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Genital System > Male Genital Pathology > Flashcards

Male Genital Pathology Flashcards

1
Q

Prostatism

A

A clinical syndrome, occurring mostly in older men,
usually caused by enlargement of the prostate gland
and manifested by irritative (nocturia, frequency,
decreased voided volume, sensory urgency and urgency incontinence) and obstructive (hesitancy, decreased stream, terminal dribbling, double voiding and urinary retention) symptoms.

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2
Q

Prostatitis

A

Inflammation of the prostate

US National Institutes of Health categorization
of prostatitis:

I – acute bacterial prostatitis

II – chronic bacterial prostatitis

III – chronic pelvic pain syndrome

  • A : inflammatory
  • B : non-inflammatory

IV – symptomatic inflammatory prostatitis

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3
Q

Granulomatous Prostatitis

A

Heterogeneous groups all causing enlargement of
the gland and urethral obstruction

Firm gland on rectal examination, mimic tumour

Idiopathic prostatitis – result from leakage of
material from distended ducts in a gland enlarged
by nodular hyperplasia

Genito-urinary tuberculosis

Secondary to ischemia related to blood vessel
damage

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4
Q

Nodular Hyperplasia:

Aetiology

A

Also known as benign prostatic enlargement or
benign prostatic hypertrophy

-Very common in men over 60 years

Nodular hyperplasia pathology

Nodular hyperplasia pathology

Prostate carcinoma

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5
Q

Nodular Hyperplasia:

Clinical Symptoms

A

Clinically it is characterized by bladder outflow
obstruction, which results in difficulty with
micturition:

  • Delay in starting to pass urine
  • Weak stream
  • Dribbling at the end of micturition

These symptoms are collectively referred to as
prostatism or LUTS

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6
Q

Nodular Hyperplasia:

Pathogenesis

A

Probably due to hormonal imbalances, i.e.
androgen levels fall with age, which results in a
relative increase in estrogen levels.

This causes the peri-urethral (central zone) prostatic
tissue to undergo hyperplasia.

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7
Q

Nodular Hyperplasia:

Pathology-Macroscopy

A

The prostate is enlarged with a
mass of 50g to 200g (normal mass is 20g).

On cut-section the prostate has a nodular
appearance

The tissue is partly solid and partly spongy

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8
Q

Nodular Hyperplasia:

Pathology-Microscopy

A

There is both an increase in the fibromuscular stroma of the prostate as well as the prostatic glands, creating nodular groups of large glands with papillary projections

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9
Q

Nodular Hyperplasia:

Complications

A

Obstruction of bladder outflow results in:

Hypertrophy and trabeculation of the bladder wall.

Hydroureter, hydronephrosis and chronic renal
failure.

Urinary stasis with infections.

Acute urinary retention (often seen in cases of
infarcts).

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10
Q

Carcinoma of the Prostate:

Introduction

A 
most common non-cutaneous malignancy in the
white male population
 very common in elderly men
 peak incidence between 60 and 85 years
 very rare before 50 years of age
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11
Q

Prostate Carcinoma:

Aetiology

A

largely unknown
 possibly hormonal basis
 growth is stimulated by androgens and slowed
by estrogens

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12
Q

Prostate Carcinoma:

Pathology-Macroscopy

A

macroscopically, commonly located in the
subcapsular region (peripheral zone) of the
gland
 often in the posterior aspect of the prostate
 tumours are poorly circumscribed, and usually
firm and yellow-white in colour (not always
appreciable macroscopically)

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13
Q

Prostate Carcinoma:

Pathology-Microscopy

A

microscopically, carcinomas usually detected in
the subcapsular region of the prostate
 has the features of an adenocarcinoma
 most cases are usually well-differentiated, but
moderate- and poorly-differentiated tumours also
occur
 the neoplastic glandular structures are mostly
small
 perineural infiltration is common

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14
Q

Prostate Carcinoma:

Spread

A
  1. Direct, i.e. through the capsule into the surrounding tissue, seminal vesicles, bladder and rarely the rectum
  2. Lymphatic, i.e. to iliac and para-aortic lymph nodes
  3. Haematogenous, i.e. mainly to bone, liver and lungs (note that vertebral metastases are the most common and are osteosclerotic)
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15
Q

Prostate Carcinoma:

Prognosis

A

Most tumours respond to hormonal manipulation and the stage and grade influence the prognosis.

Stage A: very small carcinoma, chance finding,
excellent prognosis.

Stage B: tumour confined to prostate, 80% 5 year survival

Stage C: extracapsular spread, 50% 5 year survival

Stage D: distant metastases, 20% 5 year survival

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16
Q

Orchitis

A

Any inflammatory condition of the testes.

There are four main types:

  1. Mumps Orchitis
  2. Idiopathic Granulomatous orchitis
  3. Syphilitis Orchitis
  4. Tuberculosis Orchitis
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17
Q

Mumps Orchitis

A

With parotitis, usually unilateral

Vascular dilatation and oedema of interstitium with
lymphocytes.

Increased pressure in swollen testis produce ischaemia
from blood vessel compression – necrosis of
seminiferous tubules.

◼

18
Q

Idiopathic granulomatous orchitis

A

Unknown aetiology, 45 – 60 yrs

◼ Firm, unilateral testis mass – mimics tumour

19
Q

Syphilitis orchitis

A

 Now rare, was common site for gumma

 Unilateral painless enlargement – mimic tumour

20
Q

Tuberculous orchitis

A

 One of the most common causes of testis mass forming
lesions, caused by mycobacterium tuberculosis
 Example of isolated organ tuberculosis – see MDIS
 Usually starts in the eppidydimus
 Casseus necrosis, epitheloid cell granulomas and
langhans giant cells

21
Q

Urethritis

A

Inflammation of the urethra which is in association with more proximal infection or

Adjacent to a local urethral lesion:

  • Calculus
  • Indwelling urinary catheter

Most common cause – sexually transmitted infection:

  • Gonococcal urethritis (gonorrhoea)
  • Non-gonococcal (non-specific) urethritis
22
Q

Gonococcal urethritis (gonorrhoea)

A

Neisseria gonorrhoeae

Acute inflammation of urethra

Incubation 2-5 days after intercourse

90% of males symptomatic, 70% of females
asymptomatic

Involves peri-urethral glands, prostate,
epididymis

Urthral stricture

Gram-negative gonococci within polymorphs

23
Q

Non-gonococcal urethritis

A

Non-specific urethritis

Commonest sexually transmitted disease

40% - chlamydia trachomatis,
40% - ureaplasma urealyticum, histoplasma genitalium

Remainder no organisms

Mucopurulent urethral discharge and dysuria

Gonococci not detected by microscopy or
culture

24
Q

Torsion of the testis

A

 Torsion of the spermatic cord involves
thwisting of the testis and epididymis on their
axis
 Acute surgical emergency
 Presents with swollen, hard, painful testis
 13-16 years
 Hemorrhagic infarction due to venous outflow
obstruction followed by arterial flow obstruction
 Management: orchidopexy or orchidectomy

25
Q

Cryptorchid testis

A

Undescended testis – during fetal
development testis descends from post
abdominal wall to the scrotum

Cannot be palpated in scrotum – can be in the
inguinal canal or intra-abdominal

If not surgically drawn into scrotum adequate
spermatogenic activity does not develop and
long term risk of neoplasia

26
Q

Testicular Tumours:

Incidence

A

Fairly rare

Incidence has recently increased in many western countries

In South Africa they were virtually never seen in
black men, however the incidence has recently increased black men in South Africa

27
Q

Testicular Tumours:

Aetiology

A

Aetiology is unknown

Increased incidence in undescended testes (cryptorchidism)

Possibly due to increased temperature

28
Q

Testicular Tumours:

Classification

A

Testicular tumours can be classified into broad
main groups – general classification:

  1. Germ cell tumours (90%)
  2. Non-germ cells tumours
  3. Malignant lymphoma

Others:

Soft tissue tumours

Tumours of other structures like epididymis and
cord

29
Q

Germ Cell Tumours

 
 Seminomatous tumours
 
 
 Non-seminomatous germ cell tumours (35%)
▪ adult teratoma
▪
A
  1. Intratubular germ cell neoplasia (ITGCN)
  2. Seminomatous tumours:
  3. 1 Seminoma - classic (40%)
  4. 2 Spermatocytic seminoma
  5. Non-seminomatous:
  6. 1.Teratoma-Adult/Immature
  7. 2 Teratocarcinoma
    1. Embryonal Carcinoma
    1. Choriocarcinoma
    1. Yolk Sac Tumour
  11. Mixed Germ Cell Tumors-Seminoma and Teratoma
30
Q

Non-Germ Cell Tumours

A
  1. Leydig Cell Tumour
  2. Sertoli Cell Tumour
  3. Other sexcord-stromal tumours
31
Q

Seminoma:

Incidence

A

Most common testicular tumour.

Age incidence 30 to 50 years

Generally presents with painless enlargement of
the testis

32
Q

Seminoma:

Pathology-Macroscopy

A

It is well-circumscribed, oval in shape, solid in consistency and white in colour (also called a ‘potato tumour’)

33
Q

Seminoma:

Pathology-Microscopy

A

microscopically, seminoma consists of sheets of
large cells with distinct cell borders
 the cells possess clear cytoplasm (glycogen)
 the cells have large nucleoli
 sheets of cells are separated by thin fibrous
septae containing a lymphocytic infiltrate and sometimes a graulomatous reaction is noted

34
Q

Seminoma:

Spread

A

Lymphatic, i.e. to para-aortic nodes (common)

Haematogenous spread is rare

35
Q

Seminoma:

Prognosis

A

Generally good

Seminomas are sensitive to radiotherapy

Cure rate of 90 to 95%

36
Q

Non-seminomatous germ cell tumours

A

Slightly less common than seminomas

Patients are usually between 15 to 30 years of
age

37
Q

Adult (mature) teratoma

A

Also known as a differentiated teratoma

Rare

Usually partially cystic, filled with hair, keratin, bone and cartilage

Entire tumour composed of mature tissue

If present in a pre-pubertal child – usually benign, but in adolescents and adults – malignant adult teratoma

38
Q

Embryonal Carcinoma

A

Solid in consistency

Microscopically, consists of sheets of pleomorphic undifferentiated cells without organoid differentiation

Lymphatic and haematogenous spread

Prognosis reasonable (cure rate 70%)

39
Q

Syphilis

A 
 
 
 Spirochete Treponema pallidum
 Primary chancre, secondary stage, tertiary stage
 
 
 

40
Q

Tumours of the Penis

A

Tumours of the penis:

 Intra-epithelial carcinoma

 Invasive squamous cell carcinoma

Genital System (12 decks)

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