Male Pathology Syndromes: Gupta Flashcards
Hypospadia and Epispadia
in the male it’s an abnormal development of the urethra:
hypospadia - opens to ventral aspect of penis
epispadia - opens to dorsal aspect of penis
Balanitis and Balanoposthitis;
Causes
Balanitis = inflammation of the glans penis
Balanoposthitis = inflammation of the overlying prepuce (foreskin)
Causes include candida, anaerobes, gardnerella, pyogenic bacteria
*Most cases occur as a consequence of poor local hygiene in uncircumscised males
Phimosis
a condition in which the prepuce cannot be retracted easily over the glans penis; can be normal but becomes pathologic when interfering with normal function
Squamous cell carcinoma of the penis
- assoc’d with HPV infection and most cases occur in uncircumcised males
- ulceration on the glans or shaft of penis
- can spread to inguinal nodes and rarely to distant sites
Cryptorchidism
- failure of testicular descent from the abdomen into the scrotum
- unknown cause
- assoc’d with 3-5 fold inc. risk of testicular cancer
Testicular atrophy
testes diminish in size and may be accompanied by loss of function
Inflammatory lesions of the testes
- more common in the epididymis
- can be caused by UTI spread through the vas deferens, mumps infection (20% adult males, rarely in kids), or TB
- UTI spread - NT infiltrate
- mumps - lymphoplasmacytic inflammatory infiltrate
- TB - granulomatous infiltration and caseous necrosis
Testicular torsionw
- the obstruction of testicular venous drainage leaving the arteries patent; this is a urologic emergency because there’s about 6hrs to fix it or the testes may not remain viable
- neonatal = in utero or shortly after birth
- adult = sudden onset of pain where there’s an anatomic defect allowing for increased motility
Seminoma
in testes
- a malignant germ cell tumor of the testicles; may or may not have syncytiotrophoblasts but that doesn’t affect prognosis
- 40-50yo’s
- will see sheets of polygonal cells with LCs in the stroma
Embryonal carcinoma
in testes
- malignant tumor of undifferentiated cells and primitive gland-like structures
- nuclei are large and hyperchromatic
- primary can be small but metastatic and pure cases are rare, typically mixed cell types
Yolk sac tumor
in testes
- tumors often have eosinophilic hyaline globules in which alpha-1-antitrypsin and AFP can be demonstrated
- contain Schiller-Duval bodies
- often children
Choriocarcinoma
in testes
- tumor contains cytotrophoblastic (central nuclei) and syncytiotrophoblastic cells (multiple dark nuclei embedded in eosinophilic cytoplasm)
- hemorrhage and necrosis are prominent
Teratoma
in testes
- germ cell tumor which can have mature or immature elements
- pure teratomas are second only in frequency to yolk sac tumors in kids
- can occur at any age but in pre-pubertal males - usually benign; if in post-pubertal males usually malignant
3 Major conditions of the prostate
- Prostatitis
- BPH/Nodular Hyperplasia
- Carcinoma
Prostatitis
bacterial infection of the prostate, most common organism is E. coli or another Gram-neg rod; may be chronic or acute; will have NT infiltration of the prostate
BPH (aka Nodular Hyperplasia)
- proliferation of benign stromal and glandular elements
- major stimulus for proliferation is DHT
- can form nodules which compress the urethra; sx include hesitancy, urgency, nocturia, and poor stream
- chronic obstruction predisposes to UTIs
Carcinoma of the prostate
- cancerous tissue becomes more solid and white than the spongy normal prostate
- Grading is by the Gleason system; correlates with pathologic stage and prognosis
- IHC stains will show normal basal cells in normal glands and NO basal cells in malignant glands but inc. expression of racemase (red cytoplasmic stain)
- men over 50y; accounts for 25% of cancer in US (2009)
- androgens, heredity, environmental factors, and acquired somatic mutations have found to have a role in pathogenesis
Double/Bifid ureter
congenital - multiple or split ureters; most are unilateral and no clinical significance
Ureteropelvic junction (UPJ) obstruction
- anything obstruction the UPJ; it’s the MCC of hydronephrosis (cystic dilation and enlarged kideys) in infants/kids
- can be caused by: abnormal organization of smooth muscle bundles at the UPJ; deposition of collagen between smooth muscle bundles; or extrinsic compression of UPJ by renal vessels
- seen in males, bilateral (20%), assoc’d with other congenital abnormalities
Diverticular of the ureter
(Diverticula = saccular outpouchings of the ureteral wall)
- these are uncommon; may be congenital or acquired
- typically asymptomatic but can cause urinary stasis and lead to recurrent infections
Urothelial carcinomas
- primary malignant tumors of the ureter resemble those arising in the renal pelvis, calyces, and bladder
- occur most often in people in their 50s/60s and cause obstruction of the ureteral lumen
- can be multifocal and often occur concurrently with similar neoplasms in the bladder or renal pelvis
Urinary obstruction:
- what can cause obstruction
- what does obstruction lead to
- Causes:
Intrinsic = caliculi, strictures, tumors, blood clots, neurogenic
Extrinsic = pregnancy, periureteral inflammation, endometriosis, tumors - May lead to: hydroureter, hydronephrosis, pyelonephritis; kidney involvement is a major consequence
Sclerosing Retroperitoneal Fibrosis
- sclerosis of the RP that can cause ureteral narrowing or obstruction
- uncommon, occurs in middle-late age males
- may be related to IgG4 diseases, with plasma cells that produce IgG4; assoc’d w/ Riedel’s thyroiditis?
Vesicoureteral reflux
the backward flow of urine from the bladder into the kidneys; the most common and serious congenital anomaly as it contributes to renal infection and scarring
Exstrophy of the bladder
developmental failure in the anterior wall of the abdomen and the bladder, so that the bladder directly communicates with the surface of the body, or lies as an opened sac
Urachal anomalies
- the urachus (normally connects fetal bladder with the allantois) is normally obliterated at birth, but sometimes remains patent
- totally patent = fistulous urinary tract connects bladder with umbilicus
- partially patent = urachal cysts; cysts may give rise to carcinomas (if you have a pt with bladder tumor and cyst, it’s likely connected)
Cystitis: Malakoplakia
- inflammatory condition that causes raised mucosal plaques (non-neoplastic); filled with foamy MPs and occasional MNGC and LCs
- the MPs have abundant granular cytoplasm 2/2 phagosomes stuffed with particulate and membranous debris of bacterial origin
- Michaelis-Gutmann bodies also present = mineralized concretions resulting from deposition of Ca
Bladder Neoplasm
- causes include smoking, occupational carcinogens, and Schistosoma haematobium
- Schistosoma = flatworms infect the venous plexuses of the bladder and associated with development of SCC
4 types of bladder neoplasms - and death rates
- Papilloma - none
- PUNLMP - none
- LGUC - 2-3%
- HGUC - 20%
Syphilis
- an ulcerative genital disease/infection caused by spirochete Treponema pallidum (best seen on silver stain)
- micro: proliferative endarteritis with plasma cell inflammatory infiltrate
- primary = chancre (usually painless despite ulceration, and heal spontaneously)
- secondary = palmar rash, lymphadenopathy, chondyloma latum
- tertiary = neurosyphilis, aortitis, gummas (irregular firm mass of necrotic tissue surrounded resilient CT)
- congenital = late abortion/stillbirth, infantile (rash, osteochondritis, periostitis, lung/liver fibrosis), childhood (interstitial keratitis, teeth, CN8 deafness)
Benign epithelial tumors of the urethra
- squamous papilloma
- urothelial papilloma
- inverted urothelial papilloma
- condylomas
Urethral caruncle
- An inflammatory lesion that presents as a small, red, painful mass about the external urethral meatus, typically in older females.
- It consists of inflamed granulation tissue covered by an intact but extremely friable mucosa, which may ulcerate and bleed with the slightest trauma.
- Surgical excision affords prompt relief and cure.
