Uterine Pathology Flashcards
(77 cards)
1
Q
Leiomyoma Prevalence, age, ethnicity
A
· Most common tumor of the female pelvis
· Occurs in 20-30% of women of reproductive age
• Occurs at a greater rate in Afracan Amercians
2
Q
Symptoms of leiomyoma
A
- Menorrhagia
- Spotting
- Increased abdominal girth
- Pain
- Urinary frequency/uregency
- Lower back pain
- Leg discomfort/swelling
3
Q
Leiomyoma (Fibroids) History
A
More common with a family history (40% greater chance)
4
Q
Leiomyoma etiology
A
- No known cause of fibroids
* Arise after menache and regress after menopause, ESTROGEN is a promoter of growth
5
Q
Locations of leiomyoma
A
- Intramural
- Submucous
- Subserosal
6
Q
Leiomyoma types
A
- Pedunculated
- Submucosal
- Subserosal
- Calcified
7
Q
Sonographic findings leiomyoma
A
Heterogenous myometrium
• Irregular endometrial stripe
• Hypoechoic areas within the myometrium
• Whorled internal architecture of a mass
• Calcifications
• Posterior bladder contour changes
8
Q
Leiomyoma treatment
A
- If patient is asymptomatic: routine follow ups
- Oral contraceptive to reduce or eliminate symptoms
- Myomectomy if myoma is large and patient wishes to become pregnant
- Uterine artery embolization
- Hysterectomy
9
Q
Endometrial Hyperplasia Prevalence
A
• More common in post-menopausal women
10
Q
Endometrial Hyperplasia Symptoms
A
• Most common cause of abnormal uterine bleeding
11
Q
Endometrial Hyperplasia Etiology
A
• Excessive growth of the endometrium
12
Q
Endometrial Hyperplasia Causes
A
- High estrogen levels
- Hormone repacement therapy
- Tamoxifen
- Diabetes
- Obesity
- PCOD/Anovulatory cycles
13
Q
Endometrial Hyperplasia sonographic findings
A
- Thickened endometrium
- Homogenous, heterogenic endometrium with small cystic areas (Dilated cystic galnds)
- Nonspecific on sonography therefore a bipsoy or D and C is necessary to confirm diagnosis
14
Q
Endometrial Hyperplasia Treatment
A
- Hysteroscopy
- D and C
- Porgesterone IUD
- Progesterone orally
- Hysterectomy
15
Q
Asherman’s Syndrome Symptoms
A
- Fertility problems
- Recurrent pregnancy losses
- Normal to absent menses
16
Q
Asherman’s Syndrome Etiology
A
Adhesions of the endometrium
17
Q
Asherman’s Syndrome Causes
A
- Trauma
- Surgery
- Cesarean section
- D and C
18
Q
Asherman’s Syndrome Sonographic appearance
A
- 2D imaging: Normal or hypoechoic bridgelike bands
- Sonohystogram: Bridgining tissue bands. Cavity distortion, thin, free-floating membranes; lack of distension in the prsence of thick membranes
19
Q
Gartner’s Duct Cyst Symptoms
A
• Most commonly asymptomtic and found on routine plevic exams
If large, can cause symptoms :
• Pressure symptoms
• Dyspareunia
20
Q
Gartner’s Duct Cyst etiology
A
- Common lesion of the vagina
* Caused by remnant of mesonephric duct (embryonic urogenital structure)
21
Q
Gartner’s Duct Cyst sonographic appearance
A
- can delineate the location of the cyst in anterolateral vaginal wall
- Appears as an anechoic or complex mass
- Well defined margins
- Good sound transmission
22
Q
Gartner’s Duct Cyst treatment
A
- Do not require follow up if asymptomatic
* If symptomatic: drainage and removal to aid symptoms
23
Q
Inflammatory Process of Fallopian tubes Symptoms
A
- Fever
- Pain
- Elevated WBC
24
Q
Inflammatory Process of Fallopian tubes Types
A
- PID
- Pyosalpinx
- Tubo-Ovarian abscess
- Non Gynecological abscesses
25
Abscess Symptoms
* Fever
* Tenderness/pain
* Swelling at surgery site (Postoperatively)
* Chills
* General malaise
* Weakness
26
Abscess Etiology
• Infectious process involving the tubes, ovaries, appendix, bowel, peritoneum or bowel perforation
27
Abscess sonographic appearance
* Difficult to image due to gas bubbles
* May be loculated and within the pelvis and paracolic gutters or extend out of the pelvis
* Fluid collects in upper and right upper quadrant (surronding the kidneys)
* May have fluid levels within the mass
28
Abscess other tests
* Increased white blood cells
* Sepsis
* Possible posutive bacterial cultures
* CT is a very accurate method of diagnosing infectious disease within the pelvis
29
Hematoma symptoms
* Possible palpable mass
* Hypertension
* Decreased Renal Function
30
Hematoma Etiology
Collection of blood due to trauma or a disease process
31
Hematoma Causes
* Ectopic pregnancy
* Cyst rupture
* Postoperative bleeding due to renal transplant, surgery or trauma
32
Hematoma sonographic appearance
* Well defined, walled off mass
* Complex appearance, ranging from swirling mobile mass cotents to partilly solid and anechoic to totally anechoic
* Appearance varies depending on the age of the hematoma
33
Hematoma other tests
Decreased hematocrit level
34
Leiomyosarcoma prevalence
* 3% of uterine tumors
| * 1% of uterine malignancies
35
Leiomyosarcoma Risk factors
* Nulliparity
* 50 years and older
* Obesity
* Pelvic Radiation
* Tamoxifen exposure
36
Leiomyosarcoma symptoms
* Abnormal vaginal bleeding
* Palpable pelvic mass
* Pelvic/abdominal pain
37
Leiomyosarcoma Etiology
* Dervived from the smooth muscle of the wall of the uterus
| * Agressives and poor prognosis (Mets common)
38
Leiomyosarcoma sonographic appearance
* Usually intramural
* Rapidly growing heterogenous mass
* Acoustic enhancement (due to increased vascularity)
* Increased intra-tumoral flow
* Anechoic or complex areas due to tumor liquefaction
39
Leiomyosarcoma Treatment
* Total hysterectomy
* Peritoneal washing
* Nodule Sampling
* Radiotherapy
40
Leiomyosarcoma other tests
* CT
| * MRI
41
Leiomyosarcoma Differential Diagnosis
• Other uterine sarcomas, endometrial adenocarcino, adenomyomas, GI and bladder carcinomas
42
Endometrial Carcinoma prevalence
* Most common gynecologic cancer
* Most common in 6th-7th decade of life
* Most common in white women
43
Endometrial Carcinoma risk factors
* Obesity
* Nulliparity
* Late Meonpause
* Adenomatous polyps
* Family history
* Unopposed Estrogen
44
Endometrial Carcinoma predisposing factors
* Herediatry colon cancer
| * Breast cancer (tamoxifen treatment)
45
Endometrial Carcinoma Decreased risk
* Oral contraceptives
| * Smoking
46
Endometrial Carcinoma Symptoms
* Bleeding
* Pain
* Uterine distention
47
Endometrial Carcinoma Etiology
• Histologically, 80% of endometrial carcinomas are of the endometrioid typ
48
Endometrial Carcinoma Stage 1/2
• Confined to the uterus
49
Endometrial Carcinoma Stage 3/4
* Extends beyond the uerus
* Bladder/rectum infiltration
* Adjacent mass
* Ureteral obstruction
50
Endometrial Carcinoma Sonographic appearance
* Heterogenous, echo-texture with irregular or poorly defined margins
* Cystic changes within the endometrium
* May cause hydrometra or hematometra
* Enlargment with lobular contour of the uterus and mixed echogencity is more indicitive of an advanced disase stage
51
Endometrial Carcinoma Treatments
* Total hysterectomy (Uterus, Ovaries, Tubes)
* Lymphadenectomy (higher grade cancer)
* Radiation and chemo
52
Endometrial Carcinoma Other treats
• MRI/CT (can help identify lymphadenopathy and metastic disease)
53
Endometrial Carcinoma DD
* Endometrial hyperplasia
* Endometral polyps
* Leiomyoma
* Cervical Cancer
54
Carcinoma of the Cervix Prevalence
* Second most common gynecologic malignancy
| * Occurs 3rd-4th decade of life
55
Cervical Carcinoma risk factors
* Human papilloma virus infection
* Early sexual activity
* Multiple partners
* Low socioeconomic status
* Smoking
* Oral contraceptives
* Weak immune system
* DES exposure
56
Cervical cancer symptoms
* Often asymptomatic in early stages
* Abnormal vginal discharge
* Post-coital bleeding
* Bladder irritability
* Low black pain
* Ureteral obstruction
57
Cervical cancer stage 1/2
* Normal size and echogenicity
| * Hematometra due to cerrvical stenosis
58
Cervical cancer stage 3/4
* Bulky cervix
* Bladder invasion
* Hydronephrosis
* Liver metastasis
* Nodeformation aorund aorta and IVC
59
Cervical cancer treatments
```
• Cone biopsy to preserve fertility
• Radiotherapy
Extra cervical spread
• Surgery
• Radiotherapy/chemo
```
60
Cervical cancer other tests
• Pap Test (Papanicolau smear)
61
Invasive mole prevalence
* Reproductive Age (Complication of pregnancy)
| * More common in women over 40
62
Invasive mole symptoms
* Persistent heavy bleeding
| * Elevated HCG
63
Invasive mole risk factors
• History of multiple molar pregnancies
64
invasive mole is a type of what?
PTN (Persitent Trophoblastic Neoplasia)
65
Invasive mole etiology
80-90% of cases
• Complication of pregnancy
• Pathology occurs when an abnormal ovum (inactive maternal chromosomes or absent chromosomes) is fertilized by a normal hapoloid sperm
• No fetus (embryo demises early)
• Proliferation of trophoblasts and presence of chorionic villi within the endometrium and myometrium
66
what are types of PTN
* Invasive Mole
* Choriocarcinoma
* Placental Site Trophoblastic Tumor
* Epitheliod Trophoblastic Tumor
67
Invasive mole sonographic appearance
* Heterogenous wiith hypoechoic areas representing hemorrhage or vascular lakes
* Doppler/colour doppler can be used to evaulate the extent of tumor an response to chem
68
Invasive mole treatment
* Methotrexate
* Multidrug chemotherapy
* Avoiding pregnancy for 1 year
* Monitoring hCG (at some sites)
69
Invasive Mole other tests
• Serum beta HCG is used as a tumor marker
70
Choriocarcinoma prevalence
* Reproductive Age (Complication of pregnancy)
| * More common in women over 40
71
Choriocarcinoma risk factors
* Complete or partial mole
* Normal pregnancy
* Still birth
* Spontaneous abortion
* Ectopic pregnancy
* History of multiple molara pregnancies
72
Choriocarcinoma symptoms
* Cough
* Hemopysis
* Neurologic disturbances or hemorrhage
73
Choriocarcinoma etiology
```
Rare subtype of PTN
• Complication of pregnancy
• Pathology occurs when an abnormal ovum (inactive maternal chromosomes or absent chromosomes) is fertilized by a normal hapoloid sperm
• No fetus (embryo demises early)
• Abnormal, proliferating trophoblast
• Absence of chorionic villi
```
74
Choriocarcinoma sonographic appearance
* Focal, hemorrhagic nodule within the endometrium
* Secondary masses to cervix or vagina
* Mets to liver
75
Choriocarcinoma treatment
* Chemo (Methotrexate)
* Avoiding pregnancy for 1 year
* Monitoring hCG (at some sites)
76
Choriocarcinoma DD
* Incomplete Abortion
* Hydropic degneration of the placenta
* Dermoids
* Adenomyosis
* Ovarian tumors
* Cystic paipillary Adenomas
77
Choriocarcinoma other tests
* CT
* MRI
* High levels of Beta HCG
