Reproductive Flashcards
Sonic hedgehog gene
- Produced at base of limbs in zone of polarizing activity - - Involved in patterning along anteroposterior axis and CNS development
- Mutation can cause holoprosencephaly
Wnt-7 gene
- Produced at apical ectodermal ridge (thickened ectoderm at distal end of each developing limb)
- Necessary for proper organization along dorsal-ventral axis
FGF gene
- Produced at apical ectodermal ridge
- Stimulates mitosis of underlying mesoderm, providing for lengthening of limbs
Homeobox (Hox) genes
- Involved in segmental organization of embryo in a craniocaudal direction
- Code for transcription factors
- Hox mutations → appendages in wrong locations
Within week 1
- hCG secretion begins around the time of implantation of blastocyst
- Blastocyst sticks at day 6
Within week 2
- Bilaminar disc (epiblast, hypoblast)
- 2 weeks = 2 layers
Weeks 3-8
- Gastrulation forms trilaminar embryonic disc
- Cells from epiblast invaginate → primitive streak → endoderm, mesoderm, ectoderm
- Notochord arises from the midline mesoderm
- Overlying the ectoderm becomes neural plate
- 3 weeks = 3 layers
Week 4
- Heart begins to beat
- Upper and lower limb
- 4 weeks = 4 limbs and 4 heart chambers
Week 6
Fetal cardiac activity visible by transvaginal ultrasound
Week 8
- Fetal movements start
- “Gait at week 8”
Week 10
Genitalia have male/female characteristics
Surface ectoderm
- Epidermis
- Adenohypophysis (from Rathke pouch)
- Lens of eye
- Epithelial linings of oral cavity, sensory organs of ear, and olfactory epithelium
- Epidermis
- Anal canal below the pectinate line
- Parotid, sweat and mammary glands
Neuroectoderm
- Brain (neurohypophysis, CNS neurons, oligodendrocytes, astrocytes, ependdymal cells, pineal gland)
- Retina
- Spinal cord
“Neuroectoderm - think CNS”
Neural crest
- PNS (dorsal root ganglia, cranial nerves, autonomic ganglia, Scwann cells)
- Melanocytes
- Chromaffin cells of adrenal medulla
- Parafollicular (C) cells of thyroid
- Pia and arachnoid
- Bone of skull
- Odontoblasts
- Aorticopulmonary septum
- Endocardial cushions
Mesoderm
- Muscle
- Bone
- Connective tissue
- Serous linings of body cavities (eg peritoneum)
- Spleen (derived from foregut mesentery)
- Cardiovascular structures
- Lymphatics
- Blood
- Wall of gut tube
- Upper vagina
- Kidneys
- Adrenal cortex
- Dermis
- Testes
- Ovaries
- Notochord induces ectoderm to form neuroectoderm (neural plate), its only postnatal derivative is the nucleus pulposus of the intervertebral disc
Mesodermal defects = VACTERL
- Vertebral defects
- Anal atresia
- Cardiac defects
- Tracheo-Esophageal fistula
- Renal defects
- Limb defects (bone and muscle)
Endoderm
- Gut tube epithelium (including anal canal above the pectinate line)
- Most of the urethra and lower vagina (derived from urogenital sinus)
- Luminal epithelial derivatives (eg lungs, liver, gallbladder, pancreas, eustachian tube, thymus, parathyroid, thyroid follicular cells)
Deformation vs malformation
DEFORMATION: extrinsic disruption; occurs after embryonic period
MALFORMATION: intrinsic disruption; occurs during embryonic period (weeks 3-8)
ACE inhibitors
Renal damage
Alkylating agents
Absence of digits, multiple anomalies
Aminoglycosides
Ototoxicity
Antiepileptic drugs
- Neural tube defects
- Cardiac defects
- Cleft palate
- Skeletal abnormalities (eg phalanx/nail hypoplasia, facial dysmorphism)
- High dose folate supplementation recommended.
- Most commonly valproate, carbamazepine, phenytoin, phenobarbital
Diethylstibestrol
- Vaginal clear cell adenocarcinoma
- Congenital Mullerian anomalies
Folate antagonists
- Neural tube defects
- Includes trimethroprim, methotrexate, antiepileptic drugs
Isotretinoin
- Multiple severe birth defects
- Contraception mandatory
Lithium
Ebstein anomaly (apical displacement of tricuspid valve)
Methimazole
Aplasia cutis congenita
Tetracyclines
Discolored teeth, inhibited bone growth
Thalidomide
Limb defects (phocomelia, micromelia - “flipper” limbs)
Warfarin
- Bone deformities
- Fetal hemorrhage
- Abortion
- Ophthalmologic abnormalities
Alcohol
- Common cause of birth defects and intellectual diability
- Fetal alcohol syndrome
Cocaine
- Low birth weight
- Preterm birth
- IUGR
- Placental abruption
- Cocaine → vasoconstriction
Smoking (nicotine, CO)
- Low birth weight (leading cause in developed countries)
- Preterm labor
- Placental problems
- IUGR
- SIDS
Iodine (lack or excess)
Congenital goiter or hypothyroidism (cretinism)
Maternal diabetes
- Caudal regression syndrome (anal atresia to sirenomelia)
- Congenital heart defects
- Neural tube defects
- Macrosomia
Methylmercury
- Neurotoxicity
- Highest in swordfish, shark, tilefish and king mackerel
Vitamin A excess
Extremely high risk for spontaneous abortions and birth defects (cleft palate, cardia)
X-rays
Microcephaly, intellectual disability. Minimized by lead shielding.
Fetal alcohol syndrome
- Leading cause of intellectual disability in the US
- Newborns of alcohol-consuming mothers have ↑ incidence of congenital abnormalities
- Pre and postnatal developmental retardation
- Microcephaly
- Facial abnormalities (eg smooth philtrum, thin vermillion border [upper lip], small palpebral fissures)
- Limb dislocation
- Heart defects
- Heart-lung fistulas and holoprosencephaly in most severe forms
- MECHANSIM IS FAILURE OF CELL MIGRATION
Dizygotic twins
Arise from 2 eggs that are separately fertilized by 2 different sperm (always 2 zygotes) and will have 2 separate amniotic sacs and 2 separate placentas (chorions)
Monozygotic twins
- Arise from 1 fertilized egg (1 egg + 1 sperm) that splits in early pregnancy
- The timing of cleavage determines chorionicity (number of chorions) and amnionicity (aumber of amnions)
- Cleavage at 0-4 days → dichorionic, diamniotic (25%)
- Cleavage at 4-8 days → monochorionic, diamniotic (75%)
- Cleavage at 8-12 days → monochorionic, monoamniotic (rare)
- Cleavage after 13 days → monochorionic, monoamniotic (conjoined - rare)
Cytotrophoblast
- Inner layer chorionic vili
- Makes cells
Syncytiotrophoblast
- Outer layer chorionic villi
- Synthesizes and secretes hormones (eg hCG - structurally similar to LH; stimulates corpus luteum to secrete progesterone during first trimester)
- Lacks MHC-I expression → ↓ chance of attack by maternal immune system
Decidua basalis
- Derived from endometrium
- Maternal blood in lacunae
Single umbilical artery (2-vessel cord)
Associated with congenital and chromosomal anomalies
Umbilical arteries and vein are derived from
Allantois
Urachus
- In the 3rd week the yolk sac forms the allantois, which extends into urogenital sinus
- Allantois becomes the urachus, a duct between the fetal bladder and umbilicus
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 the umbilicus and bladder
- Can lead to infection, adenocarcinoma
Vesicourachal diverticulum
Slight failure of urachus to obliterate → outpouching of bladder
Vitelline duct
7th week - obliteration of vitelline duct (omphalo-mesenteric duct), which connects yolk sac to midgut lumen
Vitelline fistula
Vitelline duct fails to close → meconium discharge from umbilicus
Meckel diverticulum
- Partial closure of vitelline duct, with patent portion attached to ileum (true diverticulum)
- May have heterotropic gastric and/or pancreatic tissue → melena, hematochezia, abdominal pain
1st aortic arch
Part of maxillary artery.
“1st arch is maximal”
2nd aortic arch
Stapedial artery and hyoid artery.
“Second = Stapedial”
3rd aortic arch
Common carotid and proximal part of internal carotid artery.
“C is the 3rd letter of the alphabet”
4th aortic arch
- On left, aortic arch
- On right, proximal part of right subclavian artery
“4th arch (4 limbs) = systemic”
6th aortic arch
Proximal part of pulmonary arteries and (on left only) ductus arteriosus.
Right recurrent laryngeal nerve loops around
Right subclavian artery
Left recurrent laryngeal nerve loops around
Aortic arch distal to ductus arteriosus
1st branchial cleft
External auditory meatus
2nd-4th branchial clefts
- Temporary cervical sinuses, which are obliterated by proliferation of 2nd arch mesenchyme
Persistent cervical sinus
- From 2nd-4th branchial clefts
- Within lateral neck, anterior to sternocleidomastoid muscle
- IMMOBILE during swallowing
1st branchial arch cartilage
- Maxillary process → maxilla, zygoMatic arch
- Mandibular process → Meckel cartilage → Mandible, Malleus, and incus, sphenoMandibular ligamen
1st branchial arch muscles
- Muscles of Mastication (temporalis, Masseter, lateral and Medial pterygoid)
- Mylohyoid
- Anterior belly of digastric
- Tensor tympani
- Tensor veli palatini
1st branchial arch nerves
- CN V2 and V3
- Chew
2nd branchial arch cartilage
Reichert cartilage: Stapes, Styloid profess, lesser horn of the hyoid, Stylohyoid ligament
2nd branchial arch muscles
- Muscles of facial expression
- Stapedius
- Stylohyoid
- PlatySma
- Posterior belly of the digastric
2nd branchial arch nerves
- CN VII (facial expression)
- Smile
3rd branchial arch cartilage
Greater horn of the hyoid
3rd branchial arch muscles
Stylopharyngeus (think of stylopharyngeus innervated by glossopharyngeal nerve)
3rd branchial arch nerves
- CN IX
- Stylopharyngeus → swallow stylishly
4th-6th branchial arch cartilages
- Arytenoids
- Cricoid
- Corniculate
- Cuneiform
- Thyroid
“Used to sing and ACCCT”
4th-6th branchial arch muscles
- 4th arch: most pharyngeal constrictors, cricothyroid, levator veli palatini
- 6th arch: all intrinsic muscles of larynx except cricothyroid
4th-6th branchial arch nerves
- 4th arch: CN X (superior laryngeal branch) [simply swallow]
- 6th arch: CN X (recurrent laryngeal branch) [speak]
Pierre Robin sequence
- 1st and 2nd branchial arch defect
- Micrognathia
- Glossoptosis
- Cleft palate
- Airway obstruction
Treacher Collins syndrome
- 1st and 2nd branchial arch defect
- Neural crest dysfunction → mandibular hypoplasia, facial abnormalities
1st branchial pouch
- Middle ear cavity, eustachian tube, mastoid air cells
- Contributes to endoderm-lined structures of ear
2nd branchial pouch
Epithelial lining of palatine tonsil
3rd branchial pouch
- Dorsal wings → inferior parathyroid glands
- Ventral wings → thymus
- 3rd pouch structures end up below 4th pouch structures
4th branchial pouch
- Dorsal wings → superior parathyroid glands
- Ventral wings → ultimobranchial body → parafollicular C cells of thyroid
DiGeorge syndrome
- Chromosome 22q11 deletion
- Aberrant development of 3rd and 4th pouches → T cell deficiency (thymic aplasia) and hypocalcemia (failure of parathyroid development)
- Associated with cardiac defects (conotruncal anomalies)
Cleft lip
Failure of fusion of the maxillary and medial nasal processes (formation of primary palate)
Cleft palate
Failure of fusion of the 2 lateral palatine shelves or failure of fusion of lateral palatine shelves with the nasal septum and/or median palatine shelf (formation of secondary palate)
Female genital embryology
- Default development
- Mesonephric duct degenerates and paramesonephric duct develops
Male genital embryology
- SRY gene on Y chromosome - produce testis-determining factor → testes development
- Sertoli cells secrete Mullerian inhibitory factor (MIF) that suppresses development of paramesonephric ducts
- Leydig cells secrete androgens that stimulate development of mesonephric ducts
Paramesonephric (Mullerian) duct
- Develops into female internal structures - fallopian tubes, uterus, upper portion of vagina (lower portion from urogenital sinus)
- Male remnant is appendix testis
Mesonephric (Wolffian) duct
- Develops into male internal structures (except prostate) - Seminal vesicles, Epididymis, Ejaculatory duct, Ductus deferens (SEED)
- In females, remnant of mesonephric duct → Gartner duct
Mullerian agenesis (Mayer-Rokitansky-Kuster-Hauser syndrome)
May present as primary amenorrhea (due to a lack of uterine development) in females with fully developed secondary sexual characteristics (functional ovaries)
Septate uterus
- Commonly anomaly vs normal uterus
- Incomplete resorption of septum
- ↓ fertility
- Treat with septoplasty
Bicornuate uterus
- Incomplete fusion of Mullerian ducts
- ↑ risk of complicated pregnancy
Uterus didelphys
- Complete failure of fusion → double uterus, vagina, cervix
- Pregnancy possible
Genital tubercle
- DHT → glans tubercle, corpus cavernosum, spongiosum
- ESTROGEN → glans clitoris, vestibular bulbs
Urogenitalsinus
- DHT → bulbourethral glands (of cowper), prostate gland
- ESTROGEN → greater vestibular glands (of Bartholin), urethral and paraurethral glands (of Skene)
Urogenital folds
- DHT → ventral shaft of penis (penile urethra)
- ESTROGEN → labia minora
Labioscrotal swelling
- DHT → scrotum
- ESTROGEN → labia majora
Hypospadias
- Abnormal opening of penile urethra on ventral surface of penis due to failure of urethral folds to fuse
- Associated with inguinal hernia and cryptorchidism
Epispadias
- Abnormal opening of penile urethra on dorsal surface of penis due to faulty positioning of genital tubercle
- Associated with exostrophy
Gubernaculum (band of fibrous tissue)
- MALE REMNANT: anchors testes within scrotum
- FEMALE REMNANT: ovarian ligament + round ligament of the uterus
Processus vaginalis (evagination of peritoneum)
- MALE REMNANT: forms tunica vaginalis
- FEMALE REMNANT: obliterated
Gonadal venous drainage
Left ovary/testis → left gonadal vein → left renal vein → IVC
Right ovary/testis → right gonadal vein → IVC
Gonadal lymphatic drainage
Ovaries/testes → para-aortic lymph noes
Body of uterus/ cervix/ superior bladder → external iliac nodes
Prostate/ cervix/ corpus cavernosum/ proximal vagina → internal iliac nodes
Distal vagina/ vulva/ scrotum/ distal anus → superficial inguinal nodes
Glans penis → deep inguinal nodes
Infundibular ligament
- Suspensory ligament of the ovary
- Connects ovaries to lateral pelvic wall
- Contains ovarian vessels
- Ligate vessels during oophorectomy to avoid bleeding
- Ureters course retroperitoneally, close to gonadal vessels → at risk of injury during ligation of ovarian vessels
Cardinal ligament
- Connects cervix to side of wall of pelvis
- Contains uterine vessels
- Ureter at risk of injury during ligation of uterine vessels in hysterectomy
Round ligament of the uterus
- Connects uterine fundus to labia majora
- Derivative of gubernaculum
- Travels through round inguinal canal above the artery of Sampson
Broad ligament
- Connects uterus, fallopian tubes, and ovaries to pelvic wall
- Contains ovaries, fallopian tubes, round ligament of the uterus
- It is a fold of peritoneum that comprises the MESOSALPINX, MESOMETRIUM, and MESOVARIUM
Ovarian ligament
- Connects medial pole of ovary to lateral uterus
- Derivative of gubernaculum
Compare histology of the uterus during proliferative and secretory phase
- Simple columnar epithelium
- PROLIFERATIVE: with long tubular glands
- SECRETORY: with coiled glands
Urethral injury from pelvic fracture
Damage to posterior urethra - membranous urethra, specifically. Injury can cause urine to lead into retropubic space.
Urethral injury from perineal straddle injury
Damage to anterior urethra - bulbar and penile urethra. Injury can cause urine to leak beneath deep fascia of Buck. If fascia is torn, urine escapes into superficial perineal space.
How does progesterone influence the myometrium
↓ myometrium excitability
How does progesterone influence body temperature
↑ body temperature
Length of luteal phase
14 days
When does menstruation occur
Ovulation + 14 days = menstruation
When is follicular growth fastest
During the 2nd week of the follicular phase
When does implantation occur
Implantation within the wall of the uterus occurs 6 days after fertilization.
When does hCG begin to be secreted
Sycytiotrophoblasts secrete hCG, which is detectable in blood 1 week after conception and on home test in urine 2 weeks after conception
Gestational age
Calculated from date of last menstrual period
Embryonic age
Calculated from date of conception (gestational age minus 2 weeks)
Physiologic adaptations in pregnancy
- ↑ CO (↑ preload, ↓ afterload, ↑ HR → ↑ placental and renal perfusion)
- Anemia (↑↑ plasma, ↑ RBCs → ↓ viscosity)
- Hypercoaguability (to ↓ blood loss at delivery)
- Hyperventilation (eliminate fetal CO2)
When does hCG peak
8-10 weeks
Function of hCG
- Maintains corpus luteum (and thus progesterone) for first 8-10 weeks of pregnancy by acting like LH (otherwise no luteal cell stimulation → abortion)
- After 8-10 weeks, placenta synthesizes its own estriol and progesterone and corpus luteum degenerates
- Has identical α subunit as LH, FSH, TSH (states of ↑ hCG can cause hyperthyroidism)
- β subunit is unique (pregnancy tests for this)
- ↑ in multiple gestations, hydatiform moles, choriocarcinomas, and Down syndrome
- ↓ in ectopic/failing pregnancy, Edward syndrome, and Patau syndrome
What does APGAR stand for
Appearance, Pulse, Grimace, Activity, and Respiration
Low birth weight is associated with
- ↑ risk of SIDS
- Impaired thermoregulation and immune function
- Hypoglycemia
- Polycythemia
- Impaired neurocognitive/ emotional development
What coordinates closing of the epiphyseal plates
Estrogen converted from testosterone
Effects of exogenous testosterone
Inhibition of hypothalamic-pituitary-gonadal axis → ↓ intratesticular testosterone → ↓ testicular size → azoospermia
Klinefelter syndrome labs
- (47, XXY)
- Dysgenesis of seminiferous tubules → ↓ inhibin B → ↑ FSH
- Abnormal Leydig cell function → ↓ testosterone → ↑ LH → ↑ estrogen
Turner syndrome labs
- (46, XO)
- ↓ estrogen → ↑ LH, ↑ FSH
Double Y males
- XYY
- Phenotypically normal (usually undiagnosed), very tall
- Normal fertility
- May be associated with severe acne, learning disability, autism and spectrum disorders
Ovotesticular disorder of sex development
- 46, XX > 46, XY
- Both ovarian and testicular tissue present (ovotestis)
- Ambiguous genitalia
- Previously called true hermaphrodtism
Defective androgen receptor labs
↑ testosterone, ↑ LH
Testosterone-secreting tumor, exogenous steroids labs
↑ testosterone, ↓ LH
Primary hypogonadism labs
↓ testosterone, ↑ LH
Hypogonadotropic hypogonadism
↓ testosterone, ↓ LH
Placental aromatase deficiency
- Inability to synthesize estrogens from androgens
- Masculinization of female (46, XX) infants (ambiguous genitalia), ↑ testosterone and androstenedione
- Can present with maternal virilization during pregnancy (fetal androgens can cross the placenta)
Androgen insensitivity syndrome
- 46, XY
- Defect in androgen receptor resulting in normal-appearing female
- Female external genitalia with scant sexual hair, rudimentary vagina
- Uterus and fallopian tubes absent
- Patients develop normal functioning testes (often found in labia majora; surgically removed to prevent malignancy)
- ↑ testosterone, estrogen, LH
5α-reductase deficiency
- AR
- Sex limited to genetic males (46, XY)
- Inability to convert testosterone to DHT
- Ambiguous genitalia until puberty, when ↑ testosterone causes masculinization/ ↑ growth of external genitalia
- Testostrone/estrogen levels are normal
- LH is normal or ↑
- Internal genitalia are normal
Kallmann syndrome
- Failure to complete puberty
- A form of hypogonadotropic hypogonadism
- Defective migration of GnRH cells and formation of olfactory bulb
- ↓ GnRH synthesis in the hypothalamus
- ANOSMIA
- ↓ GnRH, FSH, LH, testosterone
- Infertility (low sperm count in males, amenorrhea in females)
Placental abruption (abruptio placentae)
- Premature separation (partial or complete) of placenta from uterine wall before delivery of infant
- RISK FACTORS: trauma, smoking, hypertension, preeclampsia, cocaine abuse
- PRSENTATION: abrupt, painful bleeding (concealed or apparent) in 3rd trimester; possible DIC, maternal shock, fetal distress
- Life threatening for mother and fetus
Placenta accreta/ increta/ percreta
- Defective decidual layer → abnormal attachment and separation after delivery
- RISK FACTORS: prior C-section, inflammation, placenta previa
- 3 types distinguishable by depth of penetration
- PRESENTATION: often detected on ultrasound prior to delivery
- No separation of placenta after delivery → postpartum bleeding (can cause Sheehan syndrome)
Placenta accreta
Placenta attaches to myometrium without penetrating it, most common type
Placenta increta
Placenta penetrates into myometrium
Placenta percreta
Placenta penetrates (“perforates”) through myometrium and into uterine serosa (invades entire uterine wall); can result in placental attachment to rectum or bladder
Placenta previa
- Attachment of placenta to lower uterine segment over (or
Vasa previa
- Fetal vessels run over, or in close proximity to, cervical os
- May result in vessel rupture, exsanguination, fetal death
- TRIAD: MEMBRANE RUPTURE, PAINLESS VAGINAL BLEEDING, FETAL BRADYCARDIA (
Postpartum hemorrhage
- Due to 4 Ts
- Tone (uterine atony, most common)
- Trauma (lacerations, incisions, uterine rupture)
- Thrombin (coagulopathy)
- Tissue (retained products of conception)
Cause of preeclampsia
Caused by abnormal placental spiral arteries → endothelial dysfunction, vasoconstriction, ischemia
When does preeclampsia present
New-onset hypertension with either proteinuria or end-organ dysfunction after 20th week of gestation (
Complications of preeclampsia
- Placental abruption
- Coagulopathy
- Renal failure
- Uteroplacental insufficiency
- Ecclampsia
Gestational hypertension
- Pregnancy induced hypertension
- Presents after 20th week
- NO PROTEINURIA OR END-ORGAN DAMAGE
HELLP syndrome can lead to
Hepatic subcapsular hematomas → rupture → severe hypotension
Compare follicular and theca-lutein cysts
- FOLLICULAR CYST: distention of unruptured graafian follicle; may be associated with hyperestrogenism, endometrial hyperplasia; most common ovarian mass in young women
- THECA-LUTEIN CYST: often bilateral/multiple; due to gonadotropin stimulation; associated with choriocarcinoma and hydatiform moles
Which ovarian neoplasm is associated with pseudomyxoma peritonei
Mucinous cystadenocarcinoma. It is an intraperitoneal accumulation of mucinous material from ovarian or appendiceal tumor.
What type of teratoma contains neuroectoderm
Immature teratomas. Malignant, aggressive. Typically represented by immature/embryonic like neural tissue. Usually post-menopausal (mature cystic teratomas/dermoid cysts generally present in women 10-30)
Lynch syndrome is a risk factor for what endometrial condition
Endometrial carcinoma
Fibrocystic changes
- Most common in premenopausal women > 35 years
- Presents with premenstual breast pain or lumps; often bilateral and multifocal
- Nonproliferative lesions include simple cysts (fluid-filled duct dilation, blue dome), papillary apocrine change/metaplasia, stromal fibrosis
- Risk of cancer is usually not increased
Comedocarcinoma
- Ductal, central necrosis
- Subtype of DCIS
Peyronie disease
- Abnormal curvature of penis due to fibrous plaques within tunica albuginea
- Associated with erectile dysfuction
- Can cause pain, anxiety
- Consider surgical repair once curvature stabilizes
- Distinct from PENILE FRACTURE (rupture of corpora cavernosum due to forced bending)
Dilation of which veins causes varicocele
Pampiniform plexus
Extragonadal germ cell tumors
- Arise in midline locations
- In adults, most commonly in retroperitoneum, mediastinum, pineal and suprasellar regions
- In infants and young children, sacrococcygeal teratomas are more common
Congenital hydrocele
Common cause of scrotal swellings in infants, due to incomplete obliteration of processus vaginalis
Acquired hydrocele
- Scrotal fluid collection usually secondary to infectin, trauma or tumor
- If bloody → hematocele
Spermatocele
- Cyst due to dilated epididymal duct or rete testis
- Paratesticular fluctuant nodule
Leydig cell tumor
- Golden brown color
- Contains Reinke crystals (eosinophilic cytoplasmic inclusions)
- Produce androgens or estrogens → gynecomastia in men, precocious puberty in boys
Sertoli cell tumor
Androblastoma from sex cord stroma
Testicular lymphoma
- Most common testicular cancer in older men
- Not a primary cancer
- Arises from metastatic lymphoma to testes
- Aggressive
Is BPH hyperplasia or hypertrophy
Smooth, elastic firm nodular enlargement (hyperplasia not hypertrophy) of periurethral (lateral and middle lobes) which compress the urethra into a vertical slit. NOT premalignant.
Prostatitis
- Dysuria, frequency, urgency, low back pain
- Warm, tender, enlarged prostate
- ACUTE: bacterial
- CHRONIC: bacterial or abacterial
