Female reproductive epithelial histology

Transformation zone
Squamocolumnar junction (most common area
for cervical cancer)

Female sexual response

cycle

Most commonly described as phase of excitement (uterus elevates, vaginal

lubrication), plateau
(expansion of inner vagina), orgasm (contraction of uterus), and resolution; mediated
by
autonomic nervous system. Also causes tachycardia and skin flushing.
*Tanner stages of sexual
development

A Tanner stage is assigned independently to genitalia, pubic hair, and breast (e.g., a
person can
have Tanner stage 2 genitalia, Tanner stage 3 pubic hair).
Lactation After labor, the in progesterone and estrogen disinhibits lactation. Suckling

is required to
maintain milk production, since nerve stimulation oxytocin and prolactin.
Prolactininduces and maintains lactation and reproductive function.
Oxytocinassists in milk letdown; also promotes uterine contractions.
Breastmilk is the ideal nutrition for infants < 6 months old. Contains maternal
immunoglobulins
(conferring passive immunity; mostly IgA), macrophages, and lymphocytes.
Breastmilk reduces
infant infections and is associated with reduced risk for the child to develop asthma,
allergies, diabetes
mellitus, and obesity. Exclusively breastfed infants require vitamin D
supplementation.
Breastfeeding decrease maternal risk of breast and ovarian cancer, and facilitates
mother-child bonding
hCG

subunit structurally identical to subunits of LH, FSH, and TSH. subunit is unique
(pregnancy tests detect subunit). hCG is increased in multiple gestations and
pathologic states (e.g.,
hydatidiform mole, choriocarcinoma).
Androgens

In the male, androgens are converted to estrogen

by cytochrome P-450 aromatase (primarily in
adipose tissue and the testis).
and they added in seminiferous tubules that both sertoli and leydig cells have
aromatase
Turner syndrome

Can result from mitotic or meiotic error.

Can be complete monosomy (45,XO) or
mosaicism (e.g., 45,XO/46,XX).

Pregnancy is possible in some cases (oocyte

donation, exogenous estradiol-17and
progesterone).
True hermaphroditism
(46,XX or 47,XXY)

Also called ovotesticular disorder of sex

development.
Aromatase deficiency Inability to synthesize estrogens from androgens.

Masculinization of female (46,XX) infants

(ambiguous genitalia), and increased serum testosterone and androstenedione. Can
present with maternal
virilization during pregnancy (fetal androgens cross the placenta).
Kallmann syndrome Failure to complete puberty; a form of hypogonadotropic

hypogonadism. Defective migration of

GnRH cells and formation of olfactory bulb; synthesis of GnRH in the hypothalamus;
anosmia;
decreased GnRH, FSH, LH, testosterone, and infertility (low sperm count in males;
amenorrhea in
females).
Hydatidiform mole

Placenta accreta/
increta/percreta

Defective decidual layer abnormal

attachment and separation after delivery.
Risk factors: prior C-section, inflammation,
placenta previa. Three types distinguishable
by the depth of penetration:
Placenta accretaplacenta attaches to
myometrium without penetrating it; most
common type.
Placenta incretaplacenta penetrates into
myometrium.
Placenta percretaplacenta penetrates
(perforates) through the myometrium and
into uterine serosa (invades entire uterine
wall); can result in placental attachment to
rectum or bladder.
Presentation: no separation of placenta after
delivery massive bleeding. Life threatening
for mother.

Polyhydramnios 1.52 L of amniotic fluid; associated with fetal malformations (e.g.,

esophageal/duodenal atresia,

anencephaly; both result in inability to swallow amniotic fluid), maternal diabetes,

fetal anemia,
multiple gestations.
Cervical pathology
Dysplasia and
carcinoma in situ

Typically asymptomatic (detected

with Pap smear) or presents as abnormal
vaginal bleeding (often postcoital).
Endometritis

Treatment: gentamicin + clindamycin with or without ampicillin

Endometriosis

Can be due to retrograde flow, metaplastic

transformation of multipotent cells, or
transportation of endometrial tissue via the
lymphatic system.
Treatment: NSAIDs, OCPs, progestins, GnRH
agonists, surgery.
Adenomyosis Extension of endometrial tissue (glandular) into

the uterine myometrium.

Caused by hyperplasia of the basalis layer of the
endometrium.
Dysmenorrhea, menorrhagia.
Uniformly enlarged, soft, globular uterus.
Treatment: hysterectomy

Adenomyoma (polyp) Well-circumscribed collection of endometrial tissue within the

uterine wall. May contain smooth

muscle cells. Can extend into the endometrial cavity in the form of a polyp.

Ovarian neoplasms Most common adnexal mass in women > 55 years old. Can be

benign or malignant. Arise from

surface epithelium, germ cells, and sex cord stromal tissue.
Majority of malignant tumors arise from epithelial cells. Majority (95%) are epithelial
(serous
cystadenocarcinoma most common). Risk with advanced age, infertility,
endometriosis, PCOS,
genetic predisposition (BRCA-1 or BRCA-2 mutation, HNPCC, strong family history).
Risk
with previous pregnancy, history of breastfeeding, OCPs, tubal ligation. Presents with
adnexal
mass, abdominal distension, bowel obstruction, pleural effusion. Diagnose surgically.
Monitor
progression by measuring CA-125 levels (not good for screening).
they changed the classification of ovarian tumors and added some drawings ( but in
general the new, important points Ill add them here) :
a benign tumor :
Thecoma Like granulosa cell tumors, may produce estrogen. Usually present as
abnormal uterine bleeding in
a postmenopausal woman.
Immature teratoma Aggressive, contains fetal tissue, neuroectoderm. Immature
teratoma is most typically represented
by immature/embryonic-like neural tissue. Mature teratoma are more likely to contain
thyroid
tissue.
Granulosa cell tumor Most common sex cord stromal tumor. Predominantly women in
their 50s. Often produce estrogen
and/or progesterone and present with abnormal uterine bleeding, sexual precocity (in
preadolescents),

breast tenderness. Histology shows Call-Exner bodies (resemble primordial follicles)

Choriocarcinoma Presents with abnormal -hCG, shortness of breath, hemoptysis.
Hematogenous spread to
lungs. Very responsive to chemotherapy.
Malignant breast
tumors

Commonly postmenopausal. Usually arise from

terminal duct lobular unit. Overexpression
of estrogen/progesterone receptors or c-erbB2
(HER-2, an EGF receptor) is common; triple
negative (ER , PR , and Her2/Neu )
more aggressive; type affects therapy and
prognosis. Axillary lymph node involvement
indicating metastasis is the single most
important prognostic factor. Most often
located in upper-outer quadrant of breast.
Risk factors: estrogen exposure, total number
of menstrual cycles, older age at 1st live birth,
obesity ( estrogen exposure as adipose tissue
converts androstenedione to estrone), BRCA1
and BRCA2 gene mutations, African American
ethnicity (increased risk for triple breast cancer).
( add whats marked )
Ductal carcinoma in
situ (DCIS)

Often seen early as microcalcifications on

mammography.
Paget disease

Also seen on vulva,

though does not suggest underlying malignancy
Common breast conditions
Proliferative breast
Disease
. Sclerosing adenosis risk (1.52) of developing cancer
Acute mastitis Treat with dicloxacillin and continued breast-feeding
Fat necrosis Abnormal calcification

on mammography; biopsy shows necrotic fat, giant cells.

Benign prostatic
hyperplasia

Characterized by a smooth, elastic, firm

nodular enlargement of the periurethral
(lateral and middle) lobes,
Testicular germ cell
tumors

Most often occur in young men. Risk factors: cryptorchidism,

Klinefelter syndrome
Seminomamost

common in 3rd decade, never in infancy

Yolk sac (endodermal

sinus) tumorAggressive malignancy of testes

Most common testicular tumor in boys < 3 years old

Choriocarcinoma Malignant, hCG. Disordered syncytiotrophoblastic and
cytotrophoblastic elements.
Hematogenous metastases to lungs and brain (may present with hemorrhagic
stroke due to
bleeding into the metastasis. May produce gynecomastia or symptoms of
hyperthyroidism (hCG
is an LH and TSH analog).
Embryonal carcinoma Malignant, hemorrhagic mass with necrosis
Penile pathology
Squamous cell
carcinoma

More common in Asia, Africa, and South America. Precursor in situ lesions: Bowen
disease (in
penile shaft, presents as leukoplakia), erythroplasia of Queyrat (cancer of glans,
presents as
erythroplakia), Bowenoid papulosis (presents as reddish papules). Associated with
HPV, lack of
circumcision