Male Reproduction (path) Flashcards
Hypospadias
opening of urethral canal on VENTRAL surface of penis (failure of urogenital folds to close correctly)
Cause: genetic and environmental, common
Complications: UTIs, infertility
Epispadias
opening of urethral canal on DORSAL side of penis
Cause: abnormal (low) positioning of genital tubercle
Complications: bladder exstrophy, UTIs, infertility
Phimosis
orifice of prepuce is too small for normal retraction.
= congenital, w/ inflammatory complications (infection/scarring, cancer)
condyloma accuminatum
= genital warts (benign)
from HPV 6 or 11 (low risk types)
–> koilocytic changes in nuclei of infected cells
Penile Intraepithelial Neoplasm (PIN)
benign squamous hyperplasia of penis, usually w/ HPV infection. *NOT invasive
grades I-III (III = “Bowen disease” - full thickness affected)
Squamous Cell Carcinoma (of penis)
malignant squamous neoplasm,
Risk factors: high risk HPV infection (16, 18, 31, 33), no circumcision, *Bowen disease = precursor
** high risk vascular spread!
Testicular torsion
twisting of the spermatic cord
–> venous obstruction, hemorrhagic infarction
* Dx: absent cremasteric reflex
Risk Factors: incomplete descent, absent scrotal lig, small testis
Lesions of tunica vaginalis
hydrocele (serous fluid build-up) - incomplete closure of process vaginalis, can be trans-illuminated.
Hemocele (blood build-up)
Lymphocele (chyle build-up)
Lesions of the ductus afferentes or rete testis
spermatocele - abnormal sperm drainage
varicocele
Dilation of spermatic vein bc impaired drainage.
“bag of worms” appearance,
** most often left side (bc drains into L renal v), & assoc. w/ renal cell carcinoma
Cryptorchidism
incomplete migration of testis (“undescended”);
most = inguinal, abdominal or suprascrotal less so.
Complications: tubular atrophy & fibrosis, increased risk torsion & testicular cancer.
testicular ectopia
when testicle(s) migrate to the WRONG place (not even along normal path of descent)
pre-testicular causes of infertility
hypopituitarism, testicular exhaustion (after prolonged FSH)
testicular causes of infertility
Genetic: Klinefelter (XXY)
Developmental: cryptorchidism, anorchia, ectopia
Systemic: Diabetes, cirrhosis, malnutrition
Other: atherosclerosis, varicocele, EtOH, chemo/radiation
Post-testicular causes of infertility
= lesion/blockage to excretory ducts (congenital, inflammatory or iatrogenic)
Acute Epididymitis
= neutrophilic, complication of UTIs (bacterial)
Path: neutrophil infiltrate, tissue destruction/fibrosis
*may spread to testes
Chromic Epididymitis
= lymphocytic, post-infection from mumps, influenza, varicella,.etc.
Idiopathic Granulomatous Epididymitis
interstitial and intertubular granulomas, mimic neoplasms;
Cause: autoimmune (?)
* most common cause of granulomatous orchitis in USA
Tuberculous granulomatous Epididymitis
epididymitis followed by orchitis, secondary to pulm. TB;
Path: caseous necrosis => post-inflamm. fibrosis
Sperm granuloma => granulomatous epididymitis
granulomatous reaction to extravasated sperm (from trauma), in M <40.
Classic Seminoma
= most common type of testicular germ cell tumor, Age: ~40s, mets to lymph nodes 1st
Histo: large, uniform cells w/ clear cytoplasm & lymphocytic infiltrate
* VERY radiosensitive!
Intratubular Germ Cell Neoplasia (“ITGN”)
in situ lesion of testicle that typically preceeds malignant germ cells tumors.
* = isochromosome 12p (gene mut on short arm)
Spermatocytic Seminoma
seminoma (germ cell tumor) NOT assoc. w/ i12p.
Histo: mix of 3 cell sizes
* mets = rare, very good prognosis
Non-seminonatous germ cell tumor types (4)
- Embryonal carcinoma
- Yolk Sac tumor
- Choriocarcinoma
- Teratoma
* most often = mised types, more aggressive.
Peak age: 30 yrs old
Emryonal Carcinoma
malignant germ cell tumor that forms glands
Histo: hemorrhagic necrosis, + epithelial markers (cytokeratin, epith. membrane Ag)
Yolk sac tumor
malignant, most commoon childhood (1testicular tumor.
HIsto: schiller Duvall bodies, vascular “capsule,” makes AFP!!!
Choriocarcinoma
VERY malignant germ cell tumor,
makes hCG.
* early spread, but may regerss too
** benign (NOT 12p) in PRE-pubertal boys.
Teratoma
(testicular, from maternal fetal tissue.
Spreards early. Makes hCG draw from co,
- Mature:
- IMMature: worse prognosis,
Acute Prostatitis
Bacterial infection of prostate, from urine reflux or surgery.
Sx: dysuria, fever, chills, perineal pain, tender prostate
Path: neutrophilic infiltrate & necrosis
Chronic bacterial prostatitis
insidious/repeated infection of prostate, from urine reflux or local obstruction;
w/ Hx of repeated UTIs.
+ culture from prostatic secretions, >10 leuks
Chronic Abacterial prostatitis (aka: Chronic Pelvic Pain Syndrome)
insidious suprapubic/perineal/low back pain,
w/ NO Hx of UTIs.
prostate secretion culture -, variable leuks
Granulomatous Prostatitis
prostate infection caused (in USA) by Bacillus-Calmette-Guerin (attenuated mycobacterium) into bladder as urothelial tumor Tx;
* histo like TB! but not.
Benign Prostatic Hyperplasia (BPH)
expansion of transitional zone (around urethra), bc increased DHT –> increased cell survival
*NOT pre-malignant
Possible complications from BPH
cystitis, pyelonephritis, hydronephrosis, bladder hypertrophy/diverticula
Prostatic Adenocarcinoma
Most common non-skin cancer in men.
= malignant neoplasia in peripheral zone
–> risk involving neurovascular bundle!
*use Gleason scale for grading.
Gleason Scale
grading system for cancer, based solely on architecture of pattern.
Choose # (1-5) by MOST differentiated apparent.
*can give 2 part score (1st # = most predom. level)
1 = Uniform, NO invasion
3 = discrete glands, but varied & w/ infiltrates
5 = solid sheets of cells, central necrosis
Risk factors for Prostatic Adenocarcinoma
1. Age (older = worse)
- Race (Af.Amer > caucasian > asian)
- Family Hx (BRCA2, etc)
- Environment (high fat diet, lycopenes & VitD decrease risk)
Clinical approach to Prostatic Adenocarcinoma
To Dx: rectal exam, PSA, ultrasound, CT
Tx: surgery, radiation, anti-androgen meds
* very good prognosis if treated.
PSA testing types
- measures serine protease, is specific to prostate, but NOT necessarily cancer
- Doubling time (<10 yrs = bad)
- density (PSA/prostate volume)
- velocity (PSA change/time)
When use PSA for screening?
screen men >50 yo w/ life expectancy > 10 yrs
