Lesson 2 Abnormal Female Pelvis: Uterus and Endometrium Part 1

what may Nabothian cysts be caused by?

chronic cervicitis

what is stroma and what role does it have?

connective tissue - has a structural role (ex. Endometrium)

AUD

deviation from normal menses- volume, regularity, timing

adenomyosis can be_____ or ____?

diffuse or focal

what does adenomyosis cause?

dysmenorrhea and AUB

what will be present if RPOC in likely?

echogenic mass with vascularity

what does endometrial hyperplasia look like sonographically?

endometrium is diffusely thickened although asymmetric or focal thickening may be present

what does will the uterus look like with adenomyosis?

enlarged

what is the most common gynecologic cancer?

enodmetrial adenocarcinoma

what is unopposed estrogen?

estrogen without progesterone

adenomyosis may coexist with what other conditions?

fibroids

what does the smooth muscle in adenomyosis become?

hyperplastic

when may leiomyomas cause pain?

if they degenerate

what is hematometra causes by?

imperforated hymen, cervical stenosis, vaginal neoplasm

endometrial polyps are most prevalent in?

in perimenopausal and postmenopausal women

what is the leading cause of hysterectomys?

leiomyomas

what must the endometrial thickness be for RPOC to be unlikely?

less than 10mm

what is the most common type of leiomyomas?

myometrial

hydrosapinx may be caused by?

old infections or STD as well as previous surgery, adhesions, endometriosis

dysmenorrhea?

painful periods

most cases of endometrial adenocarcinoma are diagnosed in ______women?

post menopausal

most common clinical presentation of endometrial adenocarcinoma is?

postmenopausal bleeding

Immediate postpartum findings may include ?

residual fluid and echogenic material representing hemorrhage within the endometrial cavity

what shape are hydrosapinx?

sausage

what type of fluid are hydrosapinx filled with?

serous or clear fluid

hypomenorrhea?

short, light menstrual flow

gartner duct cyst?

small cysts within the vagina

myomectomy?

surgical removal of fibroids from the uterus. Uterus left in place, and may make pregnancy more likely than before. Preferred fibroid treatment if patient wants to become pregnant

are leiomyomas multiple and varying in size?

yes

what is varix?

- like varicose vein - enlarged and convoluted vein, artery, or lymphatic vessel

sonographic appearance of endometrial polyps?

-A polyp is typically isoechoic to the surrounding endometrium causing the appearance of either focal or global endometrial thickening -Cystic spaces within the polyp -Evidence of a vascular feeding vessel on color Doppler imaging -Polyps are well defined when outlined by saline instilled during sonohysterography

what are retained products of conception?

-After delivery of an infant or after an abortion: -Some of the gestational contents may remain within the uterine cavity and cause bleeding or infection -The retained products of conception (RPOC) typically consist of placental tissue, which can persist for months and result in AUB

what do you see with cervical carcinoma?

-Epithelial neoplasm -Intermenstrual or postcoital bleeding -Hypoechoic or heterogenous retrovesical mass -Endometrial fluid collection

fibroid locations and describe the locations (4)

-Intramural(myometrial most common) -Subserosal distort the uterine contour -Pedunculated grow off a stalk -Submucosal and intramural cause abnormal uterine bleeding (AUB)

CASE -A 65-year-old nulliparous woman with postmenopausal bleeding is evaluated by her physician. She is not receiving hormone replacement therapy. A pelvic sonogram is ordered. The adnexae appear normal; however, the sonographer notes an abnormality on the longitudinal midline image of the uterus -List at least two differential diagnoses for this finding?

-The differential diagnoses for a thickened endometrium in a postmenopausal woman include endometrial carcinoma, endometrial hyperplasia, or polyps -Sonohysterography can help determine if endometrial thickening is the result of a mass, such as a polyp, or if diffuse thickening is present -An endometrial biopsy is the next diagnostic procedure to differentiate between hyperplasia and carcinoma.

CASE -A 59-year-old woman with new-onset postmenopausal spotting is seen by her physician -A pelvic sonogram is ordered, and the sonographer notes no masses in the myometrium or adnexal regions -The endometrium measures 0.14 cm, and the appearance is as shown in the image -What is the most likely diagnosis?

-The endometrium in a postmenopausal patient with bleeding measures less than 5 mm -The most likely diagnosis is endometrial atrophy

how big or small are enodmetrial polyps?

-Their size is variable; some measure 1 mm, and others fill the entire endometrial cavity -May extend into the cervix or vagina

risk factors of endometrial adenocarcinomas? (5)

-Unopposed estrogen stimulation -Obesity, nulliparity, diabetes, hypertension -Tamoxifen therapy for breast cancer -Chronic anovulation -The presence of atypical endometrial hyperplasia

sonographically what does endometrial carcinoma look like?

-a thickened endometrium > 4mm in postmenopausal woman is -visualizedHeterogenous echotexture, hematometra, enlarged uterus -Biopsy is need to differentiate between hyperplasia and a carcinoma

endometrial adenocarcinoma effects almost ___ in every ___ women

1 in every 50 women

CASE -A 46-year-old multiparous woman sees her physician because of concerns about abnormal menses -Her last normal menstrual period occurred several months ago; however, 3 weeks before her visit, she experienced a heavy menstrual period that lasted 7 days -Physical examination findings are unremarkable and include a normal-size, non-tender uterus SONOGRAPHIC FINDINGS -The sonographer notes a normal endometrium, a globular appearance to the uterus, and a diffusely heterogeneous myometrium -What are two differential diagnoses for the sonographic appearance and an additional imaging modality that can aid in the diagnosis?

1-The striations evident in the images are typical of adenomyosis 2-The uterine shape and heterogeneity can also be attributed to fibroids Other imaging: -MRI can provide further evaluation of the junctional zone to evaluate for adenomyosis

adenomyosis is found in __% of hysterectomy specimens?

70%

2-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? A. Endometrial hyperplasia B. Submucosal fibroid C. Endometrial polyp D. Adenomyosis

A. Endometrial Hyperplasia

8-A 75-year-old woman with postmenopausal bleeding undergoes pelvic sonography, which reveals a 1.5 cm endometrium. What is the most likely diagnosis? A. Endometrial carcinoma B. Subserosal fibroids C. Submucosal fibroids D. Adenomyosis

A. endometrial carcinoma

what is Asherman syndrome?

Adhesions from a previous deep curretage or endometrial infection

what is endometrial hyperplasia?

An abnormal proliferation (growth) of the endometrium in response to excess or unopposed estrogen

are Nabothian cysts sypmptomatic or asymptomatic?

Asymptomatic

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. The patient wishes to maintain fertility. Which of the following is not a treatment option likely to be offered? A. Myomectomy B. Endometrial ablation C. Uterine artery ablation D. Progestin-releasing IUD

B. Endometrial ablation

9-An adnexal mass is palpated 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? A. Submucosal fibroid B. Pedunculated fibroid C. Intramural fibroid D. Uterine cancer

B. Pedunculated fibroid

4-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 the endometrial appearance? A. Submucosal fibroid B. Tamoxifen changes C. Adenomyosis D. Intramural fibroid

B. Tamoxifen Changes

what are endometrial polyps?

Benign focal overgrowths of endometrial glands and stroma

10-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? A. Endometrial polyps B. Endometrial hyperplasia C. Adenomyosis D. Pedunculated fibroids

C. Adenomyosis

1-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? A. Adenomyosis B. Submucosal fibroid C. Endometrial polyp D. Intramural fibroid

C. Endometrial polyp

5-A 30-year-old woman with menorrhagia undergoes a pelvic sonogram that reveals a hypoechoic mass distorting the endometrium. This mass attenuates the sound beam, it has a broad base, and the endometrium courses over it. What is the most likely diagnosis? A. Tamoxifen changes B. Endometrial polyps C. Submucosal fibroid D. Endometrial hyperplasia

C. Submucosal Hyperplasia

what can Tamoxifen do? and what does this increase the risk of?

Can stimulate cell growth and proliferation in endometrial tissue, enhancing the risk of endometrial abnormalities: -Carcinoma -Hyperplasia -Polyps

uterine artery ablation?

Catheter guided from femoral artery to location of feeding arteries

clinically Asherman syndrome may be?

Clinically, may be asymptomatic, amenorrhea, dysmenorrhea, hypomenorrhea, infertility

6-A 45-year-old woman with intermenstrual spotting undergoes transvaginal sonography. Endometrial thickness is 20 mm, and saline introduced during hysterosonography outlines a focal mass isoechoic to the endometrium. What is the most likely diagnosis? A. Submucosal fibroid B. Intramural fibroid C. Adenomyosis D. Endometrial polyp

D. Endometrial Polyp

3-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 β human chorionic gonadotropin testing is negative. What is the most likely cause of AUB? A. Endometrial hyperplasia B. Ectopic pregnancy C. Endometrial carcinoma D. RPOC

D. RPOC

what is hydrosapinx?

Distally blocked fallopian tube

what is adenomyosis

Glands and stroma from the basal layer of endometrium penetrate into the myometrium

what is the most common pelvic tumor?

Leiomyomas

what do Nabothian cysts look like?

Multiple or solitary anechoic structures <2cm May contain internal echoes

what are Leiomyomas also known as?

Myomas/ fibroids

what are Nabothian cysts?

Obstructed inclusion cysts in cervix

what can hematometra cause?

Pelvic pain, amenorrhea, hypomenorrhea and pelvic mass

what can endometrial polyps cause?

Polyps can cause coital spotting, intermenstrual bleeding, menorrhagia, and menometrorrhagia

what is Tamoxifen?

Tamoxifen is a drug administered to women with breast cancer to block estrogenic effects on breast tissue

CASE -A 35-year-old multiparous woman is referred for a pelvic sonogram because of menorrhagia -The endometrial and myometrial findings are demonstrated in the sonogram. -What is the most likely diagnosis?

The hypoechoic mass within the endometrium most likely represents a submucosal fibroid

-A 37-year-old woman undergoes a pelvic sonogram for AUB -The endometrium appears abnormally thick, so a sonohysterogram is performed -The findings are demonstrated in the image -What is the most likely diagnosis?

The mass demonstrated on the hysterosonogram most likely represents an endometrial polyp

-A 42-year-old woman undergoes a pelvic sonogram because of pelvic fullness and menorrhagia -The sonographic findings are shown in the image -What is the most likely diagnosis?

The myometrial mass shown in the image most likely represents a fibroid

sonographic findings of RPOC

The uterus immediately postpartum is enlarged and typically returns to normal size and shape within 6 to 8 weeks after delivery

how do you rule out RPOC?

To rule out RPOC, evaluate the endometrial cavity for a focal echogenic mass and assess endometrial thickness

menometrorrhagia

abnormally heavy/prolonged bleeding occurring frequently and irregularly

menorrhagia

abnormally heavy/prolonged menstrual bleeding

hematometra

accumulation of blood in uterus

what type of race are Leiomyomas more common in?

african american

Asherman syndrome poses an inability to distinguish what?

an endometrial cavity

perimenopausal

around menopause" - the period of life shortly before the occurrence of menopause - the natural transition to menopause

endometrial polyps are asymptomatic or symptomatic?

asymptomatic

what do leiomyomas look like?

benign smooth muscle tumors

hydrosapinx are unilateral or bilateral?

bilateral

hematometrocolpos?

blood accumulation in the uterus and vagina

hematocolpos?

blood accumulation in the vagina

An echogenic mass without vascularity may represent either RPOC or_______?

blood clots

Hematometra is?

blood trapped in the endometrial cavity

asherman syndrome may have ______ echoes in the ______ cavity?

bright endo

3rd most common Gynecological malignancy?

cervical carcinoma