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What specifically does the paramesonephric ducts develop into in the female?

o 2 paramesonephric ducts (1 on each side)  Fallopian tubes, ovaries, uterus, cervix, and distal 1/3 of vagina


3. Urogenital sinus?

o Anterior 2/3 of vagina


What are the same structures that will develop in both males and females as far as clitoris vs. head of the penis (same structure that develops into either one of those 2)?

o Genital tubercle


5. What is the SRY gene? What does it stand for? Where is it found?

o Sex-determining region on the Y chromosome
 Testis-determining factor
o In its absence of the SRY gene, female development is established
 Male: XY
 Female: XX


6. Know what happens during the migration of the germ cells

o Doesn't ask time frames (don’t worry about months/weeks)
 Understand processes
o Where does it start? What happens when it gets to that gonadal ridge? What is happening at that gonadal ridge to accommodate the germ cells? (You can’t talk about that without talking about the sex cords)
 Mesenchymal or stem cells (future sperm or eggs) that develop in the wall of the yolk sac near the allantois that migrate along the mesentery of the hindgut (this occurs at ~ 3rd week of embryologic development)
 A pair of longitudinal ridges, anterior to the mesonephros, are the primitive gonads without the germ cells which are formed by the proliferation of epithelium and the underlying mesenchyme
 The primordial germ cells continue migration until the reach the gonadal ridges and penetrate into the primitive gonad by the 6th week
 Before and during the arrival of the primordial germ cells, the overlying epithelium of the genital ridge proliferates and penetrates the underlying mesenchyme forming a number of primitive sex cords. Some of the primordial germ cells are surrounded by cells of the primitive sex cords
 There is no differentiation of sex at this point, and the gonads are called indifferent


7. What is the imperforate hymen?

 Genital outflow tract abnormality (vaginal outflow obstruction)
o What’s the difference in neonate vs. an adolescent?
 Neonate
• At birth, the presence of increased mucus secretions in the vagina secondary to the maternal estrogen effects may result in a mucocolpos (mucous in vagina) appearing as a bulging hymenal membrane between the labia
• The membrane may be white because of the trapped mucoid material and may lead to urinary tract infections or bladder obstruction due to urethral compression
 Adolescent
• Amenorrhea (absence of menses)
• Bluish hymenal membrane in the introitis, due to collected menstrual blood (hematocolpos AKA accumulation of blood in the vagina)
o Most common clinical presentation in an adolescent?
 Amenorrhea (absence of menses)


8. What does DES stand for?

 Diethylstilbesterol
o Why was it used?
 Used in the 1940’s and 1950’s for high-risk pregnancies (used to prevent abortion)
o What does it cause 99% of the time?
 Vaginal Adenosis
• Adenosis= abnormal development or enlargement of glandular tissue
o What is that process that is involved?
 At the 10th week of gestation, the upgrowth of squamous epithelium derived from the urogenital sinus replaces the glandular (mullerian) epithelium lining the vagina and exocervix
 DES exposure anywhere from the 10th to about the 18th week of gestation, arrests this transformation process and glandular tissue remains within the vagina (adenosis)
 Manifests grossly as red, granular patches on the vaginal mucosa which usually disappear as the woman gets older
 Rarely causes clear cell adenocarcinoma of the vagina in the daughters of women treated with DES


9. Know the 3 types of uterine malformations because of a malpositioning of the 2 paramesonephric ducts

o Bicornis (septate) Uterus
 Uterus with a common fused wall between two distinct uterine cavities
 Due to a failure of the common wall between the apposed Mullerian ducts to degenerate, forming a single uterine cavity
o Uterus Didelphys
 Refers to a double uterus with a double vagina
 Again due to failure of the two Mullerian ducts to fuse during embryonic life
o Uterus Septae
 Refers to a single uterus with a partial remaining septum, owing to failure of the wall of the fused mullerian ducts to fully resorb


10. Normal histology of the vulva, vagina, and the cervix?

o Vulva
 Mons Pubis
• Adipose tissue covered by coarse pubic hair
 Labia Majora
• Adipose tissue and sebaceous and sweat glands
 Labia Minora
• Two folds of skin, devoid of hair growth and contains a few sweat glands, but many sebaceous glands
 Clitoris
• Erectile tissue and nerves
o Vagina
 Stratified squamous epithelium and connective tissue that lies in a series of transverse folds called the rugae
o Cervix
 Stratified squamous epithelium


11. 2 layers of the endometrium?

 Stratum Functionalis
 Stratum Basalis
o Which one is the active one?
 Stratum Functionalis
o Inactive (proliferating) one?
 Stratum Basalis


12. Where would you find the tunica albuginea?

o Capsule of collagenous connective tissue immediately deep to the germinal epithelia of the ovaries


13. What is a graffian follicle? (mature follicle in the ovary)

o Made up of a mature ovum and its surrounding tissues that secretes estrogens


14. Know characteristics of vulvar vs. vaginal cancers? What type are they? More likely to get it age wise?

o Vulvar carcinoma
 3% of all GYN cancers
 Cancer of older women, the median age at diagnosis is 60 years
 Tumor can be recognized by gross inspection of the external genitalia and presents as a wart-like or slightly raised mucosal lesion or ulcers
 Invasive cancer is preceded by carcinoma in situ (CIS), and this is called vulvar intraepithelial neoplasia (VIN)
 Preneoplastic lesions may also lead to invasive cancer, such as Leukoplakia
 Clinical symptoms include itching, discomfort, pain, and bleeding, but a significant number of patients are asymptomatic
 Histologically, the tumor almost always presents as a squamous cell carcinoma, usually slow growing
 If the diagnosis is made before it has metastasized to the lymph nodes, the patient has a 70% chance of a 5-year survival following surgical resection
 Patients with tumors that have spread to the lymph nodes have a less favorable prognosis
 Treatment include surgical resection of the tumor or the entire vulva, supplemented with radiation therapy and chemotherapy
o Vaginal carcinoma
 2% of the all GYN cancers
 It is also a disease of older women, histologically a squamous cell carcinoma
 This accounts for over 90% of all primary malignant tumors of the vagina
 Detected only upon GYN examination
 5 yr. survival rate for tumors confined to the vagina (stage I)= 80%
 Extensive spread (stage IV)=20%


15. Risk factors for squamous cell carcinoma of the cervix (4 of them)

o Sexual intercourse at an early age
o Multiple sex partners (prostitutes)
o Evidence of HPV infection
o Other venereal diseases, such as Herpes or Syphilis (all point to environmental causes)


16. Most common cause of death in far advanced squamous cell carcinoma of the cervix?

o Complete urinary tract obstruction causes slowly progressive renal failure, which is still the most common cause of death in these patients


17. Differentiate the location of the Skeens Glands vs the Bartholin’s Glands? (normal histology question)

 Bartholins Glands are located on either side of the vaginal orifice
 Skenes Glands are located behind and on either side of the urethra
o What are the other names for these 2?
 Bartholins Glands= Greater Vestibular Glands
 Skenes Glands= Lesser Vestibular Glands


18. What is Lichen sclerosis? Where is it most commonly found? In what age?

 Abnormal growth of the vulvar skin characterized by white plaques, atrophy of the skin, and a parchment-like consistency to the skin with contracture of the vulvar tissue
 Usually seen in middle aged to older women
 Slowly developing but progressive lesions that have no malignant potential


19. Know the general histology of the breast. How many lobes are there? What are the lobes made of? What are the suspensory ligaments of cooper?

o Branched tubule-alveolar glands that lie over the pectoral major muscles
o Each breast consists of 15-20 lobes, or compartments, separated by adipose tissue
o In each lobe are several lobules, composed of connective tissue, in which milk-secreting cells referred to as Alveoli are embedded
o Between the lobules are stands of connective tissue called the suspensory ligaments of cooper


20. What are the 3 layers of uterus? What is their histology?

 Perimetrium (serosa)
• Outer layer composed of a layer of mesothelial cells
• Laterally, the serosa becomes the broad ligament
• Anteriorly, it is reflected over the bladder
 Myometrium
• Middle layer that forms the bulk of the uterine wall
• It consists of smooth muscle fibers, thickest in the fundus and thinnest in the cervix
 Endometrium
• Innermost layer of the uterus
o Consists of 2 layers:
 Stratum Functionalis
• Layer closest to the uterine cavity and the layer shed during menstruation
 Stratum Basalis
• Deep narrow layer whose glands and connective tissue elements proliferate and thereby regenerate the functionalis during each menstruation cycle


21. What is known as the transformation zone? Where would you find the transformation zone?

o Transformation zone= an area of changing cells
o The cervix contains two kinds of cells: rectangular columnar cells and flat, scale-like squamous cells
o Columnar cells are constantly changing into squamous cells in an area of the cervix called the transformation (transitional) zone
 Squamocolumnar junction of the cervix