12. Reproductive pathology/ male Flashcards
Describe the features of benign prostatic hyperplasia and prostatic carcinoma
Describe the common lesions of the urethra Describe the features of cystic lesions of the
testis, and of orchitis
Describe the pathological features of tumours of the testis
Describe the main causes of male infertility Describe the common abnormalities of the
epididymis and spermatic cord
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Frequent disorders of the prostate
Benign prostatic hyperplasia
Carcinoma
Prostatitis
Describe the features of benign prostatic hyperplasia (BPH): Cause? What is it? Premalignant? Consequences?
Cause: Non-neoplastic. is it associated with hormonal imbalance
What is it?
- Nodular hyperplasia of glands and stroma
- Involves transition zone of prostate plus peri-urehtral glands
- Not premalignant
Consequences:
- Obstructs urine flow
- Associated with infection
- Compress and elongate urethra
- Involvement of peri-urethral zone interferes with urethral sphincter
- Urinary retention: Acute = painful, chronic = painless and gradual
- Treatable
Complication of BPH?
Compression of urethra Nodular enlargement of prostate gland Trabeculation Muscular hypertrophy Renal: Infection, failure, calculi, secticaemia, bilateral hydronephrosis Bilateral hydroureter Diverticulum
Do you palpate the para-aortic lymph nodes when there is a testicular mass?
No although that’s where the lymph drainage is it
Differences between BPH and prostate carcinoma?
BPH:
- Hyperplasia of peri-urethral zone
- Median groove palpable on rectal examination
Carcinoma of prostate:
- Subcapsular focus of carcinoma
- Median groove obliteration by carcinoma arising in posterior subcapsular zone i.e. invasion of the capsule
Prostate cancer:
- Precursor?
- Position/shape of the adenocarcinoma?
- Adenocarcinoma metastasise?
- Epidemiology of latent or incidental carcinoma?
Precursor: Prostatic intraepithelial neoplasia
Position/shape of the adenocarcinoma: Posterior subscapular area, Asymmetric firm enlargement
Adenocarcinoma metastasise: Yes, to bone **
Epidemiology of latent or incidental carcinoma:
- Old age
- Are dormant
- Metastases in 30% after 10yrs
- Microscopic incidental focus
What is a gleason score?
Process of assessing the differentiation and distrubution of tumours in prostate cancer
Stage TN: Direct, via lymphatics, via blood
Presentation of prostate carcinoma?
Urinary symptoms
Incidental finding on rectal examination
Bone metastases
Lymph node metastases
Challenges presented by prostate carcinoma?
Screening:
- For PSA abnormalities
- High level = cancer
- Medium/normal levels = non-specific to inflammation, cancer, normal
- Also do rec exam to confirm diagnosis
- No representation if it’s latent, in situ, indolent, aggressive
Diagnosis of prostate carcinoma?
Imaging Ultrasound Cystoscopy Biochemistry: PSA Haematology: Bone marrow involvement -Biopsy
treatment options for prostate carcinoma?
Oestrogens GnRH analogues Orchidectomy Radiotherapy Radical prostatectomy
Possible abnormalities found in the penis and scrotum?
- Venereal infection
- Congenital malformations
- Inflammation and infections
- Tumours
Examples of congenital malformations of the penis and scrotum?
Hypospadias: urethral opening on inferior aspect of penis
Epispadias: Urethral opening on upper penis aspect. Often accompanied by abnormal development of bladder
What is phimosis?
Congenital narrowing of foreskin so it cannot be retracted
what is Paraphimosis?
Foreskin is trapped behind the glans penis
Examples of tumours of the penis and scrotum?
Bowen’s disease (non-invasive)
- Occur anywhere on penis
- Erythematous patch
- Keratotic surface
- Raised red plaque
Invasive squamous cell carcinoma
- HPV
- Glans penis or inner aspect of prepuce
- Nodule or plaque
- Metastasises to inguinal lymph node
Features of bowen’s disease?
Bowen’s disease (non-invasive)
- Occur anywhere on penis
- Erythematous patch
- Keratotic surface
- Raised red plaque
Features of Invasive squamous cell carcinoma?
Invasive squamous cell carcinoma
- HPV
- Glans penis or inner aspect of prepuce
- Nodule or plaque
- Metastasises to inguinal lymph node
Abnormalities that can occur with the urethra?
Obstruction
- Congenital valves
- Rupture
- Stricture
Urethritis
- Gonococcal (bacteria that causes gonorrhoea)
- Non-gonoccocal
Rupture
Tumours:
- Warts
- Transitional cell carcinoma
Features of gonococcal urethritis?
Later urethral stricture Acute urethritis Prostatitis Epididymitis Gram-negative diplococci in polymorphs
3 different forms of testicular lesions?
Developmental and cystic lesions e.g. Undescended testis, hydrocele, haematocoele
Orchitis (testes inflammation) e.g.
- Mumps orchitis
- Idiopathic granulomatous orchitis
- Syphilitic orchitis
Testicular tumours
Main 3 forms of testicular tumours?
Teratoma
* Seminoma*
Lymphoma (in elderly)
Presentation of testicular tumours?
Testicular tumors may present with
Painless unilateral enlargement of testis
Secondary hydrocele
Symptoms from metastases Retroperitoneal mass Gynaecomastia
Features of seminoma?
Commonest type of testicular tumour Germ cell origin Peak incidence 30-50yrs Types: -Classical -Spermatocytic -Anaplastic (with syncytiotrophoblast giant cells) -Combined
Features of a teratoma?
-Germ cell origin
-Peak incidence 20-30yrs
-More aggressive than seminoma. Never completely benign
-Types:
Differentiated
Intermediated
Undifferentiated
Trophoblastic
Markers: beta-hCH and alpha=fetoprotein
Name 4 non-germ cell tumours of the testis?
Malignant lymphoma: Common in elderly men
Leydig cell tumour: May produce androgens
Sertoli cell tumorus
Metastatic tumours
Staging of testicular tumours
Stage I - confined to testis and its coverings
Stage II - involves testis and para- aortic lymph nodes
Stage III - involves lymph nodes in mediastinum and/or supraclavicular region
Stage IV - visceral metastases
3 causes of male infertility
Endocrine disorders e.g. GnRH deficiency, oestrogen excess
Testicular lesions e.g. cryptorchidism, abnormal spermatogenesis
Post-testicular lesions e.g. obstruction of efferent ducts
Potential abnormalities of the epididymis and spermatic cord?
Congenital abnormalities Epididymal cysts and spermatocoeles Varicocoele Torsion of the spermatic cord and testis Inflammatory lesions – Epididymo-orchiti Tumours - rare
