L24 - Pathology of the Male genital tract Flashcards
List 3 congenital anomalies of the penis?
Hypospadia and Epispadia
Congenital urethral valvular obstruction
Phimosis
Complications of hypospadia and epispadia?
Predispose to urinary tract infection
interfering with normal ejaculation
Describe the abnormality in Congenital urethral valvular obstruction?
Membranous flap in the prostatic urethra
> > cause urinary obstruction
Describe the abnormality in Phimosis?
orifice of the prepuce is too small for its normal retraction
congenital or produced after inflammatory scarring
List some nonspecific infections of the penis and causative agents?
prepuce (balanitis) and glans (prosthitis)
Candida albicans, Mumps, Tuberculosis
Tract the ascending route of STD infection?
urethra > prostate > vas deferens > epididymis > testis (atrophy, scarring)
Complications of chronic STD?
Persistent inflammation > Fibrosis in:
Urethra: fistula, stricture
Testis: atrophy, scarring
Systemic complication of STDs?
endocarditis (valves), arthritis
Causative agent of Condyloma acuminata (venereal warts) ?
Human Papilloma Virus (HPV) types 6 and 11
Most common non-gonorrhea infection?
Chlamydial infections
Gross appearance of venereal warts?
- single or multiple warty papillary growth on penis/scrotum
- may spread locally to involve anogenital region
Histological appearance of venereal warts?
- fibroblastic branching stalk covered by acanthotic squamous epithelium
- koilocytes: perinuclear halo + smudged nuclei
- differentiated from squamous carcinoma by the mature epithelium
Most common malignant tumour of penis? Age of incidence?
Squamous cell carcinoma
50-70 years
Etiology of penile scc?
- Not Circumcised
- Poor hygiene and smegma
- HPV infection
Gross, histological appearance of penile SCC and route of spread?
Gross: exophytic ulcerated growth or nodular plaques
Histology: squamous cell carcinoma
Course: regional lymph nodes metastasis
Gross appearance of penile carcinoma in-situ and disease progression?
Smooth, soft red plaques OR elevated, red scaly papules on the glans and penis.
May develop into invasive squamous cell carcinoma
Causative agents of acute and chronic prostatitis?
Nonspecific infection caused by coliform bacteria, gonococci or chlamydia
May Extend from the bladder or urethra
List 2 inflammatory diseases of the prostate?
Acute and chronic prostatitis
Granulomatous prostatitis
Causes of granulomatous protatitis?
1) specific infections such as tuberculosis or syphillis
2) inflammatory reaction to inspissated secretion/ autoimmune causation
What is the most common prostate disease?
Benign prostatic hyperplasia (BPH)
Gross morphology of BPH?
distinct circumscribed grey white nodules in the periurethral zone
Histological appearance of BPH?
glandular and fibromuscular stromal proliferation
+/- infarct, infection, squamous metaplasia
Clinical presentation of BPH?
(i) asymptomatic
(ii) compression of urethra-difficulty in urination, frequency or dribbling
(iii) retention of urine > hydronephrosis, hydroureters, bladder distention and hypertrophy
Complications of BPH?
retention of urine:
- bladder distention and hypertrophy
- hydroureters and hydronephrosis
- chronic renal failure
superimposed infections-prostatitis or cystitis
Etiology and tumour marker for prostatic carcinoma?
Androgen causing growth of the tumor
Prostatic specific antigen PSA
Clinical presentation of prostatic carcinoma?
Prostatism: nocturia, frequency, urgency…etc
hard mass find during rectal examination/ Incidental finding during biopsy for BPH
signs and symptoms of metastasis (e.g. back pain due to vertebral metastasis)
4 clinical uses for tumour marker PSA?
· Screening of occult prostate cancer
· Detection of recurrence
· Find distant metastasis
· Identify primary metastatic tumour/ ectopic tumour
Gross and histological appearance of Prostatic carcinoma?
Gross = yellowish, hard, gritty tissue
Histological = · Adenocarcinoma with acini
Mode of prostatic carcinoma spread?
· Local -causing prostatic urethra obstruction and infiltrate adjacent tissue
· Lymphatics -presacral in pelvis, iliac and paraaortic lymph nodes
· Blood/ Retrograde venous -vertebra, osteoblastic, widespread metastasis: Batson’s Plexus to spine**
Treatment for prostatic carcinoma?
surgery +/- hormonal therapy
Describe one congenital anomaly of the testes and epididymis?
Cryptorchidism(undescended testes)
failure of the intraabdominal testes to descend into the scrotal sac
Complications of Cryptorchidism?
inguinal hernia, trauma, testicular atrophy (at and after puberty),
increased incidence of testicular tumor
Infetility (if bilateral)
List 2 inflammatory diseases of testes and epididymis?
1) Granulomatous orchitis: due to extravasated sperm, tuberculous orchitis or testicular tumour
2) Infection:
- Gonorrhea, STI and TB»_space; epididymitis
- Syphilis»_space; orchitis
- Mumps
Name and describe one vascular lesion of the testis?
Torsion = Twisting of spermatic cord
interferes with venous drainage and causes engorgement and hemorrhagic infarct of the testis.
Describe the general origin of testicular tumours? Malignant or niot?
rare, nearly always malignant
90% of primary testicular tumours = germ cell origin;
5% from gonadal stroma;
rest from other components of the testis.
Give examples of germ cell testicular tumours affecting newborn?
yolk sac tumour
Teratoma
Examples of germ cell testicular tumours affecting young children? pattern of spread?
Choriocarcinoma = blood Teratoma = blood and lymphatic
Germ cell testicular tumours affecting young adults? pattern of spread?
Embryonal carcinoma (anaplastic) Lymphatic and blood
Germ cell testicular tumours affecting middle age men? Pattern of spread?
Seminoma
Lymphatic
Germ cell testicular tumours affecting old age men?
Spermatocytic seminoma
2 etiologies of germ cell testicular tumours?
Cryptochidism: may involve other normal testis
Strong genetic familial predisposition
Presentation of testicular tumours?
Testicular enlargement or pain, Distant metastasis
General Treatment of testicular cancer?
surgery, irradiation and chemotherapy.
Define the histogenesis of yolk sac tumour and choriocarcinoma of testis?
Germ cell > embryonal carcinoma in extra-embryonic tissue:
cytotrophoblastic and syncytiotrophoblastic cells = choriocarcinoma
Yolk sac = yolk sac tumour
Define the histogenesis of teratoma of testis?
Germ cell > embryonal carcinoma in embryonic tissue:
More than one of mesoderm, ectoderm, endoderm elements involved
> > teratoma
Gross morphology of testicular seminoma?
Well-demarcated tan-white homogeneous mass
uniform cells in lobules separated by a fine stroma
Histological appearance of testicular seminoma?
large, round, central hyperchromatic nucleus with prominent nucleoli
sharp cell border
Treatment of seminoma?
orchidectomy and postsurgical irradiation.
2 distinct features of yolk-sac tumour and name one 1 tumour marker?
1) distinctive perivascular structures
2) hyaline globules
alpha-fetoprotein
Tumour marker for choriocarcinoma?
Serum and urinary Human chorionic gonadotrophin (hCG)
normally Secreted by sycytiotrophoblastic cells in the placenta
Define the malignancy of testicular teratoma?
Differentiated mature teratomas = benign in infants and young children
Mature/ immature teratoma in postpubertal male = malignant
Most common type of gonadal Stromal tumours in males?
Leydig cell tumours
Most common non-germ cell testicular tumour in men over 60?
Testicular lymphoma
Mostly secondary
Ddx scrotal mass.
Ø Testicular tumour
Ø Tumour-like conditions e.gg hydrocele and haematocele
Ø Hernia
Ø Orchitis
Ø Torsion
Ø Tumour and tumour-like conditions of spermatic cord and testicular appendages
List 3 prognostic factors of testicular germ cell tumours?
All about cryptorchidism
- Abdominal vs inguinal
- Undescended vs contralateral descended
- Orchipexy vs no orchipexy (correct cryptorchidism)
Describe the pathohistological changes to undescended testis?
INTERSTITIAL FIBROSIS + SHRINK
NO spermatogenic cells
Progressive Degeneration
Ddx raised Alpha-fetoprotein?
• Hepatocellular carcinoma, severe cirrhosis
• Germ cell tumour: testis:
–yolk sac tumour
–embryonal carcinoma
Which testicular tumours have increased hCG?
Choriocarcinoma (most) ****
Embryonal carcinoma (some)
Seminoma (ST) (some)
