Pathology of the Female Reproductive System Flashcards
What determines sex? What hormones will the sexes produce for sexual development?
presence/absence of Y chromosomes
XY = testes = testosterone and Anti-Mullerian hormones allows the Wolffian (mesonephric) duct to persist and the Mullerian (paramesonephric) duct to regress
XX = ovaries = Mullerian duct persists and the Wolffian duct regresses
What determines external genitalia development?
hormones from the gonads —> penis and scrotum or clitoris and vulva
What are disorders of sexual development?
abnormalities of sex chromosome origin that result in abnormal appearing genitalia
What is clitoromegaly?
partial fusion of the vulvar lips caused by true hermaphroditism (ovotestes) causing the female genitalia to be partially masculinized due to exposure to testosterone and AMH
What is ovotestes?
true hermaphroditism where females become masculinized due to the presence of testosterone and AMH from Sertoli cells
True hermaphroditism:
abnormal internal reproductive organs from a bitch
- hypoplastic uterus
- bilateral ovotestes with an attached epididymis
Ovotestes:
What is Freemartinism?
disorder with female and male bovine twins where a female is genetically female, but has many male characteristics making them infertile, but the male is normal
What causes Freemartinism?
anastomoses develop between the placental vascular system of the 2 fetuses and male hormones masculinize/sterilize the female genital organs causing them to become hypoplastic
What are the 6 common presentations of Freemartinism?
- hypoplasia of ovaries and uterus
- ovotestes
- failure of the paramesonephric duct to fuse and form a single uterine body
- presence of vesicular glands
- uterus and vagina do not communicate
- prominent clitoris and a long tuft of hair attached ventrally to the vulva
Where are follicle-stimulating hormone (FSH) ad luteinizing hormone developed (LH)? What do they do?
FSH - anterior pituitary; initiates growth of the follicle
LH = anterior pituitary; stimulated follicular growth and rupture/formation of CL
Where are estrogen, progesterone, and prostaglandins produced? What do they do?
ESTROGEN = ovaries; prepares uterus for pregnancy and causes secondary female characteristics
PROGESTERONE = CL and placenta; maintains pregnancy
PROSTAGLANDINS = causes CL rupture and follicular rupture
Follicle development:
What cysts form on the outside and inside of the ovaries?
OUTSIDE = periovarian cysts common in bitches, mares, and cats, typically from embryonic structures and most commonly an incidental finding
INSIDE = ovarian cysts that are follicular, rete ovarii, and sub/surface epithelial in origin - tends to cause disease
Where do periovarian cysts arise from?
remnants of the Mullerian duct (paramesonephric) and Wolfiann duct (mesonephric)
What are cystic epoophorons?
cysts that arise from the mesonephric tubules (Wolffian) and extend from the proximal pole of the ovary
- common in mares
- typically an incidental finding
What are fimbrial cysts?
paramesonephric duct cysts that extend from the fimbriae of the uterine tube
- common in mares
- incidental finding
What cysts are commonly found near the uterus?
cystic remnant of a mesonephric duct, typically found adjacent to the uterine tube
What are the 3 most common types of intraovarian cysts?
- cystic rete ovarii - arises from mesonephric (Wolffian) duct remnants at the hilus of the ovary
- epithelial inclusion cyst of the mare - normal epithelium of the ovary become trapped in the ovarian stroma at the ovulation fossa
- follicular cysts (anovulatory follicular cyst)
In what animals are cystic rete ovarii most common? Where does this arise from? Where are they most commonly found?
dogs, cats, guinea pigs
mesonephric (Wolffian) duct remnants
hilus of the ovary
How do epithelial inclusion cysts occur? Where are they most commonly found? How do they cause infertility?
surface epithelium of the ovary becomes entrapped during ovulation
ovulation fossa
block ovulation and compress the ovary
What makes epithelial inclusion cysts different compared to ovarian follicle cysts?
persist and slowly increase in size
Epithelial inclusion cyst:
What kind of follicular cysts occurs inside of the ovary? What causes this? What is a common sign?
anovulatory follicular cysts (Graffian follicle) - larger than usual at ovulation
failure of the mature follicle to ovulate, causing it to persist
hyperestrogenism - bone marrow suppression and changes in uterus
(cystic endometrial hyperplasia > mucometra > pyometra)
How do you determine if a follicle is actually becoming a cysts in cows, sows, sheep/goats, and bitches?
SIZE
- cows > 2.5 cm
- sows 1 cm
- sheep/goats 1 cm
- bitches 0.75 cm
Follicular cysts:
What is duplication of the ovaries?
2 ovaries present where one should be
What is ovarian remnant syndrome?
ovarian tissue remains inside of the body after a female dog has been spayed, resulting in the continued production of estrogen and signs of heat
What happens during equine ovarian varicosities?
veins dilate, causing thrombosis and infarction in severe cases, however most are incidental
- most common in old mares
What is oophoritis? What is the most common cause?
inflammation of the ovary
ascending infection from uterus
What are granulosa (theca) cell tumors? What are 2 common signs?
unilateral, large, cystic masses that are usually benigns and produce estrogen, inhibin, testosterone, and AMH
- nymphomania, Stallion-like behavior
- atrophy of the contralateral ovary
What is dysgerminoma? How does it present? How does metastasis compare in dogs and horses?
comparable to seminoma in testicle, ovarian tumor originating from germ cells
unilateral, solid, soft
dogs = 10-20% metastasize
horses = more aggressive
How do teratomas present?
- well-differentiated and benign
- have differentiation into 2 of the 3 germ cell layers
- frequently have teeth, hair, lung tissue, fat, nerves, etc.
In what species are ovarian carcinomas/cystadenocarcinomas most common? Where do they arise from?
+++ dogs, chickens
surface epithelium of SES
How do most ovarian carcinomas/cystadenocarcinomas present?
- bilateral > unilateral
- papillary structures extending from the surface giving them cauliflower-like appearance
- peritoneal implantation leads to ascites
Ovarian carcinoma/cystadenocarcinoma:
Ovarian carcinoma/cystadenocarcinoma, chicken:
What is hydrosalpinx? What are 2 common causes?
blockage resulting in fluid accumulation in the salpinx
- blockage from congenital defects (freemartinism, segmental aplasia of the uterine horn)
2 inflammation
What is salpingitis commonly secondary to?
- uterine disease
- traumatic from manual manipulation of the ovary
How does acute and chronic salpingitis compare?
ACUTE: T. pyogenes, Staph/Strep, pyosalpinx
CHRONIC: Mycoplasma, ureaplasma
Uterus:
What is this?
segmental aplasia of the uterus
What is the difference between endometritis and metritis?
ENDOMETRITIS: inflammation confined to the endometrium (postcoitus, postparturition)
METRITIS: invades the myometrium and is most commonly bacterial (Campylobacter, Tritrichomonas, E. coli)
What does endometritis commonly predispose the animal to?
pyometra
How are endometrial biopsies graded to determine severity?
- glandular nesting/loss
- periglandular and interstitial fibrosis
- type of inflammation
graded I, II, III
How does the grade of endometrial biopsies determine the chances of carrying a foal to term?
Grade I = > 80%
Grade II = >50-80%
Grade IIb = >10-50%
Grade III = 10% or less
How do the presence of neutrophils, lymphocytes, and eosinophils determine the type of inflammation occurring the endometrial biopsies?
NEUTROPHILS = active inflammation, bacterial infection
LYMPHOCYTES = chronic inflammation
EOSINOPHILS = pneumovagina and/or pooling urine into vagina making it susceptible to uterine infections
Why is cystic endometrial hyperplasia so important?
common prelude to other conditions
Endometrial hyperplasia, canine:
What hormones are released in CEH-pyometra syndome? What do they cause?
ESTROGEN: hyperplasia of endometrial glands
PROGESTERONE: causes epithelium to become secretory; hyperplasia of endometrial glands
When is CEH-pyometra syndrome most common? What is the most common cause? What are 2 possible sequela?
few weeks after estrus, especially in bitches that are not bred
E. coli
- toxemia, bacteremia
- glomerulonephritis
What is the most common cause of pyometra in cows?
endometritis —> inhibition of CL destruction —> persistence of CL —> increase in progesterone —> pyometra
What 3 uterine neoplasias are most common?
- leiomyoma/leiomyosarcoma
- uterine adenocarcinoma
- lymphoma (BLV)
In what animals are uterine leiomyomas most common?
What is the most common tumor in domestic rabbits? How do they present?
uterine adenocarcinoma
multicentric masses, usually involving both horns
What is the most common cause of uterine lymphoma?
bovine leukemia virus (BLV)
What are the 3 most common causes of uterine torsion?
- gravid uterus
- hydrometra/pyometra
- uterine neoplasia
- can result in death of fetus and rupture
What are 3 common predisposing causes of uterine prolapse?
- prolonged dystocia relieved by forced traction
- retained plascenta
- postparturient hypocalcemia
When is uterine artery rupture most common? What is it caused by?
old mares with multiple pregnancies and copper deficiencies
weakening of the wall of the artery as a result of advanced age and repeated enlargement and shrinkage of the vessels
When does uterine artery rupture most commonly happen in regards to the pregnancy? What happens when it is severe?
peripartum
hemorrhage into the abdomen and hypovolemic shock
- mild = hemorrhage maintained in broad ligament
What are endometrial polyps made out of? What do they look like? What can they predispose to?
CT stroma with dilated glands (common in dogs and cats)
pedunculated
prolapse
What is subinvolution of placental sites (SIPS)? What 3 things can it cause?
prolonged uterine hemorrhage following whelping that manifests as bloody vaginal discharge lasting more than 6 weeks, and is usually self-limiting
- ascending infection
- endometritis
- open pyometra
