Male Genital Pathology Flashcards
Prostatism
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.
Prostatitis
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
Granulomatous Prostatitis
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
Nodular Hyperplasia:
Aetiology
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
Nodular Hyperplasia:
Clinical Symptoms
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
Nodular Hyperplasia:
Pathogenesis
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.
Nodular Hyperplasia:
Pathology-Macroscopy
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
Nodular Hyperplasia:
Pathology-Microscopy
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
Nodular Hyperplasia:
Complications
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).
Carcinoma of the Prostate:
Introduction
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
Prostate Carcinoma:
Aetiology
largely unknown
possibly hormonal basis
growth is stimulated by androgens and slowed
by estrogens
Prostate Carcinoma:
Pathology-Macroscopy
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)
Prostate Carcinoma:
Pathology-Microscopy
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
Prostate Carcinoma:
Spread
- Direct, i.e. through the capsule into the surrounding tissue, seminal vesicles, bladder and rarely the rectum
- Lymphatic, i.e. to iliac and para-aortic lymph nodes
- Haematogenous, i.e. mainly to bone, liver and lungs (note that vertebral metastases are the most common and are osteosclerotic)
Prostate Carcinoma:
Prognosis
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
Orchitis
Any inflammatory condition of the testes.
There are four main types:
- Mumps Orchitis
- Idiopathic Granulomatous orchitis
- Syphilitis Orchitis
- Tuberculosis Orchitis
Mumps Orchitis
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.
◼
Idiopathic granulomatous orchitis
Unknown aetiology, 45 – 60 yrs
◼ Firm, unilateral testis mass – mimics tumour
Syphilitis orchitis
Now rare, was common site for gumma
Unilateral painless enlargement – mimic tumour
Tuberculous orchitis
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
Urethritis
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
Gonococcal urethritis (gonorrhoea)
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
Non-gonococcal urethritis
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
Torsion of the testis
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
