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Pathoma Male Genital System Pathology
Terms in this set (63)
Opening of the urethra on the inferior surface of the penis is called
. It is due to the failure of the urethal folds to close.
What is this condition and why does it occur?
Opening of the urethra on the superior surface of the penis is called
and is due to abnormal positioning of the genital tubercle.
What is this condition and why does it occur?
Bladder Exstrophy is a congenital anomaly in which part of the urinary bladder is present outside the body. It is typically associated with what pathology of the Penis?
Condyloma Acuminatum is caused by HPV infection (Type 6 or 11)
What underlying infection would you suspect in a patient presenting with this benign warty growth in his genitalia?
Koilocytic change due to HPV infection
These raisin-like nuclei are characteristic of infection?
Necrotizing granulomatous inflammation of the inguinal lymphatics and lymph nodes caused by Chlamydia Trachomatis (serotypes L1-L3):
LG eventually heals with fibrosis and peri-anal involvement may result in rectal strictures.
What is a long-term complication of lymphogranuloma venereum?
1. High Risk HPV (16, 18, 31, 33) in 2/3 of cases;
2. Lack of circumscision as foreskin acts as a nidus for inflammation and irritation if not properly maintained.
What are the risk factors for squamous cell carcinoma of the penis?
1. Bowen Disease;
2. Erythroplasia of Queyrat;
3. Bowenoid Papulosis;
List the precursor in situ lesions for squamous cell carcinoma of the penis:
In situ carcinoma of the penile shaft or scrotum that presents as leukoplakia:
Erythroplasia of Queyrat
In situ carcinoma of the glans that presents as erythroplakia:
Bowenoid Papulosis (occurs in younger patients relative to Bowen Disease and Erythroplasia of Queyrat)
In situ carcinoma that presents as multiple reddish papules and that does NOT progressive to invasive carcinoma.
Cryptorchidism -- failure of the testicle to descend into the scrotal sac. Seen in 1% of male infants.
Considered the most common congenital male reproductive abnormality:
While most cases resolve spontaneously, orchioplexy should be performed before 2 years of age in those that do not. Complications include testicular atrophy with infertility and increased risk for seminoma.
What are the complications of undescended testicles in a male child?
Inflammation of the testicle:
1. Chlamydia Trachomatis (D-K) or Neisseria Gonorrhea in young sexually active adults.
2. E. Coli and Pseudomonas in older adults (UTI inf. spreads to repro tract);
3. Mumps Virus in teenage males (increased risk of inferility)
4. Autoimmune orchitis
List the causes of Orchitis:
Leydig cells (i.e. Testosterone production) are spared.
While there is increased risk of sterility, libido is not affected in orchitis caused by Chlamydia or Neisseria -- why?
Characterized by non-necrotizing granulomas involving the seminiferous tubules --- i.e. Acid-Fast TB:
Twisting of the spermatic cord resulting in obstruction of thin-walled veins, which leads to congestion and hemorrhagic infarction.
It is usually due to congenital failure of testes to attach to the inner lining of the scrotum via the processus vaginalis.
What is testicular torsion and how does it happen?
(above: hemorrhagic infarction of testicle)
Presents in adolescents with sudden testicular pain and absent cremasteric reflex.
How do individuals with testicular torsion typically present?
Varicocele -- dilation of the spermatic vein due to impaired drainage that is seen in a large percentage of infertile males.
Patient presents with scrotal swelling with a "bag of worms" appearance. What is the Dx?
Left testicular vein drains into the left renal vein, while the right testicular vein drains directly into the IVC. RCC often invades the renal vein which would affect the testicular vein on the left but not the right side.
Why are varicoceles associated with renal cell carcinoma typically left sided?
Hydrocele -- fluid collection within the tunica vaginalis that is associated with incomplete closure of the processus vaginalis leading to communication with the peritoneal cavity (in infants) or blockage of lymphatic drainage (in adults).
Patient presents with scrotal swelling that can be trans-illuminated. What is the diagnosis and how does it happen?
1. They arise from germ cells or sex cord stroma;
2. Present as firm, painless testicular mass that cannot be transilluminated;
3. Usually not biopsied due to risk of seeding the scrotum;
What are three basic rules/facts about testicular tumors?
True -- they must be removed via radical orchiectomy;
Most testicular tumors are malignant germ cell tumors - True or False?
Testicular Lymphoma -- often bilateral and usually the diffuse B-cell type;
Most common cause of a testicular mass in males over the age of 60:
1. Cryptorchidism (undescended testes);
2. Klinefelter's Syndrome
Germ cell tumors are the most common type of testicular tumors (>95% of cases) and they usually occur in patients between the age of 15-40. What are the risk factors?
1. Seminoma (55%)
2. Non-seminoma (45%) (i. embryonal; ii. yolk sac; iii. choriocarcinoma; iv. teratoma)
What are the two categories of germ cell tumors. List the relevant subtypes.
Seminomas are highly responsive to radiotherapy, metastasize late, and have an excellent prognosis;
Non-Seminoma show variable response to treatment and often metastasize early.
How do Seminoma and Non-seminoma germ cell tumors of the testicle differ?
Malignant tumor of the testicle comprised of large cells with clear cytoplasm and central nuclei, that resemble spermatogonia:
Homogenous mass with no hemorrhage or necrosis that often resembles ovarian dysgerminoma;
How would you describe the gross appearance of seminoma?
In rare cases, seminomas may produce a hormone typically produced by the placenta during pregnancy:
Name this malignant tumor comprised of immature, primitive cells that may produce glands and that forms a hemorrhagic mass with necrosis.
is aggressive with early hematogenous spread. Chemo may result in differentiation into another type of germ cell tumor (e.g. teratoma). Increased AFP or B-hCG may be present.
Describe the nature/spread, response to treatment, and markers of Embryonal carcinoma:
Yolk Sac (endodermal sinus) tumor -- AFP is classically elevated.
These glomerulus-like structures known as
are found in what germ cell tumor that is the most common testicular tumor in children? What marker is elevated?
Choriocarcinoma -- associated with elevations of
which may lead to hyperthyroidism or gynecomastia due to homologous alpha subunit of B-hCG to that of FSH, LH and TSH.
Malignant tumor of syncytiotrophoblasts and cytotrophoblasts (i.e. placenta-like tissue, but absent villi) that spreads early via blood. What is typically elevated in these patients? What other findings are common as a result?
Teratoma -- typically is malignant in males as opposed to benign in females.
__________ is a tumor comprised of mature fetal tissue derived from two or three embryonic layers. How does it differ in males vs. females?
Sex Cord Stromal Tumors:
- Leydig Cell tumors --> androgen production --> precocious puberty in children or gynecomastia in adults;
- Sertoli Cell tumor --> comprised of tubules and is usually clinically silent.
Characteristic Reinke crystals may be seen on histology.
Pictured above is an image of the normal testicle. What testicular pathology (think tumor) can resemble normal testicular histology?
How do these patients present based on particular cellular involvement? What is a characteristic finding on histology?
Mixed germ cell tumor
______________ are germ cell tumors whose prognosis is based on the worst component.
Small, round organ that lies at the base of the bladder encircling the urethra. Sits anterior to the rectum such that the posterior aspect is palpable by DRE.
Describe the anatomic relation of the prostate with respect to the bladder, urethra, and rectum:
Glands and stroma are maintained by androgens.
Glands are composed of an inner layer of luminal cells and an outer layer of basal cells --- secrete alkaline, milky fluid that is added to sperm and seminal vesicle fluid to make semen.
The prostate consists of glands and stroma. How are they maintained? What is the function of the glands?
Young adults -- Chlamydia trachomatis and Neisseria Gonorrhea;
Older adults -- Escherichia Coli and Pseudomonas
What are the common causes of acute prostatitis in young adults vs. older adults?
While in both conditions patients present with dysuria and prostatic secretions with WBCs, patients with acute P typically have fever and chills while those with chronic P have pelvic or low back pain.
cultures reveal bacteria
in acute P and are
in chronic P.
How does the presentation of acute prostatitis differ from chronic prostatitis?
Benign Prostatic Hyperplasia (BPH)
Age related change that is present in most men by the age of 50 years with no increased risk for cancer:
Testosterone is converted to DHT by 5-alpha reductase in stromal cells. DHT acts on the androgen receptor of stromal and epithelial cells resulting in hyperplastic nodules.
What is the relationship of dihydrotestosterone (DHT) to Benign Prostatic Hyperplasia (BPH)?
Prostate adenocarcinoma usually arises in the peripheral, posterior region of the prostate and hence, does not produce urinary symptoms early on. BPH occurs in the central peri-urethral zone of the prostate and leads to compression of the urethra.
Why is it that urinary symptoms are not present until late in the course of prostate adenocarcinoma as compared to benign prostatic hyperplasia?
1. Problems starting and stopping urine stream;
2. Impaired bladder emptying;
4. Microscopic hematuria;
5. PSA elevation
6. Hypertrophy of bladder wall smooth muscle/diverticula
List the clinical features of BPH:
Complication of BPH resulting from impaired bladder emptying that may lead to infection:
PSA is slightly elevated due to the increased number of glands. PSA is made by prostatic glands and liquefies semen.
What is Prostate-Specific Antigen (PSA)?
1. Terazosin (alpha-1 antagonist);
2. Tamsulosin (selective alpha-1 antagonist) for normotensive individuals;
3. 5-alpha reductase inhibitors
What are 3 treatment options for BPH?
These drugs block the conversion of testosterone to DHT thereby reduce male patterned baldness.
However, they take months to produce results and often have side effects such as gynecomastia and sexual dysfunction.
What are the advantages and disadvantages of using a 5a-reductase inhibitor in BPH?
Malignant proliferation of prostatic glands that is the most common cancer in men and 2nd most common cause of cancer related deaths:
1. Race (Black > White > Asian);
2. Diet high in saturated fat;
What are the risk factors of prostate adenocarcinoma?
Usually arises in the peripheral, posterior region of the prostate and, hence, does not produce urinary symptoms early on.
Why is prostatic carcinoma most often clinically silent?
Screening begins at 50 with DRE and PSA levels. Normal serum PSA increased with age due to BPH (2.5 for 4--49 and 7.5 for 70-79). PSA >10 is worrisome at any age.
At what age do you begin screening for prostate cancer and what does it entail?
False --- decreased % Free-PSA is suggestive of cancer (cancer makes bound PSA).
%-free PSA is increased in prostate cancer - true or false?
False -- Prostatic biopsy is required to confirm the presence of carcinoma.
Elevated PSA is required to confirm the presence of prostate cancer - True or False?
Shows small, invasive glands with prominent nucleoli.
Describe the microscopic appearance of prostate adenocarcinoma:
Gleason Grading System (based on architecture alone and NOT nuclear atypic).
Multiple regions of the tumor are assessed because architecture varies from area to area. A score of (1-5) is assigned for 2 distinct areas and then added to produce a final score (2-10). Higher score suggests worse prognosis.
How is Prostate cancer graded?
Results in osteoblastic metastases that present as low back pain and increases serum alkaline phosphatase, PSA, and prostatic acid phosphatase.
Prostate cancer typically spreads to the lumbar spine or pelvis. How does this present?
Localized = Prostaectomy
Advanced = hormone suppression to reduce testosterone and DHT (e.g. Leuprolide, Flutamide). As prostate cancer is dependent on androgens in order to grow/thrive.
What are the treatment options for both localized and advanced prostate cancer?
Continuous GnRH analog that shuts down the hypothalamus, resulting in decreased LH and FSH:
Competitive inhibitor of the androgen receptor:
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