Pathology Chapters 13-17

A mother brings her 15-year-old daughter to her pediatrician's office for increasing pelvic pain over the last few days. The mother is concerned that her daughter may have an ovarian cyst. While obtaining the patient's history, the patient seems hesitant to answer questions and seems elusive, but does state that she had her appendix removed when she was 10 years old. After the pediatrician asks the mother to step out for a few minutes, the daughter states that she has been sexually active with a guy. A urine test is negative for pregnancy, but the patient's temperature is 100.7 F. What is the likely diagnosis?

Acute PID

A 26-year-old woman presents to the emergency department with acute left lower quadrant and flank pain. The patient reports pain was better when she laid still and worse with movement or sitting. She claims no sexual activity for the last few months. Initial laboratory works shows an elevated WBC count, and urinalysis is negative for RBC's. A CT scan shows no evidence of a kidney stone but reveals bilateral cystic masses in the pelvis. Sonography shows a 4 cm right ovarian cyst and a left adnexal tubular structure with internal echoes and hyperemia. What is the most likely diagnosis?

Acute left pyosalpinx

A 50-year-old woman experiencing AUB undergoes pelvic sonography. The uterine body is globular and slightly heterogeneous in appearance, several myometrial cysts are identified, and the endometrial-myometrial junction is not clearly delineated. What is the most likely diagnosis?

Adenomyosis

A 27-year-old woman with recurrent miscarriages presents for a pelvic sonogram. Sonography reveals a subtle fundal indentation on the uterus with a slightly concave uterine cavity. These findings are associated with which uterine anomaly?

Arcuate uterus

A 75-year-old woman undergoes a pelvic sonogram because of increasing abdominal girth and complains of feeling exhausted. Sonographic evaluation demonstrates a 20 cm, complex, predominantly cystic mass occupying her pelvis and abdomen. Multiple papillary projections and septations are evident within the mass, which demonstrates vascularity on color Doppler imaging. What is the most likely diagnosis?

Cystadenocarcinoma

A 19-year-old woman was referred for a pelvic sonogram because of a palpable right adnexal mass and no other symptoms. The sonographer was unable to identify a normal right ovary but noticed a discrete area with hyperechoic dots and lines, including a rounded echogenic area that produced a shadow. At first, the area was thought to be bowel, but on observation, there was no peristalsis. These findings are most consistent with which type of ovarian mass?

Cystic teratoma

A patient with a positive serum pregnancy test and an IUD in place is seen for ultrasound. The US reveals an IUD within the uterine cavity with no evidence of an intrauterine gestation. A complex adnexal mass separate from the ovary is identified and a moderate amount of hypoechoic fluid is noted in the cul-de-sac and RUQ. The patient's last menstrual period was 7 weeks prior. What is the most likely diagnosis?

Ectopic pregnancy

A 25-year-old woman with menorrhagia undergoes a pelvic sonogram, which demonstrates multiple intramural and subserosal fibroids, with the largest measuring 8 cm. The physician presents several treatment options for the patient. The patient wishes to maintain fertility. Which of the following is NOT a treatment option likely to be offered?

Endometrial ablation

A 75-year-old woman with postmenopausal bleeding undergoes pelvic sonography, which reveals a 1.5 cm endometrium. What is the most likely diagnosis?

Endometrial carcinoma

A 48-year-old woman undergoes a pelvic sonogram because of AUB. The uterus has a homogeneous echotexture, and the endometrial thickness is 1.7 cm. Sonohysterography reveals diffuse endometrial thickening with no intraluminal masses. What is the most likely diagnosis?

Endometrial hyperplasia

A 45-year-old woman with intermenstrual spotting undergoes transvaginal sonography. Endometrial thickness is 20 mm, and saline introduced through hysterosonography outlines a focal mass isoechoic to the endometrium. What is the most likely diagnosis?

Endometrial polyp

A 50-year-old woman with AUB undergoes a pelvic sonogram. Transvaginal sonography reveals a thickened endometrium with a single vascular feeding vessel apparent on color Doppler imaging. What is the most likely diagnosis?

Endometrial polyp

The sonographic images of a unilateral ovarian mass in a 25-year-old woman with menstrual irregularities demonstrates a well-defined 5 cm homogeneous unilocular mass containing low-level internal echoes and posterior enhancement. These findings are most consistent with which ovarian pathology?

Endometrioma

A 28-year-old woman with dysmenorrhea since age 14 comes in for a pelvic sonogram. A right ovarian cyst is seen with thick walls and fluid/debris level. That same mass was seen sonographically 3 months ago. It is tender on imaging with the vaginal probe. What is the most likely diagnosis?

Endometrioma (28)

A 30-year-old woman with pelvic pain and dyspareunia presents for a pelvic sonogram. Sonography demonstrates a thin-walled cystic mass with low-level internal echoes and through transmissions in the left adnexa. The right ovary and uterus appear normal. What is the most likely diagnosis?

Endometrioma (30)

A 19-year-old woman is seen in her obstetrician's office 1 week after C-section. The C-section was urgent in nature and was performed at 27 weeks', 3 days gestational age for ruptured membranes, breech presentation, and extended period of fetal heart rate decelerations. The patient states that she has had increasing uterine tenderness over the last few days, which now is severe. She also says that she has had very minimal bleeding but a foul-smelling discharge and fever. The patient has no history of pelvic infections in the past. What is the most likely diagnosis?

Endometritis

A 45-year-old woman with mild pelvic discomfort undergoes a sonographic examination, and a 3 cm hypoechoic solid ovarian mass is discovered. The images also demonstrate ascites and marked attenuation posterior to the mass. Which of the following is the most likely diagnosis?

Fibroma with Meigs' syndrome

A 28-year-old woman presents to the emergency department with increasing abdominal and pelvic pain. The patient states that she has been treated twice within the last year for PID, but she has not felt like this during the previous episodes. She thinks she may have a pelvic infection again, but she is also having pain in her right upper quadrant that is more severe when she coughs or moves. Sonography of the GB appears normal. What is the likely diagnosis?

Fitz-Hugh_Curtis syndrome

A pediatric patient with elevated estrogen levels is referred for a pelvic sonogram after receiving a diagnosis of precocious puberty. A solid mass is discovered in the left adnexa, with no evidence of a normal left ovary. What is the most likely diagnosis?

Granulosa cell tumor

A 29-year-old woman with left lower quadrant pain is referred for a pelvic sonogram to rule out ovarian torsion. The images demonstrate a 4 cm left ovarian mass containing a reticular pattern of echoes with posterior enhancement and peripheral ovarian flow by color Doppler imaging. A follow-up sonogram performed 2 months later demonstrates a normal left ovary and a 2.5 cm dominant follicle on the right ovary. By the time of the follow-up sonogram, the patient was asymptomatic. Which of the following is the most likely diagnosis for the first examination?

Hemorrhagic ovarian cyst

The sonographic appearance of a copper wire IUD includes which of the following?

Highly echogenic stem with intense posterior shadowing

A 35-year-old woman with pelvic pain undergoes a pelvic sonogram. She has had an IUD for the past 3 years without complication. The sonogram reveals a normal-appearing uterus with an IUD located in the lower uterine segment. This is consistent with which of the following?

IUD migration

A 40-year-old woman presents for a pelvic sonogram because of abnormal menses. The sonogram reveals a Copper 7 IUD, which has been in place for 12 years. What is the most likely course of treatment for this patient?

IUD removal because Copper IUDs lose effectiveness after 10 years

A 37-year-old woman is undergoing IVF. After receiving gonadotropins, her physician orders a transvaginal sonogram. The purpose for this sonogram is to

Measure follicle size

A 55-year-old woman with stomach cancer is referred for a pelvic sonogram because of pelvic discomfort. The sonogram reveals bilateral solid ovarian masses. This finding is most consistent with which of the following?

Metastatic tumors

A 23-year-old woman undergoes a pelvic US for missing IUD strings. Her last menstrual period was 6 months prior, and a recent pregnancy test was negative. An IUD with a hypoechoic stem and hyperechoic arms is identified in the endometrial cavity. Based on the patient's history and sonographic findings, what type of IUD is imaged

Mirena

A 45-year-old woman undergoes a pelvic sonogram because of a family history of ovarian cancer. Her CA 125 levels are not elevated, and she is not experiencing any unusual symptoms other than weight gain. Sonography reveals a 15 cm, predominantly cystic mass with multiple septations, several papillary projections, and low-level echoes within the mass. Color Doppler imaging reveals vascularity within the solid components. Given the patient's history and sonographic findings, which of the following is the most likely diagnosis?

Mucinous cystadenocarcinoma

A 27-year-old woman complaining of severe pelvic pain undergoes a pelvic sonogram. The patient has a history of IUD insertion after her most recent pregnancy. The IUD is eccentrically located with the right T-arm extending lateral to the endometrium. What is the most likely diagnosis?

Myometrial penetration

A 22-year-old woman with irregular menses presents for a transvaginal sonogram. The right ovary contains 15 follicles in the periphery measuring 3-6 mm in diameter. The left ovary and uterus appear normal. The sonographic findings are compatible with

PCOS (22)

A 26-year-old woman has abnormal hair growth on her chin and elevated serum testosterone levels. Her last menses was 2 years ago. Her urine pregnancy test was negative. On transvaginal sonography, both ovaries are enlarged, measuring greater than 15 mL in volume. What is the most likely cause for her symptoms and sonographic findings?

PCOS (26)

A 31-year-old woman with irregular menses and infertility presents for pelvic sonography. The ovaries have eight follicles measuring 3-6 mm in diameter. The most likely reason for this sonographic finding is

PCOS (31)

A 28-year-old woman is seen in the emergency department for pelvic pain that has increased over the last 4-5 days. She states that she had an IUD placed by a physician in a clinic approximately 2 weeks ago and has had "problems" since then. While obtaining the patient's history, the patient says she has had PID in the but has not had any problems lately. On pelvic examination, the patient experiences severe pain with any movement of the cervix. Laboratory work shows an elevated WBC count and elevated ESR. What is the diagnosis?

PID from an IUD placement

An 18-year-old female college student presents to the emergency department with pelvic pain. Initial laboratory work shows an elevated WBC count, elevated ESR, negative hCG, and normal urinalysis. During a pelvic examination, the patient experienced severe pain with any manipulation of the cervix. Sonography of the pelvis was ordered for suspected PID. On transabdominal sonogram, the uterus and ovaries appear normal with no free fluid seen. The patient refuses endovaginal sonography because of the pain. What is the likely diagnosis?

PID is still likely, even with a normal transabdominal sonogram

An adnexal mass is palpable duchess in a 34-year-old woman with pelvic pressure. Pelvic sonography reveals a 4 cm solid adnexal mass with a normal-appearing ovary adjacent to the mass. What is the most likely diagnosis?

Pedunculated fibroid

A 27-year-old woman with a history of IUD insertion 6 months prior is seen now because the IUD strings are missing. Her last menstrual period was 3 weeks ago. The pelvic sonogram reveals a normal appearing uterus without evidence of an IUD within the pelvis. What is the most likely explanation regarding the IUD?

Perforation of IUD into the peritoneal cavity

A 32-year-old woman is seen by her gynecologist in the office for pelvic pain. She describes the pain as chronic that comes and goes. On pelvic examination, there is fullness in the right adnexa. The patient has no history of PID or IUD use but has had previous surgery for an ovarian cyst. Endovaginal sonography shows a completely anechoic structure near the right ovary, but the uterus and ovaries appear normal. What is the most likely diagnosis?

Peritoneal inclusion cyst

A 45-year-old woman with menorrhagia undergoes a pelvic sonogram that reveals a multiloculated cystic mass adjacent to the right ovary. The patient's medical history includes prior pelvic surgery for endometriosis 15 years ago. The patient denies any right lower quadrant pain. Which of the following is the most likely diagnosis?

Peritoneal inclusion cyst

A patient with an IUD in place has a positive pregnancy test. A sonogram reveals a 7-week, viable gestation within the uterus. The IUD is identified in the lower uterine segment; however, the strings are not visible to the obstetrician. Leaving the IUD in situ during pregnancy increases the risk for which one of the following complications?

Preterm labor

A 30-year-old woman 2 months postpartum with AUB undergoes transvaginal sonography. The examination reveals a normal-size uterus, a 12 cm thick endometrium, and an echogenic mass within the uterine cavity. Serum beta hCG testing is negative. What is the most likely cause of AUB?

RPOC (Retained Products of Conception)

Pelvic sonography is requested for a 45-year-old, postmenopausal woman who has a history of chronic right pelvic discomfort. The patient states that she has a history of endometriosis but denies a history of PID. Sonography shows an anechoic tubular structure between the uterus and right ovary, but there are no signs of hyperemia. What is the most likely diagnosis?

Right hydrosalpinx

A 38-year-old woman presents to the emergency department complaining of intermittent right adnexal pain for the last 2 weeks. The pain became severe the night before following intercourse, but symptoms have slightly improved today. The patient states that she has a history of endometriosis. The pelvic examination reveals mild right adnexal tenderness. The right ovary appears normal on pelvic sonogram but a moderate amount of adjacent fluid with internal echoes is identified. Neither color nor spectral Doppler was performed. The report states suspicion of a right TOA, but the laboratory test results are normal. What is the most likely diagnosis?

Ruptured endometrioma

For evaluation of infertility, 3D ultrasound of the pelvic has the most utility for the diagnosis of

Septate uteri

A 30-year-old woman with menorrhagia undergoes a pelvic sonogram that reveals a hypoechoic mass distorting the endometrium. This mass attenuated the sound beam, it has a broad base, and the endometrium courses over it. What is the most likely diagnosis?

Submucosal fibroid

A patient who is scheduled for a pelvic sonogram states that she currently has a Mirena IUD in place. What is the shape of this IUD?

T-shaped

A 42-year-old woman with a history of breast cancer undergoes a pelvic sonogram, which demonstrates cystic changes within the endometrium. Which of the following is the most likely cause of endometrial appearance?

Tamoxifen changes

A 25-year-old woman is referred for a pelvic sonogram because of left lower quadrant pain. A pregnancy test is negative. The sonogram reveals a 2 cm unilocular simple cyst adjacent to the left ovary. Which of the following statements is true regarding this finding?

This most likely represents a paraovarian cyst and no treatment is necessary

A patient presents with a history of severe pelvic pain, fever, and purulent discharge. A pelvic sonogram demonstrates a properly placed IUD and a complex adnexal mass. The ovary cannot be identified within or adjacent to the adnexal mass. What is the most likely diagnosis?

Tuboovarian abscess

A pelvic sonogram is performed on a 33-year-old woman with pelvic pain. She describes the pain as a constant dull ache that seems to increase when standing. Transabdominal sonography shows an enlarged, fibroid uterus, normal ovaries, and bilateral cystic areas that appear tubular. What should the sonographer do next?

Use color Doppler to see if the tubular structures are prominent veins

Which uterine anomaly is always characterized by two cervices and two vaginas?

Uterus didelphys

A 13-year-old girl started menses 6 months ago and has cyclic pain on the left side during menses. On the sonogram, an endometrial echo is present in addition to a thick-walled oblong mass attached to the uterus on the left side. What is the most likely diagnosis?

Uterus didelphys (13)