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Flashcards in Uterine Pathology Deck (77)
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1

Leiomyoma Prevalence, age, ethnicity

· 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

Symptoms of leiomyoma

• Menorrhagia
• Spotting
• Increased abdominal girth
• Pain
• Urinary frequency/uregency
• Lower back pain
• Leg discomfort/swelling

3

Leiomyoma (Fibroids) History

More common with a family history (40% greater chance)

4

Leiomyoma etiology

• No known cause of fibroids
• Arise after menache and regress after menopause, ESTROGEN is a promoter of growth

5

Locations of leiomyoma

• Intramural
• Submucous
• Subserosal

6

Leiomyoma types

• Pedunculated
• Submucosal
• Subserosal
• Calcified

7

Sonographic findings leiomyoma

Heterogenous myometrium
• Irregular endometrial stripe
• Hypoechoic areas within the myometrium
• Whorled internal architecture of a mass
• Calcifications
• Posterior bladder contour changes

8

Leiomyoma treatment

• 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

Endometrial Hyperplasia Prevalence

• More common in post-menopausal women

10

Endometrial Hyperplasia Symptoms

• Most common cause of abnormal uterine bleeding

11

Endometrial Hyperplasia Etiology

• Excessive growth of the endometrium

12

Endometrial Hyperplasia Causes

• High estrogen levels
• Hormone repacement therapy
• Tamoxifen
• Diabetes
• Obesity
• PCOD/Anovulatory cycles

13

Endometrial Hyperplasia sonographic findings

• 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

Endometrial Hyperplasia Treatment

• Hysteroscopy
• D and C
• Porgesterone IUD
• Progesterone orally
• Hysterectomy

15

Asherman’s Syndrome Symptoms

• Fertility problems
• Recurrent pregnancy losses
• Normal to absent menses

16

Asherman’s Syndrome Etiology

Adhesions of the endometrium

17

Asherman’s Syndrome Causes

• Trauma
• Surgery
• Cesarean section
• D and C

18

Asherman’s Syndrome Sonographic appearance

• 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

Gartner’s Duct Cyst Symptoms

• Most commonly asymptomtic and found on routine plevic exams
If large, can cause symptoms :
• Pressure symptoms
• Dyspareunia

20

Gartner’s Duct Cyst etiology

• Common lesion of the vagina
• Caused by remnant of mesonephric duct (embryonic urogenital structure)

21

Gartner’s Duct Cyst sonographic appearance

• 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

Gartner’s Duct Cyst treatment

• Do not require follow up if asymptomatic
• If symptomatic: drainage and removal to aid symptoms

23

Inflammatory Process of Fallopian tubes Symptoms

• Fever
• Pain
• Elevated WBC

24

Inflammatory Process of Fallopian tubes Types

• 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