Reproduction 10

Front 1

Draw out the HPG axis

Back 1

Page 1O-3

Hypothalamus (GnRH) --> Pituitary

Pit (LH) --> Leydig
Pit (FSH) --> Sertoli Cells

Legdig --> produce T (neg feedback on hypothalamus)

Sertoli Cells --> Inhibin

Front 2

What cell types are found inside the seminiferous tubules?

Back 2

Germ cells / sertoli cells

Front 3

What cell types are found in the interstitium?

Back 3

Leydig cells

Front 4

Most of the 64 day spermiogenesis sequence is spent in which phase?

Back 4

Spermatocyte stage

Front 5

FSH acts on sertoli cells to cause what?

Back 5

Androgen binding protein synthesis and aromatose synthesis which may convert testosterone to estradiol in the periphery

Front 6

What gets added to the ejaculate by seminal vesicles?

Back 6

Fructose

Front 7

What are the 3 types of male infertility?

Back 7

1. Pretesticular - HP Axis, exogenous hormones

2. Testicular - direct damage to GC;s

3. Post testicular - epididymis and beyond

Front 8

What are 4 types of pre-testicular male infertility?

Back 8

1. Androgen excess

2. Estrogen excess

3. Thyroid / adrenal dysfunction

4. Kallman's syndrome

Front 9

What are 2 categories of post-testicular male infertility?

Back 9

1. Drugs and toxins

2. Systemic Disease

Front 10

A failure to coagulate suggests an issue with which organ?

Back 10

Absent/damaged seminal vesicles

Front 11

What is kallman's syndrome?

Back 11

Secondary to defect in GnRH secretion

Associated with cranio-facial defects, maldescent, and anosmia

Front 12

What is congenital adrenal hyperplasia (CAH)?

Back 12

Androgen excess, oversecretion of testosterone

Front 13

What are 3 characteristics of CAH?

Back 13

1. Precocious puberty and premature secondary sex characteristics

2. Gonadotrophs suppressed and normal testicular maturation impaired

3. Testicular adrenal rest tumors

Front 14

What are 3 examples of genetic causes of infertility?

Back 14

1. Klinefelter's XXY

2. XYY, and males with Yq loss

3. Autosomal abnormalities (Trisomy 21, prader-willi)

Front 15

What is cryptorchidism?

Back 15

Lack of descent of testis

Front 16

Boys with cryptochidism are at increased risk for what?

Back 16

Increased risk of neoplasia

Front 17

Cryptochidism is what % of infertility cases?

Back 17

1%

Front 18

In cryptochidism, what may be seen in the contralateral descended testis?

Back 18

May show regressive changes

Front 19

What are the 5 main causes of testicular infection?

Back 19

1. Mumps

2. TB

3. Gonorrhea

4. Syphilis

5. E. Coli (in men >35)

Front 20

What specifically in infections can have negative impacts on GC's?

Back 20

Fibrosis observed after healing

Front 21

What is one major cause of post-testicular infertility?

Back 21

Cystic fibrosis

Front 22

What syndrome, in which germ cell aplasia is seen, accounts for 5-10% of male infertility?

Back 22

Sertoli cell only syndrome

Front 23

The most common testicular tumors are derived from what cell?

Back 23

Germ cells (95%)

Front 24

The remaining testicular tumors are derived from what?

Back 24

Non-GC

Sex cord - stromal tumors

Front 25

What are 4 risk factors for germ cell tumors?

Back 25

1. Cryptorchidism

2. Prior TGCT

3. Family H(x)

4. Infertility

Front 26

What are the 2 main categories of GC tumors?

Back 26

1. Seminomas

2. Embryonal Carcinomas

Front 27

What are the 3 types of embryonal carcinomas?

Back 27

1. Yolk sac tumor

2. Choriocarcinoma

3. Teratoma

Front 28

What is "the most common pure germ cell tumor composed of relatively uniform cells with abundant clear cytoplasm, well defined cell borders, and nuclei with one or more prominent nucleoli?"

Back 28

Seminoma

Front 29

How do seminomas usually present?

Back 29

Painless testicular mass

Front 30

Histologically, what is a hallmark of seminomas?

Back 30

Tumor infiltrating lymphocytes

Front 31

Histologically, how do seminoma tumor cells appear?

Back 31

Have clear cytoplasm, large nucleus

Front 32

Are HCG and AFP positive or negative in seminomas?

Back 32

Negative

Front 33

What is the prognosis for seminomas?

Back 33

Excellent; 98% cure rate for stages I and II

Front 34

What is "a germ cell tumor composed of cells with epithelial appearance and marked cytologic atypia"?

Back 34

embryonal carcinoma

Front 35

Is necrosis and/or hemorrhage seen in embyronal carcinomas

Back 35

YES

(note: not seen in seminomas)

Front 36

What is the growth pattern for embyronal carcinomas?

Back 36

alveolar or tubular

Front 37

What is the prognosis for embyonal carcinomas?

Back 37

Very aggressive, poorest prognosis among all GCT's

Front 38

What is "GC tumor characterized by a variety of growth patterns that recapitulate yolk sac, allantois, and extra-embryonic mesenchyme"?

Back 38

Yolk Sac tumor

Front 39

Which age group tended to get Yolk sac tumors?

Back 39

Kids

Front 40

What is the common yolc sac tumor presentation?

Back 40

Non symptomatic rapid testicular enlargement

Front 41

What characteristic histological feature is seen in yolk sac tumors?

Back 41

Schiller-Duval Bodies - capillary surrounded by mesodermal cells

Front 42

95% of yolk sac tumor patient have elevated what?

Back 42

Serum alpha fetoprotein (AFP)

Front 43

What is a GC tumor composed of mononucleated cytotrophoblast and multinucleated syncytiotrophoblasts?

Back 43

Choriocarcinoma

Front 44

Are choriocarcinomas hemorrhagic and necrotic?

Back 44

Yes

Front 45

Is testicular enlargement seen in choriocarcinomas?

Back 45

NO

Front 46

Elevated levels of what is seen in choriocarcinomas?

Back 46

HCG

Front 47

What is the prognosis of choriocarcinomas?

Back 47

Poor

Front 48

What is a tumor with more than one somatic tissue of different germinal layers, namely: ectoderm, mesoderm, endoderm

Back 48

Teratoma

Front 49

What is the prognosis of teratomas?

Back 49

Kids: Good

Adults: Poor