CH14 - Male Genital System Pathology Flashcards
What is the hypospadias?
Opening of urethra on inferior surface of penis
What is hypospadias due to?
failure of the urethral folds to dose
What is epispadias?
opening of urethra on superior surface of penis
What is epispadias due to?
abnormal positioning of the genital tubercle
What is epispadias associated with?
bladder exstrophy
What is condyloma acuminatum?
Benign warty growth on genital skin
What is condyloma acuminatum due to?
HPV type 6 or 11; characterized by koilocytic change
What is lymphogranuloma venereum?
Necrotizing granulomatous inflammation of the inguinal lymphatics and lymph nodes
What is lymphogranuloma venereum caused by?
sexually transmitted disease caused by Chlamydia trachomatis (serotypes L1-L3)
What eventually happens to lymphogranuloma venereum?
it heals with fibrosis; perianal involvement may result in rectal stricture
What is squamous cell carcinoma for the penis?
Malignant proliferation of squamous cells of penile skin
What are the risk factors for squamous cell carcinoma of the penis?
1) high risk HPV (2/3 of cases) 2) Lack of circumcision
Why is a lack of circumcision a risk factor for squamous cell carcinoma of the penis?
foreskin acts as a nidus for inflammation and irritation if not properly maintained
<p>
| In squamous cell carcinoma of the penis what are the precursor in situ lesions?</p>
<p>
| 1) Bowen disease 2) Erythroplasia of Queyrat 3) Bowenoid papulosis (only CIS with no predisposition for invasion)</p>
What is Bowen disease?
in situ carcinoma of the penile shaft or scrotum that presents as leukoplakia
What is erythroplasia of queyrat?
in situ carcinoma on the glans that presents as erythroplakia
What is bowenoid papulosis?
in situ carcinoma that presents as multiple reddish papules
In whom is bowenoid papulosis seen?
Seen in younger patients (40s) relative to Bowen disease and erythroplasia of Queyrat
How invasive is bowenoid papulosis?
Does not progress to invasive carcinoma
What is cryptorchidism?
Failure of testicle to descend into the scrotal sac
Where do the testicles normally develop?
in the abdomen and then descend into the scrotal sac as the fetus grows.
What is the most common congenital male reproductive abnormality and how often is it seen?
Cryptorchidism and is seen in 1% of male infants
What is orchiopexy?
Operation to bring undescended testicle into scrotum
What happens in most cases of cryptorchidism?
most cases resolve spontaneously; otherwise, orchiopexy is performed before 2 years of age.
What are the complications for cryptorchidism?
they include testicular atrophy with infertility and increased risk for seminoma.
What is orchitis?
Inflammation of the testicle
What are the causes for orchitis?
1) Chlamydia trachomatis (serotypes D-K) or Neisseria gonorrhoeae 2) Escherichia coli and Pseadomonas 3) mumps virus 4) autoimmune orchitis
In whom is orchitis caused by Chlamydia trachomatis (serotypes D-K) or Neisseria gonorrhoeae seen in and what happens as a result?
young adults. Increased risk of sterility, but libido is not affected because Leydig cells are spared.
In whom is orchitis caused by Escherichia coli and Pseadomonas seen in and what happens as a result?
older adults and what results is that urinary tract infection pathogens spread into the reproductive tract.
In whom is orchitis caused by the mumps virus seen and what is the result?
Seen in teenage males and there is an increased risk for infertility; testicular inflammation is usually not seen in children < 10 years old.
What is autoimmune orchitis characterized by?
granulomas involving the seminiferous tubules
What is testicular torsion?
twisting of the spermatic cord; thin-walled veins become obstructed leading to congestion and hemorrhagic infarction
What is testicular torsion usually due to?
congenital failure of testes to attach to the inner lining of the scrotum via the processus vaginalis
How does testicular torsion present?
in adolescents with sudden testicular pain and absent cremasteric reflex
What is a varicocele?
dilation of the spermatic vein due to impaired drainage
What does a varicocele present as?
scrotal swelling with a bag of worms appearance
To what side does the varicocele present?
usually left sided;
Why does a varicocele present as left sided?
Because the left testicular vein drains into the left renal vein, while the right testicular vein drains directly into the IVC.
What is the varicocele associated with?
left-sided renal cell carcinoma; RCC often invades the renal vein.
In whom is the varicocele seen?
in a large percentage of infertile males
What is a hydrocele?
Fluid collection within the tunica vaginalis
What is the tunica vaginalis?
it is a serous membrane that covers the testicle as well as the internal surface of the scrotum.
What is the tunica vaginalis associated with?
incomplete closure of the processus vaginalis leading to communication with the peritoneal cavity (infants) or blockage of lymphatic drainage (adults)
How does the hydrocele present?
as scrotal swelling that can be transluminated
From where do testicular tumors arise?
from germ cells or sex cord-stroma
What do testicular tumors present as?
a firm, painless testicular mass that cannot be transluminated
When are testicular tumors biopsied?
usually not biopsied due to risk of seeding the scrotum; removed via radical orchiectomy
Are testicular tumors benign or malignant?
Most testicular tumors are malignant germ cell tumors.
What are the testicular germ cell tumors?
Seminoma, Nonseminoma, embryonal carcinoma, Volc sac tumor, choriocarcinoma, teratoma, milted germ cells
What is the most common type of testicular tumor?
Germ cell tumors (> 95% of cases)
In whom do the most common type of testicular tumor usually occur?
between 15-40 years of age
What are the risk factors for germ cell testicular tumors?
include cryptorchidism and Klinefelter syndrome
What are germ cell testicular tumors divided into?
seminoma and nonseminoma
What are seminomas?
It is 55% of testicular tumor cases and are highly responsive to radiotherapy, metastasize late, and have an excellent prognosis,
What is the prognosis for seminomas?
Excellent prognosis
What are nonseminomas?
It is 45% of cases and show variable response to treatment and often metastasize early.
What is seminoma?
it is a malignant tumor comprised of large cells with clear cytoplasm and central nuclei (resemble spermatogonia); forms a homogeneous mass with no hemorrhage or necrosis
What is the most common testicular tumor?
Seminoma; resembles ovarian dysgerminoma
In rare cases of seminoma what may be produced?
Beta-hCG
What is the prognosis for seminoma?
Its good and responds to radiotherapy
What is embryonal carcinoma?
it is a malignant tumor comprised of immature, primitive cells that may produce glands, forms a hemorrhagic mass with necrosis
Describe embryonal carcinoma.
It is aggressive, with early hematogenous spread
What is the reaction of embryonal carcinoma to chemotherapy?
It may result in differentiation into another type of germ cell tumor (e.g., teratoma).
What increased levels may be present in embryonal carcinoma?
Increased AFP or beta-hCG may be present
What is yolk sac tumor?
It?s a germ cell tumor. (endodermal sinus) tumor is a malignant tumor that resembles yolk sac elements.
What is the most common testicular tumor in children?
Volk sac (endodermal sinus)
What is seen on histology for embryonal carcinoma?
Schiller-Duval bodies (glomerulus-like structures) are seen on histology
In embryonal carcinoma what levels are characteristically elevated?
AFP
For germ cell testicular tumors, what is choriocarcinoma?
It is a malignant tumor of syncyliotrophohlasts and cytotrophoblasts
What are cytotrophoblasts?
placenta-like tissue, but villi are absent
How does choriocarcinoma spread?
It spreads early via blood
What are syncyliotrophoblasts?
They are the epithelial covering of highly vascular embryonic placental villi
What levels are elevated in syncyliotrophoblasts?
beta-hCG is characteristically elevated and may lead to hyperthyroidism or gynecomastia (beta-subunit of hCG is similar to that of FSH, LH, and TSH)
What is a teratoma?
it is a tumor composed of mature fetal tissue derived from two or three embryonic layers
How is a teratoma in males different from a teratoma in females?
It is malignant in males (as opposed to females)
What levels may be increased in a teratoma?
AFP or beta-hCG may be increased
What happens in a milted germ cell testicular tumor?
Germ cell tumors are usually mixed.
What is the prognosis for a milted germ cell tumor?
Prognosis is based on the worst component of the mixed germ cell tumor
What are sexcord stromal tumors?
Tumors that resemble sex cord-stromal tissues of the testicle; usually benign
What are leydig cell tumors?
they usually produce androgen, causing precocious puberty in children or gynecomastia in adults,
In leydig cell tumors, what may be seen on histology?
Reinke crystals
What are sertoli cell tumors comprised of?
tubules and is usually clinically silent.
What is lymphoma (testicle)?
Most common cause of a testicular mass in males > 60 years old; often bilateral
What cell type is usually involved with lymphoma of the testicle?
It?s usually of diffuse large B-cell type
What is the prostate?
Small, round organ that lies at the base of the bladder encircling the urethra
What is the location of the prostate?
anterior to the rectum;
What is palpated in a DRE?
posterior aspect of prostate is palpable by digital rectal exam (DRE),
What does the prostate consist of?
glands and stroma
What are the glands of the prostate composed of?
an inner layer of luminal cells and an outer layer of basal cells; secretes alkaline, milky fluid that is added to sperm and seminal vesicle fluid to make semen.
How are the glands and stroma of the prostate maintained?
by androgens.
What is acute prostatitis?
Its acute inflammation of the prostate; usually due to bacteria
What are the most common causes of acute prostatitis in young adults?
Chlamydia trachomatis and Neisseria gonorrhoeae
What are common causes of acute prostatitis in older adults?
Escherichia coli and Pseudomonas
How does acute prostatitis present?
Presents as dysuria with fever and chills
How does the prostate present with acute prostatitis?
it is lender and boggy on digital rectal exam
In acute prostatitis what does the prostatic secretions show?
Prostatic secretions show WBCs; culture reveals bacteria.
What is chronic prostatitis?
Chronic inflammation of prostate
How does chronic prostatitis present?
It presents as dysuria with pelvic or low back pain
What do prostatic secretions in chronic prostatitis show?
WBCs, but cultures are negative,
What is benigin prostatic hyperplasia?
It is hyperplasia of prostatic stroma and glands
What is the probability of BPH resulting in cancer?
Age-related change (present in most men by the age of 60 years); no increased risk for cancer
What is BPH related to?
dihydrotestosterone (DHT)
What is testosterone converted to? Where? By what?
Converted to DHT by 5 alpha-reductase in stromal cells
What does DHT act on?
the androgen receptor of stromal and epithelial cells resulting in hyperplastic nodules
Where does BPH occur?
in the central periurethral zone of the prostate
What are the clinical features for BPH?
They include 1. Problems starting and stopping urine stream 2. Impaired bladder emptying with increased risk for infection and hydronephrosis 3. Dribbling 4. Hypertrophy of bladder wall smooth muscle; increased risk for bladder diverticula 5. Microscopic hematuria may be present. 6. Prostate-specific antigen (PSA) is often slightly elevated (usually less than 4 ng/mL) due to the increased number of glands;
Why is PSA elevated in BPH, and what is the effect of this?
Because PSA is made by prostatic glands and liquefies semen
What is the range for PSA in patients with BPH?
4-10ng/ml
What is the treatment for BPH?
Alpha 1-antagonist (e.g., terazosin) to relax smooth muscle and 5 alpha reductase inhibitor
For BPH, what must be considered as a side effect of the treatment?
The alpha-1 antagonist also relaxes vascular smooth muscle lowering blood pressure
How is the side effect for the treatment of BPH taken into consideration?
Selective alpha 1A-antagonists (e.g., tamsulosin) are used in normotensive individuals to avoid effects on blood vessels
What does 5a-reductase inhibitor do for BPH?
It blocks the conversion of testosterone to DHT
How long does it take to produce results in treating BPH with 5 alpha reductase?
Takes months to produce results
What other effects does 5 alpha reductase have when treating BPH?
Its also useful for male pattern baldness and has side effects are gynecomastia and sexual dysfunction
What is prostate adenocarcinoma?
malignant proliferation of prostatic glands
What is the most common cancer in men?
Prostate adenocarcinoma
What is the 2nd most common cause of cancer-related death?
Prostate adenocarcinoma
What are the risk factors for prostate adenocarcinoma?
they include age, race (African Americans > Caucasians > Asians), and diet high in saturated fats.
How does prostatic carcinoma most often present clinically?
silent
Where does prostate carcinoma usually arise?
in the peripheral, posterior region of the prostate and, hence, does not produce urinary symptoms early on
When does screening for prostate adenocarcinoma begin?
at the age of 50 years with DRE and PSA
What are normal serum PSA levels?
it increases with age due to BPH (2.5 ng/mL for ages 40-49 years vs. 7.5 ng/mL for ages 70 - 79 years)
What levels of PSA would be worrisome at any age?
> 10 ng/dL is highly worrisome at any age
What aspect of PSA might be suggestive of cancer?
Decreased % free-PSA is suggestive of cancer (cancer makes bound PSA)
What is required to confirm prostatic carcinoma?
Prostatic biopsy is required to confirm the presence of carcinoma
What does prostate carcinoma show?
small, invasive glands with prominent nucleoli
What is the grading system for prostate carcinoma?
Gleason grading system is based on architecture alone (and not nuclear atypia)
What is the Gleason grading system?
- Multiple regions of the tumor are assessed because architecture varies from area to area. 2. A score (1-5) is assigned for two distinct areas and then added to produce a final score (2-10). 3. Higher score suggests worse prognosis.
In prostate carcinoma spread to what areas are common?
lumbar spine or pelvis is common;
The spread of prostate carcinoma to the lumbar spine or pelvis results in what?
osteoblastic metastases
For osteoblastic metastases or prostate carcinoma to the lumbar spine or pelvis, how does it present?
it presents as low back pain and increased serum alkaline phosphatase, PSA, and prostatic acid phosphatase (PAP)
When is prostatectomy performed?
it is performed for localized disease
What is advanced prostate carcinoma treated with?
hormone suppression to reduce testosterone and DHT
What are used in hormone suppression for the treatment of advanced prostate carcinoma?
Continuous GnRH analogs (e.g., leuprolide) and flutamide
What does continuous GnRH analog (used in hormone suppression treatment of prostate carcinoma) do?
it shuts down the hypothalamus (LH and FSH are reduced)
What does flutamide (used in hormone suppression treatment of prostate carcinoma) do?
it acts as a competitive inhibitor at the androgen receptor
