Reproductive Pathology Flashcards
Which cell determines the sex of the embryo?
The father’s X chromosome and Y chromosome (sperm cell)
Mother will only give X chromosome
Indifferent until ~week 7
SRY protein encoded on Y chromosome (becoming male)
What are the possible complications of cryptorchidism?
- Sterility/infertility
- Increased risk of Trauma
- Increased risk of Neoplasms
- Testicles may not be functioning
What is the purpose of the Pap smear
dysplasia detection
Decreased rates of cervical cancer
Guidelines vary
Age
Frequency
Vaccination
What are the causes of dysplasia in the cervix
Smoking, reduced immune function, HPV
Can effect younger woman
90% SCC
What is the cell of origin in prostate cancer?
Adenocarcinomas from
Prostatic epithelial cell
Main tumours of the female reproductive system and its cell of origin
Vagina- stratified squamous cell
Ectocervix - stratified squamous cell
Endocervix - Glandular (adeno)
Uterus proper - endometrium (adeno)
Smooth muscle (myometrium)- leiomyoma, glandular epithelium, germ cells
What is the fate of most embryos & what is the most critical time of development?
Critical time - 1st trimester
Spontaneous abortion is common
main causes of Pelvic inflammatory disease
- Gonorrhoea
- Chlamydia
- Ascending infection, strep, coliform and clostridium perfringens - scarring occurs due to granualtion tissue formation and leads to infertility
Consequences of PID
Most common cause of female infertility 30-40%
Accounts for 40-50% of ectopic pregnancies
Sepsis - infection gets into blood
Peritonitis - infection in peritoneal cavity
Intestinal obstruction
Syphillis stages
Primary stage
- No symptoms
Secondary stage
- Systemic spread of spirochetes (spiral bacteria) - 2 months to 2 years later - Symptoms may or may not be visible
Latent stage
- no symptoms, blood test picks it up
Tertiary stage
- CNS and cardiovascular lesions, damages sensory nerves for gate and movement. Personality changes. Can lead to blindness
- Dramatic changes to bone structures
2 to 20 years later
Forms aneurysms - predispose to heart failure
Testicular dysgenesis syndrome symptoms
- Cryptorchidism: hidden testis. Risk factors of cancer. (doubled in incidence)
- Hypospadias: malformation of urethral orifice. It is anywhere within the penis or scrotum
Poor sperm quality
- Hypospadias: malformation of urethral orifice. It is anywhere within the penis or scrotum
Rule of 90s
90% occur in 25-45 year olds
90% Germ cell origin: 5% Leydig & Sertoli cells. 5% Metastases.
90% Malignant- All treated as such
90% Curable- Catch prior to metastasis surgery combined with radio- or chemotherapy
Two categories of testicular tumours
Germ cell
Sex-cord
Does not increase in incidence with age
Metastasis to bone - causes pain, prone to fracture
Testicular torsions
Twisting of the spermatic cord
Any age but 12-18 yr olds most common
Most common cause of testicular loss in adolescents
Bell clapper
Testicular torsions symptoms
Extreme pain
Swelling
Nausea, vomiting
What does atrophy of the male reproductive system lead to
Atherosclerosis End-stage inflammatory disease Cryptorchidism Hypopituitarism Exhaustive atrophy (Xs FSH) Malnutrition Cachexia Irradiation Prolonged treatment of anti-androgens
Prostatitis
Acute bacterial
UTI, STI
Fever, chills dysuria
Chronic bacterial
History of repeated infections
Hard to treat
Asymptomatic or dysuria, perineal, suprapubic & lower back pain
As above but without history of infection
Hormonally induced lesions causes in females
Anovulatory cycle (female does not ovulate) - Excessive exercise (female athlete) - Anorexia nervosa - Physical/psychological stress - Obesity - Start of menarche Menopause
Symptoms of endometriosis
Chronic pelvic pain [NB2] Dysmenorrhoea (painful periods) Dyspareunia (painful intercourse) Dyschesia (difficult defecation) Dysuria (painful urination) Cyclical haematuria Premenstrual spotting Heavy menstrual bleeding Period-related (catamenial) gastrointestinal symptoms (eg diarrhoea, occasionally painful abdominal bloating) Infertility
Categories of male tumours
Adenocarcinoma of prostate - increase in incidence with age
Squamous cell carcinoma of penis and the vulva
Testies - teratoma( Germ cell)
Does not increase in incidence with age
Metastasis to bone - causes pain, prone to fracture
Endometrial hyperplasia
unopposed estrogen stimulation
Can cause abnormal bleeding
Happens during: Obesity (peripheral conversion of androgens to oestrogens) Menopause PCOS (polycystic ovarian syndrome) Prolonged use of oestrogen RT Oestrogen secreting tumours
Ovarian tumours
Common
80% benign (20-45 yrs)
Benign, borderline, malignant (45-65 yrs)
Tumors of the surface epithelial
Tumors of germ cells
Tumors of the ovarian stroma & sex cord stromal cells
Metastases from tumor of other organs
Germ cell tumour of the ovary
Most common = Ovarian Teratoma or dermoid cyst
Young women often <25 yrs
96% benign
Malignant tumors (teratocarcinomas) may secrete AFP and hCG.
Can proliferate further to create malignancy
Germ cell that proliferates without stimulation and is able to differentiate into any tissue type
Choriocarcinoma
Choriocarcinoma: formed from placental tissue
In 50%, develops from hydatidiform mole
In 25%, develops from placental cells after abortion
In 25%, develops from normal placenta
Breast cancer risk factors
99% Female - hyperplasia in breasts due to cycle 5-10% germline mutations (BRCA 1&2) 15-20% 1st degree relative Race/ethnicity Age 30+ peaks @70-80 yrs Age @ menarche 20% increase if before 11 Late menopause Age @ 1st full-term pregnancy <20 reduces risk by half compared to nulliparous & mothers over 35 Long term oestrogen therapy Increased breast density 4-6 fold increase Moderate-heavy R-OH Obesity after menopause Radiation
What is endometriosis and its consequences
Endometrial glands/stroma in abnormal locations outside uterus
Ovaries, uterine ligaments, rectovaginal septum, pelvic peritoneum,
Rarely: umbilicus, vagina, vulva, appendix
Spontaneously haemorrhage but body walls off and capsulate it as it cannot exit the body easily.
Causes pain.
If it causes scarring, can cause ectopic pregnancy.
Risks of endometriosis
3-10 X increased risk if 1st degree relative affected
Early menarche
Shorter cycles
~30% identified due to infertility
Risk of multiple pregnancies
Twin to Twin Transfusion Syndrome (TTTS) 15%
- Twins share a placenta (afterbirth) and blood vessels required in the womb
2 times risk of defects
2 times risk of preeclampsia
Multiple placentas increases the risk of gestational diabetes
Teratogens
Irradiation Alcohol Drugs - Thalidomide - Folic acid antagonists - Anticonvulsants - Warfarin - Testosterone & synthetic progestogens Infections: Rubella, Syphilis, Zika
