Pathology of uterus

Nabothian cysts originate from the ______ and are considered ______

Cervix; benign

What do Nabothian cysts usually measure?

Less than 2 cm (<2cm)

What causes nabothian cysts?

Chronic cervicitis which is the inflammation of the cervix

What are nabothian cysts also called?

Epithelial inclusion cyst

What clinical symptoms do cervical polyps present with?

Irregular bleeding

Cervical polyps may be _________ and are more common in ______ women

pedunculated; middle-aged

Large cervical leiomyomas may cause _____ or _____ obstruction

Bladder; Bowel

Large leiomyomas can ______ into the _______ ______

prolapse; vaginal canal

A myoma may be pedunculated and prolapse into the _____ _____

vaginal canal

Leiomyomas and cervical polyps are best visualized with _________

Sonohysterography

What is cervical stenosis?

Obstruction of the cervical canal

What is an obstruction of the cervical canal?

Cervical stenosis

Cervical stenosis causes a ______, _____ uterus

distended; fluid-filled

Cervical stenosis is a result from prior _______, _______, ______, ______, ______, or _______

instrumentation, childbirth, surgery, atrophy, cancer, irradiation

Premenopausal patients with cervical stenosis may experience ________, _________, __________, _________

oligomenorrhea; amenorrhea; dysmenorrhea; cramping

What is the most common type of cervical cancer?

Squamous cell carcinoma

What is a precursor of cervical carcinoma?

Cervical dysplasia on PAP exam

Cervical carcinoma appears on ultrasound as a _____, ________ mass and irregular ______ or _________ areas

solid; retrovesical; hyperechoic; hypoechoic

Cervical carcinoma typically appears in ________ women

menstruating

What is the optimal view for cervical carcinoma?

Translabial and transperineal

What is this condition called?

Hematocolpos

What is the most common cyst of the vagina?

Gartner’s duct cysts

What is the most common congenital abnormality of the female genital tract, resulting in obstruction?

Imperforate hymen

Obstruction of the uterus or the vagina may result in an accumulation of fluid such as, _______, _______, ________

hydrometra; hematometra; pyometra

What may result with an imperforate hymen?

- hydrocolpos / hydrometra
- hematocolpos / hematometra
- pyocolpos / pyometra

Solid masses of the vagina are _____. When found, the lesion is usually vaginal ________ or __________

rare; adenocarcinoma; rhabdomyosarcoma

What is seen post hysterectomy?

Vaginal cuff

The normal measurement of a vaginal cuff is?

Less than 2.1 cm (<2.1 cm)

Suspicious for malignancy, if vaginal cuff is _______ or contains a _________ mass

enlarged; well-defined

Nodular areas in the vaginal cuff may be due to ________ _______

post-irradiation fibrosis

Rectouterine pouch is AKA?

Pouch of Douglas or posterior cul de sac

The rectouterine pouch is the most _________ reflection of intraperitoneal fluid collections located between the _____ and _____

posterior/inferior; rectum;vagina

What amount of fluid can be seen in posterior cul de sac transvaginally?

5 mL or greater (>5 mL)

______ in the cul de sac is a _____ finding in _______ women and can be seen during all phases of the menstrual cycle

Fluid; normal; asymptomatic

What are the primary causes for large amount of fluid collections?

• Ascites

• blood resulting from ruptured ectopic pregnancy

• hemorrhagic cyst

• pus

What is the most common benign reproductive tumor?

Leiomyomas

Leiomyomas occur to ___ to _____ of women over ____ years old

20-30%;30

Leiomyomas are more common in ______ ______ women

African American

Leiomyomas are _______ and separated from the ______ easily

encapsulated; myometrium

With _____ and _____ compromise as a result of outgrowing their blood supply, fibrotic changes and degeneration of the myomas can occur

Atrophy; vascular

Leiomyomas are ______ dependent

estrogen

Leiomyomas can be seen with ___, ___, ___, ___ and ___

atrophy; calcification; hemorrhage; liquefaction; necrosis

Leiomyomas may increase in size during ______ or -__________

pregnancy; post-hormone replacement therapy

Leiomyomas rarely develop in _________ women

postmenopausal

What are clinical symptoms of a leiomyoma?

Uterine irregularity; uterine enlargement; pelvic pressure; pain; menometrorrhagia; menorrhagia

Myomas contribute to _______ by distorting the fallopian tube or endometrial cavity.

infertility

Leiomyomas may be ______ and ______

pedunculated; migratory

Leiomyomas can be located in ____ portion of the _________. Can be uncommonly found in the _______, _____, and ______

any; uterine; lower uterine segment; cervix; broad ligament

Leiomyomas can be described as three types, what are they?

Submucosal; Intramural; subserosal

Submucosal leiomyomas can disrupt the _______, causing ______, or ______ bleeding and _______

endometrium; irregular; heavy; infertility

Intramural leiomyomas are located within the ______, they are the most ______, cause _____ or recurrent _____

myometrium; common; infertility: miscarriages

Subserosal leiomyomas are located in the _______ or _______

Perimetrium; pedunculated

Sonographic findings of leiomyomas are:

• Uterine enlargement

• Heterogenous

• Contour distortion

• Hypoechoic normally, or hyperechoic

• Calcifications

• Difficult to image

What is the measurement of an abnormal endometrium in the follicular phase?

Greater than 6mm (>6mm)

What is the measurement of an abnormal endometrium with untreated menopause?

Greater than 5mm (>5mm)

What is the treatment of choice in cases of infertility and a submucosal myoma?

Surgery by myomectomy

What is the treatment of choice in cases of menorrhagia for myomas?

• Hormonal suppression (hormonal suppression)

• Endometrial ablation

• Uterine artery embolization (UAE)

• High intensity focused ultrasound (HIFU)

What is the least invasive treatment for women with menorrhagia for myomas?

Hormonal suppression

Leiomyomas are the most common cause of uterine _________

calcifications

What is a less common uterine calcification?

Arcuate artery calcification

What is a benign disease with a collection of ectopic endometrial tissue infiltrating within the myometrium that may be diffuse or focal?

Adenomyosis

Adenomyosis may be ___ or ___ and is more common on the ___ wall

diffuse; focal; posterior

Adenomyosis sonographically presents as a ___, ___ uterus without ___

bulky; enlarged; focal mass

Adenomyosis has a ___ or ___ pattern

Swiss cheese; honeycomb

With adenomyosis, the tissue penetration reaches a depth of ______ from the basal layer of the endometrium

Greater than 2.5 mm

Adenomyosis may be diffuse or focal, with ___ pattern being the most common

diffuse

Focal pattern appears as isolated _________ and creates an enlarged _______

adenomyoma; uterus

Focal adenomyosis appears as isolated _______

adenomyomas

60% of women with adenomyosis experience:

• Abnormal uterine bleeding (hypermenorrhea)

• Prolonged/profuse uterine bleeding (menorrhagia)

• Irregular, acyclic bleeding (metrorrhea)

25% of patients with adenomyosis also suffer from ______ during menstruation (_______)

pelvic pain; dysmenorrhea

Patients with adenomyosis are often _______ and ______ than patients with endometriosis

multiparous; older

Adenomyosis is managed with ________

hormone therapy

Clinical symptoms of adenomyosis cause patient to present with:

• Painful, ____ _____

• The uterus is found to range from normal to ______ times the normal size

• Globular in _____, _____, and somewhat _____

abnormal menses;

3x

contour; boggy; tender

Uterine arteriovenous malformations consist of a ____ ____ of arteries and veins without an intervening ______ network

vascular plexus; capillary

Uterine arteriovenous malformations are _____ and usually involve the _______, rarely the ________

rare; myometrium; endometrium

Uterine arteriovenous malformations can be _____, but most are __________ (acquired) resulting from _______, _______, and ________

congenital; teratogenic; pelvic trauma; surgery; pregnancy

What is a clinical symptom of uterine AV malformation?

Metrorrhagia (heavy, extended bleeding)

Sonographic findings of subtle myometrial inhomogeneity, tubular spaces within the myometrium, intramural uterine mass, endometrial or cervical mass, or prominent parametrial vessels are present with what?

Uterine AV malformations

With uterine AV malformations, color doppler will show a ___-colored ___ pattern

Florid; mosaic

Uterine leiomyosarcoma is a ____, rapidly growing aggressive uterine malignancy that accounts for ___ of all uterine malignancies

rare; 1%

Pre-existing ______ are common in those with leiomyosarcoma

leiomyomas

Leiomyosarcoma arises from the ______ or _______ and is commonly found in the ______

myometrium; endometrium; myometrium

Leiomyosarcoma can affect any age group but most common in women ____-____ yrs of age

40-60

Normal endometrial thickness (mm)

Menstrual:

Early proliferative (3 line sign):

Preovulatory:

Secretory (thickest; about to menstruate):

• 2-3mm

• 4-6 mm

• 6-8 mm

• 8-15 mm

Reasons for an abnormally thick endometrium:

• Early pregnancy

• Gestation trophoblastic disease (molar pregnancy)

• Endometrial hyperplasia (precursor of endometrial cancer)

• Secretory phase

• HRT (breast cancer patients taking tamoxifen)

• Polyps

• Endometrial carcinoma

What is sonohysterography?

Evaluation of the endometrium using saline infusion

In premenopausal women, sonohysterography is performed in the _________ cycle, usually between days ___ and _____

midmenstrual; 6;10

Sonohysterography is NOT performed in women with acute _____

PID (pelvic inflammatory disease)

what is the most common cause of abnormal uterine bleeding?

Endometrial hyperplasia

What is endometrial hyperplasia?

Thickening of the endometrium

In premenopausal women, if the endometrium measures more than ____, hyperplasia is suggested

14 mm

In asymptomatic postmenopausal women, if the endometrium measures more than _____, hyperplasia is suggested

8 mm

Endometrial hyperplasia is a _____ to endometrial cancer

precursor

What is an endometrial polyp?

An overgrowth of endometrial tissue covered by epithelium

Patients with endometrial polyps can be _____

Asymptomatic

Endometrial polyps typically cause ____ or _____ endometrial thickening and are seen in ________ and _________ women

diffuse; focal; perimenopausal; postmenopausal

What is the sonographic appearance of endometrial polyps?

• Isoechoic/hypoechoic to endometrium

• Echogenic, round

• Feeding artery