Reproductive Flashcards
1
Q
What develops from the Mesonephric (Wolffian) duct?
A
SEED
- Seminal vesicles
- Ejaculatory duct
- Epididymis
- Ductus deferens
2
Q
What is the female remnant of the mesonephric duct?
A
Gartner duct
3
Q
What are the structures that develop from the Mullerian duct?
A
- Fallopian tubes
- Uterus
- Upper 1/3 of vagina
4
Q
What is the male remnant of the Mullerian duct?
A
Appendix testis
5
Q
Where embryologically does the prostate originate from?
A
Urogenital sinus
6
Q
What does the urogenital sinus differentiate into in males?
A
Bladder
Prostate
Urethra
Bulbourethral glands
7
Q
Patient has a small mass on the anterior midline of her neck that can elevate when she protrudes her tongue. What is this mass likely a remnant of embryologically?
A
Thyroglossal duct
*Distal end forms the thyroid gland, proximally the duct degenerates
8
Q
Patient presents with a lateral neck mass anterior to the sternocleidomasteroid muscle that does NOT move with swallowing. What is this?
A
Pharyngeal cleft cyst due to a persistent cervical sinus embryologically
*Contrast with thyroglossal duct cyst where the mass DOES move with swallowing and is in the midline
9
Q
What is the first major site of hematopoiesis? When does hematopoiesis begin?
A
Yolk sac is the first major site
Begins after 3 weeks of development
10
Q
Give the correct sequence of hematopoiesis embryologically with time of occurrence
A
1) Yolk sac - 3rd week
2) Liver - 1 month
3) Spleen & lymphatic organs - 2-4 months
4) Bone marrow - after 7.5 months
11
Q
Cause of hypospadias
A
Failure of the urethral folds to fuse
12
Q
Cause of epispadias
A
Faulty positioning of the genital tubercle
13
Q
Fetal male sex is determined by what hormone?
A
DHT
*Determines the development of male EXTERNAL genitalia from the genital tubercle, urogenital sinus, and labioscrotal swelling
14
Q
When is sex of an embryo determined?
A
At fertilization
15
Q
Role of testosterone in male differentiation of embryo
A
Stimulates development of SEED
- Seminal vesicles
- Ejaculatory duct
- Epididymis
- Ductus deferens
16
Q
What is used as a sex indicator during ultrasound examination in a pregnant woman?
A
Genital tubercle
17
Q
What week do gonads become structurally male or female? What about external genitalia?
A
Gonads: Week 7
External genitalia: Week 12
18
Q
What specifically is the MIF (Mullerian inhibiting factor) suppressing development of?
A
Paramesonephric duct to prevent female INTERNAL sex organs from developing
19
Q
What hormone is primarily responsible for endometrial changes in the menstrual cycle?
A
Progesterone
- Proliferative & secretory phases
- *Estrogen is only for the proliferative phase
20
Q
What does FSH promote in females?
A
Folliculogenesis
21
Q
What does LH stimulate in females?
A
Ovulation
22
Q
At low doses of estrogen, what hormone does it inhibit?
A
LH
*High doses stimulate LH for ovulation
23
Q
What hormone does hCG resemble and why?
A
It’s alpha glycoprotein subunit is identical to LH!
*hCG targets the ovary and rescues the corpus luteum, preventing its degeneration and allowing it to continue secreting progesterone and estrogen until placenta fully develops
24
Q
In pregnancy, what placental hormone is the equivalent of growth hormone?
A
Human placental lactogen (hPL)
*Concentration is proportional to fetal mass, ensures adequate delivery of nutrients to the fetus
25
Which hormone sharply increases around week 28 of gestation and why?
CRH (corticotropin releasing hormone)
*Initiating role in labor and stimulating fetal cortisol production needed for fetal lung maturation
26
Which week does pre-eclampsia occur typically?
~20th week of gestation, to even 6 weeks postpartum
*HTN together with proteinuria, edema, or end-organ dysfunction
27
Reason for pre-eclampsia
Impaired remodeling of maternal spiral arteries during placentation, causing placental hypoperfusion
*Incomplete invasion of cytotrophoblasts
28
During menopause, what happens to the levels of estrogen, LH, FSH, and GnRH? Why?
Estrogen: DECREAESE
LH, FSH, GnRH: INCREASE
*Estrogen can no longer provide negative feedback on hormones
29
Function of Inhibin hormones?
Negative feedback inhibition on FSH release from the pituitary
30
If a patient has a 35 day cycle, what exact day will they ovulate on?
Day 21
*35-14 = 21
**Ovulation (beginning of luteal phase) is always 14 days before menstruation
***Luteal phase is constant (always 14 days), follicular phase can be variable
31
Why is the luteal phase so consistent in time whereas the follicular phase can be quite variable?
Due to the lifespan of the corpus luteum
*Luteal phase is always 14 days
32
For most of a woman's life, her oocytes are arrested in what cell division cycle?
Prophase I
* first meiotic division
* *Second meiotic division only after fertilization by sperm
33
What phase is an ovulated oocyte in?
Metaphase II (meiosis 2)
*During a monthly cycle, a primary oocyte becomes unattested from prophase I and completes meiosis I to form a secondary oocyte and polar body
**Secondary oocyte is formed this way and is ovulated
34
What week does hCG peak?
10 weeks gestation
35
What produces hCG (2 answers)?
Blastocyst and later the placental syncytiotrophoblast
36
What scenario would show increased FSH, decreased LH, and decreased GnRH?
Treatment for infertility
*Give GnRH analogues to prevent spontaneous LH surges and delay ovulation to increase the yield of mature oocytes
**Analogues suppress GnRH production
37
Where are most ectopic pregnancies located?
Ampulla of fallopian tube
38
List 3 causes of ectopic pregnancy
1) PID (multiple sexual partners)
2) Prior ectopic pregnancies
3) Smoking
39
History of a 1st degree relative with breast cancer is associated with increased risk of what other cancer?
Epithelial ovarian cancer
40
Erythema (eczematous changes) around the nipple could indicate what?
Pagets disease of the nipple
*Underlying adenocarcinoma within the squamous epithelium of the skin in the nipple and areola
41
Histology stains that demonstrate Pagets disease of the nipple
PAS +
| Cytokeratin +
42
What would be the diagnosis in a young patient with a small, mobile, firm nodule within the breast which fluctuates in size due to estrogen?
Fibroadenoma
43
Which tumor presents with skin changes of the nipple - lymphedema (peau d'orange)
Inflammatory carcinoma
44
What is inflammatory carcinoma frequently confused with and why?
Mastitis due to the lymphedema from the tumor cells invading lymph channels in the dermis
*Patients get prescribed antibiotics that do nothing
45
Major systemic complication of ovarian carcinoma
Ascites
46
Low & high risk HPV strains for cervical carcinoma development
6 & 11 = low risk
16, 18, 31 = high risk
47
Which nerve can be damaged due to stretching in childbirth? What does is normally innervate?
Pudendal nerve
- Sensory: Perineum
- Motor: External urethra & anal sphincters
48
_____ nerve is blocked with a local anesthetic during childbirth using the __________ as a landmark for injection
Pudendal nerve
ischial spine
49
Anatomical name for Douglas pouch in women
Rectouterine space
50
Lab finding in PCOS
2x amount of LH
| Lowered FSH
51
What produces Inhibin B in females? What's Inhibin B's role?
Granulosa cells
Inhibits FSH release from pituitary gonadotrophs
52
Karyotype of Klinefelter syndrome
47, XXY
53
Signs of Klinefelter syndrome (5)
- Gynecomastia**
- Small testes
- Infertility (absence of spermatozoa)
- Long arms & legs
- High pitched voice
54
List 1 key characteristic of the following:
- Down syndrome
- Patau syndrome
- Edwards syndrome
- Turner syndrome
- Down syndrome: Epicanthal folds
- Patau syndrome: Microcephaly
- Edwards syndrome: Rocker-bottom feet
- Turner syndrome: Webbed neck
55
What is the predominant vaginal microbiota in healthy women?
Lactobacillus
* Gram + anaerobic rods
* *Breaks down glycogen to lactic acid
56
Normal pH range of vagina
3.5-4.7
57
HER2 + has what kind of receptor? What protein would show to have high activity?
Tyrosine kinase receptor
Elevates RAS & MAPK
58
What does HELLP stand for?
Hemolytic anemia
Elevated Liver enzymes
Low Platelets
*Subset of severe pre-eclampsia
59
What is the difference between gestational hypertension & pre-eclampsia?
Gestational hypertension does NOT have proteinuria
60
Torsion of the spermatic cord causes strangulation of what vessels?
Gonadal arteries, which originate directly off of the aorta
61
How can secondary syphillus present?
Bronze colored diffuse maculopapular rash involving entire body, including palms and soles & mouth
*Diagnose with RPR (rapid plasma reagent)
62
Microscopic appearance of invasive ductal carcinoma
Desmoplastic stromal response surrounding invasive glandular structures
63
Microscopic appearance of colloid (mucinous) carcinoma
Abundant mucin secretion
64
Microscopic appearance of invasive lobular carcinoma
Single file distribution of invasive cells
65
Microscopic appearance of medullary carcinoma
Sheets of large, anaplastic tumor cells surrounded by lymphocytes & plasma cells
66
Common presentation of invasive ductal carcinoma
Palpable, fixed mass
67
What mutation is typically seen in medullary carcinoma?
BRCA1
*Usually triple negative (ER-, PR-, HER2-)
68
Physical examination reveals a cystic structure in the scrotum, which transilluminates the entire scrotum. What is the etiology of the finding?
Hydrocele
*Due to incomplete fusion of the process vaginalis
69
In males, what is the process vaginalis?
Evagination of the parietal peritoneum, descending through the inguinal canal before descent of the testis
**Normally, distal end remains patent as the tunica vaginalis
70
Predisposing risk factors for vulvovaginitis? What causes it?
Candida infection
- Diabetes
- Antibiotics
- Increased estrogen (from pregnancy, BC, estrogen)
- Immunosuppression
71
What hormone is significantly elevated in a hydatidform mole?
Beta-hCG
Thyroxine
*because of the same alpha subunit, TSH is significantly elevated, increasing thyroxine (signs are anxiety, diaphoresis, palpitations)
72
What is a complete hydatidiform mole?
Fusion of 2 spermatozoa with a single oocyte lacking a nucleus (20%)
OR
Empty ovum fertilized by single sperm with duplicate chromosome (80%)
*Cystic swellings of chorionic villi
73
Signs & labs of Androgen Insensitivity Syndrome
- 46, XY genotype
- Testosterone & LH increased
- Female external genitalia
- Testes present but fail to descend
- No male or female internal genitalia
- Bilateral masses in the labia majora (these are the undescended tests)
74
Another name for androgen insensitivity syndrome
Testicular feminization
75
Explain pathophysiology of androgen insensitivity syndrome
- Testosterone produced normally by Leydig cells in testes
- Defect in the androgen receptor
- Wolffian duct maturation needs those androgens, and thus absence of stimulation results in small or non-existent male INTERNAL genitalia (SEED)
- Female INTERNAL genitalia not present due to normal production of AMH (anti-mullerian hormone) by testes
- EXTERNAL genitalia primarily female due to inadequate DHT
76
What is seen on histology of chronic endometriosis? Is there a risk of endometrial adenocarcinoma?
- Plasma cells on biopsy
| - No risk of adenocarcinoma formation
77
Simple hyperplasia of the endometrium versus complex
SIMPLE: No atypia, benign
COMPLEX: Atypia, highly irregular glands, branching, high malignant potential
78
How does an amniotic fluid embolism occur?
When amniotic fluid enters the maternal VENOUS (not arterial!!) system and reaches pulmonary circulation, inducing ARDS
79
Causes of amniotic fluid embolism
- Abdominal trauma
- Placental abruption or previa
- Amniocentesis
- Cesarean section
- Uterine rupture
- Instrumental vaginal delivery
80
Why does amniotic fluid embolism cause ARDS
Amniotic fluid contains high amounts of prostaglandins, inducing:
- Pulmonary artery vasospasm with pulmonary hypertension**
- Hypoxia
- Left heart failure
- ARDS**
- DIC
81
Karyotype of Turner syndrome
45, X0
82
Physiologic features of Turner syndrome (3)
- Gonadal dysgenesis with atrophic streak ovaries
- Primary amenorrhea [ie: 16 year old girl has not yet had her period]
- Infertility
83
Physical features of Turner syndrome (8)
LW-CH(3)
- Webbing of neck
- Hypothyroidism
- Lymphedema
- Horseshoe kidney
- High arched palate
- Shortened 4th metacarpal
- Hydrops fetalis
- Congenital heart disease (preductal coarctation of aorta; bicuspid aortic valve)
84
Describe a patient with Turner syndrome's possibility of future fertility
Moderate probability with donor ovum
85
Why is the second X chromosome necessary in Turner syndrome?
Necessary for oogenesis and normal ovary development
*Uterus is normal so they can carry pregnancy from donor ovum
86
Most common breast mass in males under 25
Gynecomastia
*benign proliferation of ductal and stromal elements of breast due to hormonal changes (increased estrogen)
87
Presentation of intraductal papilloma. Benign or malignant potential?
Benign
-Serous or bloody nipple discharge
88
What lymph nodes do the testes drain into?
Para-aortic
89
Lab findings of Klinefelter Syndrome
- Low testosterone
- Decreased inhibin
- High FSH & LH, estrogen
90
Physical findings of 5-alpha reductase
Normal internal genitalia & testicles
Feminized external genitalia
*Male can be raised as a female and not noticed until puberty
91
Preeclampsia develops secondary to what?
Placental ischemia
92
Pregnant woman with new-onset hypertension without proteinuria, what would be diagnostic signs of pre-eclampsia? (5)
- Decreased platelets
- Pulmonary edema
- Increased creatinine
- Increased liver transaminases
- Cerebral/visual disturbances
93
Important cause of spontaneous abortion in 2nd or 3rd trimester
Chorioamnionitis
*infection of chorioamniotic membrane due to microbial pathogen
94
Which artery is responsible for postpartum hemorrhage?
Internal iliac artery
*Uterine arteries more specifically, also called hypogastric artery
95
What is Kallmann syndrome?
Idiopathic hypogonadotropic hypogonadism caused by defective migration of GnRH releasing neurons
96
Labs of Kallmann syndrome
-Decreased FSH, LH, testosterone, estrogen, progesterone
97
What fails to develop in Kallmann syndrome
Olfactory bulbs, causing anosmia
98
Male presentation of Kallmann syndrome
- Small testes
- Failure of voice to deepen
- Lack of increased muscle bulk
- No body/facial hair
99
Female presentation of Kallmann syndrome
- Primary amenorrhea
| - Absence of breast development
100
Congenital abnormalities associated with Kallmann syndrome (3)
- Midline cleft palate
- Unilateral renal agenesis
- Hearing deficit
101
Granuloma cell tumors secrete what? What are signs
Estrogen
- Abnormal bleeding
- Endometrial hyperplasia
- Breast enlargement
- Precocious puberty in kids
102
Pregnant patient presents with nystagmus, disorientation, vomiting for 3 days. What is the diagnosis and cause of her symptoms?
Wernicke encephalopathy
*Thiamine deficiency, which inhibits brain metabolism and causes neuronal injury
**Common in chronic alcoholics because of malabsorption
***This patient had hyperemesis granidarum, severe form of nausea and vomiting due to pregnancy
103
Does sclerosing adenosis have malignant potential?
Yes --> invasive carcinoma
104
Classic histology of sclerosing adenosis?
Whorled pattern
105
Proliferation of both fibrous and glandular components with no atypia is consistent with what?
Fibroadenoma
106
Dense fibrous breast tissue with focal lymphocytic infiltrate is characteristic of what and why?
Diabetic mastopathy
*Benign and only in DM1 patients because of glycosylation of connective tissue in breast
107
Strongest risk factor for developing breast cancer
Family history
108
Biggest risk factor for endometrial hyperplasia?
Obesity
*Allows chronically increased levels of endogenous estrogen due to aromatization of androgens to estrogens
109
Most common cause of nipple discharge
Intraductal papilloma
* benign
* *premenopausal women
110
What cancers can metastasize to bone?
"BLT with a Kosher Pickle"
- Breast
- Lung
- Thyroid
- Kidney
- Prostate
111
Patient has both lytic and plastic bone lesions. How can we tell what the origin of metastasis was from?
A chest xray would be negative if breast cancer, or positive if lung cancer
*We don't see breast cancers on chest xray, but obviously we do for lung
112
What condition is associated with a mass that changes in size with cycling estrogen levels?
Fibrocystic changes
*Benign
113
Common cause of fat necrosis in breast
Trauma
114
Presentation of fat necrosis of the breast
Irregular mobile non tender breast lump
115
What is a partial mole
Triploid karyotype
69, XXY
*Fertilization of an ovum with one or two sperm
116
Main two differences between complete and partial mole
COMPLETE:
- No fetal parts
- 2% risk of choriocarcinoma
- p57 negative
- hCG VERY increased
- 46, XX
PARTIAL:
- Fetal parts
- No risk for choriocarcinoma
- p57 positive
- hCG slightly increased
- 69, XXY
117
Clinic signs of mole formation (4)
1) Uterus large for gestational age
2) Snowstorm pattern on US
3) Swollen villi
4) Early preeclampsia (before 20 weeks)
118
Most common benign tumor of female reproductive tract
Leiomyoma (fibroids)
119
Histology of leiomyoma
Whorls of benign, spindle shaped smooth muscle cells
120
Macroscopic appearance of leiomyoma
Well-circumscribed, rubbery, white-tan masses
121
Tumor marker for epithelial-derived ovarian carcinomas (ie: serious & mutinous cystadenocarcinoma)
CA-125
122
Inflammatory carcinoma involves what specifically within the breast tissue?
Dermal lymphatic channels
*Reason for high stage at diagnosis
123
Atypical intraductal epithelial cell proliferation with comedo necrosis indicates what?
Ductal carcinoma in situ
*Does NOT present with skin changes or induration
124
Grossly, how do Granulosa cell tumors present
Solid, yellow ovarian masses
*producing estrogens
125
Histologically, how do Granulosa cell tumors present
Call-Exner bodies (follicle-like structures)
+ for inhibin
126
What two diseases present with "fried egg" appearance on histology
Dysgerminoma
*Seminoma is the equivalent in males
127
Bilateral ovarian cancer is metatastatic from where? What's the name of the cancer?
Gastric carcinoma (diffuse type)
Krukenberg tumor
128
Cause of functional hypothalamic amenorrhea
Intense & sustained exercise regimen with chronic dieting, which surpasses the hypothalamic secretion of GnRH
129
Lab findings of functional hypothalamic amenorrhea
LOW GnRH and estrogen
130
Frequent cause of endometrial carcinoma
Prolonged estrogen exposure in the absence of sufficient progesterone opposition
131
Tumor marker for testicular germ cell tumors
AFP
| beta-hCG
132
Function of BRCA1 & 2
DNA repair protein
133
Pregnancy & postpartum period are associated with an increased risk of thromboembolic disease in part due to changes in what?
- Increased factors 1, 2, 5, 7, 8, 10, 12
- Decrease in free protein S
- Increase in resistance to activated protein C
134
Low levels of what hormone can cause early pregnancy loss
Progesterone
135
Cause of abnormal uterine bleeding (AUB)
Anovulatory cycles
*Endometrium undergoes unopposed estrogenic stimulation
136
What does the phrase "disordered proliferative endometrium" refer to
Anovulatory cycles
*Endometrium undergoes unopposed estrogenic stimulation
137
If a young woman presents with anovulatory cycles, endometrial hyperplasia, or cancer, what could be the cause?
Unopposed estrogen such as:
- Medication use
- Ovarian granuloma cell tumor
- PCOS
138
What histological differentiates acute from chronic endometritis?
Acute: neutrophils
Chronic: plasma cells
139
Chronic endometritis is due to what?
IUD or STD (chlamydia)
140
What hormone would be given to treat endometrial hyperplasia?
Progesterone administration
*Arrests glandular proliferation and decreases mitotic activity causing secretly changes in the glands and stromal decidualization
141
What tumor marker would be seen in a Kruckenberg tumor?
CEA
142
Tumor marker of ovarian epithelial tumors (cystadenocarcinoma)
CA-125
143
Cause of Meigs syndrome & 3 characteristics of it
*Ovarian fibroma
- Hydrothorax (right sided)
- Ascites
- Ovarian fibroma
144
What is another name for uterine fibroid?
Uterine leiomyoma
*Benign smooth muscle tumor
145
Histology of endometriosis
- Hyperchromatic epithelium on H&E
- Hyperchromatic spindle shaped cells
- Hemosiderin-laden macrophages
146
Most common sites of endometriosis
- Ovaries
- Douglas Pouch
- Uterus
- Colon
147
Classic signs of pelvic congestion syndrome
1) Chronic pelvic pain
2) Increases with standing
3) Painful intercourse
148
Cause of pelvic congestion syndrome
Dilated veins within the pelvis from incompetent veins or proximal obstruction
*CT would demonstrate findings
149
CASE STUDY:
16 year old girl has not begun menstruating. Tanner stage 1 breasts & genitalia. Severely increased LH, FSH, and decreased T3 & T4. What is the most likely explanation of the abnormal sexual development in this patient?
Ovarian dysgenesis
*This is a classic presentation of Turner Syndrome
**Ovarian dysgensis leads to decreased sex steroid levels, causing compensatory increase in LH & FSH
150
List 5 causes of abnormal uterine bleeding
1) Endometrial polyps
2) Hyperplasia
3) Carcinoma
4) Endometritis
5) Leiomyoma
151
Name a benign neoplasm that grows rapidly during pregnancy and regresses after menopause (estrogen dependency)
Leiomyoma
152
Cystically dilated endometrial glands describes what pathologically?
Endometrial polyps
*Reddish-brown in color
153
Nests of benign endometrial glands within the myometrium describes what pathologically?
Adenomyosis
154
Blood gas of a pregnant woman
Compensated respiratory alkalosis
155
Describe progesterones role in respiration of the mother in pregnancy
Increases central chemoreceptor sensitivity to CO2, increasing ventilation and thus, decreasing arterial PCO2
* Causes respiratory alkalosis
* *Low bicarbonate levels in kidney to compensate alkalosis
156
Function of hPL (human placental lactogen)
Growth hormone equivalent
-Increase maternal lipolysis & ketogenesis
-Decrease maternal glucose utilization (anti-insulin)
^Cause of gestational diabetes
157
Presentation of a Sertoli-Leydig cell tumor
Ovarian neoplasm of sex cord-stomal cells secreting testosterone and causing virilization of female patients
158
How are FSH & LH affected in Sertoli-Leydig cell tumors?
Both decrease because of feedback inhibition of the high testosterone levels
159
3 key features in patients presenting with Serotli-leydig tumor
1) Rapid onset acne
2) Hirsutism
3) Amenorrhea
160
3 causes for increased levels of LH
1) Primary ovarian insufficiency
2) Pituitary disorder
3) PCOS
161
In males or females are all teratomas considered to have malignant potential post-puberty?
Males
*Solid mature teratoma
162
Another name for dermoid cyst
Mature cystic teratoma
163
Erectile physiology
1) Cavernous nerve releases ACh & NO
2) NO activates guanylate cyclase, increasing cGMP and causing smooth muscle relaxation
3) ACh increases PLC & NO
4) Vasodilation engorges the corpora cavernosa
164
Tumor marker of yolk sac tumor
AFP
165
3 main characteristics of yolk sac tumor
"SAC"
- Schiller-Duvall bodies (endodermal sinuses that resemble primitive glomeruli)
- AFP increased
- Occurs in children
166
Gross examination of a yolk sac tumor would demonstrate what?
Solid tan-grey or yellow-tan tumor with hemorrhage, necrosis, and gelatinous features (reflects presence of germ cell components)
167
A patient is diagnosed with ovarian torsion and a mass is discovered that is firm, tan, lobulated, and secretes lactate dehydrogenase (LDH). What is the tumor?
Dysgerminoma
*Malignant germ cell tumor
168
Histologically, describe dysgerminoma
Sheets of large polygonal cells with central nuclei
169
What histologically is diagnostic for a Leydig cell tumor?
Rod shaped crystals (Reinke crystals)
170
Possible precursors of invasive squamous cell carcinoma of the penis and their physical presentation
- Bowen Disease [grey-white plaque]
- Bowenoid papulosis [Multiple reddish-brown papular lesions]
- Erythroplasia of Queyrat [Soft red plaque]
- Condyloma acuminatum
- Giant condyloma
171
Characteristics of chronic endometritis histologically & main cause
Infiltration of lymphocytes, plasma cells, and histiocytes into the endometrium
*Chlamydia infection, IUD, and recent pregnancy can cause
172
Cause of acute endometritis
S. aureus
* presents with fever & foul smelling
* *Presence of micro abscesses
173
Clinical presentation of seminoma
History of cryptochidism
174
Histological presentation of seminoma
- Large cells with clear cytoplasm
| - Arranged in nests, mixed with lymphocytic stroma
175
What can HPV cause?
1) Condyloma accuminata
| 2) Squamous dysplasia [koilocytosis]
176
What clinical presentation would suggest adenomyosis?
- Severe perimenstrual pain
- Thickening of myometrium
**unknown why it occurs
177
Cryptorchidism is associated strongly with what?
INCREASED RISK OF TESTICULAR CANCER
*Both descended and non-descended at risk
