Endometrial Carcinoma and Uterine Anatomy Quiz

Ob/Gyn I Final Exam Review

• The exam covers material from previous anatomy and pathology lectures, the final review handout, and this presentation.
• Students should be familiar with the material presented to do well on the exam.

Pelvis

• The bony pelvis consists of four bones: two innominate bones (coxae), the sacrum, and the coccyx.
• These bones create two continuous compartments: the true pelvis and the false pelvis.
• The true pelvis is the pelvic cavity.

Pelvic Muscles

• The pelvic muscles include the levator ani and obturator muscles.
• Images show the anatomical location of these muscles.

Pelvic Ligaments

• The infundibulopelvic ligament (suspensory ligament of the ovary) extends from the ovary to the pelvic wall.
• The ovarian ligament supports the ovary to the uterine cornua.

Uterus

• The uterus is a pear-shaped organ with a body, cervix, and fundus.
• Diagrams and sonographic images illustrate different uterine positions such as anteverted, anteflexed, retroverted, and retroflexed.

Fallopian Tubes

• The fallopian tubes consist of parts like the infundibulum, fimbriae, ampulla, isthmus, and interstitial portion.

Uterus

• Sonographic images of normal uterus illustrate anatomical structures like endometrium, myometrium, cervix and rectum.

Uterine Positions

• Different uterine positions include anteverted (fundus and body forward), anteflexed (fundus tilted forward), retroverted (entire uterus tilted backward), and retroflexed (fundus and body bent backward).

Uterine Vasculature

• The uterine vasculature includes spiral arteries, radial arteries, and arcuate arteries.

Normal Endometrium

• Sonographic appearances of normal endometrium vary depending on the menstrual cycle phase (ovulatory, luteal/secretory, and menstrual).

Fibroids

• Fibroids are tumors in the uterus that can occur in several locations: intramural, submucosal, pedunculated, intracavitary, and subserous.

Transvaginal

• Transvaginal sonography images showing internal and external cervical os, cervical glands, and cervical canal structures.

Cervical Cancer

• Cervical cancer is the second most common gynecological malignancy, frequently occurring in women aged 20-30.
• Diagnosis is typically performed through a Pap smear.
• Sonographic findings may show an enlarged cervix, which may appear similar to a cervical myoma.
• The disease may involve other pelvic organs in later stages.

Adenomyosis

• Adenomyosis is a benign condition caused by the abnormal presence of endometrial tissue within the myometrium (uterine muscle layer).
• Sonographic findings in this condition often reveal a bulky, enlarged uterus, without any distinct masses.

Endometrial Polyp

• Sonographic images show an endometrial polyp as a focal mass with a stalk within the endometrial cavity.

Endometrial Carcinoma

• Endometrial carcinoma is the most common gynecological malignancy in postmenopausal women (75-80%).
• The typical clinical presentation involves abnormal uterine bleeding.
• The disease has links to estrogen therapy and anovulatory cycles in premenopausal women.
• The earliest sonographic indicator is thickened endometrium.
• Sonographic images show irregular and thickened endometrial appearance.

Ovaries

• The ovaries secrete estrogen and progesterone, with estrogen secreted by the follicles and progesterone secreted by the corpus luteum.
• The ovarian cycle includes follicular and luteal phases, driven by FSH and LH.
• Key ovarian landmarks facilitate ultrasound scanning.

Ovarian Cysts

• Functional cysts include follicular cysts, corpus luteal cysts, hemorrhagic cysts, and theca-lutein cysts.
• Theca-lutein cysts are related to high hCG levels during pregnancy
• Most functional ovarian cysts measure less than 5 cm in diameter and regress during the menstrual cycle.

Ovarian Torsion

• Ovarian torsion results from rotation of the ovarian pedicle, compromising blood flow.
• Sonographic findings in ovarian torsion include enlarged and edematous ovaries.
• Doppler ultrasound is crucial for assessing blood flow in suspected cases.

Polycystic Ovarian Syndrome (PCOS)

• PCOS is characterized by irregular ovulation cycles.
• Sonographically, PCOS presents with multiple ovarian follicles. - Patients may experience symptoms like irregular menstrual cycles and elevated LH levels.

Ectopic Pregnancy

• Ectopic pregnancy typically occurs within the fallopian tube (95-96%).
• Other locations include the ovary, interstitial portion of the fallopian tube and the uterine cervix, accounting for remaining cases.
• Severe internal bleeding is a risk, particularly when a pregnancy is found in the interstitial portion of the fallopian tube near the uterine cornua.
• Symptoms may include pelvic pain, vaginal bleeding, and an empty uterus on sonography.
• Elevated hCG with absence of uterine gestational sac is a strong indicator for ectopic pregnancy.
• Sonographic findings include gestational sac and adnexal mass.
• Cervical ectopic pregnancies have a high risk of severe bleeding and require immediate intervention.

Interstitial Pregnancy

• Interstitial pregnancies are located in the interstitial portion of the fallopian tube, close to the uterine cornua.
• These pregnancies carry a higher risk of severe bleeding, potentially requiring hysterectomy.

Pregnancy

• Normal pregnancy progression involves fertilization, zygote formation, morula, blastocyst formation, implantation into the uterine lining, and continued development of the embryo and supporting structures.

Early Gestational Sac

• The early gestational sac on ultrasound displays a characteristic shape.
• Ultrasound evaluation shows that the gestational sac is usually placed within the central portion of the uterine cavity and is round or oval.

Pseudo-gestational Sac

• Pseudo-gestational sacs are centrally located within the uterine cavity but not containing a viable embryo or yolk sac.

Yolk Sac

• The yolk sac has a specific growth rate.
• Normal yolk sacs have a maximum diameter of 5.5 mm during weeks 5-10 of pregnancy.
• Enlarged yolk sacs suggest potential problems.

Yolk Sac and Embryo

• Yolk sac appearance is normally present.
• Embryo development is visible within the gestational sac.

Crown-Rump Length (CRL)

• CRL measurement can be used early in pregnancy starting at 5-1/2 weeks.
• CRL measurements are accurate for dating through 12 weeks.

Cardiac Activity

• The presence of cardiac activity is a key indicator of pregnancy viability.

Bradycardia and Tachycardia

• Bradycardia (heart rate <90 bpm) and Tachycardia (heart rate >170 bpm) during pregnancy can be clinical indicators of potential pregnancy-related problems.

Placenta Development

• The placenta differentiates into distinct areas (basalis, capsularis, and parietalis).
• The chorionic plate and basal plate structures of the placenta are identified.

Embryonic Brain

• Cystic areas, e.g. rhombencephalon are identified on early pregnancy ultrasound during the first trimester.

Gestational Trophoblastic Disease (GTD)

• GTD is a condition where abnormal trophoblastic tissue develops, sometimes concurrently with fetal parts.
• Complete moles occur from fertilization of an egg lacking a nucleus by a single normal sperm.
• Invasive mole is a more invasive type of GTD. Affected patients may experience heavy bleeding.
• Sonographic findings in GTD are frequently distorted, without a typical gestational sac shape, and the sac size is often larger than typical for the gestational age.

Amnion Evaluation

• The sonographic appearance is often described as double blebs, in which two small bubbles appear next to each other.
• The double bleb sign is often found in pregnancies with 5-7 weeks gestation.

Fetal Membranes

• Ultrasound images show fetal membranes, a key part of the pregnancy environment

Blighted Ovum

• A blighted ovum is a pregnancy that does not develop normally.

Subchorionic Hemorrhage

• Subchorionic hemorrhage is a common occurrence in the first trimester.
• It appears as a fluid collection between the myometrium and the margins of the gestational sac, sometimes associated with the placenta.

Test your knowledge on endometrial carcinoma and uterine anatomy. This quiz includes questions about risk factors, uterine positions, and associated structures crucial for understanding women’s reproductive health. Challenge yourself and deepen your understanding of these important topics.