male Flashcards by Elyaa Saleh

Most hyperplastic lesions arise in?

inner transitional zone

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Most carcinomas (70-80%) arise
in?

the peripheral zones

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What syndrome presents w/ fever, chills and dysuris.
Rectal examinations: Tender and boggy organ?

Acute Bacterial Prostatits

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CF of Chronic Bacterial Prostatits

Low back pain, dysuria, perineal and suprapubic discomfort

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Epi of Benign prostatic hyperplasia

Incidence: 90% –> 80yrs of age

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causes/ pathogenesis of Benign prostatic hyperplasia

Excessive androgen (oestrogen) dependent growth of stromal and glandular elements
Synthesis of Dihydrotestosterone (DHT) in the prostate, from circulating testosterone → DHT binding to nuclear androgen receptors (causes cell proliferation) → Regulation of growth of prostatic epithelium and stromal cells

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Macroscopic Features:
* Large organ (weight: 60-100gr)
* Numerous well-circumscribed nodules, with solid and cystic areas
* Slit-like appearance of the urethra, due to compression by the hyperplastic nodules

Microscopic features:
* Proliferating glandular elements and fibromuscular stroma
* Lining of hyperplastic glands -> Inner layer of tall columnar epithelial cells and outer layer of flattened basal cells
* Intraluminal presence of corpora amylacea (proteinaceous secretory material)

features of?

Benign Prostatic hyperplasia

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CF of benign prostatic hyperplasia

Difficulty starting or stopping urine stream
straining while urinating
Urinary Urgency
Nocturia (increased urination frequency at night)

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Treatment of benign prostatic hyperplasia

1) Inhibit DHT formation
2) Block alpha-adrenergic blockers → Relaxation of smooth muscles

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Subcalssification of intra-epithelial neoplasia

1) Low-Grade PIN (LGPIN) and
2) High-Grade PIN (HGPIN)

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Types of HGPIN

1) Flat pattern
2) Tufting pattern
3) Micro-papillary
4) Cribrifrom pattern

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Epi of prostatic carcinoma

Men >50 years
* Most common form of cancer in men

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behaviour of prostatic carcinoma

Ranges from aggressive and rapidly fatal to indolent
(‘latent”) disease of no clinical significance

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70-80% of prostatic cancers arise in the —————

peripheral zone

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Who is at Risk of developing Prostatic cancer

1) Increased incidence in blacks and Scandinavians
2) family History of prostate cancer

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Microscopic Findings:
* Small glands, crowded together (“back-to-back” appearance)
* Glands lined by a single layer of cuboidal or low
columnar cells
* Absence of the basal cell layer
* pale-clear or typical amphophilic Cytoplasm
* Enlarged nuclei, with prominent nucleoli

Macroscopic Features:
* Firm, gray-white lesions
* Not well-defined margins
* Infiltrative growth into the adjacent prostatic parenchyma

features of?

Prostatic carcinoma

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what does the presence of Cribriform glands, sheets of cells ,or individual infiltrating cells in microscopic findings of a prostatic carcinoma indicate?

High-grade tumour

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Prostatic Carcinoma is ass. w?

Co-existence of HGPIN (80% of cases)

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Which Gleason pattern best corresponds to the following histopatho findings?

Fused , Cribifrom glands w/ irregular or ragged contours
Ill-defined, poorly-formed glands with slit-like lumens
Glands with intraluminal glomerulations

Gleason pattern 4

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Which Gleason pattern best corresponds to the following histopatho findings?

Tumour cells infiltrating as small nests, cords or individual cells
focally, Solid nests of tumour w/ “Comdeo” necrosis

Gleason pattern 5

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Clinical features of Prostatic carcicoma

small, non-palpable asymptomatic lesions

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Progression of Prostatic carcinomas

Locally advanced cancers →** Infiltration of the seminal vesicles and, adjacent soft tissues and organs** (i.e. bladder and rectum)
Osteoblastic metastases to the axial skeleton

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Labratory findings of Prostatic Carcinoma

↑ total PSA w/ ↓ free PSA
(notes Free PSA: Total PSA is lower in men w/ prostatic cancer than men w/ being prostatic disease)

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“Watchful waiting” for Cancers in?

Older men
Patients with substantial comorbidity
Young patients, with low serum PSA and small low grade cancers

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The most common Penile Neoplasm?

**Squamous cell carcinoma >95%**

Epi of Sqamous cell carcinoma in situ (of the penis)

Associated w/ **uncircumcised men** >40yrs **and HPV** (16/18)

Squamous cell carcinoma is aka?

**Bowen disease**

Macroscopic Features: * Solitary **plaque** on the **penis’ shaft** Microscopic Findings: * Malignant cells within the epidermis, without invasion of the underlying stroma * **Large pale keratinocytes** with abundant ground cytoplasm **(“pagetoid cells”)** * **lymphocytic infiltrates** features of?

**Bowen disease** (SCC) | *SCC: squamous cell carcinoma in situ

Macroscopic Features: * **Gray**, crusted, papular lesion; Occasionally, **ulcerated with irregular margins** Microscopic Findings: * **Keratin pearls** features of?

**Invasive squamous cell carcinoma**

Microscopic Findings: * **Bulbous (rounded), pushing deep margins**, and **no atypia** * Thin fibrovascular cores * Thick acanthotic epithelium features of?

**Verrucous carcinoma** | * Varient of SCC (papillary architecture)

Complications of Cryptorchidism

1) **Sterility** (impaired spermatogenesis) 2) 3-5-fold **increased risk for development of testicular cancer**

Microscopic Findings: * **Tubular atrophy (age: 5-6yrs**); **Hyalinisation (puberty)** * Foci of **Intratubular Germ Cell Neoplasia (IGCN)** features of?

**Cryptorchidism**

Causes of Epididymitis? | * inflammation of the epididymis

* Children--> **Coliforms** * Young men --> **Neisseria gonorrhoeae and Chlamydia trachomatis** * Older men --> **E. coli and Pseudomonas**

Pathogenesis of Epididymitis

**Primary urinary tract infection** → Vas deferens or the lymphatics of the spermatic cord → **Spread to the Testis**

Macroscopic Findings: * **Swollen and tender** organ (Epididymus) * **Creamy fibrino-purulent exudate** Microscopic Findings: * **Neutrophilic inflammatory infiltrate** features of?

**Epididymitis**

cause of Orchitis | * Inflammation of the testis

**Mumps virus**

Macroscopic Features: * **Oedematous and congested testes** Microscopic Findings: * **Lympho-plasmacytic** inflammatory infiltrate * **Extensive necrosis**, atrophy, fibrosis and sterility (**severe cases)** features of?

**Mumps Orchitis** | *Lympho-plasmacytic infiltrates = Virus

Cause of Spermatic Cord Torsion in Adults

Failure of normal posterior anchoring (positioning) of the gubernaculum testis **(“scrotal ligament”)**, epididymis and testis (**bell clapper deformity**) → Increased mobility of testes

CF of Torsion of the Spermatic cord

Sudden onset of testicular pain

Complications of Spermatic Cord Torsion

Obstruction of testicular venous drainage → Vascular engorgement & Venous **infarction** * Urologic Emergency!!

Epi of testicular Neoplasms

* Peak incidence: 15-35 years * Germ cell tumours account for 95% of testicular tumours in post-pubertal males

Risk factors of Testicular tumours

* History of Cryptorchidism * Brothers of males with Germ Cell Tumours --> 8-10-fold increased risk

Calssification of Testicular Neoplasms

1) Germ Cell Tumours 2) Sex Cord-Stromal tumours

Germ cell Tumours examples

1) Seminomas (**“Classic” Seminomas, Spermatocytic Seminoma**) 2) Non-seminomatous Germ Cell Tumours (**i.Embryonal Carcinomas, ii. Yolk-Sac Tumours, iii. Choriocarcinomas, iv.Teratomas**)

Sex Cord-Stromal Tumours

* Sertoli-Cell Tumours * Leydig-Cell Tumours

Macroscopic Features: * Soft, **well-demarcated, gray-white lesions** (on the surface of the testicle) * Large tumours: Foci of coagulation necrosis * **Lobular pattern** Microscopic Findings: * Large, uniform cells with distinct cell borders * **Clear, glycogen-rich cytoplasm** * **Round nuclei**, with **prominent nucleoli** * Arrangement of cells in small lobules, separated by fibrous septa * Usually, **lymphocytic infiltrates** * Sometimes, accompanying ill-defined granulomatous reaction * Presence of **syncytiotrophoblastic giant cells** in 15% of cases; feature of?

**Seminomas** | * Germ Cell tumour (Testicular neoplasm)

what Hormon levels are elevated in Seminomas?

**β-hCG (10% of patients)** and **PALP** | * beta-human chorionic gonadotropin

# * Germ cell tumour Epi of Spermatic Seminoma

>65 years

Microscopic Findings: * **Polygonal cells of variable size** (i.e. **lymphocyte-like cells, intermediate cells and giant cells)** * Arrangement of cells in nodules or sheets * Absent lymphocytic infiltrates, granulomas and syncytiotroph. * No association to Intratubular Germ Cell Neoplasia (IGCN) * No metastatic potential features of?

**Spermatocytic Seminoma** | * Gram cell tumour

Macroscopic Features: * **Large and well-demarcated lesions** * Low cuboidal to columnar cells * Formation of microcysts, sheets, glands and papillae * **Schiller-Duvall bodies**: Structures **resembling primitive glomeruli** * Identification of PAS positive **eosinophilic hyaline globules** features of?

Yolk Sac Tumours

What Hormones are Elevated in Yolk Sac Tumours?

α1-antitrypsin and **AFP (90% of patients)**

Macroscopic Features: * Small, **non palpable lesions** * **lobulated and Haemorrhagic and necrotic lesions** Microscopic Findings: * Sheets of small cuboidal cells, admixed with **cytotrophoblast and syncytiotrophoblast-like cells** features of?

**Choriocarcinomas**

Hormone levels elevated in Choriocarcinomas

**hCG (+)** in syncytiotrophoblast-like cells (**100% of patients)**

Epi of Teratomas

Pure forms: Common in infants and children; Rare in adults (only 2-3% of Germ Cell Tumours)

Microscopic Findings: * Heterogenous collection of **differentiated cells** or organoid structures (e.g. **neural tissue, muscle bundles, foci of cartilage and thyroid resembling tissue**, brain substance, etc.) within a **fibrous or myxoid stroma** * tissues may be mature (resembling adult tissues) or immature (resembling fetal tissues) features of?

Teratomas

List the 4 types of Teratomas

A. Neural (Ectodermal) B. Glandular (Endodermal) C. Cartilage (Mesodermal) D. Squamous Epithelial

Prognosis of Seminomas

**Excellent prognosis** (>90%)

Prognosis of Non-seminomatous tumours

**Excellent prognosis** (~90% of patients --> Complete remission and cure, with aggressive chemotherapy )

Prognosis of Pure Choriocarcinoma

**Poor prognosis**

CF of Seminomas and non-seminomatous tumours

**Painless** testicular mass