Embryology - reproductive system Flashcards
Shh:
- produced at?
- function?
- mutation causes?
- produced at: base of limbs in zones of polarity
- function:
1) patterning along A-P axis
2) . CNS development - mutation causes holoprosencephaly 前脑无裂畸形
Wnt-7:
- produced at?
- function?
- produced at apical ectodermal ridge
2. function: dorsal-ventral axis
FGF gene:
- produced at?
- function?
- produced at apical ectodermal ridge
2. function: stimulate mitosis of underlying mesoderm to length the limbs
Homeobox (Hox):
- function?
- mutation causes?
- function: segmental organization of embryo in craniocaudal directions
- mutation causes: appendages in wrong location
early fetal development:
day 0:
form zygote
early fetal development:
wk 1:
implantation of blastocyte, hCG secretion begins
early fetal development:
wk 2:
2 = 2 layers
form bilaminar disc (epiblast 上胚层)
early fetal development:
wk 3: 出现的重要结构？
3 = 3 layers
form trilaminar disc - gastrulation 原肠胚形成
出现的重要结构：
- primitive streak 原条
- notochord: 脊索
- mesoderm
- neural plate begins
which embroygenesis period is extremely susceptible to teratogens?
wks 3- 8
which embroygenesis period will neural tubes (胚层起源） be closed?
wk 4
胚层起源： ectoderm
early fetal development:
wk 4 events?
- heart starts to beat
- neural tube closes
- upper and lower limb buds start to form
(wk 4 = 4 limbs)
early fetal development:
wk 6 events?
heart beat can be detected by transvaginal ultrasound
early fetal development:
wk 10 events?
genitalia have male/female characteristics
gastrulation: define
form the 3 layers
neural crest: give rise to?
3P + ABCM
- PNS (DRG, cranial N, celiac ganglion, Schwann cells, ANS)
- Pia + arachnoid
- Parafollicular (C) cells of thyroid 【secrete calcitonin】
- Aorticopulmonary septum 【separates the aorta and pulmonary arteries and fuses with the inter ventricular septum】
- Branchial arches (Bones of the skull - 其余的骨是mesoderm形成, cartilage, odontoblasts 成齿质细胞）
- Chromaffin cells of the adrenal medulla
- Malanocytes
Dx: brain mass filled with cholesterol + calcification
胚胎起源？和哪些结构起源相同？
Craniopharyngioma
胚胎起源： Rathke pouch (surface ectoderm)
和哪些结构起源相同：
- adenohypophysis 腺垂体
- glands: parotid, sweat and mammary glands
- lens of eye,
- epithelial lining of oral cavity
- sensory organs of ear and olfactory epithelium
- epidermis
- anal canal below the pectinate line
mesoderm: 包括哪些结构？defects 口诀？
- spleen （liver， kidney等等都是内胚层）
- adrenal cortex (肾上腺髓质是neural crest外胚层起源）
- serous lining of body cavities
Notochord 脊索: function? postnatal derivative?
postnatal derivative: nucleus pulpous of the inter vertebrate disc
endoderm: 包括哪些结构？
- anal canal above the pectinate line (齿状线以下是neural crest -ectoderm origin)
- thyroid follicular cells (note: Parafollicular (C) cells of thyroid 【secrete calcitonin】- neural crest -ectoderm origin)
- 大部分内脏
Define: what type of error in organ morphogenesis is this:
absent organ due to absent primordial tissue
agenesis 缺如
Define: what type of error in organ morphogenesis is this:
absent organ despite presence of primordial tissue
aplasia 发育不全
Define: what type of error in organ morphogenesis is this:
incomplete organ , despite presence of primordial tissue
hypoplasia
Define: what type of error in organ morphogenesis is this:
2° breakdown of a previously normal tissue or structure; example?
disruption
amniotic band syndrome 羊膜索综合征：
Amniotic band syndrome (ABS)：
-rare congenital disorder that results when the amnion is damaged. This produces bands, or fibers, to wrap around or trap parts of the fetus, decreasing blood flow to those areas.
- Hands and fingers are the most common body parts to be affected by ABS, but it also may damage the face, legs or toes.
- Effects can range from slight creases in the skin to severe limb deformity or amputation. ABS is one of the main causes of club foot. Since the bands are slender, ABS often is difficult to diagnose by prenatal ultrasound. Most cases are found at birth.
amniotic band syndrome
Amniotic band syndrome (ABS)：
- rare congenital disorder that results when the amnion is damaged. This produces bands, or fibers, to wrap around or trap parts of the fetus, decreasing blood flow to those areas.
- Hands and fingers are the most common body parts to be affected by ABS, but it also may damage the face, legs or toes.
- Effects can range from slight creases in the skin to severe limb deformity or amputation. ABS is one of the main causes of club foot. Since the bands are slender, ABS often is difficult to diagnose by prenatal ultrasound. Most cases are found at birth.
Define: what type of error in organ morphogenesis is this:
Extrinsic disruption, occurs after the embryonic period
vs
intrinsic disruption, occurs during the embryonic period (wks 3 -8 )?
Extrinsic disruption, occurs after the embryonic period: deformation
intrinsic disruption, occurs during the embryonic period (wks 3 -8 ): malformation
Define: what type of error in organ morphogenesis is this:
Abnormalities result from a single 1 ° embryological event ; 举例？
sequence
举例: Potter sequence vs. Potter syn
teratogens affect which period?
exposure before that? after that?
3 - 8 wks (“embryonic period - organogenesis)
before that: all or none
after that: growth and function affected
teratogens： cause ?
ACE I
renal damage
teratogens： cause ?
alkylating agents
alkylating agents
- cyclophosphamide, ifosfamide;
- nitrosoureases [such as carmustine, lomustine, semustine, streptozocin],
- busulfan
act as tetatogens: absent digits, multiple anomalies
act on blood as carcinogen: leukemia
teratogens： cause ?
carbamazepine （other toxicity?)
DOC for complex partial seizures, generalized tonic-clonic seizures,
most severe side effects:
- agranulocytosis, aplastic anemia
as teratogen: neural tube defects
teratogens： cause ?
aminoglycosides?
CN VIII toxicity
teratogens： cause ?
diethylstibestrol （DES）
己烯雌酚 synthetic nonsteroidal estrogen
From about 1940 to 1971, DES was given to pregnant women in the mistaken belief it would reduce the risk of pregnancy complications and losses.
In 1971, DES was shown to cause a rare vaginal tumor in girls and women who had been exposed to this drug in utero. The United States Food and Drug Administration subsequently withdrew DES from use in pregnant women.
teratogens： cause ?
folate antagonists：代表药物？机制？致畸作用？
代表药物 methotrexate and pemetrexed ( Alimta)；
机制： inhibit dihydrofolate reductase (DHFR)】
致畸作用：neural tube defects
teratogens： cause ?
Lithium
Ebstein anomaly （atrialized RV)
rare heart defect in which parts of the tricuspid valve are abnormal： one or two of the leaflets are stuck to the wall of the heart and don’t move normally. Back flow from RV to RA
teratogens： cause ?
methimazole
Me‘thimazole 甲巯基咪唑,他巴唑
甲亢药，inhibit peroxidase only (最严重的副作用是agranulocytosis
teratogens： aplasia cutis congenita 先天性皮肤发育不全
teratogens： cause ?
thalidomide
反应停
teratogens： cause ?
val‘proate
丙戊酸 (抗癫痫药) 致畸作用是抗叶酸
teratogens： cause ?
warfarin? 孕妇抗凝用什么药？
heparin
fetal alcohol syn
one of the leading causes of congenital malformations in the US:
teratogens： cause ?
cocaine:
- abnormal fetal growth
- fetal addiction !
- placental abruption
teratogens： cause ?
smoking, CO?
leading cause for low birth weight;
associated with preterm labor, placental problems, IUGR, ADHD
teratogens： cause ?
Iodine (lack or excess)
congenital goiter or hypothyrodism (cretinism)
teratogens： cause ?
Maternal diabetes?
“Caudal regression syn”
- anal atresia 肛门闭锁 ， sirenomelia 人鱼腿 （并腿畸形）
- congenital heart defects
- neural tube defects
teratogens： cause ?
Vit A excess
abortion
monozygotic twins:
胚胎形成的几个关键阶段？
如何决定是否share placenta, etc?
2-cell stage - morula (桑椹胚） - blastocyst (囊)胚泡 -
分开的顺序：placenta - chorion - amnion
placenta组成, 各自功能？
- fetal component:
1) cytotrophoblast: 细胞滋养层 inner layer of chorionic villa
2) syncytiotrophoblast: 合胞体滋养层 - secrete hCG
- maternal component:
decidua basalis: 底蜕膜,基蜕膜
umbilical cord derived from ?
组成?
umbilical cord derived from allantois 尿囊 [ә’læntәuis]
2 umbilical arteries - returned deoxygenated blood from fetal internal iliac A to placenta
1 umbilical vein: drain into IVC via liver or ductus venous
urachus:
derived from? at which developmental stage?
failure of urachus to obliterate results in?
urachus: 脐尿管 duct between fetal bladder and yolk sac
derived from：allantois 尿囊 [ә’læntәuis] （extends from the talk sac into the urogenital sinus)
at which developmental stage: wk 3
failure of urachus to obliterate results in:
- Patent urachus: urines discharge from umbilicus (脐尿管完全未闭：从脐带里漏尿）
- urachal cyst: (脐尿管部分未闭：cavity lined with uroepithelium, - can lead to infection, adenocarcinoma）
- vesicourachal diverticulum: 膀胱脐尿管憩室
vitelline duct:
connect what?
obliterate at which developmental stage?
failure of vitelline duct to close results in? Cx?
卵黄管
connect: yolk sac to miggut lumen
obliterate at which developmental stage: 7th wk
failure of vitelline duct to close results in:
- vitelline fistula - meconium 胎粪 discharge from umbilicus
- meckel diverticulum: true diverticulum; Cx: melena, periumbilical pain, and ulcers
meckel diverticulum:
rue or pseudo diverticulum? 各自定义？
define meckel diverticulum
Cx?
组织学特点
Dx:
true diverticulum: 包含肠壁的全部3层：mucosa, submucosa, mascularis;
pseudo diverticulum: 包含肠壁的2层：mucosa, submucosa only [e.g.: Zenker’s diverticulum]
Cx: melena, periumbilical pain, and ulcers (感染情况下很难和急性阑尾炎区别）
组织学特点： may contain ectopic gastric mucosa and/or pancreatic tissue
Dx: 99mmTc-pertechnetate scan in the right lower abdominal quadrant 【 99m锝扫描】
aortic A derivatives:
1st: 1st is maximal - part of maxillary artery 上颌动脉 [branch of external carotid]
2nd: Second = Stapedial
Stapedial A 镫骨A + hyoid A [‘haiɒid] 舌骨
3rd: C is the 3rd letter
- Common Carotid A and proximal part of internal carotid A
4th: (4 limbs = systemic)
- left: aortic arch
- right: proximal part of right subclavian A
6th: proximal part of pulmonary a and (left) DA (ductus arterioles)
branchial apparatus:
又名？组成？胚层起源？
鳃器， 又名pharyngeal apparatus
组成: CAP
1. branchial Clefts: 鳃裂, [又名branchial grooves], derived from ectoderm
- branchial arches: 鳃弓
derived from mesoderm (- muscles, arteries) and neural crest (- bones, cartilages) - branchial pouches: 鳃囊
derived from endoderm
branchial Clefts (鳃裂) derivatives
不闭锁导致？
1st cleft: - external auditory meatus 外耳道
2nd - 4th clefts: temporary cervical sinus, will obliterated by proliferation of the 2nd arch mesenchyme
if persistent cervical sinus - 导致branchial cleft cyst within lateral neck
branchial arch (鳃弓) derivatives:
1st arch:
- cartilage:
- Muscle
- Nerves:
- abnormalities
branchial arch (鳃弓) derivatives 总体口诀：
“At the restaurant of the golden arches, children first chew (1), smile (2) then swallow stylishly (3), or simply swallow (4) and then speak (6).
1st arch:
1. cartilage: Meckel cartilage (mandible 下颌骨, malleus 锤骨, incus 砧骨, spheno-mandibular ligament 蝶下颌韧带)
- Muscle:
mastication: temporalis 颞肌, masseter 咬肌, pterygoid 翼状肌， mylohyoid 【mailou’hai,ouid] 下颌舌骨肌， anterior belly of digastric 二腹肌， tensor veli palatini 腭帆张肌， tensor tympani 鼓膜张肌 - Nerves: chew - CN V2 and V3
- abnormalities:
“Teacher Collins Syn”: 1st-arch neural crest fails to migrate - madibular (下颌骨）hypoplasia, facial abnormalities
branchial arch (鳃弓) derivatives:
2nd arch:
- cartilage:
- Muscle
- Nerves:
- abnormalities
branchial arch (鳃弓) derivatives 总体口诀：
“At the restaurant of the golden arches, children first chew (1), smile (2) then swallow stylishly (3), or simply swallow (4) and then speak (6).
2nd arch:
- cartilage: Reichert cartilage 【stapes，镫骨； styloid process 茎突; lessor horn of hyoid 舌骨; stylohyoid ligament 茎突舌骨韧带】
- Muscle： muscles of facial expression [Stapedius, Stylohyoid, platySma （pla’tisma) 颈阔肌, belly of digastric 二腹肌
- Nerves: CN VII (facial expression - Smile)
- abnormalities:
Congenital pharyngocutaneous fistula：
persistence of cleft and pouch - fistula between tonsillar area and lateral neck
branchial arch (鳃弓) derivatives:
3rd arch:
- cartilage:
- Muscle
- Nerves:
- abnormalities
branchial arch (鳃弓) derivatives 总体口诀：
“At the restaurant of the golden arches, children first chew (1), smile (2) then swallow stylishly (3), or simply swallow (4) and then speak (6).
3rd arch:
1. cartilage: greater horn of hyoid 舌骨
- Muscle: stylopharyngeus 茎突咽肌 (innervated by glossopharyngeal n)
- Nerves: CN IX [stylopharyngeus - swallow stylishly]
branchial arch (鳃弓) derivatives:
4th - 6 th arch:
- cartilage:
- Muscle
- Nerves:
- abnormalities
branchial arch (鳃弓) derivatives 总体口诀：
“At the restaurant of the golden arches, children first chew (1), smile (2) then swallow stylishly (3), or simply swallow (4) and then speak (6).
4th - 6 th arch:
- cartilage: for thyroid, cricoid 环状软骨, arytenoid 杓状软骨, corniculate 小角软骨, cuneiform 楔骨
- Muscle:
1) 4th: pharyngeal constrictors, cricothyroid 环甲肌, levator veli palatini 腭帆提肌
2) 6th: all intrinsic muscles of larynx except cricothyroid - Nerves:
1) 4th: “simply swallow” - CN X (superior laryngeal branch)
2) 6th: “speak” - CN X (recurrent laryngeal branch)
4. abnormalities
branchial pouch derivatives:
1st pouch:
“Ear, tonsil, bottom-to-top”
1st pouch: “ear”
branchial pouch derivatives:
2nd pouch:
“Ear, tonsil, bottom-to-top”
2nd pouch: tonsil 扁桃体
epithelial lining of palatine tonsil 腭扁桃体
branchial pouch derivatives:
3rd pouch:
3rd pouch contributes to 3 structures:
thymus, left + right inferior parathyroids
3rd-pouch structures end up BELOW 4th-pouch structures (superior parathyroids)
branchial pouch derivatives:
4th pouch:
“Ear, tonsil, bottom-to-top”
dorsal wings develop into uperior parathyroids
DiGeorge Syn:
Cause?
Cx?
aberrant development of 3rd and 4th pouches :
1) thymic aplasia - T-cell deficiency
2) failure of parathyroid development - hypocalcemia
3) conotruncal anomalies
MEN 2A :
mutation?
Cx?
Multiple endocrine neoplasias (MEN) 2A
mutation of germ line RET (neural crest cells):
- adrenal medulla (pheochromocytoma)
- parathyroid tumor: 3rd/ 4th pharyngeal pouch
- parafollicular cells (medullary thyroid cancer): derived from neural crest cells, associated with the 4th/5th pharyngeal pouches
Cleft lip vs. cleft palate:
etiology:
Cleft lip: failure of fusion of the maxillary (上颌) and medial nasal processes - formation of 1° palate
cleft palate: failure of fusion of the 2 lateral palatine processes, - formation of 2° palate
Genital development:
which gender is default?
sex organs derived from?
which gender is default: female
sex organs derived from: mesonephron (interact with urogenital sinus)
female genital development:
哪种结构degenerate, 哪种develop (这种结构又名）？
female genital development:
哪种结构degenerate： mesonephric duct
哪种develop: paramesonephric duct develops
这种结构又名: Mullerian duct
male genital development:
重要的一个基因和2种细胞？分别分泌什么？功能？
- SRY gene on Y-chromosome:
- produce testis-determining factor
- testes development - Sertoli cells
- secrete Mullerian inhibitory factor (MIF) 否则米勒管就发育成女性生殖器官
- suppress development of paramesonephric duct
[记忆法：男性喜欢玩SM] - Leydig cells
- secrete androgens
- stimulate the development of mesonephric ducts
[记忆法：LA是SM的天堂]
Mullerian duct: 又名？
develop into?
abnormalities result in?
Mullerian duct: 又名paramesonephric duct
develop into: female internal structures (fallopian tubes, uterus, upper portion of vagina [note: lower portion from urogenital sinus]
abnormalities result in: anatomical defects, may present as 1° amenorrhea in females with normal 2° sexual characteristics (indicting the functional ovaries)
Wolffian duct: 又名？
develop into?
abnormalities result in?
Wolffian duct: 又名mesonephric duct
develop into male internal structures
[SEED: seminal vesicles 精囊，epididymis 附睾，ejaculatory duct 射精管，ductus deferens ]
complete failure of fusion of the paramesonephric ducts?
imcomplete failure of fusion of the paramesonephric ducts? - Can lead to?
complete failure of fusion of the paramesonephric ducts: double uterus and vagina
imcomplete failure of fusion of the paramesonephric ducts - bicornuate uterus 双角子宫
- Can lead to recurrent miscarriage
5a-reductase: function? deficiency results in?
5a-reductase converts T to DHT:
T: Wolffican duct becomes male internal genitalia (expect prostate) 男性内生殖器
DHT: male external genitalia + prostate
deficiency results in: male internal genitalia, but ambiguous external genitalia until puberty
Undiff. genitalis在男、女性中分别受什么激素影响，变成什么结构？
- genital tubercle
Undiff. genitalis在男、女性中分别受什么激素影响: DHT, E2
- genital tubercle:
- male: glans penis 龟头, corpus cavernosum 海绵体 and spongiosum
- female: glans clitoris 阴蒂头, vestibular bulbs
Undiff. genitalis在男、女性中分别受什么激素影响，变成什么结构？
- urogenital sinus
Undiff. genitalis在男、女性中分别受什么激素影响，变成什么结构？
- urogenital sinus:
- male: bulbourethral gland (of Cowper) 尿道球腺, prostate gland
- female: greater vestibular glands (of Barthlin), urethral and paraurethral glands (of Skene) 尿道旁腺
Undiff. genitalis在男、女性中分别受什么激素影响，变成什么结构？
- urogenital folds
urogenital folds:
- male: ventral shaft of penis (penile urethra) 尿道海绵体部
- female: labia minora
Undiff. genitalis在男、女性中分别受什么激素影响，变成什么结构？
- labioscrotal swelling
labioscrotal swelling 阴唇阴囊突起
- male: scrotum
- female: labia majora
hypospadias vs. epispadias: 定义？成因？各自associated with which disease?
hypospadias: 尿道下裂
abnormal opening of penile urethra on inferior side, due to failure of urethral folds to close
[more common, need to be fixed to prevent UTIs]
epispadias: 尿道上裂
abnormal opening of penile urethra on superior side, due to faulty positioning of genital tubercle 生殖结节
- associated with exstrophy of bladder
descent of testes and ovaries:
- gubernaculum
- processus vaginalis
- gubernaculum: 引带
- male: anchor testes in scrotum
- female: ovarian ligament + round ligament of uterus - processus vaginalis 鞘状突:
- male: form tunica vaginalis 鞘膜 [hydrocele 睾丸鞘膜积液的部位】
- female: obliterated
Gonadal venous drainage:
left vs. right:
varicocele is more common on which side?
“Left gonadal v. takes the Longest way”
varicocele is more common on which side: left
Gonadal lymphatic drainage:
left vs. right:
从内向外：
- ovaries/ testes: → para-aortic lymph nodes
- uterus, proximal vagina → obsturator (闭孔肌), external iliac and hypogastric nodes 下腹的
- distal vagina, vulva 女阴/ scrotum → superficial inguinal nodes
盆腔韧带：
- infundibulopelvic ligament 漏斗骨盆韧带：
又名？
connect what?
里面的结构？
notes?
又名: suspensory lig. of the ovaries
connect: ovaries to lateral pelvic wall
里面的结构: ovarian vessels
notes:
- ligate vessels during oophorectomy 卵巢切除术 to avoid bleeding
- ureter courses retroperitoneally, close to gonadal vessels; at risk of injury during ligation of ovarian vessels
盆腔韧带：
- cardinal ligament 漏斗骨盆韧带：
connect what?
里面的结构？
notes?
connect: cervix to side wall of pelvis
里面的结构: uterine vessels
notes: ureter at risk of injury during ligation of uterine vessels in hysterectomy 子宫切除术
盆腔韧带：
- round ligament of the uterus
connect what?
notes?
connect: uterine fundus to labia majora
notes: derivative of guber’naculum 引带; travels through round inguinal canal, above the A. of Sampson
盆腔韧带：
- broad ligament
connect what?
里面的结构？
notes?
connect uterus, fallopian tubes, and ovaries to pelvic side wall
里面的结构: ovaries, fallopian tubes, round lig. of uterus
notes: 含3个结构：mesosalpinx 输卵管系膜, mesometrium 子宫系膜, mesovarium 卵巢系膜
盆腔韧带：
- ovarian ligament
connect what?
notes?
connect medial pole of ovary to lateral uterus
notes: derivative of guber’naculum 引带; “ovarian Lig. Latches to Lateral utereus”
female reproductive epithelial histology:
从阴道 - 宫颈 - 子宫 - 输卵管 - 卵巢， 分别是什么上皮，有什么腺体？
MC site for cervical cancer?
female reproductive epithelial histology:
- 阴道 ， 宫颈 （ectocervix 外宫颈的): stratified squamous epithelium, non-keratinized
- transformation zone between ectocervix and endocervix: squamocolumaner junction (MC site for cervical cancer)
- endocervix: simple columnar epithelium
- uterus: simple columnar epithelium, with long tubular glands
- 输卵管 : simple columnar epithelium, many ciliated cells + a few secretory (peg) cells
- 卵巢: simple cuboidal 似立方形的epithelium (germinal epi covering ovary surface)
female sexual response cycle?
mediated by?
其他症状？
- excitement (uterus elevates, vaginal lubrication)
- plateau (expansion of inner vagina)
- orgasm (contraction of uterus)
- resolution
mediated by ANS
其他症状： tachycardia, skin flushing
pathway of sperm during ejaculation? 口诀？
“SEVEN UP”
seminiferous tubules 曲细精管
tunica albuginea: 白膜
prepuce: 包皮
glans: 龟头
ANS control of the male sexual response:
- erection: 由什么N控制？ 哪些神经递质？
- emission?
- ejaculation?
- erection: 由什么N控制：pelvic N (para-symathetic, “Point and Shoot”)
哪些神经递质: NO and cGMP
[sildenafil: 昔多芬,一氧化氮样药物,商品名Viagra(伟哥);
vardenafil: 伐地那非, 治疗ED]
- emission: 遗精：Sympathetic N (hypogastric nerve 腹下神经)
- ejaculation: visceral and somatic N (pudendal N)
spermatogonia:
function and location?
精原细胞
Sertoli cells:
function and location?
sensitive to?
function:
- secrete inhibin - inhibit FSH
- produce MIF - inhibit development of Mullerian duct (paramesonephric duct)
- secrete androgen-binding protein - maintain local level of T: aromatase converts T and androstenedione to E2
- Support and nourish spermatozoa, regulate spermatogenesis
“Sertoli cells Support Sperm Synthesis” - tight junctions between adjacent Sertoli cells form Blood-testis barrier - isolate gametes from autoimmune attack
sensitive to temperature (in cryp’torchidism 隐睾, varicocele)
Testosterone produced by?
If affected by temperature?
Testosterone produced by Leydig cells
If affected by temperature: No
estrogens:
- source? 各产生什么雌激素？potency比较？
- function?
which one indicates the fetal well-being during pregnancy?
which one indicates the fetal well-being during pregnancy: 1000-fold increase of E3
P4:
effect on ERs? gonadotrophins? prolactin?
- P4 ↓ ER expression
- inhibit gonadotrophins (LH, FSH)
- fall in P4 level after delivery disinhibits prolactin - lactation
menstrual cycle:
激素变化的顺序？
分哪2phase?
画出所有激素变化的曲线？
激素变化的顺序：
E2 ↑ - LH surge - ovulation - ↑ P4 - P4 fall - menstruation (apoptosis of endometrial cells)
分哪2phase: follicular phase, luteal phase
Define:
- oligomenorrhea
- polymenorrhea
- metrorrhagia
- menorrhagia
- metromenorrhagia
- oligomenorrhea: > 35-d cycle
- polymenorrhea: < 21-d cycle
- metrorrhagia: intermenstral bleeding
- menorrhagia
- metromenorrhagia
Oogenesis:
- meisosis I arrested at which phase? until?
- . meisosis II arrested at which phase? until?
- meisosis I arrested at prophase I, until Ovulation (to form 1° oocyte)
- . meisosis II arrested at metaphase II until fertilization (to form 2° oocyte)
mittelschmerz:
define:
和什么鉴别？
经间痛
Pregnancy期间4种最主要激素的变化？
implantation happens at when?
which cells make hCG?
implantation happens at 6 days after fertilization (子宫内膜最厚的时候）
which cells make hCG： syncytiotrophoblasts 滋养层细胞
lactation: 激素变化？
↓ E2 and P4: disinhibit lactation
- prolactin
- oxytocin 催产素, 缩宫素
hCG:
- source?
2: function? - structure?
- patho?
- source: syncytiotrophoblasts of placenta
2: function: maintain the corpus luteum and thus P4 for the 1st trimester by acting like LH - structure: alpha subunit structurally identical to alpha subunit of LH, FSH, and TSH
beta subunit: unique (detected in pregnancy test) - patho: ↑ in hydratidiform mole (葡萄胎), choriocarcinoma
menopause:
hormone change?
症状的口诀？
hormone change:
↓ E2, P4
↑↑ FSH (specific for menopause, lose feedback),
↑ LH (No surge)
↑ GnRH
症状的口诀： “HAVOCS”
spermatogenesis:
begin at when?
time to fully develop?
occur at location?
impaired sperm tail mobility seen in?
Ploidy, chromatids的变化图？
begin at when： puberty
time to fully develop: 2m
occur at location: seminiferous tubules
impaired sperm tail mobility seen in: ciliary dyskinesia / Kartagener syn
Androgens: 哪几种？分别在什么地方产生？potency? function? 转化？
Androgens:
哪几种： T, DHT, androstenedione 雄甾烯二酮
分别在什么地方产生:
T, DHT: testis
AnDrostenedione: ADrenal
potency: DHT > T > androstenedione
转化: T is converted to DHT by 5a-reductase [this E. can be inhibited by finasteride （非那司提(治疗良性前列腺增生)
function?:
1. T: 男性内部器官的分化（除了前列腺）， closing of epiphyseal plates (骺板) via E2 converted from T;
- DHT: 男性外部器官的分化+前列腺； 前列腺增生，秃顶，皮脂腺
Klinefelter syn: 基因型？表现型？ 激素变化？
male, XXY (多出来Barr body), 1: 850
瘦高体型，女性化乳房，阴毛为女性化分布。
激素变化:
↓ inhibin - ↑ FSH
↓ T - ↑ LH - ↑ E
Turner syn: 基因型？有无barr body?
表现型？ 激素变化？
Turner syn: XO [mitotic or meiotic error], female, 无barr body
MCC for 1° amenorrhea
基因型: can be complete monosomy (45 XO) or mosaicsm (45 XO/46 XX)
表现型: female,
- 平胸，short,
- ovarian dysgenesis (streak ovary)
- 心脏：bicuspid aortic valve, preductal coarctation 上下肢血压差：brachial pulse > femoral + notched ribs)
- lympathic defects: webbed neck, cystic hygroma 水囊状淋巴管瘤； lymphedema in feet and hands
激素变化:
↓ E - ↑ LH and FSH
True hermaphroditism: 基因型？表现型？
真两性同体
46 XX, or 47 XXY
ovotestis: 卵睾体, 两性生殖腺(卵巢睾丸并存)
Dx:
↑ T, ↑ LH
defective AR
Dx:
↑ T, ↓ LH
T-secreting tumor, exogenous steroids
Dx:
↓ T, ↑ LH
1 ° hypogonadism
female pseudohermaphrodite:
genotype? phenotype?
cause?
假两性体, 假半阴阳体
genotype: XX
phenotype: ovaries present, external genitalia ambiguous
cause: ↑ androgens during early gestation
male pseudohermaphrodite:
genotype? phenotype?
cause?
假两性体, 假半阴阳体
genotype: XY
phenotype: testes present, external genitalia female or ambiguous
cause: androgens insensitivity syn
Androgen insensitivity syn:
genotype?
Cx?
有无女性器官？有无男性器官？
Hormone变化？
genotype: 46 XY, 男性develop女性特征
Cx：female appearing,scant sexual hair
- 有无女性器官: female external genitalia with rudimentary vagina + absent ovary and fallopian tubes; scant sexual hair
- 有无男性器官: develop testis in labia major
Hormone变化: ↑ T, E, LH
Kallmann syn:
Cause?
属于哪一大类疾病的一种？
Hormone变化？
Cause: defective migration of GnRH cells and formation of olfactory bulb; fail to complete puberty - ↓ synthesis of GnRH in the hypothalamus, anosmia 嗅觉缺失症
属于哪一大类疾病的一种:
hypogonadotropic hypogonadism
Hormone变化: ↓ GnRH, FSH, LH
in males： low sperm count
in females: amenorrhea
Gestational HTN:
define:
Rx?
define:
- after 20 wks才出现 BP > 140/90, no pre-existing HTN
- no proteinuria or end-organ damage
Rx:
- 药物： HyLAN (Hydralazine, Labetalol, a-methyldopa, Nifedipine)
- deliver at 39 wks
preeclampsia
- define:
- Cx: mild / severe
- Cause
- Incidence ↑ with which conditions?
- complications
- Rx
先兆子痫
- define:
(mild) ：HTN > 140/90 + proteinuria (> 300 mg/24hr) between 20 wks gestation - 6 wks postpartum
- [与单纯的gestational HTN区别：妊娠期高血压无蛋白尿]
- if < 20 wks: suggest molar pregnancy 葡萄胎 - Cx:
severe: BP > 160/110 with or without end-organ damage （e.g., headache, scotoma 盲点， oliguria, ↑ AST/ALT, thrombocytopenia - Cause: abnormal placental spiral arteries - result in maternal endothelial dysfunction, vasoconstriction, or hyperreflexia
- Incidence ↑ with which conditions:
pre-existing HTN, DM, chronic renal disease, autoimmune - complications:
placental abruption, coagulopathy, renal failure, uteroplacental insufficiency, or eclampisa - Rx：
1） anti-HTN (HyLAN: Hydralazine, Labetalol, a-methyldopa, Nifedipine)
2) deliver at 34 wks (severe) or 37 wks (mild)
3) IV Mg sulfate to prevent seizure
Eclampsia:
Cx?
Cause of death?
Rx
Cx: preeclampsia + maternal seizure
Cause of death: stroke - intracranial hemorrhage or ARDS (Acute respiratory distress syndrome)
Rx:
1） anti-HTN (HyLAN: Hydralazine, Labetalol, a-methyldopa, Nifedipine)
2) deliver immediately
3) IV Mg sulfate to prevent seizure
HELLP syn
Cx?
Rx?
Hemolysis, Elevated Liver enzymes, Low Platelets
Placental abruption:
症状？
产科急症，life-threatening to both mother and fetus
症状: abrupt, painful bleeding in 3rd trimester
placenta accreta/ increta / percreta:
- Cause?
- risk factor?
- Cx?
植入胎盘的不同程度：
placenta accreta: 植入胎盘 (attached to)
placenta increta (penetrate into)
placenta percreta: 穿透性 (penetrate through - perforates)
- Cause: defective de’cidual 蜕膜的 layer - abnormal attachment and separation after delivery
- risk factor: prior C-section, inflammation, placenta pre via (前置胎盘),
- Cx: no separation of placenta after delivery - massive bleeding; life threatening for mother
ectopic pregnancy:
MC location? Suspect in which population? diff? how to confirm? Rx? Risk factors?
MC location: ampulla of fallopian tube
Suspect in which population: history with amenorrhea, low-than-expected rise in hCG, sudden lower abdominal pain with or without bleeding
diff: appendicitis
how to confirm: ultrasound
Rx: 甲氨喋呤
机制- folic acid analog that inhibits dihydrofolate reductase ⇒ ↓ dTMP ⇒ ↓ DNA (both purines and thymidine) and protein synthesis
用途: 2大临床应用：肿瘤及非肿瘤
1. cancers: leukemias, lymphomas, choriocarcinoma (绒毛膜癌), sarcomas
- non-neoplastic: abortion, ectopic pregnancy, autoimmune类
Risk factors:
- history of infertility
- salpingitis 输卵管炎, PID (Pelvic inflammatory disease)
- ruptured appendix
- prior tubal surgery
polyhydramnios:
define?
associated with?
羊水过多
define: > 1.5 - 2 L of amniotic fluid
associated with:
1. fetal malformations: esophageal / duodenal atresia, etc
oligohydramnios:
define?
associated with?
Profound one can cause?
羊水过少
cervical patho: Dysplasia or carcinoma in situ (CIN):
- define
- location to begin?
- classification?
- associated with viruses? encode which genes?
- Cx? Pap smear见什么特征？
- prognosis?
- risk factors?
- define: disordered epithelial growth
- location to begin: basal layer of squamocolumnar junction (transition zone)
- classification: CIN 1, 2, 3
- associated with viruses? encode which genes?
- HPV 16 and 18, producing both E6 gene product (inhibit p53) and E7 (inhibit RB suppressor) - Cx: asymptomatic (detected by pap smear; can present as abnormal bleeding - often postcoital 性交后的
Pap smear见什么特征: koilocytes 中空细胞， wrinkled “raisinoid” nuclei
- prognosis: if untreated, can progress slowly to invasive carcinoma
- risk factors:
- #1 !!! : multiple sexual partners
- smoking
- early sexual intercourse
- HIV infection
Cervical: invasive carcinoma:
patho 分型？
Pap smear can catch at which stage？
引起renal failure的原因？
patho 分型： squamous cell carcinoma
Pap smear can catch at which stage: cervical dysplasia (kilobytes)
引起renal failure的原因: lateral invasion
endometritis [,endәumi’traitis]
- define: what inflammation cells infiltrate?
- cause?
- Rx?
子宫内膜炎
- define: what inflammation cells infiltrate: plasma cells and lymphocytes
- cause: retained with products of connection following delivery/miscarrage/ abortion/foreign bodies such as IUD
- Rx: gentamicin+ clindamycin, with or without Amp
endometriosis:
- define: 良性恶性？
- cause?
- location?
- Cx? 子宫大小？
- Rx?
- diff?
子宫内膜异位
- define: non-neoplastic endometrial glands/storma outside of the endotmetrial cavity
- cause: retrograde flow, lymphatic transportation, metaplastic transformation of multipotent cells
- location: anywhere, MC site is the ovary (“chocolate cyst”) and peritoneum - 诊断上大便痛
- Cx： cyclic pelvic pain, bleeding, dysmenorrhea, dyspareunia [交媾困难】， dyschezia [pain with defecation 大便困难], infertility, 子宫大小正常
- Rx： NSAIDs, OCPs, progestins, GnRH agonists, surgery
- adenomyosis
adenomyosis
- define/与什么鉴别？
- cause?
- Cx? 子宫大小？
- Rx?
子宫肌腺病 （过去，曾将其称为内在性子宫内膜异位症，而其他部位的内膜异位症则称之为外在性子宫内膜异位症； 现在2者要鉴别）
- define: extension of endometrial tissue into the uterine myometrium
与什么鉴别: endometriosis [non-neoplastic endometrial glands/storma outside of the endotmetrial cavity]
- cause: hyperplasia of the basalis layer of the endometrium
- Cx: 临床上主要表现为痛经、经量增多与子宫增大。dysmenorrhea, menorrhagia
子宫大小: uniformly enlarged, soft, globular uterus
- Rx: hysterectomy
adenomyoma:
define:
contain what cells?
extend to?
腺肌瘤; 子宫内膜瘤
define: well-circumscribed collection of endometrial tissue within the uterine wall
contain what cells: SMCs
extend to endometrial cavity in the form of polyp
endometrial hyperplasia:
- define:
- cause?
- ↑ risk for?
- Cx?
- risk factors?
- define: abnormal endometrial gland proliferation
- MC cause: excess E stimulation
- ↑ risk for: endometrial carcinoma
- Cx: postmenopausal vaginal bleeding
- risk factors: anovulatory cycles 无排卵周期, HRT, POS (polycystic ovarian syn), ganulosa cell tumor
MC gynecologic malignancy?
- peak age:
- Cx
- risk factors?
- prognosis?
endometrial carcinoma:
- peak age: 55 -65
- Cx: vaginal bleeding, typically preceded by endometrial hyperplasia
- risk factors: prolonged use of E without progestins, obesity, DM, HTN, nulliparity 未经产, late menopause
- ↓ prognosis with ↑ myometrial invasion
leiomyoma:
Cx? # of tumors? 种族发病率？ 对什么激素敏感？ does it progress to leiomyosarcoma?
平滑肌瘤
Cx: MC tumor in females (20 -40);
of tumors: multiple, discrete
种族发病率: ↑ in blacks
对什么激素敏感：E
does it progress to leiomyosarcoma - no (benign)
Premature ovarian failure:
age?
hormonal change?
< 40
↓ E, ↑ LH, FSH
PCOS (polycystic ovarian syn, Stein-Leventhal syn):
- cause?
- hormonal change
- Cx?
- ↑ risk for
- Rx
MCC for infertility in women
- cause:
1) theca cells synthesize excess Androgens - hyperandrogenism
2) hyperinsulinemia
insulin and T ↓ SHBG (steroid hormone binding protein) - 这个作用会被E拮抗： E ↑ SHBG, ultimately ↓ free T
- hormonal change:
↑ LH, ↑ FSH (3: 1), ↑ T, ↑ E (from aromatization) - Cx: enlarged, bilateral cystic ovaries; amenorrhea/oligomenorrhea, hirsutism, acne, infertility
- ↑ risk for endometrial cancer
- Rx:
1) hirsutism, acne: weight reduction, OCPs, anti androgens
2) infertility: clomiphene citrate 克罗米酚柠檬酸盐 (blocks negative feedback of circulating E, ↓ FSH, LH
3) metformin for insulin insensitivity
4) cyclic P4 to protect endometrial
ovarian neoplasm:
MC in age? 胚胎起源 MC type? risk factors? Cx Dx monitor
can be benign or malignant
MC in age: < 55
胚胎起源: > 95% epithelial
MC type: serous cystadenocarcinoma
risk factors: ↑ age, infertility endometriosis, PCOS, genetic (BRAC-1/2, HPNCC, family history)
Cx: adnexal 子宫附件mass, abdominal dissension, bowel obstruction, pleural effusion
Dx: surgically
monitor: CA-125
Dx for ovarian neoplasm:
MC type;
serous cystadenoma
Brenner tumor:
define
良恶性？
gross appearance?
H&E staining
rare ovarian tumor, most are benign but can be malignant
“looks like bladder”
solid tumor, pale yellow-tan in color + capsulated
“coffee bean” nuclei on H&E staining
Meigs syndrome:
triad
histology
triad: ovarian fibromas + ascites + hydrothorax
ovarian teratoma:
benign/mature contains
malignant/immature contains
ovarian teratoma:
benign/mature contains thyroid tissue
malignant/immature contains embryonic-like neural tissue
granulosa cell tumor:
MC age
hormone change
Cx
histo
MC age: 50s
hormone change: E and/or P4
Cx: abnormal uterine bleeding, breast tenderness, sexual precocity 性早熟 if in pre-adolescents
histo: Call-Exner bodies [small eosinophilic fluid-filled spaces between granulosa cells. The granulosa cells are usually arranged haphazardly around the space.]
MC malignant ovarian tumor?
单、双侧？
histo特征？
serous cystadenocarcinoma
浆液性囊腺癌
frequently bilateral
histo特征: Psammoma bodies
mucinous cystadenocarcinoma
粘液性囊腺癌
pseudomyxoma [ˌpsju:dəumik`səumə]
假粘液瘤：腹膜上的胶样生长物，常继发于卵巢囊肿
dysgerminoma:
MC in which age?
histo特征？
marker?
无性细胞瘤：一种恶性卵巢赘生物，来源于未分化胚胎性性腺原始生殖细胞，它是典型的睾丸精细胞瘤的复本(seminoma)，在肉眼和组织学上都与精细胞瘤相同
MC in which age: in adolescents
histo特征: “fried eggs”
marker: hCG, LDH
choriocarcinoma:
什么细胞的肿瘤？ are chorionic villi present？ Cx? 扩散途径 Rx
绒毛膜癌
由胎盘上皮立方细胞及合体细胞异常增生而形成的滋养层细胞恶性上皮癌，但无绒毛产生。所有病例几乎均在子宫发生，可由葡萄胎发展而来(50％)，或在流产后(25％)或在正常妊娠中(22％)发生。其余发生于子宫外妊娠以及生殖器(卵巢及睾丸)和生殖器外畸胎瘤
yolk sac tumor (endodermal sinus tumor)
age?
gender
histo
tumor marker
卵巢内胚层窦瘤,卵黄囊瘤
age: young children, MC tumor in male infants
gender: both
histo: hemorrhagic, solid mass; “Schiller-Duval bodies”
tumor marker: AFP
Krukenberg tumor:
GI malignancy, blood metastasize to the ovaries, causing a mucin-secreting signet cell adenocarcinoma
Gestational diabetes mellitus:
cause?
↑ insulin resistance
caused by:
1) hPL (human placental lactogen) 人胎盘催乳素
2) GH, E, P4, glucocorticoids
Vaginal tumors:
- SCC: 病因？
- clear cell adenocarcinoma 病因？
- sarcoma botryoides: 人群？ tumor cell shape? marker?
- SCC: 2° to cervical SCC
- clear cell adenocarcinoma: exposed to DES in utero
- sarcoma botryoides 葡萄状肉瘤: 人群: < 4-yr girls,
tumor cell shape: spindle-shaped,
marker: desmin
Fibroadenoma:
发生部位？ 良恶性 characteristics epidemiology 和激素相关？ is it a precursor to breast cancer?
发生部位: breast stroma
良恶性: benign
characteristics
epidemiology
和激素相关？
is it a precursor to breast cancer?
intraductal papilloma:
发生部位？
良恶性
characteristics
risk for breast cancer?
发生部位: in lactiferous duct, typically beneath areola
良恶性: benign (注意：虽然有血性渗液，还是良性）
characteristics： serous or bloody nipple discharge
risk for breast cancer: slight increased risk for carcinoma
Phyllodes tumor
发生部位？ 良恶性 characteristics epidemiology risk for breast cancer?
叶状肿瘤
发生部位: breast stroma (small, vs Phyllodes tumor - large, 大的乳房基质肿瘤）
良恶性： benign (but may become malignant)
characteristics: large stroma tumor (vs. small fibroadenoma); “leaf-like” projections
epidemiology: > 60
risk for breast cancer: may
Malignant breast tumors:
usually arise from?
triple negative?
the single most important prognostic factor?
ethnicity
usually arise from: terminal duct lobular unit
triple negative: ER-, PR, Her2/Neu -
the single most important prognostic factor: axillary lymph node metastasis
ethnicity: ↑ in AA
define:
DCIS (ductal carcinoma in situ):
arise from
mammography见到征象？
pathology
有无basement mem penetration?
DCIS : noninvasive 乳腺癌，早期
arise from：ductal atypia 不典型囊性导管
mammography见到征象： early micro calcifications
pathology: tumor confined to the duct and blood vessels
有无basement mem penetration- no
comedocarcinoma : define
发生部位？
病理特点？
粉刺性癌，noninvasive breast cancer, DCIS subtype
发生部位 - ductal
病理特点: caseous necrosis
“large cells in epidermis with clear halo” - name these cells
If see on nipples, indicate
if see on vulva, indicate
“large cells in epidermis with clear halo” - Paget cells
If see on nipples, indicate: DCIS
if see on vulva, usually no underlying malignancy
Invasive ductal breast cancer:
外观
细胞形态
classic infiltration?
prognosis
外观: firm, fibrous, “rock-hard” mass, sharp margins
细胞形态: small, glandular, duct-like cells
classic infiltration: “stellate” 星状的
prognosis: worst (but it’s the MC form)
invasive lobular breast cancer:
patho characterisics
单，双侧？
patho characterisics： orderly row of cells (Indian file)
often bilateral with multiple lesions in the same location
medullary breast cancer:
细胞浸润？
Px?
fleshy, cellular, lymphocytic infiltrate
good prognosis
inflammatory breast cancer:
特点？
Px?
橘皮样变
bicornuate uterus / uterus didelphys:
caused by which embryologic failure?
detected by?
双角子宫/双子宫
failure in fusion of the paramesonephric ducts
detected by hysterogram 子宫X线照相
enterobiasis [ˌentərəu`baiəsis]
age
life cycle
Dx
Rx
蛲虫病：蛲虫属线虫感染，主要是蠕形住肠线虫，即蛲虫
age: 5- 10
life cycle: live in intestine, lay eggs in perianal area - perianal itching (pruritus ani)
Dx: “Scotch tape” test
Rx:
mebendazole [mi`bendəzəul]〕甲苯达唑
albendazole 丙硫咪唑,扑尔虫,抗蠕敏
If elder pt presents high fever, skin flushing, low BP, tachycardia:
Dx?
MCC - which bacteria, from where？
Dx: septic shock
MCC: E.coli - UTI
Proliferative breast disease:
Cx
if ↑ risk for cancer
histologic types/ MC age
Cx: MCC for “breast lumps” > 25 to menopause; premenstrual breast pain and multiple lesions, often bilateral; fluctuation in sizes;
if ↑ risk for cancer: depends
histologic types/ MC age :
1) fibrosis - hyperplasia of stroma
2) cystic - ductal dilation, fluid filled
3) sclerosing adenosis
4) epithelial hyperplasia
acute mastitis:
MC bac
Rx
MC bac: S. aureus
Rx: dicloxacillin 双氯青霉素 + continued breast-feeding
fat necrosis of breast
MCC
mammography见？
biopsy见
MCC： trauma
mammography见abnormal calcification
biopsy见 necrotic fat, giant cells
gynecomastia:
causes, 口诀？
causes：
- hyperestrogenism: cirrhosis, testicular tumor, puberty, old age
- Klinefelter syn
- drugs: “Some Dope Drugs Easily Create Awkward Hairy DD Knockers”
Prostatitis:
MC bac
Acute: E.coli
chronic: abacterial
BPH (benign prostate hyperplasia)
age patho which lobes hyperplasia marker Rx
age: > 50
patho: hyperplasia, not hypertrophy! (看名字就知道了！）
which lobes hyperplasia： lateral + middle
marker: ↑ free PSA
Rx:
1) a1-antagonists to relax SMC (osin, 高血压药和BPH):
terazosin 特拉唑嗪,
tamsulosin 坦(索)洛新
2) finasteride : anti- 5a reductase 非那司提(治疗良性前列腺增生)
prostate adenocarcinoma:
location
Dx
markers
metastasis , indicated by
location: posterior lobe
Dx: ↑ PSA + needle core biopsy
markers: ↑ PSA and PAP, with ↓ fraction of free PSA
metastasis - bone
indicated by: lower back pain, ↑ ALP, PSA
crytorchidism:
change to:
T, inhibin, FSH, LH
T: normal in unilateral, ↓ in bilateral
↓ inhibin,
↑ FSH, LH
testicular tumors: 分2大类（再分细类），各占多少比例？良恶性
- germ cell tumor > 95%： malignant if not transilluminate 透照
- non-germ cell tumor: 5%
seminoma:
良恶性
age
patho, 与什么部位的肿瘤类似？
marker
特殊的激素变化？
Rx
Px
精原细胞瘤
良恶性: malig
age: ~ 30, nerv in infancy
patho: similar to germinoma in pineal gland region!
marker: ↑ placental ALP
特殊的激素变化： ↑ hCG，
Rx: radiosensitive
Px: great
choriocarcinoma in testicular region:
良恶性
转移部位？
Cx
特殊的激素变化？
良恶性: mag, ↑ hCG
转移部位: brain + lung (may Cx as “hemorrhagic stroke”)
Cx: may gynecomastia + hyperthyroidism
特殊的激素变化: ↑ hCG - analog of LH and FSH
teratoma in testis:
良恶性
特殊的激素变化？
良恶性 mag
特殊的激素变化: ↑ hCG and/or AFP
embryonal carcinoma in testis:
良恶性
patho
Px
Cx
特殊的激素变化？
良恶性 mag
patho: often glandular/papillary
Px: worse than serminoma
Cx: painful, hemorrhagic mass with necrosis
特殊的激素变化: ↑ hCG, AFP depends
tunica vaginalis lesions:
diff with testicular tumor?
分类
鞘膜
diff with testicular tumor - transilluminate 透照
分类：
- hydrocele 睾丸鞘膜积液
- spermatocele [`spə:mətəuˌsi:l] 精液囊肿,精子囊肿
squamaous cell carcinoma of the penile:
地域分布
Precursor in situ lesion?
viral association?
地域分布: Asia, Africa, South America
Precursor in situ lesion: “Bowen disease”
viral association: HPV
