Gynecologic and General Pathology: Uterus, Cervix, Vagina, and Disease Processes

Vocabulary practice flashcards covering gynecologic pathology of the uterus, cervix, and vagina, as well as general pathological processes including inflammation, abscesses, hematomas, and neoplasm differentiation.

Leiomyoma

The most common gynecologic tumor, also known as a myoma or fibroid, composed of smooth muscle cells arranged in a whorl-like pattern with variable fibrous connective tissue; it is estrogen-dependent and occurs in approximately $20\% - 30\%$ of women over $30$ years of age.

Submucosal Leiomyoma

A uterine myoma located beneath the endometrium that disrupts and projects into the endometrial cavity, frequently causing heavy, irregular bleeding (which can lead to anemia) and infertility.

Intramural Leiomyoma

A uterine myoma confined within the myometrium; it may enlarge to cause mass effect/pressure on adjacent pelvic organs, infertility, or recurrent pregnancy loss.

Subserosal Leiomyoma

A myoma that arises from the outer myometrium and projects exophytically from the peritoneal surface of the uterus, potentially compressing neighboring structures.

Pedunculated Leiomyoma

A uterine myoma that hangs off or projects away from the uterine wall, connected only by a vascular stalk.

Arcuate Artery Calcification

Peripheral uterine calcifications occurring in the outer myometrium as a consequence of calcific sclerosis of the arcuate arteries; often indicates underlying systemic vascular disease such as diabetes mellitus, hypertension, or chronic renal failure.

Adenomyosis

A benign condition characterized by the invasion of basal endometrial glands and stroma into the myometrium, most commonly located in the posterior uterine wall; sonographically presents with diffuse uterine enlargement, myometrial cysts, and linear posterior shadowing known as the Venetian blind sign.

Adenomyoma

A localized, focal form of adenomyosis consisting of isolated endometrial implants within the myometrium that provoke reactive hypertrophy in the surrounding muscular tissue.

Uterine Arteriovenous Malformation (AVM)

A rare vascular plexus of arteries and veins lacking an intervening capillary bed, typically involving the myometrium; color Doppler shows a mosaic pattern with flow reversals, and spectral Doppler displays high-velocity, low-resistance arterial flow coupled with arterialized venous flow. Dilation and curettage is contraindicated due to the risk of catastrophic hemorrhage.

Uterine Leiomyosarcoma

A rare, fast-growing malignant solid tumor arising from the myometrium or endometrium (most commonly in the fundus); typically affects women aged $40\text{ to }60$ years and may resemble a degenerating fibroid on sonography.

Sarcoma Botryoides

An extremely rare pediatric variant of rhabdomyosarcoma/uterine sarcoma characterized macroscopically by grapelike clusters of tumor tissue.

Endometrial Polyps

Benign epithelial overgrowths of endometrial tissue that can be sessile (broad-based) or pedunculated; typically appear sonographically as focal or diffuse endometrial thickening or an intracavitary echogenic round mass.

Endometritis

Inflammation or infection of the endometrial lining, most often developing in association with pelvic inflammatory disease (PID), postpartum conditions, or uterine instrumentation; sonographically characterized by a prominent or irregular endometrium, intracavitary fluid, or cul-de-sac pus.

Intrauterine Synechiae (Asherman’s Syndrome)

Endometrial adhesions resulting from trauma or surgical intervention (such as dilation and curettage) that may cause amenorrhea, hypomenorrhea, infertility, or recurrent pregnancy loss; seen sonographically as hyperechoic bridging bands traversing the cavity.

Endometrial Hyperplasia

Abnormal proliferation and thickening of the endometrium secondary to prolonged unopposed estrogenic stimulation; represents a key precursor lesion to endometrial carcinoma.

Endometrial Carcinoma

The most common gynecologic malignancy in North America, occurring predominantly in postmenopausal women presenting with abnormal uterine bleeding; sonographically suspected whenever postmenopausal endometrial thickness exceeds $> 4\text{ to }5\,\text{mm}$.

Tamoxifen

A nonsteroidal partial estrogen receptor antagonist widely prescribed as adjuvant therapy in pre- and postmenopausal women with estrogen receptor-positive breast cancer; can stimulate endometrial proliferation, leading to hyperplasia, polyps, or carcinoma.

Sonohysterography (SIS)

A specialized ultrasound technique in which sterile saline is instilled into the endometrial cavity to delineate focal intracavitary lesions from diffuse hyperplasia; performed during days $6-10$ of the menstrual cycle in premenopausal women and contraindicated in acute PID.

Mayer-Rokitanski-Kuster-Hauser (MRKH) Syndrome

A congenital condition marked by Müllerian duct failure, resulting in an absent uterus and a deformed or absent vagina in females with normal secondary sexual characteristics.

Gartner’s Duct Cyst

The most common cystic lesion of the vagina, originating from an embryologic remnant of the mesonephric (Wolffian) duct and typically located in the anterolateral vaginal wall.

Imperforate Hymen

The most common congenital obstructive anomaly of the female genital tract, caused by failure of the central hymenal membrane to perforate during embryogenesis.

Hydrocolpos

The abnormal distention and accumulation of watery secretions within the vaginal lumen proximal to an obstruction, such as an imperforate hymen or vaginal septum.

Hematocolpos

An accumulation of trapped menstrual blood within the vagina due to lower genital tract obstruction.

Hydrometrocolpos

The accumulation of retained watery secretions causing distention of both the uterine cavity and the vagina.

Hematometrocolpos

The retention of trapped menstrual blood expanding both the uterine cavity and the vagina, classically presenting at menarche with cyclic pain and primary amenorrhea.

Hematometra

The pathological collection and retention of blood within the uterine cavity, often secondary to cervical stenosis or prior uterine instrumentation.

Partial (Supra-cervical) Hysterectomy

A surgical procedure involving the removal of the upper uterine corpus (body and fundus) while sparing the cervix in situ.

Total Hysterectomy

Surgical excision of the entire uterus, including both the uterine corpus and the cervix, resulting in the formation of a vaginal cuff.

Radical Hysterectomy

Extensive gynecologic surgery that removes the entire uterus, cervix, fallopian tubes, and both ovaries.

Vaginal Cuff

The blind pouch formed at the superior terminus of the vagina following total hysterectomy; abnormal if nodular or exceeding the upper-limit length of $2.1\,\text{cm}$, which raises concern for recurrent cancer.

Rectouterine Recess (Pouch of Douglas)

The posterior cul-de-sac situated between the rectum and the posterior wall of the uterus and upper vagina; representing the most dependent peritoneal space in the female pelvis, where physiological fluid or pathologic exudates/blood accumulate.

Nabothian Cyst

A benign cervical retention cyst caused by chronic epithelial overgrowth and mucus entrapment within a cervical gland.

Cervical Polyp

A benign, hyperplastic protrusion of epithelium arising from either the endocervical or ectocervical canal, which may be sessile or pedunculated and commonly causes irregular spotting.

Cervical Stenosis

An acquired narrowing or complete obstruction of the cervical canal caused by radiation therapy, cone biopsy, laser/cryosurgery, postmenopausal atrophy, chronic infection, or cervical carcinoma.

Cervical Carcinoma

Malignant disease of the cervix, most commonly squamous cell carcinoma preceded by dysplasia; advanced disease can be identified as a retrovesical mass infiltrating the bladder or obstructing the ureters.

Translabial (Transperineal) Sonography

An ultrasound scanning technique utilizing a $5.0\text{ to }7.5\,\text{MHz}$ probe placed at the vaginal vestibule/perineum to visualize the lower uterine segment, cervix, and vagina when transvaginal probe insertion is contraindicated.

Clinical Signs

Objective medical findings observed and measured directly by health care providers, such as palpable masses, elevated laboratory values, or a positive sonographic Murphy’s sign.

Clinical Symptoms

Subjective experiences and physical complaints reported by the patient, such as pain, nausea, dizziness, or headache.

Sonographic Findings

Specific structural, echogenic, and vascular features of tissues and lesions visualized and documented on ultrasound imaging.

Acute Inflammation

An immediate tissue response to injury or infection that develops over hours to days, characterized by organ enlargement, edema, fever, pain, leukocytosis, and the four classic signs: heat, redness, swelling, and pain.

Chronic Inflammation

A persistent, prolonged inflammatory process extending over months or years, characterized by tissue atrophy, fibrous scar tissue formation, organ shrinkage, calcifications, and loss of normal function.

Abscess

A localized, encapsulated cavity of necrotic tissue, purulent exudate (pus), dead and living microorganisms, and granulocytes that fails to resolve and typically appears on sonography as an irregular, thick-walled, hypoechoic or complex mass with posterior enhancement.

Hematoma

A localized extravascular collection of blood resulting from trauma, surgery, or coagulopathy; its sonographic appearance changes over time from anechoic/hypoechoic (fresh) to complex with internal echoes (clotting) to densely echogenic with thickened contours (organized).

Benign Neoplasm (Sonographic Features)

A non-malignant new tissue growth typically characterized by a round or oval shape, smooth well-defined borders, acoustic enhancement, and peripheral vascularity.

Malignant Neoplasm (Sonographic Features)

A cancerous tissue growth that typically displays irregular or invading margins, poorly defined posterior borders, acoustic shadowing, and disorganized internal/central blood flow.