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35 Cards in this Set

  • Front
  • Back
What is the most common benign neoplasm of the female genital tract?
What is a uterine leiomyoma?
• localized proliferation of smooth muscle and connective tissue
• originates from the myometrium
What is the effect of estrogen on leiomyomas?
• tumors are estrogen sensitive
• induces rapid growth in high estrogen states (like pregnancy)
• menopause brings about cessation of tumor growth & atrophy
Where in the female reproductive system are most leiomyomas found?
• uterus (95%)
• cervical (5%)
What are the different classifications of uterine leiomyomas?
• submucosal (immediately beneath the endometrium)
• intramural OR interstitial (within the uterine wall)
• subserosal (beneath the serosa)
Although most leiomyomas are asymptomatic, what is their most common presenting symptom?
What are other symptoms of leiomyomas, besides bleeding?
• fever (usually secondary due to infection)
• pain (due to vascular compromise, torsion, or infection)
• pelvic pressure (can place pressure on rectum or ureters)
• spontaneous abortion/infertility (if myoma significantly distorts the uterine cavity)
How do uterine leiomyomas present on abdominopelvic exam?
• large, midline, irregular-contoured mobile pelvic mass
• characteristics "hard-feel" or solid qaility
What is the most commonly used imaging study for confirmation of leiomyomas?
pelvic ultrasound
What are surgical treatment options for patients with leiomyomas?
• myomectomy (warranted for patients who want to become pregnant)
• hysterectomy
What is medical treatment of leiomyomas?
• GnRH agonist (ex. Lupron)
• reduces estrogen secretion by suppressing HPO axis
What are complications of leiomyomas?
• recurrance
• infertility
• malignancy (ex. leiomyosarcoma)
• spontaneous abortions
What are specific complications of leiomyomas in pregnant women?
• dysfunctional labor
• dystocia
• increased preterm labor
• premature rupture of membrane (PROM)
What are symptoms of leiomyosarcoma?
• increase in vaginal discharge
• pelvic pain
• postmenopausal bleeding
• uterine enlargement
What is adenomyosis?
• local invasion of endometrial tissue in the myometrium
• more the 3 mm beneath the endometrium
• associated w/ muscular hypertrophy
When does adenomyosis growth occur?
• occurs only during reproductive years
• usually in parous women, increases in age and usually regresses w/ menopause
What is a Halban's sign?
uterine tenderness on palpation
What are clinical findings of adenomyosis?
• can present with anemia
• chronic pelvic pain
• dysmenorrhea
• menorrhagia
What are treatment options for adenomyosis?
• hysterectomy (used for confirmations and also is the treatment of choice)
• GnRH agonist (provide temporary relief of symptoms)
Endometrial polps occurs most often in what type of women?
peri-menopausal or immediately post-menopausal women
What are risk factors for endometrial polyps?
• hypertension
• tamoxifen therapy
• obesity
What is the most common presenting symptoms of endometrial polyps?
abnormal bleeding (menorhagia)
What presentation might indicate that infarction of endometrial polyps?
• sudden occurrence of bleeding accompanied by uterine pain in postmenopausal women
• exam may reveal ulceration of the distal tip of the polyp
What are treatment options for uterine polyps?
• hysteroscopic resection (dilitation & curettage)
• progestin (may cause regression)
• hysterectomy (for malignant changes)
What is the definition of endometriosis?
aberrant growth of endometrial tissue outside the uterus
What is the most common site of endometriosis?
What is Sampson's theory of endometriosis?
endometriosis is caused by direct implantation of endomtrial cells by retrograde menstruation
What are chocolate cysts?
• cysts associated with endometriosis
• filled with thick, chocolate-appearing fluid (primarily old blood)
What are clinical findings of endometriosis?
• dysmennorrhea
• dyspareunia
• infertility
• pelvic pain
What is the key symptom in differentiating endometriosis from dysmenorrhea?
Which lab value is often elevated with extensive endometriosis?
CA 125
What is the only way to definitively diagnose endometriosis?
laproscopy with tissue biopsy
What are medical treatment options for endometriosis?
• birth control pills
• Depo-Provera (progestins)
• Danazol (suppresses FSH & LH)
• GnRH agonists (Lupron or Nafarelin acetate nasal spray)
What is the effect of pregnancy on endometriosis?
• pregnancy has traditionally been recommended as a way to prevent or minimize the effects of endometriosis

• the prolonged progestational effect of pregnancy suppressed endometriosis
Describe the 2 types of surgical treatment options for endometriosis
• Conservative surgery
- laproscopic excision, cauterization or ablation of endometriotic lesions
- preserves the uterus (pregnancy is still possible)

• Extirpative surgery
- total abdominal hysterectomy
- bilateral salpingo-oophorectomy followed by HRT
- future pregnancy is not possible