Pathoma and Key Word Associations Flashcards
The testes of the gonadal male secrete?
Anti-mullerian hormone and testosterone
Testosterone aids in the development of what during male development?
Growth and differentiation of the Wolffian ducts which will develope into the internal male genital tract
What is the role of anti-mullerian hormone?
Causes atrophy of the mullerian ducts
What is the major androgen secreted by the Leydig cells?
Testosterone
How does LH act on the testes?
Stimulates Leydig cells to produce more testosterone by increasing cholesterol desmolase
The prostate and other accessory organs contain what enzyme for testosterone?
5 alpha-reductase, which will convert testosterone into more active dihydrotestosterone
Why are 5 alpha-reductase inhibitors (finasteride) used to treat BPH?
because they block the activation of testosterone to dihydrotestosterone in the prostate.
What is the main precursor of testosterone?
Cholesterol
How does FSH from the anterior pituitary act to regulate action of the testes?
FSH acts on sertoli cells to maintain spermatogenesis.
Sertoli cells secrete what that acts as a negative feedback inhibitor on the anterior pituitary?
Inhibin
How does LH from the anterior pituitary act to regulate action of the testes?
LH acts on Leydig cells to promote testosterone synthesis.
What is the negative feedback mechanism of testosterone on LH?
inhibiting the release of GnRH from the hypothalamus and by directly inhibiting the release of LH from the anterior pituitary.
What happens during puberty in regards to GnRH levels and what is the effect of this?
Puberty is initiated by pulsatile GnRH release from the hypothalamus. LH and FSH are secreted in a pulsatile fashion. GnRH also upregulates its own receptor in the anterior pituitary
Describe the synthesis of estrogen and progesterone in the female.
Theca cells produce testosterone which is stimulated by LH from the anterior pituatary. Androstenedione diffuses to nearby granulosa cells, which contain 17β-hydroxysteroid dehydrogenase, which converts androstenedione to testosterone, and aromatase, which converts testos- terone to 17β-estradiol (stimulated by FSH).
During the follicular phase of the menstrual cycle the hormone estrogen has what type of feedback?
Negative feedback on the anterior pituitary
During the midcycle phase of the menstrual cycle the hormone estrogen has what type of feedback?
Positive feedback on the anterior pituitary
During the luteal phase of the menstrual cycle the hormones estrogen and progesterone have what type of feedback?
Negative feedback on the anterior pituitary
What are the characteristics of the follicular phase?
Primordial follicle develops into the graffian stage with atresia of the neighboring follicles LH and FSH are up-regulated on theca and granulosa cells Estradiol levels increase and cause proliferation of the uterus FSH and LH levels are suppressed by the negative feed back effect of estradiol on the anterior pituitary.
What are the characteristics of ovulation (day 14)?
A burst of estradiol synthesis at the end of the follicular phase has positive feedback on the FSH and LH secretion (LH surge) Ovulation occurs as a result of the estrogen-induced LH-surge Cervical mucus increases in quantity, becoming less viscous and easily penetrated by sperm
What are the characteristics of the luteal phase?
Corpus luteum begins to develop and it synthesizes estrogen and progesterone Vascularity and secretory activity increase to prepare for receipt of a fertilized egg. Basal body temperature increases due to role of progesterone on the hypothalamus If there is no fertilization, the corpus luteum will regress and estradiol and progesterone levels will decrease abruptly
Abrupt withdrawal of estradiol and progesterone will cause what?
Menses, the endometrium is sloughed off
In pregnancy, the increasing levels of estradiol and progesterone will have what effect?
Maintenance of the endometrium for the fetus, suppress ovarian follicular function (by inhibiting FSH and LH secretion), and stimulate development of the breasts.
If there is proper fertilization, what is the role of hCG on the corpus luteum?
hCG produced by the placenta will rescue the corpus luteum from regression
What is the role of the corpus luteum during the first trimester?
It is responsible for the production of estradiol and progesterone
What is a Bartholin cyst?
Obstruction of duct or gland leading to painful dilation - unilateral, painful, cystic lesion
What are the characteristics of Condyloma?
Warty neoplasm due to HPV type 6 or 11
What are the characteristics of Lichen SClerosis?
Thinning of the epidermis and sclerosis of the dermis
PARCHMENT-LIKE VULVAR SKIN
What are the characteristics of Lichen Simplex Chronicus?
Thickening of the squamous vulvar epithelium. Leukoplakia with thick leathery vulvar skin. CHRONIC IRRITATION AND SCRATCHING
What is Vulvar carcinoma related to?
HPV 16 and 18
It is a carcinoma arising from the squamous epithelium
What are the two ways that Vulvar carcinoma can arise?
HPV infection leading to stepwise progression
Non-HPV - long standing Lichen sclerosis leading to chronic inflammation and irritation
What are the characteristics of Extramammary Paget disease?
Malignant epithelial cells in the epidermis of the vulva. Erythematous, pruritic, ulcerated skin
Paget disease of the nipple is associated with what?
Underlying cancer (DCIS)
Vulvar Paget disease has no underlying cancer
How can you distinguish Paget disease from melanoma?
Keratin + S100- for Paget (Keratin epithelial cell marker)
S100 + Melanoma
What happens to the epithelium of the vagina during development?
Distal 1/3 of vagina comes from UG sinus and has squamous epithelium
Proximal 2/3 comes from Mullerian duct and is lined by columnar cells.
During development the squamous epithelium extends and replaces the columnar epithelium
What is adenosis of the vagina?
Persistance of the columnar epithelium in the upper vagina
What are the characteristics of Embryonal rhabdomyosarcoma?
Mesenchymal proliferation of skeletal muscle. Usually in patients less than 5
Rhabdomyoblast - staining with desmin and myogenin
Vaginal carcinoma will spread to what lymph nodes depending on location?
Lower 1/3 or vagina - Inguinal lymph node
Upper 2/3 - Iliac nodes
What are the HPV types associated with cervical cancer?
16, 18, 31, 33
What are the HPV types associated with Condyloma?
6 and 11
Why can the high risk HPV lead to dysplastic cells?
High risk produce E6 and E7 proteins which result in increased destruction of p53 (E6) and Rb (E7). Loss of suppressor proteins increases risk on CIN.
What are the characteristic changes of Cervical intraepithelial neoplasia?
Koliocytic change
How do the different types of CIN change?
CIN I - less than 1/3 of epithelium
CIN II - Less than 2/3 of epithelium
CIN III - involves almost all of epithelium
Carcinoma in-situ - Full thickness
The higher grade is the less likely regress
Why does Cervical carcinoma arise in middle age women?
Tends to be infected in the 20s with HPV, and it takes 10-20 years to develop
Advanced cervical carcinoma can progress to where?
Invade the anterior uterine wall into the bladder
What is the major placental estrogen?
Estriol
What causes prolactin elevation during pregnancy?
Estrogen stimulates prolactin from the anterior pituitary
Why does lactation not occur during pregnancy?
Estrogen and progesterone blocks the action of prolactin on the breast
Ovulation is suppressed as long as lactation continues due to what?
The effects of prolactin
Inhibits GnRH secretion
Inhibits GnRH on anterior pituitary decreasing FSH and LH
Antagonizes FSH and LH
What is Asherman Syndrome?
Secondary amenorrhea due to loss of the basalis and scarring
Result of overaggressive dilation and curettage
What are the characteristics of an anovulatory cycle and what causes it?
Lack of ovulation
Results in an estrogen-driven proliferative phase without a subsequent progesterone-driven secretory phase
What is acute endometritis and what are the symptoms?
Bacterial infection of the endometrium - usually due to retained products of conception (left behind placenta)
Presents as fever, abnormal uterine bleeding, and pelvic pain
What are the characteristics of Chronic endometritis and what are the characteristics?
Chronic inflammation of the endometrium
Characterized by plasma cells
Caused by chronic pelvic inflammatory disease, IUD, possibly product of conception
What is an endometrial polyp and what are the characteristics?
Hyperplastic protrustion of endometrium
Presents as abnormal bleeding
What is endometriosis and what are the characteristics?
Endometrial glands and stroma outside of the uterine endometrial lining
Cycles just like the normal endometrium
Most common site of involvement is the ovary (presents as chocolate cyst)
What is adenomyosis?
Involvement of the myometrium (presence of endometriosus in the myometrium)
What is endometrial hyperplasia and what are the characteristics?
Hyperplasia of endometrial glands relative to stroma
Unapposed estrogen
What population usually presents with endometrial hyperplasia?
Postmenopausal
What is the major determinant of whether endometrial hyperplasia will progress to endometrial carcinoma?
Cellular atypia
What is endometrial carcinoma?
Malignant proliferation of endometrial glands
What are the two pathways by which endometrial carcinoma can arise? What are the characteristics of these pathways?
Hyperplasia pathway - carcinoma arises arises from endometrial hyperplasia. Average age is 50-60. Histology is endometriod.
Sporadic pathway - Carcinoma arises in an atrophic endometrium with no evident precursor lesion. Average age of presentation is 70. Tend to have p53 mutations
What is the key histology finding and mutation with sporadic pathway endometrial carcinoma?
Histology - serous and characteristic papillary structures PSAMOMMA BODIES
p53 mutations
What are the characteristics of leiomyoma?
Benign proliferation of smooth muscle from myometrium. Related to estrogen exposure. Premenopausal women. Usually multiple, well defined masses.
What are the characteristics of leiomyosarcoma?
Malignant proliferation of smooth from the myometrium. Arises de novo DOES NOT ARISE FROM LEIOMYOMA. Usually presents with a single lesion and necrosis and hemorrhage.
What is polycystic ovarian disease?
Multiple ovarian follicular cysts due to hormone imbalance.
What is the mechanism by which PCOS can occur?
It is characterized by increased LH. The increased LH induces theca cells to produce more androgen. The androgen travels to adipose and synthesizes estrone. Estrone travels to anterior pituitary and inhibits FSH secretion. This causes defects in granulosa cells.
Ovarian surface epithelium is derived from?
Coelomic epithelium
What are the two types of surface epithelial tumors and what are the characteristics of each?
Serous - full of watery fluid
Muscinous - full of mucus-like fluid
Mucinous and serous surface epithelial tumors can be graded as what?
Benign (cystadenoma) - single cyst with simple flat lining (30-40 years old)
Malignant (cystadenocarcinoma) - Composed of complex cysts with a thick, shaggy lining - most common in 60-70 year old
Borderline - has malignant potential, but has better prognosis that malignant
What are the characteristics of endometrioid tumors?
Composed of endometrial-like glands are usually malignant. May arise from endometriosis
Brenner tumors are composed of?
Bladder epithelium
What are the characteristics of cystic teratoma?
Fetal tissue derived from two or three embryologic layers. GERM CELL TUMOR
Can contain skin, hair, cartilage, gut, and thyroid.
What is struma ovarii and what tumor does it lead to?
Struma ovarii is a teratoma composed primarily of thyroid tissue
What are the characteristics of dysgerminoma?
Tumor composed of large cells with clear cytoplasm and central nuclei (resembles seminoma)
What is an endodermal sinus tumor and what are the characteristics?
Malignant tumor that mimics the yolk sac SERUM AFP IS ELEVATED
SCHILLER-DUVAL BODIES (GLOMERULAR LIKE STRUCTURES)
What are the characteristics of Choriocarcinoma?
Malignant tumor composed of cytotrophoblast and syncytiotrophoblasts (Villi are absent)
Small, hemorrhagic tumor with hematogenous spread.
High B-hCG comes from the syncytiotrophoblast
What are the characteristics of Granulosa-theca cell tumors?
Neoplastic proliferation of granulosa and theca cells
Often produces with excess estrogen.
What are the characteristics of Sertoli-Leydig cell tumors?
Composed of Sertoli cells the form tubules and Leydig cells. Characteristic REINKE CRYSTALS. May produce androgen associated associated with hirsutism and virilization.
What are the characteristics of Fibroma?
Benign tumor of fibroblasts
Associated with pleural effusions and ascites (MEIGS SYNDROME)
What are the characteristics of spontaneous abortion?
Miscarrage of fetus before 20 wks gestation
Ususally due to chromosomal anomalies.
What is placenta previa?
Inplantation of the placenta in the lower uterine segment. Placenta overlies cerival os. Presents as third-trimester bleeding.
What is placental abruption?
Separation of placenta from the decidua prior to delivery of the fetus.
What is placental accreta?
Improper implantation of the placenta into the myometrium with littele or no intervening decidua.
What is pre-eclampsia?
HTN and proteinuria in pregnancy. Due to maternal-fetal vascular interface. HELLP syndrome.
What is a hydatidiform mole?
Abnormal conception charcterized by growth of abnormal placental tissue. Swollen edematous tissue with proliferation of trophoblasts.
Elevated B-hCG and passing grape like masses (if no prenatal care)
How can you tell the difference between complete and partial hydatidiform?
Complete - Dads fault - 2 sperm and empty ovum - 46 chromosomes will have way high hCG due to more syncytiotrophoblast. Elevated risk for choriocarcinoma.
Partial - 2 sperm and a normal oocyte. 69 chromosomes.
Why would you monitor hCG after removal of hydatiform mole?
Is to screen for choriocarcinoma.
What are the two ways choriocarcinoma can arise?
Gestational or as a sponataeous germ cell tumor
Gestational responds well to chemo
What is hypospadias and what causes it?
Opening of urethra on inferior surface of the penis
Failure of the urethral folds to close
CA-125 is a serum marker for what?
Surface epithelial ovarian tumors
What is epispadias and what causes it?
Opening of urethra on superior surface of penis
Due to abnormal positioning of genital tubercle
What is Bowen disease in males?
In situ carcinoma of the penile shaft that presents as leukoplakia
What is Bowenoid papulosis?
In situ carcinoma that presents as multiple reddish papules - does not progress to invasive carcinoma
Cryptochidism can lead to seminoma because?
When undescended there can be increased temperature on the testicle leading to a seminoma
What bacteria tend to cause orchitis in young adults?
Chlamydia and neisseria
What bacteria causes orchitis in older adults?
E coli and pseudomonas
What are the characteristics of Testicular Torsion?
Twisting of the spermatic cord leading to hemorrhagic infarction. Usually due to congenital failure of testes to attach to the inner lining of the scrotum.
What is varicocele?
Dilation of the spermatic vein due to impaired drainage
LEFT SIDE BAG OF WORMS
Due to the left testicular vein drains into left renal artery
What is a hydrocele?
Fluid accumulation in the tunica vaginalis. Failure of the processus vaginalis (infants) and lymphatic blockage in adults.
What type of pain does chronic prostatitis present with that acute doesnt?
Pelvic or lower back pain
DHT is synthesized where?
In stromal cells by the enzyme 5 alpha reductase
Where does benign prostatic hyperplasia arise from?
The periurethral zone of the prostate
Prostate adenocarcinoma relates to PSA levels how?
PSA levels greater than 10 are worrysome of adenocarcinoma
What are the covered parts?
What are the characteristics of Androgen insensitivity syndrome (AIS)?
No epididymis or vas deferens; vagina that is short and ends blindly; no uterus or fallopian tubes. Will have testicles in the abdomen.
Receptors to androgens don’t function properly but the hormones themselves are normal
What are the characteristics of 5 alpha reductase deficiency?
Can have normal male external genitalia, ambiguous, or normal female external genitalia; have epididymis and vas deferens
What is true vs pseudohermaphrodism?
True hermaphroditism: individual is born with ovarian and testicular tissue
Pseudo-hermaphroditism: external genitalia don’t match expected gonadal tissue present
What is Kallman’s Syndrome?
Ansomia (lack of sense of smell) and hypogonadismGenetic disorder (can be X-linked, autosomal, recessive, or dominant); failure of GnRH neurons to migrate and enter the proper location during development
What are the characteristics of PCOS?
Hirsutism, obesity and insulin resistance, cycle changes (amenorrhea or frequent menses), elevated LH:FSH ratio
What are the characteristics of premature ovarian failure?
Before age 40, elevated FSH
Autoimmune ovarian failure - antibodies to the ovaries; associated with genetic mutations: mosaic 45X, monosomy X, Turner’s syndrome, FMR1 gene, FOXL2
What are the characteristics of straddle injuries?
Damage to external genitalia that causes bleeding into superficial perineal space; blood is limited by the superficial perineal membrane where it attaches to deep fascial planes
What are the characteristics of chlamydia infection?
In females may be asymptomatic - can cause PID, adhesions, infertility, and ectopic pregnancy; epididymitis and prostatitis in males
Chlamydia bacteria infects columnar epithelium of endocervix, urethra, oropharynx, or rectum
What are the characteristics of gonorrhoeae infection?
Urethritis, penile dischagre, dysuria in males; often asymptomatic in females but can cause severe PID
Infects columnar epithelium of endocervix, urethra, oropharynx, or rectum
What are the characteristics of a mature teratoma?
Most common germ cell ovarian tumor; 1/4 of ovarian tumors; benign
Well differentiated derivatives of the 3 germs layers with predominant ectoderm
Cystic; can find skin, teeth, hair, cartilage, bone, etc in tumor; predominant ectoderm but all 3 germ layers present
What are the characteristics of a Thecoma?
Estrogen secretion, abnormal uterine bleeding, endometrial hyperplasia
Sex cord/stromal tumor
Lipid laden cells resembling theca internal cells associated with fibroblasts; grossly is yellow solid tumor
What is the difference between placenta accreta, increta, percreta?
Accreta: attaches to myometrium without penetrating it
Increta: placenta penetrates into myometrium
Percreta: placenta penetrates through myometriumand into uterine serosa can result in placental attachement to rectum or bladder
What is Hypoactive sexual desire disorder (HASDD)?
Persistent or recurring deficiency of sexual fantasies/thoughts and/or receptivity to sexual activity
What is Female sexual arousal disorder (FSAD)
Persistent or recurring inability to attain or maintain sufficient sexual excitement; decreased lubrication or labial senstion
What is Asherman Syndrome?
Secondary amenorrhea due to loss of basalis and scarring - result of overaggressive dilation and curettage
