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Reproductive System > Week 1 - "Weak Swimmers" > Flashcards

Week 1 - "Weak Swimmers" Flashcards

1
Q

What kind of organs are the:
1. Scrotum
2. Testes
3. Epididymis

Anatomy

A

Outpouching organs of the lower anterior abdominal wall into the peritoneum

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2
Q

What are the internal male genital organs? (5)

Anatomy

A
  1. Vas deferens
  2. Seminal vesicle
  3. Ejaculatory duct
  4. Prostate gland
  5. Bulbourethral gland
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3
Q

What are the contents of the scrotum?

Anatomy

A
  1. Testes
  2. Epididymides
  3. Lower ends of the spermatic cords
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4
Q

What are the walls of the scrotum? (4) (from most superficial to most deep)

Anatomy

A
  1. Skin –> continuous layer with the anterior abdomen
  2. Superficial fascia
  3. Spermatic fascia
  4. Tunica vaginalis
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5
Q

What are the components of the superficial fascia of the scrotum?

Anatomy

A

Fatty and membranous

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6
Q

What does the fatty component of the superficial fascia get converted into?

Anatomy

A

Dartos msucle

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7
Q

What does the membranous component of the superficial fascia get converted into?

Anatomy

A

Colles’ fascia

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8
Q

What are the components of the spermatic fascia?

Anatomy

A
  1. External spermatic fascia
  2. Cremasteric fascia
  3. Internal spermatic fascia
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9
Q

Where does the external spermatic fascia arise from?

Anatomy

A

The external oblique aponeurosis

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10
Q

Where does the cremasteric fascia arise from?

Anatomy

A

Internal oblique muscle

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11
Q

Where does the internal spermatic fascia arise from?

Anatomy

A

Fascia transervsalis

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12
Q

What is the main function of the scrotum?

Anatomy

A

Regulation mechanisms for testicular temperature

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13
Q

In what temperatures does spermatogenesis occurs, how does the location of the scrotum aid that?

Anatomy

A

Spermatogenesis –> 3 degrees below the abdominal temperature, scrotum is outside the body so helps regulate temperature

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14
Q

What are the different mechanisms involved in controlling the temperature of spermatogenesis?

Anatomy

A
  1. Constriction and relaxation of the Dartos & Cremaster muscles –> pull in or push the scrotum towards the body
  2. Countercurrent heat exchange between testicular artery and vein
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15
Q

What is tunica vaginalis?

Anatomy

A

Fluid-filled sac in the scrotum that surrounds the testes and cushions them

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16
Q

Where does tunica vaginalis originate from?

Anatomy

A

Originates as an inferior extension from the peritoneum in the abdomen –> Processus Vaginalis

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17
Q

What happens to the processus vaginalis just before birth?

Anatomy

A

Processus vaginalis shuts off and losses continuity with peritoneum to become tunica vaginalis

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18
Q

Which section of the testes does the tunica vaginalis not surround and why?

Anatomy

A

The posterior because the epididymis is located there

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19
Q

What is hydrocele testis?

Anatomy

A

Excess fluid in tunica vaginalis around the testis
Can be congenital or acquired

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20
Q

How can you determine whether or not there is fluid or mass in the testis?

Anatomy

A

Shine a flashlight through it, if light passes through it, then it is fluid –> hydrocele testis

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21
Q

What is the treatment for hydrocele testis?

Anatomy

A

Tapping the hydrocele by insertion of a cannula through the scrotal skin into the cavity of tunica vaginalis

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22
Q

What are the testes?

Anatomy

A

A firm mobile organ that lies within the scrotum and is responsible for spermatogenesis

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23
Q

What are the testes protected by?

Anatomy

A

A tough fibrous capsule: tunica albuginea

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24
Q

What is the format of testes internally?

Anatomy

A

Divided into lobules by fibrous septa, about 300 of them, each consisting of seminiferous tubules

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25
Q

What is the format of the testes externally?

Anatomy

A

Surrounded anterior and on the sides by tunica vaginalis

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26
Q

What is the ductal system of the testicular lobules?

Anatomy

A
  1. Seminiferous tubules
  2. Straight ducts (tubules)
  3. Rete testis (mediastinum)
  4. Efferent ductules
  5. Head of epididymis
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27
Q

What is the canalization process of rete testis?

Anatomy

A
  1. During fetal development, the primordial testis forms cords of epithelial cells that are initially solid.
  2. Canalization begins when the solid cords start to form lumens, which are hollow spaces within them. This is typically achieved through cell apoptosis in the central cells of the cords, which creates a pathway.
  3. The developing lumens align and merge, forming the interconnected network that becomes the rete testis.
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28
Q

What are the seminiferous tubules?

Anatomy

A

Functional units where sperm is produced

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29
Q

What epithelium lines the seminiferous tubules?

Anatomy

A

Specialised stratified epithelium

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30
Q

What are the two types of specialized stratified epithelium that line the seminiferous tubules?

Anatomy

A
  1. Nondividing supporting or sustentacular cells (Sertoli cells)
  2. Proliferative cells of the spermatogenic lineage
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31
Q

What is spermatogenesis?

Anatomy

A

Sperm production that includes cell division through meiosis and mitosis

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32
Q

What is spermiogenesis, when does it happen?

Anatomy

A

The final differentiation of the haploid male germ cells, the LAST differentiation process

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33
Q

What does the basement membrane of the seminiferous tubules contain?

Anatomy

A

Flattened, smooth muscle-like myoid cells

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34
Q

What is the function of myoid cells?

Anatomy

A

help sperm cells to be pushed to the next part of the duct system

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35
Q

What are Sertoli cells?

Anatomy

A

Columnar or pyramidal cells that largely envelop cells of the spermatogenic lineage

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36
Q

What is the nucleus of the Sertoli cells like?

Anatomy

A

Triangular in outline

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37
Q

What is the cytoplasm of Sertoli cells like?

Anatomy

A

It has many inclusions of unknown function, crystalloids, or Charcot Bottcher

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38
Q

Where do spermatogonia lie?

Anatomy

A

In a basal compartment

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39
Q

What is the blood-testis barrier?

Anatomy

A

Tight junctions between basal components and adjacent Sertoli cells in the seminiferous epithelium, protecting the sperm cells from immune reactions

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40
Q
A
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41
Q

Where are Leydig cells located?
What happens to interstitial or Leydig cells during puberty?

Anatomy

A

They are found in between seminiferous tubules

They become apparent as either rounded or polygonal cells with central nuclei and eosinophilic cytoplasm rich in lipid droplets

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42
Q

When does testosterone secretion by interstitial cells begin?

Anatomy

A

begins at puberty, promoted by LH

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43
Q

What is the transition of straight tubules from rete testis characterized by?

Anatomy

A

Many tall Sertoli cells devoid of germ cells

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44
Q

What is the function of the rete testis?

Anatomy

A

Drains about 20 efferent ductules which carry sperm to epididymis

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45
Q

What is rete testis lined by?

Anatomy

A

By a group of nonciliated cuboidal cells alternating with groups of taller ciliated cells

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46
Q

What is the purpose of the ciliated cells in the rete tetsis?

Anatomy

A

They can move the sperm cells

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47
Q

What is the purpose of the nonciliated cells in the rete testis?

Anatomy

A

absorb some of the fluid from the lumen of the rete testis which helps with the flow of sperm through the duct system

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48
Q

What is characteristic of the appearance of the rete testis epithelium?

Anatomy

A

Scalloped appearance

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49
Q

What is the epididymis?

Anatomy

A

A highly coiled tubule that lies posterior to the testis

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50
Q

What are the components of the epididymis?

Anatomy

A
  1. Expanded head
  2. Body
  3. Pointed tail
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51
Q

What is the relation of vas deferens to the epididymis?

Anatomy

A

Vas deferens is a direct continuation of the epididymic tail that ascends up on its medial side

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52
Q

What is the function of the epididymis?

Anatomy

A

Site for maturation and storage for sperms

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53
Q

What is the epithelium of the epididymal duct?

Anatomy

A

Psuedostratified columnar epitehlium

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54
Q

What are the cell types found in the pseudostratified columnar epithelium of the epididymal duct?

Anatomy

A
  1. Tall principal cells with stereocilia
  2. Small basal cells on the basal lamina
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55
Q

WHat kind of immune cells are often seen in the epididymal duct?

Anatomy

A

Macrophages and intraepithelial lymophocytes

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56
Q

What is the arterial blood supply of the testis and the epididymis?

Anatomy

A

Testicular artery

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57
Q

What is the venous drainage of the testis and the epididymis?

Anatomy

A

Pampiniform plexus

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58
Q

Which vein is the pampiniform plexus reduced to?

Anatomy

A

Testicular vein as it ascends through the inguinal canal

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59
Q

What is the lymph drainage of the testis and the epididymis?

Anatomy

A

Para-aortic lymph nodes

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60
Q

What is torsion of the testis?

Anatomy

A

Rotation of the testis around its spermatic cord within the scrotum –> associated with severe pain

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61
Q

What is the target population of torsion of testis?

Anatomy

A

Young adults

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62
Q

What are the complications of torsion of testis?

Anatomy

A
  1. Obstruction of venous drainage
  2. Edema and hemorrhage
  3. Obstruction of testicular artery
  4. Necrosis
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63
Q

What is the management of the torison of testis?

Anatomy

A

surgical emergency to correct and fix

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64
Q

What is the ductus deferens?

Anatomy

A

Fibromuscular tube that is continuous with the ductus epididymis

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65
Q

How long is the ductus deferens?

Anatomy

A

45cm

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66
Q

Where is the ductus deferens located?

Anatomy

A

Enters the pelvic cavity through the bilingual canal and passes along the side and down the posterior surface of the urinary bladder toward the prostate gland

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67
Q

What happens to the ductus deferens before it reaches the prostate gland?

Anatomy

A

Each ductus deferens enlarges to form an ampulla

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68
Q

In which portion of the ductus deferens is sperm stored?

Anatomy

A

The proximal portion of the ductus deferens, near the epididymis

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69
Q

What is the histology of the ductus deferens like? (3)

Anatomy

A
  1. Narrow lumen
  2. Mucosa is folded longitudinally
  3. Thick muscularis layer consisting of longitudinal inner and outer layers and a middle circular layer
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70
Q

What is the epithelium of the ductus deferens like?

Anatomy

A

Pseudostratified columnar epithelium with sparse stereocilia

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71
Q

What is the purpose of a very thick muscularis layer in the ductus deferens?

Anatomy

A

The direction of movement is going against gravity, so the muscles required for strong peristaltic waves

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72
Q

What are seminal vesicles?

Anatomy

A

2 lobulated organs on the base of the bladder that is responsible for 65 to 70% of seminal fluid production

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73
Q

What is the length of the seminal vesicles?

Anatomy

A

Approximately 5 cm

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74
Q

What is the epithelium of seminal vesicles?

Anatomy

A

Simple to pseudostratified columnar epithelium

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75
Q

Where is the prostate gland found?

Anatomy

A

At the base of the bladder

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76
Q

Where do the ejaculatory ducts open into, and how man of them?

Anatomy

A

Two ejaculatory ducts open into the prostatic urethra beside the office of the prostatic utricle, one on each side

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77
Q

When is prostatic fluid secreted?

Anatomy

A

During ejaculation

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78
Q

Where are the bulbourethral glands located?

Anatomy

A

Inferior to the prostate

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79
Q

How many ejaculatory ducts are there?

Anatomy

A

2, one on each side

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80
Q

What is the length of each ejaculatory duct?

Anatomy

A

ABout 2.5cm each

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81
Q

What makes up the ejaculatory duct?

Anatomy

A

Vas deferens + duct of the seminal vesicle

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82
Q

What is the location of the ejaculatory ducts?

Anatomy

A

Pass anterioinferiorly through the posterior part of the prostate along the sides of the prostatic utricle

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83
Q

What is the prostatic utricle?

Anatomy

A

Embryological remnant of the vagina and the uterus in the males

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84
Q

What are the different sections of the penis?

Anatomy

A
  1. The root
    a. The bulb
    b. The cura
  2. The body
  3. The glans
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85
Q

What is the root of the penis attached to?

Anatomy

A

Attaches the penis to the pubic arch

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86
Q

What are the components of the root of the penis?

Anatomy

A

The bulb and the cura

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87
Q

What does the bulb attach the penis to?

Anatomy

A

The urogenital diaphragm

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88
Q

What covers the bulb of the penis?

Anatomy

A

Bulbospongiosus muscle

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89
Q

What does the bulb of the pens continue anteriorly as?

Anatomy

A

Corpus spongiosum

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90
Q

What is the function of the bulbospongiosus muscle?

Anatomy

A

Forcefully propels sperm out of the body from the prostatic urethra to the urethral meatus

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91
Q

What is the cura covered by?

Anatomy

A

Ischiocavernosus msucle

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92
Q

What is the function of the ischiocavernosus muscle?

Anatomy

A

Helps stabilize the erection. and prevent blood from flowing out of the venous drainage during erection

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93
Q

What is the body of the penis supported by?

Anatomy

A

Ligaments; fundiform and supsensory

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94
Q

What happens if the ligaments that support the body of the penis get cut?

Anatomy

A

The non-erectile penis may look longer

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95
Q

What are the columns of the penis?

Anatomy

A

Two dorsal columns: the corpora cavernosa. The ventral column: the corpus spongiosum

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96
Q

What is the glans of the penis?

Anatomy

A

Dilation of the cuprus spongiosum

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97
Q

WHere is the glans of the penis located?

Anatomy

A

External urethral meatus

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98
Q

What is the arterial blood supply of the penis?

Anatomy

A

Branches of the internal pudendal artery (internal pudic)

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99
Q

What is the venous drainage of the penis?

Anatomy

A

Branches of the intrenal pudendal vein

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100
Q

What is the lymph drainage of the penis?

Anatomy

A

Superficial inguinal nodes
Internal iliac nodes

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101
Q

What is the innervation to the penis?

Anatomy

A

Pudendal nerve
Pelvic plexus –> both sympathetic and parasympathetic

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102
Q

What does the sympahetic innervation of the penis control?

Anatomy

A

Ejaculation

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103
Q

What does the parasympathetic innervation of the penis control?

Anatomy

A

Erection

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104
Q

When is genetic sex determined?

Anatomy

A

At fertilization but at that point phenotypic sex is not yet determined

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105
Q

What occurs between the genetic sex determination and the phenotypic sex appearance?

Anatomy

A

A stage of indifferent stage of gonadal development

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106
Q

What happens to the mesonephros once the metanephros develop?

Anatomy

A

The mesonephros does NOT degrade, instead, it is involved in the formation of the reproductive system
Metanephros: urological
Mesonephros: reproductive

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107
Q

What do gonads appear as in the indifferent stage of gonadal development?

Anatomy

A

They appear as genital ridges from the intermediate mesoderm

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108
Q

What happens to the primordial germ cells during the indifferent stage of gonadal development?

Anatomy

A

Primordial germ cells become spermatogonia –> they migrate from epiblasts into genital ridges

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109
Q

What happens if there is a failure of primordial germ cells to migrate?

Anatomy

A

The embryo will not have gonads

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110
Q

What happens just prior to the arrival of the primordial germ cells from the epiblast?

Anatomy

A

Genital ridges epithelium proliferates to form primary sex cords

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111
Q

What causes the primary sex cords to develop into somniferous tubules and testis?

Anatomy

A

The chromosomal SRY gene influences

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112
Q

What are the genityal ducts that male and female embryos have at the indifferent stage?

Anatomy

A

Mesonephric (Wolffian) duct (male)
Paramesonephric (Mullerian) duct (female)

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113
Q

What is the effect of the influence of fetal testosterone from developing testes on the mesonephric and paramesonephric ducts?

Anatomy

A

Mesonephric: develops into male genital ducts and connected to rete testis
Parasympathetic ducts disappear

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114
Q

Where do the seminal vesicles develop from?

Anatomy

A

They devleop from the mesonephric ducts as an outgrowth of the distal end

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115
Q

Where do the prostate and bulbourethral glands develop from?

Anatomy

A

Urogenital sinus

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116
Q

What happens to the development of the male external genitalia under the influence of fetal androgens?

Anatomy

A
  1. Genital tubercle (which is called phallus when it starts to elongate) elongates to form the penis
  2. Urethral folds also elongate and fuse to form penile urethra
  3. Genital swelling form the scrotum
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117
Q

What could cause the failure of the testes to descend?

Anatomy

A

Lack of testosterone

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118
Q

What is the descent of the testis?

Anatomy

A
  1. The abdominal testes are pulled down by the Gubernaculum testes (ligament) along with a section of the peritoneum (tunica vaginalis)
  2. An evagination of the peritoneum develops ventral to gubernaculum (processus vaginalis)
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119
Q

What is the Gubernaculum testes?

Anatomy

A

Fibrous tissue that pulls tests down

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120
Q

What is the function of Gubernaculum testes?

Anatomy

A

To limit the mobility of the testes –> if it fails then torsion occurs

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121
Q

What is the incidence of Hypospadias?

Anatomy

A

3 to 5 per 1000

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122
Q

What is hypospadias?

Anatomy

A

Incomplete fusion of urethral folds which form the penile urethra

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123
Q

What is the complication of Hypospadias?

Anatomy

A

Urethral opening occurs along ventral surface of the pneis

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124
Q

What is epispadias?

Anatomy

A

A rare condition, where the urethral opening is located on the dorsum of the penis

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125
Q

What complications are usually associated with epispadias?

Anatomy

A

It can present as an isolated defect or exstrophy of the bladder

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126
Q

What is exstrophy of the bladder?

Anatomy

A

The bladder is not closed

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127
Q

What is cryptorchidism (undescended testis)?

Anatomy

A

Absence of one or both testes in the scrotum may be found anywhere along the usual path of descent of the testes (inguinal canal all the way to the abdomen)

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128
Q

What are the causes of cryptorchidism?

Anatomy

A

Idiopathic in most cases, but deficiency of androgens by testes is a factor

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129
Q

What is the incidence of cryptorchidism?

Anatomy

A

30% of premature infants and 3% of full-term males

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130
Q

What are the consequences of cryptorchidism?

Anatomy

A

Risk of testicular cancer
Infertility

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131
Q

What is peristent processus vaginalis?

Anatomy

A

Failure of closure of the communication between the peritoneal cavity and tunica vaginalis

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132
Q

What are the complications of persistent processus vaginalis?

Anatomy

A
  1. Congenital inguinal hernia
  2. Hydrocele of the testes
  3. Hydrocele of the spermatic cord
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133
Q

What do devleopment abnormalities lead to?

Anatomy

A

Difficulty in sex determination at birth, Ambiguous genitalia

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134
Q

What is the sexual reproduction?

Physiology

A

The process in which organisms produce offspriing by means of uniting gametes

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135
Q
A
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136
Q

What are the functions of the male reproductive organs?

Physiology

A

Secrete androgen hormones, produce gametes, and facilitate fertilization

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137
Q

What are the functions of the female gametes?

Physiology

A

Secrete female hormones, produce gametes, facilitate fertilization and sustain growth of the embryo and fetus

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138
Q
A
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139
Q

What are the male gonads?

Physiology

A

Testes

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140
Q

What is the duct system of the male reproductive system?

Physiology

A

Epidydimis
Vas deferens
Ejaculatory duct
Urethra

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141
Q

What is the purpose of the system of ducts in males?

Physiology

A

Transport and store sperm, assist in their maturation aand convey them to the exterior

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142
Q

What are the accessory sex glands of males?

Physiology

A

Seminal vesicles
Prostate
Bulbourethral glands

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143
Q

What is the function of accesory sex glands (males)?

Physiology

A

Add secretions to sperm to form semen

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144
Q

What are the supporting structures of the male reproductive system?

Physiology

A

Scrotum & Penis

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145
Q

What is the function of the supporting structures of the male reproductive system?

Physiology

A

Scrotum supports the testes and penis delivers sperm into the female reproductive system

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146
Q

What are the testes?

Physiology

A

Paired oval glands in the scrotum

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147
Q

What is the importance of the testes being located in the scrotum.

Physiology

A

Kept in temperature less than normal body temperature because sperm production requires temperature 2 to 3oC lower

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148
Q

What is the tunica albuginea and what does it form?

Physiology

A

The tough capsule surrounding the testes, it forms septa that divide each testis in lobules

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149
Q

How many lobules are there, and what do they contain?

Physiology

A

200 to 300 lobules each containing 2 to 4 seminiferous tubules

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150
Q

What is the purpose of seminiferous tubules?

Physiology

A

Sperms are produces, spermatogenesis

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151
Q

What are the compartment within each lobule created by seminiferous tubules?

Physiology

A

Intralobular compartment
Peritubular compartments

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152
Q

What is the intartubular compartment of the lobule?

Physiology

A

Composed of seminiferous epithelium

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153
Q

What is the peritubular compartment within lobule?

Physiology

A

Composed of neuromuscular elements, connective tissue cells, immune cells, and the intestinal cells of Leyidig, whose main function is to produce testosterone

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154
Q

What are the two cell types of the seminiferous tubules’ epithelium?

Physiology

A

Sperm cells: spermatogonia
Sertoli cells

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155
Q

What are Sertoli cells?

Physiology

A

Nurse cells in intimate contact with all sperm cells and regulate many aspects of spermatogenesis
Function provide nutrients (nurse cells)

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156
Q

What are tight junctions, and what is their function in the Seminiferous epithelium?

Physiology

A

Important because they form blood-testis barrier to prevent immunologic reactions from affecting the sperm cells, they are formed between Sertoli cells in the seminiferous tubules

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157
Q

What is the purpose of spermatogenesis?

Physiology

A

Production of spermatozoa and begins at puberty (Tanner stage: 4)

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158
Q

What is the duration of spermatogenesis?

Physiology

A

Takes 65 to 75 days and occurs in the testes at a temperature about 2 to 3 degrees below normal body temperature

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159
Q

What is the duration of spermatogenesis?

Physiology

A

Takes 65 to 75 days and occurs in the testes at a temperature about 2 to 3 degrees below normal body temperature

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160
Q

What is spermatogenesis under indirect control of?

Physiology

A

FSH and testosterone because spermatozoa do not have androgen receptors

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161
Q

What is the process of spermatogenesis like?

Physiology

A

It begins with spermatogonia which are sperm stem cell —> primary spermatogenesis —> secondary spermatogenesis —> spermatids —> sperm cells

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162
Q

What happens to non-motile sperms?

Physiology

A

They are released into lumen of seminiferous tubules and stored in the tail of epididymis and vas deferent for several months

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163
Q

What is spermatocytogenesis?

Physiology

A

Spermatogonia type B divides by mitosis into primary spermatocyte

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164
Q

How many cycles of meiosis take place in spermiogenesis?

Physiology

A

2 meiotic cycles

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165
Q

What is the release of sperm into the lumen of seminiferous tubules called?

Physiology

A

Spermiation, breakdown of junctions between Sertoli cells and spermatogenesis

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166
Q

What is spermatogenesis adversely affected by? (6)

Physiology

A
  1. Temperature
  2. Anabolic hormones like exogenous testosterone and steroids
  3. Dietary deficiencies
  4. X-rays exposure
  5. Alcohol and smoking
  6. Infections like STDs
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167
Q

How many sperms complete the process of spermatogenesis daily?

Physiology

A

About 300 million

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168
Q

What are the different components of the sperm cells?

Physiology

A
  1. The head
  2. The neck
  3. The tail
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169
Q

What are the components of the head of sperm cell?

Physiology

A

A condensed nucleus containing 23 highly condesnsed chromosomes

An acrosomal vesicle covering the anterior two thirds of the nucleus and containing hydro lyric enzymes that play an important role in fertilisation and the prevention of polyspermy

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170
Q

What does the neck of the sperm cell contain?

Physiology

A

Two centrioles

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171
Q

What is the tail of sperm cells composed of?

Physiology

A

Middle piece
Principal piece
End piece

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172
Q

What is the middle piece of the sperm cell?

Physiology

A

The thickest part and contains a collar of mitochondria that deliver ATP for flagella beating and motility

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173
Q

What does the principal piece of the sperm cell contain?

Physiology

A

Outer circumference contains dense fibers but no mitochondria

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174
Q

How does the principal piece propel the sperm cell?

Physiology

A

By interactions between tubulin fibres

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175
Q

What is the end piece of the sperm cells like?

Physiology

A

Lacks the outer dense fibres and mitochondria

176
Q

What do the Sertoli cells represent?

Physiology

A

The true epithelial cells in the seminiferous tubules

177
Q

Where in the seminiferous tubules are the Sertoli cells located?

Physiology

A

They extend from the basal laminate to the lumen

178
Q

What kind of receptors do the Sertoli cells express?

Physiology

A

FSH receptors

179
Q

What is the function of the Sertoli cells?

Physiology

A

Surround sperm, provide structural and functional support within epithelium

180
Q

What kind of junctions do Sertoli cells form with spermatogenic cells?
What is their function?

Physiology

A

Adherens junctions and gap junctions
Sertoli cells guide sperm cells toward lumen as they advance through later stages

181
Q

What do tight junctions form, where are they found?

Physiology

A

They form the blood-testes barrier and they are found between two Sertoli cells

182
Q

What are Leydig cells?

Physiology

A

The primary endocrine cells of the testes
Steroidogenic stromal cells that produce testosterone from cholesterol stimulated by LH

183
Q

What % of the circulating testosterone comes from Leydig cells?

Physiology

A

95% of circulating testosterone, which is actually a very small of the total testosterone created by the testes

184
Q

Which hormone DIRECTLY acts on spermatogenic cells?

Physiology

185
Q

What happens to the rest of the testosterone that is NOT circulating in the blood?

Physiology

A

80% of the total testosterone will move into the seminiferous tubules which have high affinity to testosterone, 10x the concentration of testosterone in the blood

186
Q

What are the concentrations of testosterone through the day?

Physiology

A

In plasma, it follows the circadian pattern (morning concentration are 20 to 40% higher than evening ones)

187
Q

How does testosterone target tissues? What kind of tissues?

Physiology

A

Directly and indirectly targets tissues that can be reproductive or non reproductive

188
Q

Which tissues other than the testes produce testosterone and other androgens?

Physiology

A

Adipose tissue, brain, muscle, skin, adrenal cortex

189
Q

What other androgens other than testosterone are there?

Physiology

A

DHT and estradiol

190
Q

Where is 5a reductive found?

Physiology

A

Prostate gland, seminal vesicles, epidisymides, skin, hair follicles and brain

191
Q

What is the function of 5a reductase?

Physiology

A

Converts testosterone to DHT that acts locally (interacting and practice effects)

192
Q

Where is aromatase found?

Physiology

A

Sertoli cells (20%)
Adipose tissue (80%)
Brain

193
Q

What is the function of aromatase?

Physiology

A

To convert testosterone into estradiol

194
Q

What is the concentration of DHT in comparison to testosterone in the plasma?

Physiology

A

10 to 20 times less potent than testosterone

195
Q

What is the concentration of DHT in comparison to testosterone in the traget organs?

Physiology

A

10 times more potent than testosterone

196
Q

What is the importance of Estradiol in men?

Physiology

A

Essential for modulationg libido, erectile function, spermatogenesis (direct effect via estroegn receptors) as well as bone growth and calcification

197
Q

What are the actions of testosterone? (7)

Physiology

A
  1. Muscle Mass Development
  2. Bone Density
  3. Abdominal Visceral Fat
  4. Sperm Production
  5. Liver Effects: Increases VLDL, LDL, and decreases HDL levels.
  6. Pubertal Development
  7. Feedback Suppression
198
Q

What are the actions of DHT? (6)

Physiology

A
  1. Intrauterine Differentiation:
    Development of male external genitalia (penis, scrotum, urethra, prostate).
  2. Secondary Sexual Characteristics
  3. Prostate Growth
  4. Male Pattern Hair Growth
  5. Pubertal Development
  6. Epididymis, Vas Deferens, and Seminal Vesicle Maturation.
199
Q

What are the actions of estradiol?

Physiology

A
  1. Bone Growth: Supports epiphyseal plate closure in bones, contributing to height regulation.
  2. Male Behavior: Influences male sexual behavior and libido.
  3. Feedback Suppression: Suppresses gonadotropin secretion along with testosterone.
200
Q

What is the role of androgens during the mini puberty in early infancy?

Physiology

A

Influence on penile growth, the number of Sertoli cells and body growth

201
Q

What is the influnece of androgens at puberty?

Physiology

A
  1. Stimulate the development of secondary male sexual characteristics
  2. Stimulate the development of sexual functions and sexual drive
  3. Stimulate anabolism: protein synthesis –> growth of msucle abdominal bone –> increase in height
202
Q

Which hormone is responsible for changing of the voice dufring puberty?

Physiology

A

Testosterone

203
Q

Which hormone is responsible for the development of hair during puberty?

Physiology

204
Q

Which hormone is responsible for the enlargment of the penis during puberty?

Physiology

205
Q

Which hormone is responsible for the thickining of the skin and increase in sebaceous glands during puberty?

Physiology

206
Q

Which hormone is responsible for the maturation of the seminiferous tubules and production of sperm during puberty?

Physiology

A

Testosterone

207
Q

What is the hormonal control of testes like?

Physiology

A

CNS: hypothalamus (GnRH)
Anterior pituitary: LH and FSH
LH –> Leydig cells
FSH –> Sertoli cells

208
Q

What hormone from the Sertoli cells inhibits the anterior pituitary?

Physiology

209
Q

What are the effects of FSH on Sertoli cells?

Physiology

A

Release of androgen binding protein
Release of estrogens
Spermatogenesis

210
Q

What are the effects of LH on Leydig cells?

Physiology

A

Release of androgens, which later on bind to androgen-binding protein

211
Q

How are androgens converted into estrogens?

Physiology

A

Through peripheral aromatization

212
Q

What is the secretion of GnRH like?

Physiology

213
Q

What is the effect of GnRH?

Physiology

A

STimulates thenaterior pituitary to increase the secretion of LH and FSH

214
Q

How is GnRH suppressed, through which negative-feedback mechanism?

Physiology

A

Testosterone, it suppressed both GnRH and LH

215
Q

What is the effect of administration of exogenous androgens?

Physiology

A

They enter the circulation and exert excessive negative feedback on hypothalamus and pituitary –> insuficient levels of testosterone is testes –> insufficient spermatogenesis

216
Q

What is the effect of short, intensive physicalo exercise?

Physiology

A

Can increase plasma testosterone

217
Q

What is the effect of extended, exhausting physical exercise?

Physiology

A

Decrease plasma testosterone

218
Q

What are the accessory glands of the male reproductive system?

Physiology

A

Prostate
Seminal vesicles
Bulbourethral galnds

219
Q

What is the function of the seminal vesicles?

Physiology

A

Secrete a thick viscous, alkaline fluid (mainly during ejaculation), which makes up 60% of total volume of semen

220
Q

What does the thick alkaline fluid from the seminalo vesicles contain? (4)

Physiology

A
  1. Fructose: for energy
  2. Prostaglandins: to stimulate uterine and fallopian tube smooth muscle contraction
  3. Vitamin C
  4. Clotting proteins: fibrinogens
221
Q

Why is the fluid from the seminal vesicles alkaline?

Physiology

A

In order to neutralize the acidity of the male urethra and female reproductive tract

222
Q

What is the prostate?

Physiology

A

A chest-nut sized, donut-shaped gland that secretes about 30% of ejaculate volume

223
Q

What is the prostatic fluid like?
What does it contain?

Physiology

A

Thin, milk, slighlty alkaline solution which contains:
1. Citric acid for energy
2. Acid phosphotase
3. Proteolytic enzymes
4. Clotting enzymes: trigger clotting of semen in the vagina during penis withdrawn
5. Prostate-specific antigen: liquifies coagulated semen after a few minutes

224
Q

What is another name for Bulbourethral gland?

Physiology

A

Cowper’s gland

225
Q

What are the bulbourethral glands?

Physiology

A

Pea-seized glands inferior to the prostate

226
Q

What do the bulbourethral glands secrete?

Physiology

A

Protective, alkaline, thick, clear mucus that decreases sperm damage in the urethra
1. They pass down the urethrafirst during sexual excitement,
2. Clean the urethra of acidic urine traces prior to ejaculation,
3. Serve as lubricant during sexual intercourse

227
Q

What is semen?

Physiology

A

Mixture of sperms and seminal fluid, a liquid that consists of the secretion of the seminiferous tubuules, seminal vesicles, prostate amd bulbourethral glands

228
Q

What is the normal volume of semen?

Physiology

229
Q

What is the normal viscocity of semen?

Physiology

A

Liquefaction in 1 hour

230
Q

What is the normal pH of semen?

Physiology

A

pH 7 to pH 8

231
Q

What is the normla count of semen?

Physiology

A

≥ 20 million/mL

232
Q

What is the normal motility of semen?

Physiology

233
Q

What is the normal morphology of semen?

Physiology

A

≥ 60% normal

234
Q

What is the male sexual response cpntrolled by?

Physiology

A

Parasympathetic –> erection and Sympathetic –> ejaculation divisions of the ANS

235
Q

What are the 4 stages of male/female sexual response?

Physiology

A
  1. Excitement
  2. Plateau
  3. Orgasm
  4. Resolution
236
Q

How does an erection occur?

Physiology

A

Parasympathetic reflex –> local production of nitric oxide –> relaxation of smooth muscle in arterioles supplying the cavernous space –> large amounts of blood enter penis

237
Q

What are the two phases of orgasm?

Physiology

A

Emission
Expulsion

238
Q

What is the emission phase of orgasm in sexual response?

Physiology

A

Movement of the ejaculate into the prostatic urethra (closure of the sphincter at the base of the urinary bladder, and peristaltic contractions of vas deferens, seminal vesicles, and prostatic smooth msucle)

239
Q

What is the expulsion phase of the orgasm in sexual response?

Physiology

A

Forceful expulsion of ejaculate through urethra and out of the penis (facilitated by rhythmic of perineal muscles –> somatic nervous system)

240
Q

What is the resolution phase controlled by in sexual response?

Physiology

A

Sympathetic division

241
Q

How does the resolution phase occur in sexual response?

Physiology

A

Norepinephrine causes contraction of smooth muscle –> Increase in intracellular Ca2+ –> smooth muscle contraction and vasoconstriction –> decrease in blood flow to cavernous spaces

242
Q

What is the effect of PDE-5 on penile erections?

Pharmacology

A

Degrades cyclic GMP, causing vasoconstriction of erectile tissues and resulting in the loss of erection.

243
Q

What are the three main classes of pharmacotherapy of ED?

Pharmacology

A
  1. PDE-5 inhibitors
  2. Vaodilators
  3. Androgens
244
Q

What are exmaples of PDE-5 inhibitors?

Pharmacology

A

Sildenafil
Tadalafil
Vardenafil
Avanafil

245
Q

How do PDE-5 inhibitors help with ED?

Pharmacology

A

Men with ED produce insufficient amounts of NO, producing small amounts of cGMP, PDE-5 inhibitors block PDE-5 –> preventing hydrolysis of cGMP –> accumulation of cGMP which allows for vasodilation

246
Q

What is one of the indications of PDE-5 inhibitors?

Pharmacology

A

They require sexual stimulation for activation

247
Q

What is the administration route of the PDE-5 inhibitors?

Pharmacology

A

Taken orally as tabelts prior to sexual intercourse

248
Q

What is the MOA of PDE-5 inhibitors?

Pharmacology

A

Enhance the effect of nitric oxide in inducing penile vasodilation on sexual simulation, decrease in Ca2+ and accumulation of cGMP

249
Q

Which muscle of the penus does NO relax?

Pharmacology

A

Smooth muscle of corpora cavernosa peripherally

250
Q

What are the side effects of PDE-5 inhibitors?

Pharmacology

A

Headaches
Dizziness
Flushing
Nasal Congestion
GI
Visual Disturbances

251
Q

What is an example of visual disturbances caused by PDE-5 inhibitors, which one exactly?

Pharmacology

A

Blue vision due to non-specific inhibition of retinal PDE-6, Sildenafil (Viagra)

252
Q

What is Sildenafil (Viagra)?

Pharmacology

A

Most popularly used PDE-5 inhibitor, administered in 25, 50 and 100mg

253
Q

When is Sildenafil taken?

Pharmacology

A

taken 1 hour before sexual intercourse

255
Q

What is the maximum dosage of Sildenafil?

Pharmacology

A

Once daily

256
Q

What is the window of opportunity for Sildenafil?

Pharmacology

A

30 minutes to 4 to 5 hours, effective up to 12 hours

257
Q

What are the side effects of Sildenafil?

Pharmacology

A

Headaches
Facial Flushing
Dyspepsia
Dizziness
Rhinitis
Abnormal Vision

258
Q

What is the first class use of PDE-5 inhibitors?

Pharmacology

A

Sildenafil

259
Q

What is the impact of fatty meals on different PDE-5 inhibitors?

Pharmacology

A

Sildenafil: Delays onset
Tadalafil: No effect
Vardenafil: Dealys onset, unless given sublingual orally
Avanafil: No effect

260
Q

WHich PDE-5 inhibit has the longest period of onset, what is it?

Pharmacology

A

Tadalafil, 2 hours but lasts 36 hours, allows for once daily use

261
Q

Which PDE-5 inhibitor is the most potent?

Pharmacology

A

Vardenafil, bind most rapidly to PDE-5 compared to the rest –> Onset is 10 minutes

262
Q

Which PDE-5 inhibitor has the fastest onset of action?

Pharmacology

A

Avanafil, 10 to 30 minutes and lasts up to 6 hours

263
Q

What are the contraindications of PDE-5 inhibitors?

Pharmacology

A

Nitrates
Antihypertensive Drugs
Alpha Blockers

264
Q

Why are nitrates a contraindicatior of PDE-5 inhibitors?

Pharmacology

A

PDE-5 inhibitors cause transient hypotension, nitrates should not be taken for at least 48hrs, increased risk of threatening hypotension

265
Q

Why are antihypertensive drugs a contraindication of PDE-5 inhibitors?

Pharmacology

A

They already cause mild hypotensive effects

266
Q

Why are alpha blockers a contraindication for PDE-5 inhibitors?

Pharmacology

A

Can prodfoundly increase hyotensive, should be initiated at the lowest dosage possible

267
Q

How are PDE-5 inhibitors metabolised?

Pharmacology

A

Hepatic CYP450 enzymes so dosage requirement will be required with inducers and inhibitors of CYPs

268
Q

What is the effect of the drugs that inhibit CYP450?

Pharmacology

A

Inhibit the metabollic breakdown of PDE-5 inhibitors –> such agents may increase blood levels of PDE-5 inhibitors and thus lower dosage should be given

269
Q

What are examples of CYP3A4 pathway inhibitors? (6)

Pharmacology

A

Ketoconazole
Itraconazole
Erythromycin
CLarithromycin
HIV Protease Inhibitors
Grapefruit or grapefruit juice

270
Q

What is the effect of the drugs that induce CYP450?

Pharmacology

A

Will enhance the breakdown of PDE-5 inhibitors –> higher dosage of PDE-5 inhibitors required

271
Q

What are examples of CYP3A4 pathway inducers?

Pharmacology

A

Rifampin
Phenobarbital
Phenytoin
Carbamazepine

272
Q

What is the local delivery of Vasodilators of ED?

Pharmacology

A

Intracavernous injections of vasodilators

273
Q

WHat are examples of vasodilators that are locally administered into the penis?

Pharmacology

A

Alpostadil

274
Q

How is Alpostadil administered?

Pharmacology

A

injected into the penile shaft or administered as a pallet into the urethra

275
Q

What is the MOA of Vasodilators?

Pharmacology

A

Unknown, psosibly through activating adenylate cyclase –> increase cAMO levels –> relax trabecular smooth muscle and dilates the cavernosa arteries –> promoting blood flow

276
Q

What is the onset of action of Vasodilators?

Pharmacology

A

Rapid, 5 to 10 minutes
2 to 25 minutes through injections

277
Q

What are the side effects of Vasodilators?

Pharmacology

A

Priapism (prolonged, painful erection)
Penile pain
Urethral burning

278
Q

What is Alprostadil?

Pharmacology

A

Vasoactive prostaglandin E1 with almost immediate onset of action

279
Q

What is MUSE?

Pharmacology

A

REquires insertion of pellet into urethra with plastic applicator

280
Q

What is is Caverject and Edex?

Pharmacology

A

For injection directlyy into the penis’ corpus cavernosa

281
Q

What is the dosage of Alpostadil (in all forms)?

Pharmacology

A

Between 10 to 20mcg once daily up to a maximum of 3 times per week

282
Q

What are the contraindications of Alpostadil?

Pharmacology

A

Phsyical deformities of urethra
Caution if pregnant sexual partner –> PDE can cause abortion

283
Q

What is the use of androgens?

Pharmacology

A

Testosterone of benefit with men with hypogonadism to retsore libido and sexual activity. No currently recommendded as monotherapy

284
Q

What is the administration of androgens?

Pharmacology

A

Orally
Injected
Cutaneous application via gel or skin patches

285
Q

What is the MOA of Androgens?

Pharmacology

A

testosterone promotes growth and development of male sex organs and maintains secondary sex characteristics in androgen-deficient males

286
Q

What are the side effects of Angrogens?

Pharmacology

A

Headache
Acne
Aggressive Behaviour
Priapis
Gynecomastia

287
Q

Why is testosterone given in female with sexual dysfunction?

Pharmacology

A

Works to stimulate sex desire
Extremely low doses required

288
Q

How is testosterone administered in females?

Pharmacology

A

Creams
Transdermal patches
Combinations with estrogen and progesterone

289
Q

What are the side effects of testosterone given to women?

Pharmacology

A

Masculinization and could cause liver toxicity in high doses

290
Q

What is Eroxon?

Pharmacology

A

Topical gel supplied in single-use tubes, contents are rubbed onto the head of the penis immediately before sexual intercourse

291
Q

What is the MOA of of Eroxon?

Pharmacology

A

Combination of volatile solvents (alcohol and water) which evaporate when applied to the penis and stimulate nerve endings through cooling and heating effect. Release of NO

292
Q

What is the Vacuum Constriction Device?

Pharmacology

A

Non-pharmacological approach, vacuum is placed over penis, blood is drawn into penis due to cretaion of vacuum pressure around the penis

Constriction band is then placed around the base of the penis to hold blood in place

293
Q

What are complications of Vaccum Constriction Device?

Pharmacology

A

Painful ejculation and bruising

294
Q

What are penile implants?

Pharmacology

A

Used as non-pharmacological (surgical) treatment when medical treatment fails

Used as last resort therapy

295
Q

What are the two types of penile implants, what are they?

Pharmacology

A

Malleable rods: semi-rigid penis, lifted to erect position through mechanical movemnet

Hydraulic: non-visible fluid reservoir-pump system connects to two cylinders implanted in the penile shaft to allow for erection; deflation via manual valve)

296
Q

What are the structures of the male reproductive organs?

Pathology

A

The testes
The duct system (epididymis and vas deferends)
The accessory glands (prostate, seminal vesicles & bulbourethral glands)
The penis

297
Q

What is the gross appearance of the testis?

Pathology

A

Orange yellow appearance of the testis

298
Q

What are the main causes of male infertility? (16)

Pathology

A
  1. Vericocele
  2. Infection
  3. Ejaculaton Issues
  4. Tumors
  5. Cryptorchidism
  6. Testicular tumors
  7. Hormone Imbalances
  8. Tubular transport defects
  9. Chromosome defects
  10. Problems with sexual intercourse
  11. Celiac disease
  12. Medications
  13. Prior surgeries
  14. Radiation/ X-Ruas
  15. Environmental Exposures
  16. Lifetsyle
299
Q

What is Cryptorchidism?

Pathology

A

Most common congenital abnormality; The failure of testicles to descend from abdomen into scrotal sac

300
Q

In the case of cryptorchidism, where can the testes be found?

Pathology

A

Abdomen, inguinal canal or high in the scrotum

301
Q

Is cryptorchidism unilateral or bilateral?

Pathology

A

Usually unilateral, can be bilateral (10% of cases)

302
Q

What are the causes of cryptorchidism? (4)

Pathology

A

Multifactorial:
1. Genetic syndromes
2. Preterm babies
3. Small birth weight
4. Environmental factors (pesticides & hormones)

303
Q

What is the treatment for cryptorchidism?

Pathology

A

Spontaneous resolvemnet before 2 years of age, if not, orchipexy is required at 18 months

304
Q

What are the complications of cryptorchidism?

Pathology

A

Infertility & sterility
Increased risk of intratubular germ cell neoplasmia in the atrophic tubules & subsequent invasive tumor

305
Q

Why is infertility a complication of cryptorchidism?

Pathology

A

Due to tubular atrophy, increase in temperature because testes is not outside of the body –> inadequate conditions for spermatogenesis

306
Q

What is the gross appearance of the testis in the case of cryptorchidism?

Pathology

A

Small atrophic with white yellowish cut section

307
Q

What is the microscopic appearance of the testis in the case of cryptorchidism?

Pathology

A

Thickened, hyanalised basement membrane, arrested germ cells development, prominent Leydig cells

308
Q

What is testicular atrophy and decreased fertility associated with?

Pathology

A
  1. Progressive atherosclerotic changes and decreased testiclar blood supply (aging)
  2. Inflammation, end stage orchitis
  3. Irradiation & chemotherapy
  4. Antiandrigens (treatment for prostate cancer)
  5. Hypopituitarism
  6. Trauma
  7. Malnutrition and cachexia
  8. Exhaustion atrophy: persistent stimulation by pituitary FSH
  9. Cirrhosis due to increased estrogen
309
Q

What is Epididymo-orchitis?

Pathology

A

Most common cause of scrotal pain in adults, infflammation of the epididymis and the testes. Inflmmation is more prominent in the epididymis than in the testis

311
Q

How does epididymo-orchitis present as?

Pathology

A
  1. Localised testicular pain with tenderness and swelling on palpation of affected epididymis, which is located on the posterior aspect of the testis
  2. Scrotal wall erythema and a reactive hydrocele
  3. Postive Prehn sign
  4. Cremasteric reflex is positive
313
Q

What is a positive Prehn sign?

Pathology

A

Mannual elevation of the scrotum relieves pain

314
Q

What is a positive cremasteric reflex?

Pathology

A

When the inner thigh is touched, the testis elevate

315
Q

What can be the causes of epididymo-orchitis?

Pathology

A
  1. Specific infectious agents
  2. Non-specific to an infection in the area such as cystitis, urethritis or prostatis
  3. Granulomatous, ususally noncaseating granuloma
316
Q

WHat kind of specific infectious agents can cause epididymo-ochitis?

Pathology

A
  1. Mumps (in children patchy and does not result in complete atrophy or infertility, in teenagers or children > 10 it will lead to infertility)
  2. Syphilis & TB (necrotizing, caseating granuloma)
317
Q

What agents cause infection in the area which could then lead to epididymo-orchitis?

Pathology

A

Children: Gram - rods, especially in cases with congenital abnormalities
Young adults (< 35): C. trachomatis & N. gonorrhea
Older adults (> 35): E. coli & Psuedomonas (UTI organisms)

318
Q

How is epididymo-orchitis diagnosed?

Pathology

A

Clinical diagnosis: urine analysis, urethral swab culture and sensitivity, NAAT for gonorrhea/chlamydia

319
Q

What is NAAT, and why is it used to test for epididymo-orchitis?

Pathology

A

Nucleic acid amplification testing, used as initial investigation for chlamydia and gonorrhea, possible cause in young adults

320
Q

What is the management of epididymo-orchidism?

Pathology

A

Antibiotics (based on common causes), NSAIDs, ice and scrotal elevation

321
Q

What is testicular torsion?

Pathology

A

Twisting of the spermatic cord –> thin wall veins become obstructed (while arteries are not) –> congestion and hemorrhagic infraction (EMERGENCY)

322
Q

Why does testicular torsion present with HEMORRHAGIC infraction?

Pathology

A

The blood entered the area but because of occlusion of the testicular vein it cannot be drained

323
Q

Why is there venous obstruction in testicular torsion whilst the arteries are not yet occluded?

Pathology

A

Veins are thin-walled and low-pressure vessels, making them more susceptible to compression when the spermatic cord twists.

324
Q

What is the population target of testicular torsion?

Pathology

A

In neonates –> happens in utero or after birth, no anatomical abnormalities

In adolescence –> due to bilateral anatomical abnormality, abnormally anchored in the scrotal sac, bell clapper abnormality)

325
Q

What is a bell-clepper abnormality of the testes?

Pathology

A

The orientation of the testis is completely horizontal opposed to normal where it should be slightly upwards

326
Q

How does testicular torsion present?
When it usually occur?

Pathology

A

Acute scrotal pain or pain localised to lower abdomen is also common, scrotal swelling, high riding testicle with negative cremasteric reflex
–> Commonly seen after trauma or physical exercise

327
Q

What is high-riding testicle?

Pathology

A

One of the two testicles is in place whilst the other one is lifted

328
Q

How does the negative cremasteric reflex help with the diagnosis of testicular torsion?

Pathology

A

Help differentiate between testicular torsion and epididymo-orchitis

329
Q

What is the diagnosis of testicular torsion like?

Pathology

A

Done clinically, but U.S can be used in indeterminate cases

330
Q

What is the treatment for testicular torsion?

Pathology

A

Orchiopexy –> detorsion and fixation of both testis before infraction, window of opportunity is 6 to 8 hours

331
Q

In the case of infraction of the testis, in testicular torsion, what is the treatment?

Pathology

A

Orchiectomy, removal of testes

332
Q

What are the complications of testicular torsion?

Pathology

A

Teesticular infraction,
Testicular comprtment syndrome (edema after repair),
Infertility (even if unilateral testis due to immunological exposure)

333
Q

What is the gross appearance of testicular torsion?

Pathology

A

Hemorrhagic necrosis

334
Q

What is the microscopical apperance of testicular torsion?

Pathology

A

Components of testes are not identfied because of necrosis

335
Q

What is varicocele?

Pathology

A

Dilated tortious vein (testicular vein) in the pampiniform plexus surrounding the spermatic cord of the scrotum due to impaired drainage

336
Q

Which side is varcocele most likely to appear in, and why?

Pathology

A

Usually left-sided because the left testicular vein drains into the left renal vein at 90o, whilst the right testicular drains directly to IVC at an obtuse angle, facilitating flow

337
Q

What medical condition may vericocele be associated with?

Pathology

A

Renal cell carcinoma, as it ofetn invades the renal vein

338
Q

What are the clinical presentations of varicocele?

Pathology

A

SCrotal swelling with fullness especially while standing, decsribed as a “bag of worms” appearance

339
Q

What is the common population of vericocele? Why?

Pathology

A

Infertile male, temperature change due to increased blood flow becuase of vein dilation

340
Q

What is the treatment of vericocele?

Pathology

A

Cna be srgically repaired, drainage, or laparoscopically

341
Q

What is hydrocele?

Pathology

A

Fluid collections within the parietal and visceral layers of tunica vaginalis

342
Q

What are the different types of hydrocele?

Pathology

A

Can be communicating or non-communicating

343
Q

What is a communicating hydrocele?

Pathology

A

Incomplete closure of the processus vaginalis –> communication with peritoneal cavity in infants

344
Q

What is a non-communicating hydrocele?

Pathology

A

Idiopathic or associated with cystitis that leads to lymphatics blockage in adults

345
Q

How does hydrocele present?

Pathology

A

Scrotal swelling that can be transilluminated

346
Q

What is the treatment of hydrocele?

Pathology

A

Surgical repair is inidcated for communicating hydroceles taht persist beyond one or two years of age and for idiopathic, noncommunicating, symptomatic hydroceles

347
Q

What is Intratubular germ cell neoplasia?

Pathology

A

Also known as germ cell neoplasia in situ, precuror of germ cell tumors, they have genetic alterations

348
Q

Intratubular germ cell neoplasia is a precursor of germ cell tumors except of?

Pathology

A

Yolk sac, teratoma and spermatocytic seminomas

349
Q

When does intratubular germ cell neoplasia begin?

Pathology

A

Usually in utero and stay dormant until puberty

350
Q

What is the relation between intratubular germ cello neoplasia and germ cell tumors?

Pathology

A

50% of patients with intratubular gern cell neoplasia will develop germ cell tumors within 5 years, practically all patients will develop invasive tumors

351
Q

How is intratubular germ cell neoplasia diagnosed?

Pathology

A

Usually incidental, in the case that one teste is affected, careful follow-up is required for the other one

352
Q

Why is biopsy not done in the cases of testicular cancers?

Pathology

A

In the case of tumors, the mass can desiminate and spread and metastasize

353
Q

What is the morphology of intratubular germ cell neoplasia and germ cell neoplasia in situ?

Pathology

A

Atypical large germ cells with large nuclei, clear cytoplasm & prominent dark nucleoli (fried egg apperance)

354
Q

What is the traget population of testicular tumors?

Pathology

A

90% of cases, diagnosis occurs between 25 to 45 years of age

355
Q

How do testicular tumors present?

Pathology

A

Painless firm testocular masses,
Swelling,
Sharp or dull pain in the testes and lower abdomen,

356
Q

How are testicular tumors diagnosed?

Pathology

A

Radical orchiectomy since bbiopsy cannot be done

357
Q

What is the importance of tumor markers?

Pathology

A

Diagnosis and monitoring

358
Q

What are tumor markers of importance when it comes to testicular tumors?

Pathology

A

hCG, a-fetoprotein, LDH

359
Q

Which chromosomal abnormality is usually present in virtually all germ cell tumors?

Pathology

A

Extra copies of short arm of chromosome 12, usually due to presence of an isochromosome 12

360
Q

What is the metastasis of testicular tumors like?

Pathology

A

Para-aortic lymph nodes

361
Q

What is the prognosis of testicular tumors like?

Pathology

A

Treatment prognosis is good

362
Q

What are the risk factors of testicular tumors? (3)

Pathology

A
  1. Testicular dysegenesis syndrome
  2. In utero exposure to environmental factors (pesticides, synthetic sex hormones in contaminated water and food)
  3. Genetic mutations (Klinefelter syndrome)
363
Q

What is the familiar predisposition of testicular tumors like?

Pathology

A

Strong: 4x higher in father and sons of affected persons
8 to 10x higher in brothers

364
Q

How do testicular tumors that secrete hCG present?

Pathology

A

Gynecomastia
Testicular atrophy
Loss of libido
Erectile dysfunction

365
Q

When do the complications of testicular tumors arise?

Pathology

A

When malignant tumor invades nearby tissues (metastasis)

366
Q

What are the complications of testicular tumors?

Pathology

A

Lungs: dyspnea, cough, hemoptysis
Lower back pain: if it metastasizes to the retroperitoneal lymoh nodes

367
Q

What are the classifications of testicular tumors?

Pathology

A
  1. Germ cell tumors (95%) –> usually malignant
  2. Sex - cord / Stromal tumors –> usually benign
368
Q

What are the categories of germ cell tumors?

Pathology

A
  1. Seminomatous
  2. Non-seminomatous
369
Q

What are examples of seminomatous germ cell tumors?

Pathology

A
  1. Classical seminoma
  2. Spermatocytic seminoma
370
Q

What are examples of non-seminomatous germ cell tumors?

Pathology

A
  1. Embryonal carcinoma
  2. Yoc sac tumor
  3. Choriocarcinoma
  4. Teratoma
371
Q

What are examples of sex-cord / stromal tumors?

Pathology

A

Leydig cell tumors
Sertoli cell tumors

372
Q

Which category of tumors is most common?

Pathology

A

Germ cell tumors –> 10% of cancer deaths

373
Q

What is the target population of germ cell tumors?

Pathology

A

15 to 34 years of age
More common in whites than black individuals

374
Q

What is the most common type of germ cell tumors

Pathology

A

Seminoma –> 50% of germ cell tumors

375
Q

What is the target population of seminoma germ cell tumors?

Pathology

A

Peak in 3rd decade

376
Q

What are the secretions of seminoma germ cell tumors like?

Pathology

A

May secrete hCG (10% of cases) but MILD elevation
PLAP may be elevated

377
Q

What is PLAP?

Pathology

A

Placenta alkaline phosphotase

378
Q

What are seminomas like?

Pathology

A

Indolent (causing little to no pain) and likely to present with localised disease, metastasis is late

379
Q

What is the prognosis of seminomas?

Pathology

A

Highly responsive to radiotherapy, has excellent prognosis

380
Q

What is the gross appearance of seminomas?

Pathology

A

Bulky large tumot with homogenous lobulated surface, no hemorrhage and no necrosis (in rare cases: coagulative necrosis)

381
Q

What is the microscopy of seminomas? (3)

Pathology

A
  1. Sheets of cells divided by delicate fibrous speta containing lymphocytes
  2. Large & uniform cells with distinct cell borders, clear, glycogen-rich cytoplasm, round nuclei, and conspicuous nucleoli (fried egg)
  3. Sometimes granulomas & syncytiotrophoblasts may be present
382
Q

What are spermatocytic seminomas?

Pathology

A

Differ from classic seminoma both clinically and histologically
Rare –> 1 to 2% of GCT
Slow growing, do not metastasize

383
Q

What is the target population of spermatocytic seminomas?

Pathology

A

Older age groups, > 65

384
Q

What is the prognosis of spermatocytic seminomas like?

Pathology

A

Excellent prognosis

385
Q

What are examples of non-seminomatous germ cell tumors?

Pathology

A

Embryonal carcinoma
Yolktumors sac
Choriocarcinomas
Teratoma

386
Q

What are non-seminomatous germ cell tumors like in comparison to seminomatous?

Pathology

A

More aggressive and spread earlier than seminomatous
Radioresistant

387
Q

How do nonseminomatous tumors spread?

Pathology

A

Both lymphatic and blood vessels spread

388
Q

What is the age population of embyonal carcinomas?

Pathology

A

20 to 30 years of age

389
Q

How are embryonal carcinomas treated?

Pathology

A

Radiotherapy is not effective and is treated with chemotherapy

390
Q

What may embryonal carcinomas be associated with?

Pathology

A

Germ cell tumor components such as yolk sac and choriocarcinoma

391
Q

How do embryonal carcinomas metastasize?

Pathology

A

Lymphatic and homogenou spread

392
Q

What is the gross apperance of embryonal carcinomas?

Pathology

A

Poorly demarcated margins, variegated with hemorrhage and necrosis

393
Q

What is the microscopical appearance of embryonal carcinomas?

Pathology

A
  1. Sheets of highly aplastic, large tumor cells with basophilic cytoplasm
  2. Indistinct cell borders and large vesicular nuceli, prominent nucleoli and atypical mitotic figures
  3. May be arranged in glandular or papillary like structures
394
Q

What is the most common testicular neoplasm in CHILDREN?

Pathology

A

Yolk sac tumors –> Endodermal sinus tumor

395
Q

How do yolk sac tumors present in adults?

Pathology

A

No pure form in adults, component with other germinal cell tumors

396
Q

What are the secretions of yolk sac tumors like?

Pathology

A

May secrete AFP (used in diagnosis and monitoring)

397
Q

What is the prognosis of yolk sac tumors?

Pathology

A

Usually good prognosis

398
Q

What is the gross appearnce of yolk sac tumors?

Pathology

A

Large, well demarcated, homogenous, yellow-white

399
Q

What is the microscopical appearance of yolk sac tumors?

Pathology

A

Distinctive feature is the presence of structures resembling primitive glomeruli or endodermal sinus –> Schiller-Duvall bodies

400
Q

What are choriocarcinomas like?

Pathology

A

Highly malignant & most aggressive type from the germ cell tumors

401
Q

What are the secretions of choriocarcinomas like? What are the effects?

Pathology

A

Secrete hCG which can lead to gynecomatia and hyperthyroidism

402
Q

Why can choriocarcinomas present with hyperthyroidism?

Pathology

A

Secrete hCG which is of the same structural family as TSH

403
Q

What are the presentations of choriocarcinomaS?

Pathology

A

Small size mass & no testicular enlargment (only presents with a scar, the tumor has already regressed)

404
Q

What is the metastasis of choriocarcinomas like?

Pathology

A

Early metastasis via blood vessels –> lung, liver, GIT, brain, spleen and adrenals

405
Q

What is the gross appearance of choriocarcinomas?

Pathology

A

Commonly presents with hemorrhage and necrosis

406
Q

What is the microscopical appearance of choriocarcinomas like?

Pathology

A

Tumour composed of syncitrophoblasts and cytotrophoblasts but absent villi

407
Q

What are teratomas like?

Pathology

A

Composed of diferent types of cell or organ components, composed of mature cells from endodermal, mesodermal and ectodermal lines

408
Q

What is the population of teratomas?

Pathology

A

Pure form appears in children, second most common type, whilst mixed teratomas appear with other GCTs in adults

409
Q

What are the secretions of teratomas like?

Pathology

A

No elevation in tumor markers, if elevated it indicates coexistence with other germ cell tumors

410
Q

What can the elements of teratomas be like?

Pathology

A

Mature –> resembling various tissues in adults (teeth, hair etc.)
Immature –> sharing histologic features with fetal or embryonal tissues

411
Q

What is the relation between age and the malignancy of teratomas?

Pathology

A

Prepubertal males –> mature teratomas are benign, immature teratomas are malignant
Postpubertal males –> all teratomas are malignant, associated with germ cell neoplasia in situ and chromosomalo abnormalities

412
Q

What is the gross appearance of teratomas?

Pathology

A

Heterogenous, solid and cystic areas
Sometimes bone, cartilage, teeth might be present

413
Q

What is the microscopical appearance of teratomas?

Pathology

A

All three germ layers: ectoderm (skin, CNS in cases of mature teratomas), mesoderm (muscle, bone, CT, blood), and endoderm (internal organs) can be seen

414
Q

Why are ultrasounds used in testicular tumors diagnosis?

Pathology

A

To differentiate it from cysts and mark the size and border of the mass

415
Q

Why is CT/MRI used in testicular tumor diagnosis?

Pathology

A

Evidence of metastasis

416
Q

Why are blood tests used in testicular tumor diagnosis?

Pathology

A

Measure levels of tumor markers

417
Q

What are testicular sex cord stromal tumors like?

Pathology

A

They show differentiation towards Leydig cells, Sertoli cells, and/or other types of sex-cord stromal cells

418
Q

What are other types of sex-cord stromal cells?

Pathology

A

Granulosa cells

419
Q

What are the types of testicular sex-cord stromal tumors?

Pathology

A

Leydig cells
Sertoli cells
Other types of sex-cord stromal cells

420
Q

What is the most common type of sex cord stromal tumor?

Pathology

A

Leydig cell tumor

421
Q

What is the age population of Leydig cell tumors?

Pathology

A

Any age, mostly between 20 to 60

422
Q

What are Leydig cell tumors like?

Pathology

A

Usually benign, 20% are malignant

423
Q

How do Leydig cell tumors present?

Pathology

A

As testicular swelling

424
Q

What are the secretions of Leydig cell tumors like?

Pathology

A

May secrete hormones as androgens –> precocious puberty in children and gynecomastia in adults

425
Q

What is the microscopical appearance of Leydig cell tumors?

Pathology

A

Rod shaped pink cytoplasmic inclusion –> Crystalloids of Reinke

426
Q

What age group is testicular lymphoma the most common type of testicular tumors in?

Pathology

A

Males > 60

427
Q

What are testicular lymphomas like?

Pathology

A
  1. Mostly part of disseminated disease
  2. Sometimes present with only tesTes involvement –> mimics other tumors
428
Q

What is the most common type of testicular lymphoma?

Pathology

A

Diffuse large B-cell type is the most common

429
Q

What is Condyloma Acuminatum?

Pathology

A

Benign warty growth on genital skin

430
Q

What is Condyloma acuminatum secondary to?

Pathology

A

HPV type 6 or 11

431
Q

What is the histology of condyloma acuminatum like?

Pathology

A

Koilocytic changes

432
Q

What are the risk factors of penile squamous cell carcinoma?

Pathology

A
  1. High riske HPV type (16 & 18)
  2. Lack of circumcision & poor hygiene
  3. Smoking
433
Q

What are the precursors of penile squamous cell carcinoma in situ lesions?
What do they present as?

Pathology

A

Bowen disease –> insitu carcinoma. presents as leukoplakia in shaft
Erythroplasia of Queyrat –> insitu carcinoma presents as erythroplakia in glans

Reproductive System (5 decks)

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