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104 Cards in this Set

  • Front
  • Back
Where does the right ovary/testis venous drainage go?
Right gonadal vein, then the IVC
Where does the left ovary/testis venous drainage go?
Left gonadal vein, left renal vein, IVC
Where does the lymphatic drainage from the ovary/testis go?
Para-aortic lymph nodes
Where does the lymphatic drainage from the distal 1/3 of the vagina/vulva/scrotum go?
Superficial inguinal nodes
Where does the lymphatic drainage from the proximal 2/3 of the vagina/uterus go?
Obturator, external iliac, and hypogastric lymph nodes
Suspensory ligament of the ovaries
Connects the ovaries to the lateral pelvic wall, contains the ovarian vessels
Cardinal ligament
Connects the cervix to the side wall of the pelvis, contains the uterine vessels
Round ligament of the uterus
Connects the uterine fundus to the labia majora. Derived from the gubernaculum and goes through the round inguinal canal.
Broad ligament
Connects the uterus, fallopian tubes, and ovaries to the pelvic wall. Contains the ovaries, fallopian tubes, and round ligaments. It is ligated during hysterectomy.
Ligament of the ovary
Connects the ovary to the lateral uterus
What type of epithelium is present in the ovary
Simple cuboidal
What type of epithelium is present in the fallopian tube?
Simple columnar, ciliated
What type of epithelium is present in the uterus?
Simple columnar, ciliated, tubular glands
What type of epithelium is present in the endocervix
Simple columnar
What type of epithelium is present in the ectocervix
Stratified squamous
What type of epithelium is present in the vagina
Stratified squamous, nonkeratinized, glycogen
Where is the acrosome of sperm derived?
Golgi apparatus
What does the middle piece of the sperm contain?
Mitochondria and feeds on fructose
Where does the tail of the sperm come from (flagellum)
Centrioles- 9+2
What proteins do Sertoli cells secrete?
Inhibit (inhibits FSH)
Androgen Binding Protein (maintains the levels of testosterone)
AMH
What is contained in semen?
60% seminal fluid (fructose, PGs)
20% prostatic fluid (phosphatases)
20% sperm
How does spermatogenesis proceed?
Spermatogonium (Diploid-2N) ---> replication ----> primary spermatocyte (Diploid-4N) most common because prophase I lasts 22 days----> meiosis I ---> secondary spermatocyte (2N) haploid ----> meiosis II ---> spermatid (N)
What are the sources of estrogen?
Ovary (17B-estradiol), placenta (estriol), blood aromatization, fat (estrone)
How should estrogen levels change in pregnancy?
50-fold increase in estradiol and estrone
1000-fold increase in estriol
(indicates fetal well-being)
What effects does estrogen?
-Development of genitalia and breast, female fat distribution
-Follicle growth, endometrial proliferation, increased myometrial excitability
-Upregulates estrogen, LH, and progesterone receptors
-Feedback inhibition of FSH, LH, and LH surge
-Stimulation of prolactin secretion, but blocks its action at the breast
-Increases SHBG, increases HDL, decreases LDL, increases vitamin D
How do theca and granulosa cells interact?
Theca cells convert cholesterol to androstenedione by desmolase/17alpha hydroxylase (under stimulation by LH). Androstenedione then goes to the granulosa cell to be converted to estrogen by aromatase (under stimulation by FSH)
What does progesterone do?
-Stimulates endometrial glandular secretions and spiral artery development
-Maintains pregnancy
-Decreases myometrial excitability
-Thick cervical mucus (inhibits sperm entry into uterus)
-Increases body temperature
-Inhibits gonadotropins
-Uterine smooth muscle relaxation
-Decreased estrogen receptor expressivity
-Decreases HDL, increases insulin, increases fat deposition
-Proliferation of mammary gland acini
What is Mittelschmerz?
Blood from the ruptured follicle causes peritoneal irritation that can mimic appendicitis. Treat with OCPs and mild analgesics
When is beta-hCG detectable?
In the blood 1 week after conception (implantation occurs 6 days after fertilization), urine 2 weeks after conception
What allows lactation after labor?
Decrease in progesterone
What hormonal changes take place during menopause?
Decrease estrogen, increased FSH (a lot), increased LH (no surge), increased GnRH
What occurs in Klinefelter's syndrome?
-Testicular atrophy (hyalinzation and fibrosis of seminiferous tubules), long extremities, gynecomastia, female hair distribution, inactivated X chromosome (barr body) in neutrophils
-Dysgenesis of seminiferous tubules causes decreased inhibin and increased FSH
-Abnormal Leydig cell function causes decreased testosterone, increased LH, and increased estrogen
What occurs in Turner's syndrome
XO- No barr body, decreased estrogen due to ovarian dysgenesis causes increased LH and FSH
What occurs in double Y males?
Phenotypically normal, very tall, antisocial behavior, normal fertility
Female pseudohermaphrodite?
Ovaries present, but external genitalia is virilized or ambiguous. Due to innappropriate exposure to androgenic steroids early in gestation (CAH, exogenous administration during pregnancy)
Male pseudohermaphrodite
Testes present, but external genitalia are female or ambiguous

-Androgen insensitiviy: Appears female with external genitalia, rudimentary vagina (lower 2/3), no sexual hair, testes often in labia majora. Increased T, Increased E, increased LH
-5a-reductase deficiency: AR; ambiguous genitalia until puberty when T increases; Normal T and E, normal LH or increased
Kallmann syndrome
Decreased synthesis of gonadotropin in the anterior pituitary, anosmia. Decreased LH, T (hypogonadotropic hypogonadism), unilateral renal agenesis
No Sertoli cell or lack of AMN
Both male and female internal genitalia, male external genitalia (still have testosterone from the Leydig cells and DHT conversion)
What are the features of a complete mole?
46, XX or 46, XY (2 sperm + empty egg), HUGE increase in B-hCG, no fetal parts, increased uterine size, 2% convert to choriocarcinoma, 15-20% risk of malignant trophoblastic disease, described as bloody grapes
What are the features of an incomplete mole?
69, XXY or XXX
slight increase in B-hCG, no increase in uterine size, no conversion to choriocarcinoma, fetal parts present, low risk of malignancy
What is preeclampsia?
-Hypertension, proteinuria, pitting edema. Occurs between 20 weeks - 6 weeks post partum (before 20 weeks indicates molar pregnancy). Probably autoimmune.
-Present with headache, blurred vision, abdominal pain (RUQ), edema of face and extremities, AMS, hyperreflexia, thrombocytopenia, hyperuricemia
Treatment- IV Mg and diazepam
What is ecclampsia?
Preeclampsia + seizures
What is HELLP syndrome?
Hemolysis, Elevated LFTs, Low Platelets. Die due to cerebral hemorrhage and ARDS
What is abruptio placentae?
Premature detachment of placenta from implantation site. Painful bleeding in 3rd trimester. A/w smoking, cocaine, hypertension
What is placenta previa?
Attachment of placenta to lower uterine segment and can occlude internal os. Painless uterine bleeding in any trimester. Multiparity and C-section predispose
What is polyhydramnios associated with?
Esophageal/duodenal atresia, anencephaly (see in DM)
What is oligohydramnios associated with?
Placental insufficiency, bilateral renal agenesis, posterior urethral valves
What are the most common gynecologic tumors?
endometrial > ovarian > cervical
What is the order of prognosis for gynecologic tumors?
Ovarian > cervical > endometrial
What is the underlying cause of PCOS?
Increased LH production, leading to anovulation, hyperandrogenism (enhanced steroid synthesis by theca cells). A/w infertility, obesity, hirsutism, insulin resistance, increased risk of endometrial cancer, long periods without bleeding followed by severe menorrhagia
-Se increased LH, decreased FSH, increased T and E
Follicular ovarian cyst
Distention of unruptured graafian follicle. A/w hyperestrinism and endometrial hyperplasia
Corpus luteum cyst
Hemorrhage into persistent corpus luteum, regresses spontaneously
Theca-lutein cyst
BILATERAL/multiple; due to gonadotropin stimulation; A/w choriocarcinoma, moles, pregnancy related (due to increased B-hCG; a/w choriocarcinoma)
Chocolate cyst
Endometriosis cyst containing blood; varies with menstrual cycle.
Ovarian dysgerminoma
Malignant, equivalent to male seminoma, but much rarer. Sheets of uniform cells. Increased hCG, LDH
Ovarian choriocarcinoma
Rare, malignant, can occur pregnancy in mother or baby; Large, hyperchromatic syncytiotrophoblastic cells, increased frequency of theca-lutein cysts, mets to lung, increased hCG
Ovarian yolk-sac tumor
Aggressive; yellow, friable, solid mass; 50% have Schiller-Duvall bodies (look like glomeruli). AFP
Ovarian teratoma
90% of ovarian germ cell tumors are these
Mature- most frequent benign ovarian tumor
Immature- aggressively malignant
Struma ovarii- functional thyroid tissue
Ovarian serous cystadenoma
20% ovarian tumors; Bilateral, FALLOPIAN-TUBE endothelium (ciliated).
Ovarian serous cystadenocarcinoma
50% ovarian tumors, malignant, bilateral, psamomma bodies
Ovarian mucinous cystadenoma
Multilocular cyst lined with mucus-secreting epithelium. Benign, intestine-like tissue (goblet cells)
Ovarian mucinous cystadenocarcinoma
Malignant. Pseudomyxoma peritonei- accumulation of mucinous material from ovarian or appendiceal tumor in the peritoneum
Ovarian Brenner tumor
Benign; looks like bladder
Ovarian fibroma
Meigs' syndrome: Ovarian fibroma, ascites, hydrothorax.
Ovarian granulosa cell tumor
Secretes estrogen- precocious puberty in kids, endometrial hyperplaisa or cacinoma in adults. Call-exner bodies (follicles with eosinophilic secretions), abnormal uterine bleeding
Ovarian Krukenberg tumor
GI malignancy met with signet cells; adenocarcinoma
Fibroadenoma of breast
Small, mobile, firm, sharp edges. MCC tumor in < 25 years; increases in size with estrogen; Histologically, it is a cellular stroma that encircles and compresses epithelium lined by glandular and cystic spaces. NOT PRECANCEROUS
Intraductal papilloma of the breast
Small, grows in lactiferous ducts, under areola. Serous or bloody nipple discharge, slight increased risk for carcinoma
Phyllodes tumor
Large, bulky connective tissue (stroma) mass and cysts; has leaf-like projections. Can become malignant; MC in 6th decade
What is the most important prognastic factor in malignant breast tumors?
Axillary lymph node involvement
Ductal CIS of breast
Fills ductal lumen, arises from ductal hyperplasia, early malignancy w/o BM penetration; can have comedonecrosis
Invasive ductal carcinoma
Fibrous, rock-hard mass (desmoplasia, scar like, scirrhous) with sharp margins, small, glandular duct-like cells. Worst, most invasive, common. Mets to peritoneum because inactivation of E-cadherin gene
Invasive lobular carcinoma
Orderly row of cells, multiple, bilateral
Medullary carcinoma of the breast
Fleshy, cellular, lymphatic infiltrate; good prognosis
Inflammatory carcinoma of the breast
Dermal lymphatic invasion, Peau d'orange due to blocked lymphatic drainage; nipple retraction occurs if cells infiltrate suspensory ligament of the breast, new retraction means lactiferous duct involvement
Paget's disease of the breast
Eczematous patches on nipple (also seen on the vulva) suggests underlying carcinoma. Paget cells are large with clear halos and are in the epidermis (DCIS can have this)
Fibrocystic change
MCC breast lumps from age 25-menopause, no increased risk of carcinoma, may fluctuate in size; Presents with premenstrual breast pain and often bilateral (as opposed to fibroadenoma!!)
-Hyperplasia of breast stroma (fibrosis),
-Fluid filled blue domes (cystic), duct dilation, apocrine metaplasia.
-Sclerosing adenosis- Increased acini and intralobular fibrosis. a/w calcifications (acini/lobule increases)
-Epithelial hyperplasia- only increases risk of carcinoma if the cells are atypical. Occurs in women <30 years
Acute mastitis
Breast abscess during breast feeding, MCC S. aureus
Fat necrosis
Painless lump due to trauma, but patients may not remember (seatbelt)
Gynecomastia
Hyperestrogenism, Klinefelter's, drugs
What are the risk factors for ovarian non-germ cell tumors?
Family history- Most important (BRCA-1, HNPCC)
CA-125 increased
What are the risk factors for malignant breast tumors?
Increased estrogen exposure (more menses, older age at 1st live birth, obesity), Family history (erb-B2, HER-2)
What breast pathology occurs at the nipple?
Paget's disease, breast abscess
What breast pathology occurs at the lactiferous duct?
Intraductal papilloma, breast abscess, mastitis
What breast pathology occurs at the major duct?
Fibrocystic change, ductal cancer
What breast pathology occurs at the lobules?
Lobular carcinoma, sclerosing adenosis
What breast pathology occurs at the stroma?
Fibroadenoma, phyllodes tumor
Where dose BPH occur?
Hyperplasia of the lateral and middle lobes of the prostate (periurethral)
Where does prostatic carcinoma occur?
Posterior lobe of the prostate (peripheral zone)
How do PSA levels differ between BPH and prostatic carcinoma?
BPH- Increased FREE PSA
Prostatic carcinoma- Increased TOTAL PSA but DECREASED free PSA
Seminoma (testicular)
Malignant, painless, homogenous enlargement, MCC testicular tumor, 15-35, large cells in lobules (fried egg), radiosensitive, late mets, good prognosis
Embryonal carcinoma (testicular)
Malignant, painful, glandular/papillary morphology, increased AFP and B-hCG
Yolk sac (endodermal sinus) tumor of the teststicle
Yellow, mucinous, Schiller-Duval bodies (look like glomeruli), increased AFP. MC in children < 3
Choriocarcinoma (testicular)
Malignant, increased hCG, disordered syncytiotrophoblastic and cytotrophoblastic elements, mets via blood
Teratoma (testicular)
MALIGNANT (unlike females)
Leydig cell tumor (testicular)
Reinke crystals, gynecomastia in men, precocious puberty in boys, golden brown (produces androgens)
Sertoli cell tumor (testicular)
Androblastoma from sex cord stroma; 90% benign
Testicular lymphoma
MCC testicular cancer in older men
What causes a varicocele?
Dilated vein in pampiniform plexus that can cause infertility; bag of worms, more common on left (left testicular vein drains into the left renal vein)
What causes a spermatocele?
Dilated epididymal duct
Bowen's disease (CIS)
Gray, solitary, crusty plaque on shaft or scrotum. 5th decade, < 10% progress to SCC
Erythroplasia of Queyrat (CIS)
Red, velvety plaques on glans. 10% progress to SCC
Bowenoid papulosis (CIS)
Multiple papular lesions in younger age group and does not become invasive
SCC of penis
Associated with HPV; mets to inguinal and iliac lymph nodes