reproductive Flashcards
what ectoderm divided into?
surface ectoderm,
neural crest,
neural tube,
what is derived from surface ectderm?
epidermis, adenohypophysis( rathkes pouch), eye lens, epithelial lining of oral cavity, sensory organs, seat glans and mammary glands
cranopharyngioma
Neural tube derivatives are?
brain, (neurohypophysis, CNS neurons, oligodendrocytes, astrocytes, epedyme cells, pineal glands), retina, spinal cord
neural crest derivatives are?
Melanocytes, Odontoblasts, tracheal lining, enterochromaffine cells, leptomeninges (pia, arach.), PNS, adrenal medulla, schwann cells, spiral membrane, skull, endocardial cushining
endoderm derivatives are?
gut tube, urethra, vagina, epithelial derivatives: lung, gallbladder, thyroid, liver
what is the Pierre robin sequence?
micrognathia, glossoptisis, cleft palate, airway obstruction
when does hCG secreation start?
W1
bastocyte sticks at day 6
when is the bilaminar disc?
W2=2layers
Gastrulations occurs when?
W3=3layer
nural tube is formed by the neuroectoderm when?
W4=4limbs and 4Chambers
when is th fetus seen on US?
W6
fetal movement starts?
W8
genitalia formation occurs?
W10= tenitalia
persistent cervical sinus is?
pharyngeal cleft cyst within the lateral neck, ant. to the sternoclido.
What is liprolite, what is it used for?
GnRH anlog with agonist properties, it downregurates the GnRH receptor in the petuitory and decreases FSH and decreases LH
used for fibroids, endometriosis and infertility
Estrogen
ethinyl estridiol, DES, mestranol
binds to recepror
used in hypogonadism, ovarian failure
Clomiphene
antagonist of estrogen receptor in hypothalamus, increases release of LH and FSH
used in infertility
tamoxifen
Antagonist at breast, partial agonist at uterus, bone.
competitively inhibits estrogen binding to its receptor
Hot flashes, in. risk of thromboembolic events (especially with tobacco smoking), and endometrial cancer. Used to treat and prevent recurrence of ER/PR ⊕ breast cancer and to prevent gynecomastia in patients undergoing prostate cancer t herapy
raloxifene
antagoinist of breast, uterus, agonist of bone
used for osteoporosis
aromatase deficiency
inhibits peripheral conversion of androgens to estrogen
progestin
bind to progesteron receptor, thickens the mucus, contraceptive
antiprogestins
mefepristine and ulipristal
competitive inhibitors of progestins at progesteron receptors, terminates pregancy
combined contraception
progestins and ethinyl estradiol, inhib. LH/FSH, thickening mucus
danazol
synthetic androgen, that acts as a partial agonist at androgen receptor
use endometriosis, heridiaty angioedema
endometrial hyperplasia
abnorm. endom. gland prolif. usual. caused by estrogen secretion
endometrial carcinoma
most commen gyn. malignancy
sy: irreg. bleeding
two types. endometriod: not estrogen stimul. early loss of pten
serous: hist: papilla and tuft,
Early pathogenic events include loss of PTEN or mismatch repair proteins.
TP53 loss
KRAS–>PIK3CA–>MLHI–>TP53–>carcinome
usul. postmenopausal
serous cystadenoma
most common ovarian neoplasm. lined with fallopian tube-like epithelum.
Serous cystadenoma
carcinoma
most common mal. ovarian neoplasm, frequenly blilateral, psamma bodies.
monitor CA 125
KRAS, PIK3CA, TP53, BRCA high grade
epithelium, columnar epithelial cilia+ mutilcystic spaces
What is a derivative or the paranephric duct and what is another name for it?
Wolffian duct,
develops into the male internal structures except the prostate, SEED, seminal vessels, epidydimis, ejauclatory duct, ductus defference,
in females remnant is the gartner duct
What is a derivative or the paramesonephritic (müllerian) duct?
devel. into female internal structures- fallopian tube, uterus, upper vagina, lower urogenital sinus,
male reminant ist the appendic testis
what is müllerian agenis (mayer-rokitansky-küster-hauser-syndrome?
may present with 1° amenorrhae ( due to lack of uterus devel. in fem with fully developed uterus 2° sex charac. (functional ovaries)
what is lactogen?
chorionic somatomammatropin,
source: is the syncytiotrophoblast of the placenta,
function: stimulates insulin production; increases insulin resistance
what is estrogen?
ovary (17ß-estradio), placenta (estridiol), adipose tissue ( estrone via aromatization)
leydeg cell produce?
(ley)dies dig testosteron
sertoli cells serect?
inhibinB—-> inhibits FSH
secretion of androgen-binding proteins to maintain testosterone levels
cleft lip is a result of?
failure to fuse of the maxillary and merge medial nasal process
cleft palate is a result of?
failure of fusion of the two lateral palatine shelves or falure of fusion of lateral paletine shelf with the nasal septum.
warfarin causes what in pregnant women?
bone deformities, fetal hemorrhage, abortion, ophthalmologic abnormalities
aminoglycosites cause?
ototoxicity
what does placental aromataze deficiency lead too?
inability to synthesized estrogen from androgens, leads to masculinization
5 alpa reductase deficiency
autosomal recess. limited to male, inability to convert testosterone to DHT, leading to ambiguous genitalia
kallmann syndrome is?
failure to complete puberty, a form of hypoganadotropic hypognadism. faillure to reslease GnRH and falure to develop olfactoric bulb.
hydroform mole
cystic swelling of choroinic villi and prolif. of chori, epithel.
choriocarcinoma
after prenacy, malignant trophoblastic tissue, no villi, hCg
extrammary paget disease
intraepithelial adenocarcinoma
brenner tumor
resembles bladder epthelium (tras. cell tumer) cofe been
granulosa cell tumor
malignant stromal tumor, 50s, often produces estrogen/ progesteron, present with postmenopausal bleeding.
give granny a call
hist: Call-Exner bodies
Ashermann syndrome
Adhesions and/or fibrosis of the endometrium. Presents with decreased fertility, recurrent pregnancy loss, AUB, pelvic pain. Often associated with dilation and curettage of intrauterine pregnancy
what are benign tumors of the breast?
fibroadenoma
intraductal pailloma
phyllades tumor
what is a fibroadenoma?
most common in women under 35, small, well defined mobile mass
what is a intraductal pailloma?
small fibroepithelial tumor within the lactiferous duct, typ. beneath the areola
what is a phyllades tumor?
large mass of connective tissue and cysts with leasf like lobulation
what is a leydig cell tumor?
golden brown color, conteins reinke crystal (eosinonophilic cytoplasmic inclusions). Produces androgens or estrogens
sertoli cell tumor is?
androblastoma from the sex cord stroma
testicular lymphoma is?
most common testicular tumor in older male, not 1° cancer, it arises from metastac lymphoma to testes. aggressive
protastic adenocarcinoma is?
common in males > 50 years old. posterior lobe( peripheral zone) of prostate gland, increase PSA, oteopblastic mestastisis
leuprolide
leuprolide can be used in lieu of GnRH
use fibroid, endometriosis
Testosterone, methyltestosterone
agonist as androgen receptors, treat hypogonadism
finasteride
5alpha-reductase inhibitor, ae: gynacomastia
flutamite
nonsteriodal competitive inhibitor at androgen receptor
ketoconazole
inhibits steriod systhesis (inhibits 17,20-desmolase/17-alpha-hydroxylase,
ae: gynacomastia
Spironolactone
inhibits steriod binding (inhibits 17,20-desmolase/17-alpha-hydroxylase,
ae: gynacomastia
Tamsulosin
selective alpha1-antagonist used in BPH
17α-hydroxylase
XY: ambiguous genitalia, undescended testes
XX: lacks 2° sexual development
21-hydroxylase
Most common
Presents in infancy (salt wasting) or childhood (precocious puberty)
XX: virilization
11β-hydroxylase
Presents in infancy (severe hypertension) or childhood (precocious puberty)
XX: virilization
Virilization is a condition in which a female develops characteristics associated with male hormones (androgens), or when a newborn has characteristics of male hormone exposure at birth.
Congenital Adrenal Hyperplastion
A(aldost.) HTN T(testos)
21: 2 1
17alpha: 1 7
11beta: 1 (only HTN) 1
1=increase
Urachus
Allantois forms from hindgut and extends into urogenital sinus.
Patent urachus
Total failure of urachus to obliterate—–>urine discharge from umbilicus
Urachal cyst
Partial failure of urachus to obliterate; fluid-filled cavity lined with uroepithelium, between umbilicus and bladder. Cyst can become infected and present as painful mass below umbilicus
Vesicourachal diverticulum
Slight failure of urachus to obliterate—–>outpouching of bladder
Vitelline duct
Also called omphalomesenteric duct. Connects yolk sac to midgut lumen. Obliterates during week 7 of development
Patent vitelline duct
Total failure of vitelline duct to obliterate—–>meconium discharge from umbilicus.
Vitelline duct cyst
Partial failure of vitelline duct to obliterate. increased risk for volvulus
Meckel diverticulum
Slight failure of vitelline duct to obliterate——>outpouching of ileum (true diverticulum, arrow in B).
Usually asymptomatic. May have heterotopic gastric and/or pancreatic tissue—–>melena, hematochezia, abdominal pain.
Absence of Sertoli cells or lack of Müllerian
Absence of Sertoli cells or lack of Müllerian inhibitory factor—->develop both male and female internal genitalia and male external genitalia (streak gonads)
5α-reductase deficiency
inability to convert testosterone into DHT—–>male internal genitalia, ambiguous external genitalia until puberty (when increase testosterone levels cause masculinization
Testosterone/estrogen levels are normal
Bicornuate uterus
Incomplete fusion of Müllerian ducts
Menstrual cycle
Follicular phase can fluctuate in length.
Follicular growth is fastest during 2nd week of the follicular phase.
Luteal phase is a fixed 14 days, after which menstruation occurs.
Estrogen stimulates endometrial proliferation.
Progesterone maintains endometrium to support implantation.
decreased progesterone —-> decreased fertility.
Hydatidiform mole
Cystic swelling of chorionic villi and proliferation of chorionic epithelium (only trophoblast)
increased hCG-mediated
Complete mole
46,XX (most common); 46,XY
Hydropic villi
Most commonly enucleated egg + single sperm (subsequently duplicates paternal DNA
Partial mole
69,X X X; 69,X X Y; 69,X Y Y
Only some villi are hydropic, focal/minimal trophoblastic proliferation
2 sperm + 1 egg
Extramammary Paget disease
Intraepithelial adenocarcinoma. Carcinoma in situ, low risk of underlying carcinoma (vs Paget disease of the breast, which is always associated with underlying carcinoma).
Presents with pruritus, erythema, crusting, ulcers
Polycystic ovarian syndrome
Hyperinsulinemia and/or insulin resistance hypothesized to alter hypothalamic hormonal feedback response—-> increase LH: FSH, increases androgens (eg, testosterone) from theca interna cells, rate of follicular maturation—> unruptured follicles (cysts) + anovulation. Common cause of fertility in females.
Enlarged, bilateral cystic ovaries A; presents with amenorrhea/oligomenorrhea, hirsutism, acne, decreased fertility. Associated with obesity, acanthosis nigricans. risk of endometrial cancer 2° to unopposed estrogen from repeated anovulatory cycles.
Treatment: cycle regulation via weight reduction ( decreased peripheral estrone formation), OCPs (prevent endometrial hyperplasia due to unopposed estrogen); clomiphene (ovulation induction); spironolactone, finasteride, flutamide to treat hirsutism.
Granulosa cell tumor
Most common malignant sex cord stromal tumor. Predominantly occurs in females in their 50s. Often produces estrogen and/or progesterone. Presents with postmenopausal bleeding, endometrial hyperplasia, sexual precocity (in preadolescents), breast tenderness. Histology shows Call-Exner bodies (granulosa cells arranged haphazardly around collections of eosinophilic fluid, resembling primordial follicles; arrow in F). Tumor marker: inhibin.
“Give Granny a Call.
Adenomyosis
Extension of endometrial tissue (glandular) into uterine myometrium. Caused by hyperplasia of basal layer of endometrium. Presents with dysmenorrhea, AUB/HMB, and uniformly enlarged, soft, globular uterus. Treatment: GnRH agonists, hysterectomy, excision of an organized adenomyoma.
Germ cell tumors
Seminoma
Malignant. Painless, homogenous testicular enlargement. Most common testicular tumor. Analogous to ovarian dysgerminoma. Does not occur in infancy. Large cells in lobules with watery cytoplasm and “fried egg” appearance on histology, placental ALP (PALP). Highly radiosensitive. Late metastasis, excellent prognosis.
