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555 Cards in this Set

  • Front
  • Back
what 7 factors determine your gender?
chromosome, gonad, internal genitalia, external genitalia, perceived gender, gender role, sex object preference
The cortex of the undifferentiated gonad develops into.....?
the ovary
the medulla of the undiffereniated gonad develops into..........?
the testis
what 3 sources are the gonads derived from?
mesothelial lining of the body cavity, underlying mesenchyme, and primordial germ cells
where do the primordial germ cells come from?
the yolk sac
What gene on the Y chromosome is required to spur male development?
SRY
what does SRY gene do?
stimulates an autosome to produce H-Y antigen, stimulates sertoli cells, saves the mesonephric ducts
What does H-Y antigen do?
stimulates the medulla of the gonad to turn into a testis
Where is the gene for H-Y antigen located?
On an autosome. I don't know which one
What does the SOX9 code for?
collagen II
People with no functional SOX9 gene suffer from what condition?
Compomelic Dysplasia
What does Steroidogenic Factor (SF-1) do?
codes for androgen synthesis, stimulates MIH from Sertoli cells
What does the XH2 gene do?
codes for H type hemoglobin
What does a mutation in XH2 gene do?
gives a female phenotype to a person with XY genotype
Who is DMRT-1 expressed in, and what happens when it is deleted?
Only males express DMRT-1, and if it is deleted from the Y chromosome, you have a female phenotype
If you have a mutated or missing WT-1 gene, what will happen to you?
You will have undifferentiated streak gonads
The fibrous capsule of the testis is called the....?
tunica albuginea
What 3 structures do the embryonic seminiferous cords develop into?
seminiferous tubules, tubuli recti, and rete testis
What is the embryological origin of the Leydig cells?
the mesenchyme
What does AMH (also called MIH) do when the testes secrete it?
supresses development of the paramesonephric ducts (mulerian ducts) which are then reabsorbed
What 3 things are required for correct ovary development?
absence of functional Y chromosome, migration of germ cells to the gonad, and at least 2 functional X chromosomes
What happens to the gonads if there is a Y present, no matter how many X's?
you get balls. One Y counteracts all the X's you could throw at it
What happens to the gonads if there is only one X chromosome?
you get streak gonads, no ovaries. sorry.
What one gene is primarily responsible for ovary development?
DAX-1
What happens to the gonadal cords and rete ovarii in females?
they form, and then are re-absorped
germ cells become ova in females. How many ova does a 20 week-gestation fetus have?
20 million
germ cells become ova in females. How many ova does a newborn baby have?
2 million
How many oogonia form after a female is born?
None. They all form when you are a fetus
What is the embryonic origin of the internal genitalia in males?
wolffian ducts (mesonephric ducts)
What is the embryonic origin of the internal genitalia in females?
mulerian ducts (paramesonephric ducts)
What do the mulerian ducts turn into in females?
uterus, fallopian tubes, upper 1/3 of the vagina
What do the wolffian ducts turn into in males?
seminal vesicles, epididymus, ductus deferens
What hormone stimulates the formation of male parts from the wolffian ducts, and where does it come from?
testosterone from the fetal testes
What hormone gets rid of the mulerian ducts in males?
MIH, also called AMH
What is the tunica vaginalis?
Empty sack on the ventral side of each testis. Remnant of the peritoneum
What two structures does the gubernaculum connect?
south pole of the gonad with the inside of the external labioscrotal swelling
In an adult male, where is the ductus deferens inrelation to the ureters?
It loops up in front of them, goes over, and then down behind them to connect to the seminal vesicles
Where is sperm stored after it is made in the adult male?
made in the testicle, stored in the epididymus
What does the gubernaculum do in males?
pulls the testes down out of the body, through the inguinal canal, and into the scrotum
What does the gubernaculum do in females?
pulls the ovaries down into the pelvis, but no further. persists as a cord in adult women
What undifferentiated structures become the external genitalia?
genital tubercle, labioscrotal swelling, and urogenital folds
What does the genital tubercle become under the influence of androgens?
penis
What do the labioscrotal swellings become under the influence of androgens?
scrotum
What do the urogenital folds become under the influence of androgens?
external urethra
What do the urogenital folds become without the influence of androgens?
labia minora
What do the labioscrotal swellings become without the influence of androgens?
labia majora
What does the genital tubercle become without the influence of androgens?
clitoris
Where does the prostate come from?
endodermal outgrowths from the urethra form the glands, mesenchyme form the stroma
Where do the bulbourethral glands come from?
endodermal outgrowths from the urethra form the gland part, mesenchyme form the stroma part
Does female sexual development depend on having ovaries or hormones?
NO! it really only depends on lacking androgen influence
At how many weeks of gestation do the germ cells start to migrate?
5 weeks
At how many weeks do the undifferentiated gonads commit to either testes or ovaries?
7 weeks
At how many weeks do the wolffian/mullerian ducts commit themselves to either male or female parts?
10 weeks
At how many weeks do the external genitalia commit to becoming male or female?
14 weeks
What's the difference between sex and gender?
no hard line, but sex tends to refer to physiologic things, while gender refers to cultural or psychological things
Define intersexuality
disagreement between 2 of the organic sex criteria
Define transsexuality
disagreement between 1 organic sex critera and 1 psychological gender criteria
What is the prevalance of children born intersexed?
1 in 2000
what percentage of intersex children have congenital adrenal hyperplasia?
98%
Individuals with only 1 sex chromosome (YO) are said to have.....?
Uh, death. You can't live without an X chromosome
Individuals with only one sex chromosome (XO) are said to have......?
Turner's syndrome
What are some classical signs of a person with Turner's syndrome?
short, webbed neck, broad chest, wide inverted nipples, coarctation of aorta, bicuspid aortic valve
What do Turner's Syndrome babies look like at birth?
normal females
What do the gonads look like in females with Turner's Syndrome?
90% have streak gonads, 10% have ovaries
A person with chromosomes (XXY) are said to have....?
Klinefelter's Syndrome
People with chromosomes (XYY) are said to have......?
Uh, (47,XYY) Syndrome
What are the classical signs of Klinefelter's Syndrome?
tall, long limbs, gynecomastia, possible learning disorders
What are the classical signs of XYY syndrome?
nothing, really, they are mostly indistinguishable
What is the prevalence of babies born with Klinefelter's Syndrome?
1/800 live male births
What is the most common genetic abnormality found in miscarried fetuses?
Turner's Syndrome
What is the prevalence of babies born with Turner's Syndrome?
1/3500 live female births
How many males actually have chromosomes other than (XY)?
1 in 400
How many females actually have chromosomes other than (XX)?
1 in 700
How often are females born with XXX genotype?
1 in 1000
What are the signs of a person with the XXX genotype?
Physical abnormalities are minimal, may have menstrual irregularity/infertility
As the number of extra X chromosomes goes up, what also goes up?
Risk for mental retardation
What is the most common cause of genital ambiguity at birth?
Congenital Adrenal Hyperplasia
What is the most common form of Congenital Adrenal Hyperplasia?
the one where you are deficient in 21 hydroxylase
What is the inheritance pattern for Congenital Adrenal Hyperplasia?
autosomal recessive
What else may you find in babies with 21-OHase deficient Cong. Adrenal Hyperplasia besides ambiguous genitalia?
hyponatremia, hyperkalemia, acidosis, hypovolemia, shock
What else may you find in an 11-OHase deficient Cong. Adrenal Hyperplasia baby besides ambiguous genitalia?
hypertension, hypokalemia, alkalosis, reduced renin/aldosterone
Which adrenal deficiencies produce pseudohermaphroditism in females?
21-OHase, 11-OHase
Which adrenal deficiencies produce pseudohermaphroditism in males?
17-OHase, 3-beta hydroxysteroid
What else may you find in a 17-OHase deficient baby boy besides feminine external genitalia?
hypertension, hypernatremia, hypokalemia
Girls with Cong. Adrenal Hyperplasia are more likely to prefer "boy" activities and excel at spatial reasoning. T/F?
True. The brain is also masculinized by the excess androgens
What is the definition of true hermaphroditism?
posessing both male and female sexual anatomy: ie, one testis and one ovary, or a penis AND a vagina
What is the definition of pseudohermaphroditism?
if ovaries, then male external genitalia. If testes, then female external genitalia. No mixing of ovaries and testes
People with Androgen Insensitivity Syndrome have what genotype and what phenotype?
genotype is XY, phenotype is female
What happens to the gonads in people with Androgen Insensitivity Syndrome?
they turn into testes, but are undescended
What external and internal genitalia do people with AIS have?
external genitalia is normal female, internal female genitalia is absent; no uterus, fallopian tube, vagina ends in blind pouch
What is the gender identity of people with AIS?
Female. There is no masculinization of the brain
What is the phenotype and genotype of people with 5-alpha-reductase syndrome (guevodoces)?
XY genotype. Female phenotype as a child, male phenotype at puberty and adulthood
What is the internal genitalia of people with 5-alpha-reductase syndrome?
male. All the internal male parts are intact
What is the external genitalia of people with 5-alpha-reductase syndrome?
female or feminized at birth, may have a shallow, blind vagina. Masculinize at puberty
What gender identity do people with 5-alpha-reductase syndrome have?
in the end, it's usually male, due to testosterone influence on the brain during fetal growth and then at puberty
What is the definition of true hermaphroditism?
posessing both male and female sexual anatomy: ie, one testis and one ovary, or a penis AND a vagina
What is the definition of pseudohermaphroditism?
if ovaries, then male external genitalia. If testes, then female external genitalia. No mixing of ovaries and testes
People with Androgen Insensitivity Syndrome have what genotype and what phenotype?
genotype is XY, phenotype is female
What happens to the gonads in people with Androgen Insensitivity Syndrome?
they turn into testes, but are undescended
What external and internal genitalia do people with AIS have?
external genitalia is normal female, internal female genitalia is absent; no uterus, fallopian tube, vagina ends in blind pouch
Which cells secrete anti-mullerian hormone?
Sertoli cells
How does the secretion of GnRH affect sex hormone release?
pulsatile release of GnRH stimulates sex hormone release. Steady release of GnRH inhibits sex hormone release
What is the half-life of LH and FSH in the plasma?
about 1 hour
Which gonadal cells respond primarily to LH?
Leydig and Thecal cells
Which gonadal cells respond primarily to FSH?
Sertoli and Granulosa cells
What does LH stimulate in interstitial gonadal cells?
sex steroid production
What does FSH stimulate in supporting interstitial gonadal cells?
aromatase expression, maturation of gametes
A single cell doesn't make both testosterone AND estrogen except for cells of the.....?
Corpus Luteum
Sertoli cells also make ABP. What does it do?
Binds testosterone in the cytoplasm, to keep it around for awhile
Sertoli cells make growth factors that stimulate the proliferation of......?
Leydig cells
What is the quaternary structure of inhibin?
one alpha and one betaA chain, or one alpha and one betaB chain
What does inhibin do?
Inhibins FSH release. Does not affect LH or hypothalamus
What kind of inhibin do the testes make?
Type B (one alpha and one betaB chain)
What kind of inhibin do the ovaries make?
both type A and B
How are the structures of inhibin and activin similar?
both are dimers, inhibin of one alpha and one beta; activin of 2 betas
What does activin do in the gonad?
Nobody knows
What is the quaternary structure of activin?
2 betaA chains, or 2 betaB chains, or one betaA and one betaB
What pituitary hormone inhibits GnRH release?
prolactin
What is estrogen's effect on prolactin?
estrogen stimulates prolactin release
What happens to levels of FSH and LH if gonad function is compromised?
it goes up, because you lose the inhibitory effect of the sex steroids
In boys, at what age is puberty typically finished?
16 years old
In girls, at what age is puberty typically finished?
14 years old
What are the symptoms of Kallmann's Syndrome?
anosmia (no sense of smell), failure of pubertal development
Where do GnRH secreting neurons come from in the developing fetus?
the olfactory epithelium
What is the pathology behind the symptoms seen in Kallmann's Syndrome?
both olfactory neurons and GnRH secreting neurons come from the same source: fetal olfactory epithelium
A woman has uterine leiomyomas. How do you treat her?
With a steady does of GnRH to inhibit estrogen release
A man suffers from prostatic hyperplasia. How do you treat him?
With a steady does of GnRH to inhibit testosterone release
How many germ cells does one Sertoli cell touch?
about 47
How many other sertoli cells does one sertoli cell make tight junctions with?
about 5
What happens in Sertoli-Only Syndrome?
germ cells did not migrate to testes. Normal hormones, normal testis structure, but no sperm
What syndrome accounts for 5-10% of all male infertility?
Sertoli-Only Syndrome
What sort of receptor does LH activate on the surface of Leydig cells?
G-protein coupled receptor
What type of cell produces Sterol-Carrier Protein (SCP) and Sterol-Activating Protein (SAP)?
Leydig cells
What sort of receptor does FSH bind to on the surface of Sertoli cells?
G-protein coupled receptor
What type of cell produces Androgen-Binding Protein (ABP)?
Sertoli cells
What percent of total serum testosterone is carried bound to a protein?
98%. Only 2% is free
What receptor does testosterone and DHT bind to?
The AR (androgen receptor)
Which tissues respond more to testosterone than DHT?
muscle, reproductive organs
Which tissues respond more to DHT than testosterone?
external genitalia, hair follicles, sebaceous glands
Where are estrogen receptors located in the male?
brain, adipose tissue, bone
In what part of the cell is the androgen receptor located?
In the cytoplasm
What is testosterone's effect on RBC's?
Increases their number. That's why males have higher hematocrit that females
Where are the 3 peaks of testosterone in a male's life?
Once in utero (initial differentiation), once in the first year of life (brain masculinization?), one long peak starting at puberty
Compare post-pubertal males and females in terms of muscle mass, lean body mass, muscle cell number, and body fat
due to T, males have:
150% of female muscle mass
150% of female lean body mass
200% of female muscle cell #
50% of female body fat
What is GH and IGF-1 's effect on gonadal function?
GH and IFG-1 increase gonadal function
What is testosterone's effect on GH?
testosterone increases GH
What is testosterone's effect on bone growth?
T (and estrogen) causes bone ossification, promotes closure of the epiphyses
What is GH's effect on bone growth?
GH causes balanced cartilage growth and ossification
Why do people with delayed puberty have longer bones than other people?
GH had more time to make the bones grow before testosterone came and ossified them
What are the 3 stages of spermatogenesis?
1) proliferative
2) meiotic
3) spermiogenic
What happens during the proliferative phase of spermatogeneis?
the spermatogonia produce spermatocytes, and maintain their number by self-renewal
What are the 3 types of spermatogonia, from least differentiated to most differentiated?
Type Adark, Type Apale, TypeB
Which subtype of spermatogonia does the spermatocyte directly come from?
Type B
What happens during the meiotic phase of spermagogenesis?
1 spermatocyte undergoes meiosis, producing 4 spermatids
How many chromosomes does a spermatogonia have?
46, 2n, diploid
What happens during the spermiogenesis phase of spermatogenesis?
haploid spermatids mature into their final state
What are the 4 stages of spermiogenesis ? (which itself is the last phase of spermatogeneis)
1)golgi phase
2)cap phase
3)acrosomal phase
4)maturation phase
What happens during the golgi phase of spermiogenesis?
golgi synthesis the acrosome
What happens during the cap phase of spermiogenesis?
acrosome moves to one pole of the nucleus, and centrioles move to the other pole
What happens during acrosomal phase of spermiogenesis?
Acrosome reaches its final position, centrioles, synthesize the sperm tail, cytoplasm is sloughed
What happens during the maturation phase of spermiogenesis?
sperm leave the teste, move to epididymus, and become capable of fertilization
What are the 3 parts of the epididymus?
head, body, and tail
Wat happens to sperm in each of the three parts of the epididymus?
head: sperm are concentrated
body: sperm aquire movement
tail: sperm are stored for release
70% of sperm in the male reproductive tract are stored in the.....
tail of the epididymus
How long does the sequence of spermatogenesis take?
64 days
How does your body keep a steady supply of sperm?
every 16 days, spermatogonia start the process again
Which 2 androgens are responsibly for the vast majority of activity in the male?
testosterone and DHT
What is a normal testosterone level in a male?
300-1000 ng/dl
What is a normal testosterone level in a female?
15-65 ng/dl
Where is testosterone made in a female?
50% in ovary, 25% in adrenal cortex, 25% extraglandular
exogenous testosterone is metabolized rapidly by the.....?
liver
Adding an ester to the 17carbon of testosterone does what?
makes it more lipid soluable
Adding an alkyl group to the 17carbon of testosterone does what?
makes oral administration more effective
Why should you avoid giving testosterone orally?
Oral testosterone is very hepatotoxic
What is the most common use of testosterone therapy?
hypogonadism
What 7 disease states do you treat with testosterone therapy?
hypogonadism, breast carcinoma, decreased erythropoesis, osteoporosis, endometriosis, hormone replacement in men, muscle wasting in AIDS
How does testosterone therapy work against breast carcinoma?
acts as an anti-estrogen. Doesn't work any better than other drugs, though
How does testosterone therapy work to increase erythropoeisis?
Testosterone increases the rate of erythropoeisis?
Which methods of testosterone delivery result in steady serum levels?
patch, gel, sublingual tab
What are some disadvantages of testosterone delivery IV?
fluctuating serum levels, risk of infection
What percent of 12th graders reported using anabolic steroids at least once?
2%
What are some side effects of testosterone therapy in women?
virilization, facial hair, deeper voice, acne
What are some side effects of testosterone therapy in men?
prolonged erection, decreased sperm count, gynecomastia
What are some side effects of testosterone therapy seen in both men and women?
edema, jaundice, liver damage, elevated LDL, polycythemia, sleep apnea
What is leuprolide and what is it used for?
leuprolide is a GnRH agonist, used in a steady dose to inhibit testosterone production
What is plenaxis and what is it used for?
plenaxis is a GnRH antagonist, used to inhibit testosterone production
What is finasteride and what is it used for?
finasteride inhibits 5alpha-reductase, used to treat testosterone-overproduction
What is cyproterone acetate, and what is it used for?
cyproterone acetate is a steroid that blocks the AR receptor, used to treat testosterone excess
What are some side effects of testosterone therapy seen in both men and women?
edema, jaundice, liver damage, elevated LDL, polycythemia, sleep apnea
What is leuprolide and what is it used for?
leuprolide is a GnRH agonist, used in a steady dose to inhibit testosterone production
What is plenaxis and what is it used for?
plenaxis is a GnRH antagonist, used to inhibit testosterone production
What is finasteride and what is it used for?
finasteride inhibits 5alpha-reductase, used to treat testosterone-overproduction
What is cyproterone acetate, and what is it used for?
cyproterone acetate is a steroid that blocks the AR receptor, used to treat testosterone excess
What is flutamide, and what is it used for?
flutamide is an androgen receptor blocker, used to treat testosterone excess. It is not a steroid
What percent of cryptorchid cases have only one undescended testicle?
75%
What is the greatest health risk of cryptorchidism?
testicular cancer
How many times more likely is an undescended tesicle to develop cancer than a normal testicle?
cryptorchid testis is 10-40 fold more likely to develop cancer than a normal testicle
(t/f) in unilateral cryptorchidism, the descended tesicle is not at increased risk for cancer.
False! both testes are at risk for cancer in cryptorchidism
What is the most common cause of tesicular atrophy in the USA?
athersclerosis
What is the most common cause of atrophied testes worldwide?
malnutrition
Why are the testes atrophied in Klinefelter's syndrome?
tubular scarring, no elastic fibers, leydig cell hyperplasia
How does Immotile Cilia Syndrome make a guy infertile?
sperm can't move
What are the acquired 4 ways in which a testis can be rendered infertile?
1) torsion
2) varicocele
3) obstruction
4) inflammation
What are FSH/LH and T levels in a man with Klinefelter's Syndrome?
high FSH/LH, low T
What are the 5 common inflammatory diseases of the testes?
1) nonspecific epididymitis/orchitis
2) Mumps orchitis
3) Tuberculosis Orchitis
4) Syphilis
5) Granulomatous/autoimmune
What is the most common cause of non-specific epididymitis/orchitis in adults?
STDs: chlamydia and gonorrhoeae
What is the most common cause of non-specific epididymitis/orchitis in children?
UTI's with gram negative rods
What is the most common cause of non-specific epididymitis/orchitis in the elderly?
enterobacteria
In non-specific epididymitis/orchitis, in what order are what structures affected?
vas deferens/lymphatics first, then epididymus, then testis is last
In what percent of adult males does mumps continue to mumps orchitis?
30%
What structure is affected before the testes in mumps orchitis?
the parotid gland in the face
Describe the infiltrate in mumps orchitis
lympocytic with edema, neutrophils may be present
Does mumps orchidis result in infertility?
Not often.
Tuberculus orchitis usually manifests in isolation with no other symptoms. True or false?
False. Tuberculus orchitis is usually part of systemic tuberculosis disease
what will you see on histology if you look at a nut suffering from tuberculus orchitis?
caseating granulomas
where does tuberculus orchitis start?
starts in the epididymus, then moves to the testis
where does syphilis orchitis start?
starts in the testes, then moves into the epididymus
Decsribe the infiltrate seen in syphilis orchitis
diffuse lymphocytic, less edema, rich in plasma cells
Which inflamamtory testicular disease process results in obliterative endarteritis?
syphilis orchitis
What is a gumma, and where would you find one?
a necrotized ball of tissue/inflammatory infiltrate, found in the testes during syphilis
What is the most common type of testicular cancer?
Germ cell cancer, 95%
What demographic do germ cell cancers tend to affect?
young men, 15-35 years old
How does a germ cell tumor manifest?
painless testicular enlargement
What are the 6 types of germ cell tumor?
1) seminoma
2) spermatocytic seminoma
3) embryonal carcinoma
4) yolk sac tumor
5) choriocarcinoma
6) teratoma
What is the most common type of germ cell tumor?
seminoma
Which type of germ cell tumor can result in syncytiotrophoblastic giant cells that secrete ________?
seminomas can have those kinds of cells, which secrete hCG
What do seminomas look like grossly?
fish flesh, whatever that means
What do seminomas look like on histology?
uniform, polygonal cells, clear cytoplasm, prominent nucleolus
Which type of germ cell tumor affects older men more than younger ones?
spermatocytic seminoma
What does a spermatocytic seminoma look like on histology?
like primary and secondary spermatocytes
What is the most malignant type of germ cell tumor?
embryonic carcinoma
What do embryonic carcinoma tumors look like on histology?
dark, big nuclei, with indistinct cytoplasm
What is the most common germ cell tumor in children?
yolk sac tumor
What protein do yolk-sac tumors secrete?
alpha-fetoprotein
What do yolk-sac tumors look like on histology?
thin sheets of cells around nets of capillaries
What substance does a choriocarcinoma secrete?
hCG
What is the rarest type of germ cell tumor?
choriocarcinoma
Which extra-embryonal tissue are the germ cells producing in a choriocarcinoma?
placenta
Speaking of germ cell tumors, what does a teratoma look like grossly?
loose combination of anything: nerves, muscle, bone ,cartilage, epithelia
What percent of people with germ cell tumors have more than one kind?
60%
Other than germ cell tumors, what are the other two types of testicular cancers?
lymphomas, and sex cord stroma tumors
what are the two types of sex-cord-stroma tumors, and which is more common?
leydig cell tumor (2% of testicular tumors) and sertoli cell tumors (very uncommon)
What symptoms can a leydig cell tumor cause?
gynecomastia and precocious puberty, if it is secreting hormones
What is a condyloma acuminatum?
a genital wart on the penis
What can cause a condyloma acuminatum?
human papilloma virus
What does a koilocyte look like, and in what cases would you see one?
koilocytes are seen in Human Papilloma virus infection, and have crinkly nuclei and large perinuclear halo
What is a verrucous carcinoma, and where would you see one?
a giant genital wart, right there on the penis.
Bowen's Disease is:
squamous cancer in situ of the skin in the genital region
Squamous cancer in situ on the skin in the genital region is called?
Bowen's Disease
Squamous cancer in situ on the mucosa of the penis is called?
Queyrat's Disease
Queyrat's Disease is?
squamous carcinoma in situ of the mucosa of the penis
Which subtypes of HPV are implicated in squamous carcinoma of the male genitals?
16 and 18
african american:caucasian ratio of squamous carcinoma in situ of the penis
2:1
Where and what is the verumontanum?
In the prostate, where the ejaculatory duct meets the urethra at a 35 degree angle
What hormone stimulates the prostate to do its thing?
DHT
What are the 3 zones of the prostate?
central, transitional, peripheral
where is the central zone in the prostate?
surrounds the ejaculatory duct
where is the transitional zone in the prostate?
surrounds the proximal urethra, before the verumontanum
where is the peripheral zone?
surrounds the distal urethra, after the verumontanum
When does the prostate start to develop "prostate sand," and what is it?
as you grow older, prostatic secretions precipitate out and form solid deposits
What are the 5 common pathological categories of prostatic dysfunction?
1) inflammation
2) BPH
3) adenocarcinoma
4) PIN
5) other malignancies
What is the histological difference between acute and chronic prostatitis?
acute: neutrophils present
chronic: lymphocytes present
What are the most common causes of acute prostatitis?
E coli and S aureus from bladder infections
What is malakoplakia, and what organ does it affect?
calcified bacterial remnants (Michaelis-Gutmann bodies) lodged in the prostate
What are symptoms common to all inflammatory prostatic diseases?
obstructive urinary symptoms, low back pain, dysuria
In which zone of the prostate does BPH manifest?
transitional zone
what is the prevalence of BPH?
starting at 50, the law of tens: 50% of men 50 years old, 70% of men 70 years old, etc
What is the most common way to treat symptomatic BPH?
anti-androgens and alpha blockers
What percent of men with BPH need surgery?
5-10%
What are the symptoms of BPH?
nocturia, difficulty in starting/stopping urine flow, frequent urination
BPH can involve 3 prostatic tissues in various amounts:
epithelia, stroma, and smooth muscle
In men, how common is prostate adenocarcinoma?
2nd most common cancer after skin cancer
What factors predispose to prostate adenocarcinoma?
age (over 50), race (blacks > whites >>>> orientals), diet, family history
what are the clinical signs of prostatic adenocarcinoma?
asymptomatic, or sometimes similar to BPH
What zone of the prostate is most commonly affected by adenocarcinoma?
peripheral zone
What do prostate adenocarcinoma tumors look like, grossly?
yellowish, or unapparent
what do prostate adenocarcinoma tumors look like, microscopically?
atypical glands lined by single layer of malignant columnar cells with prominent nucleoli
What is the Gleason grade used for?
to grade prostate cancer outcomes
What is the Gleason Grade based on?
gland patterns in the prostate. The more abberant, the higher the grade.
Where do prostate adenocarcinomas commonly metastasize to?
axial skeleton, lymph nodes
Local prostate adenocarcinoma, confined to the prostate capsule, is treated how?
prostatectomy, beam radiation, radioactive "seeds"
Advanced prostate adenocarcinoma, beyond the prostate capsule, is treated how?
androgen ablation therapy, like orchiectomy, anti-androgen pills, alpha-reductase inhibitors, etc.
What hormones do prostate adenocarcinoma tumors grow in response to?
androgens
What substance is used as a clinical marker of prostate cancer?
Prostate-specific antigen (PSA), and occasionally alk phos
What is the gold standard for diagnosis of prostate adenocarcinoma?
fine needle biopsy
Malignancies of the prostate other than adenocarcinoma include:
sarcoma, lymphoma, neuroendocrine-oid tumors
Which are more aggressive: prostatic adenocarcinomas or other prostatic malignancies?
The other malignancies (sarcoma, lymphoma, etc)
What is PIN?
Prostatic Intraepithelial Neoplasia
What do PINs look like on histology?
tufted knobs of cells growing into the prostatic gland lumen, covered by basal cell layer
What does PIN lead to?
adenocarcinoma
Quick review! what are the 3 layers of the adrenal cortex and what do they secrete?
glomerulosa - aldosterone
fasciculata - cortisol
reticulata - androgens
What does Steroid Acute Regulatory Protein (StAR) do?
moves cholesterol into the mitochondria of adrenal cortex cells
What enzyme converts cholesterol into pregnenolone?
20-22 desmolase
If you have no StAR protein, what happens to the adrenal cortex?
fills with cholesterol and secretes NOTHING
In general, what is the ACTH level in a person with CAH?
very high
Deficiency of what enzyme is the most common cause of CAH?
21-OHase
People with the 21-OHase deficient form of CAH have a buildup of what substance?
17-OH progesterone
What would the relative levels of sodium and potassium be in people with 21-OHase deficient CAH?
Low salt and high potassium
How does 21-OHase deficient CAH manifest in females?
Females are virilized
How does 21-OHase deficient CAH manifest in males?
May not show up until they have delated puberty
What is the second most common form of CAH?
11-OHase deficiency (>5%)
What are the relative sodium and potassium levels in a person with 11-OHase deficient CAH?
high sodium, low potassium
Why do people with 11-OHase deficient CAH retain salt?
No aldosterone, but a buildup of 11-deoxycorticosterone, which is similar
How does 11-OHase deficient CAH manifest in females?
Virilized at birth
How does 11-OHase deficient CAH manifest in males?
may not show up until delayed puberty
How does 3-beta hydroxysteroid deficient CAH manifest itself in females?
might not be found until delayed adrenarche in puberty
How does 3-beta hydroxysteroid CAH manifest itself in males?
males are born with ambiguous genitalia
What are the relative levels of sodium and potassium in a person with 3-beta hydroxysteroid deficient CAH?
low sodium, high potassium
How does 17-OHase deficient CAH manifest itself in females?
might not be found until delayed adrenarche in puberty
How does 17-OHase deficient CAH manifest itself in males?
Males are born with ambiguous genitalia
What are the relative levels of sodium and potassium in a person with 17-OHase deficient CAH?
high sodium, low potassium
What does ketoconazole do to testosterone synthesis?
It shuts it down
Define gonadarche
The re-emergence of the hypo-pit-gonad axis during puberty
Define adrenarche
production of adrenal androgens, which is NOT under the control of the hypo or pituitary
What is the first sign of puberty in a boy?
testicular enlargement greater than 3 cc
What is the first sign of puberty in a girl?
breast bud development
Normal onset of puberty in boys is
9-14 years old
Normal onset of puberty in girls is
8-13 years old
What is the average age of menarche in caucasian girls?
12.5 years old
puberty in black/hispanic girls starts when, in relation to white girls?
1 year earlier
What constitutes Delayed Puberty in boys?
No testicular enlargement by 14 years old
What constitutes Delayed Puberty in girls?
No breast development by 13 years old,
OR
no menses 4 years after pubertal onset,
OR
no menses by 16 years old
What are the relative FSH and LH levels in a pre-pubertal kid?
FSH is higher than LH
What are the relative FSH and LH levels in a pubertal or post-pubertal kid?
LH is higher than FSH
High gonadotropins in a kid with delayed puberty suggest a defect in....?
the gonad itself
Low gonadotropin levels in a kid with delayed puberty suggest the problem is.....?
with the hypothalamus or pituitary
What is the most common cause of delayed puberty?
constitutional delay
What is the bone-age of kids with constitutional delay?
appropriate for whatever stage of puberty they are in (or not in)
What is the pathology of constitutional delay?
There is none. Puberty progesses normally, just starts later
What outside factors may contribute to suppressed gonadotropin levels in hypogonadotropic hydogonadism?
illness, stress, excessive exercise, malnutrition, anorexia
What endocrine factors can cause low FSH/LH levels in people with hypogonadotropic hypogonadism?
hyperprolactinemia, hypothyroidism, isolated gonadotropin deficiency, hypopituitarism
What congenital factors can cause low FSH/LH levels in people with hypogonadotropic hypogonadism?
Kallmann Syndrome, Prader-Willi Syndrome, CNS defects
What acquired factors can cause low FSH/LH levels in people with hypgonadotropic hypogonadism?
trauma, irradiation, infection, autoimmunity
What congenital factors can cause high FSH/LH levels in people with hypergonadotropic hypogonadism?
Klinefelter's, Turner's, gonadal dysgenesis, Noonan syndrome
What acquired factors can cause high FSH/LH levels in people with hypergonadotropic hypogonadism?
chemotherapy, irradiation to the pelvis, torsion/trauma, orchitis, cryptorchism
What tests should be run in a kid with delated puberty?
Bone age, body measurements, FSH/LH levels, prolactin, thyroid, Testosterone and estrogen, blood count, ESR
At what age does puberty start in a boy with precocious puberty?
under 9 years old
At what age does puberty start in a caucasian girl with precocious puberty?
under 8 years old
At what age does puberty start in a black/hispanic girl with precocious puberty?
under 7 years old
Which form of precocious puberty is identical to normal puberty, but it just starts sooner?
central (gonadotropin-dependant) precocious puberty
What is the most common cause of precocious puberty in boys?
CNS lesion
What 4 things can result in bilateral testicular enlargement in pre-pubertal boys?
1) central precocious puberty?
2) LH receptor activation by a hCG producing tumor
3) testitoxicosis
4) McCune-Albright Syndrome
What is usually the cause of unilateral testicular enlargement?
testicular tumor
What test distinguishes between central and peripheral precocious puberty?
GnRH stimulation test
How will a patient with central precocious puberty respond to the GnRH stimulation test?
Their response will be pubertal, with LH > FSH
How will a patient with peripheral precocious puberty respond to the GnRH stimulus test?
They will produce pre-pubertal levels: FSH > LH
What is the treatment for central precocious puberty?
Leuprolide
Peripheral precocious puberty due to McCune Albright Syndrome in girls is treated with:
aromatase inhibitors
Peripheral precocious puberty due to McCune Albright Syndrome in boys is treated with:
ketoconazole, or androgen blockers/aromatase inhibitors
Peripheral precocious puberty due to familial testitoxicosis in boys is treated with:
ketoconazole, or androgen blockers/aromatase inhibitors
benign premature adrenarche is characterized by what symptoms?
body hair growth in pre-pubertal kids, with no growth or bone age advancement
What characterizes benign premature thelarche?
breast development with no other signs of puberty, growth, or bone age advancement. Usually seen in girls under 2 years old.
Acquired hypogonadotrophic hypogonadism in males can be due to 4 things:
hemochromotosis, pituitary tumors, stress, sleep apnea
What is the most common pituitary tumor that can cause hypogonadotropic hypogonadism?
prolactinoma
What are the serum levels of LH, FSH, and testosterone in males with hypogonadotrophic hypogonadism?
low LH
low FSH
low testosterone
lab values for LH, FSH, and testosterone in a boy with Klinefelter's Syndrome:
normal LH
low FSH
low testosterone
What are the 5 causes of HYPERgonadotropic hypogonadism?
1) congenital (anorchia)
2) Klinefelter's Syndrome
3) mutations in androgen receptor
4) acquired (trauma, poison)
5) tumor that makes defective FSH/LH
Lab values for FSH, LH, and testosterone in boys with androgen receptor mutations:
high FSH, high LH, high testosterone, but no clinical effects of the androgens
Lab values for FSH, LH, and testosterone in boys with acquired hypergonadotrophic hypogonadism:
high FSH (early)
high LH (late)
low testosterone
What are some ways for boys to get Acquired Hypergonadotrophic Hypogonadism?
torsion, mumps, orchitis, alcohol, chemotherapy, diabetes
Lab values for FSH, LH, and testosterone in boys with a tumor that secretes mutated FSH and LH:
high FSH
high LH
low testosterone
(the FSH/LH react with the assay, but have no biologic activity
What is the treatment for hypergonadotrophic hypogonadism in men?
androgens, GnRH, hCG
What groups of men are contraindicated for androgen therapy who suffer from hypergonadotrophic hypogonadism?
those with hormone-sensitive cancers (prostate cancer)
How many oogonia are in the ovaries of a female fetus at 20 weeks gestation?
6-7 million
At birth, how many oogonia does a female baby have?
1-2 million
At puberty, how many oogonia does a female have?
400,000
Each menstrual cycle, about how many oogonia compete for the privilege of being released?
10-30
When in a female's life do her oogonia start meiosis 1?
as a fetus
Primary oocytes are frozen in what stage of the cell cycle?
prophase of meiosis 1
What is the state of the chromosomes in a primary oocyte?
diploid chromosomes (46), each of which is duplicated (4N)
What prompts a primary oocyte to move forward out of prophase 1?
The LH surge of the menstrual cycle
The LH surge prompts the primary oocyte to do......what now?
complete meiosis 1, and form the secondary oocyte and the first polar body
What is the state of the chromosomes in a secondary oocyte?
haploid chromosomes (23), duplicated DNA (2N)
How is the secondary oocyte different from the first polar body? How is it the same?
secondary oocyte: larger, more cytoplasm
polar body: tiny tiny.
both are duplicated haploid (23, 2N)
At what stage of the cell cycle is the secondary oocyte frozen at?
Meiosis 2
When does the secondary oocyte complete meiosis 2?
at fertilization
Where does the second polar body come from?
when the secondary oocyte completes meiosis 2, forming the bigger egg and the smaller 2nd polar body
Is there a genetic difference between polar body 1 and polar body 2?
yes.
polar body 1: duplicated haploid (23, 2N)
polar body 2: single haploid (23, 1N)
Which phase of the menstrual cycle, in terms of ovarian function, is the most consistant in its duration?
The luteal phase
Name the stages of follicular development in order:
primordial follicle -> primary follicle -> secondary follicle -> tertiary follicle -> graafian follicle
Pre-antral follicles include which stages?
primordial, primary, and secondary follicles
Antral follicles include which stages?
tertiary and graafian
After the egg is released, the follicle turns into the _________, which then turns into the ____________.
corpus luteum, corpus albicans
What distinguishes the dominant follicle from the rest of the follicles in the cohort?
the dominant follicle has a better blood supply, more estrogen around it, more FSH receptors
what are the layers found in a cross-section of a primordial follicle, from the center to the outside
primary oocyte, pregranulosa cells, basement membrane
What is the zona pelludida made of?
glycoproteins excreted from both the primary oocyte and the granulosa cells
What is the purpose of the zona pellucida?
lets only one sperm into the egg, blocks off all the others
what are the layers found in a cross-section of a primary follicle, from the center to the outside?
primary oocyte, zona pellucida, granulosa cells, basement membrane
what are the layers of a cross-section of a secondary follicle, from the inside to the outside?
primary oocyte, zona pellucida, several layers of granulosa cells, basement membrane, theca cells
At what stage of the follicle's development do the granulosa and theca cells express FSH and LH receptors, thereby becoming hormonally active?
when they become secondary follicles
What are the layers of a cross-section of a tertiary follicle, from the inside to the outside?
primary oocyte, zona pellucida, granulosa cells, antrum, granulosa cells, basement membrane, theca interna, theca externa
Inside a follicle, what is the antrum?
fluid filled space that separates the egg and company from the rest of the follicle
Inside a follicle, what is the cumulus oophorus?
the stalk of cells connecting the egg to the rest of the follicle. dissapears as the antrum completes development
What is the corona radiata?
the group of granulosa cells that is expelled from the ovary along with the egg and zona pellucida
What are the layers of a cross-section of a graafian follicle, from the inside to the outside?
primary or secondary oocyte, zona pellucida, corona radiata, antrum, granulosa cells, basement membrane, theca interna, theca externa
All the stages of follicular development contain primary oocytes, except for which one?
graafain follicles contain either primary or secondary oocytes, depending on whether the LH surge has occured or not
What does the corpus luteum do, after the oocyte is released?
secretes a lot of progesterone and estrogen
How long does the corpus luteum secrete hormones if the egg implants?
about 9 weeks, until the placenta can take over hormone secretion
how long does the corpus luteum secrete hormones if the egg does NOT implant?
about 11 days, and then it stops.
What is the most apparent effect of the corpus luteum's stoppage of hormone secretion in the case of non-implantation?
falling progesterone stimulates the uterus to shed its lining, leading to menstrual flow
In the case of egg implantation, what keeps the corpus luteum secreting hormones for those 9 weeks?
the conceptus secretes hCG, which stimulates the corpus luteum until the placenta takes over
How does the hypothalamus behave differently during the luteal phase compared with the follicular phase?
GnRH pulses are more frequent, but smaller, during follicular phase, as compared with the luteal phase
When during the menstrual cycle are FSH and LH levels equal?
early in the follicular phase
At the end of the luteal phase, what are the relative levels of FSH and LH?
FSH increases 3x, LH increases 2x
When during the menstrual cycle are FSH and LH levels at their highest?
right before ovulation
What stimulates the LH surge?
sustained high levels of estrogen
The menstrual cycle, in terms of what's going on in the uterus, can be divided into three stages, which are:
proliferative phase, secretory phase, menstrual phase
What are the three levels of the endometrium, from deepest to most superficial?
stratum basalis, stratum spongiosum, stratum compactum
Which layer of the endometrium does not change much during the menstrual cycle?
the stratum basalis
What two types of arteries feed the endometrium? Which layers do they feed?
straight arteries stay in the stratum basalis, and spiral arteries go up into the stratum spongiosum/compactum
What happens to the endometrium of the uterus during the proliferative phase of the menstrual cycle?
stroma thickens, gets vascular, glands form and elongate
What hormone brings about the changes in the endometrium during the proliferative phase of the menstrual cycle?
estrogen from the ovaries
What happens to the endometrium of the uterus during the secretory phase of the menstrual cycle?
glands become tortuous and squiggly, and secrete glycogen and fluid
the changes in the endometrium during the secretory phase of the menstrual cycle are due to what hormone?
progesterone from the corpus luteum
What happens to the endometrium of the uterus during the menstrual phase of the menstrual cycle?
spiral arteries necrose, ischemia causes the stratum spongiosum/compactum to degrade and slough off
What hormonal is responsible for the changes in the endometrium seen during the menstrual phase of the menstrual cycle?
falling levels of progesterone and estrogen stimulate the endometrium to be sloughed off
About how long does the menstrual phase of the menstrual cycle last?
5 days
About how long does the luteal phase of the menstrual cycle last?
14 days
during the follicular phase of the menstrual cycle, how often do you have a GnRH pulse?
1 every hour
during the luteal phase of the menstrual cycle, how often do you have a GnRH pulse?
1 every 3-4 hours
What levels of estrogen do you need to acheive the LH surge?
greater than 200 picograms for over 50 hours
Average amount of blood loss during menses is.......?
30 cc
What is estrogen's effect on cholesterol?
estrogen increases HDL, decreases LDL
What are the 3 main pharmacological uses of estrogen therapy?
hypogonadism in women, menopause, and contraception
What are 6 deletarious side-effects of of taking exogenous estrogen?
cardiovascular risks, cancer, changes in lipid metabolism, gall bladder disease, migraines, thromboembolisms, hypertension
What are SERMs, and what is so great about them?
Selective Estrogen Receptor Modulators; these drugs are agonists or antagonists, depending on the tissue, so you can get more good effects with less bad effects
What are the 5 general targets that exogenous estrogen can target?
breast, bone, endometrium, blood vessels, CNS.
For the best outcomes, SERMs should act as agonists in which tissues?
bone, blood vessels, CNS
For the best outcomes, SERMs should act as antagonists at which tissues?
breast, endometrium
Which SERMs are used to treat breast cancer?
tamoxifen, toremifene
Which SERMs are used to prevent osteoporosis?
raloxifene
What is the biggest risk for a women taking tamoxifen?
endometrial cancer
Who would you give clomiphene to? How does it bring about its therapeutic effects?
clomiphene is an anti-estrogen, and treats infertility by increasing GnRH levels by blocking estrogen's negative feedback
What are some physiologic actions of progesterone in women?
negative feedback on GnRH, blocks estrogen-driven endometrial proliferation, stimulates secretory endometrium
What hormone makes cells more responsive to progesterone?
estrogen
What are some pharmacologic uses of exogenous progesterone?
hormone replacement in women, cancer, contraception, dysmenorrhea
What is mefipristone, and what is it used for?
mefipristone is an anti-progesterone, used as a pregnancy terminator and ovulation preventer
What do you do first when evaluating a women with altered levels of sex hormones?
Check hCG levels to see if she's pregnant!
10% of amenorrheic women suffer from.......?
a prolactinoma
When evaluating women with sex hormone disturbances, check androgen levels only if.......?
she is suffering from hirsutism or acne
A women is amenorrheic, is not pregnant, does not have a prolactinoma. What is the next stage of testing?
induce menses with progesterone (5 mg daily for 5 days). 5 days after the bleeding, draw FSH and LH levels, which are equal in normal people
What are some causes of hypogonadotropic hypogonadism in women?
Kallmann's Syndrome, stress, malnutrition, excessive exercise
What are levels of FSH, LH, and estrogen in women with hypogonadotropic hypogonadism?
low LH, low FSH, low estrogen
What are levels of FSH, LH, and estrogen in women with hypergonadotropic hypogonadism?
high FSH, high LH, low estrogen
What are common causes of hypergonadotropic hypogonadism in females?
Turner's Syndrome, Premature Ovarian Failure
Premature Ovarian Failure is usually due to:
autoimmunity
Lab values for a women with Premature Ovarian Failure for LH, FSH, and estrogen are:
high high FSH (because of inhibin loss)
high LH
low estrogen
People with PCOS begin to show symptoms..... when?
during puberty, ALWAYS. These people have ALWAYS had period problems. It doesn't appear later in life.
What are the lab values in a women with PCOS for LH, FSH, androgens, progesterone, estrogen?
high high high LH, low FSH, high androgens, steady estrogen levels, low progesterone
What do people think is the etiology behind PCOS?
GnRH pulses come too fast
What are some symptoms of PCOS?
irregular menses, hirsutism, insulin resistance, acanthosis nigricans, acne, obesity
What are some risks and complications of having PCOS?
endometrial cancer, diabetes, hypertension, heart disease.
What will be the difference seen in a women with PCOS as opposed to a women with an androgen-producing tumor?
the lady with the tumor will have a history of normal periods, with symptoms only showing up recently. She may also have clitorromegaly and male pattern baldness
How can you distinguish a lady with PCOS from a lady with Obesity-Induced Anovulation?
the lady with O.I.A. will have a history of normal periods, and normal LH/FSH ratio. If she loses weight, her periods come back.
What is the etiology of disease in a women with obesity-induced anovulation?
excess estrogen due to aromatase activity in adipose tissue
How do you treat female hypogonadism?
estrogen replacement, progesterone replacement, clomiphene, GnRH pump
Cytologically, what is the difference between acute and chronic cervicitis?
chronic cervicitis: plasma cells and squamous metaplasia present
acute cervicitis: PMNs present, with or without epithelial erosion
What are some risk factors for acquiring an inflammed cervix?
STI's, childbirth, hypo/hyperestrogenism, antibiotics, IUD, change in host immunity
What are some sequelae of cervicitis?
vertical transmission during childbirth, spread to uterus/fallopian tubes, abscess, infertility
There are two benign tumor-like lesions of the cervix, and they are called:
nabothian cysts and endocervical polyps
What is the etiology behind a nabothian cyst?
blocked mucus duct leads to inflammation and cyst formation on the cervix
What is the etiology of an endocervical polyp?
hormonal levels cause endocervical glands to undergo hyperplasia
How do you treat endocervical polyps?
curretage pretty much cures them
How does a liquid prep of a pap smear specimen compare to a slide prep?
liquid preps are more sensitive, but more expensive
When should a women get her first pap smear?
3 years after she starts having sex, or at age 21
How often should a women under 30 years old get a pap smear?
every year
How often should a women over 30 years old get a pap smear?
if 3 consecutive paps are normal, then get a new pap every 2-3 years
What is the guideline for pap smears for women over 70 years old?
If they have been normal for the past 10 years, they can stop screening
When during the menstrual cycle should you get the pap smear done?
mid-cycle, not during menstruation
Which is more common: adenocarcinoma of the cervix, or squamous carcinoma of the cervix?
squamous
What is the cause of granulomatous endometriosis?
TB in the uterus or fallopian tubes
What is the most common cause of infertility WORLDWIDE?
granulomatous endometriosis due to TB
What are the 3 benign tumor-like lesions found in the uterus?
uterine polyp, adenomyosis, leiomyoma
What is the etiology of a uterine polyp?
chromosomal weirdness causes endometrial outgrowth. Treat with hysterectomy or polypectomy
What are some symptoms of a uterine polyp?
irregular or excessive bleeding, abnormal pap due to shedding of glands
What is going on if a woman has adenomyosis of the uterus?
endometrial glands extend into the myometrium, causing uterine enlargement
What are some symptoms of uterine adenomyosis?
can be asymptomatic, but you can also have menorrhagia, dysmenorrhea, pelvic pain
What is going on in a woman who has a leiomyoma?
fibroid swellings of uterine tissue, that grow in response to estrogen
What is the most common mass found in the uterus (besides a fetus)?
leiomyomas
What are some symptoms of having a leimyoma?
pain, bleeding not due to menstruation, impaired fertility
What are the 4 types of endometrial hyperplasia?
simple
complex
complex with atypia
endometrial intraepithelial neoplasia
Simple hyperplasia of the endometrium is characterized by what?
mild alteration, cytic gland crowding, some gland distortion
Complex hyperplasia of the endometrium is characterized by what?
moderately altered hyperplasia of the glands
What percent of complex hyperplasia of the endometrium turn into malignancies?
less than 5%
Complex hyperplasia of the endometrium with atypia is characterized by what?
gland crowding, budding, cellular mitotic activity, high grade hyperplasia
What percent of complex hyperplasia of the endometrium with atypia turns into carcinoma?
25%
What characterizes Endometrial Intraepithelial Neoplasia (EIN)?
monoclonal proliferation, usually because of the loss of the PTEN gene
What percent of EIN in the endometrium progresses to malignancy?
39%
What are 6 risk factors for developing endometrial carcinoma?
obesity, diabetes, hypertension, infertility, unapposed estrogen, atypical complex hyperplasia
What is the median age of diagnosis for endometrial carcinoma?
63 years old
There are 3 kinds of endometrial carcinoma. they are.......?
1) endometroid
2) non-endometrioid
3) clear cell
Who usually gets endometroid uterine cancer, what's the prognosis, and what's the etiology?
endometroid cancer is usually in younger women, has a better prognosis, and arises from EIN
Who usually gets non-endometroid uterine cancer, what's the prognosis, and what does it look like?
Older women get the non-endometroid cancer, it has a worse prognosis, and resembles serous ovarian tumors
What are some characteristics of clear cell carcinoma of the endometrium?
worse prognosis, rarest form.
There are 3 types of endometrial sarcomas. They are.....?
leiomyosarcoma, endometrial stromal sarcoma, and malignant mixed mullerian tumors.
How is a leiomyosarcoma different from a leiomyoma?
leiomyosarcomas arise in the myometrium, have different microscopic features, and can spread to other sites
Which endometrial sarcoma has the worst prognosis?
Malignant Mixed Mullerian Tumor
There are 5 non-neoplastic cysts that can appear in the ovary. They are........?
corpus luteum cyst, follicle cyst, PCOS cysts, serous inclusion cyst, endometriosis
Ovarian cancer accounts for ___% of all cancers in women, but _____% of all cancer deaths in women
6%, 50%
Which two genes can predispose you to getting ovarian cancer (if you are a woman, of course)?
BRCA-1 and HNCC
What demographic of women is at most risk of developing ovarian cancer?
nulliparous
What percent of ovarian tumors are benign?
80%
Ovarian neoplasms are divided into 3 broad categories, which are.......? Oh, and which ones are most common?
Epithelial (75%)
Germ cell (20%)
Sex cord stromal (5%)
Epithelial cancers of the ovary can be lumped into two categories, ______ and ______.
serous, mucinous
What are some characteristics of serous ovarian carcinomas?
usually bilateral, contain psamomma bodies
What are some characteristics of Mucinous Ovarian Carcinomas?
cauliflower-like, papillary looking tissue, secrete mucous, usually unilateral
Ovarian tumors that arise from germ cells come in 4 flavors:
dysgerminoma, yolk sac tumor, choriocarcinoma, teratoma
What are some characteristics of dysgerminomas of the ovary?
all maligant, 1/3 are aggressive, very radiosensitive, similar to seminoma in men
What determines whether a teratoma found in the ovary is likely bengin or likely malignant?
teratomas containing undifferentiated tissue (immature) are malignant. Those containing distinct tissue (teeth, hair, skin) are benign
Sex cord stromal tumors in the ovary usually make themselves known because.....?
the tumor secretes hormones which have global effects
Which is more common to find in the ovary: metastases or primary tumors?
metastasies, by a long shot
Which cancers really like to metastasize to the ovary?
colon, fallopian tube, uterus, melanoma, lymphoma, stomach
Stomach cancer that metastasizes to the ovary has a special name and distictive cytology.......discuss.
Krukenberg's Tumor, and on cytology you will see signet ring cells
Of all the pregnancies in the United States, how many are unintended?
50%
What percentage of people at these ages have had sex?
15, 19, 21
15 - 13%
19 - 72%
21 - 82%
What percentage of people at the following ages still have sex?
57-64, 65-74, 75-85
57-64 = 73%
65-74 = 53%
75-85 = 26%
Even if PID is incited by gonorrhea, mixed infections result, and the most common bugs in this mixed infection are:
H influenzae and strep pyogenes
The most severe form of PID is characterized by what?
Tubo-Ovarian Abscess (TOA)
Of all the unintended pregnancies in the US, how many are ended in voluntary abortion?
4 in 10
Of all pregnancies (excluding miscarriages) in the US, how many end in abortion?
24%
Normal semenanalysis values: ejaculate volume
greater than 2 mL
Normal semenanalysis values: sperm concentration
greater than 20 million / mL
Normal semenanalysis values: sperm motility:
greater than 50% motile
Normal semenanalysis values: morphology
14% normal
Normal semenanalysis values: progression
greater than 50% normal
What can capacitated sperm do that un-capacitated sperm can not do?
bind to the zona pellucida, increased flagellar beat of the tail, initiate the acrosome reaction
Which protein within the zona pellucia mediates sperm binding?
ZP3
When the acrosome breaks open, which two enzymes are released?
hyaluronidase, acrosin
What does fertilin do?
it is a protein responsible for fusing the membrane of the sperm with the egg
What is the zona reaction?
When the egg releases cortical granules which turn ZP3 into ZP3-F, which prevents additional sperm from fusing into the egg
What protein holds sperm chromatin in such a condensed form?
Protamines, which are specialized histones
Quick!!! What is the architecture of the sperm's tail?
central pair of microtubules, surrounded by 9 pairs of axonemes, surrounded by mitochondria
What causes the protamines holding the sperm DNA so tightly to relax once the spern enters the egg?
oocyte-derived glutathione
Define "implantation":
the attachment of the fertilized egg to the uterine lining, 6-7 days after fertilization
What part of the conceptus touches the uterine wall first during implantation?
the trophectoderm
How long after ovulation does fertilization occur?
12-24 hours
How long after ovulation does the zygote reach the 2-cell stage?
30 hours
How long after ovulation does the zygote reach the 4-cell stage?
40 hours
How long after ovulation does the zygote reach the early morula stage?
80 hours
How long after ovulation does the zygote reach the advanced morula stage?
4 days
How long after ovulation is the zygote formed into a blastocyst?
5 days
How long after ovulation does the zygote implant into the uterine wall?
5-6 days
When does the blastocyst hatch from the zona pellucida?
5 days after ovulation, when the balstocyst reaches the uterus
What is Decidualization? when does it start?
starts in the secretory phase of the menstrual cycle, refers to the endometrial cells becoming round and receptive to the coming zygote
What are pinopodes? Where are they found?
pinopodes are little villi on the endometrial epithelium, that grab the blastocyst and help it implant
What hormone stimulates formation of pinopodes? What hormone suppresses them?
progesterone stimulates pinopodes, estrogen destroys them
Adhesion of the blastocyst to the endometrial epithelium is mediated by what proteins?
integrins, heparin proteoglycans.
Where is the inner-cell mass in relation to the uterine wall during implantation?
The inner-cell mass is on the side of the blastocyst that embeds first
What happens to the trophectodem cells during the Invasion stage of implantation?
They turn into syncytiotrophoblasts and cytotrophoblasts, and extend processes into the endometrium
Where in the uterus does the zygote usually implant?
upper posterior wall
What is placenta previa?
when the zygote implants right close to the cervix
What is placenta accreta?
when the zygote implants over a prior uterine scar
The most common site of an ectopic pregancy is the......?
ampulla of the fallopian tube (80%)
The second most common site of an ectopic pregnancy is the.......?
isthmus of the fallopian tube (12%)
What are some complications of an ectopic pregnancy?
hemorrhage, rupture, maternal death. The fetus is never viable, by the way.