Genital and Gestational Pathology Prac

disruption at any level in the hypothalamic–pituitary–ovarian (HPO) axis - Hypothalamic and brain, Pituitary,Ovarian, Systemic.
Common causes are Stress, menarche, menopause, anorexia nervosa

excessive proliferation and thickness of the endometrial cells in the uterus lining.

hyperestrinism with the absence of progesterone. Commonly occurs after menopause in PCOS

endometrial cancer

When there lacks an enzyme in the adrenal gland, which results in an overproduction of androgens - causes androgeny in women and shortness in adult men - and lower production in cortisol and aldosterone

A condition where endometrial cells appear and flourish in aberrant locations outside the uterus

ovaries, interuterine ligaments, rectovaginal septum, pelvic peritoneum

vulva, vagina, appendix, umbilicus

severe dysmenorrhea and pelvic pain, infertility

laparoscopy looking for endometrial lesions, stroma or haemosiderin which is degraded haemoglobin

Regurgitation theory:
retrograde blood flow to the fallopian tubes where endometrial cells are regurgitated and adhere to the wall of peritoneal cavity
Metaplastic theory:
Where the coelomic epithelium undergoes metaplasia - causing endometrial cells on the epithelium of abdominal organs
Vascular/dissemination theory:
dissemination through lymph network and pelvic veins to explain lesions in lungs and lymph nodes.

unilateral or bilateral failure for testis to descend.

genital ridge, abdomen, inguinal canal scrotal sac

abdomen in 15% of cases, inguinal canal 25%, high scrotal 60%

at birth 3-4%, at 1yo 1%

infertility, increased risk of malignancy (4-5times) and increase of trauma due to location and crushing against ligaments and bones.

Treatment is orchiplexy, surgical placement of the testicle in the scrotal sac before 2yo of age. This may not restore fertility later on.

12-18 year olds

twisting of spermatic cord

boys with bell clapper gubernaculums - allows testis free movement to twist and move in the scrotal sac.

if rescued within 6 hours it is 100% recoverable, in 24hrs it is irretrievable and requires removal.

genital herpes (HSV), human papilloma virus (HPV), Human Immunodeficiency virus (HIV)

gonorrhea, chlamydia, mycoplasma & syphilis

Chlamydia, gonorrhea, HIV, Syphilis, Hep B

replicate at the site of infection in skin and mucous membranes. HSV1&2 affect skin and genitals

fluid filled vesicles which ulcerate after rupture

the virus remains in previously disrupted nerve cells to ganglion. They wait until reactivation, caused by depleted immunity, which causes spread of the disease.

during outbreak

over 100

1,2,4 and 7

16 and 18

cancer of the cervix, mouth, throat, anus, and 80% of penile cancers, which is rare in Aus due to hygeine and circumcision

between 20 - 30

Neisseria gonorrhoea diplococcus which is a gram negative bacteria

through columnar epithelium

False it is more common in women than in men

False it can present asymptomatically

Yes, it affects IgA and raises the likelihood of becoming infected with other STIs

burning during urination, itchiness and yellow discharge

Chlamydia trachomatis is a gram negative obligate intracellular pathogen of columnar epithelial cells.

burning, itching, yellow discharge and urethritis

True

True

Gonorrhoea

chlamydia

PID refers to the infection of the uterus, fallopian tubes and other reproductive organs

results from three main organisms gonorrhoea, chlamydia and ascending infection strep, staph, enteric bacteria

pelvic pain, fever, vaginal discharge

infertility

PID causes salpingitis which is the inflammation of the fallopian tubes, if after scarring after chronic inflammation, the tubes are partially blocked the fertilised egg may remain in the fallopian tube.

peritonitis
intestinal obstruction
bacteremia
infertility
ectopic pregnancy

salpingitis, cervicitis, vaginitis, endometritis

Caused by treponema pallidum

a systemic venereal disease with multiple presentations that eventually has CNS involvement

occurs approx 3 weeks after contact. Begins with chancre lesion. Lyphadenopathy may occur in primary or secondary stage.

occurs 2 months - 2 years after initial infection. Spread of spirochetes, fever arthritis, lymphadenopathy

2-20 years after initial infection. Active inflammation of the aorta, heart and CNS

90% 25-45 yo
90% curable
90% malignant
90% germ cell origin (5% leydig cells, sertoli cells, 5% metastases)

Seminoma
•Malignant nonseminomatous germ cell tumor
–Embryonal carcinoma
–Teratocarcinoma
–Choriocarcinoma
•Mixed germ cell tumors
•Teratoma
•Yolk sac tumor of infancy
•Sex cord tumours
–Leydig & Sertoli cells

Benign prostatic hyperplasia, and carcinoma of the prostate

affects 70% of men over 60

Acute urine retention
Frequent urination
Nocturia
Poor stream

Hyperplasia causes obstruction of the urethra leading to the retention of urine in the bladder. Greater pressure then in required for micturition which causes the ureterovesical angle to become less oblique and loss of valve function. High urine pressure is then transferred up the ureters from the bladder causing megaureter and hydronephrosis. Renal tissue undergoes atrophy - both ureters are affected so will result in renal failure

most common cancer in men, and is the 3rd highest cancer in terms of cancer related deaths

age, hormone influences, genetics, race, but otherwise unknown risk factors

hematogenous spread often seeds the carcinoma in bone, lymph spread to other organs

there is a similar argument that there is dysplasia and cellular changes as early as 10 years prior to neoplasia

70% in the peripheral zone of the prostate as opposed to prostatic hyperplasia found in the central zone

SCC at 90%

stands for cervix intraepithelial neoplasia and extends from CIN1,2,3.
CIN1 is mild dysplasia
CIN2 is moderate dysplasia
CIN3 is carcinoma in situ

72% sensitivity and 94% specificity

lymph node involvement, size, invasion and metastatic potential

Stage 1 85% confined to cervix
Stage 2 75% upper vagina
Stage 3 35% lower vagina and pelvic wall
Stage 4 10% metastases

Tumours of the myometrium and the endometrium

Leiomyomas and Leiomyosarcomas, benign is common, malignant is rare

adenosarcoma, and common

fibroids, 25% women, subserosal, submucosal, intramural.

hyperestrinism, endometrial hyperplasia, perimenopause, post menopause, endometriosis

Poor after Stage 1 which is 90%, then 50%, 20% and 5%

True

epithelium, germ cells, sex cord stroma, non specific stroma

6% in cancers in women

nulliparity, family history, BRCA1, BRCA 2

dermoid cyst

Women younger than 25

multipotential --> any tissue type, often mixed cell tumour

fertilised egg outside of the uterus.

False. 50% are

intratubal haemorrage from dissociating placenta, intratubal rupture, regression and abdominal abortion

tumour like condition of pregnancy associated trophoblastic tissue

A hydatidiform mole is a rare mass or growth that forms inside the uterus at the beginning of a pregnancy. It is a type of gestational trophoblastic disease.
Two types of moles, incomplete and partial. Complete sperm fetilizes an ovum with no nucelus, or two sperm fertilize an empty egg. (androgenesis)

Partial mole are normally triploidy

Complete molar pregnancies are linked to choriocarcinoma (2%)