Diseases of Prostate, Testis, and Penis Flashcards
Causes of testicular atrophy
- congenital
- cryptorchidism
- klinefelter’s
- acquired
- atherosclerosis
- inflammation
- malnutrition
- hypopituitarism
- hormone therapy
Categories of causes of males infertility
- disorders that affect spermatogenesis, sperm fxn, or ductal obstruction
- congenital causes
- acquired causes
- Hormonal causes: FSH, LH, GnRH abnormalities
- Klinefelter’s syndrome (47 XXY): sclerosing tubular degeneration
Congenital causes of male infertility
- Cryptorchidism,
- Immotile cilia syndrome
- Anorchia (absence of both testes at birth),
- Absent vas deferens
Acquired causes of male infertility
- Torsion
- Twisting of cords ==> blocks venous flow ==> swelling and infarction
- Infarction
- Varicocele = varicose veins of the pampiniform plexus
- Rare cause of infertility
- due to venous valve insufficiency
- Obstruction
- Inflammation
Nonspecific epididymitis or orchitis: causative organism
- Kids: UTI bugs: gram (-) rods
- Sexually active adults:
- STDs: Chlamydia trachomatis, N. gonorrhoeae
- Elderly: Enterobacteria
- Also E. coli and P. aeruginosa per Goljan
Nonspecific epididymitis or orchitis: basic morphology
- Direct extension from urinary tract (vas deferens or lymphatics)
- Tends to affect epididymis first with subsequent orchitis
- Quick to form abscess due to cinching off of end artery blood supply
Mumps orchitis: cause/basic morphology
- cause: mumps virus
- Inflammatory infiltrate in poorly draining region causing atrophy:
- Unilateral 70%, Mononuclear inflammatory
- infiltrate with interstitial edema +/- neutrophils,
- subsequent to parotid involvement
TB orchitis: cause/basic morphology
- cause: Mycobacterium tuberculosis
- morphology
- Epididymis → Testis
- Usually part of systemic disease
- Caseating granulomas
Syphillis: cause/basic morphology
- cause: Treponema pallidum
- Testis → Epididymis
- Congenital or acquired
- Diffuse mononuclear interstitial inflammation rich in plasma cells
- Obliterative endarteritis → downstream necrosis
- +/- gummas (a characteristic tissue nodule found in the tertiary stage of syphilis)
Seminoma:
Clinical Picture
Classification
Morphologic Findings
Staging and
Treatment
Epidemiology
- clinical = 40-50yo
- class = PLAP, but serum markers often negative
- morphologic
- Fish flesh appearance, rounded
- lymphocytes + tumor cells
- staging/tx
- Good prognosis, radiosensitive + chemosensitive
- epidemiology
- Most common GCT 30-50%
Spermatocytic Seminoma:
Clinical Picture
Classification
Morphologic Findings
Staging and
Treatment
Epidemiology
> 50 years old
Serum markers often negative
Mixture of cells resembling 1o and 2o spermatocytes in myxoid stroma (look like combo of spermatogonia + spermocytes)
Good prognosis
Older men, 1-2%
Embryonal carcinoma:
Clinical Picture
Classification
Morphologic Findings
Staging and
Treatment
Epidemiology
Third decade
Markers variable: PLAP (Placental Alk Phos), placental lactogen, β hCG
Gross → looks ugly; lobulated, fibrosis. Anaplastic Histology: Apoptosisand a lot of mitotic activity. Grows fast, necrotic, rosettes, papillae.
Chemosensitive,High likelihood of metastasis, recurrence common
Pure → 3%
Mixed → 85%
Teratoma:
Clinical Picture
Classification
Morphologic Findings
Staging and Treatment
Epidemiology
Infants and adults
Histology → look for mixed epithelial and cystic structures within mass.
_Morphology: _
Mature or immature tissue. Slow progression to malignant change.White cartilage
cysts → structures formed by mature epithelial cells (mixed type tissue: bronchial, pancreas, glandular, skeletal muscle, anything)
Staging and treatment
Malignant transformation (unlike mature teratoma in women).Chemoresistant tumor will regress but mature teratoma remains
Infants → 40% of testicular tumors
Adult: Pure → 2-3%; Mixed → 45%
Yolk sac tumor:
Clinical Picture
Classification
Morphologic Findings
Staging and
Treatment
Epidemiology
Children and adults
Most common testicular tumor in kids
Produces α fetal protein (AFP)
Net-like with tears (i.e. holes)
Embryoid bodies
Schiller-Duval bodies
Fairly good prognosis
Pure common in kids,
Mixed common in adults
Choriocarcinoma:
Classification
Morphologic Findings
Staging and
Treatment
Epidemiology
Produces β hCG at high levels
Differentiating towards placenta
Looks like a placenta grossly and microscopically
“Placenta is designed to be an invasive organ”
Aggressive
Metastasizes
Chemosensitive but worse prognosis
Pure → 0.3%
Mixed → 10%