Ch. 17: The Uterus and Vagina (Content)

True or false: Gartner duct cysts can cause S/Sx like pain, menorrhagia, and constipation.

*False*. Gartner duct cysts almost always have no S/Sx.

True or false: the thickness of the basal endometrium fluctuates throughout the menstrual cycle.

*False*. It is the functional layer that fluctuates. The basal layer minimally changes

True or false: fundal fibroids may require a C-section in a gravid patient.

*False*. LUS fibroids, if close enough to the cervix, will complicate labor and thus require a C-section.

True or false: Nabothian cysts are malignant masses.

*False*. They are completely benign and common.

True or false: uterine agenesis is a common malformation.

*False*. This is rare.

True or false: multiparous uterus' tend to be larger than nulliparous uterus'.

*True*

True or false: Nabothian cysts are classically asymptomatic.

*True*.

True or false: the uterus is intraperitoneal.

*True*.

True or false: pregnancy and menopause can affect fibroid size.

*True*. High estrogen levels may stimulate growth during pregnancy, and low estrogen levels after menopause may shrink them.

True or false: cervical malignancy can cause hydro/hematometra.

*True*. If the mass disrupts the cervical canal, it will cause obstruction.

Name 3 sonographic findings of a Nabothian cyst:

1. Anechoic mass in CX 2. Multiple cysts 3. Possibly complex

How does adenomyosis present clinically?

1. Boggy, tender uterus 2. Enlarged uterus 3. Multiparous, older patient (Dysmenorrhea, Menometrorrhagia, pelvic pain, dyschezia, dyspareunia)

Name 3 conditions that can cause cervical stenosis:

1. Cervical tumor 2. Scarring from radiation Tx 3. Cervical infection (Cervical atrophy)

What are the clinical findings of vaginal obstruction?

1. Cyclic pelvic pain 2. Enlarged uterus 3. Amenorrhea (Abd pain, Urinary retention)

How does cervical malignancy appear on utlrasound?

1. Heterogeneous 2. Bulky CX 3. > 4 cm A-P CX 4. Loss of normal cervical canal

Name 3 treatments for fibroids:

1. Hormone therapy 2. Myomectomy 3. Hysterectomy (Uterine artery embolization, MRI guided high-intensity focused ultrasound)

Name 3 clinical findings of leiomyomas:

1. Pelvic pressure 2. Constipation 3. Menorrhagia (Dysuria, palpable mass, enlarged uterus, urinary frequency)

Name 3 clinical findings of leiomyosarcoma:

1. Pelvic pressure 2. Enlarged, bulky uterus 3. Menorrhagia (Constipation, infertility, dysuria, palpable mass)

Name 3 sonographic findigns of leiomyosarcoma:

1. Rapid growth 2. Hypoechoic mass 3. Degenerative appearance (Shadowing, hetero/bulky/large uterus)

How does adenomyosis appear sonographically?

1. Thickened fundus or posterior uterus 2. Diffusely enlarged uterus 3. Myometrial cysts 4. Heterogeneous myometrium (Ill-defined myo-endo interface, hypo or hyper area next to endo)

What types of sonography can help Dx uterine malformations?

2D, 3D, and Saline infusion sonohysterography

In patients who've had hysterectomies, how tall (A-P) should the vaginal cuff be?

A-P: 2 cm

Although similar, what is an important differentiation between adenomyosis and endometriosis? (hint: think patient characteristics)

Adenomyosis: older, multiparous Endometriosis: younger, fertility issues

What is the most common uterine position?

Anteversion

Where do the fallopian tubes enter the uterus?

At the cornua

Describe the difference between bicornuate and unicornuate uterus'.

Bicornuate: two endometrial cavities, one cervix, and prominent funal concavity. Unicornuate: one uterine horn, endometrial cavity, and cervix.

What is the most common malignancy in female patients under 50?

Cervical malignancy

What is uterus didelphys?

Complete duplication of the uterus, cervix, and vagina

What is the main sonographic finding of vaginal obstruction?

Distended uterus and/or vagina with anechoic/complex fluid.

Premature thelarche

Early breast development w/no other hormone-dependent signs.

Isosexual precocity

Early development of 2ndary sexual characteristics (menses, ovulation, elevated gonadotropin)

Define subserosal fibroid:

Fibroid that distorts the serosal contour of the uterus.

What are the four major divisions of the uterus?

Fundus Corpus Isthmus Cervix

Where is the most common general location for fibroids?

Intramural

Premature adrenarche

Isolated pubic hair growth + increased androgens

In patients who've had hysterectomies, how long and tall (A-P) should the cervical remnant be?

L: < 4.3 cm A-P: < 4.4 cm

What are some ways to differentiate leiomyosarcoma from a regular fibroid?

Leimyosarcoma will: - Have rapid growth - Appear in peri/postmenopausal patients (usually) - Have degenerative appearance

What is the leading cause of hysterectomy and GYN surgery?

Leiomyoma (fibroid)

What is the most common benign gynecologic tumor?

Leiomyoma (fibroid)

What is a the size of a normal adult uterus?

Length: 6-8 cm Width: ~4 cm A-P: ~2.5 cm

What is the term for the isthmus during pregnancy?

Lower Uterine Segment (LUS)

How do fibroids appear sonographically?

Many appearances! - Solid, hypoechoic - Calcifications/complex if degenerative - Diffuse heterogeneity if multiple - Posterior shadowing

What embryologic structures do the female reproductive organs arise from?

Müllerian ducts

How does uterine size change throughout life?

Neonatal: 1:1 ratio uterus to cervix, tubular in shape Prepubertal: 2:1 ratio uterus to cervix Puberty/Adulthood: uterus becomes much larger than cervix Menopause: Atrophies and becomes smaller

What patient populations are more at ridk of developing fibroids?

Obese Black Nonsmokers, Perimenopausal

How do neonatal patients present with hydrometracolpos?

Palpable abdominal mass

What are the three layers of the uterus?

Perimetrium Myometrium Endometrium

What's the difference between precocious puberty and pseudoprecocious puberty?

Precocious: caused by intracranial tumor or idiopathic Pseudoprec: Ovarian/adrenal/liver tumors

What two systems develop simultaneously, and thus are more likely to have paired malformations?

Reproductive and urinary (especially uterus and kidneys)

Which uterine anomaly is most associated with SABs?

Septate uterus

Describe the difference between a septate, subseptate, and arcuate uterus.

Septate: two endometrial cavities divided by a midline septum Supseptate: incomplete septum where endometrium branches into two horns Arcuate: Concave endometrial contour at fundus, variant of subseptate *All have normal external fundal contour*

Which fibroid locations may affect fertility can cause bleeding?

Submucosal and intracavitary

What is the risk with pedunculated fibroids?

Torsion, leading to necrosis and acute pelvic pain

According to several studies, what effect did DES have on baby girls?

Uterine malformations that lead to menstrual disorders, infertility, and OB complications

What types of vaginal malformatiosn can cause obstruction?

Vaginal atresia Vaginal septum Imperforate hyman

What is adenomyosis?

implantation of endometrial tissue in the myometrium.