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155 Cards in this Set
- Front
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SEVEN UP
development of sperm |
Seminiferous tubules
Epididymis Vas deferens Ejaculatory ducts (Nothing) Urethra Penis |
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FSH
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secreted from anterior pituitary (stimulated by GnRH) to stimulate the Sertoli cells to produce androgen binding protein and inhibin...sertoli cells are vital for sperm synthesis
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LH
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released from anterior pituitary to stimulate the Leydig cells to release testosterone (for sperm production)
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Androgen binding protein
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ensures that testonsterone in seminiferous tubules is high
secreted by Sertoli cells |
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Inhibin
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inhibits FSH and is secreted by Sertoli cells
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Testosterone
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from Leydig cells; differentiates male genitalia, has anabolic effects on protein metabolism, maintains gametogenesis, maintains libido, inhibits GnRH, and fuses epiphyseal plates in bone
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androstenedione
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secreted by adrenal gland...least potent of androgens
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DHT and testosterone are secreted by...
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testis
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5-alpha reductase
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converts testosterone to DHT
inhibited by finasteride |
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Testosterone and androstenedione are converted to...
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estrogen in adipose tissue and Sertolie cells by enzyme aromatase
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function of androgens
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differentiation of wolffian duct system into internal gonadal structures; secondary sex characteristics and growth spurt during puberty, closes epiphyseal plates; required for normal spermatogenesis; anabolic effects...increases muscle size, increase RBC production...increase libido
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Sources of estrogen
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Ovary (17 beta - estradiol)
placenta: estriol blood: aromatization |
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Potency of estrogens
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estradiol > estrone > estriol
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In pregnancy...estrogen changes...
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50-fold increase in estradiol and estrone
1000 fold increase in estriol (indicator of fetal well being) |
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Estrogen functions (long list)
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1. growth of follicle
2. endometrial proliferation 3. development of genitalia 4. stromal development of breast 5. female fat distribution 6. hepatic synthesis of transport proteins (increase synthesis of sex hormone-binding globulin) 7. feedback inhibition of FSH and LH 8. LH surge (estrogen negative feedback on LH secretion switches to positive from negative just before LH surge) 9. increases myometrial excitability 10. increase HDL and decreases LDL |
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Theca cell
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stimulated by LH to increase desmolase action...desmolase will convert cholesterol to androstenedione
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Granulosa cell
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next to the theca cell...androstenedione (made in theca cell) goes to the granulosa cells...aromatase (stimulated by FSH) converts the androgen to estrogens in the granulosa cells
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Source of progesterone
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corpus luteum, placenta, adrenal cortex, testes
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Progesterone functions (long list)
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1. stimulation of endometrial glandular secretions and spiral artery development
2. maintains pregnancy 3. decreases myometrial excitability 4. produces thick cervical mucus, which inhibits sperm entry into the uterus 5. increases body temperature 6. inhibits gonadotropins (LH and FSH) 7. uterine smooth muscle relaxation (preventing contractions) (elevation of progesterone is indicative for ovulation...progesterone prepares for pregnancy) |
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Estrogen in menstrual cycle...
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stimulates endometrial proliferation
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Progesterone in menstrual cycle...
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maintains endometrium to support implantation
...thus decreasing progesterone will decrease fertility |
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What phase in the menstrual cycle can vary in length?
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follicular phase
luteal phase is usually a constant 14 days...ovulation day is menstruation day 14 |
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Stuff about ovulation
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estrogen surge day before ovulation
stimulates LH, inhibits FSH LH surge causes ovulation (rupture of follicle) increase temperature (progesterone induced) ferning of cervical mucosa oral contraceptives prevent the estrogen surge and thus the LH surge...ovulation does not occur |
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Mittelschmerz
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blood from ruptured follicle causes peritoneal irritation that can mimic appendicitis
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primary oocytes
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begin meiosis I during fetal life and complete meiosis I just prior to ovulation (remain this way for years)
4N (stuck in prophase) |
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secondary oocytes
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arrested in Metaphase until fertilization...
an egg MET a sperm stratum granulosum (2N)...stuck in metaphase |
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If fertilization occurs...
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the corpus luteum is rescued from regression by human chorionic gonadotropin...produced by the placenta
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Implantation...
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occurs 6 days after fertilization
trophoblasts secrete hCG...detectable in blood 1 week after conception and on home test in urine 2 weeks after conception |
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First trimester
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corpus luteum (stimulated by HCG) is responsible for the production of estradiol and progesterone...peak levels of HCG occur at gestational week 9 and then decline
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Second and third trimesters
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progesterone is produced by the placenta
estrogens produced by interplay of fetal adrenal gland and the placenta...fetal adrenal gland synthesizes DHEA-S, which is then hydroxylated in the fetal liver...these are transferred to the placenta... |
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hCG function
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maintains the corpus luteum (and thus progesterone) for the first trimester by acting like LH
elevated in women with hydatidiform moles or choriocarinoma |
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hormonal changes in menopause
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decrease estrogen, waaay increase in FSH, increase in LH (no surge) and increase in GnRH
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Hypospadias
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abnormal opening of penile urethra on inferior (ventral) side of penis due to failure of urethral folds to close
more common than epispadias |
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Fix hypospadias to prevent...
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UTIs!!!
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Epispadias
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abnormal opening of penile urethra on superior (dorsal) side of penis due to faulty positioning of genital tubercle
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exstrophy of bladder is associated with
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epispadias...you hit your eye when you pee with epispadias...on dorsal side
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Klinefelter's syndrome
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XXY
1:850 testicular atrophy, eunuchoid body shape, tall, long extremities, gynecomastia, female hair distribution presence of inactivated X chromosome (Barr body) common cause of hypogonadism seen in infertility workup |
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Klinefelter's syndrome...hormonal stuff
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increase of pituitary hormones because of loss of feedback inhibition...
dysgenesis of seminiferous tubules leads to decrease in inhibin and increase in FSH abnormal Leydig cell function leads to decrease in testosterone which leads to increase in LH and increase in estrogen eunuchoid because dont close epiphyseal plates |
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Turner's syndrome
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XO!!!
1:3000 short stature, ovarian dysgenesis (streak ovary), webbing of neck, preductal coarctation of the aorta, most common cause of primary amenorrhea, no barr body |
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Hormonal stuff in Turner's syndrome
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XO
decrease estrogen leads to increase LH and FSH |
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Double Y males (XYY)
1:1000 |
phenotypically normal, very tall, severe acne, antisocial behavior (1-2% of XYY males)
normal fertility observed with increased frequency among inmates of penal institutions |
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Female pseudo-hermaphrodite
XX |
(pseudo-hermaphrodite: disagreement between the phenotypic...external genitalia...and gonadal sex...testes vs ovaries
ovaries are present, but external genitalia are virilized or ambiguous; due to excessive and inappropriate exposure to androgenic steroids during early gestation (like congenital adrenal hyperplasia or exogenous administration of androgens during pregnancy) |
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male pseudo-hermaphrodite
XY |
testes present, but external genitalia are female or ambiguous; most common form is androgen insensitivity syndrome (testicular feminization)
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True hermaphrodite
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both ovary and testicular tissue present; ambiguous genitalia; very rare
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Androgen insensitivity syndrome
46 XY |
defect in androgen receptor resulting in normal appearing female
female external genitalia with rudimentary vagina; uterus and uterine tubes generally absent; develops testes (often found in labia majora; surgically removed to prevent malignancy) levels of testosterone, estrogen and LH are all high |
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5 alpha reductase deficiency
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unable to convert testosterone to DHT
ambiguous genitalia until puberty, when testosterone causes masulinization of genitalia testosterone/estrogen levels are normal; LH is normal or increased; 'penis at 12' (when testosterone production begins at puberty, it stimulates growth of external male genitalia) |
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Hydatidiform mole
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a pathologic ovum (empty egg...ovum with no DNA) resulting in cystic swelling of chorionic villi and proliferation of chorionic epithelium (trophoblast)
most common precursor of choriocarcinoma high beta hCG honeycombed uterus, cluster of grapes appearance characteristically occurs in early months of pregnancy...eventuates to choriocarcinomas in 2-3% cases |
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Complete mole
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46 XX and is COMPLETELY paternal in origin...2 sperm + empty egg (no maternal chromosomes)
NO associated fetus and commonly lead to an abnormally enlarged uterus |
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Partial mole
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made up of 3 or more PARTS (triploid or tetraploid); may contain fetal PARTS
2 sperm + 1 egg less likely to be associated with excessive uterine size |
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more about hydatidiform moles...
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moles can lead to uterine rupture; treat with dilitation and curettage and methotrexate
monitor beta-hCG |
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Preeclampsia
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triad of hypertension, proteinuria and edema
affects 7% of pregnant women from 20 weeks gestation to 6 weeks postpartum (before 20 weeks suggests molar pregnancy) |
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Eclampsia
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hypertension, proteinuria and edema WITH SEIZURES
medical emergency!!! treat with IV magnesium sulfate and diazepam |
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increased incidence of pre-eclampsia/eclampsia...
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preexisting hypertension, diabetes, chronic renal disease and autoimmune disorders
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Etiology of preeclampsia-eclampsia
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placental ischemia (lack of trophoblastic invasion of spiral arteries in myometrium)
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HELLP syndrome
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can be associated with pre-eclampsia...hemolysis, elevated LFTs, low platelets
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Clinical features and mortality with pre-eclampsia/eclampsia
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mortality due to cerebral hemorrhage and ARDS
headache, blurred vision, abdominal pain, edema of face and extremities, altered mentation, hyperreflexia; lab findings show thrombocytopenia and hyperuricemia |
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Treatment of preeclampsia
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delivery of fetus as soon as possible
otherwise bed rest, salt restriction, and monitoring and treatment of HTN |
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Painful bleeding
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ABRUPTIO PLACENTAE
premature detachment of placenta from implantation site PAINFUL uterine bleeding (usually during 3rd trimester) fetal death may be associated with DIC increased risk with smoking, hypertension and cocaine use |
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Massive bleeding!
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PLACENTA ACCRETA
defective decidual layer allows placenta to attach directly to myometrium predisposed by prior C section or inflammation may have massive hemorrhage after delivery |
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Painless bleeding
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PLACENTA PREVIA!!!
attachment of placenta to lower uterine segment; may occlude internal os PAINLESS bleeding in any trimester; prior C-section predisposes |
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Pain without bleeding
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ECTOPIC PREGNANCY
most often in fallopian tubes, predisposed by salpingitis (PID) suspect with increase in hCG and sudden lower abdominal pain confirm with ultrasound often clinically mistaken for an appendicitis |
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polyhydramnios
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> 1.5 - 2 L of amniotic fluid
associated with esophageal/duodenal atresia, causing inability to swallow amniotic fluid, and with anencephaly About 20% cases are due to maternal diabetes, which causes hyperglycemia of the fetus, hence fetal polyuria (fetal urine is a major source of amniotic fluid) |
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oligohydramnios
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< 0.5 L of amniotic fluid
associated with bilateral renal agenesis or posterior urethral valves (in males) and resultant inability to excrete urine can give rise to Potter's syndrome |
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Dysplasia and carcinoma in situ (cervical)
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disordered epithelial growth
squamo-columnar junction!!! begins at basal layer of squamo-columnar junction and extends outward classified as CIN 1, CIN 2 or CIN 3, depending on the extent of dysplasia associated with HPV 16 and 18 Vaccine: Gardasil (tetravalent) may progress slowly to invasive carcinoma |
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Invasive carcinoma (cervical)
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often squamous cell carcinoma
most frequently from preexisting CIN at the squamocolumnar junction; evloves through a series of increasing epithelial abnormalities proceeding from dysplasia to carcinoma in situ and then to invasive carcinoma lateral invasion can block ureters, causing renal failure |
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Role of HPV
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dysplastic cells frequently demonstrate koilocytosis!! (as in HPV induced conyloma acuminatum)
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HPV sequences...
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often integrated into genomes of dysplastic or malignant cervical epithelial cells
HPV types 16, 18, 31 and 33 are most common... |
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HPV viral protein E6
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inactivates p53
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HPV viral protein E7
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inactivates Rb
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Non-neoplastic endometrial glands/stroma in abnormal locations outside the uterus
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endometriosis!!
ectopic endometrial tissue causes may include retrograde dissemination of endometrial fragments through fallopian tubes during menstruation, with implantation on the ovary or other peritoneal structures...or blood-borne or lymphatic-borne dissemination of endometrial fragments |
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"chocolate cysts"...blood filled...
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ectopic endometrial tissue
endometriosis! in ovary or peritoneum SEVERE MENSTRUAL RELATED PAIN can be due to retrograde menstural flow |
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Adenomyosis
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endometriosis within the myometrium
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Endometrial hyperplasia
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abnormal proliferation of the endometrial glands
usually caused by excess estrogen stimulation (can be caused by anovulatory cycles, polycystic ovary disease, estrogen secreting ovarian tumors like granulosa cell tumors and estrogen replacement therapy) incresed risk for endometrial carcinoma |
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most commonly manifests clinically as post-menopausal vaginal bleeding
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endometrial hyperplasia
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Endometrial carcinoma
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most common gynecologic malignancy
peak age 55-65 years of age clinically presents with vaginal bleeding typically preceeded by endometrial hyperplasia |
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risk factors of endometrial carcinoma
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prolonged use of estrogen without progestins, obesity, diabetes, hypertension, nulliparity, and late menopause
Prognosis correlates with degree of myometrial invasion |
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Leiomyoma (fibroid)
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most common of all tumors in females
MOST COMMON UTERINE TUMOR often presents with multiple tumors with well-demarcated borders increase incidence in blacks benign SM tumor malignant transformation is rare estrogen sensitive - tumor size increases with pregnancy and decreases with menopause usually develop subserosally or within the myometrium |
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Peak occurrence of leiomyomas
and clinical features |
20-40 years old
may be asymptomatic or may cause abnormal uterine bleeding severe bleeding may lead to iron deficiency anemia does NOT progress to leiomyosarcoma |
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whorled pattern of SM bundles
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leiomyoma!! (fibroid)
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Leiomyosarcoma
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bulky, irregular shaped tumor with areas of necrosis and hemorrhage
typically arising de nov (NOT from leiomyomas)... increased incidence in blacks highly aggressive tumor with tendency to recur; may protrude from cervix and bleed |
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incidence of gynecological tumors...
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endometrial > ovarian > cervical!
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worst prognosis of gynecological tumors...
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ovarian > cervical > endometrial
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Polycystic ovarian syndrome
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increase LH, decrease FSH and increase testosterone
increase LH leads to anovulation, hyperandrogenism due to deranged steroid synthesis increased risk of endometrial cancer |
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Clinical manifestations of polycystic ovarian syndrome
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enlarged, bilateral cystic ovaries...amenorrhea, infertility, obesity and hirsutism
associated with insulin resistance markedly thickened ovarian capsule; multiple small follicular cysts and cortical stromal fibrosis |
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Treatment of polycystic ovarian disease
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weight loss, OCPs, gonadotropin analogs, clomiphene or surgery
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Clomiphene
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SERM!!
used mainly in female infertility due to anovulation (PCOS); inhibits action of estrogens |
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Follicular cyst
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distention of unruptured graafian follicle
may be associated with hyperestrinism and endometrial hyperplasia |
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Corpus luteum cyst
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hemorrhage into persistent corpus luteum
menstrual irregularity |
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Theca-lutein cyst
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often bilatera/multiple
due to gonadotropin stimulation associated with choriocarcinomas and hydaditiform moles |
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Chocolate cyst
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blood containing cyst from ovarian endometriosis; varies with menstrual cycle
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Dysgerminoma
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malignant ovarian germ cell tumor
analagous to testicular seminoma sheets of uniform cells hCG is the tumor marker |
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Choriocarcinoma
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ovarian germ cell tumor
rare, but malignant; can develop during pregnancy in mother or baby large, hyperchromatic syncytiotrophoblastic cells increase frequency of theca-lutein cysts hCG is the tumor marker |
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Yolk sac (endodermal sinus tumor)
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aggressive malignancy in ovaries (testes in boys) and sacrococcygeal area of young children
tumor marker: alpha-feto protein |
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Teratoma
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90% of ovarian germ cell tumors
contains cells from 2 or 3 germ layers |
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Mature teratoma
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'dermoid cyst'
most frequent benign ovarian tumor |
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Immature teratoma
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aggressively malignant
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Struma ovarii
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teratoma
contains functional thyroid tissue can present as hyperthyroidism monodermal teratoma; cyst of a single element |
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Serous cystadenoma
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ovarian non-germ cell tumors
20% of ovarian tumors frequently bilateral, lined with fallopian tube-like epithelium benign |
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Serous cystadenocarcinoma
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50% ovarian tumors
malignant and frequently bilateral |
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Mucinous cystadenocarcinoma
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multilocular cyst lined by mucus-secreting epithelium
benign |
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Mucinous cystadenocarcinoma
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malignant
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Pseudomyxoma peritonei
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intraperitoneal accumulation of mucinous material from ovarian or appendiceal tumor
(assoicated with mucinous cystadenocarcinoma) |
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Brenner tumor
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benign ovarian non-germ cell tumor
small islands of epithelial cells resembling bladder; transitional epithelium; interspersed within fibrinous stroma |
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Fibromas
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ovarian non-germ cell tumors
bundles of spindle-shaped fibroblasts |
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Meigs' syndrome
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triad of ovarian fibroma, ascites, and hydrothorax
pulling sensation in groin (under fibromas heading) |
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Granulosa cell tumor
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ovarian non germ cell tumor
secretes estrogen leads to precocious puberty in kids can cause endometrial hyperplasia or carcinoma in adults |
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Call-Exner bodies
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associated with granulosa cell tumor
small follicles filled with eosinophilic secretions important diagnostic tool |
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Krukenberg tumor
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GI malignancy that metastasizes to ovaries; causing a mucin-secreting signet cell adenocarcinoma
ovarian non-germ cell tumor |
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Squamous cell carcinoma of the vagina
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2% go to cervical SCC
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clear cell adenocarcinoma
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vaginal carcinoma
exposure to DES |
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sarcoma botryoides
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rhabdomyosarcoma variant
vaginal carcinoma affects girls < 4 years old spindle shaped tumor cells that are desmin positive |
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Benign tumors of the breast
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fibroadenoma, intraductal papilloma, phyllodes tumor
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Fibroadenoma
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benign tumor of the breast
most common tumor < 25 years old small, mobile, firm mass with sharp edges; increase size and tenderness with pregnancy not a precursor to breast cancer |
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Intraductal papilloma
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benign tumor of breast
tumor of lactiferous ducts presents with serous or bloody nipple discharge |
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Phyllodes tumor
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benign tumor of the breast
large, bulky mass of CT and cysts tumor may have 'leaf-like' projections some may be malignant (cystosarcoma phyllodes) |
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Malignant tumors of the breast (carcinomas)
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common postmenopause
arise from mammary duct epithelium or lobular glands overexpression of estrogen/progesterone receptors or erb-B2 (HER-2, an EGF receptor) is common |
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What is the single most importnat prognostic factor for malignant tumors of the breast
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axillary lymph node involvement
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Noninvasive malignant breast tumor
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ductal carcinoma in situ
early malignancy without basement membrane penetration |
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Invasive ductal
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most common malignant tumor of the breast
no specific type firm, fibrous mass worst and most invasive common |
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Invasive lobular
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often multiple, bilateral, orderly rows of cells
malignant tumor of the breast |
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Medullar carcinoma of the breast
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1.2 - 10%
fleshy, cellular, lymphocytic infiltrate good prognosis |
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Comedocarcinoma
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1.6%
malignant tumors of breast ductal, caseous necrosis |
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Inflammatory carcinoma of the breast
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lymphatic involvement; red, swollen; peau d'orange
(breast skin resembles an orange peel) |
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Paget's disease of the breast
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invasive carcinoma of the breast
eczematous patches on nipple paget cells: large cells with clear halo; suggests underlying carcinoma also seen on vulva (invade epidermis) |
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Risk factors of breast cancer
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gender, age, early 1st menarche (before 12 years old), delayed first pregnancy (later than 30 years old), late menopause (>50), family history of 1st degree relative with breast cancer at young age
risk is NOT increased by fibroadenoma or nonhyperplastic cysts |
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Fibrocystic disease
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most common cause of 'breast lumps' from age 25 to menopause
presents with diffuse breast pain and multiple lesions, often bilateral usually does NOT indicate increased risk of carcinoma |
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Blue dome
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cystic part of fibrocystic disease...fluid filled cyst
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Sclerosing fibrocystic disease
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increased acini and intralobular fibrosis
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Epithelial hyperplasia of fibrocystic disease
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increase in number of epithelial cell layers in terminal duct lobule
increased risk of carcinoma with atypical cells occurs in women > 30 years old |
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Acute mastitis
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breast abscess
during breast-feeding increase risk of bacterial infection through cracks in the nipple...staph aureus is the most common pathogen |
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Fat necrosis
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benign painless lump; forms as a result of injury to breast tissue
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Gynectomastia
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results from hyperestrogenism (cirrhosis, testicular tumor, puberty, old age), Klinefelter's syndrome, or drugs (estrogen, weed, heroin, psychoactive drugs, SPIRONOLACTONE, DIGITALIS, CIMETIDINE, ALCOHOL, AND KETOCONAZOLE)
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Drugs that cause gynecomastia
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spironolactone, digitalis, cimetidine, alcohol and ketoconazole
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BPH
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HYPERPLASIA
may be due to age related increase in estradiol with possible sensitization of the prostate to the growth promoting effects of DHT nodular enlargement of the periurethral (lateral and middle) lobes of the prostate gland...compressing the urethra into a vertical slit |
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BPH may lead to...
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distention and hypertrophy of the bladder, hydronephrosis, and UTIs
not considered a pre-malignant lesion increase in free prostate-specific antigen!! most frequent cause of urinary tract obstruction |
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Prostatic adenocarcinoma
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posterior lobe (peripheral zone!!)
digital rectal examination (hard nodule) and prostate biopsy prostatic acid phosphatase (PAP) and PSA are useful tumor markers osteoblastic metastases in bone may develop in late stages...lower back pain and an increase in serum alkaline phosphatase and PSA |
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increase total PSA with decrease in fraction of free PSA
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prostatic adenocarcinoma
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Cryptorchidism
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failure of testes to descend into scrotum
lack of spermatogenesis because of increase in body temperature associated with increased risk of germ cell tumors (especially seminoma and embryonal carcinoma) prematurity increases risk of cryptorchidism |
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Seminoma
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testicular germ cell tumor
malignant painless testicular enlargement; most common testicular tumor, mostly affecting males age 15-35 large cells in lobules with watery cytoplasm and a 'fried egg' appearance radiosensitive late metastasis excellent prognosis analogous to dysgerminoma ovarian tumor |
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Embryonal carcinoma
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testicular germ cell tumor
malignant; painful; worse prognosis than seminomas often glandular/papillary morphology can differntiate to other tumors |
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Schiller-Duval bodies
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Yolk sac (endodermal sinus) tumor
analogous to ovarian yolk sac tumor primitive glomeruli (increase alpha feto protein) peak incidence in infancy and early childhood |
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Choriocarcinoma (testicular cancer)
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malignant
increased hCG cells that look like syncytiotrophoblast and cytotrophoblasts |
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Teratoma in males
|
testicular germ cell tumor
most common testicular cancer in older men |
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Leydig cell tumor
|
benign, contains Reinke crystals
usually androgen producing, gynecomastia in men, precocious puberty in boys |
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Reinke crystals
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Leydig cell tumors
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Sertoli cell tumor
|
benign; androblastoma from sex cord stroma
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Testicular lymphoma
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most common testicular cancer in older men
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Varicocele
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dilated vein in pampiniform plexus
can cause infertility 'bag of worms' |
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Hydrocele
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serous, fluid filled; persistence of continuity of tunica vaginalis
secondary to fluid secondary to incomplete fusion of processus vaginalis |
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Spermatocele
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dilated epididymal duct
(mostly intratestcular) sperm containing cyst |
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Erythroplasia of Queyrat
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red velvety plaques
usually involving the glans otherwise similar to Bowen's disease |
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Bowenoid papulosis
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multiple papular lesions
affects younger age group than other subtypes usually does not become invasive resembles condyloma accuminatum, HPV 16 |
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Bowen's disease
|
gray, solitary, crusty plaque, usually on the shaft of the penis or on the scrotum; peak incidence is 5th decade of life; progresses to invasive SCC in < 10% cases
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SCC of penis
|
rare in circumcised men
uncommon in US and Europe, more common in Asia, Africa and South America commonly associated with HPV (16, 18, 31 and 33) |
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Peyroine's disease
|
bent penis due to acquired fibrous tissue formation
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