Histopathology Male Genital System 1 and 2 Flashcards
Spermatoceole
Benign epithelial cyst of epididimus
Varicocoele
Dilated blood vessels (tortuous)
Hydrocoele
Accumulation of serous fluid in body cavity (ascites or testicular)
Cryptochidism → Definition
Permanent retention of testis outside the scrotum
Cryptochidism → Prevalence
Occurs in 1% of boys
Cryptochidism → Presentation
Must are idiopathic and unilateral
If bilateral, can results in sterility
Cryptochidism → Risks associated
30-4- x more risk of developing GCT
If a cryptorchid testis is surgically placed in the scrotum, it may still develop a germ cell neoplasm especially if operated after 6 years of age
Atrophy →Can be secondary to
- Cryptochidism
- Inflammation – mumps
- Oestrogens (Cirrhosis and hormonal therapy for PCa)
- Chemotherapy, particularly cyclophosphamide (cause cell death as rapidly dividing cells)
- Radiation exposure
- Testicular regression syndrome (possibly secondary to infarction in-utero)
Male Infertility → Causes can be grouped into three categories
- Pre testicular – extra-testicular endocrine disorder
- Testicular – all the causes of atrophy
- Post testicular – obstruction of the ducts – can be located by surgery
Mumps Orchitis → Epi
Mumps usually occurs in children involving parotid gland.
In adults, about 25% of the cases are complicated by orchitis
Mumps Orchitis → Definition
The testis is enlarged and very tender due to stretching of the tunica albugenia
In many cases, however the testis becomes atrophic and if bilateral can lead to infertility.
Mumps Orchitis → Types
Idiopathic Granulomatous Orchitis
Syphillic Orchitis
Mumps Orchitis → Idiopathic Granulomatous Orchitis
Uncommon causes of unilateral testicular enlargement in middle-aged men
Mumps Orchitis → Idiopathic Granulomatous Orchitis microscopically
Granulomas are centred on the tubules and into the interstitium
Mumps Orchitis → Idiopathic Granulomatous Orchitis possible aetiology
Includes reaction to estravasated sperms (Rupture of seminiferous tubules stimulates an immune response.
Mumps Orchitis → Syphillic Orchitis
Now rarely seen
Was common site of development of Gumma
M/s granulomatous inflammation with central necrosis
Mumps Orchitis → Features
1o Ulcer
2ndry Wafty lesions mucocutaneous junction
3 o Involves CVS – artic aneurysm/spial dorsal column → neurosyphilis
Testicular Tumours → Peak incidence
15-34 years
Most common tumour of male in this age group
Accounts for less than 1% of all cancer deaths in UK
Testicular Tumours → Can be classified into:
- Germ cell tumour (90%)
- Sex-cord stromal tumours (sertoli and leydig cells)
- Mixed germ cell sex cord stromal tumours
- Primary tumours not specific to the testis e.g. lymphoma
- Metastatic tumours
Germ Cell Tumours → Description
Most testicular GCT are malignant
Germ Cell Tumours → Derived from
Germ cells, therefore able to differentiate towards any embryonic or extraembryonic tissue.
Germ Cell Tumours → Can present with
- Painless unilateral enlargement of testis
- Secondary hydrocele
- Symptoms from metasteses
- Retroperitoneal mass
- Gynaecomastia
Germ Cell Tumours → Risk Factors
• Cryptorchidism – higher the location greater the risk
Germ Cell Tumours → Genetic predisposition
- Sibs have 10-fold high risk
* Blacks in Africa have very low incidence
Germ Cell Tumours → Testicular dysgenesis
Testicular feminisation
Klinefelter syndrome
Germ Cell Tumours → Cytogenic changes
Involving chromosome 12 and 1 (isochromosome of short arm of chromosome 12 – in 90%)
Germ Cell Tumours → Classification
In situ
Invasive
Germ Cell Tumours → In situ
Intratubular Germ cell Neoplasia
Germ Cell Tumours → Invasive
Seminoma
Non seminomatous Germ cell Tumours
Mixed
Germ Cell Tumours → Non seminomatous germ cell tumours types
Embryonal Carcinoma
Yolk sac tumour
Choriocarcinoma
Teratoma
Germ Cell Tumours → Intratubular germ cell Neoplasia
- In situ stage
- Proliferation of neoplastic germ cells within seminiferous tubules
- Upto 80% of GCT show ITGCN in the adjacent tissue.
- Sometimes seen in the biopsy performed for the study of infertility or cryptochidism
Germ Cell Tumours → Seminoma
• Commonest type of germ cell tumour
• Main sub-types includes
→ Classical 95%
→ Spermocytic
Germ Cell Tumours → Classical seminoma with histological appearance
Commonest sub-type
Peak in 4th decade
m/s sheets of rounded cells with clear cytoplasm and variable lymphocytic infiltrate in the stroma
Spermatocytic Seminoma
Accounts for 3-5% of all seminomas
Occurs in older age group
M/s mixed population of small intermediate and giant cells with increased mitotic rate
Spermatocytic Seminoma prognosis
Excellent
Embryonal Carcinoma: Epi
Mostly in 20-30 years age group
Embryonal Carcinoma: Description
More aggressive than seminoma
Embryonal Carcinoma: M/S
The cells are anaplastic and arranged in glandular, alveolar, solid or papillary growth patterns.
Embryonal Carcinoma: Usually associated with
Other germ cell tumour, pure form constitutes only 3% of GCT
Yolk sac Tumours → Epi
In children pure form, most common GCT in infants and children up to 3 yrs of age, good prognosis.
Yolk sac Tumours → In adults associated with
Embryonal carcinoma
Yolk sac Tumours → Characteristic structures
Schiller-Duval bodies formed by a perivascular layer of tumour cells.
Yolk sac Tumours → Serum shows
Levels of AFP are raised and the neoplastic cells are positive for AFP
Choriocarcinoma: Incidence
Only 0.3% occurs in pure form whereas 1.5% of NSGCT tumours habe choriocarcinoma component.
Choriocarcinoma: Composed of both
Cyto and syncitiotrophoblasts – multinucleated
Choriocarcinoma: Serum
Raised serum HCG levels
Choriocarcinoma: Prognosis
Highly malignant
Teratoma → Differentiation
Can differentiate into any of the three germ cell layers
Teratoma → These tumours can have
Mature 9adult type) tissue – TD
Immature (foetal type) tissue
Teratoma → Pure teratoma (TD) 2nd common in children prognosis
Good
Teratoma → Adult poor form prognosis
Only 2-3% treated as malignant as they have metastatic potential.
Mixed Tumours → Prevalence
14% of all testicular GCT
Mixed Tumours → Description
Various combination occurs including seminoma and NSGCT
Mixed Tumours → Treated as
NSGCT
Dissemination → Description
Direct spread to rete testis and epididymis
Dissemination → Spread via
- The Lymphatics to para-aortic lymph nodes and then to mediastonal lymph nodes.
- Blood to lung, liver and bone (teratoma).
Dissemination → Prognosis of Germ cell Tumour
Seminoma v/s NSGCT
Dissemination → Stage 1
Confined to the testis
Dissemination → Stage II
Testis + para-aortic lymph nodes
Dissemination → Stage III
Testis + mediastinal and/or supraclavicular LNs
Dissemination → Stage IV
Visceral metastasis
Prostate → Anatomy
Surrounds the bladder neck and proximal urethra
Prostate → Normal weight
Approx. 20 mg
Prostate → Also divded into
Inner (periurethral) and the outer (cortical) zone
Prostate →Inner Zone
Nodular hyperplasia
Prostate → Outer zone
Carcinoma
Prostate → M/s
The glandular component is divided into ducts and acini
Prostate → Glandular component cellular component
Two cell layers
Prostate → The Stroma is
Fibromuscular
Prostrate Inflammation →Acute and Chronic bacterial prostatitis
Occurs secondary to UTI
Prostatic secretions are positive for bacterial culture
Difficult to treat chronic prostatitis
Prostrate Inflammation → Chronic abacterial prostatisis
Most common form
Prostatic secretion contains leukocytes but negative for bacterial culture
Nodular Hyperplasia → Prevalence
Extremely common in men over the age of 50 years (70% by the age of 60 years)
Nodular Hyperplasia → Involves
Periurethral region of the prostate
Nodular Hyperplasia → Results in
Urinary Retention
Nodular Hyperplasia → Caused by
Androgens (dihydrotestosterone DHT)
Nodular Hyperplasia → Increased weight
60 to 100 mgs
Nodular Hyperplasia →M/s
There is increase in glandular and stromal component in both
Nodular Hyperplasia → 5 alpha reductase
Testosterone converted to DHT (more potent)
Carcinoma of Prostate →Prevalence
Commonest form of cancer in males but second commonest cause of death – die w/ cancer not because of it.
Carcinoma of Prostate → Incidence
Increased incidence after the age of 50 years
Carcinoma of Prostate →Incidence
Blacks> Whites> Asian
Carcinoma of Prostate → Etiology
Multifactorial
• Hormone – androgen receptor (large no. of receptors in these cells)
• Genetic, susceptibility genes 1q24-25, 1st degree relatives
• Fat consumption
• Lycopene in tomatoes (protective)
Premalignant lesions associated with Carcinoma of prostate
59-100% of prostatic adenocarcinoma in radical prostatectomy specimens
Carcinoma of Prostate → M/S
Adenocarcinoma i.e. tumour forms small glandular structures lined by layer of cells
Carcinoma of Prostate → Grading
Glessons score depending up to the growth patterns.
Carcinoma of Prostate → Prevalence Staging
A: not palpable
Stage B Palpable, confined to prostate
Stage C Extracapsular extension
Stage D Metastatic
Carcinoma of Prostate → Diagnosis
Raised PSA level, range according to the age
Digital PR examination
Imaging Biopsy