Chapter 43: Pathology of the uterus

Menstrual phase endometrial thickness

2-3mm

Early proliferative endometrial thickness

4-6mm

Late proliferative (periovulatory) phase endometrial thickness

6-8mm

Secretory phase endometrial thickness

8-15mm

Invasion of endometrial tissue into the myometrium

Adenomyosis

The upper size limit of a normal vaginal cuff is: A. 3cm B. 2.1cm C. 4.2cm D. 5cm

B. 2.1cm

In premenopausal women, SIS is preformed in mid-menstrual cycle, usually between days ___ and ___. A. 5, 10 B. 6-10 C. 5-12 D. 12-15

B. 6, 10

Precocious puberty is defined as the development of pubic hair, breasts, and the genitals before the age of: A. 13 B. 8 C. 5 D. 10

B. 8

The rigid region of the uterus located between the vagina and the isthmus is the: A. Cornu B. Corpus C. Cervix D. Fundus

C. Cervix

Acquired condition with obstruction of the cervical canal

Cervical stenosis

A garner cyst is located within: A. Uterus B. Ovary C. Cervix D. Vagina E. Oviduct

D. Vagina

Most common type of leiomyoma; deforms the myometrium

Intramural leiomyoma

Most common gynecological tumor

Leiomyoma

Most common type of cervical cancer

Squamous cell carcinoma

Clinical finding of cervical polyps: A. Dysmenorrhea B. Oligomenorrhea C. Irregular bleeding D. Pelvic pain

C. Irregular bleeding

Mullerian anomaly with highest incidence of fertility issues.

Septate uterus

Most common type of cervix carcinoma

Squamous cell carcinoma

Location of leiomyoma that causes heavy/ irregular bleeding and infertility

Submucosal

Type of leiomyoma found to deform the endometrial cavity and cause heavy or irregular menses

Submucosal leiomyoma

Location of leiomyoma that projects exophytically and may be pedunculated

Subserosal

An antiestrogen drug used in treating some breast carcinomas; reported to cause growth in leiomyomas

Tamoxifen

Duplication of uterus with common cervix with or without rudimentary horn

bicornuate uterus

pain associated with menstruation

dysmenorrhea

pregnancy occurring outside the uterus, commonly in the uterine tubes

ectopic pregnancy

injection of sterile saline into the endometrial cavity under ultrasound guidance

sonohysterography

In premenopausal women, if the endometrium measures more than ___mm hyperplasia is suggested. Where as in postmenopausal women ____mm is the upper limit of normal. A. 14, 8 B. 15, 6 C. 5, 10 D. 10, 5

A. 14, 8

With endometritis dilation of Fallopian tubes can show fluid-filled tubular shapes with well-defined echogenic walls. Thickened tubal wall of ___ or more is indicative of acute disease. A. 5mm B. 3mm C. 2mm D. 8mm

A. 5mm

____ consists of vascular plexus of arteries and veins without intervening capillary network. Rare, usually involving myometrium and rarely endometrium. Acquired due to pelvic trauma, surgery, or gestational trophoblastic neoplasia. A. AVM's B. AVF's C. Arteriosclerosis D. Arcuate artery sclerosis

A. AVM's

Endometrial hyperplasia consists of the following sonographic findings: A. Abnormal l thickening of endometrium B. Irregular borders of endometrium C. Hyperechoic calcifications of endometrium D. Hypoechoic or isoechoic nodules within hyperechoic endometrium

A. Abnormal l thickening of endometrium

Multiparity is a risk factor associated with which of the following abnormalities? A. Adenomyosis B. Endometriosis C. Nabothian cyst D. Hematometrocolopos E. Polycystic ovarian disease

A. Adenomyosis

Hemorrhage in islands of endometrial tissue appears as small hypoechoic myometrial cysts. Calcifications resulting from prior instrumentation are seen along the inner myometrium and cervix. Has been described as Swiss cheese or honeycomb pattern. A. Adenomyosis B. Leiomyoma C. Squamous cell carcinoma D. Nabothian cysts

A. Adneomyosis

This mullerian anomaly is related to exposure to the drug Diethylstilbestrol (DES) A. Arcuate (class 6) B. Septate uterus (class 5) C. Didelphys uterus (class 3) D. Bicornate (class 4)

A. Arcuate (class 6)

____ is found in women with post traumatic or post-surgical histories. Includes uterine curettage and may be cause of infertility or recurrent pregnancy loss. A. Asherman's syndrome B. Endometrial fibrosis C. Squamous cell carcinoma D. Cervical carcinoma

A. Asherman's syndrome

The most common uterine anomaly is the: A. Bicornis unicollis B. Bicornis bicollis C. Uterus didelphys D. Septate uterus

A. Bicornis unicollis

The most likely factor of cervical polyps is: A. Chronic inflammation B. Leiomyoma C. Endometriosis D. Ectocervix

A. Chronic inflammation

The largest part of the uterus is the: A. Corpus B. Isthmus C. Cervix D. Fundus

A. Corpus

Most common gynecological malignancy in North America A. Endometrial carcinoma B. Leiomyosarcoma C. Endometriosis D. Squamous cell carcinoma E. Myoma

A. Endometrial carcinoma

Hypervascularity within the endometrium is characteristic finding in: A. Endometritis B. Adenomyosis C. Endometriosis D. Asherman syndrome E. Endometrial hyperplasia

A. Endometritis

The vaginal cuff can bee seen in: A. Hysterectomy patients after surgery B. Premenarchal patients C. Postmenopausal patients D. Patients 24-48 hours postpartum

A. Hysterectomy patients after surgery

What is the most common a gynecologicic tumor? A. Leiomyoma B. Leiomyosarcoma C. Endometrial carcinoma D. Gartner' duct cyst

A. Leiomyoma

____ tumors composed of spindle-shaped, smooth muscle cells arranged in a whorl-like pattern, and is sensitive to estrogen stimulation. A. Myoma B. Müllerian duct C. Endometrial polyp D. Endometrial carcinoma

A. Myoma

The most common cause of uterine calcifications is ____ with a less common cause being ____. A. Myoma, arcuate artery calcification B. Gartner cysts, interlobar artery calcifications C. Endometrial carcinoma, fibroids D. Lymphoma, leiomyomas

A. Myoma, arcuate artery calcification

All of the following are clinical findings associated with leiomyomas except: A. Myometrial cysts B. Infertility C. Palpable pelvic mass D. Menorrhagia

A. Myometrial cysts

Eccentric position of IUD from midline suggests: A. Myometrial penetration B. Incomplete removal of IUD C. Malposition D. Fallopian tube perforation

A. Myometrial penetration

A 38 y/o female pt presents to the ultrasound department for a pelvic sonogram with an indication of pelvic pain. Upon ultrasound interrogation, the sonographer notes an anechoic mass within the cervix. This mass most likely represents a: A. Nabothian cyst B. Benign follicular cyst C. Dermoid cyst D. Gartner duct cyst

A. Nabothian cyst

Obstruction of an inclusion cyst results in a: A. Nabothian cyst B. Cystic teratoma C. Endometrial polyp D. Corpus luteum cyst E. Serous cystadenoma

A. Nabothian cyst

Ultrasound evaluation of the uterus demonstrates multiple solid masses within the uterine myometrium, what is your diagnosis: A. Uterine leiomyosarcoma B. Uterine polyps C. Uterine carcinoma D. Uterine adenomyosis

A. Uterine leiomyosarcoma

Tumors in the vagina are usually: A. Vaginal adenocarcinoma, rhaddomyosarcoma B. Vaginal adenocarcinoma, squamous cell carcinoma C. Squamous cell carcinoma, leiomyosarcoma D. Leiomyosarcoma, endometrioma

A. Vaginal adenocarcinoma, rhaddomyosarcoma

When full thickness of epithelium composed of undifferentiated neoplasticism cells lesion refers to as:

Adenomyosis

benign invasive growth of the endometrium that may cause heavy, painful menstrual bleeding

Adenomyosis

What should be looked for with a unicornate uterus that is small and off to one side?

Agenesis of contralateral kidney

On TV sonography, atrophic endometrium is thin measuring: A. <3mm B. <5mm C. <8mm D. <4mm

B. <5mm

Most endometrial malignancies are ____ occurring in peri or postmenopausal patients with irregular bleeding. The earliest change of endometrial carcinoma is a thickened endometrium. A. Squamous cell carcinoma B. Adenocarcinoma C. Endometrial carcinoma D. Leiomyoma

B. Adenocarcinoma

The invasion endometrial tissue into the myometrium of the uterus is referred to as: A. Amenorrhea B. Adenomyosis C. Endometriosis D. Adenomyomatosis

B. Adneomyosis

A rapid increasing pelvic mass is most suspicious for a(n): A. Leiomyoma B. Cystadenoma C. Endometrioma D. Dysgerminoma

B. Cystadenoma

_____ is a landmark for identification of long axis of the uterus. A. Vaginal canal B. Endometrial canal C. Cervix D. Internal os

B. Endometrial canal

The inner mucosal lining of the uterus is the: A. Myometrium B. Endometrium C. Serosal layer D. Perimetrium

B. Endometrium

All of the following are true of endometrial carcinoma EXCEPT: A. Most cases occur in postmenopausal women B. it is caused by prolonged stimulation of the endometrium by progesterone C. It is preceded by endometrial hyperplasia in most cases D. It can metastasize via lymphatic and/or hematogenous routes E. The most important prognostic factor is the stage of the tumor

B. Explanation: A and D are pretty self-explanatory. B is incorrect because it is not stimulated by progesterone, but estrogen (tricky, I know). C is correct; most cases do arise in a background of endometrial hyperplasia. However, remember that hyperplasia in and of itself is not pre-neoplastic (there are many, many cases of hyperplasia that never go on to become carcinoma). E is correct; the depth of invasion (and presence or absence of metastases) - which is basically the stage of the tumor - is the most important factor in prognosis.

A 24-year-old female patient presents to the ultrasound department for a pelvic sonogram with an indication of pelvic pain. Upon ultrasound interrogation, the sonographer notes an anechoic mass within the vagina. This mass most likely represents a: A. Nabothian cyst B. Gartner's duct cyst C. Dandy-walker cyst D. Ovarian cyst

B. Gartner's duct cyst

Rare malignancy, less than 5% of uterine malignancies, solid tumor arising from myometrium or endometrium. Commonly found in fundus of uterus with rapid growth A. Endometrial carcinoma B. Leiomyosarcoma C. Endometriosis D. Squamous cell carcinoma E. Myoma

B. Leiomyosarcoma

The uterus and the upper third of the vagina is derived from: A. Gartner's ducts B. Mulleria ducts C. Embryonic ducts D. Vaginal ducts

B. Mulleria ducts

____ is more likely to occur with uterine cancer. A. Hydrometrocolpos B. Pyometra C. Pyometrocolpos D. Cervical obstruction

B. Pyometra

____ procedure is not preformed in women with acute pelvic inflammatory disease. A. Transvaginal scan B. SIS C. EV scan D. Transabdominal scan

B. SIS

Which mullarian anomaly has the highest incidence of infertility? A. Arcuate B. Septate C. Didelphys uterus D. Bicornuate

B. Septate

Why is diagnosis so critical for Arteriovenous Malformations?

Because dilation and curettage may lead to catastrophic hemorrhaging

Size and shape of a normal uterus is related to: A. Gravidity, sexual status, age B. Hormonal status, gravidity, age C. Age, hormonal status, parity D. Age, hormonal status, sexual status

C. Age, hormonal status, parity

Absence of a menstrual period is referred to as: A. Dysuria B. Dysmenorrhea C. Amenorrhea D. Menorrhagia

C. Amenorrhea

Intrauterine synechia are also known as endometrial adhesions, or ____. A. Gartner's syndrome B. Uterine curettage C. Asherman's syndrome D. Müllerian syndrome

C. Asherman's syndrome

Perforation of the uterus by an IUD almost always occurs ____. A. 14-20 days after insertion B. During the first mensuration post insertion C. At time of insertion D. Within first week of insertion

C. At time of insertion

Difficult or painful intercourse is referred to as: A. Dysuria B. Dysmenorrhea C. Dyspareunia D. Hydrocolpos

C. Dyspareunia

Majority of women with postmenopausal uterine bleeding are experiencing ____ A. Endometrial hyperplasia B. Endometrial polyps C. Endometrial atrophy D. Endometrial fibroids

C. Endometrial atrophy

Demonstration of myometrial invasion is clear evidence for ____. A. Squamous cell carcinoma B. Adenocarcinoma C. Endometrial carcinoma D. Leiomyoma

C. Endometrial carcinoma

_____ has strong association with HRT. In premenopausal women, anovulatory cycles and obesity are also considered risk factors. A. Lymphoma B. Cervical carcinoma C. Endometrial carcinoma D. Leiomyosarcoma

C. Endometrial carcinoma

The inferior portion of the cervix closest to the vagina is the: A. Cornu B. Internal so C. External so D. Inferior fornix

C. External os

The layer of the endometrium that is altered as a result of hormonal stimulation during the menstrual cycle is the: A. Myometrium B. Endometrial cavity C. Functional layer D. Basal layer

C. Functional layer

The most common location for a uterine leiomyoma to develop is: A. Serosal B. Subserosal C. Intramural D. Submucosal E. Pedunculated

C. Intramural

If mullerian anomalies encountered, _____ should be examined for ipsilateral agenesis or morphological abnormalities. A. Spleen B. Renal arteries C. Kidneys D. Renal veins

C. Kidney's

A patient presents with a history of postmenopausal bleeding. A heterogeneous intrauterine mass is identified on sonography. On the basis of clinical history, the sonographic findings are most suspicious for: A. Leiomyoma B. Endometrioma C. Leiomyosarcoma D. Hematometrocolps E. Endometrial hyperplasia

C. Leiomyosarcoma

The surgical removal of a fibroid is termed: A. Hystosonogram B. Total abdominal hysterectomy C. Myomectomy D. Uterine eatery embolization

C. Myoectomy

The hypoechoic halo surrounding the endometrium should NOT be included in measurements because this represents inner compact layer of the____.

C. Myometrium

Chronic inflammatory retention cysts are also known as: A. Gartner cyst B. Duplication cyst C. Nabothian cyst D. Peripelvic csyt

C. Nabothian cyst

As infection (endometritis), periovarian adhesions may form and fuse inflamed tube and ovary called: A. Adnexitis B. Hydrosalpinx C. Tubo-ovarian complex D. None of the above

C. Tubo-ovarian complex

Endometrial polyps are usually asymptotic but may cause ____. Typically cause diffuse or focal endometrial thickening, more frequently seen in perimenopausal women. A. Dysmenorrhea B. Oligomenorrhea C. Uterine bleeding D. Uterine pain

C. Uterine bleeding

When full thickness of epithelium composed of undifferentiated neoplasticism cells lesion refers to as:

Carcinoma in situ

Hyperplastic protrusion of the epithelium of the cervix; may broad-based or pedunculated

Cervical polyp

Clinical findings of irregular bleeding may be the result of ____, a condition that arises from the hyperplastic protrusion of the epithelium of the endodermis and ectocervix.

Cervical polyps

Scrapping with a curette to move 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

Curettage

A benign disease with global infiltration of the endometrium, characterized as an ectopic occurrence of endometrial tissue within myometrium; more common in posterior aspect: A. Leiomyoma B. Adenocarcinoma C. Adenomyosarcoma D. Adenomyosis

D. Adenomyosis

____ is not reliably diagnosed by ultrasound, but is well characterized by MRI A. Endometrial carcinoma B. Adenocarcinoma C. Leiomyoma D. Adenomyosis

D. Adenomyosis

Endometrial thickening (endometritis) most often occurs in association with: A. PID B. Postpartum state C. Instrumentation invasion D. All of the above

D. All of the above

Inability to distinguish the endometrial cavity is an identifiable sonographic finding in: A. Infertility B. Endometriosis C. Tamoxifen therapy D. Asherman syndrome E. Polycystic ovarian disease

D. Asherman syndrome

The nonfunctional outer layer of the endometrium is the: A. Myometrium B. Endometrial cavity C. Functional layer D. Basal layer

D. Basal layer

A small percentage of leiomyomas originate in the ____ with most of them originating in the ____. A. Myometrium, cervix B. Vagina, cervix C. Cervix, endometrium D. Cervix, myometrium

D. Cervix, myometrium

All of the following are sonographic findings consistent with adenomyosis except: A. Diffuse, enlarged uterus B. Myometrial C. Hypoechoic areas adjacent to the endometrium D. Complex adnexal mass

D. Complex adnexal mass

Cervical carcinoma has all of the following clinical findings except: A. Can be asymtomatic B. Vaginal discharge C. Bleeding D. Endometrial polyps

D. Endometrial polyps

Clinical symptoms of low back pain, fever, lower abdominal pain, dysmenorrhea, menorrhagia, sterility, and constipation are indicative of: A. Squamous cell carcinoma B. Endometrial hyperplasia C. Leiomyoma D. endometritis

D. Endometritis

A patient presents with a history of breast cancer and tomixifen therapy. Which of the following pelvic structures requires additional evaluation? A. Uterus B. Ovary C. Dane a D. Endometrium E. Fallopian tubes

D. Endometrium

Tamoxifen therapy is most likely to affect which of the following structures: A. Cervix B. Ovaries C. Myometrium D. Endometrium E. Fallopian tubes

D. Endometrium

A 32-year-old woman had a firm nodule palpable on her uterus three years ago noted on a routine physical examination. The nodule has slowly increased in size and is now about twice the size it was when first discovered. She is asymptomatic. Which of the following does this patient most likely have? A. Adenocarcinoma B. Leiomyosarcoma C. Rhabdomyosarcoma D. Leiomyoma

D. Explanation: The nodule grew slowly, and the patient is asymptomatic. Malignant tumors (A - C) would be more likely to grow quickly and produce nasty symptoms.

The most superior and widest portion of the uterus is the: A. Corpus B. Isthmus C. Cervix D. Fundus

D. Fundus

Abnormal accumulation of blood within the vagina is termed: A. Hydrometra B. Hematometra C. Hydrocolpos D. Hematocolpos E. Hematometrocolps

D. Hematocolpos

Calcifications caused by calcifications sclerosis within arcuate arteries can indicate underlying disease, such as diabetes mellitus, hypertension, or chronic renal failure. Such calcifications have been termed: A. Fibroids B. Gartner's arteriosclerosis C. Duplication myoma D. Monckerberg's arteriosclerosis

D. Monckerberg's arteriosclerosis

The paired embryonic ducts that develop into the fable urogenital tract are the: A. Fallopian ducts B. Wolffian ducts C. Gartner ducts D. Müllerian ducts

D. Mullarian ducts

What is the most common type of cervical cancer? A. Endometrial carcinoma B. Leiomyoma C. Leiomyosarcoma D. Squamous cell carcinoma

D. Squamous cell carcinoma

Which location is a fibroid most likely to cause irregular bleeding? A. Cervical B. Subserosal C. Intramural D. Submucosal E. Pedunculated

D. Submucosal

Which of the following fibroid location is most likely to cause menorrhagia? A. Corneal B. Intramural C. Subserosal D. Submucosal E. Pedunculated

D. Submucosal

Vaginal atresia is diagnosed by development of: A. Hydrocolpos B. hydrometrocolpos C. Hematometrocolpos D. Same symptoms as imperforated hymen E. All of the above

E. All of the above

Prophylactic antibiotics are given to women with chronic PID and women with a history of ____ to preform SIS. A. Mitral valve prolapse B. Cardiac disorders C. Endometrial carcinoma D. All of the above E. Both A and B

E. Both A and B

Which of the following is a common clinical symptom associated with adenomyosis? A. Amenorrhea B. Mittelschmerz C. Lower back pain D. Urinary frequency E. Uterine tenderness

E. Uterine tenderness

Portion of the canal of the uterine cervix that is lined with squamous epithelium

Ectocervix

Malignancy characterized by abnormal thickening of the endometrial cavity; usually associated with irregular bleeding in perimenopausal and postmenopausal women

Endometrial carcinoma

Benign condition that results from estrogen stimulation to the endometrium without the influence of progesterone; frequent cause of bleeding

Endometrial hyperplasia

Pedunculated or sessile well-defined mass attached to the endometrial cavity

Endometrial polyp

Infection within the endometrium of the uterus

Endometritis

If fluid is present in the endometrium it should be included in the endometrial measurement. True or false?

False

Most common cystic lesion of the vagina

Gartner's duct cyst

small cyst within the vagina

Gartner's duct cyst

Accumulation of blood in the vagina

Hematocolpos

Obstruction of the uterus characterized by an accumulation of blood

Hematometra

Blood filled vagina and uterus

Hematometrocolps

Accumulation of fluid in the vagina

Hydrocolpos

Obstruction of the uterus characterized by an accumulation of fluid

Hydrometra

Fluid accumulation within the uterus and vagina

Hydrometrocolpos

Most common congenital abnormality of the female genital tract

Imperforated hymen

Most common leiomyoma location, causes infertility and recurrent pregnancy loss

Intramural

A 43 year old perimenopausal patient presents with abnormal vaginal bleeding and pelvic pain. A previous sonogram showed a small hypoechoic mass within the uterine wall. A recent ultrasound shows significant growth of the mass displacing the contour of the uterus. What is the most likely diagnosis?

Leimyosarcoma

Most common benign gynecological tumor in women during their reproductive years

Leiomyoma

Irregular, acyclic bleeding

Metrorrhea

Most common cause of uterine calcifications

Myomas

Benign tiny cysts within the cervix

Nabothian cyst

Most common finding of the cervix

Nabothian cyst

The most common finding, seen frequently in middle-aged women, is the presence of ___

Nabothian cysts

Two most commonly used IUD's

Paraguard and Mirena

What are the two most commonly used IUD's?

Paraguard, Mirena

Accumulation of pus in the vagina

Pyocolopos

obstruction of the uterus and/or the vagina characterized by an accumulation of pus

Pyometra

Complete duplication of the uterus, cervix, and vagina

Uterus didelphys

type of leiomyoma that may become pedunculated and appear as an extrauterine mass

subserosal leiomyoma