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Flashcards in Reproductive Deck (167):
1

Sonic hedgehog gene

- Produced at base of limbs in zone of polarizing activity - - Involved in patterning along anteroposterior axis and CNS development
- Mutation can cause holoprosencephaly

2

Wnt-7 gene

- Produced at apical ectodermal ridge (thickened ectoderm at distal end of each developing limb)
- Necessary for proper organization along dorsal-ventral axis

3

FGF gene

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

4

Homeobox (Hox) genes

- Involved in segmental organization of embryo in a craniocaudal direction
- Code for transcription factors
- Hox mutations → appendages in wrong locations

5

Within week 1

- hCG secretion begins around the time of implantation of blastocyst
- Blastocyst sticks at day 6

6

Within week 2

- Bilaminar disc (epiblast, hypoblast)
- 2 weeks = 2 layers

7

Weeks 3-8

- Gastrulation forms trilaminar embryonic disc
- Cells from epiblast invaginate → primitive streak → endoderm, mesoderm, ectoderm
- Notochord arises from the midline mesoderm
- Overlying the ectoderm becomes neural plate
- 3 weeks = 3 layers

8

Week 4

- Heart begins to beat
- Upper and lower limb
- 4 weeks = 4 limbs and 4 heart chambers

9

Week 6

Fetal cardiac activity visible by transvaginal ultrasound

10

Week 8

- Fetal movements start
- "Gait at week 8"

11

Week 10

Genitalia have male/female characteristics

12

Surface ectoderm

- Epidermis
- Adenohypophysis (from Rathke pouch)
- Lens of eye
- Epithelial linings of oral cavity, sensory organs of ear, and olfactory epithelium
- Epidermis
- Anal canal below the pectinate line
- Parotid, sweat and mammary glands

13

Neuroectoderm

- Brain (neurohypophysis, CNS neurons, oligodendrocytes, astrocytes, ependdymal cells, pineal gland)
- Retina
- Spinal cord

"Neuroectoderm - think CNS"

14

Neural crest

- PNS (dorsal root ganglia, cranial nerves, autonomic ganglia, Scwann cells)
- Melanocytes
- Chromaffin cells of adrenal medulla
- Parafollicular (C) cells of thyroid
- Pia and arachnoid
- Bone of skull
- Odontoblasts
- Aorticopulmonary septum
- Endocardial cushions

15

Mesoderm

- Muscle
- Bone
- Connective tissue
- Serous linings of body cavities (eg peritoneum)
- Spleen (derived from foregut mesentery)
- Cardiovascular structures
- Lymphatics
- Blood
- Wall of gut tube
- Upper vagina
- Kidneys
- Adrenal cortex
- Dermis
- Testes
- Ovaries
- Notochord induces ectoderm to form neuroectoderm (neural plate), its only postnatal derivative is the nucleus pulposus of the intervertebral disc

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

16

Endoderm

- Gut tube epithelium (including anal canal above the pectinate line)
- Most of the urethra and lower vagina (derived from urogenital sinus)
- Luminal epithelial derivatives (eg lungs, liver, gallbladder, pancreas, eustachian tube, thymus, parathyroid, thyroid follicular cells)

17

Deformation vs malformation

DEFORMATION: extrinsic disruption; occurs after embryonic period

MALFORMATION: intrinsic disruption; occurs during embryonic period (weeks 3-8)

18

ACE inhibitors

Renal damage

19

Alkylating agents

Absence of digits, multiple anomalies

20

Aminoglycosides

Ototoxicity

21

Antiepileptic drugs

- Neural tube defects
- Cardiac defects
- Cleft palate
- Skeletal abnormalities (eg phalanx/nail hypoplasia, facial dysmorphism)

- High dose folate supplementation recommended.
- Most commonly valproate, carbamazepine, phenytoin, phenobarbital

22

Diethylstibestrol

- Vaginal clear cell adenocarcinoma
- Congenital Mullerian anomalies

23

Folate antagonists

- Neural tube defects
- Includes trimethroprim, methotrexate, antiepileptic drugs

24

Isotretinoin

- Multiple severe birth defects
- Contraception mandatory

25

Lithium

Ebstein anomaly (apical displacement of tricuspid valve)

26

Methimazole

Aplasia cutis congenita

27

Tetracyclines

Discolored teeth, inhibited bone growth

28

Thalidomide

Limb defects (phocomelia, micromelia - "flipper" limbs)

29

Warfarin

- Bone deformities
- Fetal hemorrhage
- Abortion
- Ophthalmologic abnormalities

30

Alcohol

- Common cause of birth defects and intellectual diability
- Fetal alcohol syndrome

31

Cocaine

- Low birth weight
- Preterm birth
- IUGR
- Placental abruption
- Cocaine → vasoconstriction

32

Smoking (nicotine, CO)

- Low birth weight (leading cause in developed countries)
- Preterm labor
- Placental problems
- IUGR
- SIDS

33

Iodine (lack or excess)

Congenital goiter or hypothyroidism (cretinism)

34

Maternal diabetes

- Caudal regression syndrome (anal atresia to sirenomelia)
- Congenital heart defects
- Neural tube defects
- Macrosomia

35

Methylmercury

- Neurotoxicity
- Highest in swordfish, shark, tilefish and king mackerel

36

Vitamin A excess

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

37

X-rays

Microcephaly, intellectual disability. Minimized by lead shielding.

38

Fetal alcohol syndrome

- Leading cause of intellectual disability in the US
- Newborns of alcohol-consuming mothers have ↑ incidence of congenital abnormalities
- Pre and postnatal developmental retardation
- Microcephaly
- Facial abnormalities (eg smooth philtrum, thin vermillion border [upper lip], small palpebral fissures)
- Limb dislocation
- Heart defects
- Heart-lung fistulas and holoprosencephaly in most severe forms
- MECHANSIM IS FAILURE OF CELL MIGRATION

39

Dizygotic twins

Arise from 2 eggs that are separately fertilized by 2 different sperm (always 2 zygotes) and will have 2 separate amniotic sacs and 2 separate placentas (chorions)

40

Monozygotic twins

- Arise from 1 fertilized egg (1 egg + 1 sperm) that splits in early pregnancy
- The timing of cleavage determines chorionicity (number of chorions) and amnionicity (aumber of amnions)
- Cleavage at 0-4 days → dichorionic, diamniotic (25%)
- Cleavage at 4-8 days → monochorionic, diamniotic (75%)
- Cleavage at 8-12 days → monochorionic, monoamniotic (rare)
- Cleavage after 13 days → monochorionic, monoamniotic (conjoined - rare)

41

Cytotrophoblast

- Inner layer chorionic vili
- Makes cells

42

Syncytiotrophoblast

- Outer layer chorionic villi
- Synthesizes and secretes hormones (eg hCG - structurally similar to LH; stimulates corpus luteum to secrete progesterone during first trimester)
- Lacks MHC-I expression → ↓ chance of attack by maternal immune system

43

Decidua basalis

- Derived from endometrium
- Maternal blood in lacunae

44

Single umbilical artery (2-vessel cord)

Associated with congenital and chromosomal anomalies

45

Umbilical arteries and vein are derived from

Allantois

46

Urachus

- In the 3rd week the yolk sac forms the allantois, which extends into urogenital sinus
- Allantois becomes the urachus, a duct between the fetal bladder and umbilicus

47

Patent urachus

Total failure of urachus to obliterate → urine discharge from umbilicus

48

Urachal cyst

- Partial failure of urachus to obliterate
- Fluid-filled cavity lined with uroepithelium, between the umbilicus and bladder
- Can lead to infection, adenocarcinoma

49

Vesicourachal diverticulum

Slight failure of urachus to obliterate → outpouching of bladder

50

Vitelline duct

7th week - obliteration of vitelline duct (omphalo-mesenteric duct), which connects yolk sac to midgut lumen

51

Vitelline fistula

Vitelline duct fails to close → meconium discharge from umbilicus

52

Meckel diverticulum

- Partial closure of vitelline duct, with patent portion attached to ileum (true diverticulum)
- May have heterotropic gastric and/or pancreatic tissue → melena, hematochezia, abdominal pain

53

1st aortic arch

Part of maxillary artery.

"1st arch is maximal"

54

2nd aortic arch

Stapedial artery and hyoid artery.

"Second = Stapedial"

55

3rd aortic arch

Common carotid and proximal part of internal carotid artery.

"C is the 3rd letter of the alphabet"

56

4th aortic arch

- On left, aortic arch
- On right, proximal part of right subclavian artery

"4th arch (4 limbs) = systemic"

57

6th aortic arch

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

58

Right recurrent laryngeal nerve loops around

Right subclavian artery

59

Left recurrent laryngeal nerve loops around

Aortic arch distal to ductus arteriosus

60

1st branchial cleft

External auditory meatus

61

2nd-4th branchial clefts

- Temporary cervical sinuses, which are obliterated by proliferation of 2nd arch mesenchyme

62

Persistent cervical sinus

- From 2nd-4th branchial clefts
- Within lateral neck, anterior to sternocleidomastoid muscle
- IMMOBILE during swallowing

63

1st branchial arch cartilage

- Maxillary process → maxilla, zygoMatic arch
- Mandibular process → Meckel cartilage → Mandible, Malleus, and incus, sphenoMandibular ligamen

64

1st branchial arch muscles

- Muscles of Mastication (temporalis, Masseter, lateral and Medial pterygoid)
- Mylohyoid
- Anterior belly of digastric
- Tensor tympani
- Tensor veli palatini

65

1st branchial arch nerves

- CN V2 and V3
- Chew

66

2nd branchial arch cartilage

Reichert cartilage: Stapes, Styloid profess, lesser horn of the hyoid, Stylohyoid ligament

67

2nd branchial arch muscles

- Muscles of facial expression
- Stapedius
- Stylohyoid
- PlatySma
- Posterior belly of the digastric

68

2nd branchial arch nerves

- CN VII (facial expression)
- Smile

69

3rd branchial arch cartilage

Greater horn of the hyoid

70

3rd branchial arch muscles

Stylopharyngeus (think of stylopharyngeus innervated by glossopharyngeal nerve)

71

3rd branchial arch nerves

- CN IX
- Stylopharyngeus → swallow stylishly

72

4th-6th branchial arch cartilages

- Arytenoids
- Cricoid
- Corniculate
- Cuneiform
- Thyroid

"Used to sing and ACCCT"

73

4th-6th branchial arch muscles

- 4th arch: most pharyngeal constrictors, cricothyroid, levator veli palatini
- 6th arch: all intrinsic muscles of larynx except cricothyroid

74

4th-6th branchial arch nerves

- 4th arch: CN X (superior laryngeal branch) [simply swallow]
- 6th arch: CN X (recurrent laryngeal branch) [speak]

75

Pierre Robin sequence

- 1st and 2nd branchial arch defect
- Micrognathia
- Glossoptosis
- Cleft palate
- Airway obstruction

76

Treacher Collins syndrome

- 1st and 2nd branchial arch defect
- Neural crest dysfunction → mandibular hypoplasia, facial abnormalities

77

1st branchial pouch

- Middle ear cavity, eustachian tube, mastoid air cells
- Contributes to endoderm-lined structures of ear

78

2nd branchial pouch

Epithelial lining of palatine tonsil

79

3rd branchial pouch

- Dorsal wings → inferior parathyroid glands
- Ventral wings → thymus
- 3rd pouch structures end up below 4th pouch structures

80

4th branchial pouch

- Dorsal wings → superior parathyroid glands
- Ventral wings → ultimobranchial body → parafollicular C cells of thyroid

81

DiGeorge syndrome

- Chromosome 22q11 deletion
- Aberrant development of 3rd and 4th pouches → T cell deficiency (thymic aplasia) and hypocalcemia (failure of parathyroid development)
- Associated with cardiac defects (conotruncal anomalies)

82

Cleft lip

Failure of fusion of the maxillary and medial nasal processes (formation of primary palate)

83

Cleft palate

Failure of fusion of the 2 lateral palatine shelves or failure of fusion of lateral palatine shelves with the nasal septum and/or median palatine shelf (formation of secondary palate)

84

Female genital embryology

- Default development
- Mesonephric duct degenerates and paramesonephric duct develops

85

Male genital embryology

- SRY gene on Y chromosome - produce testis-determining factor → testes development
- Sertoli cells secrete Mullerian inhibitory factor (MIF) that suppresses development of paramesonephric ducts
- Leydig cells secrete androgens that stimulate development of mesonephric ducts

86

Paramesonephric (Mullerian) duct

- Develops into female internal structures - fallopian tubes, uterus, upper portion of vagina (lower portion from urogenital sinus)
- Male remnant is appendix testis

87

Mesonephric (Wolffian) duct

- Develops into male internal structures (except prostate) - Seminal vesicles, Epididymis, Ejaculatory duct, Ductus deferens (SEED)
- In females, remnant of mesonephric duct → Gartner duct

88

Mullerian agenesis (Mayer-Rokitansky-Kuster-Hauser syndrome)

May present as primary amenorrhea (due to a lack of uterine development) in females with fully developed secondary sexual characteristics (functional ovaries)

89

Septate uterus

- Commonly anomaly vs normal uterus
- Incomplete resorption of septum
- ↓ fertility
- Treat with septoplasty

90

Bicornuate uterus

- Incomplete fusion of Mullerian ducts
- ↑ risk of complicated pregnancy

91

Uterus didelphys

- Complete failure of fusion → double uterus, vagina, cervix
- Pregnancy possible

92

Genital tubercle

- DHT → glans tubercle, corpus cavernosum, spongiosum
- ESTROGEN → glans clitoris, vestibular bulbs

93

Urogenitalsinus

- DHT → bulbourethral glands (of cowper), prostate gland
- ESTROGEN → greater vestibular glands (of Bartholin), urethral and paraurethral glands (of Skene)

94

Urogenital folds

- DHT → ventral shaft of penis (penile urethra)
- ESTROGEN → labia minora

95

Labioscrotal swelling

- DHT → scrotum
- ESTROGEN → labia majora

96

Hypospadias

- Abnormal opening of penile urethra on ventral surface of penis due to failure of urethral folds to fuse
- Associated with inguinal hernia and cryptorchidism

97

Epispadias

- Abnormal opening of penile urethra on dorsal surface of penis due to faulty positioning of genital tubercle
- Associated with exostrophy

98

Gubernaculum (band of fibrous tissue)

- MALE REMNANT: anchors testes within scrotum
- FEMALE REMNANT: ovarian ligament + round ligament of the uterus

99

Processus vaginalis (evagination of peritoneum)

- MALE REMNANT: forms tunica vaginalis
- FEMALE REMNANT: obliterated

100

Gonadal venous drainage

Left ovary/testis → left gonadal vein → left renal vein → IVC

Right ovary/testis → right gonadal vein → IVC

101

Gonadal lymphatic drainage

Ovaries/testes → para-aortic lymph noes

Body of uterus/ cervix/ superior bladder → external iliac nodes

Prostate/ cervix/ corpus cavernosum/ proximal vagina → internal iliac nodes

Distal vagina/ vulva/ scrotum/ distal anus → superficial inguinal nodes

Glans penis → deep inguinal nodes

102

Infundibular ligament

- Suspensory ligament of the ovary
- Connects ovaries to lateral pelvic wall
- Contains ovarian vessels
- Ligate vessels during oophorectomy to avoid bleeding
- Ureters course retroperitoneally, close to gonadal vessels → at risk of injury during ligation of ovarian vessels

103

Cardinal ligament

- Connects cervix to side of wall of pelvis
- Contains uterine vessels
- Ureter at risk of injury during ligation of uterine vessels in hysterectomy

104

Round ligament of the uterus

- Connects uterine fundus to labia majora
- Derivative of gubernaculum
- Travels through round inguinal canal above the artery of Sampson

105

Broad ligament

- Connects uterus, fallopian tubes, and ovaries to pelvic wall
- Contains ovaries, fallopian tubes, round ligament of the uterus
- It is a fold of peritoneum that comprises the MESOSALPINX, MESOMETRIUM, and MESOVARIUM

106

Ovarian ligament

- Connects medial pole of ovary to lateral uterus
- Derivative of gubernaculum

107

Compare histology of the uterus during proliferative and secretory phase

- Simple columnar epithelium
- PROLIFERATIVE: with long tubular glands
- SECRETORY: with coiled glands

108

Urethral injury from pelvic fracture

Damage to posterior urethra - membranous urethra, specifically. Injury can cause urine to lead into retropubic space.

109

Urethral injury from perineal straddle injury

Damage to anterior urethra - bulbar and penile urethra. Injury can cause urine to leak beneath deep fascia of Buck. If fascia is torn, urine escapes into superficial perineal space.

110

How does progesterone influence the myometrium

↓ myometrium excitability

111

How does progesterone influence body temperature

↑ body temperature

112

Length of luteal phase

14 days

113

When does menstruation occur

Ovulation + 14 days = menstruation

114

When is follicular growth fastest

During the 2nd week of the follicular phase

115

When does implantation occur

Implantation within the wall of the uterus occurs 6 days after fertilization.

116

When does hCG begin to be secreted

Sycytiotrophoblasts secrete hCG, which is detectable in blood 1 week after conception and on home test in urine 2 weeks after conception

117

Gestational age

Calculated from date of last menstrual period

118

Embryonic age

Calculated from date of conception (gestational age minus 2 weeks)

119

Physiologic adaptations in pregnancy

- ↑ CO (↑ preload, ↓ afterload, ↑ HR → ↑ placental and renal perfusion)
- Anemia (↑↑ plasma, ↑ RBCs → ↓ viscosity)
- Hypercoaguability (to ↓ blood loss at delivery)
- Hyperventilation (eliminate fetal CO2)

120

When does hCG peak

8-10 weeks

121

Function of hCG

- Maintains corpus luteum (and thus progesterone) for first 8-10 weeks of pregnancy by acting like LH (otherwise no luteal cell stimulation → abortion)
- After 8-10 weeks, placenta synthesizes its own estriol and progesterone and corpus luteum degenerates
- Has identical α subunit as LH, FSH, TSH (states of ↑ hCG can cause hyperthyroidism)
- β subunit is unique (pregnancy tests for this)
- ↑ in multiple gestations, hydatiform moles, choriocarcinomas, and Down syndrome
- ↓ in ectopic/failing pregnancy, Edward syndrome, and Patau syndrome

122

What does APGAR stand for

Appearance, Pulse, Grimace, Activity, and Respiration

123

Low birth weight is associated with

- ↑ risk of SIDS
- Impaired thermoregulation and immune function
- Hypoglycemia
- Polycythemia
- Impaired neurocognitive/ emotional development

124

What coordinates closing of the epiphyseal plates

Estrogen converted from testosterone

125

Effects of exogenous testosterone

Inhibition of hypothalamic-pituitary-gonadal axis → ↓ intratesticular testosterone → ↓ testicular size → azoospermia

126

Klinefelter syndrome labs

- (47, XXY)
- Dysgenesis of seminiferous tubules → ↓ inhibin B → ↑ FSH
- Abnormal Leydig cell function → ↓ testosterone → ↑ LH → ↑ estrogen

127

Turner syndrome labs

- (46, XO)
- ↓ estrogen → ↑ LH, ↑ FSH

128

Double Y males

- XYY
- Phenotypically normal (usually undiagnosed), very tall
- Normal fertility
- May be associated with severe acne, learning disability, autism and spectrum disorders

129

Ovotesticular disorder of sex development

- 46, XX > 46, XY
- Both ovarian and testicular tissue present (ovotestis)
- Ambiguous genitalia
- Previously called true hermaphrodtism

130

Defective androgen receptor labs

↑ testosterone, ↑ LH

131

Testosterone-secreting tumor, exogenous steroids labs

↑ testosterone, ↓ LH

132

Primary hypogonadism labs

↓ testosterone, ↑ LH

133

Hypogonadotropic hypogonadism

↓ testosterone, ↓ LH

134

Placental aromatase deficiency

- Inability to synthesize estrogens from androgens
- Masculinization of female (46, XX) infants (ambiguous genitalia), ↑ testosterone and androstenedione
- Can present with maternal virilization during pregnancy (fetal androgens can cross the placenta)

135

Androgen insensitivity syndrome

- 46, XY
- Defect in androgen receptor resulting in normal-appearing female
- Female external genitalia with scant sexual hair, rudimentary vagina
- Uterus and fallopian tubes absent
- Patients develop normal functioning testes (often found in labia majora; surgically removed to prevent malignancy)
- ↑ testosterone, estrogen, LH

136

5α-reductase deficiency

- AR
- Sex limited to genetic males (46, XY)
- Inability to convert testosterone to DHT
- Ambiguous genitalia until puberty, when ↑ testosterone causes masculinization/ ↑ growth of external genitalia
- Testostrone/estrogen levels are normal
- LH is normal or ↑
- Internal genitalia are normal

137

Kallmann syndrome

- Failure to complete puberty
- A form of hypogonadotropic hypogonadism
- Defective migration of GnRH cells and formation of olfactory bulb
-↓ GnRH synthesis in the hypothalamus
- ANOSMIA
- ↓ GnRH, FSH, LH, testosterone
- Infertility (low sperm count in males, amenorrhea in females)

138

Placental abruption (abruptio placentae)

- Premature separation (partial or complete) of placenta from uterine wall before delivery of infant
- RISK FACTORS: trauma, smoking, hypertension, preeclampsia, cocaine abuse
- PRSENTATION: abrupt, painful bleeding (concealed or apparent) in 3rd trimester; possible DIC, maternal shock, fetal distress
- Life threatening for mother and fetus

139

Placenta accreta/ increta/ percreta

- Defective decidual layer → abnormal attachment and separation after delivery
- RISK FACTORS: prior C-section, inflammation, placenta previa
- 3 types distinguishable by depth of penetration
- PRESENTATION: often detected on ultrasound prior to delivery
- No separation of placenta after delivery → postpartum bleeding (can cause Sheehan syndrome)

140

Placenta accreta

Placenta attaches to myometrium without penetrating it, most common type

141

Placenta increta

Placenta penetrates into myometrium

142

Placenta percreta

Placenta penetrates ("perforates") through myometrium and into uterine serosa (invades entire uterine wall); can result in placental attachment to rectum or bladder

143

Placenta previa

- Attachment of placenta to lower uterine segment over (or

144

Vasa previa

- Fetal vessels run over, or in close proximity to, cervical os
- May result in vessel rupture, exsanguination, fetal death
- TRIAD: MEMBRANE RUPTURE, PAINLESS VAGINAL BLEEDING, FETAL BRADYCARDIA (

145

Postpartum hemorrhage

- Due to 4 Ts
- Tone (uterine atony, most common)
- Trauma (lacerations, incisions, uterine rupture)
- Thrombin (coagulopathy)
- Tissue (retained products of conception)

146

Cause of preeclampsia

Caused by abnormal placental spiral arteries → endothelial dysfunction, vasoconstriction, ischemia

147

When does preeclampsia present

New-onset hypertension with either proteinuria or end-organ dysfunction after 20th week of gestation (

148

Complications of preeclampsia

- Placental abruption
- Coagulopathy
- Renal failure
- Uteroplacental insufficiency
- Ecclampsia

149

Gestational hypertension

- Pregnancy induced hypertension
- Presents after 20th week
- NO PROTEINURIA OR END-ORGAN DAMAGE

150

HELLP syndrome can lead to

Hepatic subcapsular hematomas → rupture → severe hypotension

151

Compare follicular and theca-lutein cysts

- FOLLICULAR CYST: distention of unruptured graafian follicle; may be associated with hyperestrogenism, endometrial hyperplasia; most common ovarian mass in young women
- THECA-LUTEIN CYST: often bilateral/multiple; due to gonadotropin stimulation; associated with choriocarcinoma and hydatiform moles

152

Which ovarian neoplasm is associated with pseudomyxoma peritonei

Mucinous cystadenocarcinoma. It is an intraperitoneal accumulation of mucinous material from ovarian or appendiceal tumor.

153

What type of teratoma contains neuroectoderm

Immature teratomas. Malignant, aggressive. Typically represented by immature/embryonic like neural tissue. Usually post-menopausal (mature cystic teratomas/dermoid cysts generally present in women 10-30)

154

Lynch syndrome is a risk factor for what endometrial condition

Endometrial carcinoma

155

Fibrocystic changes

- Most common in premenopausal women > 35 years
- Presents with premenstual breast pain or lumps; often bilateral and multifocal
- Nonproliferative lesions include simple cysts (fluid-filled duct dilation, blue dome), papillary apocrine change/metaplasia, stromal fibrosis
- Risk of cancer is usually not increased

156

Comedocarcinoma

- Ductal, central necrosis
- Subtype of DCIS

157

Peyronie disease

- Abnormal curvature of penis due to fibrous plaques within tunica albuginea
- Associated with erectile dysfuction
- Can cause pain, anxiety
- Consider surgical repair once curvature stabilizes
- Distinct from PENILE FRACTURE (rupture of corpora cavernosum due to forced bending)

158

Dilation of which veins causes varicocele

Pampiniform plexus

159

Extragonadal germ cell tumors

- Arise in midline locations
- In adults, most commonly in retroperitoneum, mediastinum, pineal and suprasellar regions
- In infants and young children, sacrococcygeal teratomas are more common

160

Congenital hydrocele

Common cause of scrotal swellings in infants, due to incomplete obliteration of processus vaginalis

161

Acquired hydrocele

- Scrotal fluid collection usually secondary to infectin, trauma or tumor
- If bloody → hematocele

162

Spermatocele

- Cyst due to dilated epididymal duct or rete testis
- Paratesticular fluctuant nodule

163

Leydig cell tumor

- Golden brown color
- Contains Reinke crystals (eosinophilic cytoplasmic inclusions)
- Produce androgens or estrogens → gynecomastia in men, precocious puberty in boys

164

Sertoli cell tumor

Androblastoma from sex cord stroma

165

Testicular lymphoma

- Most common testicular cancer in older men
- Not a primary cancer
- Arises from metastatic lymphoma to testes
- Aggressive

166

Is BPH hyperplasia or hypertrophy

Smooth, elastic firm nodular enlargement (hyperplasia not hypertrophy) of periurethral (lateral and middle lobes) which compress the urethra into a vertical slit. NOT premalignant.

167

Prostatitis

- Dysuria, frequency, urgency, low back pain
- Warm, tender, enlarged prostate
- ACUTE: bacterial
- CHRONIC: bacterial or abacterial