Reproductive Flashcards
Gross: ovarian tumor appears yellow
Histo: cells in microfollicular/rosette pattern
What is secreted by this tumor?
Secretes - estrogen (precocious puberty in young girl)
Granulosa cell tumor (sex-cord stromal tumor)
Call-Exner bodies on histo
Lipid content in theca cells
Dyspnea, hemoptysis and continued vaginal bleeding s/p uncomp vaginal delivery and inc B-hCG can be caused by what?
choriocarcinoma (gestational trophoblastic disease)
Prolif of cytotrophoblasts and syncytiotrophoblasts without villi.
Hemoptysis and dyspnea due to pulm mets from hematogenous spread
Cells of evacuated tissue: Edematous (hydropic) villi seen; no fetal tissue
Complete mole (46XX, XY), only parental DNA Note: 46 XX is more common.
Cells of evacuated tissue: fetal tissue with triploid karyotype. Chorionic villi with focal edema and trophoblastic proliferation
partial mole (69 XXX, XXY)
Type A and B blood create what immunoglobulins? Do they cross the placenta?
IgM. No
Type O blood create what immunoglobulins? Do they cross the placenta?
IgG. Yes
Anti-Rh immune globulin belongs to which immunoglobulin class?
IgG anti-D abs that opsonize Rh+ fetal erythrocytes –> clearance by maternal RES macrophages and preventing maternal RH sensitization
HER2 oncogenes code for what type of receptor with tyrosine kinase activity in the intracellular domain?
Human epidermal growth factor
Plays a role in activation of transduction pathways that control epithelial growth and differentiation
What are the 3 cell types of the ovary?
surface epithelium - inc CA-125
germ cells
sex cord stroma
Ovarian tumor: Cystadenomas/cystadenocarcinomas (mucinous and serous ovarian tumors) are derived from what cell type?
surface epithelium
Note: epithelial ovarian cancers histo show anaplasia of epithelial cells with invasion into the ovarian stroma, along with multiple papillary formations with celular atypia. Occasional psammoma bodies
Ovarian tumor: Endometrioid carcinomas of the ovary are derived from what cell type?
surface epithelium
Ovarian tumor: Cystic teratomas are derived from what cell type?
germ cells
Struma ovarii is a teratoma composed mainly of thyroid tissue
Ovarian tumor: Brenner tumors are composed of bladder-like epithelium and are derived from what cell type?
surface epithelium
Ovarian tumor: Fibroma (assoc with Meigs syndrome) are derived from what cell type?
sex cord-stromal
Ovarian tumor: dysgerminomas are derived from what cell type? What is the male counterpart? What will be elevated
germ cells
Seminoma in males
LDH elevated
Ovarian tumor: Endodermal sinus tumors are derived from what cell type?
germ cell
MC in kids
AFP elevated
Schiller-duval bodies (glomerulus-like) seen on histo
Note: into Dermatologist Anne (AFP) Schneider (Schiller-duval)
Ovarian tumor: This malignant tumor is composed of cytotrophoblasts and syncytiotrophoblasts with absent villi. B-hCG elevated. These are derived from what cell type?
choriocarcinoma
germ cell
Ovarian/testicular tumor: Sertoli-Leydig cell tumors are derived from what cell type?
sex cord-stromal tumors
Have Reinke crystals (pink cells with crystal)
Females - may produce androgen (assoc with hirsutism and virilization)
Males - leydig tumors produce androgens –> precocious puberty; sertoli tumors silent
Ovarian/testicular tumor: Embryonal carcinoma are derived from what cell type?
Germ cell
What are the 2 cell types of the testicle?
Germ cell
sex-cord stromal
Does NOT have surface epithelium unlike the ovary
Testicular tumor: Seminoma are derived from what cell type?
germ cells
dysgerminoma in females
Testicular tumor: teratomas are derived from what cell type?
germ cell
MALIGNANT unlike in females
Testicular tumor: choriocarcinoma are derived from what cell type?
germ cell
Testicular tumor: yolk sac (endodermal sinus) tumor are derived from what cell type?
Germ cell
Schiller-duval bodies
AFP elevated
Note: into Dermatologist Anne (AFP) Schneider (Schiller-duval)
Progestin challenge (admin of progesterone then withdrawal): if withdrawal bleeding occurs 2-7 days after withdrawn indicates what? Causes?
amenorrhea is due to anovulation
Causes: hyperandrogenism (eg due to excess adipose tissue) or osteopenia. PCOS
Progestin challenge (admin of progesterone then withdrawal): no bleeding occurs after progesterone withdrawal indicates what?
low serum estradiol
hypothalamic-pituitary axis dysfunction
nonreactive endometrium
cervical stenosis or uterine adhesions (asherman’s syndrome)
Progestin challenge (admin of progesterone then withdrawal): no bleeding Admin of estrogen after a course of progestin causing withdrawal bleeding suggests what?
hypoestrogenism
If no bleeding occurred this would suggest cervical stenosis or asherman’s syndrome
Presence of endometrial glands within the myometrium of the uterus
Adenomyosis
Note: Although they can occur together, endometriosis is when endometrial cells (the lining of the uterus) are in a location outside of the uterus. Adenomyosis is when these cells exist or grow into the uterine wall. Although both can cause pain, endometriosis does not always cause heavy bleeding.
Uterus would be enlarged
Treatment of preeclampsia?
Delivery
How do varying levels of estrogen affect FSH and LH, and how does it assist in fertility?
Low - inhibit FSH and LH secretion (neg feedback)
High/sustained- positive feedback causing surge in FSH and LH secretion
LH surge induces ovulation
What are levels of LH, FSH, and GnRH in menopause?
LH - inc FSH - inc GnRH - inc Low estrogen (decreased production of steroid hormones by ovarian follicles)- no neg feedback on these hormones Loss of monthly cycling
MCC of bloody nipple discharge and presents without breast masses or skin changes
Intraductal papilloma - prolif of papillary cells in a cyst wall or duct
Hypospadias should be repaired to reduce likelihood of what 2 complications?
- increase freq of UTI
2. sterility
What stage do secondary oocytes arrest at prior to ovulation?
Metaphase of meiosis II
What stage do primary oocytes arrest at?
Prophase of meiosis I
Androgenic alopecia can be treated with what?
5-a reductase inhibitors (eg finasteride)
dec conversion of testosterone to DHT
Which STIs cause painful lesions?
Chancroid (haemophilus ducreyi) Genital herpes (HSV1 and HSV2)
How does anorexia cause amenorrhea?
Loss of pulsatile GnRH release from hypothalamus –> dec LH and FSH from the pituitary –> low estrogen
Uterine curettage of an ectopic pregnancy would show what on histo?
Decidual changes in the endometrium (dilated, coiled endometrial glands and edematous stroma) due to progesterone secretion but no embryonic or trophoblastic tissue (eg no villi)
Hydronephrosis during pregnancy is most common on which side and why?
R side because sigmoid colon cushions ureter on the L from compression by the uterus.
First trimester preeclampsia (HTN, proteinuria, edema) + extremely elevated B-hCG is nearly always caused by what?
hydatidiform mole.
What is the most efficient way to reduce sx and progression of endometriosis?
Prevent endometrial prolif and ovulation via GnRH therapy. Release in continuous manner to decrease LH and FSH secretion.
Note: if given in pulsatile, it would stimulate LH and FSH
Also, OCPs can reduce menstrual pain by inhibiting ovulation, but not always effective
Flutamide MOA?
Androgen receptor antagonist used to treat prostate cancer
Impairs androgen-receptor interaction
Leuprolide MOA?
GnRH analog that provides medical castration for patients with prostate cancer. Has BIPHASIC effect on anterior pituitary (initially stimulates secretion of LH and FSH; later downregulates).
Hormone replacement therapy inc risk of endometrial carcinoma by inc prolif of endometrial lining. What can prevent this?
Co-admin of progestin during HRT
Treat seizure in pregnant woman (eclampsia) with what pharm?
Magnesium sulfate - inhibit release of acetylcholine at the motor endplate and by directly inhibiting mm via competitive inhibition of calcium.
Both estrogen and progesterone delay LH surge. Which transforms proliferative endometrium to secretory endometrium?
Progesterone (inhibits gonadotropin release)
Immediately before delivery, estrogen stimulates upregulation of ____ between individual myometrial smooth mm cells?
Gap junctions (consist of aggregated connexin proteins)
Differentiate high grade and low grade CIN
Low grade - atypical cells have NOT invaded past lower 1/3 of cervical epithelium
High grade - atypical cells have invaded beyond lower 1/3 of cervical epithelium
Secondary amenorrhea through obstruction from scarring of the uterine cavity usually due to postpartum endometritis or procedures (D/C)
Asherman syndrome
Primary amenorrhea, absent secondary sex characteristics, and olfactory sensory defect. MOA?
Kallmann syndrome
impaired synth of GnRH by the hypothalamus
Genetically male with female phenotype. Breast dev (periph conversion of testosterone to estrogen), but no pubic or axillary hair. Primary amenorrhea.
Androgen insensitivity syndrome.
Due to resistance to testosterone. Complete absence of Mullerian structures
MOA of infertility in women with Turner syndrome. How can it be overcome?
Infertile secondary to ovarian failure
IVF
Note: sufficient estrogen and progestin supplementation may help develop a thick endometrial lining to support a pregnancy)
Mifepristone MOA?
Progesterone antagonist - progesterone is needed for implantation and maintenance of pregnancy
Glucocorticoid antagonist
How do mentropin and hcG admin help with infertility?
Mentropin (human menopausla gonadotropin) - acts like FSH and triggers dominant ovarian follicle formation
hCG - mimics LH surge, inducing ovulation
Anastrazole, letrozole, exemestane MOA?
Aromatase inhibitors - dec synthesis of estrogen from androgens, suppressing estrogen – slow progression of ER positive tumors
Absolute contraindications to OCPs
- prior hx of thromboembolic event or stroke
- Hx estrogen-dependent tumor
- Over 35yo who SMOKE heavily
- hypertriglyceridemia
- decompensated or active liver disease
- pregnancy
Bilateral ligation of what artery can dec uterine blood flow and control postpartum hemorrhage that is unresponsive to medical management?
Internal iliac artery
Ocp moa
Supp lh secretion from pit, dec ovarian androgen prod for pcos
Fibroids on what part of the uterus can put pressure on the colon –> constipation and bulk-related symptoms?
Posterior
eg posterior subserosal uterine leiomyoma
Ovarian torsion typically involves twisting of what ligament?
infundibulopelvic ligament (susp lig of ovary)–> occlude blood and nerve supply to ovary
Which ligament is irritated during pregnancy? (sharp pain due to irritation from sudden movements)
Round ligament
Which ligaments result in uterine prolapse into the vagina?
Uterosacral ligaments
Bicornuate uterus is due to what?
Failed lateral fusion of the paramesonephric ducts
Note: Uterine anomalies often coexist with renal anomalies (eg unilateral renal agenesis)
Can present with recurrent preg loss
Differentiate bicornuate uterus from longitudinal uterine septum (failed involution of paramesonephric ducts)
Septate uterus has normal outer uterine contour
Bicornuate shows abnormal contour to the uterine fundus
Midline episiotomy is a vertical incision from the posterior vaginal opening to what?
Perineal body. Transects vaginal submucosal tissue, but not external anal sphincter or rectal mucosa
Orchiopexy to correct undescended testes (cryptorchidism) is done for what purpose?
Decrease risk for testicular cancer
If done b/f 1-2yo, can provide advantage to future fertility
What hormone inhibits lactation during pregnancy?
Progesterone
Secreted by corpus luteum, and later by the placenta. High levels have neg feedback on prolactin.
Note: prolactin is stim by TRH
How do OCPs prevent pregnancy?
Difference between progestin-only pill vs combined progestin and estrogen OCP?
Act through progestins - inhibit ovulation by decreasing GnRH and FSH and LH synthesis in the anterior pituitary
Estrogen is added to improve the bleeding profile
Progestin only works by thickening cervical mucus, preventing sperm from accessing the uterus. Same as levonorgestrel IUD
Note: Copper IUD release copper and elicits inflam rxn in uterus that is toxic to sperm, preventing fertilization
During an oophorectomy, the ovarian artery must be ligated. What ligament contains this artery?
Suspensory (infundibulopelvic ligament)
Why is anovulation common in the first several years after menarche?
immature hypothalamic-pitutiary - ovarian axis
How can a testicular tumor result in hyperthyroidism
Paraneoplastic hyperthyroidism - testicular malignancy secreting hCG. hCG has structure similar to TSH and can stim TSH receptors
Note: hCG can also cause gynecomastia
hCG has the same alpha unit as LH, FSH, TSH. Increase in hCG -> increase in LH -> more testosterone (via Leydig cells) -> more estrogen (via aromatase in adipose tissue and testis) -> gynecomastia
Choriocarcinoma from hydatidiform mole most likely originated from what cell type?
Trophoblast (cytotrophoblast, syncytiotrophoblast)
What drug can assist with infertility?
Clomiphene - partial estrogen agonist
inhibits estrogen receptors in the hypothalamus, inhibiting negative feedback of estrogen on gonadotropin release, leading to up-regulation of the hypothalamic–pituitary–gonadal axis
Semen analysis show: quality - normal quantity - normal color - white fructose - 5% of normal content Cause of infertility?
Seminal vesicles
The thick secretions from the seminal vesicles contain proteins, enzymes, fructose, mucus, vitamin C, flavins, phosphorylcholine and prostaglandins. The high fructose concentrations provide nutrient energy for the spermatozoa when stored in semen
How can pregnancy result in elevated T4?
Increased ESTROGEN produces higher levels of thyroid-binding globulin, a protein that transports thyroid hormone in the blood.
These normal hormonal changes can sometimes make thyroid function tests during pregnancy difficult to interpret.
Male with inability to sustain erection, dec libido, dec energy, gynecomastia should be treated with what?
Testosterone - Gynecomastia is overdevelopment of the male breast. The glandular tissue of the breast swells, usually in response to an excess of the female hormone estrogen or a lack of testosterone, a male hormone.
If a patient undergoes radical prostatectomy, what structure is at greatest risk of injury during removal?
Pelvic parasympathetic nerves
Serum studies for PCOS show what for the following:
- fasting insulin
- testosterone
- LH
- fasting insulin: insulin resistant however
- testosterone
- LH
All will be increased
Tanner stage 2 for females can begin as early as what age?
8-15yo
Stage 3 - 10-15
Female with heavy, painful menses, infertility, retroflexed uterus, ovarian cysts and a peritoneal cyst suggests what?
Endometriosis - proliferative endometrial tissue
Note: PCOS would likely present with amenorrhea
Order of female puberty
• Female puberty: breast buds (thelarche) at age 9.5, pubic hair follows, menarche at mean age of 12.5 (2-3 years after thelarche)
Differentiate Placenta Accreta, Percreta and Increta
Accreta - superficially invades the myometrium
Increata - invades halfway in myometrium
Percreta - penetrates through myometrium to serosa (eg maybe into bladder)
What kind of fish should pregnant women avoid?
Pregnant patients should avoid fish and seafood products that are high in mercury. In general, this means that shellfish and big salt-water fish should be avoided (tuna, swordfish, shark, king mackerel, tilefish, etc)*
Woman with infertility and menses every 19 to 45 days. ENdometrial bx hshows stromal breakdown assoc with proliferative glands. Cause of infertility?
Anovulation
Chronic anovulation is a common cause of infertility. Long periods are often anovulatory, where lack of an LH surge leads to unchecked estrogen and prevents ovulation and the secretory and menstrual phases that follow, leading to chronic proliferative-phase endometrium and irregular menses, which can be long or short, often light (as only the endometrial tissue that outgrows its blood supply sloughs off).*
