Download PMD 12. Reproddisorders.doc

D’YOUVILLE COLLEGE
PMD 604 - ANATOMY, PHYSIOLOGY, PATHOLOGY II
Lecture 12: Reproductive Disorders
Robbins chapters 18 & 19
1.
Male Reproductive Disorders:
• disorders of penis:
- hypospadias & epispadias: abnormal formations of urethra in which external
opening is on ventral (hypospadia) or dorsal (epispadia) surface of penis; rare
disorders (usually congenital) that may cause obstruction or urinary incontinence;
surgical correction
- inflammations: glans & prepuce are usual sites
- may be attributable to poor hygiene (mostly in uncircumcised
individuals); materials accumulated under prepuce (smegma) may contain irritants or
infective agents that provoke inflammation
- sexually transmitted diseases (STDs) are usual sources of infections
-tumors: squamous cell carcinomas are most frequent type; most often
associated with human papilloma virus (HPV) infection
• testicular disorders:
- cryptorchidism (failure of testicular descent) (ppt. 1) is a congenital defect
that results in atrophy of seminiferous tubules (ppt. 2); if condition is unilateral,
fertility may be retained; bilateral cryptorchidism or accompanying contralateral atrophy
results in sterility
- testosterone production is normal
- an undescended testis is more vulnerable to tumor development
- inflammations may result from genitourinary infections (e.g. STDs); chronic
inflammations may involve autoimmune lesions (e.g. following tuberculosis)
- testicular tumors: majority develop from spermatogenic tissue (germ
cells)
- tumors that retain spermatogenic cell characteristics (seminomas) are less
likely to metastasize & are sensitive to radiation so cure rates are high
- nonseminomatous tumors involve neoplasias that express more
totipotent characteristics (e.g. trophoblastic traits, yolk sac traits, or undifferentiated
traits); tumor markers that may be detected include hCG (trophoblastic product) and
 fetoprotein (yolk sac product)
metastases spread to epididymis, pelvic lymph nodes, urethra & bladder, and lungs;
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• prostate disorders:
- prostatitis: bacterial (acute) or fungal (chronic) infection
- benign prostatic hypertrophy (BPH): normal increase in size (hyperplasia,
not hypertrophy) after age 45, increases frequency with age; more appropriately
known as nodular hyperplasia; nodular characteristics vary according to regional
distribution of hyperplastic growth (fig. 18 - 10 & ppt. 3)
- may contribute to urinary obstruction in more severe cases (fig. 18 - 11 &
ppt. 4)
- increased risk of bladder infection or pyelonephritis due to urine
retention
- prostatic carcinoma: no evidence that tumor development is linked to
BPH
- tumors are often smaller & peripheral, so little urinary obstruction
occurs and tumors can progress substantially before detection (fig. 18 - 13 & ppt. 5)
- advanced neoplasms have increased risk of metastasis
- detected by testing for elevation of prostate specific antigen (PSA)
2.
Female Reproductive Disorders:
• pelvic inflammatory disease: vaginal infections, e.g., from sexually
transmitted diseases (STDs), may pass into uterus, uterine tubes, ovaries and other
points in peritoneal cavity; purulent exudate results & may be expelled via vagina or
produce abscesses more internally
- sexual promiscuity increases risk as does such interventions as C-section
surgery, D & C surgery and even high frequency of vaginal douching
- scarring from inflammatory response may produce adhesions, strictures of
uterine tubes, tubal and/or ovarian abscesses; scarring (evident in endoscopic exam)
is diagnostic
- likely loss of fertility
- predisposes patient to such conditions as endometriosis, ectopic pregnancy or
ovarian tumors
• uterine disorders: usually involve lining (endometrium), cervical epithelium
or muscular wall (myometrium); often accompanied by uterine bleeding
- cervical carcinoma follows a standard progression involving dysplasia in
transformational zone (fig. 19 - 5 & ppt. 6); these growths are termed cervical
intraepithelial neoplasias (CINs) and some more severe growths may develop into
cancer (fig. 19 - 6 & ppt. 7)
- most often related to exposure of exocervix to human papilloma virus
(HPV) infections, frequently as a result of sexual promiscuity
- cancers are mostly squamous cell carcinomas or adenocarcinomas
- metastasis via lymphatics, especially targets liver or lungs
- PAP smear usually detects growth changes before carcinoma develops
(fig. 19 - 8 & ppt. 8) & has substantially reduced incidence of squamous cell carcinomas
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- endometriosis is a condition involving bits of endometrium that become
established at extrauterine sites (mostly ovaries, but also lymphatics or distant sites)
- may spread via vascular or lymphatic embolization, regurgitation of
menses through uterine tube or metaplasia of peritoneum (fig. 19 - 10 & ppt. 9)
- the tissue cycles like the intrauterine endometrium (proliferation,
secretion, necrosis & bleeding) with associated pain, cramping & dysmenorrhea
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- endometrial carcinoma may be caused by excessive levels of estrogen
(endometrioid carcinoma) or a genetic mutation (serous carcinoma)
- may invade myometrium, metastasize to ovaries or lungs
- usual treatment is hysterectomy
• ovarian disorders:
- ovarian cysts may develop from graafian follicles
- polycystic ovarian syndrome (PCO): enzyme defect causes excessive
androgen production, resulting in hirsutism
- conversion of androgens to estrogens in adipose generates a feedback
that disrupts normal hypothalamo-hypophysial-gonad axis function, resulting in
anovulation with development of multiple cysts & infertility (ppt. 10)
- ovarian tumors: malignancies are particularly dangerous since detection is
unlikely to precede metastasis
- tumors may arise via transformation of various ovarian cell types (fig.
19 - 16 & ppt. 11)
- tumors of germ cell tissue are mostly benign; epithelial tumors are more
often malignant and may resemble endometrium (endometrioid adenocarcinoma)
• disorders of pregnancy:
- ectopic pregnancy: implantation occurs at a site other than the intrauterine
endometrium (mostly in uterine tube)
- may develop with endometriosis or with obstructed uterine tube as a
sequel of pelvic inflammatory disease
- embryonic growth may burst uterine tube causing hemorrhage and
circulatory shock, but many cases lead to spontaneous degeneration & resorption
(approximately 40% of all pregnancies end in spontaneous abortion for various
genetic &/or congenital reasons)
- gestational tumor: two main growths, both associated with elevated hCG
- the invasive mole, which doesn't metastasize, but may perforate uterine
wall; associated with chromosomal aberration involving extra paternal chromosomes
- the highly malignant choriocarcinoma, which may be associated with
normal or unsuccessful pregnancies; metastasizes early & widely
- preeclampsia/eclampsia: pregnancy-induced hypertension, accompanied
by loss of albumin in urine (albuminuria) and systemic edema (preeclampsia)
- placental ischemia & infarction due to abnormal placental blood flow may
cause emergence of seizures (eclampsia) (ppt. 12)
• breast cancer:
- two types of neoplasia include carcinoma in situ (CIS), which is
noninvasive, but may transform to invasive carcinoma
- the first develops in ducts and glandular tissue, while the invasive type spreads
to stroma and lymphatics and can metastasize; metastasis may be delayed for years
- treatment involves surgical removal (lumpectomy or mastectomy) often
followed by tamoxifen, a drug that blocks estrogen support of tumor growth
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- TNM grading system is widely used to determine treatment options (ppt.
13)