GYN-Unit 2 Vaginal/Cervix Pathology

What is the most common congenital abnormality of the female genital tract?

Imperforate hymen resulting in obstruction

What may an obstruction of the vagina and/or uterus result in?

Accumulation of fluid(hydro) blood (hemato) or pus (pyo)

What is a Gartner’s Cyst?

Most common cystic lesion of the vagina

What does a Gartner’s Cyst occasionally cause?

Obstruction

What is the US appearance of a Gartner’s Cyst

Small cystic lesions

What is this image showing?

Gartner’s Cyst

What is a Rhabdomyosarcoma?

A malignant cancer of the vagina

What is the US appearance of a Rhabdomyosarcoma?

Grape like cluster protruding from vagina

What is vaginal Adenocarcinoma?

A rare type of vaginal cancer formed from the DES pregnancy exposure

What is the US appearance of Vaginal Adenocarcinoma?

Solid appearance

With an S/P hysterectomy, what is the normal measurement of the vaginal cuff?

<2.1 cm

There may be a suspicion for recurrence from a hysterectomy if the vaginal cuff is:

• >2.1 cm

• Defined mass seen with increased echogenicity

Why might the vaginal cuff be nodular?

Due to post radiation fibrosis

What is this image showing?

Vaginal Cuff

What is the posterior cul-de-sac?

Most posterior and inferior reflection of peritoneal cavity

What is a frequent site for intraperitoneal fluid collections and how much can be detected transvaginally?

Posterior cul de sac and as little as 5mL

True or false: Fluid in cul-de-sac can be a normal finding throughout the menstrual cycle

True

What are common pathologic fluid collections?

• Ascites

• Blood resulting from:

  • Pelvic abscesses

  • Hematomas

What are Nabothian cysts?

Common benign inclusion cysts within the cervix

Nabothian cysts are common in middle aged women and can be caused by what?

• chronic cervicitis

• Obstructed or dilated transcervical gland

What is the US appearance of a Nabothian cyst?

• Discrete cyst

• < 2 cm

What are Cervical Polyps?

• Hyperplastic protrusion of endocervix or ectocervix

  • Pedunculated

  • Broad based

What are the causes of cervical polyps?

Chronic inflammation

Who is most affected by cervical polyps?

Late middle age

What are these images showing?

Nabothian Cysts

What are leiomyomas?

• Also called fibroids

• Most common benign condition

• Small % originates at cervix

What is the US appearance of a leiomyoma?

• Varying echotexture

• Within cervical tissue

• Pedunculated

• Internal protrusion

What is this image showing?

Leiomyoma

What is a Cervical Stenosis?

• A benign acquired condition

• An obstruction at either the internal or external os

What are the causes of cervical stenosis?

• Prior instrumentation

• Childbirth

• Surgery

• Cancer

• Irradiation (post radiation)

US appearance of cervical stenosis postmenopausal?

• Fluid-filled uterus

• Asymptomatic

US appearance of cervical stenosis premenopausal?

• Oligomenorrhea/Amenorrhea

• Dysmenorrhea

What is the most common type of cervical cancer?

Squamous Cell Carcinoma

What type of infections are precursors to cervical cancer?

HPV infections

What are the risk factors of cervical carcinoma?

• Early sexual partners

• Multiple sexual partners

• STI’s

What is this image showing?

Squamous cell carcinoma

Cervical cancer is most prevalent in what age and how can it be detected early?

• Menstrual age

• PAP smear can be an early detection

What are the clinical symptoms of Cervical Carcinoma?

• Asymptomatic- early

• Vaginal discharge- bleeding

• Malodorous

• Palpable mass

US appearance of Cervical Carcinoma?

• Hypoechoic mass

• Enlarged cervix

• Invasion of surrounding structures- spread

• Cervical stenosis can cause hematometra

What imaging modality is best for cervical carcinomas?

• CT/MRI

  • Staging of lymph nodes

What is this image showing?

Cervical Carcinoma

What is this image showing?

Cervical Cancer

Prognosis of cervical cancer depends on what?

The disease stage

What is stage 0 of cervical cancer and prognosis?

Early, confined to surface of cervix

What is stage 1 survival rate of cervical cancer and prognosis?

Greater than 90% and

What is stage 2 survival rate of cervical cancer and prognosis?

60-80% and spread beyond cervix into vaginal wall

What is stage 3 survival rate of cervical cancer and prognosis?

Approximately 50% and spread beyond the cervix and uterus

What is stage 4 survival rate of cervical cancer and prognosis?

Less than 30% and spread to surrounding organs (bladder and rectum)

What is this image showing?

Cervical Cuff