[GYNE] BENIGN TUMORS OF CERVIX AND UTERUS

CLUSTER EXAM ON BENIGN TUMORS OF THE CERVIX, UTERUS, AND OVARIES

MOST COMMON BENIGN TUMORS IN MULTIPAROUS WOMEN (40-50)

ENDOCERVICAL AND ECTOCERVICAL POLYPS

DESCRIBE ENDO AND ECTOVERCICAL POLYP

ENDOCERVICAL POLYP - LONG NARROW PEDICLE
ECTOCERVICAL POLYP - SHORT BROAD BASE

LINING OF ENDOCERVICAL POLYP

COLUMNAR EPITHELIUM

DESCRIPTION OF POLYPS

SMOOTH, SOFT, REDDISH PURPLE, CHERRY RED FRAGILE

MOST COMMON COMPLAINT WITH PATIENTS WITH POLYPS / CLASSIC SYMPTOM

POSTCOITAL BLEEDING

DETERMINE IF ENDOCERVICAL OR ENDOMETRIAL POLYP: CANNOT TURN IT 360 DEGREES

ENDOCERVICAL POLYP

DETERMINE IF ENDOCERVICAL OR ENDOMETRIAL POLYP: CAN TURN IT 360 DEGREES

ENDOMETRIAL POLYP

2 CAUSES OF POLYPS

1. INFLAMMATION

2. ABNORMAL HORMONAL STIMULATION

DIFFERENCE OF MYOMA VERSUS POLYPS

Myoma - comes from the muscle, firm

Polyp - soft

DIFFERENCE OF CERVICAL MALIGNANCY VERSUS POLYPS

HAS GROWTH OF MASS + IRREGULAR SURFACE, ULCERATED AND NECROTIC

Management of cervical polyp if symptomatic and bleeding

Grasping and Twisting Base of Polyp

Retention cysts of endocercival columnar cells with mucin

Nabothian Cyst

Pathophysiology of nabothian cysts

Constant process of repair and squamous metaplasia of transformation zone

Mechanical dilation of cervix

Cervical Laceration

Appearance of a cervical laceration if not repaired

Fish Mouth appearance

Medical management of cervical myoma

GnRH Agonist - due to hypoestrogenism

Surgical management of cervical myoma if within the vaginal canal

Myomectomy

Surgical management of cervical myoma if big and with presence of other myomas

Hysterectomy

Cervix arises from what?

Mullerian duct

Blood within the uterine cavity

Hematometra

Blood will be absorbed and become fluid within the cavity

Hydrometra

Caused by obstruction due to tumors or cancers

Pyometra

Management for cervical stenosis

Cervical dilators

Localized overgrowth of endometrial glands and stroma

Endometrial polyp

Broad base endometrial polyp

Sessile polyp

Slender pedicle endometrial polyp

Pedunculated polyp

Cause of endometrial polyps

Unopposed estrogen - thicker endometrium

Benign condition wherein one can see numerous small polyps within the endometrial cavity

Polypoid hyperplasia

Give risk factors of endometrial polyps

1.Chronic Tamoxifen use

2.Obesity, DM, Hypertension

3.Postmenopausal in HRT, with metabolic syndrome

4.Multiparity

Common symptom of endometrial polyps

Abnormal uterine bleeding

Symptom of endometrial polyp if the polyp is large or big

Infertility

Cervical polyps

Tongue-like protrusion that may easily bleed

Gross finding of endometrial polyps

Velvety, succulent, large central vascular core

Imaging of choice for Endometrial polyp: patient complains of intermenstrual bleeding with normal sized uterus

SIS - Saline infusion sonohysterography

Biopsy - due to possibility of endometrial cancer

Imaging of choice for Endometrial polyp: patient has AUB in late reproductive age, 45 y/o

Management for endometrial polyp

Hysteroscopy - both therapeutic and diagnostic

Better than dilatation and curettage because it is guided with UTZ

Collection of blood extending in the uterine cavity as a result of partial or complete obstruction of lower genital tract

Hematometra

Congenital causes of Hematometra

Imperforate hymen and Transverse vaginal septum

Most common benign tumors of the uterus in nulliparous women ages 30 to 50

Leiomyomas / Fibroids

Most common leiomyomas

What are its two types and differentiate the two?

Intramural leiomyomas

Intramural

a. Submucosa: growth inward

b. Subserosa: growth outward

Why can leiomyomas be resected?

Presence of pseudocapsule

Describe histology of Leiomyomas

a. Elongated smooth muscle cells and whorl pattern

b. Eosinophilic cytoplasm

c. Uniform cigar shaped nuclei

d. Absent or Sparse mitotic spindles

Most troublesome type of leiomyomas and why?

Submucosal leiomyomas - uterus wants to expel it

FIGO Classification 0

Pedunculated intracavitary

FIGO Classification 4

Intramural

FIGO Classification 7

Subserosal pedunculated

FIGO Classification 1

<50% Intramural

FIGO Classification 2

>/= 50% Intramural

FIGO Classification 3

Contact with endometrium, 100% Intramural

FIGO Classification 8

Others

FIGO Classification 6

<50% Intramural, Subserosa

FIGO Classification 5

>/=50% Intramural, Subserosa

Bimanual exam of subserosal leiomyomas

knobby contour, asymmetrically enlarged

Imaging of choice for leiomyomas

TVS

Mildest common degenerative change in leiomyomas

Hyaline

Most acute form of degenrative change in leiomyomas occurring during pregnancy

Red / Carneous

Rapid growth of myomas after menopause

Sarcomatous type or Sarcomatous degeneration

Myomectomy Indications and Contraindications

Indications: Persistent AUB, heavy bleeding, Pain or pressure symptoms, >8 cm myomas

Contraindications: Pregnancy, Malignancy, Multiple myomas, advanced adnexal disease, Non-functional uterus

Hysterectomy Indications for Leiomyomas

Uterine size of 14 to 16 weeks AOG

Young and nulliparous

Rapid growth of myomas after menopause

Proliferation of endo glands and stroma of more than 1 LPF from the basal layer of the endometrium

Adenomyosis

Difference between focal and diffuse adenomyosis

Focal: With pseudocapsule, asymmetric

Diffuse: Not encapsulated, symmetric, involves posterior (more common) and anterior walls of the uterus