Male Genital Tract Flashcards
clinical significance of penile congenital anomalies
ascending UT
sterility
most important pathology of male gential tract
inflammation
tumors
more common congenital anomaly
hypospadias
malformation of urethral groove and urethral canal on the dorsal surface
epispadias
abnormal small opening which prevents normal retraction of the prepuce
phimosis
phimosis is prone tto
repeated infection
carcinoma
when phismotic prepuce is foribly retracted over glans penis
paraphimosis
infections of the glans and prepuce caused by a wide variety of organisms
balanoposthisis
common agents of balanoposthisis
candida albicans
anaerobe
gardenerella
pyogenic bacteria
accumulation of desquamated epithelial cells, sweat, debris
smegma
common cause of phimosis
inflammation
most frequent penile neoplasms are
condyloma acuminata
SCC
cause of condyloma acuminata
HPV
agents of condyloma acuminata
HPV 6,11
transmission of HPV 6,11
skin contact
gross feature of condyloma acuminatum
single or multiple sessile or pedunculated, red papillary excrescences
coronal sulcus, prepuce
histo condylomata acuminatum
papillary ct stroma like proliferation koilocytosis (perinuclear vacuolization) acanthosis degenerative atypia basement membrane intact
in situ malignant penile tumor
Bowen’s disease, bowenoid papulosis
invasive malignant penile tumor
SCC
Bowen’s dse occurs in
35
male, female
gross Bowen’s disease
solitary thickened gray white opaque plaque with shallow ulcerations and crustin
histo Bowen’s disease
mitoses in epidermis
dysplastic, hyperchromatic nuclei
lack of orderly maturation
sharply demarcated bm
occurs in sexually active adult
multiple reddish brown lesions
Bowenoid papulosis
Bowenoid papulosis agent
HPV 16
prognosis of Bowenoid papulosis
good
spontaneously regress
culprit of invasive carcinoma
HPV 16, 18
invasive papilloma begins on the
glans
inner surface of the prepuce near the coronal sulcus
gross invasive CA of penis
papillary
flat
graying fissuring of mucosal surface
ulcerated papule
histo invasive penile ca
similar with SCC with varying differentiation
most common form of cryptorchidism
unilateral
cryptorchidism may be accompanied by
with GUT abnormalities like hypospadias
histo of cryptorchidism
hyalinization and thicken of BM of spermatic tubules
prominent leydig cells
causes of testicular atrophy
atherosclerosis orchitis cryptorchidism hypopituitarism cachexia irradiation antiandrogen chronic use exhaustion atrophy
histo of testicular atrophy
fibrosis or ghosting of spermatic tubules
atrophy as a primary genetic failure
Klinefelter syndrome
other patterns associated with decreased fertility
hyposprematogenesis
maturation arrest
vas deferens obstruction
syphilis first affects the
testis
<35 year old nonspecific epididymitis and orchitis
chlamydia
neisseria
> 35 y/o nonspecific epididymitis and orchitis
E coli
Pseudomonas
testicular mumps
edema
congestion
chronic inflammatory infiltrate
cause atrophy and sterility
TB testicular inflammation
granulomatous inflammation
caseous necrosis
begins in the epididymis to testis
painful testicular mass mimicking testicular tumor
autoimmune granulomatous orchitis
histology of autoimmune granulomatous orchitis
plasma cells
granuloma at spermatic tubules
twisting of spermaticord
testicular torsion
twisted testis is viable within
6 hours
neonatal torsion occrs
in utero
shortly after birth
no anatomic defect
adult torsion
adolescents presenting as sudden onset
adult torsion results from bilateral anatomic defect where the testis has increased mobility
bell-clamper abnormality
most common cause of painless enlargement of testis
testicular neoplasm
peak incidence of testicular neoplasms
15-34
testicular neoplasms are associated with
germ cell maldevelopment
suspect neoplasm in patients with
cryptorchidism testicular dysgenesis (xxy)
genetic common finding of testicular neoplasms
isochromosome 12, i(2p)
testicular Neoplasms are offen
benign
5% o pf testicular neoplasms are secondary to
non Hodgkin’s lymphoma
most common testicular neoplasm in men regardless of age
diffuse large B cell lymphoma
testicular tumor with best prognosis because it is radiosensitive
seminomas
nonseminomas undergo
totipotential differentiation
germ cell precursor undergo gonadal differentiation
seminoma
embryonal neoplasm undergo trophoblastic differentiation
choriocarcinoma
emryonal CA undergoes yolk sac differentiation
yolk sac tumor
in choriocarcinoma, there is an increase in
beta-hCG
yolk sac tumor is common in
infancts and children less than 3 years old
yolk sac tumor is positive in
alpha feto protein
seminomas in females are called
dysgerminoma
gross seminoma
bulky mass pale homogenous surface gray white lobulated no hemorrhage or necrosis
micro seminoma
clear seminoma cells or germ cells
delicate septa
lymphocytic infiltrates
prognosis of seminoma
good
most common in all testicular neoplasms
seminoma
peak incidence of seminomas
30-50
in seminoma this part is not penetrated
tunica albuginea
seminoma may extend to
epididymis
spermatic cord
scrotal sac
microscopic seminoma
large, round, polyhedral and has a distinct cell membrane
clear or watery appearing cytoplasm
large nuclei
embryonal carcinoma gross
hemorrhagic necrotic alveolar or tubular patterns smaller doesnt replace entire testis poorly demarcated at the margins with punctated foci of hemorrhage or necrosis tunica albuginiea to epididymis or cord
histology embryonal carcinoma
alveolar or tubular patters papillary convulsions undifferentiated lesions➡️ sheets of cells epithelial appearance, large, anaplastic hyperchromatic nuclei
highly malignant carcinoma that presents as small palpable nodule
choriocarcinoma
gross of choriocarcinoma
small palpable nodule
hemorrhage
necrosis
less than 5 cm in diameter
histo of choriocarcinoma
syncitiotrophoblast
cytotrophoblast
large, have many irregular or lobular hyperchromatic nuclei and abundant eosinophilic vacuolated cytoplasm
syncytiotrophoblast
more regular, tend to be polygonal with distinct borders and clear cytoplasm
cytotrophoblastic cells
cytotrophoblastic cells pattern of growth
cords and masses
single fairly uniform nucleus
yolk sac tumor aka
endodermal sinus tumor
yolk sac tumor usually affects
infants and children up to 3,y/o
gross yolk sac tumor
nonencapsulated
yellow white mucinous appearance
yolk sac histo
lacelike reticular network of medium sized cuboidal or flattened cells
SCHIVER-DUVAL bodies
arranged in a central capillary
mesodemal core with central papillary and visceral- resemble primitive glomeruli
tumors in yolk sac contain
AFP
alha trypsin
conglomeration of tissue arising from the ectoderm, mesoderm, endoderm
teratoma
teratoma in females
mature-malignant
immature
male teratomas
postpubertal- malignant, bad prognosis
gross teratoma
heterogenous with solid cartilaginous and cystic areas
teratoma of testis
disorganized collection of glands, smooth muscle, immature stroma
sex cord or gonadal tumors incidence
rare
sex cord tumor that may elaborate androgens or some both androgens and estrogens even corticosteroids
leydig cell tumor
onset of testicular tumor
20-60
glandular epithelial and stromal nodular hyperplasia
BPH
bph is associated with
old age urinary obstruction frequency bladder hypertrophy bladder trabeculations
is BPH a premalignant lesion?
NOOOO
BPH is an extremely common dse in
men over 50
main component of hyperplastic process in BPH
impaired cell death
major trophic factor mediating prostatic hyperplasia
dihydrotestosterone
markedly reduces DHT content of the prostate
decrease in prostatic volume and urinary obstruction
therapy with 5 alpha reductase inh
morphology of BPH
60-100 gms
transition zone
first nodule stromal cells- epithelial cells
median lobe hypertrophy
median lobe hypertrophy
BPH
projects into the floor of the urethra as a hemispheric mass directly beneath the mucosa of the urethra
gross BPH more pronounced in
lateral lobes
primary glandular involvement BPH
yellow pink tissue with a soft consistency and milky white prostatic fluid oozes out
primarily fibromuscular involvement BPH
each nodule is pale gray tough, does not exude fluid and less demarcated surrounding prostatic nodule
frequently performed operation for symptomatic nodular hyperplasia
transurethral resection - ruberry prostatic chips
histo- more prominently involved in BPH
glandular rather than stroma
histo BPH
larger glands
more complex infolding
double layer of uniform columnar cells and basal cuboidal cells with no atypia
dilatation and prolif of acini
3 conditions in BPH histo that favor benign process
absent nucleoli
basal nuclei
glands separated by thin fibrous tissue- not back to back
micro BPH hallmark
nodularity due to glandular proliferation or dilatation and to fibrous or muscular proliferation of the stroma
other histo changes associated with BPH
foci of squamous metaplasia
small areas of infarction
squamous metaplasia in BPH tend to occur in, confused with
margins of the foci of infarctions as nests of metaplastic reactive squamous cells
adenoca or urothelial ca
clinical course of BPH
compression of urethra with difficulty in urination retention of urine distention and hypertrophy of bladder infection the urine devt of cystitis renal infections
most common cancer in men
prostate carcinoma
screening age for prostate carcinoma
40
race preference of prostate cancer
uncommon in asians
frequent in blacks
prostate ca hormonal factors
does not occur in eunuch
orchiectomy, estrogen inh growth
prostatectomy including testes inh spread
prostate CA genetic factors
increased risk of first order relatives
symptomatic CA (blacks>whites)
hypermethylation of glutathione S transferase gene promoter
GSTP1 is located on
chromosome 11q13
prostate CA environmental factors
geographic differences
change of incidence with migration
prostate CA clinical course
clinically silent DRE PSA >4 ng/ml, free PSA <25% transrectal ultrasound needle biopsy prostatism metastasis - osteoblastic
gross prostate CA
irregular yellowish nodules
peripheral zone- posterior
gritty and firm *diff when embedded
histo adenoCA
prostate CA glands are smaller than BPH glands
small, irregular, crowded
no intervening stroma
presence of NUCLEOLI- malignancy
perineural invasion of prostatic adenoCA
prostate gland cells surround nerve spaces- malignancy
pain
hematogenous spread on the axia skeleton of prostateCA
white cannonball lesions
gleason score
predominant pattern (1-5) secondary pattern (1-5)
best score gleason score
2
gleason score 10
ze worst
gleason grade ranges
1-5
gleason score ranges
2-10
grade 1 prostate CA
most well- differentiated neoplastic glands are uniform
round in apperance, packed, well-circumscribed
Grade 5
no glandular diff
tumor cells infiltrate the stroma in the form of cords, sheets, nests
well diff gleason score
2-4
intermediate gleason score
5-6
moderate-poorly differentiated
7
high grade cancer
8-10
staging- microscopic only
A T1
macroscopic staging (palpable)
B T2
staging- extracapsular
C T3, T4
staging- metastatic
D N1-3, M1
prognosis of prostate CA is dependent on
stage
histologic grade
10 year survival for A&B
A T1 microscopic
B T2 macroscopic
prognosis 90%
10 year survival for C, D
C T3,4 extracapsular
D N1-3, M1 metastatic
10-40%
gynecomastia may be the first symptom of this disorder
testicular swelling
leydig cell tumor
pimary manifestation of leydig cell tumor in children
hormonal
sexual precocity
leydig cell tumor gross
form circumscribed nodules
less than 5 cm in diamete
distinct golden brown, homogenous cut surface
leydig cell tumor histology
similar to normal counterparts
large and round or polygonal
abundant granular eosinophilic cytoplasm with a round central nucleus
cytoplasm: lipid granules, vacuoles or lipofuscin pigment
RODSHAPED crystalloids of REINKE 25%
10% are invasive, produce metastases
sex cord tumor that is hormonally silent and present as a testicular mass
Sertoli cell tumor
sertoli cell tumor gross
firm small nodules with a homogenous gray-white to yellow surface
sertoli cell tumor histology
distinctive trabeculae that tend to form cordlike structures and tubules
benign but 10% become malignant
tumor confined to the testis, epididymis, or spermatic cord
stage 1 testicular tumor
distant distant spread confined to retroperitoneal nodes below the diaphragm
stage 2 rtesticular tumor
metastases outside the retroperitoneal nodes or above the diaphragm
stage 3 testicular tumor
prostate normal weight
20g
shape of prostate
pearl or chestnut shaped
normal histology of prostate
basal layer of low cuboidal epith covered by a layer of columnal secretory cells
control the growth and survival of prostatic cells
testicular androgens
most prostate carcinomas arise from the
palpable during the rectal digital exam
peripheral glands
arise from the more centrally situated glands and more likely to produce obstruction than CA
nodular hyperplasia
normal prostate zones
central
peripheral
transitional
periurethral
usual site of hyperplasia, BPH
transitional zone
acute bacterial prostatitis agents
E coli
gram - rods
enterococci
staphylococci
seeding of acute bacterial prostatitis
usually from distant foci or infection
implanted in the prostate intraprostatic reflux or urine from posterior urethra or bladder
diagnosis of acute bacterial prostatitis
urine culture
clinical features
morphology of acute bacterial prostatitis
minute discemminated abscess
large coalescent focal areas of necrosis
diffuse edema, congestion and boggy suppuration of entire gland
clinical symtoms of chronic bacterial prostatitis
low back oain
dysuria
perineal and suprapubic discomfort
prostatitis usually presents with
cystitis
urethritis
diagnosis of chronic bacterial prostatitis
leukocytosis in the expressed prostatic secretions
positive bacterial culture
appears insidiously without obvious provocation
most common diagnose chronic prostatitis
chronic abacterial prostatitis
diagnosis of chronic abacterial prostatitis
expressed prostatic secretions >10 leukocytes/high power field
- bacterial cultures
most common cause of granulomatous prostatitis in the US
instillation of BCG within the bladder for treatment of —
types of granulomatous prostatitis
specific or nonspecific
fungal or idiopathic
diagnosis of relatively common granulomatous prostatitis
secretions from ruptured ducts or acini
no bacteria seen but some have recent urinary tract infection
