Q1 - pathology of the uterus

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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?


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