2. 1. Coverings Of spermatic cord& origin:
a- Internalspermatic fascia (innermost) : from fascia transversalis
b- Cremasteric muscle & fascia (middle) : from internal oblique muscle
c- External spermatic fascia (outermost) : from aponeurosis of external oblique
muscle
2. Embryology (moved tourinary module)
3. Embryology (moved tourinary module)
4. Two actions of levator ani:
a- increaseintra-abdominal pressure(both muscles) —> help in defecation &
labour
b- supports externalanal sphincter (puborectalis)
c- supports prostate“males” & sphincter for vagina “females” (pubococcygeus)
5. Histological structure &functionof epididymis:
a- Structure:
- formed of a single convoluted epididymal duct divided into head, body and
tail regions. & covered by tunica albuginea (fibrous CTCapsule)
- Epididymal duct: lined by pseudostratified columnar epithelium formed of 2
types of cells; 1) principal cells: tall columnar with steriocilia —>
secretory/absorptivecells. 2) Basal cells: shorttriangular —> stem cells.
- Lamina propria: contains vascular CT. & surrounded by smooth musclefibres.
b- Function:
- shortterm storageof sperms
- Absorption of excess fluid & removalof residualbodies not removed by
Sertoli cells
- Final maturation of sperms as:
* sperms becomemotile.
* Secretion Of glycolipid decapacitation factors (block acrosomalreaction till
capacitation occurs justbefore fertilisation)
3. 6. Histological characteristics of Sertoli cells:
- nucleus: large, euchromatic & basalin position. Ithas “tripartite nuclear
apparatus”
- Cytoplasm:
* by LM: pale (lipid droplets)
* by EM: sER (around lipid droplets) & Golgi (well-developed) & mitochondria
(elongated) & lysosomes & microtubules & microfilaments
- Lateral boundaries:
* not well-seen (dueto extensive cytoplasmic recesses)
* Show “occluding junctions” forming “blood-testis barrier”.
7. Histological structure of Fallopiantube:
- Mucosa: highly folded (primary, secondary & tertiary folds)
* Epithelium: simple columnar partially ciliated (ciliated —> movement of
mucus film & fertilised ovum towards uterus .... non-ciliated —> secrete
glycoprotein mucus)
* Lamina propria: looseCT & BVs.
- Musculosa: thick, formed of inner circular & outer longitudinal layers of SM
fibres. (—> capturing of ova from ovary & peristaltic waves to move ova
towards uterus)
- Serosa: thin, formed of CT & large-sized BVs & covered by peritoneum (flat
squamous mesothelial cells).
4. 8. Differencesbetweenresting &lactating mammary glands:
Resting mammary gland Lactating mammary gland
Stroma:
full of CT septa (interlobar,
interlobular)
& highly cellular intralobular CT
containg (fibroblasts, lymphocytes,
plasma cells, macrophages)
Stroma:
thin septa (interlobar, interlobular)
& very little intralobular CT.
CT & adipose tissueare decreased in
amount.
Parenchyma:
Ducts are small;
1) intralobular ducts -> lined by
simple cuboidal or low columnar
cells.
2) interlobular ducts -> lined by 2
layers of cuboidal cells.
3) lactiferous duct (United
interlobular ducts & open in
nipple) -> lined by stratified
squamous epithelium.
Parenchyma:
evident lobular pattern of gland
(intralobular, interlobular and
lactiferous ducts)
& large number of secretory alveoli.
Secretory alveoli -> lined by:
1)high pyramidalcells (& apical milk
granules)
2) cuboidal cells (& milk in ducts and
lumina of alveoli)
3) cuboidal cells (withoutmilk in
lumina)
4)regenerating columnar cells (without
apical milk granules)
* alveoli are surrounded by stellate
myoepitheilial cells. * ducts are
surrounded by longitudinally arranged
spindle-shaped myoepithelial cells.
No milk secretion Milk is secreted by: merocrine &
apocrine methods.
5. 9. Lab diagnosis of acute & chronic gonococcal infectioninmales & females:
# During acute stage:
specimens:
- Males: urethral discharge.
- Females: urethraldischarge& cervical swab.
a- smears: stained by Gramstain & methylene blue.
b- culture: inoculated specimens on chocolate blood agar are examined &
colonies are identified by: 1)oxidasetest (+ve) 2)Gm stained films. 3)acid
production fromglucose. 4)coagglutination test using monoclonalAbs.
c- Ag detection (ELISA) & Nucleic acid probe (gene probe)
* in males: diagnosis can be done through smears.
* in females: smears has a low sensitivity, so culture is necessary.
# During chronic stage:
Specimens:
- Males: morning urethral drop or prostatic secretion.
- Females: cervical swab
* smears areof no value (notused)
* Culture: inoculated specimens on a selective medium “Thayer-Martin
medium” are examined as mentioned before.
10. Main lines usedfor lab diagnosis of HSV:
1. Cytopathology: to stain scrapings from the base of the vesicle (with Giemsa
stain); the presence of multinucleated giant cells suggests HSV infection.
2. Isolation & identification of virus: the definitive diagnostic procedure. Done
on tissueculture cells. Virus is then identified.
3. PCR: specific diagnosis of HSV infections of CNS.
4. Serology: by tests such as neutralization, immunoflurescenceand ELISA.
6. 11. Mucinous OvarianTumors (types &morphology):
Morphology:
- Grossly: largemultilocular cysts containg mucinous fluid in their cavities. In
malignant mucinous cystadenocarcinoma, solid areas are seen.
- Microscopically:
1. Benign mucinous cystadenomas:
Lined by simple columnar non-ciliated epithelium. They are either
endocervical-like or intestinal-like.
2. Borderline tumors:
Characterised by:
* stratification Of lining epithelium
* Papillary formation
* Atypia
* No stromalinvasion
3. Mucinous cystadenocarcinomas:
Characterised by:
* stratification Of lining epithelium
* Formation of solid masses
* Pleomorphism& increased mitosis
* Invasion of stroma
7. 12. Histological features of fibrocystic changes inbreast &their clinical
significance:
a- Histological features:
# non-proliferative:
3 microscopic findings arefound:
- Fibrosis: stroma around the cysts is compressed and infiltrated by
lymphocytes
- Adenosis: increased no. of acini per lobule
- Cystformation: cysts vary in sizeand shape:
Small cysts -> lined by cuboidal to columnar epithelium
Large -> lined by flattened or atrophic epithelium
Apocrinemetaplasia is seen in mostcysts [cuboial or columnar epithelium
transforms into large polygonalcells with abundant granular eosinophilic
cytoplasm]
# prolifertive:
There is fibrosis, adenosis & cystformation + epithelial hyperplasia OR
sclerosing adenosis:
- Epithelial hyperplasia: Of ductal epithelium. Itcan be: mild, moderate or
severedepending on number of layers. Sometimes there are papillae “ductal
papillomatosis”. Hyperplasia cells may show atypia.
- Sclerosing adenosis: Proliferation of small ductules and acini + Marked
stromalfibrosis which may compress the lumina of the ducts and acini so they
appear as solid cords of cells simulating cancer.
b- clinical significance:
it’s the most common cause of palpable masses in the female breast& occurs
at age of 25-50 years.
8. 13. Complications of benign prostatic hyperplasia:
1. Frequency, urgency, and nocturia (UB irritation)
2. Difficulty in starting & stopping of urinary stream.
3. Painful distension of UB
4. Infections (cystitis and / or pyelonephritis) due to residualurine & chronic
obstruction.
5. Stone formation (due to stasis & infections)
6. Hypertrophy & dilation of UB
7. Bilateral hydronephrosis —>Chronic renal failure.
14. Mechanismof actionof combinedoral estrogen/progesterone pills:
1. Inhibition Of ovulation: by suppressing releaseof Gn from ant. pituitary.
Estrogen mainly inhibits release of FSH, while progesteronemainly inhibits the
release of LH.
2. Inhibition Of implantation: produceendometrial changes that prevent
implantation of fertilised ovum.
3. Inhibition Of fertilization: progesteroneincreases viscosity of cervical mucus
secretion, no sperms can penetrate.
15. Two Sexual side effects of anabolic steroids:
1. Azoospermia in males
2. Virilization in females
3. Precocious puberty in children
16. Oral VD drug for erectile dysfunction:
(sildenafil , vardenafil& tadalafil)
* Mechanismof action:
- selective PDE-5 inhibitors
- Increases cGMP level —> maintain VD & erection —> enhanced sexual
performance.
9. 17. Role of Sertoli cells inspermatogenesis:
1. They supportthe developing germinal cells
2. They secrete nutrients for newly formed sperms
3. They phagocytosedead sperms
4. They help in converting spermatids into spermatozoa (spermiation)
5. They remove mostof cytoplasm of spermatic.
6. They play a role in shaping Of head & tail of sperms.
7. They secrete estradiol (estrogen) which seems to be required as stimulators
factor in spermatogenesis.
8. They secrete Androgen-binding protein (ABP) which maintains high
concentrations of testosteronein tubular fluid to complete the process of
spermatogenesis.
18. Hormones responsible for cyclic changes onthe endometrium&their
effects onbreast:
1. Estrogen: it increases the sizeof uterus & causes proliferation of
endometrial stroma & development of endometrial glands.
* Effect on breast: Itinitiates growth of breastand milk producing apparatus.
2. Progesterone: it promotes secretory changes during the latter half of the
cycle, preparing the uterus for implantation Of fertilized ovum.
* effect on breast: Itpromotes development of lobules & alveoli causing
alveolar cells become secretory. Italso causes breast to swell (by secretory
development of alveoli and lobules & by increased fluid in the tissue)
تمبحمدهللا^^
