Week 4 Part 2
Week 4 Part 2
Venous
Left ovary/testis, left gonadal vein, left renal
vein, IVC
Lymphatic
Ovaries/testes, para-aortic lymph nodes
Acrosome
Golgi apparatus
Neck
Contains mitochondria Utilizes fructose
Tail (flagellum)
Centrioles
Erection
Parasympathetic, pelvic nerve
Nitrous oxide, smooth muscle relaxation,
vasodilation, erection
Emission
Sympathetic, hypogastric nerve
Ejaculation
Visceral, somatic, pudendal nerve
spermatocytes
Sertoli cells
Secrete inhibin, inhibits FSH Secrete androgen-binding protein Maintains local testosterone levels Forms blood-testis barrier Isolates gametes from autoimmune attack Regulate spermatogenesis
Sertoli cells
Secrete testosterone
GnRH
From hypothalamus,
LH
Stimulates Leydig
FSH
Stimulates Sertoli
Androgens, 458
Testosterone, DHT (testis) Andostenedione (adrenal gland) Testosterone function
seminal vesicles Increase muscle, growth spurt, size of penis, libido, spermatogensis Close epiphyseal plates (via estrogen) Deepen voice
Androgens, 458
DHT function
Differentiate penis, scrotum, prostate
Balding Increased sebaceous gland actitivity
Prostate growth
Androgens, 458
Potency
DHT>testosterone>androstenedione
5 reductase
Converts testosterone to DHT, inhibited by
finasteride
Aromatase
Converts testosterone/androstenedione to
Estrogens, 458
Growth of follicle Endometrial proliferation Development of genitalia, breasts Female fat distribution Hepatic synthesis of transport proteins Feedback inhibition of FSH/LH LH surge Myometrial excitability Increase HDL, decrease LDL
Progesterone, 458
spiral artery development Maintenance of pregnancy Decrease myometrial excitability Production of thick cervical mucous, inhibits sperm entry to uterus Increase body temperature Inhibit FSH/LH Uterine smooth muscle relaxation, prevent contractions
Oogenesis, 460
Pregnancy, 460
Fertilization most commonly occurs in upper fallopian tube, within 1 day of ovulation Implantation in wall of uterus 6 days after fertlization Trophoblasts secrete HCG, detectable in urine 1 week after conception
Pregnancy, 460
Lactation
After labor, decrease in steroids induces
Prolactin
Induces, maintains lactation, inhibits ovulation
Oxytocin
Involved in milk letdown and uterine
contractions
hCG, 461
Menopause, 461
Age related decline in ovarian follicles Decreased estrogen production
Symptoms include hot flashes, vaginal atrophy, osteoporosis, coronary artery disease Average age is 51
XXY (male)
Presence of inactivated X chromosome (Barr
body)
Testicular atrophy, eunuchoid body shape, tall, long extremities, female hair distribution Common cause of hypogonadism Dysgenesis of seminiferous tubules
increased estrogen
XO (female)
Short stature, ovarian dysgenesis (streak
ovary), webbing of neck, preductal coarctation of aorta, Most common cause of primary amenorrhea Decreased estrogen
Increased LH and FSH
Double Y males
XYY (male)
Phenotypically normal, normal fertility Tall, acne, antisocial behavior
True hermaphroditism
46,XX or 47,XXY Both ovary and testicular tissue present
Ambiguous genitalia
Pseudohermaphroditism, 462
Disagreement between phenotypic and gonadal sex Female (XX)
Ovaries present
steroids during gestation Caused by congenital adrenal hyperplasia or exogenous administration of androgens
Pseudohermaphroditism, 462
Male (XY)
Testes present, external genitalia feminized or
Extrauterine implantation of pregnancy, most often in fallopian tube Presents as abdominal pain without bleeding Increased risk with salpingitis Suspect with increased hCG and sudden lower abdominal pain, confirm with ultrasound Differentiate from appendicitis
Polyhydramnios
>1.5-2 L amniotic fluid Associated with esophageal/duodenal
Oligohydramnios
<0.5 L amniotic fluid Associated with bilateral renal agenesis and
junction, extends outward CIN 1-3 depending on dysplasia Associated with HPV 16,18 May progress to invasive carcinoma
Cervical Pathology
Invasive carcinoma
Often squamous cell carcinoma
Pap smear used for early detection of
dysplasia (koilocytes) Lateral invasion can block ureters, lead to renal failure
Endometriosis, 464
Non-neoplastic glands/stroma in abnormal locations outside uterus Cyclic menstrual bleeding from ectopic tissue Results in blood filled chocolate cysts Presents as severe menstrual related pain May cause infertility Adenomyosis
Endometrium within myometrium
Endometrial hyperplasia
Endometrial gland proliferation caused by
increased estrogen stimulation Increased risk of endometrial carcinoma Presents as post-menopausal bleeding Risk factors include anovulatory cycles, HRT, PCOS, granulosa cell tumor
Endometrial carcinoma
Most common gyn malignancy Most common in 55-65 years Presents as vaginal bleeding Preceded by endometrial hyperplasia Risk factors are unnopposed estrogen therapy, obesity, diabetes, HTN, nulliparity, late menopause Deeper myometrial invasion worsens prognonsis
Leiomyoma
Most common female tumor
Benign, smooth muscle tumor, with rare
malignant transformation Multiple tumors with well demarcated borders Most common in 20-40s, blacks Estrogen sensitive
Increase in size with pregnancy, decrease
with menopause
Leiomyoma
May be asymptomatic or cause abnormal
uterine bleeding
May cause iron deficient anemia
Leiomyosarcoma
Bulky, irregular shaped tumor
Areas of necrosis, hemorrhage Highly aggressive, likely to recur
Increased LH/FSH ratio leads to anovulation Hyperandrogenism Enlarged, bilateral cystic ovaries Presents with amenorrhea, infertility, obesity, hirsutism Associated with insulin resistance, increased risk of endometrial cancer Treat with weight loss, OCPs, gonadotropin analogs, clomiphene, surgery
Follicular cyst
Distentension of unruptured graafian follicle
Associated with hyperestrinism, endometrial
hyperplasia
Theca-lutein cyst
Bilateral/multiple, due to gonadotropin
Chocolate cyst
Blood containing cyst from
Dysgerminoma
Malignant, equivalent to male seminoma Sheets of uniform cells hCG tumor marker
Choriocarcinoma
Rare, malignant Can develop in pregnancy (mother or fetus) Large hyperchromatic synctiotrophoblastic cells Increased frequency of theca-lutein cysts hCG tumor marker
Teratoma
Contains 2-3 germ layers Mature teratoma (dermoid cyst) Most common benign tumor Immature teratoma Aggressively malignant Struma ovarii Contains functional thyroid tissue
Brenner tumor
Benign, looks like bladder
Fibromas
Bundles of spindle-shaped fibroblasts Meigs syndrome Ovarian fibroma, ascites, hydrothorax Pulling sensation in groin
Krukenberg tumor
GI malignancy that metastasizes to ovary
Mucin-secreting signet cell adenocarcinoma
Serous cystadenoma
Benign, bilateral, lined with fallopian tube
Serous cystadenocarcinoma
Malignant, bilateral
Mucinous cystadenocarcinoma
Malignant Pseudomyxoma peritonei Accumulation of mucinous material from ovarian or appendiceal tumor
Sarcoma botyroides
Girls <4 years Spindle shaped tumors Desmin positive
Fibroadenoma
Small, mobile, firm mass with sharp edges
Most common in <25 years Increase in size and tenderness with
Intraductal papilloma
Small, grows in lactiferous ducts
Typically beneath areola Serous/bloody discharge
Phyllodes Tumor
Large, bulky mass of connective tissue and
cysts Leaf-like projections Most common in 6th decade May become malignant
membrane penetration
Invasive ductal
Firm, fibrous mass
Small, glandular, duct-like cells Most invasive and common
Invasive lobular
Orderly rows of cells Multiple, bilateral
Medullary
Fleshy, cellular,
Comedocarcinoma
Ductal, caseous necrosis
Inflammatory
Dermal lymphatic invasion
Fibrocystic disease
Most common breast lumps from age 25-
menopause Premenstrual breast pain, multiple bilateral lesions, fluctuating size Does not indicate increased risk of carcinoma
Fibrocystic disease
Fibrosis Hyperplasia of breast stroma Cystic Fluid filled, blue dome Sclerosing adenosis Increased acini and intralobular fibrosis Epithelial hyperplasia Increased epithelial cell layers in terminal duct lobule Increased risk of carcinoma with atypical cells
Acute Mastitis
Breast abscess
Associated with breast feeding Bacterial infection through cracks in nipples
Fat Necrosis
Benign painless breast lump
Secondary to injury to breast tissue
Gynecomastia
Results from hyperestrogenism Cirrhosis, testicular tumor, puberty, old age
Klinefelters syndrome
Drugs Estrogen, marijuana, heroin, psychoactive drugs, spironolactone, digitalis, cimetidine, alcohol, ketoconazole
Common in men >50 Related to age-related increase in estradiol, sensitization of prostate to DHT Nodular enlargement of periurethral (lateral and middle) lobes, compresses urethra into vertical slit Presents with frequency, nocturia, hesitancy, dysuria May lead to distention/hypertrophy of bladder, hydronephrosis, UTIs Increased PSA, not premalignant
Prostatitis, 469
Symptoms
Dysuria, frequency, urgency, low back pain
Etiology
Acute: bacterial Chronic: abacterial (most common),
bacterial
PSA
Osteoblastic metastasis
Low back pain
Increased serum
alkaline phosphatase
Cryptorchidism, 469
Undescended testis Decreased spermatogenesis secondary to increased body temperature Increased risk of germ cell tumors Prematurity increases occurrence
Malignant, most common testicular tumor Painless testicular enlargement Males 15-35 Radiosensitive, late metastasis Excellent prognosis
Seminoma
Large cells in lobules with watery cytoplasm,
Embryonal carcinoma
Malignant
Painful testicular enlargement Worse prognosis
Glandular/papillary morphology
Can differentiate to
other tumors
Choriocarcinoma
Malignant
Increased hCG
Teratoma
Usually malignant
Testicular lymphoma
Most common testicular
Varicocele
Dilated vein in pampiniform
Hydrocele
Increased fluid secondary to incomplete
Spermatocele
Dilated epididymal duct
Carcinoma in situ
Bowens disease Gray, solitary, crusty plaque Usually on shaft of penis or scrotum Peak incidence in 5th decade Progresses to sqamous cell carcinoma in <10% of cases
Carcinoma in situ
Erythroplasia of Queyrat Red, velvety plaques Usually involves glans Similar to Bowens disease
Carcinoma in situ
Bowenoid papulosis Multiple papular lesions Affects younger age group Usually not invasive
Peyronies disease
Bent penis
Aquired fibrous tissue formation
Anti-androgens, 471
Finasteride
5 reductase inhibitor
Decreases conversion of testosterone to
Flutamide
Non-steroidal competitive inhibitor of
Anti-androgens, 471
Ketoconazole
Inhibits steroid synthesis
Spironolactone
Inhibits steroid binding
Both used in treatment of PCOS and hirsutism May cause gynecomastia, amenorrhea
Leuprolide, 471
Pulsatile administration
GnRH analog with agonist properties
Continuous administration
GnRH analog with antagonist properties
Used in
Infertility (pulsatile), prostate cancer
Pros:
Reliable Decrease risk of endometrial/ovarian cancer,
Cons:
Increased triglycerides, weight gain, nausea,
Used in:
Treatment of menopausal symptoms Hot flashes, vaginal atrophy Prevention of osteoporosis
hysterectomy
Dinoprostone
PGE2 analog
Causes cervical dilation, uterine contraction Induces labor
Ritodrine/terbutaline
B2 agonists Relax uterus
Anastrozole/exemestane, 472
Aromatase inhibitors
Aromatase converts androgens to estrogens
Testosterone, 472
Agonist at androgen receptors Used in:
sexual characteristics Stimulation of anabolism (burn, injury) Treatment of ER-positive breast cancer
Estrogens, 472
Bind estrogen receptors Used in:
Treatment of hypogonadism/ovarian failure Treatment of menstrual abnormalities Hormone replacement therapy in post-
Progestins, 472
Bind progesterone receptors Reduce growth and increase vascularization of endometrium Used in:
Clomiphene
Partial agonist at estrogen receptors in
pituitary Prevents estrogen feedback inhibition of LH/FSH release from pituitary Increased LH/FHS stimulates ovulation Used in treatment of PCOS and infertility May cause hot flashes, ovarian enlargement, multiple simultaneous pregnancies, visual disturbances
Tamoxifen
Estrogen antagonist in breast tissue
Used to treat and prevent recurrence of ER-
Raloxifene
Estrogen agonist in bone Used to treat osteoporosis