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3002 > 69 Reproductive pathology: male > Flashcards

69 Reproductive pathology: male Flashcards

1
Q

Frequent prostate disorders?

A
  1. Benign prostatic hyperplasia
  2. Carcinoma
  3. Prostatitis
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2
Q 
Describe the features of benign prostatic hyperplasia (BPH):
• Cause?
• What is it?
• Premalignant?
• Consequences?
A
  1. Cause:
    • Non-neoplastic: associated with hormonal imbalance
  2. What is it?
    • Nodular hyperplasia of glands and stroma
    • Involves transition zone of prostate plus peri-urethral glands
  3. Not premalignant
4. Consequences:
• Associated with infections
• Obstructs urine flow
• Compress and elongate urethra
• Involvement of peri-urethral zone interferes with urethral sphincter
• Causes urinary retention: 
– Acute retention: painful
– Chronic retention: painless, more gradual
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3
Q

Complications of BPH?

A
  1. Prostate gland: Nodular enlargement
  2. Urethra: Compression
  3. Bladder:
    • Trabeculation
    • Muscular hypertrophy
    • Diverticulum
  4. Ureter:
    • Bilateral hydroureter
5. Kidney:
• Infection
• Renal failure
• Calculi
• Septicaemia
• Bilateral hydronephrosis
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4
Q

Differences between BPH and prostate carcinoma?

A

BPH:
• Hyperplasia of peri-urethral zone
• Median groove palpable on rectal examination

Prostate carcinoma:
• Subscapular focus of carcinoma
• Median groove obliterated by carcinoma arising in posterior subscapular zone - invasion of capsule

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5
Q 
Prostate carcinoma:
• Precursor?
• Position/shape of the adenocarcinoma?
• Adenocarcinoma metastasise?
• Epidemiology of latent or indolent (incidental) carcinoma?
A
  1. Precursor:
    • Prostatic intraepithelial neoplasia
  2. Position/ shape of adenocarcinoma (usually > 50 years):
    • Posterior subscapular area
    • Asymmetric firm enlargement
  3. Adenocarcinoma metastasises (esp to bone)
  4. Epidemiology of latent or indolent (incidental):
    • Microscopic incidental focus
    • Common: incidence high in old age
    • Lesions dormant: metastases in 30% after 10 years
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6
Q

What is a Gleason score?

A

• Process of differentiation and distribution of tumours in prostate cancer

• Stage TN:
– Direct
– Via lymphatics
– Via blood

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7
Q

Presentation of prostate carcinoma?

A
  • Urinary symptoms
  • Incidental finding on rectal examination
  • Bone metastases
  • Lymph node metastases
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8
Q

Challenges presented by prostate carcinoma?

A

Screening:
• For PSA abnormalities
• High level = cancer
• Medium/ normal levels = non-specific to inflammation, cancer, normal
• Also do rectal exam to confirm diagnosis
• No representation if it’s latent, in situ, indolent, aggressive

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9
Q

Diagnosis of prostate carcinoma?

A
  • Imaging - ultrasound, MRI, isotope bone scan
  • Cystoscopy
  • Biochemistry: PSA
  • Haematology - bone marrow involvement
  • Biopsy
  • Molecular pathology
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10
Q

Treatment of prostate carcinoma?

A
  • Oestrogens
  • GnRH analogues
  • Orchidectomy
  • Radiotherapy
  • Radical prostatectomy
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11
Q

Possible abnormalities in penis and scrotum?

A
  • Venereal infection
  • Congenital malformations
  • Inflammation and infections
  • Tumours
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12
Q

Examples of congenital malformations in penis and scrotum?

A
  • Hypospadias - urethral opening on inferior aspect
  • Epispadias - often accompanied by abnormal development of bladder
  • Phimosis, paraphimosis
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13
Q

What is phimosis?

A

Congenital narrowing of foreskin so it cannot be retracted

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14
Q

What is paraphimosis?

A

Foreskin is trapped behind the glans penis

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15
Q

Examples of tumours of the penis and scrotum?

A
  • Bowen’s disease (non-invasive)

* Invasive squamous cell carcinoma

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16
Q

Features of Bowens’s disease?

A
  • Intraepithelial carcinoma
  • Occur anywhere on penis Erythematous patch Keratotic surface
  • Raised red plaque
17
Q

Features of invasive squamous cell carcinoma?

A
  • Rare in UK
  • HPV
  • Glans penis or inner aspect of prepuce
  • Nodule or plaque
  • Metastasises to inguinal lymph nodes
18
Q

Carcinoma of the scrotum?

A
  • Nodular ulcerated mass
  • Squamous carcinoma
  • Inguinal nodes - possible ulceration
19
Q

Abnormalities that can occur with the urethra?

A
  1. Obstruction:
    • Congenital valves - rare in males
    • Rupture
    • Stricture
  2. Urethritis:
    • Gonococcal
    • Non-gonococcal (non-specific)
  3. Rupture
  4. Tumours:
    • Warts
    • Transitional cell carcinoma
20
Q

Features of gonococcal urethritis?

A
  • Prostatitis
  • Epididymitis
  • Acute urethritis
  • Later urethral stricutre
  • Gram -ve diplococci in polymorphs
21
Q

Where does the lymphatic drainage of testes drain to?

A

Para-aortic nodes

22
Q

3 different forms of testicular lesions?

A
  1. Developmental and cystic lesions:
    • Undescended testis (cryptorchidism)
    • Hydrocoele
    • Haematocoele
  2. Orchitis:
    • Mumps orchitis
    • Idiopathic granulomatous orchitis
    • Syphilitic orchitis
  3. Testicular tumours
23
Q

Testicular tumours statistics?

A
  • Uncommon (increasing incidence) but treatable
  • Occur in young men (commonest tumour <35yrs) and old men
  • Aetiology unknown but undescended testis is predisposing factor (x 10 risk)
  • In situ neoplasia does occur and is a precursor
24
Q

Main 3 forms of testicular tumours?

A
  1. Teratoma - younger men
  2. Seminoma - older men
  3. Lymphoma
25
Q

Presentation of testicular tumours?

A
  • Painless unilateral enlargement of testis
  • Secondary hydrocele
  • Symptoms from metastases
  • Retroperitoneal mass
  • Gynaecomastia
26
Q

Features of seminoma?

A 
• Commonest type of testicular tumour
• Germ cell origin
• Peak incidence: 30-50 years
• Types:
1. Classical
2. Spermatocytic
3. Anaplastic - with syncytiotrophoblast giant cells (may present with gynaecomastia)
4. Combined
27
Q

Features of teratoma?

A 
• Germ cell origin
• Peak incidence: 20-30 years
• More aggressive than seminoma
• Types:
1. Differentiated
2. Intermediate
3. Undifferentiated
4. Trophoblastic
• Beta-hCG and alpha-fetoprotein are useful markers
28
Q

Name 5 germ cell tumours

A
  1. Seminoma
  2. Teratoma
  3. Intratubular germ cell neoplasia - precursor lesion
  4. Yolk sac tumour (children) - AFP useful marker: extra-embryonic differentiation
  5. Combined germ cell tumours
29
Q

What can be used as a tumour marker?

A

AFP - Alpha-fetoprotein

30
Q

Name 4 non-germ cell tumours

A
  1. Malignant lymphoma - elderly men
  2. Leydig cell tumour - may produce androgens
  3. Sertoli cell tumour
  4. Metastatic tumours
31
Q

Staging of testicular tumours

A
  • Stage I - confined to testis and its coverings
  • Stage II - involves testis and para-aortic LNs
  • Stage III - involves LNs in mediastinum and/or supraclavicular region
  • Stage IV - visceral metastases
32
Q

Causes of male infertility?

A
  1. Endocrine disorders:
    • GnRH deficiency
    • Oestrogen excess
  2. Testicular lesions e.g.
    • Cryptorchidism
    • Abnormal spermatogenesis
  3. Post-testicular lesions:
    • Obstruction of efferent ducts
33
Q

Abnormalities of epididymis and spermatic cord?

A
  • Congenital abnormalities
  • Epididymal cysts and spermatocoeles
  • Varicocoele
  • Torsion of the spermatic cord and testis
  • Inflammatory lesions: epididymo-orchitis
  • Tumours: rare

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