Q1 - pathology of the uterus
class 5: in septate uterus
2 uterine cavities are seen closely spaced, with ONE fundus sometimes 2 cervical canals or a vaginal septum
intracavitary myoma
3D coronal image of the uterine cavity demonstrates this finding:
cervical stenosis with large endometrial fluid collection
A 63-year old asymptomatic woman on cyclic hormone replacement therapy demonstrates this abnormality of the lower uterine segment:
nabothian cysts
Identify the abnormality demonstrated in this transvaginal sagittal image of the cervical canal
intramural leiomyoma
Most common type of leiomyoma; deforms myometrium
enlarged uterus
Pregnancy Postpartum Leiomyoma
menorrhagia
Prolonged or profuse menses.
endometrial adenocarcinoma
Sagittal transvaginal images of the uterus demonstrate this finding:
curettage
Scraping with a curette to remove the contents of the uterus, as is done following inevitable or incomplete abortion; to obtain specimens for use in diagnosis; and to remove growths, such as polyps
bicornuate uterus
What are the sonographic findings on this 3D coronal image of the uterus?
submucosal
________ myomas may erode into the endometrial cavity and cause irregular or heavy bleeding, which may lead to anemia
endometritis
_________ most often occurs in association with PIS, in the postpartum state, or following instrumentation invasion
uterine arteriovenous malformation (AVMs)
_______________________ consist of a vascular plexus of arteries and veins without an intervening capillary network
intrauterine contraceptive device (IUD)
a 28-year-old women reports left lower quadrant pain. her last menstrual period was 2 weeks earlier. sonographically, the uterine body displays a highly echogenic structure in the endometrial cavity. this appearance most likely represents which one of the following conditions?
endometritis
a 3-day postpartum woman complains of intense pelvic pain. sonographically, the uterus appears hypoechoic with an irregular endometrium. this condition most likely represents which one of the following?
adenomyosis
a benign invasion of endometrial tissue into the myometrium is known as which one of the following conditions?
cervix
a small percentage o leiomyomas are located in which one of the following structures?
cuff
a vaginal _______ is seen in hysterectomy patients after surgery
metrorrhagia
abnormal bleeding from the uterus
hypermenorrhea
abnormal uterine bleeding (excessive)
amenorrhea
absence of menstruation
cervical stenosis
acquired condition with obstruction of the cervical canal
cervical stenosis
an acquired condition with obstruction of the cervical canal at the internal or external os resulting from radiation therapy, previous cone biopsy, postmenopausal cervical atrophy, chronic infection, laser surgery or cryosurgery, or cervical carcinoma is _____________
tamoxifen
an antiestrogen drug used in treating some breast carcinomas; reported causing growth in leiomyomas
endometrial hyperplasia
benign condition that results from estrogen stimulation to the endometrium without the influence of progesterone; frequents cause bleeding
adenomyosis
benign invasive growth of the endometrium that may cause heavy, painful menstrual bleeding
Nabothian cyst
benign tiny cyst within the cervix
hematometrocolpos
blood filled vagina and uterus
large endometrial fluid collections
centrally cystic, round, moderately enlarged uterus obstruction may be congenital, imperforate hymen (most common), vaginal septum, vaginal atresia, or rudimentary uterine horn
cervical polyps
clinical findings of irregular bleeding may be the result of ____________, a condition that arises from the hyperplastic protrusion of the epithelium of the endocervix or ectocervix
hydrometrocolpos
collection of fluid in the vagina and uterus
class 3: uterus didelphys
complete duplication of the uterus, cervix, and vagina
near the cervix
complications in delivery may occur with pregnancy if a fibroid is located in or near which one of the following structures?
class 6: arcuate uterus
dip in the uterine fundus/ endometrial cavity
class 4: bicornuate uterus
duplication of the uterus and sometimes the cervix bilobed uterine cavity has wide-shaped cavities fundus is attached (unlike didelphys)
ambiguous genitalia
embryo has the potential to develop as a male or female most true hermaphrodites= 46,XX some are mosaics = (46,XX/ 46,XY) female pseudohermaphrodities= 46,XX
thickened endometrium
endometrial hyperplasia retained products of conception inflammatory disease endometrial carcinoma
unopposed estrogen stimulation
endometrial hyperplasia develops from which one of the following?
endometrial fluid
endometritis retained products of conception PID disease cervical obstruction (stenosis)
menometrorrhagia
excessive uterine bleeding at both the usual time of menstrual periods and at other irregular intervals
uterine tumors
fibroid tumors (leiomyoma or myomas) carcinoma
hydrocolpos
fluid filled vagina
hydrometra
fluid in uterus
endometrial shadowing
gas (bubbles) intrauterine device (IUD) calcified fibroids or vessels retained products of conception
sonolucent fluid collection in the uterine canal
hydrometra appear sonographically as a
cervical polyp
hyperplastic protrusion of the epithelium of the cervix; may be broad based or pedunculated
sequential
ideally, women using ___________ hormones should be studied at the beginning or end of her hormone cycle, when the endometrium is theoretically at its thinnest
2
in a patient after a hysterectomy, the normal vaginal cuff should not exceed ___ cm
5
in postmenopausal patients, an endometrial thickness of less than ______ mm reliable excludes an endometrial abnoramlity
vagina
in which of the following structures would a Gartner's duct cyst be found?
endometritis
infection of the endometrium intense pelvic pain
endometritis
infection within the endometrium of the uterus
oligomenorrhea
infrequent menstruation
sonohysterography (SHG)
injection of sterile saline into the endometrial cavity under ultrasound guidance
synechiae
intrauterine _____________ (endometrial adhesions, asherman's syndrome) are found in women with post-traumatic or postsurgical histories, including uterine curettage (bridging bands of tissue that distort the cavity or as thin, undulating (wavy) membrane in endometrium)
metrorrhea
irregular, acyclic bleeding
metrorrhea
irregular, acyclic bleeding is defined as which one of the following?
submucosal; intramural; subserosal
leiomyomas are characterized as: --___________ (displacing or distorting the endometrial cavity with subsequent irregular or heavy menstrual bleeding) --__________ (confined to the myometrium, most common type) -- _________ (projecting from the peritoneal surface of the uterus, sometimes becoming pedunculated and appearing as extrauterine masses)
endometrial carcinoma
malignancy characterized by abnormal thickening of the endometrial cavity; usually associated with irregular bleeding in perimenopausal women
endometrial thickness related to phases of the menstrual cycle
menstrual phase = 2-3 mm early proliferative phase = 4-6 mm periovulatory phase = 6-8 mm secretory phase = 8-15 mm early IUP, endometrial polyps, and endometrial carcinoma cause abnormally thick endometriums
leiomyoma
most common benign gynecologic tumor in women during their reproductive years
squamous cell carcinoma
most common type of cervical cancer
estrogen
myomas are _________ dependent and may increase in size during pregnancy, although about 1/2 of all myomas show little change during pregnancy
small endometrial fluid collections
normal < 2ml
hematometra
obstruction of the uterus and/or vagina characterized by an accumulation of blood
hydrometra
obstruction of the uterus and/or vagina characterized by an accumulation of fluid
pyometra
obstruction of the uterus and/or vagina characterized by an accumulation of pus
heterogeneous
on ultrasound, the characteristic appearance of degenerating leiomyoma is __________
10
only _____% of women with postmenopausal bleeding have endometrial carcinoma
endometrial polyps
overgrowths of endometrial tissue covered by epithelium
dysmenorrhea
pain associated with menstruation
endometrial hyperplasia, polyp, and carcinoma
patients on tamoxifen therapy have an increased risk of which one of the following reactions?
endometrial polyp
pedunculated or sessile well-defined mass attaches to the endometrial cavity
ectocervix
portion of the canal of the uterine cervix that is lined with squamous epithelium
ectopic pregnancy
pregnancy occurring outside of the uterine cavity
class 1: segmental mullerian agenesis or incomplete vaginal canalization
produces a transverse vaginal septum or vaginal atresia large cystic pelvic abdominal mass
pyometra
pus in the uterus
class 7: T-shaped
related to drug exposure of diethylstilbestrol (DES)
Gartner's duct cyst
small cyst within the vagina
polyps
sonographically, _________ appear toward the end of the luteal phase and are represented by a hypoechoic region within the hyperechoic endometrium
cancer
sonographically, a thickened endometrium (> 4-5 mm) must be considered _______ until proven otherwise
locations of leiomyomas
submucosal (endometrium) intramural (myometrium; most common) subserosal (outer; extrauterine)
intrauterine contraceptive
the __________ device appears as highly echogenic structure in the endometrial cavity within the uterus body that are separate from normal, central endometrial echoes
Leiomyoma (fibroids)
the benign tumor called a _______ is the most common gynecologic tumor, occurring in approx. 20-30% of women over the age of 30 with a higher incidence in African American women
leiomyoma
the clinical signs of a 32-year-old woman with an enlarged uterus on physical exam and a history of cyclic profuse and prolonged bleeding with increasing pain most likely represents which one of the following?
endometrial carcinoma
the earliest change associated with _____________ is a thickened endometrium; it is also associated with endometrial hypertrophy and polys
myomas
the earliest sonographic finding of ___________ shows uterine enlargement with a heterogenous texture and contour distortion along the interface between the uterus and the bladder
adenomyosis
the ectopic occurrence of nests of endometrial tissue within the myometrium is ________ and is most extensive in the posterior wall
hyperechoic, hyperechoic
the endometrium should be measured from _______ layer to _______ layer
myomas; arcuate
the most common cause of uterine calcification is ___________; a less common cause is __________ artery calcification in the periphery of the uterus
myomas
the most common cause of uterine calcification is which one of the following?
imperforate hymen
the most common congenital abnormality of the female genital tract is a(n) ____________, resulting in obstruction
Gartner's duct cyst
the most common cystic lesion of the vagina is the ___________; it usually is found incidentally during sonographic examination
nabothian cysts
the most common finding, seen frequently in middle-ages women, is the presence of ________
NOT family history (correct = age, hormonal status, parity)
the size and shape of the normal uterus are related to all of the following except
uterine leiomyosarcoma
tumors originate from the myometrium of the endometrial lining, are highly aggressive and have a poor prognosis commonly in fundus most common presentation is abnormal vaginal bleeding, pelvic pain, and an enlarge uterus
submucosal leiomyoma
type of leiomyoma found to deform the endometrial cavity and cause heavy or irregular menses
subserosal leiomyoma
type of leiomyoma that may become pedunculated and appear as an extrauterine mass
usually involves the myometrium
uterine arteriovenous malformations (AVM):
class 2: unicornuate uterus
uterus is long and slender (cigar-shaped) and deviated to one side
endometrial hyperplasia
what is the most common cause of abnormal uterine bleeding in both premenopausal and postmenopausal women?
Congenital Virilizing Adrenal Hyperplasia
what is the most common cause of ambiguous genitalia?
fibroids
what is the most common cause of uterine calcifications?
gartner's duct cyst
what is the most common cystic lesion of the vagina?
Nabothain cysts (in cervix)
what is the most common finding with sonography?
Leiomyomas (uterine fibroids)
what is the most common gynecologic benign (pelvic) tumor?
endometrial carcinoma (adenocaricnoma)
what is the most common gynecologic malignancy in north America?
squamous cell carcinoma
what is the most common type of cervical cancer?
FALSE = elevated progesterone levels may promote the growth of myometrial islands (TRUE= adenomyosis can be managed with hormone therapy; adenomyosis may cause abnormal uterine bleeding; adenomyosis may cause pelvic pain during menstruation)
which of the following statements about adenomyosis is false?
cervical stenosis
which one of the following is most likely the result of an acquired condition with obstruction of the cervical canal?
intramural
which one of the following is the most common site for a leiomyoma to occur?
submucosal
which one of the following locations of a fibroid will most likely cause heavy irregular uterine bleeding?
abnormal thickening of the endometrial cavity, usually with irregular bleeding in perimenopausal and postmenopausal women
which one of the following sonographic characteristics is the most common finding of endometrial carcinoma?
cervical polyps
which ones of the following conditions is described as a hyperplastic protrusion of the epithelium of the cervix that may be broad-based or pedunculated?
