DMSO 3221 Gynecologic Sonography Lecture 8: Uterine Pathology Flashcards

Flashcards covering Uterine Pathology from DMSO 3221, Lecture 8, including normal variations, leiomyomas, adenomyosis, arteriovenous malformations, leiomyosarcoma, and gestational trophoblastic disease. There are 250 question and answer flashcards.

What is an objective related to intrauterine contraceptive devices (IUCDs)?

To differentiate between the types of intrauterine contraceptive devices and describe their sonographic appearance.

What is a characteristic of normal uterine positions?

They are variable and may lie obliquely on either side of the midline.

What is the usual uterine position referred to as?

Antevert; anteflex.

How is a retroverted uterus described?

The uterine fundus flips backwards.

How is a retroflexed uterus described?

The uterine body tilts posteriorly.

What does 'flexion' refer to in relation to the uterus?

It refers to the axis of the fundus relative to the cervix.

What does 'version' refer to in relation to the uterus?

It refers to the axis of the cervix relative to the vagina.

What sonographic method is excellent at assessing a retroverted or retroflexed uterus?

Endovaginal sonography.

What defines a bicornuate uterus?

One cervix and two uterine horns.

What is another name for uterine didelphys?

Double uterus.

What characteristics describe uterine didelphys?

Two vaginas, two cervices, and two uterine horns.

What are considered the most common variations of uterine morphology?

Bicornuate uterus, uterine didelphys, and septate/sub-septate uterus.

What are leiomyomas more commonly called?

Myomas or fibroids.

What is the most common gynecologic tumor?

Leiomyoma (myoma or fibroid).

What percentage of leiomyomas occur in women over 30 years old?

20%-30%.

Which demographic group experiences leiomyomas more commonly?

African Americans.

What are leiomyomas comprised of?

Smooth muscle cells with various amounts of fibrous tissue.

What do leiomyomas consist of?

Nodules of myometrial tissue.

Is it common for multiple myomas to be present?

Yes, usually multiple myomas are present.

Why is determining the location of a leiomyoma important?

Location impacts symptoms and treatment.

What is the most common cause of calcifications in the uterus?

Myomas (leiomyomas).

What might arcuate artery calcifications signify?

Underlying conditions such as Diabetes Mellitus, Hypertension, or Chronic Renal Failure.

What is an intramural leiomyoma?

A leiomyoma confined to the uterus.

What is the most common location for a leiomyoma?

Intramural.

What is a subserosal leiomyoma?

A leiomyoma projecting from the serosal layer of the uterus.

What is a submucosal leiomyoma?

A leiomyoma that distorts the endometrial cavity.

What type of leiomyoma has a stalk and projects from the endometrial cavity (projecting inward into the endometrial cavity)?

Pedunculated submucosal.

What type of leiomyoma has a stalk and projects from the serosal layer of the myometrium (projecting outward)?

Pedunculated subserosal.

What factors are leiomyomas dependent on?

Estrogen and vascular supply.

When do leiomyomas typically increase in size? What does it cause to grow?

During pregnancy. Estrogen cause them to grow.

When do leiomyomas typically atrophy?

In post-menopausal (PMP) women not on Hormone Replacement Therapy (HRT).

What occurs when leiomyomas lack blood supply?

Necrosis, hemorrhage, and calcification.

What effect does a decrease in blood supply have on leiomyoma growth?

It will stop the growth.

What are some increased risks associated with multiple myomas?

Pregnancy loss, anemia, infertility and menorrhagia.

How can multiple myomas cause infertility?

By distortion of the fallopian tubes or endometrial cavity.

What surgical complication in pregnancy is associated with cervical myomas?

Cesarean deliveries.

What imaging modality is more useful for differentiating the number, size, and location of myomas compared to ultrasound?

MRI (Magnetic Resonance Imaging).

Where is a submucosal leiomyoma located specifically?

Under the basalis layer of the endometrium.

What clinical symptom is often associated with submucosal leiomyomas?

Heavy clots and bleeding.

What is a differential diagnosis for submucosal leiomyomas?

Endometrial polyps.

How can Color Doppler help differentiate submucosal leiomyomas from endometrial polyps?

Color Doppler can differentiate them.

How do submucosal leiomyomas appear sonographically regarding the endometrial stripe?

They will distort the normal course of the endometrial stripe.

Where is an intramural leiomyoma contained?

Within the myometrial tissue.

What can intramural leiomyomas cause due to their presence?

Pressure on adjacent structures.

What reproductive issue can intramural leiomyomas contribute to?

Infertility or recurrent pregnancy loss.

How does an intramural leiomyoma appear sonographically?

Myometrial tissue will be visualized on both sides of the myoma.

From where does a subserosal leiomyoma arise?

From the myometrium extending into the serosal layer.

In what direction does a subserosal leiomyoma project?

Outward (exophytically).

What effect can subserosal leiomyomas have on surrounding anatomy?

Pressure on adjacent structures.

How does a subserosal leiomyoma appear sonographically?

It will protrude outward, creating a lobular contour of the uterus.

Describe a pedunculated subserosal leiomyoma.

It extends from the serosa of the myometrium, creating a stalk.

Describe a pedunculated submucosal leiomyoma.

It extends from the endometrial layer, creating a stalk.

What is a differential diagnosis for a pedunculated submucosal leiomyoma?

Endometrial polyp.

How common are pedunculated leiomyomas?

Uncommon.

What sonographic feature helps identify a pedunculated leiomyoma?

A stalk will be present with the visualization of Color Doppler.

What is the typical sonographic appearance of leiomyomas?

Variable, commonly hypoechoic, sometimes with hyperechoic calcifications.

What is a characteristic of the normal echogenicity of the uterus?

Inhomogenous.

What is usually the first sonographic sign of leiomyomas?

Increased uterine size and distortion.

What type of areas are seen in leiomyomas on ultrasound?

Heterogenous areas with no definable walls.

What acoustic artifact is often associated with leiomyomas on ultrasound?

Increased acoustic shadowing.

What do Doppler evaluations of myomas often show?

Thin vessels with low velocity flow.

Are myomas easy to measure when calcified?

No, myomas are difficult to measure in calcified stages.

Which myomas should be measured?

Only discrete myomas.

What type of transducer is optimal for imaging larger leiomyoma lesions transabdominally?

Lower frequency transducers.

What is adenomyosis?

A benign disease process termed as the 'ectopic' location of endometrial tissue into the myometrium.

What are the forms of adenomyosis?

Both focal and diffuse forms.

Which form of adenomyosis is most common?

Diffuse is the most common form.

What is the minimum extension of endometrial basalis layer into the myometrium required for adenomyosis?

2.5mm extension.

How does adenomyosis typically appear sonographically?

As an area of increased/decreased echogenicity, most often in the posterior aspect of the uterus.

What other sonographic feature may sometimes be seen with adenomyosis?

Cystic areas.

What uterine pathology is adenomyosis often mistaken for?

Myomas (leiomyomas).

What are common clinical symptoms of adenomyosis?

Heavy, painful menstrual cycles and intercyclic bleeding.

Which patient demographic is typically associated with adenomyosis?

Older, multiparous patients.

What hormonal factor is often increased in patients with adenomyosis?

Increased estrogen levels.

What are some treatment options for adenomyosis?

Hormone therapy and partial hysterectomy.

Which imaging modality is better at differentiating adenomyosis compared to ultrasound?

MRI (Magnetic Resonance Imaging).

What are Arteriovenous Malformations (AVMs)?

Artery-vein connections without a capillary system.

Where do AVMs typically occur in the uterus?

In the myometrium.

Are AVMs common in the endometrium?

No, rarely in the endometrium.

Can AVMs be congenital?

Yes, they can be congenital.

Can AVMs be acquired?

Yes, they can be acquired (teratogenic).

What post-operative complication is associated with acquired AVMs from a D&C?

Massive hemorrhage.

What are clinical symptoms of AVMs?

Metrorrhagia with blood loss and anemia.

How do AVMs appear sonographically?

As subtle myometrial heterogeneity with tubular spaces in the myometrium.

What can AVMs mimic on ultrasound?

An endometrial, cervical, or intramural uterine mass.

What Doppler technique is utilized to aid in the diagnosis of AVMs?

Color Doppler.

What pattern does Color Doppler typically show with AVMs?

A Mosaic Doppler pattern.

What do Spectral Doppler findings reveal for AVMs regarding arterial flow?

High velocity, low resistant arterial flow.

What do Spectral Doppler findings reveal for AVMs regarding venous flow?

High velocity venous flow with an arterial component.

What is leiomyosarcoma?

A rare malignant uterine pathology.

What percentage of uterine malignancies do leiomyosarcomas account for?

1.3%.

What is a questionable transformation involved with leiomyosarcoma?

Transformation of a preexisting leiomyoma.

What is the most common location for leiomyosarcoma in the uterus?

The fundus of the uterus.

How many lesions are typically found in leiomyosarcoma?

Usually a single lesion.

What are common clinical symptoms of leiomyosarcoma?

They can be asymptomatic or present with uterine bleeding.

Is it easy to differentiate leiomyosarcomas from leiomyomas?

No, differentiation from leiomyomas is difficult.

What may be the only indication for malignancy in leiomyosarcomas?

Rapid growth.

What is Gestational Trophoblastic Disease (GTD)?

A proliferative disease of trophoblastic cells occurring from an abnormal pregnancy.

What is the spectrum of diseases under GTD?

Hydatidiform Mole (benign), and Invasive Mole and Choriocarcinoma (malignant).

What are extremely elevated levels of beta-hCG a clinical presentation of?

Gestational Trophoblastic Disease (GTD).