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Flashcards in Reproduction Deck (316):
1

Sonic Hedgehog Gene
Where is it produced?
What axis does it pattern?
Involved with the development of what system??
Mutations lead to

Produced at base of limbs in zones of polarizing activity
Anterior Posterior Axis
Involved in CNS development
Mutations --> holoprosencephaly

2

Wnt 7 gene
Where is it produced?
What axis does it pattern?

Produced at apical ectodermal ridge (thickened ectoderm at distal end of each developing limb)
Dorsal Ventral Axis

3

FGF Gene
Where is it produced?
What does it do?

Produced at apical ectodermal ridge
Stimulates mitosis of underlying mesoderm, providing for lengthening limbs

4

Homeobox (Hox) Genes
What dos it do?
What axis?
Mutations result in

Involved in segmental organization of embryo in craniocaudal direction
Hox mutations --> appendages in wrong location

5

Day 0

Fertilization by sperm forms zygote initiating embryogenesis

6

Week 1

hCG secretion begins after implantation of blastocyst

7

Week 2

"2 weeks = 2 layers"
Bilaminar disc with epiblast and hypoblast

8

Week 3

3 weeks = 3 layers
Trilaminar disc
Gastrulation
Primitive streak, notochord, mesoderm and its organization, and neural plate begins to form

9

Week 3 - week 8
By week 4
Danger?

Embryonic Period
Neural tube formed by neuroectoderm and closes by week 4
Heart begins to beat at week 4
4 weeks = 4 limbs
upper and lower limb buds begin to form
Organogenesis
Extremely susceptible to teratogens

10

Week 8

Start of fetal period
Fetal movement and fetus looks like a baby

11

Week 10

Genitalia have male/female characteristics

12

Gastrulation
What is established?
Starts with...

Process that forms the trilaminar disc
Establishes ectoderm, endoderm and mesoderm
Starts with epiblast invaginating to form primitive streak

13

What comes from Surface Ectoderm?

Adenohypophysis (Ant Pituitary from Rathke's Pouch), Lens, Epithelial lining of oral cavity, Sensory organ of ear, Anal canal below pectinate line, Parotid, Sweat, and Mammary glands

14

What comes from Neuroectoderm?

Brain (neurohypophysis, CNS neurons, oligodendrocytes, astrocytes, ependymal cells, pineal gland)
Retina, Optic Nerve, Spinal Cord

15

What comes from Neural Crest Cells?

PNS (DRG, CN, Celiac ganglion, Schwann cells, ANS)
Melanocytes, Chromaffin Cells of adrenal medulla, Parafollicular (C) cells of thyroid, Schwann cells, Pia and Arachnoid, Bones of skull, Odontoblasts, Aorticopulmonary septum

16

Craniopharyngioma
Origin
Histo

Benign Rathke's pouch rumor with cholesterol crystals and calcification

17

What comes from Mesoderm?

Muscle, Bone, Connective Tissue, Serous Lining of Body Cavities (Peritoneum), Spleen, CV Structures, Lymphatics, Blood, Wall of Gut Tube, Wall of Bladder, Urethra, Vagina, Kidneys, Adrenal Cortex, Dermis, Testes, Ovaries

18

Mesodermal Defects

"VACTERL"
Vertebral defects
Anal atresia
Cardiac defects
Tracheo-Esophageal fistula
Renal defects
Limb defects (bone and muscle)

19

What comes from Endoderm?

Gut tube epithelium (including anal canal above pectinate line)
Luminal epithelium derivatives (Liver, Lung, Gallbladder, Pancreas, Eustachian Tube, Thymus, Parathyroid, Thyroid follicular cells

20

Agenesis

Absent organ due to absent primordial tissue

21

Aplasia

Absent organ despite presence of primordial tissue

22

Deformation

Extrinsic disruption
Occurs after embryonic period

23

Hypoplasia

Incomplete organ development
Primordial tissue present

24

Malformation

Intrinsic disruption
Occurs during embryonic period (3-8 weeks)

25

Teratogenic Effects of ACEI

Renal damage

26

Teratogenic Effects of Alkylating Agents

Absence of digits
Multiple abnormalities

27

Teratogenic Effects of Aminoglycosides

"A mean guy hit the baby in the ear"
CN VIII toxicity

28

Teratogenic Effects of Carbamazepine

Neural tube defects
Craniofacial defects
Fingernail hypoplasia
Developmental delay
IUGR (IntraUterine Growth Restriction )

29

Teratogenic Effects of Diethylstilbestrol (DES)

Vaginal clear cell carcinoma
Congenital Mullerian anomalies

30

Teratogenic Effects of Folate Antagonists

Neural Tube Defects

31

Teratogenic Effects of Li

Ebstein's Anomaly (Atrialized RV)

32

Teratogenic Effects of Phenytoin

Fetal hydantoin syndrome: microcephaly, dysmorphic craniofacial features, hypoplastic nails and distal phalanges, cardiac defects, IUGR (IntraUterine Growth Restriction ), mental retardation

33

Teratogenic Effects of Tetracyclines

Discolored Teeth

34

Teratogenic Effects of Valproate

Inhibition of maternal folate absorption --> neural tube defects

35

Teratogenic Effects of Warfarin

"Do not wage Warfare on the baby, keep in Heppy with Heparin (does not cross the placenta)"
Bone deformities, fetal hemorrhage, abortion, ophthalmologic abnormalities

36

Teratogenic Effects of Thalidomide

"Limb Defects with tha-LIMB-domide"
Limb defects (flipper limbs)

37

Teratogenic Effects of EtOH

Leading cause of birth defects and mental retardation
Fetal Alcohol Syndrome

38

Teratogenic Effects of Cocaine

Abnormal fetal development and fetal addiction; Placenta abruption

39

Teratogenic Effects of Smoking (nicotine, CO)

Preterm labor, Placental problems, IUGR (IntraUterine Growth Restriction ), ADHD

40

Teratogenic Effects of Iodide (Lack or Excess)

Congenital Goiter or Hypothyroidism (cretinism)

41

Teratogenic Effects of Maternal Diabetes

Caudal regression syndrome (anal atresia to sirenomelia), Congenital Heart Defects (Transposition of the Great Vessels), Neural Tube Defects

42

Teratogenic Effects of Excess Vit A

Extremely high risk for spontaneous abortions and birth defects (cleft palate, cardiac abnormalities)

43

Teratogenic Effects of X Rays

Microcephaly, Mental Retardation

44

Fetal Alcohol Syndrome

Mental Retardation, Pre and Post Natal Developmental Retardation, Microcephaly, Holoprosencephaly, Facial Abnormalities, Limb Dislocation, Heart and Lung Fistulas

45

Source of Estrogen

Ovary --> 17β-estradiol
Placenta --> estriol
Adipose tissue --> estrone via aromatization

46

Potency of different kinds of estrogens

Estradiol > Estrone > Estiol

47

Estrogen Function
Development
In menstrual cycle
Receptors
Blood

Development of genitalia, breast, and female fat distribution
Growth of follicle, endometrial proliferation, and ↑ myometrial excitability
Feedback inhibition of LH and FSH and then LH surge
Stimulation of prolactin secretion (but blocks it's action at the breast)
Upregulates estrogen, LH, and progesterone receptors
↑ Transport proteins, SHBG, HDL, ↓LDL

48

How does pregnancy change estrogen levels

50x ↑ in estradiol and estrone
1000x ↑ in estiol (indicator of fetal well being

49

Mechanism of estrogen receptor

Expressed in cytoplasm
When bound with ligand, translocates to the nucleus

50

Molecular cascade in Theca Cells

Pulsatile GnRH --> LH --> Desmolase
D turns cholesterol in to androstenedione

51

Molecular cascade in Granulosa Cells

Pulsatile GnRH --> FSH --> Aromatase
A turns androstenedione into estrogen

52

Source of Progesterone

Corpus Luteum, Placenta, Adrenal Cortex, Testes

53

Elevation of Progesterone indicates...

Ovulation

54

Function of Progesterone
Menstural cycle
Receptors
Pregnancy

Stimulation of endometrial glandular secretions and spiral artery development
Maintains endometrium to support implantation
--/ LH and FSH
↓ myometrial excitability
↓ estrogen receptor expressivity
Maintain pregnancy
Production of thick cervical mucus (inhibits sperm entry into uterus)
↑ Body Temp
Uterine smooth muscle relaxation (prevents contractions)

55

Tanner Stages of Sexual Development

I: Childhood
II: Pubic hair appears (Pubarche), Breast bud forms (Thelarche)
III: Pubic hair darkens and becomes curly. Penis size/length and breasts enlarge
IV: Penis width ↑, Darker scrotal skin, Development of glans, raised areolae
V: Adult. Areolae are no longer raised

56

Follicular Phase
Estrogen
FSH
LH
Progesterone

Estrogen: Stead rise
FSH: Rises slightly then decreases slightly
LH: Rises slightly then decreases slightly
Progesterone: Low

57

Luteal Phase
Estrogen
FSH
LH
Progesterone

Estrogen: decreases, then spikes briefly before decreasing again
FSH low
LH low
Progesterone: increases then decreases

58

Ovulation
Estrogen
FSH
LH
Progesterone
GnRH
Temp

Estrogen: just past peak
FSH: low surge
LH: high surge
Progesterone: beginning to rise
↑ in GnRH receptors on ant pituitary
↑ Temp (due to progesterone)

59

Basic schematic of menstrual cycle

↑ estrogen --> LH surge --> Ovulation --> Progesterone (from corpus luteum) --> Progesterone levels fall --> menstruation (apoptosis of endometrial cells)

60

Length of Follicular phase

Variable

61

Length of Luteal phase

Constant 14 days

62

When is follicular growth fastest?

2nd week of proliferative phase (follicular phase)

63

Oligomenorrhea

Cycle > 35 days

64

Polymenorrhea

Cycle < 21 days

65

Menometrorrhagia

Heavy, irregular menstruation at irregular intervals

66

Mittelschmerz

Blood from ruptured follicle or follicular enlargement causes peritoneal irritation that can mimic appendicitis

67

Primary Oocytes
N
C
When do they enter and complete meiosis I

2N 4C
Begin meiosis I during fetal life and complete meiosis I just prior to ovulation

68

When is meiosis II arrested?
Until when?

"Arrested until egg MET sperm"
Meiosis II arrested at Metaphase II until fertilization

69

If fertilization does not occur within 1 day what happens to secondary oocytes?

Degenerate

70

Oogenesis
Names of cells with N and C

Oogonium (2N 2C) --> Primary Oocyte (2N 4C) --> Secondary Oocyte (1N 2C) --> Ovum (1N 1C)

71

Where and When does fertilization most commonly occur?

Upper end of fallopian tube (ampulla) within 1 day of ovulation

72

When does implantation within the wall of the uterus occur?

Within 6 days after fertilization

73

What secretes hCG?
When is hCG first detectable in blood and urine?

Trophoblast secretes hCG
Detectable in blood 1 week after conception
Detectable in urine 2 weeks after conception

74

Lactation
When does it occur?
What has changed chemically that allows it to happen?
What is required to maintain lactation?

Occurs after labor because progesterone ↓ and this allows lactation to occur
Suckling is required to maintain lactation: ↑ nerve stimulation --> ↑ oxytocin and prolactin

75

Prolactin
What does it do?

Induces and maintains lactation and ↓ reproductive function

76

Oxytocin
What does it do?

Helps with milk letdown and involved with uterine contraction

77

hCG
Source
Function
Uses

Syncytiotrophoblast of placenta
Maintains corpus luteum (and thus progesterone) for 1st trimester by acting like LH
Used to detect pregnancy

78

Why is hCG not needed in 2nd and 3rd trimesters?

Placenta synthesizes its own estriol and progesterone

79

Elevated hCG in pathological states

Hydatidiform moles, choriocarcinoma

80

Average age of menopause?
What makes it earlier?

Average age at onset is 51
Earlier in smokers

81

What is happening hormonally in menopause?

↓ estrogen production becuse of ↓ # of follicles
↑↑FSH, ↑LH (no surge), ↑GnRH
Ovaries continue to produce androgens under LH stimulation

82

What usually precedes menopause?

4-5 years of abnormal menstrual cycles

83

Source of estrogen after menopause?

Peripheral conversion of androgens

84

Best test to confirm menopause?

↑↑ FSH

85

What does Menopause produce?

"HHAVOC"
Hirsutism, Hot flashes, Atrophy of the Vagina, Osteoporosis, Coronary artery disease

86

Menopause before age 40 indicates...

Premature ovarian failure

87

Menorrhagia

Heavy and/or prolonged menses

88

Average length of menses

3-5 days

89

Average blood loss during menses

35mL (10-80)

90

Metrorrhagia

Irregular menses

91

Dysmenorrhea

Painful menses

92

As women approach menopause, how does their cycle change

Follicular part becomes shorter. Failure of ovaries to produce follicles and estrogen --> ↑↑ FSH and earlier LH/FSH surge

93

Perimenopause
What is it?
How long does it last?

Irregular/skipped menses and beginning of vasomotor symptoms
Can last 5-10 years before menopause

94

Menopause definition

12 months of amenorrhea

95

Mechanisms of osteoporosis in menopause

Estrogen --/ bone resorption by osteoclasts

96

Leuprolide
Mechanism
Uses
Toxicity

GnRH analog
Pulsatile --> Agonist
Continuous --> Antagonist (downregulation of GnRH receptors in pituitary --> ↓ FSH/LH
Pulsatile: treats infertility
Continuous: Endometriosis, Prostate cancer (w/ Flutamide), Uterine fibroids, Precocious puberty
Tox: Antiandrogen, Nausea, Vomiting

97

Testosterone, Methyltestosterone
Mechanism
Use
Toxicity

Agonist for androgen receptors
Treats: hypogonadism, Promotes development of secondary sex characteristics, Stimulation of anabolism to promote recovery after burn injury
Tox: Masculinization in females, Reduces intratresticular testosterone in males by inhibiting release of LH which leads to gonadal atrophy, Premature closure of epiphyseal plate, ↑LDL, ↓HDL

98

Names of antiandrogens

Finasteride, Flutamide, Ketoconazole, Spironolactone

99

Finasteride
Kind of drug
MoA
Uses
Tox

Antiandrogen
--/ 5α Reductase which turns T into DHT
Treats BPH and hair loss
Breast growth

100

Flutamide
Kind of drug
MoA
Uses

Antiandrogen
Nonsteroidal competitive inhibitor of androgens at the testosterone receptor
Treats prostate carcinoma

101

Ketoconazole
Kind of drug
MoA
Uses
Toxicity

Antiandrogen
Inhibits steroid synthesis (--/ 17,20 desmolase)
Treats PCOS to prevent hirsutism
Tox: gynecomastia and amenorrhea

102

Spironolactone
Kind of drug
MoA
Uses
Toxicity

Antiandrogen
Inhibits steroid binding
Treats PCOS to prevent hirsutism
Tox: gynecomastia and amenorrhea

103

Estrogens
Names
MoA
Use
Tox
Contraindication

Ethinly, Estradiol, DES, Mestranol
Binds Estrogen receptors
Treats Hypogonadism or Ovarian Failure, Menstrual abnormalities, HRT in postmenopausal women
Used in men to treat androgen dependent prostate cancer
Tox: ↑ risk of endometrial cancer, bleeding in postmenopausal women, clear cell carcinoma of the vagina/cervix in females exposed to DES in utero, ↑ risk of thrombi
ER+ breast cancer, history of DVTs

104

Names of Selective Estrogen Receptor Modulators (SERMs)

Clomiphene, Tamoxifen, Raloxifene

105

Clomiphene
Kind of Drug
MoA
Uses
Toxicity

SERM
Partial agonist at estrogen receptors in hypothalamus. Prevents normal feedback inhibition and ↑ LH and FSH from pituitary.
Treats infertility and PCOS
Tox: Hot flashes, ovarian enlargement, multiple simultaneous pregnancies, visual disturbances

106

Tamoxifen
Kind of Drug
MoA
Uses

SERM
Antagonist of estrogen receptors in breast tissue
Treats and prevents recurrence of ER+ breast cancer

107

Raloxifene
Kind of Drug
MoA
Uses

SERM
Agonist of estrogen receptors in bone and reduces bone resorption
Treats osteoporosis

108

Hormone Replacement Therapy
Uses
Toxicity

Used for the relief or prevention of menopausal symptoms (hot flashes, vaginal atrophy, etc) and osteoporosis (by ↑ estrogen --> ↓ osteoclast activity)
Unopposed use of estrogen --> ↑ risk of endometrial cancer, so progesterone is added. Possible ↑ CV risk

109

Anastrozole/Exemestane
MoA
Uses

Aromatase inhibitor used to treat postmenopausal women with breast cancer

110

Progestins
MoA
Uses

Binds progesterone receptors. Reduces growth and ↑ vascularization of endometrium
Used in oral contraceptives and treatment of endometrial cancer and abnormal uterine bleeding

111

Mifepristone (RU-486)
MoA
Co-administered with...
Use
Tox

Competitive inhibitor of progestins at progesterone receptor
Termination of pregnancy. Administered w/ misoprostol (PGE)
Tox: Heavy bleeding, GI effects (nausea, vomiting, anorexia), Abdominal pain

112

Oral Contraception
What does it consist of?
MoA
Contraindications

Progestins + Estrogen
E and P --/ LH/FSH which leads to prevention of estrogen surge. No estrogen surge --> no LH surge. No LH surge --> no ovulation
Progestins cause thickening of the cervical mucus, thereby limiting access of sperm to uterus.
Progestins --/ endometrial proliferation making it less suitable for implantation
Contraindicated in smokers >35 (CV events), Hx of Thromboembolism and stroke or Hx of estrogen dependent tumors

113

Terbutaline
MoA
Uses

β2 agonist that relaxes uterus
Reduces premature uterine contractions

114

Tamsulosin
MoA
Uses
Selectivity

α1 antagonist used to treat BPH by inhibiting smooth muscle contraction
Selective for α1A and α1D (on prostate) vs α1B (vasculature)

115

Sildenafil, Vardenafil
MoA
Uses
Tox
Contraindications

--/ Phosphodiesterase 5 causing an ↑ in cGMP, smooth muscle relaxation in corpus cavernosum, ↑ blood flow, and penile erection
Treats erectile dysfunction
Tox: "Hot and sweaty, but then Headache , Heartburn, Hypotension"
Headache, flushing, dyspnea, impaired blue-green color vision, Hypotension
Risk of life threatening hypotension in nitrate users

116

Danazol
MoA
Uses
Tox

Synthetic androgen that is a partial agonist at androgen receptor
Endometriosis and hereditary angioedema
Wt Gain, Edema, Acne, Hirsutism, Masculinization, ↓HDL, Hepatotoxicity

117

Endometriosis
What is it?
What tissue is affected?
What does it cause?
What causes it?

Non-neoplastic endometrial glands/stroma in abnormal locations
In Ovary or on Peritoneum
Cyclic bleeding (menstrual type) resulting in blood filled "chocolate cysts"
Caused by retrograde menstrual flow

118

Endometriosis
Clinical manifestation?
Treatment

Dysmenorrhea, Menorrhagia, Dyspareunia, Infertility
Uterus is normal size
Treat with oral contraceptives, NSAIDs, Leuprolide, Danazol

119

Adenomyosis
What is it?
Clinical manifestation
Treatment

Endometrium within myometrium
Menorrhagia, Dysmenorrhea, Pelvic pain
Enlarged uterus
Hysterectomy

120

Cervical Dysplasia and Carcinoma In Situ
Description
Where does it begin and extend?
Classification
Histology

Disordered epithelial growth
Begins at basal layer of squamo-columnar junction and extends outwards
CIN1, CIN2, CIN3 (severe dysplasia or carcinoma in situ) depending on how high the basal cells extend
Koilocytes: raisinoid nuclei with perinuclear halo

121

Cervical Dysplasia and Carcinoma In Situ
Viral cause?
Mechanism of viral cause?
Prevention?
Risk if untreated
Risk factors

HPV16 and HPV18 (E6 --/ p53 andE7 --/ RB)
Vaccine available
May progress to invasive carcinoma if left untreated
Multiple sexual partners, smoking , early intercourse, HIV

122

Cervical Invasive Carcinoma
Most often what kind of carcinoma?
Screen?
Complications

Often squamous cell carcinoma
Pap smear
Lateral invasion can block ureter leading to renal failure

123

PCOS
PathoPhys
Gross
Clinical manifestation
Associated w/
Increased risk for

↑ frequency of pulsatile GnRA release --> ↑LH + ↓FSH --> anovulation --> no progesterone
Hyperandrogenism b/c of deranged steroid synthesis by Theca cells
Bilaterally enlarged, cystic ovaries
Amenorrhea, infertility, obesity, hirsutism
Associated with insulin resistance
Risk for endometrial cancer (↑ estrogen + no progesterone to oppose --> ↑ aromatization of testosterone in fat)

124

PCOS treatment

Wt reduction
Low does Oral Contraceptive or medroxyprogesterone (↓ LH and androgenesis)
Spironolactone (acne and hirsutism)
Clomiphene (infertility)
Meformin (diabetes or metabolic syndrome)

125

Endometrial hyperplasia
What is it?
What causes it?
Increased risk for...
Presentation
Risk factors

Abnormal endometrial gland proliferation
Caused by excess estrogen stimulation
↑ risk for endometrial carcinoma
Postmenopausal vaginal bleeding
Anovulatory cycle, HRT, PCOS, Granulosa Cell Tumor

126

Endometrial Carcinoma
Frequency
Epidemiology
Presentation
Typically preceded by
Risk factors
Prognosis

Most common gynecologic malignancy
Peak occurrence at 55-65
Vaginal bleeding
Typically preceded by endometrial hyperplasia
Prolonged use of estrogen w/o progesterone, obesity, diabetes, HTN, nulliparity, late menopause
↑ myometrial invasion --> poor prognosis

127

Types of Myometrial tumors

Leiomyoma (fibroid)
Leiomyosarcoma

128

Leiomyoma
Type of tumor
Frequency
Gross
Epidemiology
What kind of tissue
Malignant?

Myometrial tumor
Most common of all tumors in females
Multiple tumors with well-demarcated borders
↑ incidence in blacks. Peak at 20-40
Benign smooth muscle tumor
Malignant transformation to Leiomyosarcoma is rare

129

Leiomyoma
Hormone sensitive?
Presentation
Complications
Histology

Estrogen sensitive: tumor size ↑ w/ pregnancy and ↓ w/ menopause
May be asymptomatic, cause abnormal uterine bleeding, miscarriage
Severe bleeding may lead to Iron Deficiency Anemia
Whorled pattern of smooth muscle fibers

130

Leiomyosarcoma
Kind of tumor
Gross
Where does it arise from?
Epidemiology
Prognosis

Myometrial tumors
Bulky, irregular shaped tumor with areas of necrosis and hemorrhage. May protrude from cervix and bleed
Typically arising de novo
↑ incidence in middle aged black women
Highly aggressive w/ tendency to recur

131

Hydatidiform Moles
What are they?
Types
Presentation
Precursor of...
Serum marker
Gross
Potential complication
Treatment

Cystic swelling of chorionic villi and proliferation of chorionic epithelium (trophoblast)
Complete vs Partial
Presents with abnormal vaginal bleeding
Most common precursor of choriocarcinoma
↑βhCG
Honeycomb uterus or cluster of grapes appearance. Enlarged uterus
Uterine rupture
dilation and curettage and methotrexate

132

Complete Hydatidiform moles
Appearance
Fetus?
Karyotype
hCG
Uterine size
Conversion to choriocarcinoma
Fetal parts
Components
Risk of complications

Snowstorm appearance with no fetus during 1st sonogram
46XX, 46XY
↑↑↑↑ hCG
↑ uterine size
2% choriocarcinoma
No fetal parts
2 sperm (from same sperm that replicated) + empty egg
15-20% malignant trophoblastic disease

133

Partial Hydatidiform moles
Karyotype
hCG
Uterine size
Conversion to choriocarcinoma
Fetal parts
Components
Risk of complications

69XXX, 69XXY, 69XYY
↑ hCG
No change in uterine size
Rare choriocarcinoma
Has fetal parts
2 sperm + 1 egg
Low risk of malignancy

134

Classical Preeclampsia presentation

Pregnant women with HTN, Proteinuria, and Edema

135

Classical Presentation of Eclampsia

Preeclampsia + Seizures

136

Preeclampsia
Frequency
When
↑ risk in...
Caused by
Associated w/
Mortality results from

7% of pregnant women from 20 weeks to 6 weeks postpartum
↑ risk in pts w/ HTN, Diabetes, Chronic Renal Disease, Autoimmune disorders
Impaired vasodilation of spiral arteries --> Placental ischemia --> ↑ vascular tone
Associated with HELLP syndrome
Death from cerebral hemorrhage and ARDS

137

HELLP Syndrome

Hemolysis, Elevated Liver enzymes, Low Platelets

138

Clinical Manifestations of Preeclampsia
Lab findings

Headache, Blurred vision, Abdominal pain, Edema of face and extremities, altered mentation, hyperreflexia
Thrombocytopenia and Hyperuricemia

139

Treatment Preeclampsia

Delivery of fetus as soon as possible, Bed rest, monitoring, treat HTN
IV MgSulfate to prevent seizures

140

Ovarian germ cell tumors most common in...

Adolescents

141

Dysgerminoma
What kind of tumor?
Malignant?
Equivalent in male?
Histology
Associated w/
Markers

Ovarian germ cell tumor
Malignant
Equivalent to male seminoma but rarer (1% over 30%)
Sheets of uniform cells
Associated with Turners Syndrome
hCG and LDH

142

Choriocarcinoma in females
What kind of tumor?
Frequency
Malignant
Who develops it?
When does it develop?
Source
Histology
What other pathologies is it related to?
Metastases
Serum markers

Ovarian germ cell tumor
Rare but malignant
Develops during or after pregnancy in mother or baby
From trophoblastic tissue
No chorionic villi and ↑ theca-lutein cysts
On spectrum with moles as gestational trophoblastic neoplasms
Early homogenous spread to lungs
hCG

143

Yolk Sac (Endodermal Sinus) Tumor in women
What kind of tumor?
Malignant?
Location
What kind of pt?
Gross
Histology
Marker

Ovarian germ cell tumor
Aggressive malignancy in ovaries/testes and sacrococcygeal area of young children
Yellow, friable, solid masses
50% of Schiller-Duval bodies (resemble glomeruli)
AFP

144

Teratoma in women
What kind of tumor
Frequency
Types of tissue?
Types

Ovarian germ cell tumor
90% of ovarian germ cell tumors
Contains cells from 2 or 3 germ layers
Mature vs. Immature

145

Mature Teratoma in women
Gross
Frequency
Malignant?

Dermoid Cyst
Most common ovarian germ cell tumor
Mostly benign

146

Immature Teratoma in women
Malignant?
Gross
Presentation

Aggressively malignant
Can have Struma Ovarii (functional thyroid tissue)
Can present as hyperthyroidism

147

Serous Cystadenoma
Kind of tumor
Frequency
Distribution
Histology
Malignant?

Ovarian non-germ cell tumor
45% of ovarian tumors
Bilateral
Lined with fallopian tube-like epithelium
Benign

148

Marker for Ovarian cancer?

↑ CA-125
Good for monitoring progression but not screening

149

Serous cystadenocarcinoma
Kind of tumor
Frequency
Distribution
Histology
Malignant?
Genetic risk factors

Ovarian non-germ cell tumor
45% of ovarian tumors
Bilateral
Psammoma bodies
Malignant
BRCA1, BRCA2, HNPCC

150

Mucinous Cystadenoma
Kind of tumor
Malignant
Histology

Ovarian non-germ cell tumor
Benign
Multilocular cyst lined by mucus secreting epithelium. Intestine-like tissue

151

Mucinous Cystadenocarcinoma
Kind of tumor
Malignant?
Complication

Ovarian non-germ cell tumor
Malignant
Pseudomyxoma peritonei - intraperitoneal accumulation of mucinous material from ovarian or appendiceal tumor

152

Brenner Tumor
Kind of tumor
Malignant
Distribution
Gross
Histology

Ovarian non-germ cell tumor
Benign
Unilateral
Looks like Bladder. Solid tumor that is pale yellow-tan color and appears encapsulated
Coffee bean nuclei on H&E

153

Fibromas
Kind of tumor?
Histology
Complication
Clinical Manifestation

Ovarian non-germ cell tumor
Bundles of spindle shaped fibroblasts
Meigs' Syndrome
Pulling sensation in groin

154

Meigs Syndrome

Ovarian fibroma + ascites + hydrothorax

155

Granulosa Cell Tumor
What kind of tumor
Hormones
Complications in kids vs adults
Histology
Presentation

Ovarian non-germ cell tumor
Secretes estrogen
Precocious puberty in children
endometrial hyperplasia or carcinoma in adults
Call-Exner bodies (small follicles filled with eosinophilic secretions)
Abnormal uterine bleeding

156

Krukenberg Tumors
Kind of tumor
Source
Histology

Ovarian non-germ cell tumor
GI malignancy that metastasizes to ovaries
Mucin secreting signet cell adenocarcinoma

157

Squamous Cell Carcinoma of the Vagina Usually secondary to...

SCC of cervix

158

Women at risk for Clear Cell Adenocarcinoma of the Vagina

DES exposure in utero

159

Sarcoma Botryoides (rhabdomyosarcoma variant)
Kind of tumor
Classic pt
Histology

Vaginal Tumor
Girls <4
Spindle shaped, Desmin+ tumor cells

160

Dizygotic twins
Frequency
Egg #
Amniotic sacs
Placentas

80% of twins
2 eggs
2 separate amniotic sacs
2 separate placentas (chorions)

161

Monozygotic twins that split day 0-4
Stage
Frequency
Placenta
Amniotic sacs
Chorion

Morula
25%
Fused or separate placenta
Diamniotic
Dichorionic

162

Monozygotic twins that split day 4-8
Stage
Frequency
Amniotic sacs
Chorion

Blastocyst
75%
Diamniotic
Monochorionic

163

Monozygotic twins that split day 8-12
Frequency
Amniotic sacs
Chorion

Less than 1%
Monoamniotic
Monochorionic

164

Monozygotic twins that split after day 13

Monoamniotic
Monochorionic
Conjoined

165

Fetal Components of the placenta

Cytotrophoblast and Syncytiotrophoblast

166

Cytotrophoblast
Where is it?
What is it made from?
Where is it from?

Inner layer of chorionic villi
Cytotrophoblast made from Cells
Fetal component

167

Syncytiotrophoblast
Where is it?
What does it secrete?

Outer layer of chorionic villi
Secretes hCG

168

Maternal component of placenta
Name
Derived from?

Decidua Basalis
Derived from endometrium

169

Where is maternal blood in the placenta?

In Lacunae

170

What makes up the Umbilical Cord?

2 Umbilical arteries and 1 Umbilical vein

171

Function of umbilical arteries
Source?

Return deoxygenated blood from fetal internal iliac arteries to placenta

172

Function of umbilical vein?
What does it drain into?

Supplies oxygenated blood from placenta to fetus
Drains via ductus venosus into IVC

173

Single umbilical artery is associated with...

Congenital and Chromosomal Anomalies

174

What are the umbilical arteries and veins are derived from?

The Allantois

175

Urachal Duct
What is it?
Development?
Failure to obliterate?

A duct between bladder and yolk sac
3rd week: Yolk sac forms allantois which extends into urogenital sinus. Allantois becomes urachus
Patent Urachus: urine discharge from the umbilicus
Vesicourachal diverticulum: outpouching of bladder

176

Vitelline duct
Name
Function
When is it obliterated
Failure to obliterate

Omphalo-Mesenteric Duct
Connects yolk sac to midgut lumen
Obliterated at week 7
Vitelline fistula: meconium discharge from umbilicus
Meckel's Diverticulum: Ectopic gastric and pancreatic tissue --> melena, periumbilical pain, ulcer

177

1st Aortic Arch forms

Maxillary artery (branch of external carotid)

178

2nd Aortic Arch forms

Stapedial artery and Hyoid artery

179

3rd Aortic Arch forms

Common Carotid artery and proximal part of Internal Carotid artery

180

4th Aortic Arch forms

L: Aortic arch
R: Proximal part of Subclavian artery

181

6th Aortic Arch forms

Proximal part of pulmonary arteries and (on left only) ductus arteriosus

182

Branchial Apparatus
AKA
Composition with origin

Pharyngeal Apparatus
"CAP"
Clefts (grooves) from Ectoderm
Arches from Mesoderm (muscles, arteries) and neural crest cells (bones, cartilage)
Pouches from Endoderm

183

Branchial Clefts develop into

1st: External auditory meatus
2nd - 4th: form temporary cervical sinus which are obliterated by proliferation of 2nd arch mesenchyme

184

Persistent Cervical Sinus

Branchial cleft cyst within lateral neck

185

1st Branchial Arch
Cartilage
Muscles
Nerves
Pathology

Meckel's cartilage: Mandible, Malleus, incus, spheno-Mandibular ligament
Muscles of Mastication (Temporalis, Masseter, Lat and Med Pterygoids), Mylohyoid, Anterior belly of the digastric, Tensor Tympani, Tensor Veli Palatini
V2 and V3
Treacher Collins Syndrome --> 1st arch crest fails to migrate --> Mandibular hypoplasia and facial abnormalities

186

2nd Branchial Arch
Cartilage
Muscles
Nerves

Reichert's Cartilage (Stapes, Styloid Process, Lesser horn of the Hyoid, Stylohyoid ligament)
Muscles of facial expression, Stapedius, Stylohyoid, Posterior Belly of the Digastric
CNVII

187

3rd Branchial Arch
Cartilage
Muscles
Nerves
Pathology

Greater horn of hyoid
Stylopharyngeus
CN IX ("swallow stylishly")
Congenital Pharyngo-Cutaneous Fistula: Persistence of cleft and pouch --> Fistula between tonsillar area, cleft in lateral neck

188

4th - 6th Branchial Arch
Cartilage
Muscles
Nerves

Thyroid, Cricoid, Arytenoids, Corniculate, Cuneiform
4th: Most Pharyngeal Constrictors; Cricothyroid, Levator Veli Palatini
6th: All intrinsic muscles of larynx except cricothyroid
CNX: 4th is superior laryngeal branch ("simply swallow"), 6th is recurrent laryngeal branch ("speak")

189

Branchial Arches Mnemonic

Chew, Smile, Swallow Stylishly, Simply Swallow, Speak

190

What forms posterior 1/3 of tongue

Branchia Arches 3 and 4

191

What does Branchia Arch 5 become?

5 makes no major developmental contributions

192

1st Branchial Pouch
Develops into
What does it contribute to?

Middle Ear Cavity, Eustachian Tube, Mastoid Air Cells
Contributes to Endoderm-lined structures of ear

193

2nd Branchial Pouch develops into...

Epithelial lining of palatine tonsil

194

3rd Branchial pouch
Develops into...
Where does it end up

Dorsal wings develop into inferior parathyroids
Ventral wing develops into Thymus
Ends up below 4th

195

4th Branchial pouch develops into...

Dorsal wings develop into superior parathyroids

196

DiGeorge Syndrome
What develops abnormally
PathoPhys

Aberrant development of 3rd and 4th Branchial pouches
T cell deficiency (Thymic aplasia) and Hypocalcemia (parathyroid doesn't develop)

197

Cleft Lip

Failure of fusion of maxillary and Medial Nasal Processes (formation of primary palate)

198

Cleft Palate

Failure of fusion of the lateral palatine processes, the nasal septum, and/or the median palatine process (formation of secondary palate)

199

Cleft Lip vs Cleft Palate

2 distinct etiologies but often occur together

200

Female genital development
What kind of pathway?
Ducts?

Default pathway
Mesonephric duct degenerates and Paramesonephric duct develops

201

Phys of male genital development

SRY produces testes determining factor
Sertoli cells secrete Mullerian Inhibitory Factor.
Leydig cells secrete Testosterone that stimulate development of mesonephric ducts

202

Paramesonephric duct
Name
What does it develop into?
Presentation of defect?

Mullerian Duct
Fallopian tubes, uterus, upper vagina
Primary amenorrhea with fully developed secondary sex characteristics

203

Mesonephric Duct
Name
What does it develop into?

Wolffian duct
"SEED"
Develops into Seminal vesicles, Epididymis, Ejaculatory duct, Ductus deferens

204

Bicornuate Uterus
What is it?
What can it lead to?

Incomplete fusion of Mullerian duct
Can lead to urinary tract abnormalities and miscarriages

205

What does DHT do?

Promotes development of male external genitalia and prostate

206

What happens if there are no sertoli cells or no MIF?

Development of both male and female internal genitalia and male external genitalia

207

5αReductase Deficiency
Chromosomes, Genitalia, Inheritance
PathoPhys
Presentation
Hormonal findings

XY
Internal genitalia normal
AR
Inability to convert T to DHT
Ambiguous genitalia until puberty, when T causes masculinization and ↑ growth of external genitalia
T and Estrogen levels are normal. LH normal or ↑

208

Genital Tubercle
Male
Female

Male: Glans, Corpus Cavernosum, Spongiosum
Female: Glans Clitoris, Vestibular Bulbs

209

Urogenital Sinus
Male
Female

Bulbourethral glands, Prostate
Greater vestibular glands of Bartholin and Urethral and Paraurethral glands of Skene

210

Urogenital folds
Male
Female

Ventral shaft of penis (penile urethra)
Labia Minora

211

Labioscrotal swelling
Male
Female

Scrotum
Labia Majora

212

Hypospadias
What is it?
What causes it?
Frequency
Why treat it?

"Hypo is Below"
Abnormal opening of penile urethra on inferior (ventral) side of penis
Due to failure of urethral folds to close
More common than epispadias
Fix to prevent UTIs

213

Epispadias
What is it?
What causes it?
Association

"When you have Epispadias you hit your Eye when you pEE"
Abnormal opening of penile urethra on superior (dorsal) side of penis
Due to faulty positioning of genital tubercle
Extrophy of the bladder

214

Gubernaculum
What is it?
Male remnant
Female remnant

Band of Fibrous Tissue
Anchors Testes within scrotum
Ovarian ligament and Round ligament of the uterus

215

Processus Vaginalis
What is it?
Male remnant
Female remnant

Evagination of peritoneum
Forms tunica vaginalis
Obliterated

216

Venous drainage of gonads?

L ovary/teste --> L gonadal vein --> L renal vein --> IVC
R ovary/teste --> R gonadal vein --> IVC

217

Lymphatic drainage of ovaries/testes

Para-Aortic Lymph Nodes

218

Lymphatic drainage of distal 1/3 of vagina, vulva, and scrotum

Superficial Inguinal Nodes

219

Lymphatic drainage of Proximal 2/3 of vagina and uterus?

Obturator, External Iliac and Hypogastric Nodes

220

On which side is Varicocele more common?

More common on Left because L venous pressure > R venous pressure because L spermatic vein enters L renal vein at 90 degrees, so flow is less continuous on Left

221

Suspensory Ligament of the Ovaries
Connects
Structures contained

Ovaries to lateral pelvic wall
Ovarian vessels

222

What can be damaged during oophorectomy?

Ureter is at risk during ligation of ovarian vessels in oophorectomy

223

Cardinal Ligament
Connects
Structures contained

Cervix to side wall of pelvis
Uterine vessels

224

What can be damaged during hysterectomy?

Ureter at risk of injury during ligation of uterine vessels

225

Round Ligament of the Uterus
Connects
Structures contained
Derivative from what?
What does it travel through?

Uterine Fundus to Labia Majora
Artery of Sampson
Derivative of Gubernaculum
Travels through round inguinal canal

226

Broad Ligament
Connects
Structures contained
Components

Uterus, Fallopian Tubes, and Ovaries to Pelvic side wall
Ovaries, Fallopian tubes, Round ligaments of the uterus
Mesosalpinx, Mesometrium, Mesovarium

227

Ligament of the ovary
Connects
Structures contained
Derivative from what?

"Latches ovary to Lateral uterus"
Medial pole of ovary to lateral uterus
None
Derivative of gubernaculum

228

Vagina histology

Stratified Squamous Epithelium, Nonkeritinizing

229

Ectocervix histology

Stratified Squamous

230

Endocervix histology

Simple Columnar

231

Uterus Histology

Simple columnar, Pseudostratified tubular glands

232

Fallopian tube histology

Simple columnar, ciliated

233

Ovary histology

Simple cuboidal

234

Pathway of sperm

"SEVEN UP"
Seminiferous tubules
Epididymis
Vas deferens
Ejaculatory duct
Nothing
Urethra
Penis

235

Erection
System responsible?
Nerve
Pathway

Parasympathetic nervous system
Pelvic nerve
NO --> ↑ cGMP --> smooth muscle relaxation --> vasodilation --> proerectile

236

Nervous pathology of anti-erection

NE --> ↑ [Ca] --> smooth muscle contraction --> vasoconstriction --> antierectile

237

Nervous system responsible for emission
Nerve?

Sympathetic nervous system
Hypogastric nerve

238

Nerves responsible for Ejaculation

Visceral and Somatic Nerves
Pudendal nerve

239

Spermatogonia
Function
What do they produce
Location

Maintain germ pool
Produce Primary Spermatocytes
Line seminiferous tubules

240

Sertoli cells
What do they secrete?
Connections between cells?
Function
Effects of Temp? What changes temp?

Secretes inhibin (inhibits FSH), Androgen binding protein (maintains local levels of testosterone), AMH
Tight junctions form blood-testis barrier --> isolate gametes from autoimmune attack
Support and nourish spermatozoa, Regulate spermatogenesis
Temp sensitive: Varicocele or Cryptorchidism --> ↑ Temp --> ↓ sperm production and ↓ inhibin

241

Leydig Cells
Secrete
Effects of Temp?
Location

Secrete Testosterone
Unaffected by Temp
Interstitium

242

Male Meiosis

Spermatogonium (2N2C) --> Primary Spermatocytes (2N4C)--> [Meiosis I] --> Secondary Spermatocyte (1N2C) --> [Meiosis II] --> Spermatid (NC) --> [Spermiogenesis] --> Mature spermatozoon

243

Where are the tight junctions between Sertoli cells

Between Spermatogonium and Primary Spermatocytes

244

Time for full development of sperm?

2 months

245

Process of spermatogenesis

Loss of cytoplasmic contents and gain of acrosomal cap

246

Hormone pathways of Testes

Hypothalamus --> GnRH --> AP --> FSH and LH
FSH --> Sertoli cells --> ABP and Inhibin
Inhibin --/ AP
LH --> Leydig cells --> Testosterone --/ Hypothalamus and AP

247

Androgens
Names w/ potency
Source

DHT > Testosterone > Androstenedione
T and D from testes, AnDrostenedione from ADrenal gland

248

Testosterone Functions

Differentiation of epididymis, vas deferens, seminal vesicles (internal genitalia except prostate)
Growth spurt (penis, seminal vesicles, sperm, muscles, RBCs)
Deepening of voice
Closing of epiphyseal plates (via estrogen converted to testosterone)
Libido

249

DHT functions
Early
Late

Differentiation of penis, scrotum and prostate
Prostate growth, balding, sebaceous gland activity

250

What converts testosterone and androstenedione into estrogen

Aromatase in adipose tissue

251

Klinefelter's Syndrome
Chromosomes
Pathways
Presentation
Histo

XXY
Dysgenesis of seminiferous tubule --> ↓ inhibin --> ↑ FSH
Abnormal Leydig cell function --> ↓ testosterone --> ↑ LH --> ↑ Estrogen
Testicular atrophy, eunuchoid body shape, Tall, Long extremities, Gynecomastia, female hair distribution, Developmental delay
Barr body

252

Turners Syndrome
Chromosomes
Pathways
Presentation
Gross anatomy
Risk for?
Histo

XO
↓ estrogen --> ↑ LH and FSH
Short, shield chest, amenorrhea, menopause before menarche
Streak ovaries, bicuspid aortic valve, defective lymphatics --> webbing of neck (cystic hygroma), lymphedema in feet and hands, Preductal coarctation of the aorta, horseshoe kidney
Dysgerminoma
No barr body

253

Double Y male
Presentation
Risks

Phenotypically normal, very tall, severe acne, normal fertility
Antisocial behavior and autism spectrum disorder

254

Defective androgen receptor
Testosterone
LH

Testosterone ↑
LH ↑

255

Testosterone secreting tumor or exogenous steroids
Testosterone
LH

Testosterone ↑
LH ↓

256

Primary Hypogonadism
Testosterone
LH

Testosterone ↓
LH ↑

257

Hypogonadotropic Hypogonadism
Testosterone
LH

Testosterone ↓
LH ↓

258

Female pseudohermaphrodite
Chromosomes
Gonads
External genitalia
Cause

XX
Ovaries
Virilized or ambiguous genitalia
Exposure to androgens during early gestation: congenital adrenal hyperplasia or exogenous administration

259

Male pseudohermaphrodite
Chromosomes
Gonads
External genitalia
Cause

XY
Testes
Female or ambiguous
Androgen insensitivity syndrome is most common form

260

True Hermaphroditism
Chromosomes
Gonads
Genitalia
Frequency

XX or XXY
Ovotestis
Ambiguous genitalia
Very rare

261

Androgen Insensitivity Syndrome
PathoPhys
External Genitalia
Internal Genitalia
What do they develop?
Hormonal Findings?

Defective Androgen Receptor
Normal appearing female with female external genitalia but with scant genital hair
Rudimentary vagina. No Uterus or Fallopian tubes
Testes in Labia Majora that must be surgically removed
↑ Testosterone, Estrogen, and LH

262

Kallmann Syndrome
PathoPhys
Presentation
Findings

Defective migration of GnRH cells and formation of olfactory bulb
Anosmia and lack of secondary sex characteristics
↓ GnRH, FSH, LH, T, and Sperm count

263

Abruptio Placentae
What is it?
Associated with what?
↑ risk with...
Presentation
Threat?

Premature detachment of placenta
DIC
Smoking, HTN, Cocaine
Painful bleeding in 3rd trimester
Life threatening for both fetus and mother

264

Placenta Accreta
What is it?
↑ risk with...
Presentation

Defective decidual layer allows placenta to attach to myometrium --> No separation of placenta after birth
Prior C section, Inflammation, Placenta previa
Massive bleeding after delivery

265

Placenta previa
What is it?
↑ risk with...
Presentation

Attachment of placenta to lower uterine segment over internal cervical os
Multiparity and prior C-section
Painless bleeding in any trimester

266

Retained Placental Tissue leads to

Postpartum hemorrhage and ↑ risk of infection

267

Ectopic Pregnancy
Most often location
Presentation
Dx
Risk factors
Often confused with...
Histo

Fallopian tube
Amenorrhea, lower than expected ↑ in hCG, sudden abdominal pain w/ or w/o bleeding
US
Infertility, PID, Rupture appendix, Tubal surgery
Appendicitis
Endometrial biopsy shows decidualized endometrium but no chorionic villi

268

Polyhydramnios
Amount
PathoPhys
Associated with...

More than 1.5L
Esophageal/Duodenal atresia --> inability to swallow amniotic fluid
Anencephaly

269

Oligohydramnios
Amount
PathoPhys
What can it give rise to?

Less than .5L
Placental insufficiency, bilateral renal agenesis, or posterior urethral valves (in males) leading to inability to excrete urine
Potters Syndrome

270

Endometritis
What is it?
Treatment

Inflammation of the endometrium with retained products of conception following delivery (vaginal, C-section, miscarriage, abortion, foreign body) leads to bacterial infection from vaginal or intestinal flora
Gentamycin + Clindamycin w/ or w/o Ampicillin

271

Gynecologic tumor epidemiology
Incidence
Prognosis

Endometrial > Ovarian > Cervical
Ovarian > Cervical > Endometrial

272

Premature Ovarian Failure
What is it?
Presentation
Findings

Premature atresia of ovarian follicles
Menopause before age 40
↓ estrogen, ↑ LH, ↑ FSH

273

Most common causes of anovulation

Pregnancy, PCOS, Obesity, HPO axis abnormalities, Premature Ovarian Failure, Hyperprolactinemia, Thyroid disorders, Eating disorders, Cushing's syndrome, Adrenal Insufficiency

274

Follicular Cyst
What is it?
Associated with?
Frequency

Distention of unruptured graafian follicle
Hyperestrinism and Endometrial Hyperplasia
Most common ovarian mass in young women

275

Corpus Luteum Cyst
What is it?
Course

Hemorrhage into persistent corpus luteum
Commonly regresses spontaneously

276

Theca Lutein Cyst
#
Cause?
Associated with...

Bilateral and multiple
Gonadotropin stimulation
Choriocarcinoma and moles

277

Hemorrhagic Cyst
What is it?
Course

Blood vessel rupture into cyst wall.
Cyst grows with ↑ blood retention
Usually self resolves

278

Dermoid Cyst

Mature teratoma. Cystic growth with various tissues such as fat, hair, teeth, bone, cartilage

279

Endometrioid Cyst
What is it?
How does it vary
Appearance with name

Endometriosis within ovary with cyst formation
Varies with menstrual cycle
When filled with dark, reddish brown blood it is called a chocolate cyst

280

Course of milk flow in breast

Lobules --> Terminal duct --> Major duct --> Lactiferous sinus --> Nipple

281

Fibroadenoma of the breast
Characteristics
Epidemiology
Malignant?
Hormones?

Small, Mobile, Firm Mass with sharp edges
Most common tumor in those under 35
↑ size and tenderness with ↑ estrogen
Not a precursor to breast cancer

282

Intraductal Papilloma
Size
Location
Presentation
Malignant

Small tumor
Lactiferous ducts, typically beneath areola
Serous or bloody nipple discarge
Benign with slight risk of carcinoma

283

Phyllodes Tumor
Size
Type of tissue
Appearance
Epidemiology
Malignancy

Large and Bulky
Connective tissue and Cysts
Leaf-like projections
Most common in 6th decade of life
Some may become malignant

284

Malignant Breast Tumors
When does it present
Location
Markers
Prognostic factors
Risk factors

Common postmenopause
Terminal duct lobular unit in upper outer quadrant
Estrogen/Progesterone receptors or c-erbB2 (HER2 an EGF receptor)
Axillary lymph node involvement is important prognostic factor
↑ estrogen, total # of menstrual cycles, older age at 1st live birth, obesity, BRCA1, BRCA2 mutation

285

Ductal carcinoma in situ
What kind of cancer?
What does it look like
Arise from
Malignancy?

Noninvasive malignant breast tumor
Fills ductal lumen
Arises from ductal hyperplasia
Early malignancy w/o basement membrane penetration

286

Comedocarcinoma
What kind of cancer?
Type
Location
Histo

Noninvasive malignant breast tumor
Subtype of DCIS
Ductal
Caseous Necrosis

287

Invasive Ductal Breast Cancer
What kind of cancer?
Gross
Histo
Frequency
Prognosis

Invasive malignant breast tumor
Firm, fibrous, "rock hard" mass with sharp margins
Small, glandular, duct-like cells with classic stellate morphology
Most common (76%)
Worst and most invasive

288

Invasive Lobular Breast Cancer
What kind of cancer?
Distribution
Histo

Invasive malignant breast tumor
Bilateral with multiple lesions in the same location
Orderly row of cells (Indian File)

289

Medullary Breast Cancer
What kind of cancer?
Histo
Prognosis

Invasive malignant breast tumor
Fleshy, Cellular, Lymphocytic infiltrate
Good prognosis

290

Inflammatory Breast Cancer
What kind of cancer?
PathoPhys
Gross
Prognosis

Invasive malignant breast tumor
Dermal lymphatic invasion by breast carcinoma blocking lymphatic drainage
Peau d'orange (breast skin resembles orange peel)
50% survival @ 5 years

291

Paget's Disease of Breast
Gross
Histo
What does it suggest?
Where else is it seen?

Eczematous patches on nipple
Paget cells = large cells in epidermis with clear halo
Suggets underlying DCIS
Also seen on vulva

292

Fibrocystic Disease
Epidemiology
Presentation
What does it indicate

Most common cause of breast lumps from 25 to menopause
Premenstrual breast pain and multiple bilateral lesions. Fluctuations in size of mass
Does not indicate risk of carcinoma

293

Fibrocystic Disease Subtypes

Fibrosis: hyperplasia of breast stroma
Cystic: Fluid filled, blue dome. Ductal dilation
Sclerosing adenosis: ↑ acini and intralobular fibrosis. Calcification. Often confused with cancer
Epithelial hyperplasia: ↑ # of epithelial cell layers in terminal duct lobule. ↑ risk of carcinoma with atypical cells. Occurs in women over 30

294

Acute Mastitis
What is it?
When does it present
What are they at risk for?

Breast abscess
During breast feeding
Risk of bacterial infection through cracks in nipple by S aureus

295

Fat Necrosis of the breast
Dangerous?
Presentation
What causes it?

Benign
Painless lump
Injury (usually unreported)

296

What causes Gynecomastia?

Hyperestrogenism (Cirrhosis, Testicular tumor, Puberty, Old age)
Klinefelter's Syndrome
Drugs (Estrogen, Marijuana, Heroic, Psychoactive drugs, Spironolactone, Digitalis, Cimetidine, Alcohol, Ketoconazole)
"Some Drugs Create Awkward Knockers"

297

Prostatitis
Presentation
Acute Cause
Chronic Cause

Dysuria, Frequency, Urgency, Low back pain
Acute: bacterial (E coli)
Chronic: bacterial or abacterial (most common)

298

Benign Prostatic Hyperplasia
Epidemiology
PathoPhys
Malignant

Men over 50
Nodular enlargement of periurethral (lateral and middle) lobes compresses urethra
Not premalignant

299

Benign Prostatic Hyperplasia
Presentation
Complications
Findings
Treatment

Frequency, Nocturia, Dysuria, Difficulty starting and stopping stream
Distention and Hypertrophy of the bladder, Hydronephrosis, UTIs
↑ PSA
α1 antagonists (Terazosin, Tamsulosin), Finasteride

300

Prostatic Adenocarcinoma
Epidemiology
Location
Diagnosis
Tumor markers
Metastasis?

Men over 50
Posterior lobe in peripheral zone
↑ PSA and subsequent biopsy
Prostatic Acid Phosphatase and PSA
Osteoblastic mets to bone present as lower back pain and ↑ AlkPhos

301

Cryptorchidism
What is it?
Consequences
Associated with what?
What increases risk for it?
Labs

Undescended testis
Impaired spermatogenesis (b/c of temp) but normal testosterone
Risk of germ cell tumor
Prematurity
↑ FSH, LH and ↓ inhibin (and testosterone if bilateral)

302

Varicocele
PathoPhys
Consequences
Location
Can lead to...
Gross
How is Diagnosis made?
Treatment

Dilated veins in Pampiniform plexus b/c of ↑ venous pressure
Most common cause of scrotal enlargement
More common on Left
Infertility
Bag of Worms appearance
Diagnosed by US
Varicocelectomy, Embolization

303

Testicular Germ Cell Tumor
Frequency
Danger?
Can present as...
DDx

95% of all testicular tumors
Most often malignant
Can present as mixed germ cell tumor
Testicular mass that does not transilluminate

304

Seminoma
What kind of cancer?
Malignant?
Presentation
Epidemiology
Histo
Labs
Treatment
Prognosis

Testicular Germ Cell Tumor
Malignant
Painless homogenous testicular enlargement
Most common testicular tumor mostly affecting males 15-35
Large cells in lobules with watery cytoplasm and fried egg appearance
Placental ALP
Radiosensitive
Late metastasis with excellent prognosis

305

Yolk Sac (endodermal sinus) tumor in males
What kind of cancer?
Gross
Analog
Histo
Labs

Testicular Germ Cell Tumor
Yellow, Mucinous
Analogous to ovarian yolk sac tumor
Schiller-Duval Bodies resemble primitive glomeruli
↑ AFP

306

Choriocarcinoma in males
What kind of cancer?
Danger?
Labs
What is it made of?
Metastasis?
Complications

Testicular Germ Cell Tumor
Malignant
Increased hCG
Syncuytiotrophoblastic and Cytotrophoblastic elements
Hematogenous mets to lungs
Gynecomastia because of hCG

307

Teratoma in male
What kind of cancer?
Malignant?
Labs

Testicular Germ Cell Tumor
Unlike in females, malignant in adults
Benign in children
↑ hCG +/or AFP in 50% of cases

308

Embryonal Carcinoma
What kind of cancer?
Danger?
Presentation
Prognosis
Histo
Pure?
Labs

Testicular Germ Cell Tumor
Malignant
Painful
Worse prognosis that seminoma
Glandular/Papillary morphology
Pure version is rare, most commonly mixed
↑ hCG and normal AFP (if pure). ↑ AFP when mixed

309

Testicular Non-Germ Cell Tumor
Frequency
Danger

5% of all testicular cancers
Mostly benign

310

Leydig cell cancer
What kind of cancer
Histo
What does it produce?
Presentation
Gross

Testicular non-Germ Cell Tumor
Reinke Crystals
Androgen producing
Gynecomastia in men, precocious puberty in boys
Golden Brown color

311

Sertoli cell Cancer
What kind of cancer
Description
Origin

Testicular non-Germ Cell Tumor
Androblastoma
From sex cord stroma

312

Testicular Lymphoma
What kind of cancer?
Epidemiology
Origin
Course

Testicular non-Germ Cell Tumor
Most common testicular caner in older men
Arises from lymphoma metastases to testes
Aggressive

313

Tunica Vaginalis Lesions
What is it?
Presentation
Types w/ causes

Lesions in the serous covering of testis
Present as testicular masses that can be transilluminated (vs testicular tumors)
Hydrocele: ↑ fluid secondary to incomplete fusion of processus vaginalis
Spermatocele: Dilated Epididymal Duct

314

Squamous Cell Carcinoma of the Penis
Epidemiology
Association

Asia, Africa, and South America
HPV and lack of circumcision

315

Peyronie's Disease

Bent Penis due to acquired fibrous tissue formation

316

Priapism
What is it?
Causes

Painful sustained erection not associated with stimulation or desire
Trauma, Sickle Cell Disease (RBCs trapped in vascular channel), Medication (anticoagulants, PDE5 inhibitors, antidepressants, α blockers, cocaine