Reproduction Flashcards
1
Q
Sonic Hedgehog Gene Where is it produced? What axis does it pattern? Involved with the development of what system?? Mutations lead to
A
Produced at base of limbs in zones of polarizing activity
Anterior Posterior Axis
Involved in CNS development
Mutations –> holoprosencephaly
2
Q
Wnt 7 gene
Where is it produced?
What axis does it pattern?
A
Produced at apical ectodermal ridge (thickened ectoderm at distal end of each developing limb)
Dorsal Ventral Axis
3
Q
FGF Gene
Where is it produced?
What does it do?
A
Produced at apical ectodermal ridge
Stimulates mitosis of underlying mesoderm, providing for lengthening limbs
4
Q
Homeobox (Hox) Genes
What dos it do?
What axis?
Mutations result in
A
Involved in segmental organization of embryo in craniocaudal direction
Hox mutations –> appendages in wrong location
5
Q
Day 0
A
Fertilization by sperm forms zygote initiating embryogenesis
6
Q
Week 1
A
hCG secretion begins after implantation of blastocyst
7
Q
Week 2
A
“2 weeks = 2 layers”
Bilaminar disc with epiblast and hypoblast
8
Q
Week 3
A
3 weeks = 3 layers
Trilaminar disc
Gastrulation
Primitive streak, notochord, mesoderm and its organization, and neural plate begins to form
9
Q
Week 3 - week 8
By week 4
Danger?
A
Embryonic Period Neural tube formed by neuroectoderm and closes by week 4 Heart begins to beat at week 4 4 weeks = 4 limbs upper and lower limb buds begin to form Organogenesis Extremely susceptible to teratogens
10
Q
Week 8
A
Start of fetal period
Fetal movement and fetus looks like a baby
11
Q
Week 10
A
Genitalia have male/female characteristics
12
Q
Gastrulation
What is established?
Starts with…
A
Process that forms the trilaminar disc
Establishes ectoderm, endoderm and mesoderm
Starts with epiblast invaginating to form primitive streak
13
Q
What comes from Surface Ectoderm?
A
Adenohypophysis (Ant Pituitary from Rathke’s Pouch), Lens, Epithelial lining of oral cavity, Sensory organ of ear, Anal canal below pectinate line, Parotid, Sweat, and Mammary glands
14
Q
What comes from Neuroectoderm?
A
Brain (neurohypophysis, CNS neurons, oligodendrocytes, astrocytes, ependymal cells, pineal gland)
Retina, Optic Nerve, Spinal Cord
15
Q
What comes from Neural Crest Cells?
A
PNS (DRG, CN, Celiac ganglion, Schwann cells, ANS)
Melanocytes, Chromaffin Cells of adrenal medulla, Parafollicular (C) cells of thyroid, Schwann cells, Pia and Arachnoid, Bones of skull, Odontoblasts, Aorticopulmonary septum
16
Q
Craniopharyngioma
Origin
Histo
A
Benign Rathke’s pouch rumor with cholesterol crystals and calcification
17
Q
What comes from Mesoderm?
A
Muscle, Bone, Connective Tissue, Serous Lining of Body Cavities (Peritoneum), Spleen, CV Structures, Lymphatics, Blood, Wall of Gut Tube, Wall of Bladder, Urethra, Vagina, Kidneys, Adrenal Cortex, Dermis, Testes, Ovaries
18
Q
Mesodermal Defects
A
"VACTERL" Vertebral defects Anal atresia Cardiac defects Tracheo-Esophageal fistula Renal defects Limb defects (bone and muscle)
19
Q
What comes from Endoderm?
A
Gut tube epithelium (including anal canal above pectinate line)
Luminal epithelium derivatives (Liver, Lung, Gallbladder, Pancreas, Eustachian Tube, Thymus, Parathyroid, Thyroid follicular cells
20
Q
Agenesis
A
Absent organ due to absent primordial tissue
21
Q
Aplasia
A
Absent organ despite presence of primordial tissue
22
Q
Deformation
A
Extrinsic disruption
Occurs after embryonic period
23
Q
Hypoplasia
A
Incomplete organ development
Primordial tissue present
24
Q
Malformation
A
Intrinsic disruption
Occurs during embryonic period (3-8 weeks)
25
Teratogenic Effects of ACEI
Renal damage
26
Teratogenic Effects of Alkylating Agents
Absence of digits
| Multiple abnormalities
27
Teratogenic Effects of Aminoglycosides
"A mean guy hit the baby in the ear"
| CN VIII toxicity
28
Teratogenic Effects of Carbamazepine
```
Neural tube defects
Craniofacial defects
Fingernail hypoplasia
Developmental delay
IUGR (IntraUterine Growth Restriction )
```
29
Teratogenic Effects of Diethylstilbestrol (DES)
Vaginal clear cell carcinoma
| Congenital Mullerian anomalies
30
Teratogenic Effects of Folate Antagonists
Neural Tube Defects
31
Teratogenic Effects of Li
Ebstein's Anomaly (Atrialized RV)
32
Teratogenic Effects of Phenytoin
Fetal hydantoin syndrome: microcephaly, dysmorphic craniofacial features, hypoplastic nails and distal phalanges, cardiac defects, IUGR (IntraUterine Growth Restriction ), mental retardation
33
Teratogenic Effects of Tetracyclines
Discolored Teeth
34
Teratogenic Effects of Valproate
Inhibition of maternal folate absorption --> neural tube defects
35
Teratogenic Effects of Warfarin
"Do not wage Warfare on the baby, keep in Heppy with Heparin (does not cross the placenta)"
Bone deformities, fetal hemorrhage, abortion, ophthalmologic abnormalities
36
Teratogenic Effects of Thalidomide
```
"Limb Defects with tha-LIMB-domide"
Limb defects (flipper limbs)
```
37
Teratogenic Effects of EtOH
Leading cause of birth defects and mental retardation
| Fetal Alcohol Syndrome
38
Teratogenic Effects of Cocaine
Abnormal fetal development and fetal addiction; Placenta abruption
39
Teratogenic Effects of Smoking (nicotine, CO)
Preterm labor, Placental problems, IUGR (IntraUterine Growth Restriction ), ADHD
40
Teratogenic Effects of Iodide (Lack or Excess)
Congenital Goiter or Hypothyroidism (cretinism)
41
Teratogenic Effects of Maternal Diabetes
Caudal regression syndrome (anal atresia to sirenomelia), Congenital Heart Defects (Transposition of the Great Vessels), Neural Tube Defects
42
Teratogenic Effects of Excess Vit A
Extremely high risk for spontaneous abortions and birth defects (cleft palate, cardiac abnormalities)
43
Teratogenic Effects of X Rays
Microcephaly, Mental Retardation
44
Fetal Alcohol Syndrome
Mental Retardation, Pre and Post Natal Developmental Retardation, Microcephaly, Holoprosencephaly, Facial Abnormalities, Limb Dislocation, Heart and Lung Fistulas
45
Source of Estrogen
Ovary --> 17β-estradiol
Placenta --> estriol
Adipose tissue --> estrone via aromatization
46
Potency of different kinds of estrogens
Estradiol > Estrone > Estiol
47
```
Estrogen Function
Development
In menstrual cycle
Receptors
Blood
```
Development of genitalia, breast, and female fat distribution
Growth of follicle, endometrial proliferation, and ↑ myometrial excitability
Feedback inhibition of LH and FSH and then LH surge
Stimulation of prolactin secretion (but blocks it's action at the breast)
Upregulates estrogen, LH, and progesterone receptors
↑ Transport proteins, SHBG, HDL, ↓LDL
48
How does pregnancy change estrogen levels
50x ↑ in estradiol and estrone
| 1000x ↑ in estiol (indicator of fetal well being
49
Mechanism of estrogen receptor
Expressed in cytoplasm
| When bound with ligand, translocates to the nucleus
50
Molecular cascade in Theca Cells
Pulsatile GnRH --> LH --> Desmolase
| D turns cholesterol in to androstenedione
51
Molecular cascade in Granulosa Cells
Pulsatile GnRH --> FSH --> Aromatase
| A turns androstenedione into estrogen
52
Source of Progesterone
Corpus Luteum, Placenta, Adrenal Cortex, Testes
53
Elevation of Progesterone indicates...
Ovulation
54
Function of Progesterone
Menstural cycle
Receptors
Pregnancy
Stimulation of endometrial glandular secretions and spiral artery development
Maintains endometrium to support implantation
--/ LH and FSH
↓ myometrial excitability
↓ estrogen receptor expressivity
Maintain pregnancy
Production of thick cervical mucus (inhibits sperm entry into uterus)
↑ Body Temp
Uterine smooth muscle relaxation (prevents contractions)
55
Tanner Stages of Sexual Development
I: Childhood
II: Pubic hair appears (Pubarche), Breast bud forms (Thelarche)
III: Pubic hair darkens and becomes curly. Penis size/length and breasts enlarge
IV: Penis width ↑, Darker scrotal skin, Development of glans, raised areolae
V: Adult. Areolae are no longer raised
56
```
Follicular Phase
Estrogen
FSH
LH
Progesterone
```
Estrogen: Stead rise
FSH: Rises slightly then decreases slightly
LH: Rises slightly then decreases slightly
Progesterone: Low
57
```
Luteal Phase
Estrogen
FSH
LH
Progesterone
```
Estrogen: decreases, then spikes briefly before decreasing again
FSH low
LH low
Progesterone: increases then decreases
58
```
Ovulation
Estrogen
FSH
LH
Progesterone
GnRH
Temp
```
```
Estrogen: just past peak
FSH: low surge
LH: high surge
Progesterone: beginning to rise
↑ in GnRH receptors on ant pituitary
↑ Temp (due to progesterone)
```
59
Basic schematic of menstrual cycle
↑ estrogen --> LH surge --> Ovulation --> Progesterone (from corpus luteum) --> Progesterone levels fall --> menstruation (apoptosis of endometrial cells)
60
Length of Follicular phase
Variable
61
Length of Luteal phase
Constant 14 days
62
When is follicular growth fastest?
2nd week of proliferative phase (follicular phase)
63
Oligomenorrhea
Cycle > 35 days
64
Polymenorrhea
Cycle < 21 days
65
Menometrorrhagia
Heavy, irregular menstruation at irregular intervals
66
Mittelschmerz
Blood from ruptured follicle or follicular enlargement causes peritoneal irritation that can mimic appendicitis
67
Primary Oocytes
N
C
When do they enter and complete meiosis I
2N 4C
| Begin meiosis I during fetal life and complete meiosis I just prior to ovulation
68
When is meiosis II arrested?
| Until when?
"Arrested until egg MET sperm"
| Meiosis II arrested at Metaphase II until fertilization
69
If fertilization does not occur within 1 day what happens to secondary oocytes?
Degenerate
70
Oogenesis
| Names of cells with N and C
Oogonium (2N 2C) --> Primary Oocyte (2N 4C) --> Secondary Oocyte (1N 2C) --> Ovum (1N 1C)
71
Where and When does fertilization most commonly occur?
Upper end of fallopian tube (ampulla) within 1 day of ovulation
72
When does implantation within the wall of the uterus occur?
Within 6 days after fertilization
73
What secretes hCG?
| When is hCG first detectable in blood and urine?
Trophoblast secretes hCG
Detectable in blood 1 week after conception
Detectable in urine 2 weeks after conception
74
Lactation
When does it occur?
What has changed chemically that allows it to happen?
What is required to maintain lactation?
Occurs after labor because progesterone ↓ and this allows lactation to occur
Suckling is required to maintain lactation: ↑ nerve stimulation --> ↑ oxytocin and prolactin
75
Prolactin
| What does it do?
Induces and maintains lactation and ↓ reproductive function
76
Oxytocin
| What does it do?
Helps with milk letdown and involved with uterine contraction
77
hCG
Source
Function
Uses
Syncytiotrophoblast of placenta
Maintains corpus luteum (and thus progesterone) for 1st trimester by acting like LH
Used to detect pregnancy
78
Why is hCG not needed in 2nd and 3rd trimesters?
Placenta synthesizes its own estriol and progesterone
79
Elevated hCG in pathological states
Hydatidiform moles, choriocarcinoma
80
Average age of menopause?
| What makes it earlier?
Average age at onset is 51
| Earlier in smokers
81
What is happening hormonally in menopause?
↓ estrogen production becuse of ↓ # of follicles
↑↑FSH, ↑LH (no surge), ↑GnRH
Ovaries continue to produce androgens under LH stimulation
82
What usually precedes menopause?
4-5 years of abnormal menstrual cycles
83
Source of estrogen after menopause?
Peripheral conversion of androgens
84
Best test to confirm menopause?
↑↑ FSH
85
What does Menopause produce?
"HHAVOC"
| Hirsutism, Hot flashes, Atrophy of the Vagina, Osteoporosis, Coronary artery disease
86
Menopause before age 40 indicates...
Premature ovarian failure
87
Menorrhagia
Heavy and/or prolonged menses
88
Average length of menses
3-5 days
89
Average blood loss during menses
35mL (10-80)
90
Metrorrhagia
Irregular menses
91
Dysmenorrhea
Painful menses
92
As women approach menopause, how does their cycle change
Follicular part becomes shorter. Failure of ovaries to produce follicles and estrogen --> ↑↑ FSH and earlier LH/FSH surge
93
Perimenopause
What is it?
How long does it last?
Irregular/skipped menses and beginning of vasomotor symptoms
| Can last 5-10 years before menopause
94
Menopause definition
12 months of amenorrhea
95
Mechanisms of osteoporosis in menopause
Estrogen --/ bone resorption by osteoclasts
96
Leuprolide
Mechanism
Uses
Toxicity
GnRH analog
Pulsatile --> Agonist
Continuous --> Antagonist (downregulation of GnRH receptors in pituitary --> ↓ FSH/LH
Pulsatile: treats infertility
Continuous: Endometriosis, Prostate cancer (w/ Flutamide), Uterine fibroids, Precocious puberty
Tox: Antiandrogen, Nausea, Vomiting
97
Testosterone, Methyltestosterone
Mechanism
Use
Toxicity
Agonist for androgen receptors
Treats: hypogonadism, Promotes development of secondary sex characteristics, Stimulation of anabolism to promote recovery after burn injury
Tox: Masculinization in females, Reduces intratresticular testosterone in males by inhibiting release of LH which leads to gonadal atrophy, Premature closure of epiphyseal plate, ↑LDL, ↓HDL
98
Names of antiandrogens
Finasteride, Flutamide, Ketoconazole, Spironolactone
99
```
Finasteride
Kind of drug
MoA
Uses
Tox
```
Antiandrogen
--/ 5α Reductase which turns T into DHT
Treats BPH and hair loss
Breast growth
100
Flutamide
Kind of drug
MoA
Uses
Antiandrogen
Nonsteroidal competitive inhibitor of androgens at the testosterone receptor
Treats prostate carcinoma
101
```
Ketoconazole
Kind of drug
MoA
Uses
Toxicity
```
Antiandrogen
Inhibits steroid synthesis (--/ 17,20 desmolase)
Treats PCOS to prevent hirsutism
Tox: gynecomastia and amenorrhea
102
```
Spironolactone
Kind of drug
MoA
Uses
Toxicity
```
Antiandrogen
Inhibits steroid binding
Treats PCOS to prevent hirsutism
Tox: gynecomastia and amenorrhea
103
```
Estrogens
Names
MoA
Use
Tox
Contraindication
```
Ethinly, Estradiol, DES, Mestranol
Binds Estrogen receptors
Treats Hypogonadism or Ovarian Failure, Menstrual abnormalities, HRT in postmenopausal women
Used in men to treat androgen dependent prostate cancer
Tox: ↑ risk of endometrial cancer, bleeding in postmenopausal women, clear cell carcinoma of the vagina/cervix in females exposed to DES in utero, ↑ risk of thrombi
ER+ breast cancer, history of DVTs
104
Names of Selective Estrogen Receptor Modulators (SERMs)
Clomiphene, Tamoxifen, Raloxifene
105
```
Clomiphene
Kind of Drug
MoA
Uses
Toxicity
```
SERM
Partial agonist at estrogen receptors in hypothalamus. Prevents normal feedback inhibition and ↑ LH and FSH from pituitary.
Treats infertility and PCOS
Tox: Hot flashes, ovarian enlargement, multiple simultaneous pregnancies, visual disturbances
106
Tamoxifen
Kind of Drug
MoA
Uses
SERM
Antagonist of estrogen receptors in breast tissue
Treats and prevents recurrence of ER+ breast cancer
107
Raloxifene
Kind of Drug
MoA
Uses
SERM
Agonist of estrogen receptors in bone and reduces bone resorption
Treats osteoporosis
108
Hormone Replacement Therapy
Uses
Toxicity
Used for the relief or prevention of menopausal symptoms (hot flashes, vaginal atrophy, etc) and osteoporosis (by ↑ estrogen --> ↓ osteoclast activity)
Unopposed use of estrogen --> ↑ risk of endometrial cancer, so progesterone is added. Possible ↑ CV risk
109
Anastrozole/Exemestane
MoA
Uses
Aromatase inhibitor used to treat postmenopausal women with breast cancer
110
Progestins
MoA
Uses
Binds progesterone receptors. Reduces growth and ↑ vascularization of endometrium
Used in oral contraceptives and treatment of endometrial cancer and abnormal uterine bleeding
111
```
Mifepristone (RU-486)
MoA
Co-administered with...
Use
Tox
```
Competitive inhibitor of progestins at progesterone receptor
Termination of pregnancy. Administered w/ misoprostol (PGE)
Tox: Heavy bleeding, GI effects (nausea, vomiting, anorexia), Abdominal pain
112
Oral Contraception
What does it consist of?
MoA
Contraindications
Progestins + Estrogen
E and P --/ LH/FSH which leads to prevention of estrogen surge. No estrogen surge --> no LH surge. No LH surge --> no ovulation
Progestins cause thickening of the cervical mucus, thereby limiting access of sperm to uterus.
Progestins --/ endometrial proliferation making it less suitable for implantation
Contraindicated in smokers >35 (CV events), Hx of Thromboembolism and stroke or Hx of estrogen dependent tumors
113
Terbutaline
MoA
Uses
β2 agonist that relaxes uterus
| Reduces premature uterine contractions
114
Tamsulosin
MoA
Uses
Selectivity
α1 antagonist used to treat BPH by inhibiting smooth muscle contraction
Selective for α1A and α1D (on prostate) vs α1B (vasculature)
115
```
Sildenafil, Vardenafil
MoA
Uses
Tox
Contraindications
```
--/ Phosphodiesterase 5 causing an ↑ in cGMP, smooth muscle relaxation in corpus cavernosum, ↑ blood flow, and penile erection
Treats erectile dysfunction
Tox: "Hot and sweaty, but then Headache , Heartburn, Hypotension"
Headache, flushing, dyspnea, impaired blue-green color vision, Hypotension
Risk of life threatening hypotension in nitrate users
116
Danazol
MoA
Uses
Tox
Synthetic androgen that is a partial agonist at androgen receptor
Endometriosis and hereditary angioedema
Wt Gain, Edema, Acne, Hirsutism, Masculinization, ↓HDL, Hepatotoxicity
117
```
Endometriosis
What is it?
What tissue is affected?
What does it cause?
What causes it?
```
```
Non-neoplastic endometrial glands/stroma in abnormal locations
In Ovary or on Peritoneum
Cyclic bleeding (menstrual type) resulting in blood filled "chocolate cysts"
Caused by retrograde menstrual flow
```
118
Endometriosis
Clinical manifestation?
Treatment
Dysmenorrhea, Menorrhagia, Dyspareunia, Infertility
Uterus is normal size
Treat with oral contraceptives, NSAIDs, Leuprolide, Danazol
119
Adenomyosis
What is it?
Clinical manifestation
Treatment
Endometrium within myometrium
Menorrhagia, Dysmenorrhea, Pelvic pain
Enlarged uterus
Hysterectomy
120
```
Cervical Dysplasia and Carcinoma In Situ
Description
Where does it begin and extend?
Classification
Histology
```
Disordered epithelial growth
Begins at basal layer of squamo-columnar junction and extends outwards
CIN1, CIN2, CIN3 (severe dysplasia or carcinoma in situ) depending on how high the basal cells extend
Koilocytes: raisinoid nuclei with perinuclear halo
121
```
Cervical Dysplasia and Carcinoma In Situ
Viral cause?
Mechanism of viral cause?
Prevention?
Risk if untreated
Risk factors
```
HPV16 and HPV18 (E6 --/ p53 andE7 --/ RB)
Vaccine available
May progress to invasive carcinoma if left untreated
Multiple sexual partners, smoking , early intercourse, HIV
122
Cervical Invasive Carcinoma
Most often what kind of carcinoma?
Screen?
Complications
Often squamous cell carcinoma
Pap smear
Lateral invasion can block ureter leading to renal failure
123
```
PCOS
PathoPhys
Gross
Clinical manifestation
Associated w/
Increased risk for
```
↑ frequency of pulsatile GnRA release --> ↑LH + ↓FSH --> anovulation --> no progesterone
Hyperandrogenism b/c of deranged steroid synthesis by Theca cells
Bilaterally enlarged, cystic ovaries
Amenorrhea, infertility, obesity, hirsutism
Associated with insulin resistance
Risk for endometrial cancer (↑ estrogen + no progesterone to oppose --> ↑ aromatization of testosterone in fat)
124
PCOS treatment
Wt reduction
Low does Oral Contraceptive or medroxyprogesterone (↓ LH and androgenesis)
Spironolactone (acne and hirsutism)
Clomiphene (infertility)
Meformin (diabetes or metabolic syndrome)
125
```
Endometrial hyperplasia
What is it?
What causes it?
Increased risk for...
Presentation
Risk factors
```
```
Abnormal endometrial gland proliferation
Caused by excess estrogen stimulation
↑ risk for endometrial carcinoma
Postmenopausal vaginal bleeding
Anovulatory cycle, HRT, PCOS, Granulosa Cell Tumor
```
126
```
Endometrial Carcinoma
Frequency
Epidemiology
Presentation
Typically preceded by
Risk factors
Prognosis
```
Most common gynecologic malignancy
Peak occurrence at 55-65
Vaginal bleeding
Typically preceded by endometrial hyperplasia
Prolonged use of estrogen w/o progesterone, obesity, diabetes, HTN, nulliparity, late menopause
↑ myometrial invasion --> poor prognosis
127
Types of Myometrial tumors
Leiomyoma (fibroid)
| Leiomyosarcoma
128
```
Leiomyoma
Type of tumor
Frequency
Gross
Epidemiology
What kind of tissue
Malignant?
```
Myometrial tumor
Most common of all tumors in females
Multiple tumors with well-demarcated borders
↑ incidence in blacks. Peak at 20-40
Benign smooth muscle tumor
Malignant transformation to Leiomyosarcoma is rare
129
```
Leiomyoma
Hormone sensitive?
Presentation
Complications
Histology
```
Estrogen sensitive: tumor size ↑ w/ pregnancy and ↓ w/ menopause
May be asymptomatic, cause abnormal uterine bleeding, miscarriage
Severe bleeding may lead to Iron Deficiency Anemia
Whorled pattern of smooth muscle fibers
130
```
Leiomyosarcoma
Kind of tumor
Gross
Where does it arise from?
Epidemiology
Prognosis
```
```
Myometrial tumors
Bulky, irregular shaped tumor with areas of necrosis and hemorrhage. May protrude from cervix and bleed
Typically arising de novo
↑ incidence in middle aged black women
Highly aggressive w/ tendency to recur
```
131
```
Hydatidiform Moles
What are they?
Types
Presentation
Precursor of...
Serum marker
Gross
Potential complication
Treatment
```
```
Cystic swelling of chorionic villi and proliferation of chorionic epithelium (trophoblast)
Complete vs Partial
Presents with abnormal vaginal bleeding
Most common precursor of choriocarcinoma
↑βhCG
Honeycomb uterus or cluster of grapes appearance. Enlarged uterus
Uterine rupture
dilation and curettage and methotrexate
```
132
```
Complete Hydatidiform moles
Appearance
Fetus?
Karyotype
hCG
Uterine size
Conversion to choriocarcinoma
Fetal parts
Components
Risk of complications
```
```
Snowstorm appearance with no fetus during 1st sonogram
46XX, 46XY
↑↑↑↑ hCG
↑ uterine size
2% choriocarcinoma
No fetal parts
2 sperm (from same sperm that replicated) + empty egg
15-20% malignant trophoblastic disease
```
133
```
Partial Hydatidiform moles
Karyotype
hCG
Uterine size
Conversion to choriocarcinoma
Fetal parts
Components
Risk of complications
```
```
69XXX, 69XXY, 69XYY
↑ hCG
No change in uterine size
Rare choriocarcinoma
Has fetal parts
2 sperm + 1 egg
Low risk of malignancy
```
134
Classical Preeclampsia presentation
Pregnant women with HTN, Proteinuria, and Edema
135
Classical Presentation of Eclampsia
Preeclampsia + Seizures
136
```
Preeclampsia
Frequency
When
↑ risk in...
Caused by
Associated w/
Mortality results from
```
7% of pregnant women from 20 weeks to 6 weeks postpartum
↑ risk in pts w/ HTN, Diabetes, Chronic Renal Disease, Autoimmune disorders
Impaired vasodilation of spiral arteries --> Placental ischemia --> ↑ vascular tone
Associated with HELLP syndrome
Death from cerebral hemorrhage and ARDS
137
HELLP Syndrome
Hemolysis, Elevated Liver enzymes, Low Platelets
138
Clinical Manifestations of Preeclampsia
| Lab findings
Headache, Blurred vision, Abdominal pain, Edema of face and extremities, altered mentation, hyperreflexia
Thrombocytopenia and Hyperuricemia
139
Treatment Preeclampsia
Delivery of fetus as soon as possible, Bed rest, monitoring, treat HTN
IV MgSulfate to prevent seizures
140
Ovarian germ cell tumors most common in...
Adolescents
141
```
Dysgerminoma
What kind of tumor?
Malignant?
Equivalent in male?
Histology
Associated w/
Markers
```
```
Ovarian germ cell tumor
Malignant
Equivalent to male seminoma but rarer (1% over 30%)
Sheets of uniform cells
Associated with Turners Syndrome
hCG and LDH
```
142
```
Choriocarcinoma in females
What kind of tumor?
Frequency
Malignant
Who develops it?
When does it develop?
Source
Histology
What other pathologies is it related to?
Metastases
Serum markers
```
Ovarian germ cell tumor
Rare but malignant
Develops during or after pregnancy in mother or baby
From trophoblastic tissue
No chorionic villi and ↑ theca-lutein cysts
On spectrum with moles as gestational trophoblastic neoplasms
Early homogenous spread to lungs
hCG
143
```
Yolk Sac (Endodermal Sinus) Tumor in women
What kind of tumor?
Malignant?
Location
What kind of pt?
Gross
Histology
Marker
```
Ovarian germ cell tumor
Aggressive malignancy in ovaries/testes and sacrococcygeal area of young children
Yellow, friable, solid masses
50% of Schiller-Duval bodies (resemble glomeruli)
AFP
144
```
Teratoma in women
What kind of tumor
Frequency
Types of tissue?
Types
```
Ovarian germ cell tumor
90% of ovarian germ cell tumors
Contains cells from 2 or 3 germ layers
Mature vs. Immature
145
Mature Teratoma in women
Gross
Frequency
Malignant?
Dermoid Cyst
Most common ovarian germ cell tumor
Mostly benign
146
Immature Teratoma in women
Malignant?
Gross
Presentation
Aggressively malignant
Can have Struma Ovarii (functional thyroid tissue)
Can present as hyperthyroidism
147
```
Serous Cystadenoma
Kind of tumor
Frequency
Distribution
Histology
Malignant?
```
```
Ovarian non-germ cell tumor
45% of ovarian tumors
Bilateral
Lined with fallopian tube-like epithelium
Benign
```
148
Marker for Ovarian cancer?
↑ CA-125
| Good for monitoring progression but not screening
149
```
Serous cystadenocarcinoma
Kind of tumor
Frequency
Distribution
Histology
Malignant?
Genetic risk factors
```
```
Ovarian non-germ cell tumor
45% of ovarian tumors
Bilateral
Psammoma bodies
Malignant
BRCA1, BRCA2, HNPCC
```
150
Mucinous Cystadenoma
Kind of tumor
Malignant
Histology
Ovarian non-germ cell tumor
Benign
Multilocular cyst lined by mucus secreting epithelium. Intestine-like tissue
151
Mucinous Cystadenocarcinoma
Kind of tumor
Malignant?
Complication
Ovarian non-germ cell tumor
Malignant
Pseudomyxoma peritonei - intraperitoneal accumulation of mucinous material from ovarian or appendiceal tumor
152
```
Brenner Tumor
Kind of tumor
Malignant
Distribution
Gross
Histology
```
```
Ovarian non-germ cell tumor
Benign
Unilateral
Looks like Bladder. Solid tumor that is pale yellow-tan color and appears encapsulated
Coffee bean nuclei on H&E
```
153
```
Fibromas
Kind of tumor?
Histology
Complication
Clinical Manifestation
```
Ovarian non-germ cell tumor
Bundles of spindle shaped fibroblasts
Meigs' Syndrome
Pulling sensation in groin
154
Meigs Syndrome
Ovarian fibroma + ascites + hydrothorax
155
```
Granulosa Cell Tumor
What kind of tumor
Hormones
Complications in kids vs adults
Histology
Presentation
```
Ovarian non-germ cell tumor
Secretes estrogen
Precocious puberty in children
endometrial hyperplasia or carcinoma in adults
Call-Exner bodies (small follicles filled with eosinophilic secretions)
Abnormal uterine bleeding
156
Krukenberg Tumors
Kind of tumor
Source
Histology
Ovarian non-germ cell tumor
GI malignancy that metastasizes to ovaries
Mucin secreting signet cell adenocarcinoma
157
Squamous Cell Carcinoma of the Vagina Usually secondary to...
SCC of cervix
158
Women at risk for Clear Cell Adenocarcinoma of the Vagina
DES exposure in utero
159
Sarcoma Botryoides (rhabdomyosarcoma variant)
Kind of tumor
Classic pt
Histology
Vaginal Tumor
Girls <4
Spindle shaped, Desmin+ tumor cells
160
```
Dizygotic twins
Frequency
Egg #
Amniotic sacs
Placentas
```
80% of twins
2 eggs
2 separate amniotic sacs
2 separate placentas (chorions)
161
```
Monozygotic twins that split day 0-4
Stage
Frequency
Placenta
Amniotic sacs
Chorion
```
```
Morula
25%
Fused or separate placenta
Diamniotic
Dichorionic
```
162
```
Monozygotic twins that split day 4-8
Stage
Frequency
Amniotic sacs
Chorion
```
Blastocyst
75%
Diamniotic
Monochorionic
163
Monozygotic twins that split day 8-12
Frequency
Amniotic sacs
Chorion
Less than 1%
Monoamniotic
Monochorionic
164
Monozygotic twins that split after day 13
Monoamniotic
Monochorionic
Conjoined
165
Fetal Components of the placenta
Cytotrophoblast and Syncytiotrophoblast
166
Cytotrophoblast
Where is it?
What is it made from?
Where is it from?
Inner layer of chorionic villi
Cytotrophoblast made from Cells
Fetal component
167
Syncytiotrophoblast
Where is it?
What does it secrete?
Outer layer of chorionic villi
| Secretes hCG
168
Maternal component of placenta
Name
Derived from?
Decidua Basalis
| Derived from endometrium
169
Where is maternal blood in the placenta?
In Lacunae
170
What makes up the Umbilical Cord?
2 Umbilical arteries and 1 Umbilical vein
171
Function of umbilical arteries
| Source?
Return deoxygenated blood from fetal internal iliac arteries to placenta
172
Function of umbilical vein?
| What does it drain into?
Supplies oxygenated blood from placenta to fetus
| Drains via ductus venosus into IVC
173
Single umbilical artery is associated with...
Congenital and Chromosomal Anomalies
174
What are the umbilical arteries and veins are derived from?
The Allantois
175
Urachal Duct
What is it?
Development?
Failure to obliterate?
A duct between bladder and yolk sac
3rd week: Yolk sac forms allantois which extends into urogenital sinus. Allantois becomes urachus
Patent Urachus: urine discharge from the umbilicus
Vesicourachal diverticulum: outpouching of bladder
176
```
Vitelline duct
Name
Function
When is it obliterated
Failure to obliterate
```
Omphalo-Mesenteric Duct
Connects yolk sac to midgut lumen
Obliterated at week 7
Vitelline fistula: meconium discharge from umbilicus
Meckel's Diverticulum: Ectopic gastric and pancreatic tissue --> melena, periumbilical pain, ulcer
177
1st Aortic Arch forms
Maxillary artery (branch of external carotid)
178
2nd Aortic Arch forms
Stapedial artery and Hyoid artery
179
3rd Aortic Arch forms
Common Carotid artery and proximal part of Internal Carotid artery
180
4th Aortic Arch forms
L: Aortic arch
R: Proximal part of Subclavian artery
181
6th Aortic Arch forms
Proximal part of pulmonary arteries and (on left only) ductus arteriosus
182
Branchial Apparatus
AKA
Composition with origin
```
Pharyngeal Apparatus
"CAP"
Clefts (grooves) from Ectoderm
Arches from Mesoderm (muscles, arteries) and neural crest cells (bones, cartilage)
Pouches from Endoderm
```
183
Branchial Clefts develop into
1st: External auditory meatus
| 2nd - 4th: form temporary cervical sinus which are obliterated by proliferation of 2nd arch mesenchyme
184
Persistent Cervical Sinus
Branchial cleft cyst within lateral neck
185
```
1st Branchial Arch
Cartilage
Muscles
Nerves
Pathology
```
Meckel's cartilage: Mandible, Malleus, incus, spheno-Mandibular ligament
Muscles of Mastication (Temporalis, Masseter, Lat and Med Pterygoids), Mylohyoid, Anterior belly of the digastric, Tensor Tympani, Tensor Veli Palatini
V2 and V3
Treacher Collins Syndrome --> 1st arch crest fails to migrate --> Mandibular hypoplasia and facial abnormalities
186
2nd Branchial Arch
Cartilage
Muscles
Nerves
Reichert's Cartilage (Stapes, Styloid Process, Lesser horn of the Hyoid, Stylohyoid ligament)
Muscles of facial expression, Stapedius, Stylohyoid, Posterior Belly of the Digastric
CNVII
187
```
3rd Branchial Arch
Cartilage
Muscles
Nerves
Pathology
```
Greater horn of hyoid
Stylopharyngeus
CN IX ("swallow stylishly")
Congenital Pharyngo-Cutaneous Fistula: Persistence of cleft and pouch --> Fistula between tonsillar area, cleft in lateral neck
188
4th - 6th Branchial Arch
Cartilage
Muscles
Nerves
Thyroid, Cricoid, Arytenoids, Corniculate, Cuneiform
4th: Most Pharyngeal Constrictors; Cricothyroid, Levator Veli Palatini
6th: All intrinsic muscles of larynx except cricothyroid
CNX: 4th is superior laryngeal branch ("simply swallow"), 6th is recurrent laryngeal branch ("speak")
189
Branchial Arches Mnemonic
Chew, Smile, Swallow Stylishly, Simply Swallow, Speak
190
What forms posterior 1/3 of tongue
Branchia Arches 3 and 4
191
What does Branchia Arch 5 become?
5 makes no major developmental contributions
192
1st Branchial Pouch
Develops into
What does it contribute to?
Middle Ear Cavity, Eustachian Tube, Mastoid Air Cells
| Contributes to Endoderm-lined structures of ear
193
2nd Branchial Pouch develops into...
Epithelial lining of palatine tonsil
194
3rd Branchial pouch
Develops into...
Where does it end up
Dorsal wings develop into inferior parathyroids
Ventral wing develops into Thymus
Ends up below 4th
195
4th Branchial pouch develops into...
Dorsal wings develop into superior parathyroids
196
DiGeorge Syndrome
What develops abnormally
PathoPhys
Aberrant development of 3rd and 4th Branchial pouches
| T cell deficiency (Thymic aplasia) and Hypocalcemia (parathyroid doesn't develop)
197
Cleft Lip
Failure of fusion of maxillary and Medial Nasal Processes (formation of primary palate)
198
Cleft Palate
Failure of fusion of the lateral palatine processes, the nasal septum, and/or the median palatine process (formation of secondary palate)
199
Cleft Lip vs Cleft Palate
2 distinct etiologies but often occur together
200
Female genital development
What kind of pathway?
Ducts?
Default pathway
| Mesonephric duct degenerates and Paramesonephric duct develops
201
Phys of male genital development
SRY produces testes determining factor
Sertoli cells secrete Mullerian Inhibitory Factor.
Leydig cells secrete Testosterone that stimulate development of mesonephric ducts
202
Paramesonephric duct
Name
What does it develop into?
Presentation of defect?
Mullerian Duct
Fallopian tubes, uterus, upper vagina
Primary amenorrhea with fully developed secondary sex characteristics
203
Mesonephric Duct
Name
What does it develop into?
Wolffian duct
"SEED"
Develops into Seminal vesicles, Epididymis, Ejaculatory duct, Ductus deferens
204
Bicornuate Uterus
What is it?
What can it lead to?
Incomplete fusion of Mullerian duct
| Can lead to urinary tract abnormalities and miscarriages
205
What does DHT do?
Promotes development of male external genitalia and prostate
206
What happens if there are no sertoli cells or no MIF?
Development of both male and female internal genitalia and male external genitalia
207
```
5αReductase Deficiency
Chromosomes, Genitalia, Inheritance
PathoPhys
Presentation
Hormonal findings
```
XY
Internal genitalia normal
AR
Inability to convert T to DHT
Ambiguous genitalia until puberty, when T causes masculinization and ↑ growth of external genitalia
T and Estrogen levels are normal. LH normal or ↑
208
Genital Tubercle
Male
Female
Male: Glans, Corpus Cavernosum, Spongiosum
Female: Glans Clitoris, Vestibular Bulbs
209
Urogenital Sinus
Male
Female
Bulbourethral glands, Prostate
| Greater vestibular glands of Bartholin and Urethral and Paraurethral glands of Skene
210
Urogenital folds
Male
Female
Ventral shaft of penis (penile urethra)
| Labia Minora
211
Labioscrotal swelling
Male
Female
Scrotum
| Labia Majora
212
```
Hypospadias
What is it?
What causes it?
Frequency
Why treat it?
```
"Hypo is Below"
Abnormal opening of penile urethra on inferior (ventral) side of penis
Due to failure of urethral folds to close
More common than epispadias
Fix to prevent UTIs
213
Epispadias
What is it?
What causes it?
Association
"When you have Epispadias you hit your Eye when you pEE"
Abnormal opening of penile urethra on superior (dorsal) side of penis
Due to faulty positioning of genital tubercle
Extrophy of the bladder
214
Gubernaculum
What is it?
Male remnant
Female remnant
Band of Fibrous Tissue
Anchors Testes within scrotum
Ovarian ligament and Round ligament of the uterus
215
Processus Vaginalis
What is it?
Male remnant
Female remnant
Evagination of peritoneum
Forms tunica vaginalis
Obliterated
216
Venous drainage of gonads?
L ovary/teste --> L gonadal vein --> L renal vein --> IVC
| R ovary/teste --> R gonadal vein --> IVC
217
Lymphatic drainage of ovaries/testes
Para-Aortic Lymph Nodes
218
Lymphatic drainage of distal 1/3 of vagina, vulva, and scrotum
Superficial Inguinal Nodes
219
Lymphatic drainage of Proximal 2/3 of vagina and uterus?
Obturator, External Iliac and Hypogastric Nodes
220
On which side is Varicocele more common?
More common on Left because L venous pressure > R venous pressure because L spermatic vein enters L renal vein at 90 degrees, so flow is less continuous on Left
221
Suspensory Ligament of the Ovaries
Connects
Structures contained
Ovaries to lateral pelvic wall
| Ovarian vessels
222
What can be damaged during oophorectomy?
Ureter is at risk during ligation of ovarian vessels in oophorectomy
223
Cardinal Ligament
Connects
Structures contained
Cervix to side wall of pelvis
| Uterine vessels
224
What can be damaged during hysterectomy?
Ureter at risk of injury during ligation of uterine vessels
225
```
Round Ligament of the Uterus
Connects
Structures contained
Derivative from what?
What does it travel through?
```
Uterine Fundus to Labia Majora
Artery of Sampson
Derivative of Gubernaculum
Travels through round inguinal canal
226
Broad Ligament
Connects
Structures contained
Components
Uterus, Fallopian Tubes, and Ovaries to Pelvic side wall
Ovaries, Fallopian tubes, Round ligaments of the uterus
Mesosalpinx, Mesometrium, Mesovarium
227
Ligament of the ovary
Connects
Structures contained
Derivative from what?
"Latches ovary to Lateral uterus"
Medial pole of ovary to lateral uterus
None
Derivative of gubernaculum
228
Vagina histology
Stratified Squamous Epithelium, Nonkeritinizing
229
Ectocervix histology
Stratified Squamous
230
Endocervix histology
Simple Columnar
231
Uterus Histology
Simple columnar, Pseudostratified tubular glands
232
Fallopian tube histology
Simple columnar, ciliated
233
Ovary histology
Simple cuboidal
234
Pathway of sperm
```
"SEVEN UP"
Seminiferous tubules
Epididymis
Vas deferens
Ejaculatory duct
Nothing
Urethra
Penis
```
235
Erection
System responsible?
Nerve
Pathway
Parasympathetic nervous system
Pelvic nerve
NO --> ↑ cGMP --> smooth muscle relaxation --> vasodilation --> proerectile
236
Nervous pathology of anti-erection
NE --> ↑ [Ca] --> smooth muscle contraction --> vasoconstriction --> antierectile
237
Nervous system responsible for emission
| Nerve?
Sympathetic nervous system
| Hypogastric nerve
238
Nerves responsible for Ejaculation
Visceral and Somatic Nerves
| Pudendal nerve
239
Spermatogonia
Function
What do they produce
Location
Maintain germ pool
Produce Primary Spermatocytes
Line seminiferous tubules
240
```
Sertoli cells
What do they secrete?
Connections between cells?
Function
Effects of Temp? What changes temp?
```
Secretes inhibin (inhibits FSH), Androgen binding protein (maintains local levels of testosterone), AMH
Tight junctions form blood-testis barrier --> isolate gametes from autoimmune attack
Support and nourish spermatozoa, Regulate spermatogenesis
Temp sensitive: Varicocele or Cryptorchidism --> ↑ Temp --> ↓ sperm production and ↓ inhibin
241
Leydig Cells
Secrete
Effects of Temp?
Location
Secrete Testosterone
Unaffected by Temp
Interstitium
242
Male Meiosis
Spermatogonium (2N2C) --> Primary Spermatocytes (2N4C)--> [Meiosis I] --> Secondary Spermatocyte (1N2C) --> [Meiosis II] --> Spermatid (NC) --> [Spermiogenesis] --> Mature spermatozoon
243
Where are the tight junctions between Sertoli cells
Between Spermatogonium and Primary Spermatocytes
244
Time for full development of sperm?
2 months
245
Process of spermatogenesis
Loss of cytoplasmic contents and gain of acrosomal cap
246
Hormone pathways of Testes
Hypothalamus --> GnRH --> AP --> FSH and LH
FSH --> Sertoli cells --> ABP and Inhibin
Inhibin --/ AP
LH --> Leydig cells --> Testosterone --/ Hypothalamus and AP
247
Androgens
Names w/ potency
Source
DHT > Testosterone > Androstenedione
| T and D from testes, AnDrostenedione from ADrenal gland
248
Testosterone Functions
Differentiation of epididymis, vas deferens, seminal vesicles (internal genitalia except prostate)
Growth spurt (penis, seminal vesicles, sperm, muscles, RBCs)
Deepening of voice
Closing of epiphyseal plates (via estrogen converted to testosterone)
Libido
249
DHT functions
Early
Late
Differentiation of penis, scrotum and prostate
| Prostate growth, balding, sebaceous gland activity
250
What converts testosterone and androstenedione into estrogen
Aromatase in adipose tissue
251
```
Klinefelter's Syndrome
Chromosomes
Pathways
Presentation
Histo
```
XXY
Dysgenesis of seminiferous tubule --> ↓ inhibin --> ↑ FSH
Abnormal Leydig cell function --> ↓ testosterone --> ↑ LH --> ↑ Estrogen
Testicular atrophy, eunuchoid body shape, Tall, Long extremities, Gynecomastia, female hair distribution, Developmental delay
Barr body
252
```
Turners Syndrome
Chromosomes
Pathways
Presentation
Gross anatomy
Risk for?
Histo
```
XO
↓ estrogen --> ↑ LH and FSH
Short, shield chest, amenorrhea, menopause before menarche
Streak ovaries, bicuspid aortic valve, defective lymphatics --> webbing of neck (cystic hygroma), lymphedema in feet and hands, Preductal coarctation of the aorta, horseshoe kidney
Dysgerminoma
No barr body
253
Double Y male
Presentation
Risks
Phenotypically normal, very tall, severe acne, normal fertility
Antisocial behavior and autism spectrum disorder
254
Defective androgen receptor
Testosterone
LH
Testosterone ↑
| LH ↑
255
Testosterone secreting tumor or exogenous steroids
Testosterone
LH
Testosterone ↑
| LH ↓
256
Primary Hypogonadism
Testosterone
LH
Testosterone ↓
| LH ↑
257
Hypogonadotropic Hypogonadism
Testosterone
LH
Testosterone ↓
| LH ↓
258
```
Female pseudohermaphrodite
Chromosomes
Gonads
External genitalia
Cause
```
XX
Ovaries
Virilized or ambiguous genitalia
Exposure to androgens during early gestation: congenital adrenal hyperplasia or exogenous administration
259
```
Male pseudohermaphrodite
Chromosomes
Gonads
External genitalia
Cause
```
XY
Testes
Female or ambiguous
Androgen insensitivity syndrome is most common form
260
```
True Hermaphroditism
Chromosomes
Gonads
Genitalia
Frequency
```
XX or XXY
Ovotestis
Ambiguous genitalia
Very rare
261
```
Androgen Insensitivity Syndrome
PathoPhys
External Genitalia
Internal Genitalia
What do they develop?
Hormonal Findings?
```
Defective Androgen Receptor
Normal appearing female with female external genitalia but with scant genital hair
Rudimentary vagina. No Uterus or Fallopian tubes
Testes in Labia Majora that must be surgically removed
↑ Testosterone, Estrogen, and LH
262
Kallmann Syndrome
PathoPhys
Presentation
Findings
Defective migration of GnRH cells and formation of olfactory bulb
Anosmia and lack of secondary sex characteristics
↓ GnRH, FSH, LH, T, and Sperm count
263
```
Abruptio Placentae
What is it?
Associated with what?
↑ risk with...
Presentation
Threat?
```
```
Premature detachment of placenta
DIC
Smoking, HTN, Cocaine
Painful bleeding in 3rd trimester
Life threatening for both fetus and mother
```
264
Placenta Accreta
What is it?
↑ risk with...
Presentation
Defective decidual layer allows placenta to attach to myometrium --> No separation of placenta after birth
Prior C section, Inflammation, Placenta previa
Massive bleeding after delivery
265
Placenta previa
What is it?
↑ risk with...
Presentation
Attachment of placenta to lower uterine segment over internal cervical os
Multiparity and prior C-section
Painless bleeding in any trimester
266
Retained Placental Tissue leads to
Postpartum hemorrhage and ↑ risk of infection
267
```
Ectopic Pregnancy
Most often location
Presentation
Dx
Risk factors
Often confused with...
Histo
```
Fallopian tube
Amenorrhea, lower than expected ↑ in hCG, sudden abdominal pain w/ or w/o bleeding
US
Infertility, PID, Rupture appendix, Tubal surgery
Appendicitis
Endometrial biopsy shows decidualized endometrium but no chorionic villi
268
Polyhydramnios
Amount
PathoPhys
Associated with...
More than 1.5L
Esophageal/Duodenal atresia --> inability to swallow amniotic fluid
Anencephaly
269
Oligohydramnios
Amount
PathoPhys
What can it give rise to?
Less than .5L
Placental insufficiency, bilateral renal agenesis, or posterior urethral valves (in males) leading to inability to excrete urine
Potters Syndrome
270
Endometritis
What is it?
Treatment
Inflammation of the endometrium with retained products of conception following delivery (vaginal, C-section, miscarriage, abortion, foreign body) leads to bacterial infection from vaginal or intestinal flora
Gentamycin + Clindamycin w/ or w/o Ampicillin
271
Gynecologic tumor epidemiology
Incidence
Prognosis
Endometrial > Ovarian > Cervical
| Ovarian > Cervical > Endometrial
272
Premature Ovarian Failure
What is it?
Presentation
Findings
Premature atresia of ovarian follicles
Menopause before age 40
↓ estrogen, ↑ LH, ↑ FSH
273
Most common causes of anovulation
Pregnancy, PCOS, Obesity, HPO axis abnormalities, Premature Ovarian Failure, Hyperprolactinemia, Thyroid disorders, Eating disorders, Cushing's syndrome, Adrenal Insufficiency
274
Follicular Cyst
What is it?
Associated with?
Frequency
Distention of unruptured graafian follicle
Hyperestrinism and Endometrial Hyperplasia
Most common ovarian mass in young women
275
Corpus Luteum Cyst
What is it?
Course
Hemorrhage into persistent corpus luteum
| Commonly regresses spontaneously
276
Theca Lutein Cyst
#
Cause?
Associated with...
Bilateral and multiple
Gonadotropin stimulation
Choriocarcinoma and moles
277
Hemorrhagic Cyst
What is it?
Course
Blood vessel rupture into cyst wall.
Cyst grows with ↑ blood retention
Usually self resolves
278
Dermoid Cyst
Mature teratoma. Cystic growth with various tissues such as fat, hair, teeth, bone, cartilage
279
Endometrioid Cyst
What is it?
How does it vary
Appearance with name
Endometriosis within ovary with cyst formation
Varies with menstrual cycle
When filled with dark, reddish brown blood it is called a chocolate cyst
280
Course of milk flow in breast
Lobules --> Terminal duct --> Major duct --> Lactiferous sinus --> Nipple
281
```
Fibroadenoma of the breast
Characteristics
Epidemiology
Malignant?
Hormones?
```
Small, Mobile, Firm Mass with sharp edges
Most common tumor in those under 35
↑ size and tenderness with ↑ estrogen
Not a precursor to breast cancer
282
```
Intraductal Papilloma
Size
Location
Presentation
Malignant
```
Small tumor
Lactiferous ducts, typically beneath areola
Serous or bloody nipple discarge
Benign with slight risk of carcinoma
283
```
Phyllodes Tumor
Size
Type of tissue
Appearance
Epidemiology
Malignancy
```
```
Large and Bulky
Connective tissue and Cysts
Leaf-like projections
Most common in 6th decade of life
Some may become malignant
```
284
```
Malignant Breast Tumors
When does it present
Location
Markers
Prognostic factors
Risk factors
```
Common postmenopause
Terminal duct lobular unit in upper outer quadrant
Estrogen/Progesterone receptors or c-erbB2 (HER2 an EGF receptor)
Axillary lymph node involvement is important prognostic factor
↑ estrogen, total # of menstrual cycles, older age at 1st live birth, obesity, BRCA1, BRCA2 mutation
285
```
Ductal carcinoma in situ
What kind of cancer?
What does it look like
Arise from
Malignancy?
```
Noninvasive malignant breast tumor
Fills ductal lumen
Arises from ductal hyperplasia
Early malignancy w/o basement membrane penetration
286
```
Comedocarcinoma
What kind of cancer?
Type
Location
Histo
```
Noninvasive malignant breast tumor
Subtype of DCIS
Ductal
Caseous Necrosis
287
```
Invasive Ductal Breast Cancer
What kind of cancer?
Gross
Histo
Frequency
Prognosis
```
Invasive malignant breast tumor
Firm, fibrous, "rock hard" mass with sharp margins
Small, glandular, duct-like cells with classic stellate morphology
Most common (76%)
Worst and most invasive
288
Invasive Lobular Breast Cancer
What kind of cancer?
Distribution
Histo
Invasive malignant breast tumor
Bilateral with multiple lesions in the same location
Orderly row of cells (Indian File)
289
Medullary Breast Cancer
What kind of cancer?
Histo
Prognosis
Invasive malignant breast tumor
Fleshy, Cellular, Lymphocytic infiltrate
Good prognosis
290
```
Inflammatory Breast Cancer
What kind of cancer?
PathoPhys
Gross
Prognosis
```
Invasive malignant breast tumor
Dermal lymphatic invasion by breast carcinoma blocking lymphatic drainage
Peau d'orange (breast skin resembles orange peel)
50% survival @ 5 years
291
```
Paget's Disease of Breast
Gross
Histo
What does it suggest?
Where else is it seen?
```
Eczematous patches on nipple
Paget cells = large cells in epidermis with clear halo
Suggets underlying DCIS
Also seen on vulva
292
Fibrocystic Disease
Epidemiology
Presentation
What does it indicate
Most common cause of breast lumps from 25 to menopause
Premenstrual breast pain and multiple bilateral lesions. Fluctuations in size of mass
Does not indicate risk of carcinoma
293
Fibrocystic Disease Subtypes
Fibrosis: hyperplasia of breast stroma
Cystic: Fluid filled, blue dome. Ductal dilation
Sclerosing adenosis: ↑ acini and intralobular fibrosis. Calcification. Often confused with cancer
Epithelial hyperplasia: ↑ # of epithelial cell layers in terminal duct lobule. ↑ risk of carcinoma with atypical cells. Occurs in women over 30
294
Acute Mastitis
What is it?
When does it present
What are they at risk for?
Breast abscess
During breast feeding
Risk of bacterial infection through cracks in nipple by S aureus
295
Fat Necrosis of the breast
Dangerous?
Presentation
What causes it?
Benign
Painless lump
Injury (usually unreported)
296
What causes Gynecomastia?
Hyperestrogenism (Cirrhosis, Testicular tumor, Puberty, Old age)
Klinefelter's Syndrome
Drugs (Estrogen, Marijuana, Heroic, Psychoactive drugs, Spironolactone, Digitalis, Cimetidine, Alcohol, Ketoconazole)
"Some Drugs Create Awkward Knockers"
297
Prostatitis
Presentation
Acute Cause
Chronic Cause
Dysuria, Frequency, Urgency, Low back pain
Acute: bacterial (E coli)
Chronic: bacterial or abacterial (most common)
298
Benign Prostatic Hyperplasia
Epidemiology
PathoPhys
Malignant
Men over 50
Nodular enlargement of periurethral (lateral and middle) lobes compresses urethra
Not premalignant
299
```
Benign Prostatic Hyperplasia
Presentation
Complications
Findings
Treatment
```
Frequency, Nocturia, Dysuria, Difficulty starting and stopping stream
Distention and Hypertrophy of the bladder, Hydronephrosis, UTIs
↑ PSA
α1 antagonists (Terazosin, Tamsulosin), Finasteride
300
```
Prostatic Adenocarcinoma
Epidemiology
Location
Diagnosis
Tumor markers
Metastasis?
```
```
Men over 50
Posterior lobe in peripheral zone
↑ PSA and subsequent biopsy
Prostatic Acid Phosphatase and PSA
Osteoblastic mets to bone present as lower back pain and ↑ AlkPhos
```
301
```
Cryptorchidism
What is it?
Consequences
Associated with what?
What increases risk for it?
Labs
```
Undescended testis
Impaired spermatogenesis (b/c of temp) but normal testosterone
Risk of germ cell tumor
Prematurity
↑ FSH, LH and ↓ inhibin (and testosterone if bilateral)
302
```
Varicocele
PathoPhys
Consequences
Location
Can lead to...
Gross
How is Diagnosis made?
Treatment
```
Dilated veins in Pampiniform plexus b/c of ↑ venous pressure
Most common cause of scrotal enlargement
More common on Left
Infertility
Bag of Worms appearance
Diagnosed by US
Varicocelectomy, Embolization
303
```
Testicular Germ Cell Tumor
Frequency
Danger?
Can present as...
DDx
```
95% of all testicular tumors
Most often malignant
Can present as mixed germ cell tumor
Testicular mass that does not transilluminate
304
```
Seminoma
What kind of cancer?
Malignant?
Presentation
Epidemiology
Histo
Labs
Treatment
Prognosis
```
Testicular Germ Cell Tumor
Malignant
Painless homogenous testicular enlargement
Most common testicular tumor mostly affecting males 15-35
Large cells in lobules with watery cytoplasm and fried egg appearance
Placental ALP
Radiosensitive
Late metastasis with excellent prognosis
305
```
Yolk Sac (endodermal sinus) tumor in males
What kind of cancer?
Gross
Analog
Histo
Labs
```
```
Testicular Germ Cell Tumor
Yellow, Mucinous
Analogous to ovarian yolk sac tumor
Schiller-Duval Bodies resemble primitive glomeruli
↑ AFP
```
306
```
Choriocarcinoma in males
What kind of cancer?
Danger?
Labs
What is it made of?
Metastasis?
Complications
```
```
Testicular Germ Cell Tumor
Malignant
Increased hCG
Syncuytiotrophoblastic and Cytotrophoblastic elements
Hematogenous mets to lungs
Gynecomastia because of hCG
```
307
Teratoma in male
What kind of cancer?
Malignant?
Labs
Testicular Germ Cell Tumor
Unlike in females, malignant in adults
Benign in children
↑ hCG +/or AFP in 50% of cases
308
```
Embryonal Carcinoma
What kind of cancer?
Danger?
Presentation
Prognosis
Histo
Pure?
Labs
```
Testicular Germ Cell Tumor
Malignant
Painful
Worse prognosis that seminoma
Glandular/Papillary morphology
Pure version is rare, most commonly mixed
↑ hCG and normal AFP (if pure). ↑ AFP when mixed
309
Testicular Non-Germ Cell Tumor
Frequency
Danger
5% of all testicular cancers
| Mostly benign
310
```
Leydig cell cancer
What kind of cancer
Histo
What does it produce?
Presentation
Gross
```
```
Testicular non-Germ Cell Tumor
Reinke Crystals
Androgen producing
Gynecomastia in men, precocious puberty in boys
Golden Brown color
```
311
Sertoli cell Cancer
What kind of cancer
Description
Origin
Testicular non-Germ Cell Tumor
Androblastoma
From sex cord stroma
312
```
Testicular Lymphoma
What kind of cancer?
Epidemiology
Origin
Course
```
Testicular non-Germ Cell Tumor
Most common testicular caner in older men
Arises from lymphoma metastases to testes
Aggressive
313
Tunica Vaginalis Lesions
What is it?
Presentation
Types w/ causes
Lesions in the serous covering of testis
Present as testicular masses that can be transilluminated (vs testicular tumors)
Hydrocele: ↑ fluid secondary to incomplete fusion of processus vaginalis
Spermatocele: Dilated Epididymal Duct
314
Squamous Cell Carcinoma of the Penis
Epidemiology
Association
Asia, Africa, and South America
| HPV and lack of circumcision
315
Peyronie's Disease
Bent Penis due to acquired fibrous tissue formation
316
Priapism
What is it?
Causes
Painful sustained erection not associated with stimulation or desire
Trauma, Sickle Cell Disease (RBCs trapped in vascular channel), Medication (anticoagulants, PDE5 inhibitors, antidepressants, α blockers, cocaine
