Male Repro Flashcards

Question

serum PSA

Answer 1

marker for prostate carcinma found in serum

Answer 2

* Starts by having those spermatogonia, at the time of puberty when testosterone levels reach the right number, divide mitotically * Will undergo a number of mitotic divisions giving rise to two types of spermatogonia that, histologically, you cannot tell the difference: * Type A spermatogonia: remain always associated with basal lamina and always remain as germ cells to give rise to the next wave **•Type B spermatogonia: These enter and continue the process to develop into spermatozoa**

Answer 3

* Benign glands (stratified epithelium) containing atypical cells [nucleoli] * Precursor lesion * Increased risk for development of prostate cancer

Answer 4

* Most common cancer in men: 25-40 yrs old * Presents with painless enlargement of testis or with metastasis * Wide spectrum of cellular differentiation – complex classification **•Characteristic marker : oncogenes duplicated on short arm of chromosome 12 (= isochromosome 12p = i12p)**

Answer 5

AM - T levels highest (AM erection phenomenon lost n poor sleepers, night workers

Answer 6

* Golgi phase: Golgi produces granules that coalesce to eventually produce acrosome * Acrosome phase: Acrosome becomes fairly complete, mitochondria being to move to mid piece, and centrioles move to opposite pole you get the developing complex that will give rise to the spermatozoa * Enveloping sertoli cell phagocytosizes excess cytoplasm, or residual body, in maturation phase. * When released, this is called spermiation * The acrosome contain a number of hydrolytic enzymes * Not clear if sole function is to get through zona pellucida or whether there is mechanical shearing in addition

Answer 7

testicular failure (viral, klinefelters)

Answer 8

* At higher magnification can get an appreciation of highs and lows of epithelium (black arrow) * This will lead into epididymis on the bottom (blue arrow) * Round, see stereo-cilia projecting up into the lumen

Answer 9

"BPH" glandular and stromal hyperplasia high proportion of men by 80s diffuse and nodular enlargement, compression of urethra glandular areas and stromal tissue increases

Answer 10

prostate cancer (acutally prbably safe) breast cancer BPH

Answer 11

sertoli cells and spermatogonia ## Footnote * Between the tubules there are clumps of cells = interstitial cells of Leydig * They don’t sit in the seminiferous tubules

Answer 12

NO T treatment suppresses spermatogenesis - has a low T but giving T will make it worse

Answer 13

Effects: incomplete emptying of bladder leading to nocturia Causes bladder to hypertrophy and thicken muscle Predisposition to bacterial infection bc don’t empty bladder totally

Answer 14

hypothalamic or pituitary dysfunction

Answer 15

spermatozoa are released inot the lumen after spermatogenesis

Answer 16

•Another picture of a prostatic concretion and nicely showing the pseudo-stratified columnar epithelium that makes up this gland

Answer 17

twisting of vascularsupply infarction swollen dusky scrotum - extremely painful predisposing causes - incomplete descent, atrophy, trauma immediate surgery

Answer 18

prob of cranial development can't smell pituitary and hypthaamaus not connected

Answer 19

•Higher power showing penile urethra (black arrow) and glands of Letray (blue arrow) and connective tissue

Answer 20

signs and symtoms total T checked in AM less than 350

Answer 21

* obesity * diabetes * prior injury to testes * secondary – thyroid, anabolic steroids

Answer 22

undescended testis do not descend into scrotal sac can stop anywhere not due to hormonal disorders * Histologic changes occur after 2 years –recommended to perform surgical correction by 2 yrs * Risk of trauma, infertility and 5-10 x increase in risk of tumor development

Answer 23

* Seminal vesicles on top left (black arrow) with finger-like projections * Prostate gland (yellow arrow) and prostatic urethra (blue arrow) * What is unique about the prostate gland is that it is a fibromuscular organ loaded with elastic tissue and a LOT of smooth muscle * It is called tubular alveolar because it doesn’t have a single duct * When it contracts forcefully the fluid is sprayed into the urethra through a number of different ducts * Analogy: squeeze a wet sponge -\> water will spray everywhere and not just in one place

Answer 24

prostate ## Footnote Prostate Folded medium sized glands Several layers line it Concretions (debris in lumen)

Answer 25

A condition in which the opening of the penis is on the underside rather than the tip.

Answer 26

drowsiness, dizziness, insomnia, nausea, sexual dysfunction

Answer 27

An epispadias is a rare type of malformation of the penis in which the urethra ends in an opening on the upper aspect (the dorsum) of the penis. It can also develop in females when the urethra develops too far anteriorly.

Answer 28

vas deferens * Here is a tubular organ that is very muscular: * 3 layers of smooth muscle = inner longitudinal layer, circular layer and outer longitudinal layer * How to distinguish this from ureter? * Epithelium! * This is pseudo-stratified columnar epithelium, it would be transitional in ureter

Answer 29

•Haploid spermatids undergo spermiogenesis and develop into spermatozoa. Three specific phases can be found: **•Golgi phase:** Golgi apparatus begins to produce granules that will bleb off the trans-golgi, fuse with one another and turn into the acrosome **•Acrosomal phase:** Fusions of granules continue and spread over anterior surface of what will be the condensed nucleus. Centrioles will also migrate to the OPPOSITE pole as the acrosome because from centrioles will come flagella •Chromatin will begin to condense and mitochondria begin process of moving towards neck region **•Maturation phase:** Acrosome is fully formed, flagella is fully formed, mitochondria are wound around mid-piece and there’s an awful lot of cytoplasm that has to be blebbed off and thrown away * That bleb is called the residual bodies * At the end of the maturation phase, spermatozoa is ready to be released into the lumen to move onto next phase * Sperm that finish in the seminiferous tubules during this process of development are incapable of fertilizing an egg. Look fine, but still need to be tuned up in epididymis

Answer 30

sympathetic (and somatic) S2-S4 bladder neck closes relaxation of external (striated) urinary sphincter rhythic contraction of bulbospongiosus/pelvic floor muscles

Answer 31

* diabetes * radical pelvic surgery (prostatectomy) – chance to regain erection function at 2 years

Answer 32

* Prostate CAncer gene 3 – non-coding RNA * Urinary biomarker * Determined in urine collected after rectal exam (prostate massage) * Supplements PSA – low sensitivity, higher specificity * With PSA -Reduces number of unneeded biopsies

Answer 33

smooth muscle cells of sinusoids/arteries increase intracellular Ca – erection * cell relaxed by sequestration of Ca à drive Ca into ER * reset: phosphodiesterase 5 – breaks down cAMP, GMP – turn off event *

Answer 34

most common testicular tumor solid, pale, hemotgenous lobules of uniform round clear cells surrounded by fibrous septa containing lymphocytes

Answer 35

testicular tumor ## Footnote * Peak age = 30 years * Macro: Varied appearance, hemorrhage & necrosis * Micro: Sheets, papillary or glandular patterns, marked anaplasia (variation in nuclear size and shape) * Keratin expression + (immunohistochemistry) [neg in seminoma]

Answer 36

* Connection between mediastinum of testes and epididymis is called efferent ductules * Easy to see efferent ductules because they have scalloped appearance (highs and lows, highs and lows) * Epithelium covering this is made up of alternating cuboidal cells and tall columnar ciliated cells Function of these cells is to sweep and move things “downhill”

Answer 37

Sertoli Cells

Answer 38

first phase of spermatogenesis * Starts by having those spermatogonia, at the time of puberty when testosterone levels reach the right number, divide mitotically * Will undergo a number of mitotic divisions giving rise to two types of spermatogonia that, histologically, you cannot tell the difference: * Type A spermatogonia: remain always associated with basal lamina and always remain as germ cells to give rise to the next wave * Type B spermatogonia: These enter and continue the process to develop into spermatozoa * During spermatocytogenesis, spermatogonia undergo a number of divisions eventually giving rise to a primary spermatocyte

Answer 39

pituitary adenoma or other CNS lesion (brain)

Answer 40

testis failure i.e. klinefelters testicles don't work and trying to compensate

Answer 41

Over treating prostate (indolent cancer) Gleason 6 is considered indolent- wont metastasize and won’t die form it So treat Gleason 7-10 but NOT Gleason 6 For Gleason 6– active surveillance – rebiospy every 6 months for 3 years and if changes score (biopsy different region not progression of disease) then offer surgery For higher scores: surgery - radical radiation - pellets in prostate and external beam hormonal than chemo if metastatic

Answer 42

* suppository – put it an inch into the penis * corpus spongeosum has own blood supply * pellet falls out and comes out and is absorbed * erection can be really really sore – prostaglandins from pain * for people who have spinal cord injury and can’t feel anything

Answer 43

obesity T to E in periph

Answer 44

Minimally invasive surgery– tunnel out pieces of prostate using scope up the urthera TRUP- trans-urtehral R of prostate

Answer 45

Androgen Binding Protein (ABP) - binds T (from Leydig cells) to keep concentration high in tubules for spermatogenesis ## Footnote •MIF to cause degradation of mullerian ducts

Answer 46

* Penis has erectile tissue, deep artery in the center of the corpus cavernosum * Urethra runs through corpus spongiosum

Answer 47

Alpha blockers– relax smooth muscle, open up urethra

Answer 48

nondisjunction - poor fertility

Answer 49

* If you see a dividing cells (blue arrow), it’s probably a primary spermatocyte * The secondary ones go quickly to spermatids

Answer 50

5HT-1 enhances seuxal response (can be hypersensitive in PE) 5HT-2 inhibits sexual response

Answer 51

FDA approved OTC topical lidocaine only deep nerves for ejaculation not sensory nerves

Answer 52

cause: UTI bacteria (E coli, gram neg) neutro[hils symp: dysuria, frequency, lower back pain diagnosis: fractionated urine (after palpation of prostate see if there are more neutrophils) treat: abx

Answer 53

* Following straight tubules you get to rete testis. * Rete testis have cuboidal cells lining the ducts * These cells, along with sertoli cells, have one major function to absorb fluid from cohort of sperm that have been shed into duct

Answer 54

straight from seminiferous tubules ## Footnote * Seminiferous tubules are blind ended ducts that begin and end at the mediastinum of testes * As you get to the end of ducts, the germinal epithelium goes and your left with sertoli cells that form the walls of the next intratesticular ducts which are called your straight tubules

Answer 55

1. spermatocytogeneis = spermatogonia to primary spermatocytes 2. meiosis = Primary spermatocyte that are formed now undergoes a process called meiosis and you end up with haploid cells 3. spermiogeness - golgi phase, acrosome phase, maturation phase to become spermatozoa 4. spermiation -•Sperm are released into the lumen

Answer 56

1 + 2 are benign 3 - glands 4 - cords 5 - solid sheets find the top 2 patterns and add the numbers together 5 diagrams (scores) Heterogeneous disease – so look at most common cancer pattern then the second Take the patterns and add those 2 numbers and get the Gleason score out of 10 Closer to 10 predicts worse 1 and 2 found to be benign though so really looking at 3-5 3à start to form singular glands 4à start to form cords of glands 5à they form sheets of glands

Answer 57

* Sertoli cells are cells with triangular shaped nucleus with a prominent nucleolus * The cytoplasmic reaches of sertoli cells are intimately associated into EVERY single one of the various developing cohort of sperm **•Sertoli cells attach very tightly (via tight junctions with the basal lamina) and form the blood-testes barrier** •NOTHING gets through that barrier because the spermatogonia that existed at the beginning is recognized by i**mmune system a**s self, but everything else would be recognized as non-self **•Sertoli cells set off 2 different compartments** **•Spermatogonia = basal compartment** **•Rest of the compartment = adluminal compartment** * Something occurs when you get at type B spermatogonia that will continue this process of spermatogenesis to allow it to squeeze through that tight junction and then it seals right behind it * 2 entirely different environments created by sertoli cells * Sertoli cells are there to nourish, feed and care for the cohort * Because of tight junctions, nothing is getting through (ex. Nutrients, oxygen, and etc.) **•Sertoli cells are long-lived** **•They don’t divide, they are resistant to things that would kill most other things (X-ray)** •In addition to their role as protecting/nourishing cohort of developing sperm, they also have other functions: **•Secrete MIF to cause degradation of mullerian ducts** **•Secrete androgen-binding proteins under influence of FSH** * Process of spermatogenesis is based on presence of testosterone * To keep testosterone levels high enough, sertoli cells secrete androgen-binding proteins which bind testosterone and allow spermatogenesis to occur

Answer 58

•Prominent nucleolus of Sertoli cell (blue arrow)

Answer 59

arise in periophery (unlike BPH) macro - firm, hard to see micro - simple glands, crowded, looks like prostate but simpler NO BASAL CELLS •Rules of “2s” – “2” many; 2 crowded; 2 small; 2 simple; 2 large nucleoli (glands) • Monoclonal = Lumenal cell (no basal cells)

Answer 60

* Basal lamina (blue arrow) * Spermatogonia (black arrow) * Sertoli nucleus (yellow arrow) * Primary spermatocyte (green arrow) * Early spermatid (bolded red arrow) * Late spermatid (orange arrow on top)

Answer 61

* Vas deferens is thick, fibrous tubular organ with an enormous amount of smooth muscle * All of these parts have enormous amount of smooth muscle because sympathetics are responsible for ejaculation from L1 and L2 * Similar to cross section of ureter * Penile urethra also covered by pseudo-stratified cells

Answer 62

cause: bacterial and apacterial asymptomatic - no pain tx: longer duration of abx and NSAIDs (antiinflam)

Answer 63

Serotonin Reuptake Inhibitors (for depression) - start at very low doses EMLA cream (lidocaine) - 20-30 min pre intercourse Promescent - FDA approved, OTC - topical lidocaine that only hits deep nerves for ejaculation NOT sensory nerves from intercourse

Answer 64

* The spermatogonia develop into sperm via spermatogenesis * Going from germ cell to a spermatozoa * The process moves in an orderly fashion from basal lamina to the lumen * Earliest form of sperm, spermatogonia, is sitting right up against the basal lamina * Latest form that is shed into lumen, spermatozoa, are going to be furthest away because they are most developed * Takes about 64 days to go through this process of spermatogenesis From spermatogonia to spermatozoa

Answer 65

ejaculation w min stimulation, before the man wishes, causes distress

Answer 66

* Sertoli cells attach very tightly (via tight junctions with the basal lamina) and form the blood-testes barrier * NOTHING gets through that barrier because the spermatogonia that existed at the beginning is recognized by immune system as self, but everything else would be recognized as non-self * Sertoli cells set off 2 different compartments **•Spermatogonia = basal compartment** **•Rest of the compartment = adluminal compartment**

Answer 67

1. remove tumor and see if it's seminoma or non seminoma 2. seminoma - radiation 3. NSGCT - dissection of lymph nodes all tumors: chemo if stage II or III

Answer 68

* hypertensive * poorly controlled lipids * diabetes * CAD * **ED is a predictor of CAD/stroke** – same factor as smoker or family history, if poor blood flow into their penis also poor blood flow in other places * study to send to cardiologist – overall shows health

Answer 69

incrase estrogen with age --\> increase DHT Receptor --\> increase T efect on zone ## Footnote Due to: increase in estrogen receptors

Answer 70

* catastrophic lowering of BP – heart attack, give NO, die * only dangerous if combine with NO * headache * flushing * back pain * visual disturbances * be careful with angina * non-arteritic anterior ischemic optic neuropathy – optic nerve loses blood flow, incredibly rare – NAION * tachyphylaxis – body gets used to drug and it stops working * very rare in this – likely signifies progression of disease state – TAKE SERIOUSLY! * PDEI failure * 70% discontinue in 1 year – drug doesn’t work, underlying disease need to work up

Answer 71

hepatotoxicity infertility edema gynecomasita apnea CVD?

Answer 72

* At higher power: * Scalloped appearance at bottom of image are efferent ductules (black arrow) * Epididymis on top, basal cells, pseudo-stratified columnar epithelium (blue arrow) * At luminal surface you can see stereo-cilia (red arrow) * Continue down into part of vas deferens

Answer 73

polycythemia - opp of anemia mostly in weekly injectins

Answer 74

sexual dysfunction (libdo, erectile anejaculation low energy,concentration, mood, strength ospteopenia, decreased insulin sensitivty, truncal obesity, metabolic syndrome

Answer 75

bone ## Footnote Metastasis of prostate cancer Has great predisposition to go to bone Will present with lumbar bone metastasize before the prostate cancer found Bone thickens and collapses Cytokines released by cancer in the bone marrow released and cause this

Answer 76

* if drugs fail or blood flow shot * inflatable * mechanical malfunction under 10 years – have to replace if it dies (can keep in if don’t want to be sexually active) * may not like it * may not like size

Answer 77

* Primordial germ cells that go up dorsal mesentery to populate the gonadal ridge sit there quiescently until the right time * The spermatogonia develop into sperm via spermatogenesis * Going from germ cell to a spermatozoa

Answer 78

prostate cancer

Answer 79

* Starts by having those spermatogonia, at the time of puberty when testosterone levels reach the right number, divide mitotically * Will undergo a number of mitotic divisions giving rise to two types of spermatogonia that, histologically, you cannot tell the difference: **•Type A spermatogonia: remain always associated with basal lamina and always remain as germ cells to give rise to the next wave**

Answer 80

sensory experience can occur independently of erection, emission, ejection

Answer 81

small in kids and enlarges in adults most predisposed to cancer

Answer 82

* Leydig cells sit in interstitial space (black arrow) * Under influence of LH, group of Leydig cells begin to secrete testosterone * This group of Leydig cells are inactive

Answer 83

* As you move up, you get these things with a unique appearance (yellow arrow) * These are early spermatids * They are going to develop through process talked about to the terminal, late spermatids (bolded red arrow) * Still have nucleus pushing into the Sertoli cells

Answer 84

* Corpus cavernosa are just erectile tissue * Corpus cavernosa (middle top image) can see cavernous spaces * Top right image has arrow pointing to one of the helicine arteries

Answer 85

1. epididymus 2. vas deferens 3. penile urethra

Answer 86

* Higher power image showing pseudo-stratified columnar epithelium * Seminal fluid nicely sitting in the valleys (black arrow) * Easy to distinguish seminal vesicles from gallbladder as seminal vesicles have much higher projections that flop

Answer 87

* Epididymis: has multiple parts – head and tail * Takes 12 days to make transit from head to tail * Physiologically: sperm removed from tail of epididymis can fertilize egg * Developmental process occurring during transit * Composed of a pseudo-stratified columnar epithelium (common in male reproductive system - will see this all the way down to the urethra) * From the surface of the pseudo-stratified cells are long cilia-looking things that are actually stereo-cilia * Stereo-cilia increase surface area for absorption of liquids and ingestion of residual bodies as it makes its way down