Week 10 – Reproductive & Gestational Pathology – Study Guide

Key Terms

• Atrophy – shrinkage of cells/tissue due to decreased stimulation or aging.
• Hyperplasia – increase in cell number.  • Hypertrophy – increase in cell size.
• Metaplasia – reversible replacement of one cell type with another.
• Neoplasia – abnormal, uncontrolled growth (benign or malignant).
• Endometriosis – ectopic endometrial tissue outside uterus.
• PID (Pelvic Inflammatory Disease) – infection of female reproductive tract.
• Leiomyoma – benign smooth muscle tumour (fibroid).

A. Cellular Adaptations

• Testicular atrophy – autophagy and apoptosis from pressure or hormonal decline.
• Prostate gland – pseudo-hyperplasia from hormonal stimulation or receptor upregulation.
• Post-menopausal uterus – apoptosis due to hormone withdrawal.
• Pregnant uterus – endometrial hyperplasia and myometrial hypertrophy (hormonal).

B. Congenital Conditions

• Undescended testis (cryptorchidism): incomplete descent → torsion, infarction, infertility, cancer risk.
• Congenital = present at birth; not all congenital conditions are genetic.
• Examples: Down syndrome (genetic), rubella infection (non-genetic).

C. Endometriosis

• Endometrial glands/stroma found outside uterus (ovary, tubes, peritoneum).
• Responds to hormonal cycle → cyclical bleeding → inflammation → scarring.
• Symptoms: dysmenorrhoea, infertility, pelvic pain.
• Improves during pregnancy (no menstrual cycles).

D. Neoplasia of Reproductive Organs

• Male tumours:
   – Testes: germ cell tumours (seminoma, teratoma).
   – Prostate: adenocarcinoma (common in older men).
   – Penis: squamous cell carcinoma; HPV-related.
• Female tumours:
   – Cervix: SCC (HPV-related) or adenocarcinoma (endocervix).
   – Uterus: leiomyoma (benign), leiomyosarcoma (malignant, rare), endometrial carcinoma.
   – Ovary: cystadenoma (benign) or cystadenocarcinoma (malignant); risk factors = ovulation, obesity, genetics, age.
   – Breast: fibroadenoma (benign), adenocarcinoma (malignant).

E. Infections (STIs and PID)

• HIV – infects CD4 T cells; transmitted sexually, perinatally, via blood.
• HSV – latent virus causing recurrent vesicles; crosses placenta causing foetal damage.
• HPV – >100 serotypes; low-risk (warts), high-risk (cancers of cervix, vulva, anus, oropharynx).
• Syphilis – Treponema pallidum; congenital form causes developmental anomalies.
• PID (Pelvic Inflammatory Disease):
   – Usually due to gonorrhoea or chlamydia.
   – Chronic inflammation → scarring, hydrosalpinx, infertility, ectopic pregnancy, abscess, sepsis.

F. Gestational Conditions

• Teratogens – agents causing foetal malformation (e.g. thalidomide, alcohol, infections).
• Gestational Diabetes – pregnancy-induced insulin resistance due to placental hormones.
• Risk factors: obesity, maternal age; increases risk of large baby and later diabetes.
• Early development (first 12 weeks) critical for organogenesis; disruption → miscarriage or congenital malformations.

Key Takeaways / Exam Points

• Endometriosis → cyclic pain, infertility; improves in pregnancy.
• PID → infertility and ectopic pregnancy due to scarring.
• HPV major cause of cervical and vulvar SCC.
• Testicular and ovarian tumours are mostly germ-cell in origin.
• Gestational diabetes and PCOS predispose to type II diabetes.