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Flashcards in Exam 1 Deck (27):
1

What are the gonad homologs?

testes and ovaries

2

What is the genital tubercle homolog?

penis and clitoris

3

What is the urethral swellings homolog?

scrotum and labia majora

4

What is the urethral folds homologs?

spongy urethra and labia minora

5

What is the SRY gene?

Sex determining region of the Y chromosome

6

What does the SRY gene do?

Provides instructions for making a transcript factor called the sex-determining region Y protein

7

What gene is responsible for the initiation of male sex determination in humans?

SRY gene

8

What does the presence of the SRY gene mean? Absense?

The fetus will be male. If absent then female

9

What is the other name for paramesonephric duct and its male homolog?

Paramesonephric duct in female, also called Mullerian ducts.
In male it is Mesonephric ducts, also called Wolffian ducts.

10

What do the paramesonephric ducts and mesonephric ducts differentiate into?

Know all the components that are possible.
- Paramesonephric ducts in female
o Cranially
 Opens up, funnel like structure
 Will become fallopian tube fimbria/open ended fallopian tubes
o Caudally
 Runs lateral to the mesonephric duct
 Contacts the early urogenital sinus
 Separated by a septum
 Fuses together to form
 Uterine canal
 Uterus, cervix, distal 1/3 of the vagina

- Mesonephric duct in male
o Epididymis
o Vas deferens
o Seminal vesicles
o Ejaculatory duct
o Connects to the primitive kidney

11

Describe the migration of the primitive germ cells where do they begin, migrate, where do they insert (penetrate)

- Primordial germ cells develop in the wall of the yolk sac near allantois
- Migrate along the mesentery of the GI tract, called the hindgut
- Primordial germ cells continue migration until they reach the gonadal ridges and penetrate into the primitive gonad
- The genital ridge proliferates and penetrates underlying mesenchyme forming a number of primitive sex cords, inserted itself down past the epithelium
- These germ cells/stem cells are now the immature eggs or sperm and they are surrounded by the sex cord cells
- The sex cord cells will be the follicle cells
o YOLK SAC
o HINDGUT
o GONADAL RIDGE
o GENITAL RIDGE
o PENETRATE INTO PRMITIVE GONAD
o PRIMITIVE SEX CORD
o FOLLICLE

12

What structures develop from first the production the urogenital sinus then the canalization of the urogenital sinus that has to do with some internal external reproductive structures?

- Contact of the urogenital sinus by the paramesonephric ducts…
o induces formation of the sinovaginal bulbs, a collection of endoderm from the wall of the urogenital sinus
- Sinovaginal bulbs proliferation of a solid column of endodermal tissue
- Canalization of the solid column to form the lower portion of the vagina
- Hymen formation occurs during canalization
- Formation of inferior 2/3 of vagina complete
- --
- The paramesonephric ducts fuse and join the urogenital sinus at the sinus tubercle

13

What is DES, what does it cause, both benign and the most malignant component of it?

- DES medication given in the 40’s and 50’s that was prescribed to women to help them keep their at risk pregnancies from aborting, termed the morning after pill, does the opposite of abortion
o Glandular epithelium does not convert to squamous epithelium (does not undergo squamous metaplasia) IN DES DAUGHTERS***
o DES exposure in the 10th-18th week of gestation when the replacement of glandular epithelium to squamous epithelium arrests the transformation process
o Instead of squamous epithelium, you continue to have glandular tissue within the vagina (adenosis)
o Looks like red, granular patches on vaginal mucosa
- Malignancy: CLEAR CELL ADENOCARCINOMA of the vagina
o Rare tumor of the vagina encountered exclusively in women exposed to DES (1/1000)
o Develops on the anterior wall of the upper third of the vagina
o Abundant glycogen account for the clear nature of the cytoplasm
- 1970’s the DAUGHTERS of women who took DES had this condition

14

What are the manifestations of imperforated hymen in newborns. vs adolescent female, complications that occur when the blood is obstructed

- Imperforate hymen in the neonate
o The presence of increased mucus secretions in the vagina secondary to maternal estrogen effects may result in Mucocolpos, appearing as a bulging hymenal membrane between the labia
o The membrane may be white because of the trapped mucoid material and may lead to
 Urinary tract infections
 Bladder obstructions
o Due to urethral compression
- Imperforate Hymen in the adolescent
o Primary amenorrhea (no period/menstrual cycle)
o Presence or absence of secondary sexual characteristics should be noted
o Lower abdominal or pelvic pain
o Urinary retention/constipation
o Diagnosis is made when a distended bluish hymenal membrane is observed in the vaginal orifice/opening due to collected menstrual blood (hematocolpos)
- Consequences
o Trapped menstrual secretions/blood backs up into the uterus = hematometrocolpos
o Reflux of endometrial tissue and blood through the fallopian tubes = hematosalpinx, secondary endometriosis
 Endometriosis: tissue that normally lines the inside of your uterus, grows outside of the uterus
 Displaced endometrial tissue continues to act as it normally would, thickens, breaks down and bleeds with each menstrual cycle
 Because this displaced tissue has no way to exit your body, it becomes trapped
o An accumulation of infected material within the vaginal cavity may cause ascending genital tract infections

15

Histologically, what is vaginal adenosis and why do we get it due to DES

- Vaginal adenosis
o No metaplasia of glandular epithelium conversion to squamous epithelium in the lining of the vagina and exocervix
- DES is an endocrine disruptor, it was mistakenly given to women thinking it would prevent miscarriages
- In the 10th-18th week of gestation, it had the potential to cross the placenta and disrupt the conversion of glandular epithelium to squamous epithelium

16

What part of the histology of the female genital tract, to find FIMBRIA, vestibule, Bartholin’s glands, vaginal rugae, corpus luteum, tunica albuginea

vaginal rugae, corpus luteum, tunica albuginea
Vagina: stratified squamous epithelium (no glands) || Cervix: lower end of uterus; stratified squamous epithelium, cervical os: squamous epithelium changes to tall columnar mucinous epithelium (squamocolumnar junction = transformation zone || endometrium: columnar cells, glands, stroma || fallopian tube: columnar epithelium, glands, secretory function
- Fimbria: fringe tissue around the ostium of the fallopian tube (opening)
- Vestibule: the region between the labia minora where the vagina, the urethra, and bartholin’s glands open
- Tunica albuginea: connecting tissue fibers covering the ovaries
- Corpus luteum: temporary endocrine structure in female mammals involved in the production of relatively high levels of progesterone
Penelope Ruoff, Reproduction Review PG 5
o Develops from primary follicle, secondary follicle, after rupture of the mature oocyte, the follicle is turned into a corpus luteum
- Bartholin’s gland: 2 pea sized compound alveolar/acinar gland located slightly posterior and to the left and right of the opening of the vagina. They secrete the mucus to lubricate the vagina to provide vaginal lubrication during female sexual arousal
Vaginal Rugae: inside the vagina there are lots of folds/bumpy tissue called rugae, allows for expansion

17

What do the primitive sex cords develop into in the female reproductive tract?

- Primitive sex cords differentiate into follicles, the cells that surround the primitive germ cells that become the eggs/sperm cells
- Follicles are estrogen producing cells

18

What type of cancers will be vulvar, vaginal and cervical? Compare their incidence/frequency/mortality

- Vulvar Carcinoma: 3% of all GYN cancers
o Cancer of older women
o Wart like or slightly raised mucosal lesion/ulcers
o In Situ or Invasive Cancer
o Almost always squamous cell carcinoma
o Vulvar Intraepithelial Neoplasia (VIN)
o Preneoplastic lesions Leukoplakia (white plaque)
o 70% chance survivability, 5 years
Penelope Ruoff, Reproduction Review PG 6
- Vaginal Carcinoma: 2% of all GYN cancers
o Cancer of older women
o >90% are squamous cell carcinomas
o 80% chance survivability, 5 years stage I
o 20% survivability, stage IV
- Carcinoma of the Cervix: 20% of all malignant tumors in the female reproductive tract
o Accounts for more deaths > uterus, vagina, vulva cancers combined
o N:C ratio INCREASE

19

Which features associated with cervical cancer?

- Lack of normal maturation of squamous epithelium  dysplasia, graded as mild, moderate or severe
- Cervical intraepithelial neoplasia CIN
- These transformed cells do not respond to normal regulatory stimuli in the tissue, they do not mature as the normal cervical cells do but remain undifferentiated and proliferate uncontrollably.

20

Risk factors for cervical cancer (etiology)

- Cause is unknown however…risk factors:
o 1. Sexual intercourse at an early age
o 2. Multiple sex partners
o 3. Evidence of HPV infection
o 4. Other venereal diseases (STD’s) such as Herpes or Syphilis
o 5. Smoking/HIV

21

What are the dysplasia’s and how are they graded up until the invasive cancer of the cervix?

- Cervical Dysplasia is a precancerous condition in which abnormal cell growth occurs on the surface lining of the cervix, the opening between the uterus and the vagina.
- Cervical Intraepithelial Neoplasia (CIN)
- Strongly associated with HPV infection
- Usually discovered by routine PAP test (3-6months)
- In many women with cervical dysplasia, HPV is found in cervical cells

22

What is the most common cause of death in advance cervical cancer?

- Carcinoma cells crossing the basement membrane, no longer IN SITU, becomes INVASIVE
- Spreads to lymphmatics/blood streams and metastasize to distant sites

23

Compare a Bartholin gland cyst vs. Lichen Sclerosis

Bartholin Gland Cyst

- These paired glands produce a clear mucoid secretion, which continuously lubricates the vestibular surface
- The ducts are prone to obstruction and consequent CYST formation
- Infection of the cyst lads to abscess formation (PUS)
- Frequently caused by microorganisms/bugs: Staph, Chlamydia, and anaerobes.
- Treatment: Incision/Drainage + antibiotics

Lichen Sclerosis
- Abnormal growth of the vulvar skin, characterized by WHITE plaques, atrophy of the skin, parchment like consistency (VERY THIN SKIN IN OLDER WOMEN)
- 99% of the time benign, not caused by any bacteria/microorganisms, skin is just thin
- Slowly developing but progressive lesions that have no malignant potential
- Extreme rare cases, vulvar cancer can look like Lichen Sclerosis of the Vulva where the white plaques are confined to the vulva

24

What’s the pathophysiology of the different uterine malformation

Bicornis (Septate) Uterus
- Only the UPPER part of the mullerian ducts fail to fuse, not the whole
- Double uterus, single vagina
- Heart shaped
- Caudal part of the uterus (lower part) is NORMAL
- Uterus composed of 2 horns, separated by a septum
- Fusion process of the upper part of the paramesonephric ducts is altered
- DOUBLE UTERUS; 1 VAGINA
----Uterus Didelphys
- Both mullerian ducts (full length) fail to fuse during development
- Refers to a double uterus with a double vagina
- Failure to fuse of the mullerian ducts
- Double uterus with 2 separate cervices, double vagina
- DOUBLE UTERUS; DOUBLE VAGINA

------Uterus Septae
- The two mullerian ducts have fused, but the partition between them is STILL PRESENT, splitting the system into 2 parts
- Refers to a single uterus with a partial remaining septum
- Failure of the wall of the fused mullerian ducts to fully resorb
- 1 UTERUS; 1 VAGINA, but there is still a SEPTUM/WALL/TISSUE in between

25

Know the general histology of the breast…(alveoli, acini, ducts, lobe, lobules, suspensory ligaments of cooper)

- Branched tubule-alveolar glands that lie over the pectoral major muscles
- Made up of 15-20 lobules of glandular tissue embedded in fat/adipose tissue
- Each lobe has several lobules
- Each lobule is composed of
o Connective tissue
o Alveoli, secrete milk because they are lined with milk secreting cuboidal cells, surrounded by myoepithelial cells
o Alveoli are also called acini
- In between the lobules are connective tissue
o Named the Suspensory ligaments of cooper
o Help maintain structural integrity
o Lobules are separated by these suspensory ligaments of cooper.
- Each lobule has a duct = lactiferous duct
o Drains milk into openings in the nipple

26

Where are the locations of leimyomas, what are they? (for next exam)
- Benign tumors originating from the smooth muscle cells of the MYOMETRIUM
- Myometrium is the middle layer of the uterine wall, consisting mainly of uterine smooth muscle cells and vascular tissue

(for next exam)
- Benign tumors originating from the smooth muscle cells of the MYOMETRIUM
- Myometrium is the middle layer of the uterine wall, consisting mainly of uterine smooth muscle cells and vascular tissue

27

What are some of the differences in staging of cervical cancer, picture and list to illustrate this:

- Stage 0: no gross lesions. The carcinoma is limited to the mucosa (Carcinoma In Situ or CIS)
- Stage 1:Invasive, but confined to the cervix
- Stage 2: Cancer extends beyond the cervix, not reaching the pelvic wall or upper vagina
- Stage 3: Cancer reaches the pelvic wall and invades the lower third of the vagina
- Stage 4: cancer has spread beyond the pelvis and has infiltrated adjacent organs