Male Genital System Pathology (Pathoma) Flashcards
Testicular Tumor Basics
Arise from germ cells or sex-cord stroma
Presents as a firm, painless testicular mass that cannot be transilluminated
Not biopsied due to risk of seeding scrotum and most are germ cell tumors (thus malignant); removed via radical orchiectomy
Germ Cell Tumors
MC type of testicular tumors
Usually occur between 15-40 years of age
Risk factors: cryptoorchidism (undescended testicle) and Klinefelter syndrome
Divided into seminoma and nonseminoma
All are malignant
Seminoma
Malignant tumor of large cells w/ clear cytoplasm and central nuclei
Homogenous mass w/ no hemorrhage or necrosis
Rare cases may produce B-hcg
Good prognosis –> response to radiotherapy (doesn’t metastasize often)
Embryonal Carcinoma
Malignant tumor of immature, primative cells that may form glands
Hemorrhage mass w/ necrosis
Aggressive w/ early hematogenous spread
Chemotherapy may result in differentiation (i.e. become teratoma)
Increased AFP or B-hCG may be present
Yolk Sac Tumor
Malignant tumor that resembles yolk sac elements
MC testicular tumor in children
AFP is elevated
Schiller-Duval body is characterisitic (glomeruloid structure)
Choriocarcinoma
Malignant tumor of synctiotrophoblasts (makes B-hCG) and cytotrophoblasts
Spreads early via blood (synctiotrophoblasts are programmed to find blood vessels) –> big tumors in body; small tumor in testicle
B-hcg is characteristically elevated; may lead to hyperthyroidism or gynecomastia (Due to alpha subunit of B-hcg stimlating TSH, FSH, LH receptors)
Don’t get villi –> only synctio and cytotrophoblasts
Teratoma
Tumor of mature fetal tissue
Derived from two to three embryonic layers
Malignant in males (benign in females)
AFP or B-hCG may be increased
Mixed Germ Cell Tumors
Germ cell tumors are usually mixed
Prognosis is based on the worst component
Sex-Cord Stromal tumor
Tumors resemble sex cord-stromal tissue
Usually benign.
Leydig Cell Tumor
Usually produce androgen
Precocious puberty in children or gynecomastia in adults
*Characteristic Reinke crystals seen on histology
Sertoli Cell Tumor
Compised of tubules
Usually clinically silent
Lymphoma
MCC of testicular mass in males >60; often bilateral
Usually diffuse large B-cell lymphoma
Hypospadias
Opening of urethra on inferior surface of penis
Due to failure of urethral folds to close**
Epispadias
Opening of urethra on superior surface of penis
Much more rare than hypospadias
Due to abnormal positioning of genital tubercle
Associated w/ exxtrophy of bladder
Conyloma Acuminatum
Benign warty growth of of genital skin
HPV 6 and 11
Characterized by karyocytic change (raisin appearing nuclei)
Lymphogranuloma Venereum
Necrotizing granulomatous inflammation of inguinal lymphatics and lymph nodes
STD cause by Chlamydia trachomatis (L1-L3)
Eventually heads w/ fibrosis; perianal involvement may result in rectal strictures.
Squamous Cell Carcinoma of the Penis
Malignant proliferation of squamous cells of penile skin
Risk factors: High risk HPV (2/3 of cases); lack of circumcision w/ improper maintenance
Precursor lesions (SCC in situ): Bowen disease (Shaft); Erythroplasia of Queyrat (glans); Bowenoid papulosis (reddish papules)
Cryptoorchidism
Failure of testicle to descend into scrotal sac.
MC congenital male reproductive abnormality (1%)
Most cases resolve spontaneously
Complications include testicular atrophy w/ infertility (increased temp) and increased risk for seminoma
Orchiplasty (tach testicle into scrotum) if not resolved by age 2
Orchitis
Inflammation of testicle
Chlamydia trachomatis (D-K) or Neisseria
E. coli and Pseudomonas (UTI in older folks)
Mumps virus
Autoimmune orchitis (granulomas of testicles –> ddx vs. TB)
Testicular torsion
Twisting of spermatocord) leading to blockage of venous drainage causing hemorrhagic infarction (arterial supply preserved)
Due to congenital failure of testes to attach to inner lining of scrotum.
Presents in adolescents w/ sudden testicular pain and absent cremasteric reflex (scraping inner thigh –> ascend into abdomen)
Varicocele
Dilatation of spermatic vein due to impaired drainage
Presents as scrotal swelling w/ “bag of worms appearance)
Usually left-sided; associated w/ left sided renal cell carcinoma (anatomy of left renal vein w/ branching gonadal vein)
Seen in a large percentage of infertile males (warm blood theory)
Hydrocele
Fluid collection within tunica vaginalis
Associated w/ incomplete closure of processus vaginalis (infants) or blockage of lymphatic drainage (adults)
Presents as scrotal swelling that can be transilluminated.
Acute Prostatits
Acute inflammation of prostate, usually due to bacteria
Same bugs as orchitis
C trachomatis and N gonorrhoeae (young adults)
E coli and Pseudomonas (older adults –> UTI)
Presents w/ dysuria and fever and chills
Prostate is tender and boggy on DRE
Prostatic secretions shows WBCs and culture +.
Chronic Prostaitis
Chronic inflammation of the prostate
Presents as dysuria with peliv or low back pain
Prostatic secretions show WBCs, but cultures are negative
BPH
Hyperplasia of prostatic stroma and glands
Age related change; NO INCREASED RISK FOR CANCER
Related to DHT
Occurs in the periutrethral zone of prostate –> compression of urethra
Sx: Problems starting and stopping; impaired emptying; dribbling; hypertrophy of bladder wall smooth muscle (possible diverticulae in wall); microscopic hematuria
PSA is often slightly elevated (4-10)
Can cause hydronephrosis
Rx: alpha-1 antagonists (terazosin) to relax smooth muscle in hypertensive patietns;
Selective alpha-1a antagonists (tamulosin) in normotensive individuals;
5alpha-reductase inhibitors (reduce DHT levels; takes months before relief)
Prostate Adenocarcinoma
Malignant proliferation of prostatic glands
MCC of Cancer in men; 2nd MCC of cancer death
Risk factrors: Age, race (black>white>asians), and a diet high in saturated fats
Occurs in posterior periphery (palpable on physical exam) and only urinary sx when very late
Screening:
- Begins at 50 with DRE and PSA
- Normal PSA increases w/ age (0-4 = normal; 4-10 = borderline)
- PSA > 10 is worrisome at any age
- Decreased % free-PSA is suggestive of cancer (makes bound PSA)
Prostatic biopsy required to confirm presence of cancer
Nuclei contain dark nucleoli on biopsy
Gleason grading system (based on architecture; not nuclear atypia).
Spread to lumbar spine is common –> osteoblastic metastasis that presents w/ low back pain, increased alk phos, PSA, and PAP
Rx: Prostatectomy (local disease); continuous GnRH analogs (leuprolide) and androgen receptor inhibitors (flutamide)
