Benign Disease

Benign Diseases of the Female Pelvis - Overview

  • Scope: Examination of benign pathologies affecting the cervix and uterus, including their sonographic appearances.

Learning Objectives

  • Discuss benign pathology affecting the cervix and uterus.

  • List and describe sonographic appearances of benign neoplasms:

    • Nabothian cysts

    • Endometrial hyperplasia

    • Polyps

    • Fibroids

  • Summarize effects of surgery and trauma on the uterus (e.g., synechiae and uterine dehiscence).

  • Distinguish between extrauterine and intrauterine masses (abscesses, hematomas, lymphoceles, appendicitis).

Nabothian Cysts

  • Definition: Retained secretions from nabothian glands, typically found in the cervix.

  • Characteristics:

    • Commonly asymptomatic.

    • Frequently identified post-pregnancy or due to chronic cervicitis.

    • Typically small and fluid-filled on ultrasound.

  • Sonographic Appearance:

    • Smooth-bordered, fluid-filled with posterior enhancement.

    • Important to differentiate from ovarian follicles or pelvic fluid.

  • Treatment:

    • Asymptomatic cysts often don't require treatment.

    • May require drainage if malignancy is suspected or if large.

Polyps

  • Definition: Benign soft tissue masses attached to the endometrial or endocervical canal.

  • Occurrence: Common in multiparous women (10-24% prevalence).

  • Characteristics:

    • May be singular or multiple.

    • Difficult to identify due to size and echogenicity similar to the endometrial lining.

  • Sonographic Appearance:

    • Round/oval solid masses, echogenic to isoechoic, with a vascular feeding stalk (confirmed via Doppler).

  • Symptoms: Spotting, heavier periods, vaginal discharge.

  • Treatment: Polypectomy for symptomatic or suspicious polyps; otherwise, removal is not necessary.

Fibroids

  • Definition: Smooth muscle tumors of the uterus; most common benign tumor in women.

  • Prevalence: Seen in 20-30% of reproductive-aged women.

  • Characteristics:

    • May be asymptomatic initially but can cause symptoms as they grow (e.g., bleeding, pelvic pressure).

    • Can appear in various sizes and locations within the uterus.

  • Sonographic Appearance:

    • Hypoechoic, heterogeneous, often round with smooth borders.

  • Symptoms: Vary based on location—can include abnormal bleeding, dyspareunia, and urinary issues.

  • Management: Myomectomy or hysterectomy may be necessary if symptomatic; otherwise, monitoring may be sufficient.

Endometrial Hyperplasia

  • Description: Thickening of the endometrium due to excess estrogen without progesterone.

  • Causes: Hormonal treatments, obesity, PCOS, anovulatory cycles.

  • Symptoms: Abnormal uterine bleeding.

  • Sonographic Findings: Thickened endometrium, possibly displaying heterogeneous appearance or dilated cystic spaces.

  • Management: Depends on abnormal cell type; options include monitoring, progesterone therapy, or hysterectomy.

Synechiae

  • Definition: Scarring of the endometrium post-surgery (e.g., D&C, cesarean).

  • Symptoms: Can lead to infertility or abnormal bleeding.

  • Diagnosis: Best visualized with HSG or SIS; appears as hypoechoic bands in the endometrial canal.

Uterine Dehiscence

  • Description: Partial rupture of the uterine scar, typically diagnosed during pregnancy.

  • Causes: Past surgeries like C-sections or myomectomies.

  • Ultrasound Findings: Thinning of the lower uterine segment and any defects in the myometrium.

Extrauterine Masses

  • Types: Abscess, hematoma, lymphocele, appendicitis.

  • Importance: Accurate assessment necessary to differentiate and diagnose conditions that may resemble gynecologic diseases.

Clinical Relevance

  • Understanding these conditions is crucial for diagnosis and management in obstetrical and gynecological practice, ensuring appropriate treatment and monitoring.