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. 6.

Reproductive Embryology
19
Two periods in human life where the phenotypic
characteristics will differentiate:
INTRODUCTION o Embryonic period
The reproductive system of humans is composed o At onset of puberty
EMBRYONIC PERIOD
of 3 subsystems: gonadal system, internal
Primary sexual characteristic formation
genitalia system, and external genitalia system.
Formation of primary phenotypic sex of the embryo is
o Gonadal System testis (M) & ovaries (F) categorized into 3 diff structures
(gonads) o Gonad formation
o Internal genitalia system transit of o Internal genitalia formation
sperms cells (M: efferent ductules up to o External genitalia formation
ejaculatory duct & F: fallopian tube, uterus,
cervix of uterus, and upper 3rd of vagina) INDIFFERENT EARLIEST WEEK IT
o External genitalia system organ for STAGE CAN BE USED AS
copulation; usually used as organ in LONE CRITERIA FOR
identifying the sex of human species (not SEX DETERMINATION
the full criterion in identifying ones sex) Gonad 3rd-6th week 7th week
AOG
Ductal system 3rd-7th week 8th week
OVERVIEW AOG
MALE FEMALE Cloacal fold 3rd-11th week 12th week
Wolffian duct Male internal AOG
genitalia Table 1. Window period: Non-productive period wherein you
Mullerian duct Female internal cannot determine whether the gonad is male or female.
genitalia
Cloacal folds Penile shaft, Labia majora,
scrotal sac labia minora, Indifferent organs will become:
clitoris o Gonad: ovary / testis
o Ductal system: Mullerian / Wolffian duct
o Cloacal fold: participates in formation of penile
GENITAL SYSTEM shaft or clitoris (especially on the 11th week AOG;
TRIVIA: All are destined to become females by default.
at this point the clitoris is much longer than the
penile shaft)
For perpetration of human species & determination of sex
Interwoven with urinary system Key to sexual dimorphism is presence or absence of Y
o Major parts are derived and developed from a chromosome
common mesodermal ridge: intermediate o All DNA base pairs found in Yp11 = SRY gene
mesoderm (master gene for testes formation)
Two ways of how to determine sex of human species - Has a protein product: testes determining
o Genotypic sex factor, TDF -- gives instruction regarding
o Phenotypic sex what will happen to the gonad; converts
indifferent gonad to testis
GENOTYPIC SEX - Activates 3 genes (Ch9, Ch13q11-12, Ch17q)
o Presence/absence of Y chromosome will turn
- based on chromosomal configuration of the cell on/off the default mechanism that all are
44 autosome/somatic chromosome + X + Y sex destined to be females
chromosome/allosome = male o Acts in conjunction with SOX9 (sex determining
44 autosome/somatic chromosome + X + X sex region in chromosome Y homeobox 9) found in
chromosome/allosome = female Ch17q
o Downregulates/inhibit upregulation of ch1 gene
(WNT-4, wingless type 4 gene -- master gene for
PHENOTYPIC SEX ovary formation)

TRANSCRIBERS: 16B (Fred, Kerr, Mikee, Natasha, Nicole, Danna, Jaja) 1


SUBTRANSHEAD:
o Binds to a promoter region of an unknown gene
o If expressed, it induces Sertoli cells to synthesize
and secrete mullerian inhibiting substance (MIS,
antimullerian hormone, destroys male embryos
mullerian duct) as early as 8th week AOG
Mnemonic: Ser8MIS
o Reason why males dont have the unaleria
(immediate anlagen that would give rise to uterus,
cervix, and upper 1/3 of vagina, fallopian tubes)

SRY gene with or without the help of SOX9 will upregulate


another gene, FGF9 (fibroblast growth factor 9) in
ch13q11-12
o Leads to penetration of renal corpuscles of
degenerating mesonephros through hilum of forming
testes
o Establishes continuity between parenchyma of testes
and Wolffian duct, especially on 8th week AOG
(during which Sertoli cells synthesize MIS)
o 8th week AOG: Leydig cells will start to synthesize and
secret testosterone which leads to virilization and
masculinization of Wolffian duct and the process
byproduct leads to the formation of ductuli
efferentes
o Testosterone also virilizes the remaining parts of the
Wolffian duct: the epididymis, paradidymis, vas
deferens, seminal vesicle and ejaculatory duct
Degeneration of Mullerian duct leads to progression of o Sertoli cells: disappearance of Mullerian duct
Wolffian duct o Leydig cells: virilization and masculinization of
o Leads to formation of internal genitalia of male Wolffian duct
o Gives rise to: ductuli efferentes, epididymis, o Mnemonic: L8t ang celebration ni Ser and MIS
paradidymis, vas deferens, seminal vesicle and SRY gene with or without the help of SOX9 will upregulate
ejaculatory duct another gene, SF1(steroidogenic factor1)
o Except for the most cranial part (will become o Differentiate mesenchymal cells of the testes to
appendix testes; male homologue of female fallopian become Leydig cells and those inside will differentiate
tube) and most caudal part (will become utriculus to become Sertoli cells
prostaticus found inside prostate gland; male o Key regulatory gene for Leydig cell and Sertoli cell
homologue to female uterus) Mnemonic: FAT, UPU formation
(Fat ba ako? U pu)
How about if genotypic sex of the embryo is XX?
o Two functional X allosomes leads to upregulation of a
gene found in ch1: WNT-4 (key regulatory gene for
ovary formation; induce back the X chromosome
upregulating another gene, DAX1)
o DAX1: dosage sensitive sex reversal adrenal
hyperplasia critical region of chromosome X gene 1
found between Xp21.3-21.2 or all DNA base pairs
found between 30,082,120-30,087,136
Area of concern of genetic engineers helping
a family with no female child yet
Reverses sex of male zygote to female zygote
Inhibits the effect of ch17q gene (SOX9)
which leads to progression of mullerian duct
Leads to its differentiation into fallopian
tube and unaleria

TOPIC: 1. Reproductive Embryology 2


LECTURER: Dr. J.A. Amistad, MD
Unaleria will give rise to uterus, cervix,
upper 3rd of the vagina
Wolffian duct will become epoophoron of Rossenmuller,
paroophoron of Johnson, Gartners cyst (remnants of
Wolffian duct) in females
o Review: The appendix testis and utriculus
prostaticus are Mullerian duct remnants in male
WNT-4 upregulates genes that participate in ovary
formation
TAFii105: TATA box associated factor of RNA polymerase
2 105 kilodalton; found in Ch8q24.12
o Responsible for follicular cell formation (which
will synthesize aromatase that will convert theca
interna cell secretion, testosterone, into
estrogen which leads to feminization of gonad,
Mullerian duct, and cloacal fold)/
Four types of estrogen
o Estradiol: 14-40yrs old
o Estetrol and estriol: pregnancy
o Estrone: menopause

Indifferent stage: 3rd6th week AOG of indifferent gonad


Located between dorsal mesentery of midgut, hindgut
and mesonephros (intermediate mesoderm derived
organs)
Gonads and mesonephros are both derived from
intermediate mesoderm
o Mesonephric duct: wolffian duct
o Paramesonephric duct: mullerian duct
Urogenital ridge: genital ridge + mesonephric ridge
Genital ridge
MALE FEMALE
Cortex Sertoli cells Follicular cells
Seminiferous (that will
tubules become
Reti testes granulosa cells
cumulus
cells etc)
Medulla Leydig cells Theca externa
Theca interna
*Cortex surface epithelial cells; Medulla- mesenchyme cells

o Genital ridge differentiation depends on


chromosomal configuration of primordial germ
cells (mesenchymal cells that will become
egg/sperm cells; Epiblastic cells that remain
epiblastic)

TOPIC: 1. Reproductive Embryology 3


LECTURER: Dr. J.A. Amistad, MD
- Male o Degeneration of mesenchymal cells will send positive
o 3rd week AOG: PGCs are located at most caudal feedback to surface epithelial cell to try again to form cell
part of yolk sac near allantois clusters
o 4th week AOG: start to move via ameboid o 2nd set of cell clusters will lose epithelial
movement from yolk sac, allantois, cloaca, arrangement and will surround each blood
hindgut and dorsal mesentery island; will become follicular cells
o 5th week AOG: reach hilum of genital ridge o Follicular cell + blood island + oogonium =
(Mnemonic: HI5) primary follicle
o 6th week AOG: penetrate the genital ridge o Will transform into a THIN tunica albuginea
o 7th week AOG: surface epithelial cells start to
undergo proliferation which forms cells clusters
that start to penetrate and receive the invading
sperm cells (PGC)
o These testicular cords/medullary cords will
become seminiferous tubules
o Tiny network of cell strands from distal
region of seminiferous tubules reti testes
Seminiferous tubules and reti testis
are not derivatives of wolffian duct
and not part of internal genitalia of
male. They are derived from the
testicular cords
Ductuli efferentes, epididymis, vas
deferens, seminal vesicle ejaculatory GENITAL DUCTS
duct are derivatives of Wolffian duct.
There are under the internal genitalia o Indifferent stage: 3rd week to 7th week AOG.
of male o Both male and female embryos contain two ductal
o Formation sends negative feedback systems: Mullerian and Wolffian
surface epithelial cells are replaced by o Mullerian: paramesonephric duct; Wolffian:
thick dense of fibrous CT called tunica mesonephric duct
albuginea o Earliest week wherein you can determine which duct will
o 4th month AOG: irregular medullary cords will degenerate: 8th week AOG.
transform into horseshoe shaped cords that will
give rise to future seminiferous tubules
- Female
o PGCs penetrate the hilum and medulla
o 7th week AOG: undergo proliferation, forming
cell clusters that will wait for instruction from Y
chromosome

Male
o Start of sertoli and leydig cell formation
o Sertoli will synthesize MIS destruction and
degeneration of most parts of Mullerian duct
o Leydig cells will synthesize testosterone
o Absence of Y chromosome leads to loss of epithelial
masculinization/virilization of Wolffian duct internal
arrangement and formation into free mesenchymal cells
genitalia of male
that will degenerate and will be replaced by blood islands
Female
o Each blood island will house 1 PGC: marks the
o Since there is no leydig and sertoli cells, Wolffian duct will
start of formation of PGC to oogonium
continue to regress simultaneous to the degeneration of
o *in these case PGC is same as primordial egg cell
2nd kidney system
o Mullerian ducts will remain

TOPIC: 1. Reproductive Embryology 4


LECTURER: Dr. J.A. Amistad, MD
o Convertion of testosterone to estrogen feminization of The color yellow is called sinus vaginal bulbs. It
Mullerian duct fallopian tubes + unaleria gives rise to the lower 2/3 of vagina and hymen

CLINICAL CORRELATIONS

GARTNERS CYST

o Very tight vagina + cysts on external wall of vagina


Dihydrotestosterone: main hormone that leads to
O Remnants of Wolffian: high propensity to become cystic
masculinization of cloacal fold penile shaft + fusion of
- Mullerain duct will give rise to:
genital swelling to forms scrotum.
- Upper 3rd of the duct distal half of fallopian tube
o Dihydrotestosterone: external genitalia
- Middle 3rd proximal half of fallopian tube
o Testosterone: internal genitalia
- Lower 3rd will fuse to its opposite counterpart
forming unaleria
- 6th week AOG: Mesoderm of yolk sac + allantois = urorectal
septum (divides cloaca into 2 regions: urogenital sinus
(urinary bladder, urachus, urethra (3Us)) + anorectal
canal (anal canal and rectum)

- Cloacal fold: lower 2/3 of vagina


- Vagina has dual origin. Upper 3rd from the Mullerian
and lower 2/3 from cloacal folds (specifically
urogenital sinus)
- Sinovaginal bulbs: lower 2/3 of vagina, hymen
- 8th week AOG: Theca interna cells will synthesize and
secrete androgens. The granulosa cells on the other hand
will synthesize aromatase responsible for the
o In males, the most constricted part will become
aromatization of androgens to estrogens
membranous and prostatic urethra; the longest will become
o Estrogen leads to the feminization of Mullerian
spongy urethra
duct and cloacal fold
o In females, the constricted part will become the upper half
- In females, the distal tip of unaleria is called of female urethra and the longest part urogenital sinus will
paramesonephric tubercle. become the lower half urethra
Gives rise to cervical canal, portio vaginalis of o The posterior wall of the upper half of female urethra will
cervix, fornices surrounding the cervix and upper form the sinovaginal bulbs. The bulbs will combine and
3rd of the vagina condense to form sinovaginal plates

TOPIC: 1. Reproductive Embryology 5


LECTURER: Dr. J.A. Amistad, MD
o The cells inside the sinovaginal plates will continue to - Common
undergo mitosis increasing the distance between
paramesonephric tubercle and urethra. It forms the lower 2/3 UTERUS BICORNIS BICOLLES UNICOLPOS
of the vagina and hymen WITH 1 RUDIMENTARY HORN (D)

- Atresia of one of the mullerian ducts


- Rudimentary part usually lies as appendage to wall of well-
developed side
- PID (pelvic inflammatory disease)
- Rudimentary horn
o Communicating
o Noncommunicating
o Atretic
o Total absence of atretic part

ATRESIA OF CERVIX (E)

- Atresia of cervix due to under/mal development of


Terms:
paramesonephric tubercle
Uterus - metra, cornu; cervix - colles; vagina colpos; fallopian
o Absence of cervical canal, portio vaginalis, fornices and
tube salpinx upper 3rd of the vagina
o Having a blind ended pouch of vagina
- Very short vagina
- Able to conceive baby with IVF, birth through CS, no
menstrual bleeding (hematometrosalpinx with monthly PID
pelvic inflammatory disease)

ATERISA OF VAGINA (F)

- Mullerian ducts are normal but sinovaginal bulb fails to


develop
- Dimpling of hymen, atretic vaginal vault
- Able to conceive baby with IVF, birth through CS, no
menstrual bleeding (hematometrosalpinx with monthly PID)

Figure. Main abnormalities of the uterus and vagina,


EXTERNAL GENITALIA
description are below.
- Indifferent stage: 3rd 11th week AOG
UTERUS DIDELPHYS (A)
- Earliest to use cloacal folds as lone criterion in identifying
- Bicornis, bicollex, bicolpos the sex of the baby: 12th AOG
- Tubercle fails to fuse - Derived from cloacal folds
- Uterus and rest of internal genitalia are duplicated Found on the most caudal part of the growing
- Metromenorraghia: abnormal uterine heavily bleeding embryo
menstrual flow because endometrium is duplicated Ectoderm derived
- Dyspareunia: pain during sexual intercourse Cover the cloaca (endoderm cavity)
- Extremely rare, severe insult.
Cloacal membrane: between cloaca and cloacal
membrane.
UTERUS ARCUATUS (B)
Internally lined by endoderm
- Slight indentation at fundus Externally lined by ectoderm
- Space occupying lesion that may disturb organogenesis of
presenting part of developing fetus, especially in breech
presentation
- More common, less severe

UTERUS BICORNIS BICOLLES UNICOLPOS (C)

- Failure of site of fusion to fuse completely


- Metromenorraghia

TOPIC: 1. Reproductive Embryology 6


LECTURER: Dr. J.A. Amistad, MD
- Spongy urethra is derived from urethral folds except for
distal 2cm of urethra (which is derived from ectoderm,
external meatal plug)
o Invagination of external meatal plug
produces urethral pit which produces a
continuation between Glanular part
(navicular fossa) and spongy part of urethra
- 11th week AOG: clitoris is longer than penile shaft because
of the idle time of aromatases.
o Use external meatal plug instead as a
parameter to determine male/female.

CLINICAL CORRELATION

- Can be divided into three regions EPISPADIA


o Anterior 1/3 will combine and condense in the
midline with SHH to form genital tubercle - Split in the dorsum part of penile shaft
o Middle 1/3 will fuse at the ventrum to form: - Failure of VLL cells to close the infraumbilical region
Urethral folds - Usually associated with bladder extrophy
Genital swellings
o Distal 1/3: will form the anal fold HYPOSPADIA
Portion that receives hardly any
- Split in the ventral part of penile shaft
dihydrotestosterone will become the
external anal sphincter - Extra orifice in glands penis: glanular hypospadia
Ectoderm inside Proctodeum - Orifice in neck region: coronal hypospadias
lower half of anal canal - Middle part of penile shaft: Midshaft
- Orifice in midneck (root of penile shaft and start of scrotum):
penoscrotal
- Within scrotal raphe: scrotal hypospadias
- In perineal: perineal

- Genital tubercle, genital swelling, and urethral folds: MALE FEMALE


contain high concentration of dihyrotestosterone Genital glans penis, dorsal half of clitoris,
receptor. tubercle penile shaft, dorsal half clitoral hood
of prepuce, corpora
- Ectoderm between urethral folds and anal fold receives
cavernosa
perineal body and becomes perineal skin (skin between
base of scrotum and anal sphincter) Urethral folds corpus spongiosum, Labia minora
spongy urethra
o 6th week AOG: mesoderm of yolk sac and
allantois will combine to form urorectal Genital will receive descending Labia majora
septum which divides cloaca into two swellings testis to become scrotum
regions Cloacal Vulva
membrane Prior to giving
o Distal tip of caudally migrating septum will
birth: hymen
become perineal body.
After giving
birth:
myrtiform
- If every part is split: globular
- Usually associated with chordee (abnormal anteflexion of the
glans penis to the penile body)
- Causes:
- Congenital
- Iatrogenic/doctor induced

TOPIC: 1. Reproductive Embryology 7


LECTURER: Dr. J.A. Amistad, MD
PERSISTENT CLOACAL FOLDS

- Biscrotal, diphallia
- Failure of the cloacal folds to fuse at the midline.

WANDERING SCROTUM

- Genital swelling forms a distance away from normal


- Usually associated with diphallia

BIFID PENIS

- Diphallia

MICROORCHIDISM PHIMOSIS

- Small testicles - Only medical indication for circumcision


- Usually associated with Klinefelter syndrome (XXY) - Failure of meatal plug to dissolve

MACROORCHIDISM TRANSPOSITION OF GENITALS

- Large testicles - The anal fold received a lot of DHT receptor


- In Escalante syndrome
- Usually associated with micropenis

MRKH (MAYER ROKITANSKY KUSTER


HAUSER SYNDROME)

TOPIC: 1. Reproductive Embryology 8


LECTURER: Dr. J.A. Amistad, MD
- blind ending vagina, total absence of internal genitalia (total - Ectomorphic lean slender body built with some muscle
absence of uterus, upper 3rd of vagina, with or without development
fallopian tube - Lanky thin tall and weak looking
- congenital; secondary to agenesis of Mullerian duct - Dolichostenomelia long narrow weak extremities
- Two types: - With youthful skin turgor
o Total absence of Mullerian duct derivatives - Poor adrenarche
o Absence of unaleria with fallopian tube - Gynecomastia
- Behavior:
o Low cognition
o Low neurophysio function: poor executive function;
follower due to extreme shyness
o Delays in motor development, poor muscle control and
muscle coordination
- Language learning and reading impairments
- Causative factor: nondisjunction of sex chromosomes during
meiosis
- Nondisjunction: MII oogonia, MI sperm

*Review the clinical part for female (page 6)

TURNER SYNDROME

- 45 X
- characterized by: High hair line in front, low hair line at the
back; poor visual acuity; downslanting of eyelids; citicorina
(birds beak nose); low set of ears; problem with dentition with
high arched palate (hot potato voice type); shield like chest
with wide set breast and inversion of nipple; equal hip-waist
ratio; lymph edema at dorsum of feet and hand; genu valgum
UTERUS DIDELPHYS
(knock knee) and cubitus valgus; webbing of the neck
- Two vaginal canals - Causative factor: one x is missing
- Hallmark: gonadal dysgenesis absence of oocytes
- Rudimentary ovaries
o Amenorrhea
o Reproductive sterility
- Behavior:
o Cognition: math, social skills, spatial memory, speech
impairments
o Concentration: ADHD
- Usual complaint: absence of menarche, pubarche
- Incidental findings: Horseshoe kidney, coarctation of thoracic
aorta (narrow), short 4th metacarpal

Chromosomal abnormalities
FEMALE PSEUDOHERMAPHRODISM
KLINEFELTER SYNDROME - 46 XX female
- Masculine physique, ambiguous genitalia
- 47 XXY man: aneuploidy
- Two types:

TOPIC: 1. Reproductive Embryology 9


LECTURER: Dr. J.A. Amistad, MD
TRUE FALSE/PSEUDO o Mesentery will become ligamentous (cranial genital
Common ambiguous genitalia ligament + caudal genital ligament)
(clitoramegaly, rugated labia majora) Cranial genital ligament
Basis for ovotestes Male type: gonad is M: Disappears
discrimination (presence functional testes F: Will become suspensory ligament of
of both Female type: gonad is ovary
functional functional ovaries Caudal genital ligament: will undergo
ovaries and (Most common cause) mesenchymal condensation rich with ECM
testes) Congenital adrenal M: gubernaculum testes
hyperplasia: problem F: gubernaculum ovary which will split
converting cholesterol into two (round ligament of uterus which
holds fundus of the uterus causing its
*Congenital adrenal hyperplasia anterverted and anteflex uterus position
- Causative factor: (-) 21-hydroxylation; mutation of ch6q21.3 + ligament of the ovary proper)
(CYP21A, CYP21P genes) causes problems in synthesis of 21- - 8th week AOG: primordial testes at posterior abdominal
hydroxylase (21A) and synthesis of aromatase (21P) wall
- Hallmark: poor cortisol production - 12th week AOG: outgrowth of extra abdominal portion of
- Effects: the gubernaculum testis, the testis is displaced from the
o Ambiguous external genitalia posterior abdominal wall to the inguinal ring
o Sexual infantilism o Abdominal cavity will produce an evagination
o Menstrual irregularity (processus vaginalis of male, extra abdominal;
o Anovulation homologue of canal of Nuck in female) as shock
absorber for the testes
ANDROGEN INSENSITIVITY SYNDROME - 28th week AOG: increasing abdominal pressure due to
elongation of intestine and growth of liver, testes is
- Female habitus, 46XY displaced from inguinal ring to inguinal canal (due to
- Formerly: testicular feminization increasing pressure)
- Failure of cloacal folds appreciate dihydrotestosterone - 33rd week AOG: due to regression, retraction, and
receptor shortening of gubernaculum testes, the testes contacts
- Causative factor: failure of the tissues to respond to r-DHT-C the scrotal floor
(receptor dihydrotestosterone complex) o Whole length of processus vaginalis will obliterate
- Hallmark: cloacal folds not responding except for distal most pouch (which will become
- Male gonad and internal genitalia; female external genitalia the tunica vaginalis)
- Effects: - Prior descent
o Gonad: male o Band of mesenchyme terminates in the inguinal
region: gubernaculum testes
o Wolffian ducts: male
Terminates between the differentiating
o Cloacal fold: female
internal and external oblique muscles
Both muscles will participate in
SWYER SYNDROME
unsheathing the testes
- 46XY female Transversus abdominis will not participate
- Causative factor: mutation of Yp11 - Sheaths coming from the anterolateral abdominal
- Hallmark: point mutation of SRY muscles
- Effects: o Mnemonic: ICE TIE
o Gonad: female (streak gonad) o External spermatic sheath is derived from
o Wolffian duct: regressed aponeurosis of external oblique
o Cremasteric fascia and muscle are derivatives of
o Mullerian ducts: stay, will become female
internal oblique
o Cloacal fold: female
o Internal spermatic fascia is a derivative of
transversalis fascia
DESCENT OF TESTIS

- At the end of 7th week AOG, indifferent gonad and 2 nd


kidney system are attached to the posterior abdominal
wall via a mesentery, urogenital mesentery
- At the end of 8th week AOG, all indications of
mesonephros will disappear
o Urogenital mesentery will continue holding the
gonad only

TOPIC: 1. Reproductive Embryology 10


LECTURER: Dr. J.A. Amistad, MD
DESCENT OF THE OVARY

- Settles right after the pelvic brim


- Herniation of ovary though canal of Nuck: If the ovary
continues to move downwards between labia minora and
majora or between the fourchette and external anal
sphincter.

The exam will include 30 points from the mock quiz


excluding clinical correlations. MOCK QUIZ ON THE
NEXT PAGE HAPPY STUDYING!

REFERENCES:

1. Lecture Notes
2. Recordings
3. Past trans

CLINICAL CORRELATION

PATENT PRCESSUS VAGINALIS (M)/CANAL


OF NUCK (F)

- Processus vaginalis fail to obliterate


- High chance for intestinal loop herniation

HYDROCELE

- Certain segment fails to obliterate


- Secretory activity of the lining continues synthesis of mucin
(a strong water attractant, which becomes mucus)
- Accumulation of mucus leads to cyst formation
- Transillumination technique

MICROPENIS

- Measure the dorsal length of the penile shaft at erected


state from the root to the distalmost part of the glans
stretched to resistance
- < 2 inches: micropenis (less than 2.5 SD of standard)
- Among boys 8-14years: not true micropenis (false positive)
o Delayed onset of puberty
o Body framework of boys if much larger than penile length
o 2cm of normal root is covered and concealed by baby fats

TOPIC: 1. Reproductive Embryology 11


LECTURER: Dr. J.A. Amistad, MD
MOCK QUIZ

ITEM KEY REGULATORY GENE


G Key to sexual dimorphism A. TAFii105
F Master gene for testis formation B. DAX-1
E Master gene for ovary formation C. SF-1
D Known to bind to promoter region of a transcription factor which
D. SOX-9
promotes & elevates Anti Mullerian Hormone (AMH) synthesis
H Induces penetration of mesonephric tubules to hilum of indifferent
E.WNT-4
gonad
C Stimulate differentiation of Sertoli & Leydig cells F. SRY
B Inhibits SOX-9 function which permits Mullerian ducts differentiation
G. Y
into female internal genitalia
A Known ovarian follicular cells key regualator H. FGF-9

CHROMOSOMAL LOCI/LOCATION OF GENES GENES


F Ch17q A. SRY
B Ch13q11-12 B. FGF-9
C Ch9 C. SF-1
E Ch1 D. DAX-1
D Xp21.3-21.2 (30,082,120 30,087,136th DNA base pairs) E. WNT-4
G Ch8q24.12 F. SOX-9
A Yp11 G. TAFii105

ITEM MONITORED & USUAL LOCATION OF Primordial Germ Cells (PG Cells) In weeks
AOG
A In the most caudal part of the yolk sac near the allantois A. 3rd
B PGCells migrate via amoeboid movement form allantois, cloaca, B. 4th
hindgut dorsal mesentery of hindgut
C Hilum of indifferent gonad C. 5th
D Penetrates the mesenchyme/parenchyma of the indifferent gonad D. 6th
E Gonad start to differentiate into either ovary or testis through E. 7th
PGCells secreted hormone

ITEM CELLULAR DEVELOPMENT DERIVED FROM


WHICH SPECIFIC
PART OF THE
INDIFFERENT
GONAD
A Follicular cells surrounding the egg cells/ female PG cells a. Surface
A Sertoli cells within the forming seminiferous tubules epithelium
B Leydig cells of primordial testis (cortex)
B Theca interna of primordial ovary b. Mesenchyme
(medulla)

TOPIC: 1. Reproductive Embryology 12


LECTURER: Dr. J.A. Amistad, MD
ITEM FROM INDIFFERENT STAGE TIME
A The earliest week you could use GONAD A. 7th week AOG
in determining the sex of embryo/fetus B. 8th week AOG
B The earliest week you could use the C. 12th week AOG
DUCTAL SYSTEM/INTERNAL GENITALIA in
the determining the sex of the
embryo/fetus
C The earliest week you could use the
EXTERNAL GENITALIA in identifying the
sex of the fetus

ITEM Adult (Internal Genitalia) Derivatives Embryonic structures


A Epididymis & Paradidymis
A Vas deferens
B Appendix testis of female
B Utriculus prostaticus of female
A Ejaculatory duct A. Mesonephric duct aka Wolffian
duct
C Seminiferous tubules
B. Paramesonephric duct aka
B Fallopian tube
Mllerian duct
B Uterus & Cervix of the Uterus
C. Testicular Cords of Primordial
D LOWER 2/3rds OF THE VAGINA
Testis
B Upper 3rd of the Vagina
D. Female posterior Urogenital Sinus
C Rete testis (called sinovaginal bulbs)
A Ductuli efferentes
A Paroophoron of Johnsons
A Epoophoron of Rosenmller
A Gartners duct

ITEM MALE Adult (External Genitalia) Derivatives Embryonic structures


B Wall of penile spongy urethra
E Spongy urethra + Corpus spongiosus +
A. Genital tubercle
ventral half of penile shaft & ventral half of
B. Urethral folds
prepuce
C. Anal folds
A Corpora cavernosa + dorsal half of penile
D. Genital Swelling
shaft & dorsal half of prepuce + Glans penis
E. Cloacal Membrane
C External Anal Sphincter
F. External Urethral Meatal Plug
D Scrotum
(ectoderm)
F Navicular fossa of Glans penis (last 2cm of
penile urethra)

ITEM Female Adult (Internal Genitalia) Derivatives Embryonic structures


E Hymen + Vestibule A. Genital tubercle
D Labia Majora B. Urethral folds
B Labia Minora + Fourchette C. Anal folds
A Clitoris + Clitoral Hood D. Genital swelling
C External Anal Sphincter E. Cloacal Membrane

TOPIC: 1. Reproductive Embryology 13


LECTURER: Dr. J.A. Amistad, MD
ITEM TESTICULAR ENSHEATHING DURING DESCENT EMBRYONIC ORIGIN
D Internal Spermatic Sheath A. External Oblique
Aponeurosis
A External Spermatic Sheath B. Internal Oblique
Aponeurosis
B Cremasteric Fascia & Cremasteric Muscle C. Transversus Abdominis
Aponeurosis
C NO PARTICIPATION as it arches over the D. Transversalis Fascia
descending testes

ITEM REPRODUCTIVE STRUCTURES GERM LAYER OF ORIGIN


C Gonads (i.e. ovary, testis) a. Ectoderm
C Wolffian Duct and Mullerian Duct b. Endoderm
A External genitalia (except prostate gland; lower 2/3rds of c. Mesoderm
vagina wall of male urethra internal lining of hymen) Intermediate
from CLOACAL FOLDS mesoderm
B Prostate gland lower 2/3rds of vagina wall of male d. Undifferentiated &
urethra internal lining of hymen non-lyonized epiblast
D Primordial germ cells (e.g. first colony of cells
sperm/egg cells)

ITEM DESCRIPTION (DEVELOPMENTAL MILESTONES) IN WEEKS AOG


DURING DESCENT OF TESTIS
A Testes are located in the posterior abdominal wall a. 8th week
retroperitoneally b. 12th week
B Testes have reached the pelvic brim/ inguinal c. 28th week
region near symphysis pubis d. 33rd week
C Testes begin to descent through the inguinal canal
D The earliest time testes have contacted the scrotal
floor

TOPIC: 1. Reproductive Embryology 14


LECTURER: Dr. J.A. Amistad, MD