Reproductive System

Female Reproductive The primary function of the system is to provide a female reproductive cell
System (the ovum), hormones, and a site for the development of the zygote.
 one pair of ovaries, which are the primary sex organs, and the
secondary sex organs, which include
 one pair of fallopian tubes,
 uterus
 vagina,
two breasts
Vulva (External  mons pubis,
Genetalia)  labia majora and minora
 clitoris
 openings of the urethra and vagina
 Perineum.
Vagina connects the external genitalia with the uterus and is the mode of exit for
menstrual fluids and conception products.
uterus  Is a pear-shaped organ, and its primary purpose is to provide an
environment for fetal growth and development.
 Located within the pelvic cavity, it can be divided into the upper
portion, termed the fundus; the midportion, termed the body; and
the lower portion, termed the cervix.
 Is flexed so that the cervix and lower portion of the body lie anterior
to the rectum.
 The actual cavity within the uterus is fairly small and can be well
visualized with ultrasonography.

Walls of Uterus
endometrial layer  Inner layer,
myometrial layer  middle, muscular layer
parietal peritoneum.  outer layer
 drapes over the fundus and the upper three fourths of the body but
does not enclose the lower fourth of the body or the cervix.
Cavity of uterus
The actual cavity within the uterus is fairly small and can be well visualized with ultrasonography.
It is divided into:
 internal os, leading to the cervical canal,
 External os, which opens into the vagina.
Portions of uterus
Fundus  Upper portion
 Normally lies superior to the bladder.
Body Midportion
cervix  Lower Portion
 Connects the uterine cavity with the upper vagina.
pessary is inserted into the vagina to provide proper uterine support.
fallopian tubes  extend from the upper, outer edges of the uterus and expand
distally into the infundibulum located close to, but not attached to,
the ovaries.
 These tubes serve as a passageway for the mature ova and are the
normal site of fertilization.
ovaries  the primary reproductive glands
 responsible for ovulation
 secretion of estrogen and progesterone.
 each ovary contains numerous graafian follicles enclosing ova.
 After puberty, several graafian follicles and ova grow and develop
each month.
Breasts  like the fallopian tubes, uterus, and vagina are considered secondary
sex organs.
 function as accessory reproductive glands to secrete milk for the
newborn.
 During pregnancy, changes in estrogen and progesterone levels
prepare breasts for lactation.
Breast parenchyma  differs according to age and parity.
 Women in their 20s and 30s, especially nulliparous women, have
dense, fibroglandular parenchyma that may conceal breast masses
during a clinical breast examination and imaging.

involutional change  is the conversion of glandular breast tissue into adipose as well as
loss of the supportive tissue.
 As a result of this slow process, the breast changes its architecture,
and fibroglandular tissue is replaced by fat.
 aids the imaging professional and the interpreting physician because
fatty tissue is radiolucent and enhances the radiographic visibility of
many breast masses
mastaglia  pain in one or both breasts.
 is indicative of breast cancer; however, it is more closely related to
architectural changes in breast tissue.
Imaging Considerations
hysterosalpingography  It is an examination performed for screening of the nongravid
(HSG). (nonpregnant) woman, especially in cases of suspected infertility.
 does not define the extent of certain conditions such as
endometriosis, it is useful in revealing the shape of the uterus and
certain characteristics of the fallopian tubes other than their
patency.
 10 to 30 mL of contrast medium into the uterine cavity and the
injection should be done slowly to avoid causing spasms and
discomfort. Spillage of the contrast medium from the fallopian tubes
indicates the patency of the tubes.
 can also be used therapeutically for restoring tubal patency or to
dilate or stretch the fallopian tubes.
sonohysterography  An adjunct procedure that has the potential to replace the
conventional HSG
 normal saline, instead of an iodinated contrast agent, is injected into
the uterus
Mammography  provides important information about specific clinical problems such
as a breast mass, pain, nipple discharge, and abnormalities of the
skin and lymph nodes.
 valuable examination tool in the detection and evaluation of breast
disease in individuals with augmentation prostheses.
Needle guidewire  is a specialized procedure to identify nonpalpable, mammo-
localization graphically detected abnormalities of the breast.
 cause minimal morbidity, with complications including hematoma
formation, intraoperative wire dislodgement, and wire breakage.
Sonography  highly recommended by the ACR for suspected gynecologic adnexal
masses.
 primary modality for examining the gravid or nongravid female
reproductive system because of its excellent accuracy and because
it presents no radiation hazards to the fetus or the mother.
 also useful in normal gynecologic examinations to visualize the
reproductive organs or to monitor the progress of a regimen of
fertility medication.
 excellent modality for differentiating cystic masses from solid
masses within the breast.
Transabdominal pelvic requires a distended urinary bladder to serve as an “acoustic window” for
sonography good visualization of the pelvic organs. In addition, the fluid within the
urinary bladder displaces bowel gas away from the area of interest.
Magnetic Resonance  gives detailed information on pelvic, uterine, and ovarian masses.
Imaging  accurately demonstrates proliferation into other pelvic structures. In
addition, multiple leiomyomas can be detected and localized in a
short period.
 also used to detect faulty or leaking breast implants.
fat suppression  is used to suppress the normal breast tissue and detect the presence
imaging of silicone in surrounding tissue.
CT  often performed to diagnose diseases of the female and male
reproductive systems.
 helpful in assessing neoplastic growth and abscess formation
resulting from inflammatory processes.
 is also used in conjunction with sonography to demonstrate
anomalies of the seminal vesicles and prostate gland.
Congenital Anomalies
bicornuate uterus paired uterine horns extend into the fallopian tubes
unicornuate uterus occurs when the uterine cavity is elongated and has a single fallopian tube
emerging from it.
Uterus didelphys is a rare congenital anomaly with complete duplication of the uterus, cervix,
and vagina.
Inflammatory Diseases
Pelvic inflammatory  is a bacterial infection of the female reproductive system,
disease specifically the fallopian tubes.
 generally bilateral, and without treatment, the infection spreads to
the peritoneum, resulting in bacteremia.
 Tubo-ovarian abscess formation may also occur with PID, often
resulting in sterility.
Causes:
 Gonococcus
 Staphylococcus or Streptococcus.
Mastitis  Inflammation of the breast
 often caused by Staphylococcus aureus.
 Acute mastitis begins when bacteria gain access to breast tissue via
the ducts.
 This bacterial route of infection occurs because of cracks or fissures
in the nipple that may develop during the first weeks of lactation
and the subsequent nursing of an infant.
Neoplastic Diseases
Ovarian Cystic Masses  Simple ovarian cysts
 fairly common in women in the reproductive age group. They are
frequently asymptomatic but may cause abdominal aching and
pressure. Acute, sharp abdominal pain may indicate rupture or
hemorrhage of the cyst.
Follicular ovarian cysts result from faulty reabsorption of the fluid from incompletely developed
follicles.
Corpus luteum ovarian occur when reabsorption of any blood leaked into the cavity after
cysts ovulation leaves a small cyst behind
endometriosis, a disease caused by the presence of endometrial tissue or glands outside
the uterus in abnormal locations within the pelvis. is believed to arise from
lymphatic spread, seeding from retrograde menstruation, or from direct
surgical spread.
External commonly involves the ovaries, the uterine ligaments, the rectovaginal
endometriosis septum, and the pelvic peritoneum; however, it may also attach to the rectal
wall, the ureters, or the urinary bladder
Polycystic ovaries  Consist of enlarged ovaries containing multiple small cysts. The
ovaries are bilaterally enlarged and have a smooth exterior surface,
with multiple cysts lying just below the outer surface.
 Polycystic ovaries are often associated with Stein-Leventhal
syndrome, a fairly rare disease.
Stein-Leventhal rarely ovulate because of an endocrine abnormality that inhibits
syndrome maturation and release of the ovarian follicle.
cystic teratomas  often referred to as dermoid cysts
 account for approximately 15% to 25% of ovarian tumors and are
the most common type of germ cell tumor containing mature tissue.
 These masses arise from an unfertilized ovum that undergoes
neoplastic change.
 Cystic teratomas have only a 1% to 2% chance of containing
malignant cells.
Cystadenocarcinoma  is a malignant tumor of the bi, accounting for more than 60% of all
ovarian cancers.
 primarily occurs in perimenopausal and post-menopausal women
over age 40 years.
 signs and symptom are very vague and include urinary bladder or
rectal pressure, back pain, and bloating.

Cervical carcinoma or  is a common malignancy of the female reproductive system caused

dysplasia by an abnormal growth pattern of epithelial cells around the neck
of the uterus.
 sexually transmitted disease, as a history of multiple sexual partners
or prior sexually transmitted infections predisposes women to this
disease.
 Associated risk factors include cigarette smoking and
immunodeficiency.
Uterine Masses
Leiomyomas (Uterine  are benign, solid masses of the uterus, which develop from an
Fibroids) overgrowth of the uterine smooth muscle tissue.
 Symptoms include uterine enlargement and distortion, low back
pain, pressure on the bowel and the bladder, intermenstrual
bleeding, and acute pain.
 tend to grow under the influence of estrogen, may enlarge during
pregnancy, and stop growing at menopause. After menopause,
leiomyomas are replaced largely by fibrous scar which has led to the
misnomer uterine fibroids.
 they often contain radiographically visible calcification
 They may remain asymptomatic until they grow large enough to
place pressure on surrounding structures, and they are usually
detected on pelvic examination.
endometrial  it is histopathologically different from cervical carcinoma.
carcinoma  one of the most common cancers of the female reproductive
system, second only to breast cancer.
BREAST MASSES
Fibroadenoma  is a common benign breast tumor. It is usually unilateral and
consists of a solid, well-defined mass that does not invade
surrounding tissue.
 The neoplasm is formed by an overgrowth of fibrous and glandular
tissues and is commonly located in the upper, outer quadrant of the
breast.
 almost always occur in women under 30 years of age and most
frequently in those 21 to 25 years of age.
 appear to be estrogen dependent and may grow rapidly during
pregnancy. These lesions are often painless and can usually be
moved about within the breast.
Fibrocystic Breasts  overgrowth of fibrous tissue or cystic hyperplasia
 This condition may be unilateral however, it is most frequently
bilateral, with variably sized cysts located throughout the breast.
Breast carcinoma  generally are discovered as a lump in the breast by the patient. With
the exception of inflammatory breast cancer, which is very virulent
and associated with diffuse inflammation and breast enlargement,
most begin as slow-growing, relatively painless masses, but as they
grow, they may infiltrate the suspensory ligaments, causing them to
shorten and retract the overlying skin.
 Although the exact cause of breast cancer is unknown, it is believed
to be a multifactorial disorder.
peau d’orange (orange peel) appearance.
DISORDERS DURING PREGNANCY
Amniotic Fluid is produced by various physiologic functions within the mother and the
fetus.
Oligohydramnios too little amniotic fluid
polyhydramnios refers to an excess of amniotic fluid.
Ectopic Pregnancy refers to the development of an embryo outside the uterine cavity. The
most common site for an ectopic pregnancy is the fallopian tube, but it
may also occur in the ovary, cervix, or abdominal cavity.
Disorders of the placenta
Placenta previa  a condition in which the implantation of the placenta leaves part or
all of the cervical os covered. Several degrees are recognized: total,
partial, marginal, and lowlying previa.
 These degrees of previa are related to the position of the placenta in
relation to the internal cervical os.
 In placenta previa, the mother experiences painless vaginal bleeding
during the later stages of pregnancy because of the partial
separation of the placenta from the uterine wall.
placental abruption  Premature separation of placenta to the uterus
 may be life-threatening to the fetus.
 Predisposing factors for abruption include a history of a prior
abruption, pregnancy-induced hypertension, smoking, alcohol
abuse, cocaine abuse, external abuse, and multiple gestation.
Placental percreta  a condition in which the placenta extends into the myometrium,
causing an unduly firm attachment that bleeds at delivery because
it will not separate normally.
 In rare cases, failure of the placenta to separate after birth results in
the need for an immediate hysterectomy
Hydatidiform mole  refers to an abnormal conception in which usually no fetus is
present.
 With this condition, the uterus is filled with cystically dilated
chorionic villi that resemble a bunch of grapes, known as
trophoblastic tissue

Male reproductive system

The male reproductive system is composed of glands, ducts, and supporting structures.
glands include a pair of testes, a pair of seminal vesicles, a pair of bulbourethral
glands, and one prostate gland.
testes  are enclosed by a white, fibrous covering within the scrotum.
 They are responsible for the production of sperm and the secretion
of hormones, mainly testosterone.
 divided into lobules that contain seminiferous tubules, which
converge into larger ducts and emerge at the head of the
epididymis.
prostate gland  lies just inferior to the bladder, and the urethra actually passes
through this gland
 responsible for secreting the majority of the seminal fluid and is
normally about the size of a walnut.
 The ducts that connect the glands include a pair of epididymides, a
pair of vasa deferentia, a pair of ejaculatory ducts, and one urethra.
epididymides  lie superior and lateral to the testes and serve as a passageway for
sperm.
 They are also responsible for secreting a portion of the seminal fluid.
vasa deferentia  extend from the epididymides and pass through the inguinal canal
into the pelvic cavity.
 They pass superior to the bladder and continue down the posterior
surface of the bladder to join the ducts emerging from the seminal
vesicles.
 This junction forms the ejaculatory ducts. These ducts eventually
empty into the urethra, which is responsible for delivering the
seminal fluid to the exterior of the body

Congenital Anomalies
Cryptorchidism  refers to undescended testes. The rate of malignancy is much
greater in men with this condition, so treatment involves either
bringing the testicle down and fixing it surgically or removing it.
Prostatic Hyperplasia a common benign enlargement of the prostate gland, is caused by the
development of discrete nodules within the gland and is palpable through
the rectum.
transurethral is performed by passing an endoscope through the urethra to core out the
resection of the gland.
prostate
prostatic calculi, Many men over age 50 years develop small, multiple calcifications within the
prostate.
Adenocarcinoma of the prostate
Testicular Masses
Testicular torsion  occurs if a testicle twists on itself, inducing severe pain and
swelling.
 Failure to correct this surgically in an immediate fashion may result
in severe compromise of testicular vascularity
epididymo-orchitis inflammatory response by the epididymis and testis
Hydroceles are common intrinsic scrotal masses, sometimes congenital in nature,
caused by a collection of fluid in the testis or along the spermatic cord
Spermatoceles spermatic cysts, are fluid-filled, painless scrotal masses within the testis
adjacent to the epididymis
Testicular seminomas  arise from the seminiferous tubules and account for approximately
40% of malignant testicular tumors
 Seminomas grow rapidly but tend to remain localized for a fairly
long time before metastasizing.
 These neoplasms have an excellent prognosis because of their
extreme radiosensitivity. If treated with radiation therapy,
seminomas carry a 10-year survival rate of approximately 90%
Testicular teratomas  arise from primitive germ cells and account for approximately 25%
of the malignant testicular masses.
 highly malignant, spreading to the renal hilum via the lymphatics
and via hematogenous spread.
testicular embryonal They are smaller than seminomas; however, they are very invasive and
carcinomas metastasize fairly quickly. Embryonal carcinomas carry a 10-year survival
rate of approximately 35%.
Testicular  make up the smallest portion of malignant testicular tumors,
choriocarcinomas accounting for only 1% of malignant neoplasms of the testes.
 However, are very small and aggressive neoplasms.
 They are often nonpalpable and metastasize very early. carry the
worst prognosis, with a 10-year survival rate of approximately 10%.
Gynecomastia is the proliferation of breast tissue in the male patient.