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Y2S2-Renal/Repro-Pathology > Male Genital system > Flashcards

Male Genital system Flashcards

1
Q

What are the different testicular lesions?

A

1) Cryptorchidism

2) Inflammatory lesions

3) Vascular disturbances (varicocele, torsion)

4) Male infertility

5) Tumors

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2
Q

What can we find inside the leyding cells?

A

They contain “lipid droplets” and “rod-shaped crystals” in their cytoplasm

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3
Q

What can we find in the cytoplasm of the Sertoli cells?

A

They are epithelial cells that are connected by tight junctions, and They contain cytoplasmic filaments called (Charcot-Bottcher crystals)

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4
Q

What is meant by cryptorchidism?

A
  • It is the failure of the descent of the testicles into the scrotum, diagnosed after 1 year
  • It is the most common congenital abnormality of the GUTract
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5
Q

Does spermatogenesis stop or continue in cryptorchidism?

A

Spermatogenesis stops, however, the testosterone production continues

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6
Q

What are the complications of cryptorchidism?

A

1) The undescended testes become atrophic (if bilateral, it results in sterility

2) 3-5 fold increased risk for testicular cancer (in the undescended testes, SEMINOMA being the most common malignancy)

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7
Q

What is the microscopic photo of cryptorchidism?

A

1) Small tubules

2) Few-No germ cells

3) Thick basement membrane

4) Interstitial fibrosis

5) Increased leyding cells (as they have more room)

6) Replacement of the germ cells with large cells that has a clear cytoplasm. large nuclei, prominent nucleoli (Germ cell neoplasia in situ)

7) IHC: PLAP+

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8
Q

What is the cause of testicular inflammation, and where in the GUTract is it common?

A
  • It is more common in the epididymis than in the testes
  • It is caused by:

1) STDs

2) Mumps

  • Rare before puberty, common after puberty, especially after (parotid inflammation “parotiditis)
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9
Q

What is a varicocele?

A
  • It is a mass of tortuous and dilated veins of the pampiform plexus and the testicular vein of the spermatic cord
  • It results from the incompetent valve at the left testicle vein as it empties into the renal vein
  • It results in infertility as the accumulated blood in the venous plexus could increase the testicular temperature of both testes, or it could be due to the increased ROS, which disrupts the HPA axis
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10
Q

In which testes does varicocele mostly occur?

A

In the left testes, as there is a higher chance of its occurrence due to the venous drainage that goes 90 degrees into the renal vein

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11
Q

What is meant by torsion?

A
  • It is the twisting of the spermatic cord
  • This will result in the obstruction of the testicular venous drainage, meanwhile the thick-walled arteries remain patent, leading to a massive vascular engorgement, then infarction
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12
Q

What are the causes of torsion?

A

1) Neonatal torsion: Not associated with an anatomic defect

2) Adult torsion: Due to a congenital bilateral anomaly (bell clapper abnormality), where the testes are transverse and float in the scrotal sac

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13
Q

What are the complications of torsion?

A

1) Infarction

2) Infertility

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14
Q

What is the clinical picture of torsion?

A

Sudden severe testicular pain

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15
Q

What is the meaning of infertility, impotence, and sterility?

A

1) Infertility: Inability to conceive after 1 year of sexual activity with the same partner without using contraceptives

2) Impotence: Erectile dysfunction

3) Sterility: Incurable cases of infertility

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16
Q

What are the different causes of infertility?

A

1) Supra (pre-) testicular

  • Injury of the hypothalamic pituitary area

2) Testicular infertility

  • Chromosomal abnormalities (like Klinefelter)
  • Non-chromosomal (varicocele, cryptorchidism, chemo/radio therapy)

3) Post-testicular infertility

  • Blockage of the excretory ducts through which the sperm reaches the urethra

4) Sertoli-only syndrome: No germ cells which results in Azoospermia, which could be due to (Y-chromosome microdeletions, chemicals or toxins or radiation, or severe testicular injury)

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17
Q

What are the differential diagnoses for scrotal enlargement?

A

We perform the transillumination test if it was:

1) Positive: It could be a hydrocele or a spermatocele

2) Negative: Tumor

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18
Q

What are the causes of scrotal enlargement?

A

1) Spermatocele

2) Hydrocele

3) Tumors

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19
Q

What is a spermatocele?

A

1) Dilation of the efferent ductules in the rete testis or the head of the epididymis

2) It is idiopathic

3) Painless

4) +Ve Transillumination test

5) Forms a cyst that displaces the testis if it gets large enough

6) Usually on the upper pole where the efferent tubules and vas deferens

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20
Q

What is a hydrocele?

A

1) Accumulation of serous fluid of the tunica vaginalis

2) Painless mass

3) Transillumination positive

4) US it is found as a cyst that envelops the testis, but it does not displace it

5) Enlarges the scrotum anteriorly

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21
Q

What are the age peaks for testicular tumors?

A

1) 2-4 years

2) 20-40 years

3) >60 years

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22
Q

What are the risk factors for testicular tumors?

A
  • They arise from the seminiferous epithelium, associated with:

1) Environmental factors (male infertility, history of mumps orchitis, inguinal hernia)

2) Genetic factors (cryptorchidism, gonadal dysgenesis, Klinefelter syndrome, family history of testicular cancer)

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23
Q

What is the pathogenesis of the testicular tumors?

A

1) An extra copy of the short arm of chromosome 12

2) Oncogenic mutations in KIT

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24
Q

What are the malignant germ cell tumors of the testis that are derived from GCNIS?

A

1) Seminoma

2) Embryonal carcinoma

3) Yolk sac tumor (post-pubertal type)

4) Trophoblastic tumor

5) Teratoma (post-pubertal type)

6) Teratoma with somatic-type malignancy

7) Mixed germ-cell tumors (post-pubertal type)

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25
What are the testicular germ cell tumors that are not derived from the GCNIS?
1) Spermatocytic tumor 2) Yolk sac tumor (pre-pubertal type) 3) Teratoma (pre-pubertal type) 4) Mixed-germ cell tumor (pre-pubertal type
26
What are the different sex cord stromal benign tumors?
1) Leyding cell tumor 2) Sertoli cell tumor 3) Granulosa cell tumor 4_ Fibroma/thecoma
27
What is a seminoma?
- The most common testicular cancer - OCCURS IN PEOPLE AGED 30-40 YEARS - IHC is positive for PLAP and CD117
28
Describe the gross structure of the seminoma
1) Soft 2) Well-defined 3) Grey-white 4) Multinodular 5) Replaces the entire testis
29
What is the microscopic photo of seminoma?
1) Monotonous (no polymorphism) 2) Large cells 3) Clear 4) Glycogen-rich cytoplasm 5) Nests with fibrous septa with lymphocytes
30
What is the embryonal carcinoma?
- Occurs in patients between 20-30 - It has a serological marker which is LDH (the higher it is, the higher the probability of an embryonal carcinoma) - IHC positive for CD30
31
What is the gross picture of an embryonal carcinoma?
1) Poorly circumscribed 2) Gray-white mass with hemorrhage and necrosis 3) Does not replace the entire testis
32
What is the microscopic photo of embryonal carcinoma?
1) Anaplastic epithelial cells 2) Arranged in solid sheets, tubules, glands and papillary 3) Necrosis
33
What is the Yolk-sac tumor?
- It can occur pre- and post- puberty - It is the most common primary testicular neoplasm in children - Rises the serum levels of AFP - IHC positive for AFP
34
What are the gross features of the yolk-sac tumor?
1) Multicystic 2) Yellow-white 3) Mucinous 4) Soft
35
What are the microscopic findings of the yolk-sac tumor?
1) Cuboidal to columnar epithelial cells that form glands, sheets, and papillae 2) Hyaline globules (globules containing AFP, giving them their hyaline appearance) 3) Schiller-Duval body
36
What is a teratoma?
- It also has two types (pre- and post-puberty) - It is composed of ectoderm, endoderm, and mesoderm
37
What are the gross features of teratoma?
1) Lobulated 2) Cysts of mucinous, gelatinous or serous material
38
What are the microscopic features of teratoma?
- Post-pubertal: 1) Haphazardly arranged tissue 2) GCNIS - Pre-puberty: 1) The tissue has an oragnois appearance 2) NO GCNIS
39
What is a choriocarcinoma?
- It arises from the chorionic villi - High levels of serum hCG - It is the most aggressive NSGCT - Spreads rapidly by blood - Sometimes it does not affect the size of the testis - IHC positive for hCG
40
What is a spermatocytic tumor?
- Occurs in patients older that 50 years - It is not mixed with other GCT and does not metstesize - IHC negative for PLAP
41
What is the gross picture of a spermatocytic tumor?
1) Soft, well-defined, grey-white, Multinodular. 2) Replaces entire testis 3) Mucoid material and cysts
42
What is the microscopic photo os a spermatocytic tumor?
1) Polymorphic cells (small cells "scant cytoplasm", intermediate cells "granular chromatin", Giant cells "Multinucleation" 2) In sheets
43
What are the cancers that are derived from GCNIS and have "Mixed tumor"?
1) Embryonal carcinoma 2) Yolk sac tumor 3) Teratome 4) Choriocarcinoma 5) Rarely seminoma
44
What are the risk factors for prostatic inflammation?
1) After a surgical procedure (like a catheter) 2) Prostatic enlargement 3) Recent bladder infection - Where bacteria can enter the prostate from the urethra (infected urine) or infected stool from the rectum, or an STD
45
How to diagnose prostatic inflammation?
Based on urine and prostatic secretions (found in the rectal examination)
46
What are the different types of prostatic inflammation?
1) Acute bacterial prostatitis (same bacterias as UTI) 2) Chronic bacterial prostatitis (recurrent UTI which is difficult to treat) 3) Chronic nonbacterial prostatitis/chronic pelvic pain syndrome (similar to chronic one but with a negative culture, it is associated with chlamydia trachomatis or ureaplasma urealyticum) 4) Granulomatous prostatitis
47
What is meant by benign prostatic enlargement?
- It is a non-cancerous enlargement of the prostate, and it is not pre-malignant - The most common benign prostatic disease in men >50 - The most common non-cancerous cause of PSA elevation in serum
48
How to diagnose benign prostatic hyperplasia?
BIOPSY
49
What is the pathogenesis of benign prostatic hyperplasia?
1) Conversion of testosterone to DHT (via type-2 5a reductase) 2) DHT will then bind to the androgen receptors in the prostate 3) Binding of the DHT to the androgen receptors will result in the release of growth factors, leading to the proliferation of the stromal cells of the prostate 4) The DHT will also travel to the epithelial lining and decrease their apoptosis, and thus increase proliferation and accumulation = hyperplasia
50
Describe the gross features of benign prostatic hyperplasia
1) Enlarged prostate with multiple nodules 2) As the prostate enlarges, it might compress the urethra
51
What is the microscopic photo of benign prostatic hyperplasia?
1) Well circumscribed 2) Non-capsulated 3) Presence of corpora amylacea 4) The glands are lined by a double layer of epithelium
52
What is the clinical picture of benign prostatic hyperplasia?
1) Elderly (>50) 2) Difficulty in starting the process of urinating 3) Urine retention 4) Intermittent interruption of the stream while voiding
53
What are the complications of benign prostatic hyperplasia?
1) Hypertrophy of the bladder 2) Increases the risks of infections (cystitis, pyelonephritis) - Prolonged severe obstruction might result in hydroureter, hydronephrosis, and ultimately renal failure
54
What is meant by high-grade prostatic intraepithelial neoplasia (HG-PIN)?
It is a pre-cancerous change in the prostatic gland (some prostate cells look abnormal under the microscope, but they have not invaded the surrounding tissue yet) - It does not have a gross picture - It does not cause elevated PSA nor abnormal digital examination findings nor radiological abnormalities
55
What is the microscopic photo of high-grade PIN?
- Enlarged cell nuclei with prominent nucleoli (Nucleomegaly (enlarged nucleus), Nucleolomegaly (enlarged nucleolus)) - The basal cells are present, but they might be attenuated
56
What is the management of HG-PIN?
1) Focal (in one site): Follow-up PSA every 6-24 months 2) Multifocal (more than 2 sites): Re-biopsy
57
What are the risk factors for prostatic cancer?
1) Age: 65-75 2) Family history 3) Hereditary factors (mutations of BRCA2)
58
In which part of the prostate is prostatic cancer more common?
1) Central zone (apex) 2) Peripheral zone (base) 3) Transitional zone (middle)
59
What is the most common form of cancer in men?
Prostatic cancer
60
What are the causes of prostatic cancer?
1) Androgen receptor signaling 2) Genetic mutations in BRCA2 3) Chromosomal rearrangement (ETS next to TMPRSS2), ETS translocate to the TMPRSS2 gene and becomes under its control and it overexpresses it 4) PCA3 overexpression
61
What is the gross morphology of prostatic cancer?
1) Multifocal 2) Neoplastic tissue is firm and gritty in cut-section
62
What is the microscopic photo of prostatic carcinoma?
1) Crowded small cell acini lined by a single cell epithelium 2) No basal cells 3) Nucleolomegaly and nucleomegaly 4) Crystalloids (composed of inorganic sulfur) 5) Acidic mucin (looks basophilic)
63
How to
Using the Gleason scale
64
What is the Gleason scale?
- Based on architecture - Classified into five grades - It is the sum of the primary and secondary patterns
65
Describe the scoring of the Gleason score
- Grade 1 is the cancer forming a well-defined nodule with clear acini, and the more you go down, the more that image or architecture distorts. - In grade 3, they start to move away from each other. - In grade 4, they even start to fuse - By grade 5, they lose their ability to form acini at all. We are left with solid sheets of malignant cells forming these big structures, some of which have a necrotic center. - The score is calculated because multiple areas could have different grades, the primary being the grade we see the most of, and the secondary being the second grade we see the most of. So, a prostatic cancer that is 3+4 will behave better than a 4+3. If a tumor is only showing one pattern, then it is 3+3, for example
66
What are the biomarkers in prostatic carcinoma?
1) PSA: Produced by the prostatic epithelium 2) Prostatic acid phosphate: elevated when the prostatic cancer spreads beyond the prostate; however not prostate-specific 3) Alkaline phosphatase, but also not specific 4) PCA3 mRNA in urine 5) TMPRRSS2-ERG fusion DNA in urine
67
What is the most loved organ for prostate cancer?
- It loves the bone, but it doesn't break it down; rather, it stimulates the osteoblasts to increase the bone formation - Early stages is asymptomatic as it grows in the peripheral zone and does not block the urethra

Y2S2-Renal/Repro-Pathology (7 decks)

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