male Flashcards
Most hyperplastic lesions arise in?
inner transitional zone
Most carcinomas (70-80%) arise
in?
the peripheral zones
What syndrome presents w/ fever, chills and dysuris.
Rectal examinations: Tender and boggy organ?
Acute Bacterial Prostatits
CF of Chronic Bacterial Prostatits
Low back pain, dysuria, perineal and suprapubic discomfort
Epi of Benign prostatic hyperplasia
Incidence: 90% –> 80yrs of age
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
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
CF of benign prostatic hyperplasia
- Difficulty starting or stopping urine stream
- straining while urinating
- Urinary Urgency
- Nocturia (increased urination frequency at night)
Treatment of benign prostatic hyperplasia
1) Inhibit DHT formation
2) Block alpha-adrenergic blockers → Relaxation of smooth muscles
Subcalssification of intra-epithelial neoplasia
1) Low-Grade PIN (LGPIN) and
2) High-Grade PIN (HGPIN)
Types of HGPIN
1) Flat pattern
2) Tufting pattern
3) Micro-papillary
4) Cribrifrom pattern
Epi of prostatic carcinoma
Men >50 years
* Most common form of cancer in men
behaviour of prostatic carcinoma
Ranges from aggressive and rapidly fatal to indolent
(‘latent”) disease of no clinical significance
70-80% of prostatic cancers arise in the —————
peripheral zone
Who is at Risk of developing Prostatic cancer
1) Increased incidence in blacks and Scandinavians
2) family History of prostate cancer
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
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
Prostatic Carcinoma is ass. w?
Co-existence of HGPIN (80% of cases)
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
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
Clinical features of Prostatic carcicoma
small, non-palpable asymptomatic lesions
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
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)
“Watchful waiting” for Cancers in?
- Older men
- Patients with substantial comorbidity
- Young patients, with low serum PSA and small low grade cancers
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
