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274 Cards in this Set
- Front
- Back
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Describe the function of the mesonephric duct
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Males - Becomes ductus deferens
Females - Degenerates Both sexes - Responsible for kidney development |
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Describe the function of the paramesonephric duct
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Males - Degenerates
Females - Persists |
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When, during fetal development, does sexual differentiation begin
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Week 7
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When during male fetal development does MIF production begin and what cells produce it
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Week 16 - Sertoli Cells
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When during male fetal development does testosterone production begin and what cells produce it
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Week 9 - Leydig Cells
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Absence of leydig and sertoli cells in female fetal development causes what
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No leydig = no testosterone = no ductus deferens
No sertoli = no MIF = paramesonephric duct persistence |
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Above the fusion site of the paramesonephric duct becomes what
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Future uterus
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Below the fusion site of the paramesonephric duct becomes what
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Vagina
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The fusion site of the paramesonephric duct becomes what
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Cervix/fornix
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The attachment site of the paramesonephric ducts to the urogenital sinus becomes what
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Hymen
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What is stimulated by DHT
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Penis development:
- Lengthening of the genital tubercle - Midline fusion of labia minora to form external urethral - Allows genital swellings to swell and fuse caudally to form scrotum |
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Kleinfelters has what karyotype and what phenotype
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47 XXY - Taller than average male with female features
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Turners has what karyotype and what phenotype
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45 X - Webbed neck, shield chest, horseshoe kidney, coarctation of aorta, streak ovaries, absent breasts
(gonadal dysgenesis) |
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A cranial/cephalad mesonephric duct remnant in women may cause/be known as
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Paratubal cyst
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A caudal mesonephric duct remnant in women may cause/be known as
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Gartner's cyst
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An XY karyotype that has androgen insensitivity would result in what
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Body still makes MIF so paramesonephric ducts are lost, therefore:
- Female phenotype without a uterus |
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XX karyotype with increased androgen influence might be due to what
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21-hydroxylase deficieny leading to congenital adrenal hyperplasia
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Describe Hypospadias
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Abnormal ventral opening of urethra on penis from incomplete closure
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Describe epispadias
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Uretral meatus is on dorsal aspect of penis
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Describe bladder exstrophy
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Bladder mucosa is exposed on the outside and features epispadias
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If the process vaginalis does not obliterate what occurs
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Congenital inguinal hernia
Hydrocele |
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Describe a follicular cyst
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Unruptured or resealed Graafian follicle
- Unilocular, thin walled, smooth surface, with a serous filling - Outer teca interna and inner granulosa cell layers |
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Describe a corpus luteum cyst
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Persistence of the corpus luteum
- Only abnormal when this occurs without pregnancy - Convoluted lining of large luteinized granulosa cells, with internal connective tissue layer - It secretes estrogen and progesterone |
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Describe the (possible) clinical presentation of PCO syndrome
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Low/no menstruation
Infertility Virilization Anovulation |
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What is the histologic appearance of PCO syndrome
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Large, whitened ovaries w/ thick superficial cortex and 8-10 small peripheral follicles
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Describe the pathophysiology of PCO syndrome
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Insulin resistance, increased androgen synthesis, hypothalamic/pituitary dysfunction with elevated LH
Hyperinsulinemia, increased IGF-1, and no progesterone |
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Why does PCO syndrome have increased risk of endometrial cancer
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Chronic endometrial stimulation by estrogen
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Endometrioma has what distinctive characteristic
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Chocolate cyst lined by endometrium-like epithelium
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Describe serous inclusion cysts
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Small simple cysts in ovarian cortex
Follicle traps surface epithelium (so lined by ovarian surface epithelium) |
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Describe multiple functional ovarian cysts
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From excessive gonadotropin stimulation
Multiple tin-walled luteinized follicular cysts resolve spontaneously Theca-lutein cysts - excessive hCG (hydatiform or choriocarcinoma) Ovarian Hyperstimulation Syndrome - Iatrogenic: FSH, LH, clomiphene citrate |
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When do epithelial ovarian neoplasms tend to occur
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Mostly in 40s and 50s
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What are the different types of epithelial ovarian neoplasms
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Benign serous cystadenoma
Benign mucinous cystadenoma Brenner tumor Borderline ovarian tumors Invasive epithelial carcinoma (Serous, endometrioid, and clear cell) |
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Describe a benign serous cystadenoma of the ovary
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Most common ovarian epithelial neoplasm
Unilocular with a smooth surface, filled w/ clear fluid Lined by single layer of tubular columnar epithelium |
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Describe a benign mucinous cystadenoma of the ovary
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Multilocular
Lined by tall gastro-intestinal or endocervical columnar cells with goblet cells |
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Describe a Brenner tumor of the ovary
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Benign
Very rare Nest of transitional type cells in fibrous stroma |
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Describe borderline ovarian tumors (LMP)
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Proliferative activity and nuclear abnormalities, but NO STROMAL INVASION
Younger mean age Good 5 year survival |
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Describe the general features of invasive epithelial carcinoma of the ovaries
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Older patients
Vague, non-specific symptoms Serous, endometrioid, and clear-cell types |
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Describe serous invasive epithelial carcinoma of the ovaries
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From fallopian tubes
See psammoma bodies |
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Describe the etiology of endometrioid cand clear cell invasive epithelial carcinoma of the ovaries
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From retrograde menstruation
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What is a cause of pseudomyxoma peritonei that we recently discussed
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Invasive epithelial carcinoma of the ovaries
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What are the germ cell neoplasms that we discussed
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Dysgerminoma
Teratoma Endodermal sinus tumor (Yolk sac tumor) Choriocarcinoma Mixed |
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Describe the basic epidemiology of germ cell tumors
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20% of ovarian neoplasms
95% benign Average age 10-30yo Under 20yoa, 70% of ovarian tumors are GCT 1/3 are malignant |
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Describe a dysgerminoma
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Most common malignant GCT
From undifferentiated cells Large islands of epithelioid cells separated by thin fibrous septae Tumor marker: LDH Good prognosis Associated with abnormal (streak) gonads |
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What is the tumor marker for a dysgerminoma
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LDH
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Describe an endodermal sinus tumor (yolk sac tumor)
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Second most common malignant GCT
Seen in young women (median 19yoa) See Schiller-Duval bodies - microcysts that resemble a glomerulus Tumor marker: Alpha-fetoprotein |
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What is the tumor marker for an endodermal sinus tumor
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Alpha-fetoprotein
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Describe the pertinent information regarding teratomas
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Benign - aka dermoid cyst
- presents w/ torsion during repro years - Mature tissue of origin Malignant - From immature proliferating embryonal tissue - May have intraperitoneal spread |
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Describe a choriocarcinoma
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Highly malignant
From syncytio- and cytotrophoblasts Tumor marker: hCG Very chemo-responsive |
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What are the different types of sex cord-stromal neoplasms we discussed
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Granulosa cell tmors - Most common
Sertoli-Leydig cell tumors Fibroma Thecoma |
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Describe granulosa cell tumors
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Most common sex cord-stromal neoplasm
Secretes estrogen Call-Exner bodies (macro/microfollicular pattern) Coffee bean nuclei Tumor marker: Inhibin |
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Call -Exner bodies are seen in what
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Granulosa cell tumors
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Coffee bean nuclei are seen in what
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Granulosa cell tumors
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Psammoma bodies are seen in what
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Serous invasive epithelial carcinoma
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Schiller-Duval bodies are seen in what
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Endodermal sinus tumors
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What is the tumor marker for granulosa cell tumors
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Inhibin
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Describe sertoli-Leydig cell tumors
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Very rare
Primarily between 20-30yoa Benign Secrete angrogens ==> virilization Golden yellow appearance |
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Describe sex cord fibromas
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Post menopause
Solid Benign From excessive fibroblasts Meig's syndrome - pelvic mass, right pleural effusion and ascites |
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Describe Meig's syndrome
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Pelvic mass, right pleural effusion, ascites
Sex cord fibroma |
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Describe a thecoma
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Rarely alone (usually with fibroma)
May secrete estrogen |
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Describe Krukenberg tumors
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From stomach
See signet rings Poor prognosis 5% of malignant ovarian tumors |
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Describe salpingitis
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From suppurative infection (mostly gonorrhea and chlamydia)
Severe peritonitis on rupture Possible scarring leading to infertility, ectopic pregnancy and chronic pain Perihepatic adhesions (Fitzhugh-Curtis) |
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Describe Hydrosalpinx
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Dilation of fallopian tube due to blockage from scarring/surgery
Asymptomatic, can look like cancer on ultrasound |
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Describe serous tubal intraepithelial carcinomas (STICs)
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Precancer lesions of fallopian tube
Fibrial end lesions found in BRCA mutation carriers Precursors of serous tubal and ovarian epithelial carcinoma |
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Describe adenocarcinoma of fallopian tube
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Very rare
Older women BRCA = increased risk Presents with sero-sanguinous vaginal discharge |
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Severely decreased fertility involving the loss of functioning cilia in the fallopian tube can be a part of what
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Kartagener's Syndrome
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What types of cells make up a blastocyst
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Embryoblasts and trophoblasts (cyto and syncytio)
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Describe the organization of a blastocyst
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Embryoblasts - located at one pole, develops into embryo
Trophoblasts - >Cytotrophoblasts - Mitotically active; divide and fuse to become syncytiotrophoblasts > Syncytiotrophoblasts - comprise the villi that the blastocyst needs to attach to the endometrium; secrete hCG to maintain the corpus luteum and its progesterone secretion |
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After implantation, what happens to the embryoblast
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Differentiates into two layers:
- Epiblast (ectoderm) - becomes embryo - Hypoblast (endoderm) - gives rise to Heuser's membrane which becomes primary yolk sac (exocelomic cavity) |
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List the layers of the developing embryo at day 12 from outside near uterine space to inside
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endometrium
(cyto)trophoblasts extraembryonic mesoderm chorionic cavity extraembryonic mesodderm Heuser's membrane Yolk sac space Hypoblast Epiblast Amniotic cavity |
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When does the yolk sac split into two resulting in a definitive yolk sac surrounding the embryoblast
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Day 13
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Describe placental (blood-interface) development
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Syncytiotrophoblasts comprise villi that invade endometrium
Villi start attaining vacuoles/lacunae and are then classified as tertiary (mature) villi Lacunae of tertiary villi and maternal capillaries fuse to form sinusoids (fetal-maternal circulation complete) |
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What parts can the placenta be separated into
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The endometrium of the uterus opposite the developing embryo - decidua parietalis
The area where the maternal and fetal circulations are mixing (aka villous chorion) - decidua basalis The area covering the smooth chorion - decidua capsularis |
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Describe the structure of the mature placenta
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Actual placenta is decidua basalis (mother's side) + villous chorion (fetal side)
Connecting stalk becomes umbilical cord |
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Describe the path of oxygen from the mother through the fetus and back
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Uterine artery supplies capillaries between chorionic villi -> diffusion into villi -> fetal umbilical vein -> fetus -> deoxygenated blood flows back to placenta via the two umbilical arteries
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If an aborted fetus is not delivered or resorbed what is it considered
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Fetus papyraceus
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What increases the risk of ectopic pregnancy and how does it present
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Risk - PID, IUD, endometriosis, and other scarring
Presents with abdominal pain and shock 6 wks after normal menses - Hematosalpinx if tube ruptures or placenta separates |
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Describe placenta previa
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Placenta implants over cervical os
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Describe retroplacental hematoma
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associated with placental abruption
Premature placental detachment -> blood accumulates between placenta and uterine wall See with cocaine use |
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Describe abnormal insertion of the umbilical cord
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Velamentous (membranous) - inserts on fetal membranes
Vessels are not protected by placenta and can easily rupture |
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Short umbilical cord length can be seen with
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Limb Body Wall Anomaly
(And thoraco/abdomino-schisis, limb defects, and exencephaly) |
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Fraternal twins have what type of chorion and amnion
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Di-Di
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Mono-Mono are what
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Identical twins
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Twin-twin transfusion syndrome mainly occurs in what type of chorion amnion
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Mono-Di
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Preeclampsia and eclampsia have what etiology
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Abnormal trophoblastic implantation so that normal decidual vessel dilation doesn't occur leading to placental hypoxia
Results in endothelial dysfunction and reduced PGI2 = hypercoagulability |
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Describe the main point of gestational trophoblastic disease
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Proliferation of trophoblastic tissue with persistently elevated HCG
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How does an hydatidiform mole present
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Vaginal bleeding
Large uterus preeclampsia |
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An hydatidiform mole typically has what karyotype and cause
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46XX where an empty egg is fertilized by two sperm
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Describe gestational choriocarcinoma
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Extremely high HCG levels (higher than moles)
Often arise from moles, abortions, or previous pregnancy Trophoblasts, but no villi in soft fleshy tumor Mets to lungs, vagina, and brain Very responsive to chemotherapy |
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Describe the process of conception
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Sperm and egg combine:
- Sperm head receptors and zona ligands in zona pelucida bind --> acrosome reaction releases enzymes allowing fusion of plasma membranes --> cortical reaction allows cortical granules beneath oocyte membrane to release their contents --> zona reaction results in hardening of the zona pelucida |
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In what stage does a fertilized egg reach the uterus
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Morulla
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Describe the process of implantation from a morulla
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Morula --> blastocyst, hatches from zona pelucida 1-3 days later
Trophoblasts bind endometrial integrins and attachment to wall occurs - trophoblasts also release HCG |
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Describe the lacking enzymes of the fetoplacental unit
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Placenta lacks 17 a-hydroxylase (can't make estrogen) and 16 a-hydroxylase and 17/20 lyase (desmolase)
Fetus lacks 3 beta hydroxysteroid dehydrogenase (can't make progesterone) and aromatase |
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What is the function of progesterone in pregnancy
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Corpus luteum from 8-10 weeks, then placenta
Stimulates decidua formation Inhibits PGI synthesis and smooth muscle contraction |
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What is estriol used for (as in clinical measurement/diagnosis)
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Used to measure fetal well being
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What occurs in placental sulfatase deficiency
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Placenta can't remove sulfate groups
See high DHAS and low estrogen Labor does not occur (requires C section), ichthyosis on neck/trunk/palms, corneal opacities, cryptochidism, and pyloric stenosis |
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What is the function of estrogen during pregnancy/labor
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Increases uterine contractility, growth, and vascular permeability
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Describe the synthesis of progesterone by the fetoplacental unit
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Maternal or placental cholesterol
--> maternal or placental pregnenolone --> converted to progesterone in placenta |
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Describe the synthesis of estrone by the fetoplacental unit
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Maternal or placental cholesterol
-> maternal or placental pregnenolone -> pregnenolone to fetal or maternal compartment -> pregnenolone to DHA sulfate and back to placenta -> desulfonation to DHA -> DHA to estrone |
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Describe the synthesis of estradiol by the fetoplacental unit
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Maternal or placental cholesterol
-> maternal or placental pregnenolone -> pregnenolone to fetal or maternal compartment -> pregnenolone to DHA sulfate and back to placenta -> desulfonation to DHA -> DHA to estradiol |
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Describe the synthesis of estriol by the fetoplacental unit
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Maternal or placental cholesterol
-> maternal or placental pregnenolone -> pregnenolone to fetal compartment -> pregnenolone to DHA sulfate (adrenal) -> DHA sulfate to 16 a-OH DHA sulfate (liver) -> Back to placental compartment -> 16a-OH androstenedione -> estriol |
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Describe Human Placental Lactogen
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Produced by syncytiotrophoblasts
Ensures fetus gets its glucose, antagonizes maternal insulin (so she may become diabetic) |
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What is a particular issue that was discussed regarding high blood glucose in pregnant women
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Fat baby getting stuck in birth canal -> should dystocia
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Describe the hormonal factors involved in parturition
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Decline in progesterone activity (not levels)
CRH from placenta -> increased ACTH -> cortisol -> fetal lung maturation -> increased DHEA sulfate -> increased estrogen -> increased prostaglandins ----> labor |
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Describe the effects of estrogen on lactation
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Induces growth and branching of the ductal system
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Describe the effects of Prolactin on lactation
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Stimulates milk production and gland growth
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Describe the effects of Oxytocin on lactation
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Stimulates contraction of alveolar epithelial cells
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Describe prolactin levels during pregnancy
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Rise during pregnancy, but secretion inhibited by high estrogen and progesterone
Inhibition ends after delivery High levels inhibits FSH/LH release |
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What are the SERMs we discussed
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Tamoxifen
Raloxifene Clomiphene Citrate |
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Describe tamoxifen
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An estrogen receptor blocker (a SERM)
Exerts an anti-estrogen effect in treatment of breast cancer Estrogen agonist in bone and endometrium (increased risk of endometrial cancer) Increased DVT risk |
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A drug that is an estrogen agonist in both bone and endometrium might be
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Tamoxifen
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Describe raloxifene
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Estrogen agonist in just bone (no endometrial growth)
Increased DVT risk |
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Describe clomiphene citrate
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Anti-estrogen in brain = increased FSH = follicular development = ovulation
Can have hot flashes, moodiness, and visual changes like tracers and "acid trip" Stop if visual changes occur |
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What are the aromatase inhibitors that were mentioned
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Letrozole and anastrozole
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What do aromatase inhibitors do
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Block aromatase in granulosa cells = no estrogen
Treats breast cancer and infertility |
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What is the anti-progestin drug we discussed
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Mifepristone (RU486) - "Abortion Pill"
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How does mifepristone work
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Anti-progestin:
-Blocks the pro-gestation effects of progesterone = >Decidual degeneration, cervical softening and dilation > Trophoblasts detach = decreased HCG = decreased progesterone from corpus luteum |
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Describe the injectable gonadotropins
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HMG (FSH and LH in a shot)
Used with HCG (mimicking the LH surge) to stimulate ovaries in infertility Can cause ovarian hyperstimulation syndrome where capillaries become very leaky |
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Describe ovarian hyperstimulation syndrome
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Possibly from HMG injection
Capillaries become very leaky leading to polycythemia, painful ovaries, and ascites |
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What are the GnRH related drugs that we discussed
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Leuprolide and ganirelix
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Describe how Lupron works
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GnRH agonist (desensitizes receptors)
Treatment of infertility -> all FSH/LH shoot out at once --> more eggs/follicles Can cause menopause symptoms |
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Describe how Ganirelix works
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GnRH agonist (desensitizes receptors)
Treatment of infertility -> prevents premature LH surge Can cause menopause symptoms |
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What is "add back" therapy
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Low level estrogen and progesterone to counteract the symptoms of menopause (potentially caused by lupron or ganirelix)
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What are the uterine drugs that we discussed (pregnancy/delivery)
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Dinoprostone
Methergine Terbutaline and Ritrodrine (and Pitocin) |
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Describe dinoprostone
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PGE2 ?agonist?
"Ripens" cervix before induction of labor |
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Describe methergine
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ergot derivative
Contracts the uterus preventing postpartum hemorrhage |
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Describe Terbutaline and Ritrodine
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Beta-2 selective ?agonist?
Stops contractions in preterm pregnancy - Helps with uterine hyperstimulation |
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Oral contraceptives are used for what (other than contraception)
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Dysfunctional uterine bleeding
Dysmenorrhea Mittleschmerz (pain on ovulation) Hypothalamic amenorrhea therapy Endometriosis |
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What are the mechanisms of action of oral contraceptives
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Estrogen - Suppresses ovulation by suppressing LH/FSH release
Progestin - Thickens cervical mucus and thins the uterine lining |
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What are the benefits and side effects of oral contraceptives
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Benefits - Contraception, Protection against endometrial and ovarian cancer, More regular menses, Less salpingitis
Side effects - Break-through bleeding, CV disease (increased risk of MI in smokers and increased risk of thromboembolism), rarely Weight gain, worsening of SLE |
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What are the hormones in HRT and what are they in certain special situations
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low dose estrogen and progestin normally
Progestin only if estrogen sensitive Estrogen only if no uterus |
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What are some contraindications for HRT
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Liver disease
Active thromboembolic disease Estrogen related malignancy |
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Describe primordial follicles
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Resting/inactive oocytes frozen in prophase 1
Surrounded by a single layer flattened follicular cells |
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Describe primary follicles
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Single to multiple cuboidal granulosa cells that are stimulated by FSH
Mucopolysaccharide coating known as zona pellucida develops |
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Describe secondary follicles
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Theca layer develops outside of basement membrane
Antrum fills with liquor folliculi starts developing in granulosa layer |
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Describe tertiary follicles
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Antrum large and bulging on surface of the ovary
Granulosa cells under the egg (cumulus oophorus) and around the egg (corona radiata) |
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Describe the process of ovulation
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LH surge triggers first meiotic division and release of egg - Produces oocyte and one polar body
- Next meiotic division occurs after fertilization with secondary polar body being made Follicular wall thins and oocyte is released with the corona radiata, cumulus oophorus and follicular fluid |
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Describe the corpus luteum and its function
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Luteinized granulosa and theca cells
Granulosa cells accumulate lipid and produce progesterone Early corpus luteum is a blood clot surrounded by foamy granulosa cells Late corpus luteum involutes, degenerates, scars forming the corpus albicans |
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Which estrogen is the most potent and abundant
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Estradiol
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Where is estrone made
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peripheral tissues
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Describe theca cells
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Theca interna - like leydig cells
Stimulated by LH No aromatase (don't make estrogen) Makes androgens that are passed to granulosa cells |
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Describe granulosa cells
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Like Sertoli cells
Stimulated by FSH No 17a hydroxylase (can't make androgens) Convert androgens from theca cells into estrogen |
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What are the main actions of estrogens in a typical woman
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Growth of secondary sex characteristics
Moisturizing of lower genital tract Prevention of osteoporosis by increased bone growth Increased clotting factors, hormone binding globulins and progesterone receptors Increases HDL and decreases LDL |
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What are the main actions of progestins in a typical woman
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Precursor to estrogens and androgens
Produces secretory endometrium for blastocyst implantation Thickens cervical mucus Antagonizes aldosterone (so less sodium retention) Decreases bowel/uterine motility (constipation) |
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Describe the ovarian cycle of the menstrual cycle
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Follicular phase (variable length):
- During prior luteal phase, FSH stimulates growth of new follicles - Follicles secrete estrogen which inhibits FSH production until the dominant follicle (with the most FSH receptors) remains - FSH induces LH receptors on granulosa cells (which then secrete progesterone later) - Estrogen has positive feedback = LH surge Ovulation - LH surge 1 day after estradiol peak, ovulation 10-12 hrs later Luteal phase (14 days) - Follicle becomes corpus luteum = progesterone production - CL maintained by HCG - negative estrogen feedback |
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Describe the basic organization of the uterine wall
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Perimetrium - faces peritoneal cavity
Myometrium - entirely smooth muscle, 3 layers, central stratum vasculare is highly vascularized Endometrium - > stratum basale, supplied by basal artery, not sloughed > stratum functionale, faces lumen, supplied by spiral arteries, sloughed |
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Describe the uterine/endometrial cycle of the menstrual cycle
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Menstrual phase - less progesterone and no HCG
- Just before, the spiral arteries constrict causing endometrial ischemia and necrosis; then they dilate and cause hemorrhage and sloughing Proliferative phase - Endometrial growth stimulated by estrogen, glands are straight with organized simple columnar lining Secretory phase - Upward growth stops and glands become longer and corckscrewed and fill with secretions |
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What is the effect of estrogen on cervical mucus
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Makes it abundant, watery, and thin
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What is the effect of estrogen on the vagina
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Keratinizes vaginal cells
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What is the effect of progesterone on the vagina
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Makes cells smaller with less keratin and increases number of leukocytes
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What is thelarche
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Breast development, first sign of puberty
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What is adrenarche
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Increased adrenal androgens leading to pubic and axillary hair
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What is menarche
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first menses
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Describe the result of an anovulatory cycle
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Most common cause of dysfunctional uterine bleeding
Due to prolonged estrogen stimulation without progesterone Causes - endocrine, ovarian lesions, metabolic, idiopathic |
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Describe inadequate luteal phase
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Low progesterone leading to early menses and infertility
A cause of dysfunctional uterine bleeding |
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Describe acute endometritis
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Uterine inflammation
NEUTROPHILS Uncommon Usually from bacterial infection after delivery/miscarriage |
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Describe chronic endometritis
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Uterine inflammation
PLASMA CELLS Caused by POC, PID, IUDs, idiopathic |
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What is adenomyosis
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Endometrium growing in myometrium
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Describe endometrial polyps
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Presentation: asymptomatic or abnormal bleeding with no pain
Associated with tamoxifen use |
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Describe endometrioid carcinoma
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Most common cancer of female genital tract
An adenocarcinoma Type I - Most common, good prognosis, hyperplasia, PTEN PIK3A KRAS (not p53) Type II - Grade 3 endometrioid, papillary serous, clear cell, and MMMT, often see p53 mutation |
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Describe a Malignant Mixed Mullerian Tumor (MMMT)
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aka carcinosarcoma - see malignant glands AND stroma
Postmenopausal women present with bleeding Highly malignant, not good prognosis |
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What are the endometrial tumors with stromal differentiation? Describe them
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Adenosarcoma - malignant stroma mixed with benign endometrial glands, low grade, high recurrence
Stromal tumors - Stromal nodules that are benign and well circumscribed, a stromal sarcoma = diffuse myometrial or lymphatic invasion |
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What is a bartholin cyst
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Blockage of gland ducts secondary to infection in vagina
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Describe the non-neoplastic epithelial disorders of the vulva
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Lichen Sclerosis - epidermal thinning, increased SCCA risk
Squamous cell hyperplasia - acanthosis (epidermal thickening), no increased SCCA risk BOTH show leukoplakia and hyperkeratosis |
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Describe condyloma acuminatum
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aka genital wart/squamous papilloma
A benign exophytic lesion Associated with HPV 6&11 perineum, perianal, vaginal, and cervical Papilloma with koilocytic atypia - hyperchromatic wrinkled nuclei and perinuclear halo |
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Describe basaloid and warty carcinoma
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A malignant squamous neoplastic lesion
Develop from classic VIN Associated with HPV *16*,18,31 Reproductive age women Prominent koilocytosis, no keratin pearls |
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Describe keratinizing squamous cell carcinoma
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Develop from differentiating VIN
Older age omen See prominent keratin pearls |
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Describe papillary hydradenoma
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A well circumscribed benign nodule of labia majora
Papillary projections with two cell layers - Top layer, columnar secretory - Bottom layer, flattened myoepithelial cells |
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What are some developmental anomalies of the vagina
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Septate (double) vagina - failed mullerian duct fusion
Vaginal adenosis - endocervical epithelium in upper vagina (glands where they don't belong) Gartner Duct Cyst - wolffian duct remnant in upper vaina |
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What are some malignant conditions of the vagina
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Vagina squamous cell carcinoma - Rare, HPV association, VIN precursor, Mets to lower vagina
Embryonal rhabdomyosarcoma (sarcoma botryoides) - Pediatric, grapelike mass, "small blue cells" |
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Cervicitis infectious organisms of interest/concern are
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Mycoplasma
HSV Chlamydia Gonorrhoea |
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Describe an endocervical polyp
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Benign, exophytic
Irregular spotting Fibromyxomatous stoma plus dilated glands |
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Describe a fibroadenoma
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The most common tumor in women under 35
Small, mobile, firm mass with a sparsely cellular tumor and ductal epithelium Estrogen sensitive - may enlarge during pregnancy |
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Describe a phyllodes tumor
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Breast tumor
Like a fibroadeoma, but stroma is more cellular Pushes epithelia into leaf-like projections Can be very large |
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Describe fibrocystic change/disease
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Most common cause of "breast lumps" in 25+yoa
Size fluctuates with menstrual cycle See duct hyperplasia without much epithelial proliferation > Blue dome cysts > Sclerosing adenosis (radial scar looking like cancer > Microcalcifications |
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Describe intraductal papilloma
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Branching ductal epithelium with a fibrovascular core
easily infarcts > Might see bloody or serous nipple discharge |
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Describe atypical/lobular hyperplasia
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precursor to CIS, often multifocal and bilateral
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Describe ductal carcinoma-in-situ
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Low grade - continuous spread (resectable), not palpable
High grade - palpable, coarse microcalcifications - markedly enlarged ducts with central necrosis - Discontiguous spread (difficult to resect) - Looks malignant without invasion |
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Describe lobular carcinoma-in-situ
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Increased lobule size with extensive hyperplasia within lobules
Puts both breasts at risk of developing carcinoma |
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Invasice carcinoma of the breast typically metastasizes where
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Ipsilateral axillary lymph node
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Describe an "Inflammatory" invasive carcinoma of the breast
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Get hot red swollen breasts, but no inflammatory cells
Can lead to skin necrosis and peau d'orange |
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Describe an infiltrating ductal carcinoma of the breast
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Most common breast cancer w/ worst prognosis
Firm, stellate mass of glandular (duct like) cells |
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Describe Paget's disease of the breast
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red/itchy/scaly patches on nipple
Associated with deeper DCIS or invasive carcinoma because the cells migrate to the skin surface |
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Describe an infiltrating lobular carcinoma
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ill defined mass
Often caught late Single file cell columns Often bilateral with multiple lesions |
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Describe the Nottingham tumor grading score for breast tumors
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TM
Tubules - resemblence to normal ducts Nuclei - is there atypia Mitosis - high number of cells undergoing mitosis |
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Discuss the gene expressions related to breast cancer
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Estrogen Receptor positive - better differentiated tumor that may respond to hormonal manipulation
HER2 positive - Poor prognosis, treat with herceptin (anti-HER2 antibody) |
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Describe the subtypes of breast cancer
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Luminal A - ER +, HER2 -
- More common in postmenopausal women - Slow growing Basal-like - All neg. - BRCA1 familial cancer - Cancer before 30 - Poor prognosis, no good treatment |
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Describe the maternal cardiovascular changes in pregnancy
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Decreased Blood Pressure
Increased blood volume (plasma:RBC increases) Increased CO (HR > 100 is abnormal, most increase comes from stroke volume) Larger, dextrorotated, flattened heart Edema (decreased oncotic pressure, increased capillary permeability) Decreased venous return (uterus compresses the veins) Decreased peripheral resistance (placenta is a giant AV shunt!) |
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Describe the maternal respiratory changes in pregnancy
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Increased respiratory rate (1-2 bpm higher) and O2 consumption
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Describe the maternal renal changes in pregnancy
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GFR increased
Increased total urine output Decreased serum creatinine and BUN |
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Describe the maternal GI changes in pregnancy
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Decreased bowel motility due to progesterone
Biliary stasis --> gallstones |
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Describe the maternal liver changes in pregnancy
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Increased alk phos from placenta, cholesterol, and liver dependent clotting factors
Transaminases are not changed (if changed, think preeclampsia |
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Describe the maternal thyroid changes in pregnancy
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TSH should be unchanged, but total thyroid hormone may increase
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Describe the maternal pancreatic changes in pregnancy
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Placental degradation of insulin leads to increased insulin resistance and production
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Describe the maternal uterus changes in pregnancy
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Vasodilation leads to lower resistance to blood flow
Myometrial hypertrophy |
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Describe the maternal systemic changes in pregnancy
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Increased temp., water loss, weight
2-3lbs in first trimester, 3lbs/month after that |
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Describe the maternal changes during labor
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Cervix - stretched, softened, purple, increased water, decreased collagen --> chorion becomes exposed during opening and is broken down
Increased placental CRH production leads to PG production --> Estrogen, progesterone, and NO = negative feedback --> Cortisol and neuropeptides = positive feedback |
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What are some causes of preterm labor
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*Infection*
abruption anatomic maternal fetal idiopathic |
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How are the contractions of preterm labor treated
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Magnesium sulfate
B-2 sympathomimetic NSAIDs |
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Describe the sources of energy for the fetus
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0-5 weeks - Internal cell stores and passive diffusion
5+ weeks - placenta |
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Describe the anatomy of the fallopian tube
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Infundibulum - most distal, has fimbriae
Ampulla - Longest section, location of sperm capacitation and fertilization Isthmus - Short narrow region close to uterus Intramural portion - directly embedded in uterine wall |
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Describe the lumenal lining of the fallopian tube
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Mucosal lining with many extensions into the lumen
- Unlike seminal vesicles, extensions don't cross entire lumen Has ciliated cells and Peg cells (dark staining secretory cells with a long oblong nucleus that look "hammered" between other cells) |
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Describe the muscular layer of the fallopian tube
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Well developed inner circular layer and indistinct outer longitudinal layer
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Describe the histology of the cervix
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Above cervical os - dense stroma with highly branched cervical glands, simple columnar lining, and accumulation of gland product on the surface (luminal side)
Below cervical os - stratified squamous epithelium! At transition zone - Nabothian cysts (from blockage of Nabothian glands), benign, and irrelevant unless very large |
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How could a histologic preparation of esophagus and vagina be told apart
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vaginal cells store lots of glycogen an have a washed out clear appearance
No glands No muscularis mucosa |
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Describe the histologic appearance of inactive breast tissue
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sparse alveoli
lots of stroma Portions of secretory ducts (cuboidal epithelia overlying myoepithelial cells) |
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Describe the histologic appearance of active breast tissue
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(activated in response to estrogen and progesterone)
Ducts give rise to secretory alveoli which are hypertrophied Stromal components, including adipose tissue, are decreased |
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Describe milk production
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Fats are released through apocrine secretion (surrounded by maternal cell membrane)
Proteins are secreted through merocrine secretion (simple exocytosis) |
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Describe the histologic appearance of the nipple
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Collagen appears dark red with isolated pink bundles of smooth muscle and melanin near the basement membrane
Montgomery's tubercles --> Sweat and sebaceous glands secreting products directly onto the suface of the nipple instead of through a hair follice |
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Describe the temperature control mechanism for the testes
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Hang outside of main body cavity
Cremaster muscle can pull them in Pampiniform plexus of veins acts as a heat exchanger |
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Describe the layers of the capsule of the testes
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Tunica vaginalis - outermost layer, simple squamous
Tunica albuginea - thickest, dense irregular connective tissue Tunica vasculosa - thin, connective tissue with vessels |
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Describe the histologic appearance of sertoli cells
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Tall columnar cells with well developed nucleoli and brown oblong nuclei
lateral processes fuse to form the blood-testes barrier, prevents autoimmune destruction of gametes |
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What are the "M"s of spermatogenesis
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Basal M = Mitosis
Luminal M = Meiosis High luminal M = Morphogenesis (spermiogenesis) |
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Describe primary spermatocytes on histology
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Largest cells of seminiferous epithelium
Large round nuclei with coarse chromatin |
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Describe mature spermatocytes on histology
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Dense triangulated nucleus
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What are the only cells the touch the lumen of the seminiferous tubule
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Sertoli cells and sperm
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Where does one find leydig cells and how do they appear
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Testicular interstitium
Deeper staining cells with round nuclei |
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What are the male genital ducts
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Tubuli recti
Rete testis Ductuli efferents Epididymis Vas deferens |
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Describe the tubuli recti
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Low cuboidal epithelium with round nuclei
No spermatogonia/cytes |
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Describe the rete testis
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Network on tubes with variable lining, stains darker
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Describe the ductuli efferents
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Scalloped appearing lining from alternating ciliated and cuboidal cells
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Describe the epididymis
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A single convoluted tubule lined by stereocilia
Has a layer of smooth muscle cells below tall pseudostratified columnar epithelial cells that function to have an absorptive effect, not movement |
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Describe the vas deferens
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vibrantly staining pseudostratified columnar epithelium
Has three muscular layers - inner and outer longitudinal, middle circular |
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Describe the seminal vesical's appearance
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Prominant mucosal folds that bridge the lumen
Lined by pseudostratified columnar epithelium with large amounts of lipfuscin |
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Describe the layers of the prostate from urethra outwards
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Mucosal glands "central zone" - secrete directly into urethra
Submucosal glands "transition zone" - secrete in ducts, site of BPH Main prostatic glands "peripheral zone - site of prostate cancer |
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What are corpora amyacea
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Uniform eosinophilic concretions in the lumen of the prostate
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What is the site of Peyronie's disease
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The tunica albuginea of the penis
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How is vulvovaginal candidiasis diagnosed
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Pseudohyphae and budding yeast on a KOH prep
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How is vulvovaginal candidiasis treated
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-azoles
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How do the -azoles work
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Inhibit fungal cholesterol (ergosterol) production = disrupted membranes
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Bacterial vaginosis is often caused by what organis
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Gardenella vaginalis
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What are the features of bacterial vaginosis
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Fishy smell
NO itchiness, inflammation, or dysuria |
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How is bacterial vaginosis diagnosed
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Clue cells (vaginal epithelia coated with bacterial cocco/bacilli
Positive whiff amine test |
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How is bacterial vaginosis treated
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Metronidazole
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Protozoal vaginosis is typically caused by what organism
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Trichomonas vaginalis
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What is the presentation/feature(s) of protozoal vaginosis
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Green yellow frothy discharge from the vagina
Strawberry cervix due to pinpoint hemorrhages Inflammation Pruritis Stinky |
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What is the treatment for protozoal vaginosis
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Metronidazole
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What is "GET GAP - metronidazole" (aka GET GAP on the metro)
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G - Giardia
E - Entomoeba histolytica T - Trichomonas G - Gardnerela A - Anaerobes (clostridium, bacteroides, actino.) P - H. Pylori |
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Describe the sequelae of a Neisseria gonorrhoae infection
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Cervicitis + discharge
Urethritis + dysuria septic arthritis neonatal conjunctivitis PID |
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What is the treatment for gonorrhea
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One time injection of ceftriaxone - 3rd gen. cephalosporin
May also try tetracyline of macrolide to delay resistance |
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What is the most common STI
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Chlamydia
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What is an obligate intracellular STI that we discussed
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Chlamydia
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What is the treatment for chlamydia
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Macrolides (azithromycin, clindamycin, erythromycin)
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PID can lead to what syndrome? Describe it
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Fitzhugh-Curtis Syndrome
Inflammation of liver capsule leading to secondary adhesions to surrounding peritoneal surfaces - can cause pain and difficulty breathing |
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What are some possible causes of Fitzhugh-Curtis Syndrome
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Chlamydia and gonorrhea
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Describe HSV-1
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Vesicular, pustular on face/lips
Lays dormant in dorsal root ganglia of trigeminal nerve |
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Describe HSV-2
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Vesicular, pustular on genitals
Lays dormant in dorsal root ganglion of sacral plexus |
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How might herpes be diagnosed
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Tzank prep looking for cowdry bodies
Viral culture PCR |
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What is the treatment for herpes
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Acyclovir
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What organism causes syphilis
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Treponema pallidum
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Describe the three stages of syphilis
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Stage 1) PAINLESS chancre
Stage 2) papular rash of the palms and soles, condyloma lata (large lesions of the mucosa) Stage 3) tabes dorsalis (loss of touch and proprioception, wide based gait for balance), argyll robertson pupil |
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What is the treatment for syphilis
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Penicillin G (IV form of penicillin)
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Describe some characteristics of congenital syphilis
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Saber shins - anterior bowing of tybia
Hutchinson's triad - notch incisors, interstitial keratitis, CN VIII deafness Saddle nose from cartilage degeneration |
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Describe chancroid
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Rare in US
Caused by Haemophilus ducreyi (so painful you "do cry") School of fish collection negative rods in a chain Multiple painful genital ulcers Inguinal adenopathy Treat with zithro, cipro, ceftri |
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Describe a lymphogranuloma venerum infection
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Rare in US
Chlamydia trachomatis Self limited genital ulcer with lymphadenopathy and rectal strictures Treat with doxycycline |
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What is the cause of condyloma acuminata
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HPV 6 & 11 (16 & 18 indicate high risk)
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What is the clinical presentation of condyloma acuminata
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Genital warts with possible bleeding and pruritis
Koilocytes |
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What is the clinical presentation of molluscum contagiosum
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Dome shaped papules with an umbilicated center
Possible bacterial superinfection resolves spontaneously |
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What is "chordee" in men
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Fibrosis tethering the penis
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What is phimosis and what causes it
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Can't retract foreskin due to scarring from infection
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Describe Peyronie's disease
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Deposition of dense collagen on fascia (tunica albuginea) connected to corpus cavernosum leading to a painful erection and curvature of the penis
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Carcinoma in-situ in men is related with what
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HPV 16 infection
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What is the leading cause of infertility of men in the developing world
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TB
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Describe a "classic" seminoma
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Younger male
Unilateral, uniform gray-white tumor |
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Describe the specific types of nonseminomatous germ cell tumors (NSGCT)
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Embryonal carcinoma - sheets of undifferentiated cells
Yolk sac tumor - targetoid arrangement of epithelial cells around a blood vessel Choriocarcinoma - Trophoblasts producing HCG, invades blood vessels and causes hemorrhage Teratoma |
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What stimulates spermatogenesis and what cells are responsible for spermatogenesis
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FSH on Sertoli cells
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What stimulates the expression of LH receptors on leydig cells
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FSH
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What does LH do to leydig cells
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Stimulates testosterone production by stimulating the activity of StAR CYP 11A1 in the mitochondria to produce pregnenolone
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What is gondorelin hydrochloride/acetate? What is it used for?
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Factrel/Lutrepulse
Helps hypothalamic causes of hypogonadism (or to differentiate them from other causes) |
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What is the treatment for precocious puberty in males
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Superactive GnRH analogs like Lupron
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What does lupron do in males
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Treats precocious puberty and prostate cancer
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What is Finasteride (Proscar) and what is it used for
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A 5a-reductase inhibitor
Treats BPH by blocking DHT production |
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What androgen receptor antagonist might be used to treat hirsutism
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Cyproterone acetate (androcur)
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What is flutamide and how does it work
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blocks DHT receptor and along with finasteride it treats BPH
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What are danazol and stanozolol
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androgens/steroids that are often abused
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