DIT review - Reproduction 1 Flashcards
Describe the difference between a direct and indirect hernia
- Indirect inguinal hernia
- Goes through the internal (deep) inguinal ring, external (superficial) inguinal ring, and into the scrotum
- Enters internal inguinal ring lateral to inferior epigastric vessels
- Direct inguinal hernia
- Protrudes through the inguinal triangle
- Goes through the external (superficial) inguinal ring only
- Covered by external spermatic fascia
- Bulges directly through parietal peritoneum, medial to the inferior epigastric vessels but lateral to the rectus abdominis
During genital embryology, what is produces by Leydig cells and what is produced by Sertoli cells?
Leydig = testosterone
Sertoli = AMH
Describe the sequence of events caused by the SRY gene during genital embryologic development
- SRY gene on chr Y produces testes determining factor (TDF)
- TDF stimulates the development of testes
- Tested produce Sertoli cells and Leydig cells
- Sertoli cells produce Anti-Mullerian hormone
- AMH causes degeneration of paramesonephric ducts
- Leydig cells produce Testosterone
- Testosterone causes Wolffian duct to develop into male internal genitalia (except the prostate)
- Testosterone is also converted to DHT via 5 a-reductase in order to cause the development of male external structures + prostate
- Sertoli cells produce Anti-Mullerian hormone
What cell is responsible for maintaining high levels of testosterone in the testes?
Sertoli cells
o Androgen-binding protein (ABP) within the seminiferous tubules binds testosterone and DHT to make them less lipophilic and reduce diffusion out of the luminal fluid
o ABP is synthesized by Sertoli cells in response to FSH
o Sertoli cell dysfunction may manifest as normal serum testosterone (hypothalamus, pituitary, and Leydig cells are fine) with low concentration of testosterone in the seminiferous tubules due to inadequate ABP production
What is the presentation, histology, and prognosis of seminoma?
- Most common type of testicular cancer
- Malignant
- Painless, homogenous testicular enlargement
- “Fried egg” appearance under histology
- Radiosensitive – excellent prognosis
What is the histology, lab values, and most commonly affected population of yolk sac tumor of the testes?
- Yellow, mucinous
- Schiller duval bodies (resemble glomeruli)
- Increased AFP
- Most common testicular tumor in boys < 3 y/o
What are the relevant lab values of choriocarcinoma of the testes?
- Malignant
- Increased hCG
- Disordered syncytiotrophoblasts and cytotrophoblasts
- Hematogenous metastasis
What is the difference between teratoma in males and females
Malignant in males but not females
What is the presentation and lab values of embryonal carcinoma of the testes?
- Malignant tumor comprised of immature, primitive cells that may produce glands
- Painful, hemorrhagic mass with necrosis
- Increased hCG and normal AFP
What are the 3 non-germ cell tumors of the testes?
Leydig cell, Sertoli, and testicular lymphoma
Presentation and histology of Leydig cell tumor
- Golden brown color
- Contains Reinke crystals (eosinophilic cytoplasmic inclusions)
- Produce androgens:
- Gynecomastia in men
- Precocious puberty in boys
Population most affected by testicular lymphoma
- Most common testicular cancer in older men > 60 y/o
- Not a primary cancer – arises from metastatic lymphoma
What is Peyronie disease?
- Abnormal curvature of the penis due to fibrous plaque within the tunica albuginea
- Associated with erectile dysfunction
- May cause pain or anxiety
- Can consider surgical repair
What are precursor lesions/increased risk of squamous cell carcinoma of the penis?
- Bowen disease - presents as leukoplakia in the shaft
- Erythroplasia of Queyrat - presents as erythroplakia of the glans
- Bowenoid papulosis - presents as reddish papules
- HPV
- Lack of circumcision
Is BPH due to hypertrophy or hyperplasia
Hyperplasia
Treatment of BPH
- Alpha-1-antagonists
- 5a-reductase inhibitors
Common metastatic location of prostatic adenocarcinoma
Bone
What pathology occurs in the lateral/middle vs. posterior lobe of the prostate
BPH = lateral/middle (compression of urethra into vertical slit)
Prostatic adenocarcinoma = posterior (felt on rectal exam)
Describe the differences between the different types of estrogen (estradiol, estrone, and estriol)
- THINK: 1, 2, 3 = man, woman, baby
- Estrone = one = 1 = man
- Found in men and women
- Produced by fat cells in the periphery via aromatase
- Estradiaol = di = 2 = women
- Produced in ovaries
- Strongest and most abundant form of estrogen in women
- Estriol = tri = 3 = babies
- Produced by the placenta
- Estrone = one = 1 = man
Describe what parts of meiosis I and meiosis II the egg is arrested in, and what allows the egg to continue on in the process
- Primary oocytes arrested tin Prophase I until ovulation
- Secondary oocytes arrested in Metaphase II until fertilization (an egg met a sperm)
Describe the steps of ovulation, from rise in estrogen to rise in basal body temperature
- Estrogen causes increased production of its own receptors, as well as LH and GnRH receptors (positive feedback)
- Estrogen surge stimulates an LH surge
- LH surge leads to release of the egg
- Corpus luteum secretes progesterone
- Basal body temperature rises about 24 hours after ovulation in response to increased progesterone
What is Mittelschmerz
- Transient mid-cycle ovulatory pain
- Associated with peritoneal irritation
What are the stimulators and products of theca and granulosa cells?
- Theca cells
* Stimulated by LH
* Produce androstenedione from cholesterol via desmolase- Granulosa cells
- Stimulated by FSH
- Produce estrogen (estradiol) from androstenedione via aromatase
- Granulosa cells
- Theca cells
What is vaginal adenosis?
- Persistence of columnar epithelium within the upper vagina
- Lower 1/3 of vagina derived from urogenital sinus à squamous epithelium
- Upper 2/3 of vagina derived from Mullerian duct à columnar epithelium
- Normally, squamous epithelium will grow upwards to replace the columnar epithelium
- Associated with diethylstilbestrol (DES) in utero and clear cell adenocarcinoma
