mm in diameter) - mottled inhomogeneous myometrium - "Venetian blind" type shadowing (!!!)
50
What is the second most common GYN malignancy?
cervical cancer
51
What ages is cervical cancer most commonly seen?
ages 20-30
52
What is the most common symptom of cervical cancer?
post-coital vaginal bleeding
53
How is cervical cancer diagnosed?
via: - pap smear - colposcopy - cone biopsy
54
How is cervical cancer treated?
surgically: - LEEP - conization - hysterectomy if advanced
55
What are the risk factors for cervical cancer?
- HPV infection - early sexual activity - multiple sex partners - smoking - OCP use
56
What are the sonographic findings of cervical cancer?
- normal appearance early in disease - enlarged or bulky cervix - may appear similar to cervical myopia - hydronephrosis (from clamping of ureters) - involvement of other pelvic organs
57
What is a nabothian cyst?
- mucus retention cyst due to obstructed and dilated endocervical glands - common - benign - no clinical significance
58
Describe the sonographic findings of a nabothian cyst.
- small, well circumscribed, anechoic structure - located within cervical wall - posterior acoustic enhancement
59
What is hydrometra?
collection of serous fluid within the endometrial cavity
60
What may hydrometra be secondary to?
- cervical stenosis (especially in post-menopausal patients) - endometrial ablation - pelvic radiation therapy
61
What is uterine arteriovenous malformation (AVM) caused by?
- may be congenital | - more commonly acquired after surgical procedure or uterine trauma
62
What is uterine arteriovenous malformation associated with? How is it treated?
- associated with heavy vaginal bleeding | - treated with embolization of feeding vessels
63
What are the sonographic findings of uterine arteriovenous malformation?
- hypoechoic myometrial abnormality - abundant flow on color Doppler - low resistance, high velocity flow on spectral Doppler
64
What is the most commonly encountered gynecologic malignancy? Who most often does this occur in and how do they present?
- endometrial carcinoma - postmenopausal women (75-80%) - present with early postmenopausal bleeding
65
A relationship exists between increased _________ and development of endometrial cancer.
estrogen
66
What are the risk factors for endometrial carcinoma (5)?
- obesity and anovulatory cycles in premenopausal women - postmenopausal, with an increased risk if on estrogen replacement therapy - history of atypical hyperplasia of endometrium - history of Tamoxifen therapy - strong family history of uterine cancer
67
Describe the spread of endometrial carcinoma.
- begins in uterine cavity - invades and spreads through myometrium, cervix and into the adnexa - distant mets may occur if pelvic lymphatic system is affected
68
What are the clinical signs of endometrial carcinoma? (3)
- postmenopausal bleeding - hypermenorrhea, intermenstrual flow in patients still having periods - pain as a result of uterine distention
69
What are the sonographic findings of endometrial carcinoma? (4)
- alteration in size, shape and sonographic texture of uterine parenchyma - increased uterine size - inhomogeneity and thickening of endometrial echoes (>4-5mm), especially in postmenopausal women (varies with patient's hormone status) - fluid in endometrial cavity
70
What is endometrial hyperplasia?
- proliferation of endometrial glandular tissue | - may be diffuse or focal
71
What percentage of patients with atypical hyperplasia will undergo malignant change, progressing to endometrial carcinoma?
25%
72
What is endometrial hyperplasia a common cause of?
bleeding in peri-menopausal patients
73
What may endometrial hyperplasia be caused by in both peri- and postmenopausal women?
unopposed estrogen hormone replacement therapy
74
Name 4 other causes of endometrial hyperplasia.
1. persistent anovulatory cycles 2. PCOS 3. obesity 4. estrogen producing tumors of the ovary (ie granulose cell tumor and thecomas)
75
The clinical signs of endometrial hyperplasia are similar to those in patients with _______________.
endometrial carcinoma
76
When should sonography be before to evaluate endometrial hyperplasia?
at the beginning of the hormone cycle (immediately following menses)
77
What are the sonographic findings of endometrial hyperplasia? (6)
- smooth borders - more homogeneous texture, but possibly cystic changes - premenopausal women EC > 14mm - patient on Tamoxifen EC > 10mm - postmenopausal women on estrogen only EC > 5mm - postmenopausal women in estrogen phase, EC can be up to 8mm, then in progesterone phase, EC decreases
78
What are endometrial polyps?
localized overgrowths of endometrial tissue
79
Name the 3 types of polyps in regards to their stalks.
- pedunculated - broad-based - thin stalk
80
Occasionally, a polyp will have a long stalk and _______ into the ______ or ______.
prolapse into the cervix or vagina
81
What method is ideal for demonstrating polyp size and location?
sonohysterography
82
What are the clinical signs of endometrial polyps? (5)
- usually asymptomatic - infertility - abnormal uterine bleeding - usually discovered incidentally in D&C - occasionally causes postmenopausal bleeding
83
What are the sonographic findings of endometrial polyps? (3)
- non-specific thickened endometrium, usually focal but occasionally diffuse - discrete mass in the endometrium (focal, round and echogenic) - possibly vascular stalk demonstrated with color Doppler
84
What may endometrial polyps be indistinguishable from?
endometrial hyperplasia
85
What is saline infusion sonohysterography (SIS)? What is another name for it?
technique of introducing saline into the endometrial cavity to evaluate endometrium sonographically AKA hysterosonography
86
What are the indications for SIS? (5)
- infertility and habitual abortion - congenital anomalies and/or anatomic variants of the uterine cavity - pre- and post-operative evaluation of uterine cavity (especially with regard to myxomas, polyps and cysts) - suspected uterine cavity synechiae (ie: scarring associated with Ashermann's syndrome) - further evaluation of abnormalities detected sonographically
87
During a SIS, fluid accumulating in the posterior cul-de-sac ensures what? Images should be obtain in ____ plane(s).
- at least one patent fallopian tube | - images obtained in 2 planes
88
Preliminary tv imaging is performed prior to SIS to evaluate the ______, ______, ______, and ______. The ________ is cleansed and the catheter is placed into the ______ and sterile saline is infused.
- uterus - endometrium - ovaries - adnexae - external os - cervix

OB/GYN (6 decks)

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