Reproduction Flashcards
Cancers of pelvis, including prostate, spread to lumbar spine via the
Vertebral venous plexus (including prostatic venous plexus in men)
breast and lung cancers metastasize to spine via
Vertebral venous plexus (communicates with azygos vein)
Venous drainage from testis, epididymis and ductus deferences. Drains into testicular veins
Pampiniform plexus
Classic triad of congenital rubella
Cataracts, sensory-neural deafness and PDA
How do progestin-only (norethindrone) and levonorgestrel IUD work as contraceptives
Thicken cervical mucus to impair sperm motility
How do combined hormonal contraceptives and progestin implant/injection function as contraceptives
Suppress GnRH and gonadotropin secretion to inhibit ovulation
How does Copper IUD function
Cytotoxic inflammatory response in uterus to impair sperm migration
Which hormone causes increased insulin resistance in pregnancy during second and third trimester
Human placental lactogen (Secreted by synctiotrophoblast)
Bulk-related symptoms like pressure and constipation that are relieved by “splinting” to defecate (manual deflection of obstruction) likely indicate
Posterior subserosal uterline leiyomyoma (fibroid)
How does progesterone withdrawal cause menses
Loss of progesterone leads to increased prostaglandin, which vasoconstricts spiral arteries. Increased metalloproteases by endometrial stromal cells degrade ECM and endometrial epithelium undergoes apoptosis, thus leading to menstruation
Which arteries can be ligated during postpartum hemorrhage to stop bleeding and maintain fertility?
Internal iliac arteries (Uterine is branch of them); blood flow maintained by ovarian anastamoses
Which blood pressure medications are teratogens that can lead to renal agenesis/malformation (oligohydramnios) and hypoplasia of skull?
ACE inhibitors or ARBs (Angiotensin II is needed for renal function in babies)
Peyronie disease
Fibrotic plaque of tunica albuginea causes abnormal curvature of penis and erectile dysfunction
Bowen disease
In situ carcinoma of penile shaft that presents as leukoplakia
Erythroplasia of Queyrat
In situ carcinoma of glans that presents as erythroplakia
Bowenoid papulosis
In situ squamous cell carcinoma of penis that presents as reddish papules
HPV causes which cancer in males
Penile squamous cell carcinoma
Cause of hypospadias (opening of urethra on inferior fold)
Failure of urethral folds to close
Cause of epispadias (opening of urethra on superior surface of penis)
Abnormal positioning of genital tubercle. Associated with bladder exstrophy
Which HPV strains cause condyloma acuminatum
6 and 11
Necrotizing granulomatous inflammation of inguinal lymphatics and lymph nodes caused by
Chlamydia trachomatis
Fibrotic healing of lymphogranuloma venerum can involve perianal area with
rectal strictures
Cryptorchidism increases risk of which condition
Germ cell tumors (seminomas)
Common cause of orchitis in older adults
E. Coli or Pseudomonas
Non-necrotizing granulomas involving seminiferous tubules suggest
Autoimmune orchitis
Can occur due to failure of testes to attach to inner lining of scrotum via processus vaginalis
Testicular torsion
An adolescent male presenting with sudden, unilateral testicular pain, absent cremasteric reflex, nausea/vomiting and fever likely has
Testicular torsion
Left scrotum with “bag of worms” appearance is associated with increased risk of
Left-sided renal cell carcinoma
Scrotum that is “bag of worms” in appearance occurs due to
Dilation of spermatic vein due to impaired drainage (varicocele)
Common cause of hydroceles
Incomplete closure of processus vaginalis
Scrotal swelling that can be transilluminated is likely
Hydrocele
Cyst due to dilated epididymal duct or rete testes is a
Spermatocele
Lymph drainage of testes and epididymis
Para-aortic and lumbar lymph nodes
Small nodule on testes with elevated beta-hCG, symptoms of hyperthyroidism (weight loss, heat intolerance, lack of sleep) and gynecomastia are suggestive of what in a male?
Choriocarcinoma
Choriocarcinoma is a malignant tumor of which origin
Synctiotrophoblasts and cytotrophoblasts
Teratomas in males vs females
Malignant in males if found in 20s-40s; benign in females
Most common testicular tumor in male infants, characteristically elevated AFP
Yolk sac tumor
Testicular tumor with poorest prognosis ; chemo can cause differentiation into different type of tumor
Embryonic carcinoma
Characterized by immature, primitive cells organized in irregular patterns that may produce glands and sites of necrosis and hemorrhage
Embryonic carcinoma
Rapidly metastasize, variable response to cancer therapy
Non-seminoma germ cell tumors
Slow to metastasize, excellent response to therapy
Seminoma
Tumor of maternal fetal tissue composed of elements from 2-3 germ layers
Teratoma
Increased placental ALP
Seminoma
Hemategnous mets to lungs and brain in male
Choriocarcinoma
Presents as painful hemorrhagic testicular mass; usually mixed with other tumor types (increased AFP when mixed)
Embryonic carcinoma
Which male organ is located below bladder and anterior to rectum?
Prostate
Which two lobes tend to undergo hyperplasia in BPH?
Lateral and middle lobes
Increased risk of bladder diverticuli, hydronephrosis and UTIs associated with which condition?
BPH
Side effects of 5-alpha-reductase inhibitors
Sexual dysfunction (decreased libido), gynecomastia
Treatment for BPH
alpha-1-receptor antagonists (Terazosin) to relax smooth muscle; 5-alpha-reductase inhibitors (finasteride) to decrease DHT production
treatment for prostate cancer
Leuprolide (continuous GnRH to shut down FSH and LH)
Flutamide (competitive androgen receptor antagonist)
Injury to which nerve can cause erectile dysfunction after prostatectomy
Prostatic plexus
This nerve innervates the external urethral and anal sphincters and provides sensory innervation of external gnitalia
Pudendal
Injury to this nerve can cause fecal incontinence, decreased penile sensation or external urethral sphincter paralysis
Pudendal
Which nerve mediates the cremasteric reflex
Genitofemoral (L1-L2)
Gonadal arteries and veins are branches of
abdominal aorta, slightly below renal arteries
This artery travels in front of IVC and behind ileum
Right gonadal artery
This artery travels behind left colic and sigmoid arteries and iliac colon
Left gonadal artery
Arises off common iliac artery and becomes femoral artery
External iliac artery
Arises off common iliac artery and supplies pelvic wall/viscera, buttock, female repro organs, bladder and medial thigh
Internal iliac artery
Branch of internal iliac that provides blood to anal canal, scrotum and penis
Pudendal
Small/firm testes, azoospermia, tall stature and gynecomastia suggest
Klinefelter syndrome (XXY)
Levels of testosterone, LH and FSH and estradiol in Klinefelter
Decreased testosterone, increased LH and FSH,, increased estradiol
Lymph drainage of glans penis and superficial nodes
Deep inguinal nodes
Triad of Kartagener syndrome (primary ciliary dyskinesia)
Situs inversus, chronic sinusitis, bronchiectasis (persistent bronchial dilation)
Most common causative pathogen for acute mastitis
S. Aureus (Tx: Dicloxacillin)
Erythematous nipple with purulent discharge in a breast-feeding woman suggets
Acute mastitis
Subareolar mass with nipple retraction in a female smoker suggests
Periductal mastitis
What causes periductal mastitis
Vitamin A deficiency results in squamous metaplasia of lactiferous ducts, producing some degree of keratin that plug/block ducts leading to inflammation
Periareolar mass (inverted nipple) with green-brown nipple discharge in multi-parous post-menopausal woman
Mammary duct ectasia
Biopsy of Mammary duct ectasia would show
Inflammation with plasma cells
50% of cases are the result of trauma. Biopsy reveals giant cells and calcifications
Fat necrosis of breast
Risk of invasive cancer with fibrosis, cysts and apocrine metaplasia
No risk
Risk of invasive breast cancer with ductal hyperplasia and sclerosing adenosis
2x increased risk
Risk of invasive breast cancer with atypical hyperplasia (dark nuclei that fill acini space)
5x increased risk
Inner layer of lobules and ducts
Luminal cell layer (produces milk)
Outer layer of ducts and lobules
Myoepithelial cell layer (pushes milk forward)
What causes nipple retraction in periductal mastitis?
Myofibroblasts contract during healing process (fibrosis) of breast tissue, pulling in nipple tissue
Two characteristics of mammary duct ectasia
green-brown nipple discharge and plasma cells on biopsy
Unilateral bloody nipple discharge in a premenopausal woman. Biopsy reveals papillae with two cell layers.
Intradutal papilloma
Papillary carcinoma vs adenoma
Papillary carcinoma is more common in older women (post-menopausal). Both have bloody nipple discharge due to fibrovascular papillae, but the papillae in carcinoma do not have myoepithelial layer
Well-circumscribed, mobile marble-like mass in pre-menopausal woman likely suggests
Fibroadenoma (most common benign tumor in pre-meni females. no risk of carcinoma. Estrogen sensitive)
Difference between fibroadenoma and Phylloides tumor
Both are tumor of fibrous tissue and glands but Phyllodes has OVERGROWTH of fibrous component and is found in post-menopausal women
“Leaf-like” projections seen on biopsy suggest
Phyllodes tumor (can be malignant in some cases), seen in post-menopausal women; suggestive of genetic inheritance of breast cancer
6 risk factors for breast cancer
female gender, age, early menarche/late menopause, obesity, atypical hyperplasia, first-degree relative (sister, mother, daughter)
Which part of breast do most malignant tumors arise from?
Duct lobular unit
Which test distinguishes benign from malignant breast pathologies
Biopsy
High grade cells with necrosis and dystrophic calcification inc enter of ducts is what type of DCIS
Comedo type
Define Paget disease of breast
DCIS that moves up to skin of nipple. Presents with nipple ulceration and erythema
Detection of Paget disease of breast is important because
It is almost always associated with ductal carcinoma of breast (malignant breast cancer)
Appearance of Paget disease on biopsy
Scattered “fried egg” appearance cells
Most common type of malignant breast cancer
Invasive ductal carcinoma
How does DCIS present on mammography
calcifications in breast (no mass)
How does Invasive ductal carcinoma present on mammography
Mass greater than 1cm)
Appearance of invasive ductal carcinoma on biopsy
Duct-like structures in connective tissue stroma
Biopsy of Tubular carcinoma (Invasive ductal carcinoma)
You see a lot of ducts, but they lack myoepithelial cells
also see stromal background
good prognosis
Biopsy of Mucinous carcinoma (Invasive ductal carcinoma subtype)
Ductal cells floating in mucus pool (light-lavendar background)
Prognosis of tubular and mucinous carcinoma
Excellent
Average age of occurrence for mucinous caricnoma
70 years
Highly erythematous and inflamed breast that does not resolve with antibiotics is suggestive of
Inflammatory carcinoma
Biopsy of Inflammatory carcinoma (subtype of Invasive Ductal carcinoma)
Hyperplasia of cells in dermal lymphatics, decreasing their drainage and causing inflammation (filled circle of purple cells in pink stromal tissue)
Prognosis of inflammatory carcinoma
Very poor (double negative, ER-/PR-)
Inflammatory carcinoma is more common in
African American women around 50 years, higher BMI (obese)
Well circumscribed mass that mimics fibroadenoma on mammography. Biopsy characterized by large, high-grade cells growing in sheets with lymphocytes and plasma cells
Medullary carcinoma (Invasive duct carcinoma
Patients with BRCA1 mutations have an increased risk of which type of Invasive Duct Carcinoma subtype?
Medullary carcinoma
Multifocial and bilateral masses that have been incidentally found on mammography suggest
Lobular carinoma in situ (mutation in E-cadherin so cells are not attached to one another)
Treatment for lobular carcinoma in situ
Tamoxifen (estrogen antagonist)
Risk of progression to invasive carcinoma for LCIS
Low
Biopsy showing cells in single-file pattern and E-cadherin mutations suggest
Invasive lobular carcinoma
Most useful prognostic factor in breast cancer
Spread to axillary lymph nodes
ER and PR associated breast cancers are treated with
Tamoxifen (antiestrogenic agents)
Her2/neu (c-erbB2) amplication is treated with
Traztuzumab (anti-Her2/neu)
What is Her2/neu
Cell membrane growth receptor (oncogene)
Which population is susceptible to triple negative breast carcinoma?
African American womoen
Gene responsible for breast cancer in males
BRCA2
Gene associated with familial breast and ovarian cancers
BRCA1
Where is the highest density of breast tissue in males
Underneath nipple (subareolar) ; may produce discharge
In pregnancy, DIC is mediated by which factor
Tissue factor produced by placental trophoblast
