DIT review - Reproduction 1 Flashcards
Describe the difference between a direct and indirect hernia
- Indirect inguinal hernia
- Goes through the internal (deep) inguinal ring, external (superficial) inguinal ring, and into the scrotum
- Enters internal inguinal ring lateral to inferior epigastric vessels
- Direct inguinal hernia
- Protrudes through the inguinal triangle
- Goes through the external (superficial) inguinal ring only
- Covered by external spermatic fascia
- Bulges directly through parietal peritoneum, medial to the inferior epigastric vessels but lateral to the rectus abdominis
During genital embryology, what is produces by Leydig cells and what is produced by Sertoli cells?
Leydig = testosterone
Sertoli = AMH
Describe the sequence of events caused by the SRY gene during genital embryologic development
- SRY gene on chr Y produces testes determining factor (TDF)
- TDF stimulates the development of testes
- Tested produce Sertoli cells and Leydig cells
- Sertoli cells produce Anti-Mullerian hormone
- AMH causes degeneration of paramesonephric ducts
- Leydig cells produce Testosterone
- Testosterone causes Wolffian duct to develop into male internal genitalia (except the prostate)
- Testosterone is also converted to DHT via 5 a-reductase in order to cause the development of male external structures + prostate
- Sertoli cells produce Anti-Mullerian hormone
What cell is responsible for maintaining high levels of testosterone in the testes?
Sertoli cells
o Androgen-binding protein (ABP) within the seminiferous tubules binds testosterone and DHT to make them less lipophilic and reduce diffusion out of the luminal fluid
o ABP is synthesized by Sertoli cells in response to FSH
o Sertoli cell dysfunction may manifest as normal serum testosterone (hypothalamus, pituitary, and Leydig cells are fine) with low concentration of testosterone in the seminiferous tubules due to inadequate ABP production
What is the presentation, histology, and prognosis of seminoma?
- Most common type of testicular cancer
- Malignant
- Painless, homogenous testicular enlargement
- “Fried egg” appearance under histology
- Radiosensitive – excellent prognosis
What is the histology, lab values, and most commonly affected population of yolk sac tumor of the testes?
- Yellow, mucinous
- Schiller duval bodies (resemble glomeruli)
- Increased AFP
- Most common testicular tumor in boys < 3 y/o
What are the relevant lab values of choriocarcinoma of the testes?
- Malignant
- Increased hCG
- Disordered syncytiotrophoblasts and cytotrophoblasts
- Hematogenous metastasis
What is the difference between teratoma in males and females
Malignant in males but not females
What is the presentation and lab values of embryonal carcinoma of the testes?
- Malignant tumor comprised of immature, primitive cells that may produce glands
- Painful, hemorrhagic mass with necrosis
- Increased hCG and normal AFP
What are the 3 non-germ cell tumors of the testes?
Leydig cell, Sertoli, and testicular lymphoma
Presentation and histology of Leydig cell tumor
- Golden brown color
- Contains Reinke crystals (eosinophilic cytoplasmic inclusions)
- Produce androgens:
- Gynecomastia in men
- Precocious puberty in boys
Population most affected by testicular lymphoma
- Most common testicular cancer in older men > 60 y/o
- Not a primary cancer – arises from metastatic lymphoma
What is Peyronie disease?
- Abnormal curvature of the penis due to fibrous plaque within the tunica albuginea
- Associated with erectile dysfunction
- May cause pain or anxiety
- Can consider surgical repair
What are precursor lesions/increased risk of squamous cell carcinoma of the penis?
- Bowen disease - presents as leukoplakia in the shaft
- Erythroplasia of Queyrat - presents as erythroplakia of the glans
- Bowenoid papulosis - presents as reddish papules
- HPV
- Lack of circumcision
Is BPH due to hypertrophy or hyperplasia
Hyperplasia
