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Pathoma 14 - Male Genital System
Terms in this set (38)
What is hypospadias?
Opening of urethra on inferior surface of penis
Due to failure of urethral folds to close**
Opening of urethra on superior surface of penis d/t abnormal positioning of genital tubercle.
Assic. with bladder exstrophy
What is condyloma acuminatum?
Benign warty growth on genital skin
Due to HPV 6 and 11
Characterized by KOILOCYTIC CHANGE
What is lymphogranuloma venereum?
Necrotizing granulomatous inflammation of inguinal lymphatics and lymph nodes
STD caused by Chlamydia trachomatis (serotypes L1-L3) (obligate intracellular d/t can't make ATP - infect as primary bodies, reproduce as reticulate bodies)
Eventually heals with fibrosis; perianal involvement may result in rectal strictures
What is squamous cell carcinoma of penis?
Malignant proliferation of squamous cells of penile skin
Risk Factors: HPV (2/3 cases)- high risk- 16, 18, 31, 33., lack of circumcision (foreskin acts as nidus for inflammation and irritation if not properly maintained)
-Precursor in situ lesions:
-Bowen disease - in situ carcinoma of the penile shaft or scrotum that presents as leukoplakia
-Erythroplasia of Queyrat - in situ carcinoma on the glans that presents as erythroplakia
-Bowenoid papulosis -In situ carcinoma that presents as multiple reddish papules; younger patients (40s); does not progress to invasive carcinoma
carcinoma in situ of penile shaft or scrotum. Presents as leukoplakia. Precursor lesion of squamous cell carcinoma of penis.
Erythroplasia of queyrat
in situ carcinoma of glans. Presents as erythroplakia. Precursor lesion of squamous cell carcinoma of penis.
in situ carcinoma- presents as multiple reddish papules. Seen in younger pt.s (40s) compared to Bowen's dz or erythroplasia of queyrat.
Does NOT progress to squamous cell carcinoma.
What is cryptochidism?
Failure of testicle to descend into scrotal sac (testes normally develop in abdomen and descend into scrotal sac as fetus grows)
Most common congenital male reproductive abnormality (1% of male infants)
Most cases resolve spontaneously; orchiopexy (tack testicle into scrotum) performed before 2yrs of age
Complications include testicular atrophy with infertility (d/t high body temp.) and increased risk for seminoma
What is orchitis?
Inflammation of testicle
-Chlamydia trachomatis (D-K) or N. gonorrhoeae - younger, sexually active adults, increased sterility risk, libido spared since Leydig cells are not affected
-E. coli and pseudomonas - elderly, UTI pathogens spread to reproductive tract
-mumps virus (teenage males) - increased infertility risk
-autoimmune orchitis - granulomas in seminiferous tubules (ddx TB- use AFB stain)
What is testicular torsion?
Twisting of spermatic cord
Thin walled veins become obstructed (aa stays open) leading to congestion and hemorrhagic infarction (testicle is loosely organized tissue)
Due to congenital failure of testes to attach to inner lining of scrotum (via processus vaginalis)
Presents in adolescents with sudden testicular pain and absent cremasteric reflex** (scrape tongue depressor across inner thigh- muscles of scrotum contract and draw scrotum in)
What is a varicocele?
Dilation of spermatic vein due to impaired drainage
Presents as scrotal swelling with bag of worms appearance
Usually left-sided; a/w left sided renal cell carcinoma** (left testicular vein drains into left renal vein, right testicular vein drains directly into IVC)
Seen in large percentage of infertile males - due to warm blood piling up
What is a hydrocele?
Fluid collection within tunica vaginalis (a serous membrane that covers the testicle and internal surface of scrotum)
Associated with incomplete closure of processus vaginalis leading to communication with peritoneal cavity (infants) or blockage of lymphatic drainage (adults)
Presents as scrotal swelling that can be transilluminated
What are general characteristics of testicular tumors?
Arise from germ cells (almost all malignant) or sex-cord stroma
Presents as firm, painless testicular mass that cannot be transilluminated
Not biopsied due to risk of seeding scrotum and most are malignant anyway***
Removed via radical orchiectomy
What are germ cell tumors?
Most common type of testicular tumor
15-40 yrs age
Risk Factors: cryptochordisism and Klinefelter syndrome
Divided into seminoma (respond to radiotherapy, metastasize late, excellent prognosis) and nonseminoma (metastasize early, variable treatment response)
What is a seminoma?
Malignant tumor of large cells with clear cytoplasm and central nuclei
Homogenous mass with no hemorrhage or necrosis**
Rare cases may produce B-HCG
Good prognosis; responds to radiotherapy, metastasizes late
Resembles ovarian dysgerminoma
What is the histology of seminoma?
lymphoid stroma between the nests of seminoma.
What is an embryonal carcinoma?
Malignant tumor of immature, primitive cells that may form glands*
Hemorrhage mass with necrosis*
Aggressive with early hematogenous spread
Chemo may result in differentiation into another type of germ cell tumor (teratoma)
Increased AFP or B-HCG may present
What is the histology of embryonal carcinoma?
Immature cells that may form glands*.
What is yolk sac tumor (endodermal sinus) of testes?
Malignant tumor that resembles yolk sac elements
Most common testicular tumor in children**
AFP is elevated*
Schiller-Duval bodies (glomerulus like structures) seen on histology
What is choriocarcinoma in males?
Malignant testicular tumor of synctiotrophoblasts and cytotrophoblasts (NO VILLI)
Spreads early via blood
B-HCG elevated (from syncytiotrophoblasts)
May lead to hyperthyroidism or gynecomastia (alpha subunit of hCG is similar to that of FSH, LH, TSH)
spreads early via blood! Can be tiny tumor in testicle(or ovary) and larger tumores met. throughout body.
What is a teratoma?
Tumor of mature fetal tissue
Derived from 2-3 embryonic layers
MALIGNANT in males (benign in females)***
AFP or B-HCG may be increased
What is a mixed germ cell tumor?
Most germ cell tumors are usually mixed
Prognosis based on worst component
What are sex cord stromal tumors?
Tumors resemble sex-cord stromal tissues of testicle
Normal testicle includes sertoli cells (line tubules) + leydig cells (b/t tubules)
1) Leydig cell tumor
-usually produce androgen = precocious puberty in children or gynecomastia in adults
-characteristic Reinke crystals on histology
2) Sertoli cell tumor
-comprised of tubules
-usually clinically silent
What is lymphoma of the testes?
Most common cause of testicular mass in males >60 (germ cell tumors usually b/t ages 15-40); often bilateral
Usually diffuse large B-cell type
What is the prostate?
Small, round gland; sits at base of bladder + anterior to rectum, encircles urethra
Consists of glands and stroma
- glands are composed of inner layer of luminal cells and outer layer of basal cells; secrete alkaline milky fluid that is added to sperm and seminal vesicle fluid to make semen
- glands and stroma maintained by androgens
What is acute prostatitis?
Acute inflammation of prostate, usually due to bacteria (same as in orchitis)
-Chlamydia trachomatis and Neisseria gonorrhoae (young adults)
-E. coli and pseudomonas (older adults)
Presents as dysuria with fever and chills
Prostate is tender and boggy on DRE**
Prostatic secretions show WBCS - culture reveals bacteria
What is chronic prostatitis?
Chronic inflammation of prostate
Presents as dysuria with pelvic or low back pain
Prostatic secretion show WBCs but cultures are neg**
What is benign prostatic hyperplasia?
Hyperplasia of prostatic stroma and glands
Age-related change (60s) - no increased risk for cancer
Related to DHT (testosterone converted to DHT by 5a reductase in stromal cells; DHT acts on androgen receptor of stromal and epithelial cells resulting in hyperplastic nodules)
Occurs in periurethral zone of prostate** (prostatic adenocarcinoma is in posterior prostate)
Clinical features: problems starting and stopping urine stream; impaired bladder emptying; dribbling; hypertrophy of bladder wall smooth muscle (possible aneurysm of bladder wall); microscopic hematuria, hydronephrosis
PSA is often slightly elevated (<10 ng/ml)- PSA is made by glands- liquefies semen
What is prostate adenocarcinoma?
Malignant proliferation of prostatic glands
Most common cancer in men; 2nd most common cause of cancer death
Risk factors: age, race (black>white>asian), and diet high in saturated fats
Arises in peripheral, posterior region of prostate (Does NOT produce urinary symptoms until very late)
Usually clinically silent
What are the screening methods for prostate carcinoma?
Begins at 50 with DRE and PSA
Normal serum PSA increases with age
PSA > 10ng/dl is worrisome at any age**
Decreased % free-PSA is suggestive of cancer (makes bound PSA)
What is a leydig cell tumor?
Sex cord stromal tumor
Usually produce androgen resulting in precocious puberty in children or gynecomastia in adults
Characteristic Reinke crystals on histology
What is a sertoli cell tumor?
Sex cord stromal tumor
Comprised of tubules
What is the treatment for benign prostatic hypertrophy?
a1 antagonist (terazosin) to relax smooth muscle
- also relaxes vascular smooth muscle lowering blood pressure
- selective a1a antagonists (tamsulosin) used in normotensive individuals to avoid a1b effects on blood vessels
- blocks conversion of testosterone to DHT
- takes months to produce result
- useful for male pattern baldness
- side effects: gynecomastia, sexual dysfunction
Discuss confirmation of prostatic carcinoma presence
biopsy!- Shows small, invasive glands with prominent dark nucleoli
Where does prostatic carcinoma metastasize?
Spread to lumbar spine or pelvis common
- Results in osteoblastic metastases that present as low back pain and increased serum alkaline phosphatase, PSA, and prostatic acid phosphatase (PAP)
What is the treatment for prostatic carcinoma?
local disease = prostatectomy
systemic (hormone suppression to reduce testosterone and DHT) = leuoprolide (continuous GnRH analog shuts down hypothalamus, reducing LH and FSH)
or androgen receptor inhibitor (flutamide)
Grading for prostatic carcinoma
Gleason grading system based on architecture alone (not nuclear atypia!)- multiple pieces of tumor needed because of high architecture variability across tumor.
- Score 1 to 5 assigned to two distinct areas and added to produce final score (2-10) --- higher score suggests worse prognosis
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