D’YOUVILLE COLLEGE
BIOLOGY 307/607 - PATHOPHYSIOLOGY
Lecture 19 - REPRODUCTIVE DISORDERS
Chapter 19
1.
Male Reproductive System:
• sperm from testes reach exterior via epididymis to vas deferens; vas deferens
joins urethra within prostate and continues via urethra through penis; seminal glands &
bulbourethral glands add secretions en route
• testes (figs. 19 - 1, 19 - 5 & ppts. 1 & 2): primary sex organs of male; produce
spermatozoa that are conveyed in fluids secreted by sex accessories
- spermatogenesis occurs in seminiferous tubules of testis (fig. 19 - 2 & ppt. 3)
- requires a lower temperature than the body interior; this necessitates descent
of testes into scrotum during fetal development (fig. 19 - 3 & ppt. 4)
• testicular disorders:
- cryptorchidism (failure of testicular descent) is a congenital defect that
results in atrophy of seminiferous tubules (fig. 19 - 4 & ppt. 5) with resultant sterility
- testosterone production is normal
- an undescended testis is more vulnerable to tumor development
- testicular tumors nearly always develop from spermatogenic tissue (germ
cells); tumor growth causes pain due to pressure within the non-elastic capsule
(tunica albuginea) enclosing seminiferous tubules; metastases spread to epididymis,
pelvic lymph nodes, urethra & bladder, and lungs; tumors (seminomas) are sensitive
to radiation so cure rates are high
Bio 307/607 lec 19
- p. 2 -
• prostate disorders:
- benign prostatic hyperplasia (BPH): normal increase in size after age 45
- may contribute to urinary obstruction in more severe cases, possibly leading
to swelling of ureters, pelvis & calyces (hydronephrosis)
- 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
- increased risk of metastasis
- detected by testing for elevation of prostate specific antigen (PSA)
2.
Female Reproductive System (fig. 19 - 7 & ppt. 6):
• ova are released into body cavity & conveyed into uterine tubes (site of
fertilization, if suitably timed intercourse has occurred)
- ovum or conceptus proceeds to uterus (fig. 19 - 8 & ppt. 7) where the
unfertilized egg will be shed with sloughing endometrium (menstrual flow) or conceptus
will be implanted in endometrium that has undergone hyperplasia (ppt. 8)
- maintained by the hormonal environment
• ovaries: primary sex organs of female (ppt. 9); produce follicles that are
structures that nurture the developing oocyte as it matures into ovum
- vagina serves as passageway for menstrual discharge, birth canal for delivery
of newborn (parturition) and site of intromission of penis during sexual intercourse
Bio 307/607 lec 19
- p. 3 -
• 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; also increased risk with 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 endometriosis, ectopic pregnancy or ovarian tumors
• uterine disorders: usually involve endometrium, cervical epithelium or
myometrium (fig. 19 - 8 & ppt. 7); often accompanied by uterine bleeding
- hormonal imbalances producing anovulatory cycles may be the cause of
dysfunctional uterine bleeding because of disturbed endometrial development
- endometriosis is a condition involving bits of endometrium that become
established at extrauterine sites (mostly ovaries, but also lymphatics or distant sites)
- the tissue cycles like the intrauterine endometrium (proliferation,
secretion, necrosis & bleeding) with associated pain & cramping
- dysmenorrhea: pain & cramping during ovulation; appears to be caused by
excessive prostaglandin action on myometrium; other smooth muscle involvement
may lead to headache, nausea, and vomiting; treated with NSAIDs
- premenstrual dysphoric disorder (aka premenstrual syndrome - PMS):
involves abdominal discomfort, systemic edema, headache, breast fullness, and
psychological components affecting irritability, mood, anxiety, etc.
Bio 307/607 lec 19
- p. 4 -
- an ill-defined hormonal imbalance appears to be underlying cause
- endometrial carcinoma seems to be caused by abnormal levels of estrogen
- may invade myometrium, metastasize to ovaries or lungs
- usual treatment is hysterectomy
- cervical carcinoma follows a standard progression - metaplasia, dysplasia, &
neoplasia in transformational zone (fig. 19 - 9 & ppt. 10); related to exposure of exocervix
to vaginal influences such as acidity, trauma of coitus &/or childbirth
- carcinomas may break through basement membranes facilitating
metastasis via lymphatics, especially to liver or lungs
- PAP smear usually detects growth changes before carcinoma develops
cycle
• ovarian disorders:
- ovarian cysts may develop from graafian follicles & produce an anovulatory
- polycystic ovarian syndrome (PCO): less common condition deriving
from enzyme defect that causes excessive androgen production, resulting in hirsutism
- conversion of androgens to estrogens in adipose generates a feedback
that disrupts normal hypothalamo-hypophysio-gonad axis function, resulting in
anovulation with development of multiple cysts (fig. 19 - 12 & ppt. 11)
- ovarian tumors: malignancies are particularly dangerous since detection is
unlikely to precede metastasis
- tumors of germ cell tissue are mostly benign
- epithelial tumors are more often malignant
Bio 307/607 lec 19
- p. 5 -
• disorders of pregnancy:
- ectopic pregnancy: implantation occurs at a site other than the intrauterine
endometrium (mostly in uterine tube)
- may be associated with endometriosis or with obstruction of 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 (40% of all
pregnancies end in spontaneous abortion for various genetic &/or congenital reasons)
- gestational tumor: two main growths are the invasive mole, which
doesn't metastasize, but may perforate uterine wall, or the highly malignant
choriocarcinoma, which may be associated with normal or unsuccessful pregnancies;
metastasizes early & widely
• placenta (fig. 19 - 15 & ppt. 12)
- placenta previa: abnormal location of placenta in region of cervix presents
difficulties for normal birth and likelihood of serious hemorrhage
- abruptio placentae: premature separation of the placenta; severe hemorrhage
& excessive clotting impair normal healthy birth
- preeclampsia/eclampsia: pregnancy-induced hypertension, accompanied
by albuminuria and systemic edema (preeclampsia) (fig. 19 - 16 & ppt. 13)
widespread microcirculatory damage may cause emergence of coma or
convulsions (eclampsia)
• breast cancer:
- two types of tumor: carcinoma in situ (noninvasive) & invasive carcinoma
- the first develops in ducts and glandular tissue, while the invasive type spreads
to stroma and lymphatics and can metastasize
Bio 307/607 lec 19
- p. 6 -
- treatment involves surgical removal (lumpectomy or mastectomy) often
followed by tamoxifen, a drug that blocks estrogen support of tumor growth
- TNM grading system is widely used to determine treatment options (fig.
19 - 17 & ppt. 14)