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Flashcards in Exam 1 Review Deck (37):
1

What are the Homolog Structures for both Male and Female Gonads?

Male = Testes
Female= Ovaries

2

What are the Homolog Structures for both Male and Female Genital tubercle?

Male = Penis
Female= Clitoris

3

What are the Homolog Structures for both Male and Female Urethral swellings?

Male= Scrotum
Female= Labia majora

4

What are the Homolog Structures for both Male and Female Urethral folds?

Male= Spongy urethra
Female= Labia minora

5

What are the Homolog Structures for both Male and Female Urogenital sinus ?

Male= Prostate, Cowper’s glands, Bladder, Urethra
Female= Skeens glands, Bartholin’s glands, Bladder, Urethra, L vagina

6

What are the Homolog Structures for both Male and Female Wolffian Duct ?

Male= Rete testis, Epididymis, Vas Deferens, Seminal vesicles
Female= Rete ovarii

7

What are the Homolog Structure for both Male and Female Mullerian Duct ?

Male= Appendix testis
Female= Fallopian tubes, Uterus, Upper vagina

8

-What is the SRY gene?
-What does it mean in the absence of the gene?

-The key to sexual dimorphism is found on the short arm of the Y chromosome, called the Sex-determining region on Y, which is testis-determing factor.
-Initiates male development and formation of male testes.
-Testes secrete MIS to degenerate female ducts

-In it’s absence, female development is established.

9

In the indifferent stage, What are the 2 pairs of male and females genital ducts?

1) Mesonephric (Wolffian ) Ducts
2) Paramesonephric (mullerian) Ducts

10

What do the paramesonephric (mullerian) Ducts differentiate into in Males?
(Mesophretic Duct)

In Males, The "paramesonephric duct degenerates"
Mesophretic Duct-
Distal: becomes the SEMINAL VESICLES, EJACULATORY DICT & the VAS DEFERENS.

Proximal: portion drains the testes (rete testis, efferents, and epididymis)

11

What do the paramesonephric (mullerian) Ducts differentiate into in Females?

Female: The Mesonephric Duct degenerates

-CRANIALLY the Paramesonephric Duct opens into the abdominal cavity with a funnel-like structure, which will become the fallopian tube fimbria.

-CAUDALLY, contacts the early urogenital sinus and later (about 2 months) fuses with duct on opposite side and forms the Uterine Canal ( Uterus, Cervix and Vagina- upper 1/3)

--The upper vagina, cervix, uterus, fallopian tubes and ovaries form from the Mullerian (paramesonephric) Duct

12

1) Describe the migration of the primitive germ cell?
-Where do they begin?
-Where do they insert?

1) Mesenchymal or stem cells that develop in the WALL of the YOLK SAC near the allantois migrates along the mesentery of the hindgut (3 wk).

2) The primordial germ cells continue migration until they reach the gonadal RIDGES and penetrate in the PRIMITIVE GONAD (6 wk).

3) Land on the proliferating epithelium. Gonads still indiff. yet.

4) Before/during arrival of premoriddal germ cells overyling mesecnchyme forming a # primitive sex cords
-Some primordial germ cells are surrounded by these

13

What structures develop from the production of the Urogenital Sinus then the canalization that has to do with some external and internal female reproductive structures?

Lower 2/3 of the vagina develop from POSERIOR wall the urogenital sinus.
-ANTERIOR wall of urogenital sinus forms BLADDER and URETHRA.
--The HYMEN originates from the embryonic vagina BUDS from the Urogenital Sinus. It becomes perforated forming a central canal w/ communication between the upper vaginal tract & the vestibule of the vagina

-FIRST the contact of the urogenital sinus by the Paramesonephric Ducts induces formation of the Sinovaginal bulbs, a collection of endoderm from the wall of the urogenital sinus (21-22 slide)

14

-What is DES?
-What does it cause?
-Why was it given?

- DES-Diethylstilbesterol (morning after pill). A synthethic estrogen was using in the 1940-50's for high-risk pregnancies (prevents abortion)

-It causes: 1) Vaginal Adenosis (benign) 2) Clear Cell Carcinoma (malignant)

-Rare cases of clear cell adenocarcinoma of the vagina have also occurred in the daughters of women treated with DES

15

Regarding DES, What are the manifestations of a imperforate hymen in newborn versus adolescent?

Imperforate hymen in neonate = Mucocolpos

-At birth, the presence of increased mucus secretions in the vagina secondary to maternal estrogen effects may result in a Mucocolpos appears as bulging hymenal membrane between the labia. White membrane because of the trapped mucoid material & may lead to urinary tract infections or bladder obstruction due to urethral compression.

-Imperforate hymen in adolescent = hematocolpos
-presents with primary amenorrhea (most common) so the presence or absence of secondary sexual characteristics should be noted

SYMPTOMS: lower abdominal or pelvic pain that may be cyclic, back pain, urinary retention and constipation

Diagnosis: Examination of a distended, bluish hymenal membrane in the introitis, due to collected menstrual blood (hematocolpos).

16

-How does DES cause Vaginal Adenosis?


**Histologically what is vaginal adenosis? (how does it manifest?)

-Occurs in daughters exposed in Utero to DES
-Refers to failure of the normal glandular epithelium that lines the embryonic vagina to be replaced by squamous epithelium during fetal development.
(The glandular cells undergo squamous metaplasia)


-In the 1970’s, there was a substantial increase in the incidence of this disease.
-At the 10th week of gestation squamous epithelium derived from the urogenital sinus replaces the glandular (mullerian) epithelium lining the vagina & exocervix.

-DES exposure anywhere from the 10th to 18th week of gestation, arrests this transformation process & glandular tissue remains within the vagina (adenosis)

-Manifests grossly as red, granular patches on the vaginal mucosa, disappear as the woman gets older.

**Microscopically, there is mucinous columnar cells, similar to the endocervix, along with ciliated cells w/ eosinophilic cytoplasm, similar to the lining cells of fallopian tube and endometrium.



17

How does DES cause Clear Cell Adenocarcinoma ?
What is the both benign and malignant component of it?

Clear Cell Adenocarcinoma

-A rare tumor of the vagina encountered exclusively in women exposed to Diethly-stilbesterol (DES).
-Develops most frequently on the anterior wall of the upper third of the vagina.
-Most common between ages 17 & 22
-Abundant glycogen account for the clear nature of the cytoplasm and they are essentially curable when small & asymptomatic
-Although almost all cases of clear cell adenocarcinoma are associated with vaginal adenosis, very few women with adenosis develop this cancer.
-In more advanced stages, they may spread by hematogenous or lymphatic routes.


18

What part of the histology of the female genital tract would you expect to find fimbrae, vestibule, and barthiarn glands, rugue, corpus luetum, and tunica albuginea?

Surrounded by a fringe of finger-like projections = FIMBRAE (fallopian tube)

-The cleft between the LABIA MINORA is the VESTIBULE and contains hymen, vaginal orifice, urthera, and the opening of several ducts. (The Vulva)

-BARTHOLINS = These produce mucoid secretion that supplements lubrication during sexual intercourse. (The Vulva)

RUGAE= Allow good distention. Muscularis is composed of s. muscle (Vagina)

CORPUS LUTEUM= Glandular body develops from graffian follicle after extrusion of the ovum. Produces progesterone & estrogens (Ovaries)

TUNICA ALBUGINEA= Capsule of collagenous C.T deep to the germinal epithelia. (Ovaries)

19

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

-Follicular cells

-The primitive sex cords become cell clusters containing primitive germ cells within the outer, active surface epithelium.

- By 4 months, these cell clusters of primitive sex cords from the surface epithelium, surround the primitive germ cells (oogonia), forming follicular cells
Collectively this would be the ova surrounded by the follicles.

20

What type of cancers will there be in vulvar

-Age diagnosed?
-How does it present?
-What is VIN?
-Symptoms?
-Histologically?
-Treatment?

- Accounts for 3% of all GYN cancers.”
-It is a carcinoma of older women, diagnosis is 60 yrs.

The tumor on the external genetalia and presents as a wart-like or slightly raised mucosal lesion/ ulcers. Invasive cancer is preceded by Carcinoma Insitu (CIS), and this is called Vulvar Intraepithelial Neoplasia (VIN).”
-Preneoplastic lesions may also lead to invasive cancer, such as Leukoplakia.” (ie. leukoplakia is a preneoplastic lesion

-SYMPTOMS: itching, discomfort, pain, bleeding, but a significant number of patients are asymptomatic.”

-HISTOLOGICALLY: the tumor presents as a Squamous Cell Carcinoma, 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. (If spread to the lymph nodes = less favorable prognosis)

TREATMENT: Surgical resection of the tumor or the entire vulva, supplemented w/ radiation/ chemo.

21

What type of cancers will there be in the vaginal?

-Accounts for what % of GYN cancers?
-What cell type cancer?
-What is the survival rate?

1. “Accounts for 2% of all GYN cancers.”
2. “It is also a disease of older women, historically a Squamous Cell Carcinoma. Accounts for over 90% of ALL primary malignant tumors of the vagina.”
3. “Detected only upon GYN examination.”
4. “5 Yr. survival rate for tumors confined to the cagina (Stage I) is 80%, wheras it is only 20% for those with extensive spread (Stage IV).”

22

What type of cancers will there be in the cervical?

-accounts for what %?
-What is the reduced rate of mortality due to?

1. “Accounts for approx. 20% of all malignant tumors of the female reproductive tract, but accounts for more deaths than cancer of the body of the uterus, vagina, and vulva together.”
2. “The reduced mortality over the last 50 years is b/c of early detection of cervical cancer and related pre-neoplastic conditions by routine use of PAP smears.”

23

15. What are the dysplasias ?

Dysplasia - lack of normal maturation of squamous epithelium.
These transformed cells do not respond to normal regulatory stimuli in the tissue. They don't mature, but remain undifferentiated & proliferate uncontrollably.
( a developmental disorder or an early stage in the development of cancer)

24

how are Dysplasisas graded by the pathologist (leading up to an invasive cancer of the cervix) (CIN1, CIN2, CIN3)

They are graded on a scale of CIN-I (mild), CIN-II (moderate), CIN-III (severe).
Severe dysplasia may progress to carcinoma that is limited to the BM called Carcinoma In-Situ (CIS). Carcinoma cells may cross the BM and invade the underlying CT stroma. This is now invasive carcinoma and tumors can spread locally or by invading the lymphatics & bloodstream, & metastasize to distant sites.

-Many severe dysplasias will progress to CIS and later to invasive cancer if left untreated (40-50%)
Some mild & moderate dysplasias (20-30%) may follow the same course.
EARLY TREATMENT: removed surgically w/ a knife, laser, or cryotherapy (so invasive cancer prevented)

25

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

Complete urinary tract obstruction causes slowly progressive renal failure, which is still the MOST common cause of death with carcinoma of the cervix.

26

Compare Bartholin’s gland cyst vs. lichen sclerosis

Bartholin’s gland cyst: ducts prone to obstruction and consequent cyst formation. Infection of the cyst leads to abscess formation. Caused by staph, chlamydia, & anaerobes.
-Tx with incisional drainage and antibiotics. p.3 (pathophys)

Lichen sclerosis: 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. Seen in the middle aged to older women, Slowly developing but progressive lesions that have no malignant potential.
p. 8 (pathophys)

27

What is the pathophysiology of the different uterine malformations (bicornis, didelphis, septate)

-Bicornis (septate) Uterus: is a 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

28

What is the pathophysiology of the different uterine malformations ( didelphis)

-Uterus Didelphys: refers to a double uterus with a double vagina. Again due to a failure of the two mullerian ducts to fuse during embryonic life

29

What is the pathophysiology of the different uterine malformations (septate).

-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

30

Know the general histology of the breast. What are lobes and lobules?

-Lobes: Each breast consists of 15-20 lobes (compartments) separated by adipose tissue.
-Lobules: Each lobe contains lobules, composed of connective tissue and embedded alveoli.

31

Know the general histology of the breast. What are alveoli?

-Alveoli: Milk-secreting cells, embedded in lobules, that are arranged in grapelike clusters & convey milk into a series of secondary tubules and then into mammary ducts.

32

Know the general histology of the breast. What are ducts?

-Ducts: Secondary tubules give way to mammary ducts which drain into the ampullae. The ampullae continues as the lactiferous ducts that terminate in the nip.

33

Know the general histology of the breast. What are ampullae?

-Ampullae: Also called lactiferous sinuses. It is the site of milk storage until it is passed through the nipple.

34

Know the general histology of the breast. What are suspensory ligaments of cooper?

-Suspensory ligaments of Cooper: strands of connective tissue between lobules. These ligaments run between the skin and deep fascia and support the breast.

35

Know the general histology of the breast. Areola?

-Areola: Circular pigmented area of skin surrounding nipple. It appears rough because it contains modified sebaceous glands

36

What are some of the differences in the staging of cervical cancer?

Stage 0: No gross lesions. The carcinoma is limited to mucosa (CIS aka Carcinoma In Situ)

Stage 1: Invasive but confined to the cervix

Stage 2: Cancer extends beyond cervix, not reaching the pelvic wall or upper vagina

Stage 3: Cancer reaches pelvic wall and invades the lower third of vagina

Stage 4: Cancer has spread beyond the pelvis and has infiltrated adjacent organs

37

Q: What is the link between this and endometriosis?
-Up to _______ of endometriosis occurs on the ovary

-The link between this and endometriosis: Because of all that in the imperforate hymen you’re going to get that menstruated blood going up through the uterus --> fallopian tubes --> and out to the ovary
-Back-up of menstrual blood with the endometrial glands once she starts to menstruate = going up the uterus --> through the fallopian tubes---->out in abdomen
****Up to 90% of endometriosis occurs on the ovary