Male Reproductive Pathology Flashcards
Describe Bowen Disease
-Leukoplakia (white patch/plaque)
Premalignant lesion (HPV-associated carcinoma in-situ) on the penis
Describe Erythroplasia of Queyrat
-Erythroplakia (red patch/plaque)
Premalignant lesion (HPV-associated carcinoma in-situ) on the penis
Describe Bowenoid Papulosis
-Younger patients than the other 2 presentations (Bowen and Erythroplasia of Queyrat)
-Multiple reddish/brown papules on glans penis
-Usually transient, rare transformation to cancer
Premalignant lesion (HPV-associated carcinoma in-situ) on the penis
Describe Neoplasms (Penis)
-Squamous cell carcinoma
-Common in developing countries
Describe the clinical presentation of Neoplasms (penis)
-Gray, crusted, papular lesion usually on glans or prepuce
-Ulceration, induration, irregular margins
-Risk factors:
*poor hygiene (uncircumcised)
*smoking
*HPV
Describe Scrotal enlargement and the different types
Fluid accumulation in the tunica vaginalis (membrane covering the testes)
-Hydrocele: serous fluid
-Hematocele: blood accumulation
-Chylocele: lymph accumulation
Cryptorchidism
-Failure of testicular descent from the abdomen into the scrotum; most common congenital male reproductive abnormality
-Most resolve spontaneously; can be surgical repositioning (orchiopexy) if needed by 18 months
-Complications (even with unilateral cases): testicular atrophy (sterility); increased risk of testicular cancer
Urinary traction infection (testes)
May be secondary to an ascending bacterial (including STD) - swollen, tender, neutrophilic infiltrate
Mumps infection (testes)
Increased risk for infertility
Testicular Torsion
-Twisting of the spermatic cord obstructs venous drainage while arteries remain patent –> vascular engorgement and infarction
-Sudden onset of pain; urologic emergency- need to untwist within 6 hours to prevent necrosis
________ is the most important cause of firm, painless enlargement of the testis
Testes Neoplasms
Seminoma
-Most common testicular tumor (always malignant)
-Usually delayed metastasis
-Highly responsive to radiation; excellent prognosis
Testes (Neoplasms)
Teratoma
-Neoplastic germ cells from 2 or 3 embryonic layers differentiate toward multiple somatic cells
-Can be benign or malignant
-“Immature” (fetal-like tissue) or “mature” (fully differentiated tissues - i.e. teeth, hair)
Testes (Neoplasms)
Describe the prostate anatomy
-Located at the base of the bladder, encircling the urethra, anterior to the rectum such that the posterior aspect is palpable by digital rectal exam (DRE)
-Androgens maintain the glands and stroma which make a milky fluid added to sperm and fluid from the seminal vesicle to make semen
What does the prostate consist of histologically?
3 zones:
-Central zone
-Peripheral zone
-Transitional zone
Acute or Chronic Prostatitis
-Usually due to bacterial urinary tract infection
-Fever (in acute) and dysuria (painful or difficult urniation)
Chronic pelvic pain syndrome
-May be inflammatory or non-inflammatory (no WBCs in urine)
-Pain localized to the perineum, suprapubic and penis; often pain during or after ejaculation
-Unknown etiology and hard to treat
Prostatitis
Benign Prostatic Hyperplasia
-Very common after age 40 (90% have it at 80yrs)
-Only 10% with histologic evidence have symptoms
-Most often arises from the inner transitional or central zones (produces urinary obstruction)
Describe the symptoms seen in Benign Prostatic Hyperplasia
(symptoms only seen in 10% of patients)
-Hesitancy (difficulty starting a urinary stream) and intermittent interruption of the urinary stream while voiding
-With obstruction - urgency, frequency, nocturia (irritated bladder)
Describe the Etiology, Pathogenesis, and Treatment for Prostatic Hyperplasia
Etiology: Increase in androgens
Pathogenesis:
-Testosterone (converted by 5alpha reductase) –> dihydrotestosterone (DHT) –> nodular hyperplasia
-Increased estrogen may also increase expression of DHT receptors in the prostate
Treatment:
-5alpha reductase inhibitors: finasteride (Proscar, Propecia)
-alpha1-adrenergic blockers: relax prostate smooth muscle (ex: terazosin, tamulosin)
What does Prostatic Hyperplasia look like histologically?
-Well-defined nodules compressing the urethra
-Variable amount of normal appearing but hyperplastic glandular and stromal components
Prostatic Carcinoma
-Most common cancer in men (excluding skin SCC and BCC); much less deadly than many other cancer types
-Lifetime risk ~11%
-Age: 65-75yrs
-Highly variable disease course; can’t reliably predict which tumors will be aggressive
What is the pathogenesis of Prostatic Carcinoma?
-Androgens: promote, don’t initiate, cancer growth
-Hereditary - increased risk in 1st degree relatives
-Environmental - geographic variations, diet?
-Acquired genetic aberrations:
*most often see androgen-regulated fusion genes
*inherited BRCA1, BRCA2 mutations can increase risk
Where do Prostatic Carcinomas arise? What is typically the first sign?
-Often clinically silent
-Carcinomas (70-80%) arise from the peripheral zone (palpated on digital rectal exam)
-Often first sign is metastasis. Bone (osteolytic or osteoblastic) involvement is common
Prostate Specific Antigen (PSA)
-PSA is a normal product of prostatic epithelium, secreted in the semen
- <4ng/mL is normal, >10ng/mL suggests cancer
-Somewhat helpful for diagnosis when used with other procedures - not highly sensitive or specific
-Very helpful for monitoring patients for progression/recurrence
Describe PSA screening: 2018 US Preventive Services Task Force Report for different age groups
For 55-69 years:
-Net benefit is small for some men
For 70+ years:
-Benefits do not outweigh the expected harms
Conclusion: If 55-69 years, patient-driven decision based on discussion with physician whether to screen
-Benefits: Out of 1000 men screened may prevent about 3 cases of metastasis and 1.3 deaths over 13 years (small reduction in risk of death)
-Risks: False positives leading to biopsy with potential overtreatment including complications:
*after prostatectomy: 20% have long-term incontinence and 66% have long-term erectile dysfunction
*after radiation: >50% have long-term erectile dysfunction and ~17% have bowel urgency and fecal incontinence
Gleason Score
-From 1 (well differentiated) to 5 (no differentiation) with the 2 most common patterns added together
-Ex: Most differentiated would be (1+1=2) whereas the least differentiated would be (5+5=10).
-(Add together what they have the most of and what else they have. Ex: a lot of 5 with some areas of 1 –> 5+1=6).
-Gleason score given a grade group that correlates with prognosis
Prostatic Carcinoma Prognosis
Clinical spread and histological grade (Gleason score) correlate with prognosis
What is the treatment and prognosis of Prostatic Carcinoma?
Treatment:
-Active surveillance (watchful waiting)
-Surgery: robotic prostatectomy
-Radiation therapy: external beam or brachytherapy (internal radioactive seeds)
-Androgen deprivation (orchiectomy and/or medications- only for advanced metastatic disease
Prognosis:
-Stage T1,T2 (still in gland) - Good (90% 1- yr survival)
-Disseminated disease (has spread outside the gland) - Poor (10-40% 10 yr survival)
