Exam 1 Review Flashcards
What are the Homolog Structures for both Male and Female Gonads?
Male = Testes Female= Ovaries
What are the Homolog Structures for both Male and Female Genital tubercle?
Male = Penis Female= Clitoris
What are the Homolog Structures for both Male and Female Urethral swellings?
Male= Scrotum Female= Labia majora
What are the Homolog Structures for both Male and Female Urethral folds?
Male= Spongy urethra Female= Labia minora
What are the Homolog Structures for both Male and Female Urogenital sinus ?
Male= Prostate, Cowper’s glands, Bladder, Urethra Female= Skeens glands, Bartholin’s glands, Bladder, Urethra, L vagina
What are the Homolog Structures for both Male and Female Wolffian Duct ?
Male= Rete testis, Epididymis, Vas Deferens, Seminal vesicles Female= Rete ovarii
What are the Homolog Structure for both Male and Female Mullerian Duct ?
Male= Appendix testis Female= Fallopian tubes, Uterus, Upper vagina
- What is the SRY gene?
- What does it mean in the absence of the gene?
- The key to sexual dimorphism is found on the short arm of the Y chromosome, called the Sex-determining region on Y, which is testis-determing factor.
- Initiates male development and formation of male testes.
- Testes secrete MIS to degenerate female ducts
-In it’s absence, female development is established.
In the indifferent stage, What are the 2 pairs of male and females genital ducts?
1) Mesonephric (Wolffian ) Ducts
2) Paramesonephric (mullerian) Ducts
What do the paramesonephric (mullerian) Ducts differentiate into in Males?
(Mesophretic Duct)
In Males, The “paramesonephric duct degenerates”
Mesophretic Duct-
Distal: becomes the SEMINAL VESICLES, EJACULATORY DICT & the VAS DEFERENS.
Proximal: portion drains the testes (rete testis, efferents, and epididymis)
What do the paramesonephric (mullerian) Ducts differentiate into in Females?
Female: The Mesonephric Duct degenerates
- CRANIALLY the Paramesonephric Duct opens into the abdominal cavity with a funnel-like structure, which will become the fallopian tube fimbria.
- CAUDALLY, contacts the early urogenital sinus and later (about 2 months) fuses with duct on opposite side and forms the Uterine Canal ( Uterus, Cervix and Vagina- upper 1/3)
–The upper vagina, cervix, uterus, fallopian tubes and ovaries form from the Mullerian (paramesonephric) Duct
1) Describe the migration of the primitive germ cell?
- Where do they begin?
- Where do they insert?
1) Mesenchymal or stem cells that develop in the WALL of the YOLK SAC near the allantois migrates along the mesentery of the hindgut (3 wk).
2) The primordial germ cells continue migration until they reach the gonadal RIDGES and penetrate in the PRIMITIVE GONAD (6 wk).
3) Land on the proliferating epithelium. Gonads still indiff. yet.
4) Before/during arrival of premoriddal germ cells overyling mesecnchyme forming a # primitive sex cords
- Some primordial germ cells are surrounded by these
What structures develop from the production of the Urogenital Sinus then the canalization that has to do with some external and internal female reproductive structures?
Lower 2/3 of the vagina develop from POSERIOR wall the urogenital sinus.
- ANTERIOR wall of urogenital sinus forms BLADDER and URETHRA.
- -The HYMEN originates from the embryonic vagina BUDS from the Urogenital Sinus. It becomes perforated forming a central canal w/ communication between the upper vaginal tract & the vestibule of the vagina
-FIRST the contact of the urogenital sinus by the Paramesonephric Ducts induces formation of the Sinovaginal bulbs, a collection of endoderm from the wall of the urogenital sinus (21-22 slide)
- What is DES?
- What does it cause?
- Why was it given?
- DES-Diethylstilbesterol (morning after pill). A synthethic estrogen was using in the 1940-50’s for high-risk pregnancies (prevents abortion)
- It causes: 1) Vaginal Adenosis (benign) 2) Clear Cell Carcinoma (malignant)
- Rare cases of clear cell adenocarcinoma of the vagina have also occurred in the daughters of women treated with DES
Regarding DES, What are the manifestations of a imperforate hymen in newborn versus adolescent?
Imperforate hymen in neonate = Mucocolpos
-At birth, the presence of increased mucus secretions in the vagina secondary to maternal estrogen effects may result in a Mucocolpos appears as bulging hymenal membrane between the labia. White membrane because of the trapped mucoid material & may lead to urinary tract infections or bladder obstruction due to urethral compression.
- Imperforate hymen in adolescent = hematocolpos
- presents with primary amenorrhea (most common) so the presence or absence of secondary sexual characteristics should be noted
SYMPTOMS: lower abdominal or pelvic pain that may be cyclic, back pain, urinary retention and constipation
Diagnosis: Examination of a distended, bluish hymenal membrane in the introitis, due to collected menstrual blood (hematocolpos).
-How does DES cause Vaginal Adenosis?
**Histologically what is vaginal adenosis? (how does it manifest?)
-Occurs in daughters exposed in Utero to DES
-Refers to failure of the normal glandular epithelium that lines the embryonic vagina to be replaced by squamous epithelium during fetal development.
(The glandular cells undergo squamous metaplasia)
- In the 1970’s, there was a substantial increase in the incidence of this disease.
- At the 10th week of gestation squamous epithelium derived from the urogenital sinus replaces the glandular (mullerian) epithelium lining the vagina & exocervix.
- DES exposure anywhere from the 10th to 18th week of gestation, arrests this transformation process & glandular tissue remains within the vagina (adenosis)
- Manifests grossly as red, granular patches on the vaginal mucosa, disappear as the woman gets older.
**Microscopically, there is mucinous columnar cells, similar to the endocervix, along with ciliated cells w/ eosinophilic cytoplasm, similar to the lining cells of fallopian tube and endometrium.
How does DES cause Clear Cell Adenocarcinoma ?
What is the both benign and malignant component of it?
Clear Cell Adenocarcinoma
- A rare tumor of the vagina encountered exclusively in women exposed to Diethly-stilbesterol (DES).
- Develops most frequently on the anterior wall of the upper third of the vagina.
- Most common between ages 17 & 22
- Abundant glycogen account for the clear nature of the cytoplasm and they are essentially curable when small & asymptomatic
- Although almost all cases of clear cell adenocarcinoma are associated with vaginal adenosis, very few women with adenosis develop this cancer.
- In more advanced stages, they may spread by hematogenous or lymphatic routes.
What part of the histology of the female genital tract would you expect to find fimbrae, vestibule, and barthiarn glands, rugue, corpus luetum, and tunica albuginea?
Surrounded by a fringe of finger-like projections = FIMBRAE (fallopian tube)
- The cleft between the LABIA MINORA is the VESTIBULE and contains hymen, vaginal orifice, urthera, and the opening of several ducts. (The Vulva)
- BARTHOLINS = These produce mucoid secretion that supplements lubrication during sexual intercourse. (The Vulva)
RUGAE= Allow good distention. Muscularis is composed of s. muscle (Vagina)
CORPUS LUTEUM= Glandular body develops from graffian follicle after extrusion of the ovum. Produces progesterone & estrogens (Ovaries)
TUNICA ALBUGINEA= Capsule of collagenous C.T deep to the germinal epithelia. (Ovaries)
What do the premature sex cords develop into in the female reproductive tract?
- Follicular cells
- The primitive sex cords become cell clusters containing primitive germ cells within the outer, active surface epithelium.
- By 4 months, these cell clusters of primitive sex cords from the surface epithelium, surround the primitive germ cells (oogonia), forming follicular cells
Collectively this would be the ova surrounded by the follicles.
What type of cancers will there be in vulvar
- Age diagnosed?
- How does it present?
- What is VIN?
- Symptoms?
- Histologically?
- Treatment?
- Accounts for 3% of all GYN cancers.”
- It is a carcinoma of older women, diagnosis is 60 yrs.
The tumor on the external genetalia and presents as a wart-like or slightly raised mucosal lesion/ ulcers. Invasive cancer is preceded by Carcinoma Insitu (CIS), and this is called Vulvar Intraepithelial Neoplasia (VIN).”
-Preneoplastic lesions may also lead to invasive cancer, such as Leukoplakia.” (ie. leukoplakia is a preneoplastic lesion
-SYMPTOMS: itching, discomfort, pain, bleeding, but a significant number of patients are asymptomatic.”
- HISTOLOGICALLY: the tumor presents as a Squamous Cell Carcinoma, slow growing.
- If the diagnosis is made before it has metastasized to the lymph nodes, the patient has a 70% chance of a 5 year survival following surgical resection. (If spread to the lymph nodes = less favorable prognosis)
TREATMENT: Surgical resection of the tumor or the entire vulva, supplemented w/ radiation/ chemo.
What type of cancers will there be in the vaginal?
- Accounts for what % of GYN cancers?
- What cell type cancer?
- What is the survival rate?
- “Accounts for 2% of all GYN cancers.”
- “It is also a disease of older women, historically a Squamous Cell Carcinoma. Accounts for over 90% of ALL primary malignant tumors of the vagina.”
- “Detected only upon GYN examination.”
- “5 Yr. survival rate for tumors confined to the cagina (Stage I) is 80%, wheras it is only 20% for those with extensive spread (Stage IV).”
What type of cancers will there be in the cervical?
- accounts for what %?
- What is the reduced rate of mortality due to?
- “Accounts for approx. 20% of all malignant tumors of the female reproductive tract, but accounts for more deaths than cancer of the body of the uterus, vagina, and vulva together.”
- “The reduced mortality over the last 50 years is b/c of early detection of cervical cancer and related pre-neoplastic conditions by routine use of PAP smears.”
- What are the dysplasias ?
Dysplasia - lack of normal maturation of squamous epithelium.
These transformed cells do not respond to normal regulatory stimuli in the tissue. They don’t mature, but remain undifferentiated & proliferate uncontrollably.
( a developmental disorder or an early stage in the development of cancer)
how are Dysplasisas graded by the pathologist (leading up to an invasive cancer of the cervix) (CIN1, CIN2, CIN3)
They are graded on a scale of CIN-I (mild), CIN-II (moderate), CIN-III (severe).
Severe dysplasia may progress to carcinoma that is limited to the BM called Carcinoma In-Situ (CIS). Carcinoma cells may cross the BM and invade the underlying CT stroma. This is now invasive carcinoma and tumors can spread locally or by invading the lymphatics & bloodstream, & metastasize to distant sites.
-Many severe dysplasias will progress to CIS and later to invasive cancer if left untreated (40-50%)
Some mild & moderate dysplasias (20-30%) may follow the same course.
EARLY TREATMENT: removed surgically w/ a knife, laser, or cryotherapy (so invasive cancer prevented)
