Uterine Pathology for Ultrasound – Flashcards
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What types of things do we assess during an ultrasound of the uterus?
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Size, Texture, endometrium, Vagina and Cervix
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Adenomyosis
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benign invasive growth of the endometrium that may cause heavy, painful menstrual bleeding
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Cervical Polyp
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hyperplastic protrusion of the epithelium of the cervix; may be broad based or pedunculated
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Cervical Stenosis
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acquired condition with obstruction of the cervical canal
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curettage
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scraping with a curet to remove the contents of the uterus, as is done following inevitable or incomplete abortion; to produce abortion; to obtain specimens for use in diagnosis and to remove growths such as polyps
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dysmenorrhea
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pain in association with menstruation
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ectocervix
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a portion of the canal of the uterine cervix that is lined with squamous epithelium
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ectopic pregnancy
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pregnancy occurring outside the uterine cavity
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endometrial carcinoma
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malignancy characterized by abnormal thickening of the endometrial cavity;usually include irregular bleeding in peri-menopausal and in post menopausal women
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Endometrial hyperplasia
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condition that results from the estrogen stimulation to the endometrium without the influence of progestin; frequent cause of bleeding (especially in postmenopausal women)
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endometrial polyp
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pedunculated or sessile well defined mass attached to the endometrial cavity
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endometritis
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infection within the endometrium of the uterus
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Gartner's duct cyst
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small cyst within the vagina
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hematometra
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obstruction of the uterus and or the vagina characterized by an accumulation of blood
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hydrometra
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obstruction of the uterus and or the vagina characterized by an accumulation of fluid
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intramural leiomyoma
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most common type of leiomyoma;deforms the myometrium
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IUCD
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Intauterine Contraceptive Device
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leiomyoma
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most common benign gynecologic tumor in women during their reproductive years
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metrorrhea
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irregular, acyclic bleeding
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nabothian cyst
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benign, tiny cyst within the cervix
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pyometra
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obstruction of the uterus and or vagina characterized by an accumulation of pus
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sonohysterography
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injection of a sterile saline into the endometrial cavity under ultrasound guidance; also known as saline infused sonography (SIS)
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squamous cell carcinoma
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most common type of cervical cancer
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submucosal leiomyoma
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type of leimyoma found to deform the endometrial cavity and cause heavy or irregular menses
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subserosal leiomyoma
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type of leiomyoma that may become pedunculated and appear as an extrauterine mass
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tamoxifen
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an anti-estrogen drug used in treating breast cancer
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What 3 differentials could cause an enlarged uterus?
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pregnancy, postpartum, leiomyoma
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What 2 pathologies present as uterine tumors?
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leiomyoma and carcinoma
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What 9 pathologies can cause endometrium thickening?
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Early pregnancy, endometrial hyperplasia, retained products of conception or incomplete abortion, trophoblastic disease, endometritis, adhesions, polyps, inflammatory disease, endometrial carcinoma
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In what 4 pathologies would there be endometrial fluid?
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Endometritis, retained products, PID, cervical obstruction
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What 4 differentials might cause uterine shadowing?
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Gas (abscess), IUD, calcified myomas or vessels, retained products
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What type of leiomyoma may erode in the endometrial cavity causing heavy bleeding and infertility?
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submucosal
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What type if leiomyoma may enlarge to cause pressure on adjacent organs and infertility?
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intramural
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What type of leiomyoma may enlarge, but not cause infertility?
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subserosal
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What is another name for a nabothian cyst?
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epithelial inclusion cyst
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What is the most common benign cervical finding in women of reproductive age?
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nabothian cyst
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How do nabothian cysts arise?
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glands secrete mucous into a thinly covered "sac" created by epithelium
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How do nabothian cysts appear on U/S?
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round, anechoic - usually less than 2cm
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Can a cervical polyp cause irregular bleeding?
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yes
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What 7 things can lead to cervical stenosis?
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radiation therapy, previous cone biopsy, postmenopausal cervical atrophy, chronic infection, lase or cryosurgery, D & C, or cervical carcinoma with erosive lesions
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How do patients with cervical stenosis present?
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New onset of dysmenorrhea or amneorrhea
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What do we see on U/S with a patient that has cervical stenosis?
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Produces a distended, fluid filled uterus (can be filled with secretions, pus or blood)
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What can result in a bladder or bowel obstruction that may also be peduncualted or proplapse into the uterus?
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cervical leiomyoma
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What is cervical dysplasia?
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abnormal growth of calls on the surface of the cervix - not cancer, but considered precancerous
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How is cervical cancer best diagnosed?
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pap smear
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How might cervical cancer show up?
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may demonstrate a solid retrovesical mass
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Who would have a vaginal cuff?
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A woman with a hysterectomy
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Should the vaginal cuff still be monitored?
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yes, it can still get cancer
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All though rare, what are the two masses that may be found in the vagina?
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adenocarcinomas and rhabdomyosarcoma
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What is the most common lesion found in the vagina?
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Gartner Duct Cyst
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What is the most common congenital abnormality of the female genital tract?
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imperforate hymen
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How would a person with an imperforate hymen presnet clinically?
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abdominal/ pelvic pain and distension, primary amenorrhea, palpable mid-line pelvic mass
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What are leiomyomas also known as?
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fibroids
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Who is most likely to have a leiomyoma?
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Women over 30, and African-American women
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What are leiomyoma made of generally?
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spindle shaped smooth muscle cell with variable amounts of fibrous connective tissue
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Why would a myoma atrophy?
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Lack of vascular supply
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What hormone are leimyomas dependent on?
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estrogen
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What affects to myomas have on pregnancy?
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often found in the first trimester - tend to lead to pregnancy loss
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When would a woman that is postmenopausal have a leiomyoma?
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If she is on HRT, tamoxifen, or has an estrogen producing malignancy
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What are clinical indications of leiomyomas? (7)
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Uterine irregularity, Uterine enlargement, sensation of pelvic pressure, pain, irregular bleeding (heavy), infertility, interference with vaginal delivery
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How do leiomyomas appear sonographically?
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uterine enlargement, irregular uterine contour, heterogeneous myometrial texture, usually hyoiechoic, calcifications, sometimes acoustic attenuation
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How are myomas treated?
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hysterectomy or myomectomy or Luperon (hormone therapy)
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What is the most common cause of uterine calicifications?
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myomas
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What is a rarer cause of uterine calcification?
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arcuate artery calcification
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What is a benign disease that is commonly diffuse, an ectopic occurrence of endometrial tissue and cause a thickened uterine wall?
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adenomyosis
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What 3 ways can adenomyosis be classified?
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asymmetric, symmetric and focal
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What is thought to cause adenomyosis?
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bearing children, previous uterine trauma, c-section, D&C (anything that compromises the natural barrier)
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Why does adenomyosis tissue not bleed?
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Rises from the stratum basalis
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How would you describe a diffusely adenomyotic uterus?
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globular with a more symmetrical enlargement than fibroids
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How do the lesions seen in focal adenomyosis differ from fibroids?
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They lack the hypoechoic border
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How can adenomyosis be treated?
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With hormone therapy
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How do adenomyosis and endometriosis differ?
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Thought to be the same process, endometriosis is defined as outside of the uterus
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How would a patient present clinically with adenomyosis?
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heavy, painful, abnormal periods, physical exam would have a uterus up to 3x its normal size
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What does adenomyosis look like sonographically?
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diffuse uterine enlargement, thickening of the posterior myometrium, looks like swiss cheese or "moth eaten," can mimic myomas if focal areas are present
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What is Arteriovenous Malformation? (AVM)
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A vascular plexus of arteries and veins without an intervening capillary network
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Where do AVMs usually form?
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in the myometrium
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How do AVMs come to be?
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Usually from some sort of trauma to the uterus
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Where do leiomyomas form and why?
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They are derived from the smooth muscle of the all of the uterus and may come from pre-existing leiomyoma - generally causes concern in women who are not on HRT
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What is the biggest cause of postmenopausal bleeding?
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Endometrial hyperplasia
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How does it develop?
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From unopposed estrogen stimulation
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What thickness does endometrium need to get to before hyperplasia is suggested?
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Double thickness -14mm peri and 8mm in postmenopausal
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How does endometrial hyperplasia appear sonographically?
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Diffusely thick and echogenic with well defined margins, small cysts
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How can endometrial hyperplasia be treated?
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Progesterone therapy, Mirena IUD, D&C, Hysterectomy
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How do we better see endometrial polyps?
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With sonohysterography
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How do the ovaries appear with endometritis?
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enlarged with multiple cysts and indistinct margins
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How do patients with endometritis present clinically?
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low back pain, fever, low abdominal pain, dysmenorrhea, menorrhagia, sterility, constipation
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What is synechiae?
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Intrauterine endometrial adhesions - AKA Asherman's Syndrome
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How does synechiae appear on U/S?
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Bright echoes within the endo cavity -SIS would be helpful too
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What is stongly associated with endometrial cancers?
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estrogen replacement therapy
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What differentials would cause small endometrial fluid collections?
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Ectopic pregnancy, endometritis, degenerating myoma, and recent abortion
