reproductive Flashcards
what does the female reproductive system comprise of?
vagina, uterus, uterine tubes, ovaries
what is the most useful modality to see female repro?
US and MRI
what are the dimension of the ovaries?
1.5-3.0cm x 1.5x3.0cm x 1.0-2.0cm (length x width x thickness)
what happens to the ovaries during pregnancy?
double in size due to corpus luteum producing progesterone
where do primary lesions of ovarian cancer come from?
mosthy epithelial ovarian carcinomas that originate from fallopian tubes- poor prognosis due to late diagnoses
where do metastases of ovaries arise from?
endometrium, breast, colon, stomach, cervix
where does ovarian cancer spread to?
peritoneal surfaces- along line of abdominal cavity and to thorax
where can malignant cells from ovarian cancer implant to?
anywhere in peritoneal cavity & into the thorax
what is the most useful modality to detect ovarian cancer?
ultrasonography + chest radiography/CT (to identify spread of cancer)
how is MRI useful in detecting ovarian cancer?
MRI enables characterisation of tissue-type present to help ascertain malignancy
where does fertilisation occur in the uterine tubes?
normally in ampulla
what are the sections of the uterine tube?
infundibulum, ampulla, isthmus, intramural
what is the infundibulum surrounded with?
fimbriae surrounds the ovary but does not enclose it (ectopic pregnancy is possible- pregnancy in wrong place)
what is salpingitis?
inflammation of uterine tubes, caused by bacterial infection - causes obstruction and infertility - scar tissue formation that causes obstruction of uterine tubes
what is used to assess infertility in uterine tubes?
Hysterosonosalpingography- inject contrast medium and move backwards through ovary ducts
what is the average length of uterine tubes?
12 to 18 cm
what are the dimensions of the uterus?
7.5cm in length, 5cm wide at upper part, & 2.5cm in thickness
what are the 2 parts of the uterus?
fundus (body) & cervix
where is the uterus located?
between bladder anteriorly & rectum posteriorly
how is the uterus positioned when bladder is full?
fundus may be direction backward toward the sacrum- may be suitable for imaging
how is the uterus positioned when bladder is empty?
entire uterus is directed forward & body lies upon bladder- as bladder fills it becomes more erect
what are common positions of the uterus?
most common is anteverted (cervix angles forward) & anteflexed (body is flexed forward)
what are the 3 tissue layers of uterus?
endometrium, myometrium, perimetrium
what is the endometrium site of?
implantation- responsive to endocrine changes
what is the myometrium?
makes up uterine volume- smooth muscle- contracts
are malignant neoplasms of uterus common?
yes
what makes up most of the uterine malignancies?
endometrial carcinoma (>90%)- 95% in postmenopausal women
what is a carcinoma?
cancer in a cell that is exposed to an external environment
what is a sarcoma?
cancer from cells not exposed to external environment
what makes up remaining 5% of uterine malignancies?
uterine sarcoma (malignant cells form in the muscles of the uterus or other tissues that support the uterus)- most leiomyosarcoma/uterine fibroids (benign neoplasms)
what cancers can invade the uterus?
cervical, vaginal, tubal, colorectal carcinoma & cancers from bladder
what are signs & symptoms associated with fibroids?
abnormal vaginal bleeding, pain, infertility, palpable masses
where can fibroids grow within?
endometrial cavity of uterus (submucosal), in myometrial layer (intramural), outer wall of uterus (subserosal), extend of outer layer of uterus (pedunculated)
how do uterine fibroids appear on CT?
may distort the usually smooth uterine contour
how are uterine fibroids diagnosed?
based on biopsy - if cancer diagnosed chest imaging is performed to rule out metastasis - CT of abdomen & pelvis may also be included
what is the breast made of?
fatty tissue & glandular tissue (10-15%) - inhomogenous structure - fatty tissue increases during menopause
how is the breast anchored to chest wall?
via pec major fascia by suspensory ligaments
how does the breast pass into axilla?
axillary extension of upper lateral quadrant passes into axilla through opening in deep fascia - can find breast cancer in axilla region
how many lactiferous lobes does breast have & where do they drain?
14 to 18 lactiferous lobes which drain into lactiferous ducts which converge to drain as nipple areola complex
what stimulates ductal development?
estrogen
what stimulates lobular development & epithelial differentiation?
progesterone
what stimulates epithelial development & lactogenesis during pregnancy & lactation?
prolactin
what occurs to breast during follicular phase (days 4 to 14) of menstruation?
levels of estrogen increase, stimulating epithelial proliferation
what occurs to breast during luteal phase (days 15 to 28) of menstruation?
progesterone increases & estrogen decreases- mammary ducts dilate, epithelial cells differentiate into secretory cells,
what does estrogens do to the breast during luteal phase?
increases blood flow causing breast oedema just prior to onset of menses
when is mammography recommended?
during the 5th-10th day of cycle
how much does glandular epithelium make up of breast weight?
10 to 15% of tissue
what is each lobe of breat composed of?
several lobules that are known as terminal ductules or acini
what is epithelium of ducts surrounded by?
myoepithelial cells which are surrounded by a continuous basement membrane
what does invasion through epithelium basement membrane indicate?
invasion distinguishes invasive from in situ carcinoma - if it has penetrated through breast tissue, it is a bad sign and it has made its way out of the duct
what do the breast ducts widen to form?
lactiferous sinuses that leave through 10 to 15 orifices in nipply
where do suspensory ligament of breast travel through?
travel through breast & insert in to dermis - tumour involvement causes skin creasing located above breast lumps, tumour has escaped from the duct
what are axillary lymph nodes defined by?
their relationship to pectoralis minor muscle-
where are level I axillary nodes located?
lateral to lateral border of pec muscle
where are level II axillary nodes located?
between medial & lateral borders of pec minor muscle
where are level III axillary nodes located?
medial to medial margin & inferior to clavicle of pec minor
what nodes is most important prognostic factor?
ipsilateral axillary lymph node is most common site of involvement & in isolation, is most important prognostic factor (prognosis becomes worse if they affect lymph nodes)
how does breast appear in mammographs?
glandular tissue is homogenously dense, adipose tissue forms round or curved radiolucent areas, suspensory ligaments appear as curved, linear radiopacities, duct system is not normally visualised except near nipple
where does lymphatic drainage of breast originate from?
from breast lobules
what are the 3 pathways for lymphatic drainage of breast?
axillary or lateral pathway to axillary lymph nodes- internal mammary pathway through pectoral major & possible to contralateral breast- retromammary pathway
how much lymph does the axillary lymph node receive?
more than 75% of lymph drained from breast
what is the most common type of breast cancer?
infiltrating ductal carcinoma is most common at 75%- follwoing is lobular carcinoma in situ (peaks in womens aged 40-50 years)- infiltrating lobular carcinoma- DUCTS ARE THE SOURCE OF MOST BREAST CANCERS
where does infiltrating ductal carcinoma tend to metastasize?
via lymphatics & mostly women over 55
what are signs of malignancy detected by mammographs?
asymmetry, microcalcification (up to 90%- tiny specs of bone), mass or architectual distortion, great density
why does greater breast density increase risk of breast cancer?
dense tissue may obscure small masses & delay diagnosis
what is sensitivity in mammographic results?
ability to detect true positives
what happens if a sensitivity test in negative?
you haven’t got the disease
what is specifity in mammographic tests?
ability to detect true negatives
what happens if specific is positive?
you’ve got the disease
what happens if a test has 80% sensitivity?
80% of patients with disease are identified (true positive) & 20% of patients with disease are missed (false negs)
what happens if test has 80% specificity?
80% of patients with disease are identified (true negative) & 20% of patients without disease are identified positive (false positive)
what does the male reproductive system include?
penis, testes, epididymides, ductus deferentia, ejaculatory ducts, seminal vesicles, prostate, bulbourethral galnds- US and MRI used to image
what is the size of the prostate?
3 x 4 x 2cm
what does the prostate surround?
proximal urethra
what is the base of urethra in contact with?
bladder
what is the prostate surrounded by?
layer of muscular fibres & collagen that represents a capsule
what does the prostate contain?
central (25% of prostate volume) & peripheral zones (75%)
does difficulty to urinate occur in prostate adenocarcinomas?
not usually- difficulty to urinate may occur to frowth of benign tumour in centrally located prostate pushing against urethra
when does 70-80% of adenocarcinomas originate from?
the peripheral zones
how are prostate zones differentiated?
differentiated on T2 weighted MRI
where does benign prostatic hyperplasia develop?
in transition zone at distal end of prostate
what suggests prostatic cancer?
elevated PSA (can be elevated by a # of things) or prostatic enlargement- high false positive rates- doesn’t cause utethral obstruction- common in older men & diagnosed post mortem
what is the function of the spermatic cord?
tubular structure that suspends the testes & epididymis and passes through inguinal canal
what does the spermatic cord contain?
ductus deferens, arteries & veins, lymphatics, nerves
what does the scrotum contain?
testes, epididymides, distal spermatic cord
what is the testes covered by?
fibrous capsule called tunica albuginea & divided into 200 to 400 wedge shaped lobes
what does each lobe in testes contain?
3 to 10 coiled seminiferous tubules, which produce sperm - make up 90% of testicular mass
what is the function of sertoli cells?
support sperm production
what is the function of leydig cells?
produce testosterone
what do seminiferous tubules connect to?
epididymis (sotrage unit)
what age group does testicular cancer occur?
rare but mostly in men aged 20-40
where does testicular cancer arise from?
seminiferous tubules- investigated by US
how is testicular cancer diagnosed?
CT scan of abdomen & pelvis & chest x-ray are part of initial staging workup but US also involved
what does the body of penis contain?
three erectile structures: corpora cavernosa & corpus spongiosum
where does the urethra course through?
corpus spongiosum & opens at tip of penis (glans)
what is the corpus cavernosum?
paired dorsal structures, encased in tunica albuginea
what is the corpus spongiosum?
lies ventrally in groove of corpus cavernosum & contain penile part of urethra
what is the inguinal canal?
is a passage in anterior abdominal wall that transmits structures from pelvis to perineum
what are the 2 openings of the inguinal canal?
deep inguinal ring & superficial inguinal rings
what are the contents of the inguinal canal?
males & females (nerves)- males (spermatic cord)- female (round ligament)
what can develop in the inguinal canal?
inguinal hernia- loop of intestine passes down the inguinal ring
