CSB520 Lecture Notes - Lecture 10: Pelvic Pain, Anovulatory Cycle, Endometrial Hyperplasia
Week 10 Lecture - Genital and Gestational Pathology
Monday, 6 June 2016 11:47 AM
Gestational Trophoblastic DiseaseGestational Trophoblastic Disease
•Hydatidiform mole
○Complete mole - androgeneis
○Incomplete mole - polyspermia
•Choriocarcinoma
○In 50%, develops from hydatidiform mole
○In 25%, develops from placental cells after abortion
○In 25%, develops from normal placenta
Ectopic PregnancyEctopic Pregnancy
•Implantation of embryo outside uterus
○Mostly Fallopian tubes
○Can also be ovaries and abdominal cavity
•1/2 occur in normal tubes
•4 outcomes:
○Intratubal haemorrhage
○Tubal rupture - intraperitoneal haemorrhage
•Medical emergency
○Spontaneous regression, resorption
○Extrusion into abdominal cavity (tubal abortion)
Fate of Human ConceptionsFate of Human Conceptions
•Between 70-80% of human conceptions are lost by spontaneous
abortion in the first 6-8 weeks of pregnancy, most as a
consequence of chromosomal abnormality
•Chromosomal abnormalities are present in 3-5% of live-born
infants
MorphogenesisMorphogenesis
•Normal development = co-ordinated process of differentiation,
growth, migration & apoptosis
○E.g. fingers forming from a paddle-like structure with
apoptosis
•Fetal growth regulation
○Insulin is the major hormone stimulating growth - its action
mediated by growth factors
○Growth hormone receptors are not present during most of
foetal life
○Placental & thyroid hormones are also important
TeratogensTeratogens
•"monster formers"
•Irradiation - radiation exposure
○Radiation therapy targets rapidly dividing cells (e.g.
tumours) which includes foetus
•Alcohol - good at passing through cell membranes (one of the
only ones that can be absorbed through stomach lining)
•Drugs
○Thalidomide
○Folic acid antagonists
○Anticonvulsants
○Warfarin
○Testosterone & synthethic progestagens
•Infections
Embryonic DevelopmentEmbryonic Development
•Female XX, male XY
•Sperm decides
•Indifferent until ~week 7
•SRY protein encoded on Y chromosome
○Testicular development
○In short - protein on Y chromosome that starts to be made
induces testicular devleopment
•Default development is female
○Superfemales - no androgens, tall with long limbs
Hormones - MalesHormones - Males
•Hypothalamus goes through anterior pituitary and stimulates it,
giving off:
○LH
•Stimulates interstital cells
•Testosterone (negative feedback inhibits
hypothalamus)
•Goes to seminiferous tubules
•And secondary sex characteristics
○Follicle stimulating hormones (FSH)
•Goes to seminiferous tubules
•FSH and testosterone act together to stimulatestimulate
spermatogenesisspermatogenesis
Hormones - FemalesHormones - Females
•Hypothalamus goes through anterior pituitary and stimulates it,
giving off:
○LH
•Stimulates:
•Ovulation
•Corpeus luteum, giving off:
•Estrogen: development &
maintenance of female reproductive
structures
•Progesterone: prepares
endometrium for implantation &
mammary glands for lactation
○FSH
•Stimulates:
•Primary follicle, which goes to
•Developing follicle
•With corpeus luteum - development
& maintenance of female
reproductive structures
Ovarian CystsOvarian Cysts
•Solitary - normally not any big problem - just picked up on an
ultrasound
○Follicular cyst
○Corpus luteum cyst
•Multiple
○Polycystic ovary syndrome
•Hormonal disturbances
Female Genital Tract PathologyFemale Genital Tract Pathology
•Hormonally induced lesions
•Infections
○STIs
○Pelvic inflammatory disease (PID)
•Tumours:
○Cervix
○Uterus
○Ovaries
○Placental
Hormonally Induced LesionsHormonally Induced Lesions
•Anovulatory cycle - cycle but no ovulation, follicles aren't reaching
maturity and are not being ovulated
○Anorexia nervosa (and bulimia)
○Physical/psychological stress
○Start of menarche - when the cycle starts, and is quite
unreliable
○Menopause - can happen again towards the end
•Endometrial hyperplasia - excessive bleeding & painful