Repro System Pathology

Question 1

endometriosis

Answer 1

• Frequent: 1:10 females affected
• Endometrium is found in locations outside the uterus e.g. ovaries, bladder, bowel or other sites
• Results in tissue reacting to estrogen and progesterone with cyclic responses
• Symptoms are very variable but often include pelvic pain
• Endometriosis can sometimes lead to infertility
• Treatments:
  1. Medical treatments
  2. Surgical treatments
  3. Complementary treatments

Question 2

cervical cancer

Answer 2

• Most tumors of the cervix are of epithelial origin (70% squamous cell carcinomas)
• Affects 450,000 women worldwide each year
• Most common between 30 and 50

Question 3

risks of cervical cancer

Answer 3

Risks: frequent cervical inflammation, sexual transmitted infections (STIs) in particular oncogenic strains of Human Papilloma Virus (HPV)

• tropism for immature squamous cells of the transformation zone
• Gardasil: three-dose vaccine; protects against several subtypes of HPV - If detected early, cells often only pre-cancerous
• regular Pap (Papanicolaou) smears for early detection

Question 4

endometrium of the cervix

Answer 4

• Cervix = neck of the uterus to the vagina
• Mucus secreting simple columnar epithelium on luminal surface
• Continues with the moist non-keratinized stratified squamous epithelium covering the external (vaginal) surface of the cervix
• Transformation (transitional) zone - area between columnar and squamous cells - most common place on the cervix for abnormal cells to develop

Question 5

Gardasil targets (HPV)

Answer 5

• Gardasil targets mainly HPV-6, 11, 16, and 18
• HPV-16 and HPV-18 account for about 70% of all cervical cancers
• HPV-6 and -11 cause about 90% of genital warts
• Most HPV infections are transient and eliminated within months by an acute and chronic inflammatory response
• If HPV infection persist -> can progress to cervical intraepithelial neoplasia

Question 6

breast cancer

Answer 6

• Invasive breast cancer (carcinoma) most common cancer of women
• Usually arises from epithelial cells of ducts
• Hereditary forms (~ 10% of all cases) often associated with mutations in breast cancer susceptibility genes BRCA1 and BRCA2
• Detected by breast self-examination and mammography
• Treatment:
  o Radiation and chemotherapy
  o Surgery (radical mastectomy = removal of one or two breasts partially or complete has been mostly replaced by lumpectomy= breast-conserving surgery)

Question 7

breast cancer in men

Answer 7

Risk factors:
- Age (75% older than 50)
- Geography (US 5x higher than Japan) – environment
- Ethnicity: gentic differences, social factors and lifestyle choice
Genetic risk:
- Overexpression of proto-oncogene HER2/NEU in 30%
- Amplification of Ras and Myc,
- Mutations in tumor suppressors RB and TP53
- Hereditary forms (~ 10% of all cases) cancer susceptibility genes BRCA1 and BRCA2
o BRACA = classic tumor suppressor gene -> both alleles have to be affected

Question 8

cryptorchidism

Answer 8

• Undescended Testes
  o absence of one or both testes from the scrotum
• Descend to scrotum at ~28 weeks of fetal life
• Most common genital problem encountered in paediatrics
  o About 3-4% of full-term infant boys born with at least
  o one undescended testis
• Spermatogenesis: Production of viable sperm, is greatly affected by the temperature of the testicle
• Production of testosterone is not affected by temperature
• Treated when 6 months with special operation = Orchidopexy
• If not treated risk of: infertility, testicular torsion, cancers

Question 9

hydrocele

Answer 9

• Swelling in the scrotum
• Fluid accumulation in cavity bound by the 2 layers of tunica vaginalis
• Common in newborns (~10%)
• In adults often due to infection or injury
• Usually painless and disappears without treatment

Question 10

testicular torsion

Answer 10

• Spermatic cord, which provides blood flow to the testicle, rotates and becomes twisted
• Twisting cuts off the testicle’s blood supply and causes sudden pain and swelling
• Spontaneous or post trauma
• Requires immediate surgery to save the testicle

Question 11

prostate cancer

Answer 11

• Most common form of cancer in men
• Adenocarcinoma of the prostate occurs mainly in men > 50 years
• Most carcinomas detected clinically are not visible grossly
• Androgens are central in the pathogenesis
• Decreased prostate cancer mortality over last decades due to effective screening programs

Question 12

risks for prostate cancer

Answer 12

• Androgens
• Heredity: mutations near Myc oncogene
• Aquired somatic mutations:
  o Fusion gene of androgen regulated promoter and ETC transcription factor
  o Mutations of tumor suppressor PTEN
• Environment: diet etc.

Question 13

testicular cancer

Answer 13

• Most common tumors of men in age group 15-34
• Heterogenous group of tumors but often germ cell tumors
• Cause of testicular neoplasms is unknown
• Risk in undescended tested is 3-5x greater
• Genes: Brothers of males with germ cell tumors have 8-10 x increased risk