male reproductive pathology Flashcards
what symptoms might present with male reproductive pathology
vomiting penile pain penile ulceration scrotal swelling urinary frequency haematuria acute/chronic abdominal pain abdominal swelling rectal pain testicular pain incontinence urinary retention
what is benign prostatic hyperplasia
common associated with hormonal imbalance hyperplasia of glands and stroma not premalignant obstructs urine flow associated with infection treatable may be acute or chronic
how might BPH present compared with prostatic carcinoma
BPH commonly presents with urinary symptoms
by the time carcinoma is found the patient may already have metastatic disease or local invasion
what might a prostatic carcinoma feel like on rectal exam
loss of median sulchus hardy, rocky prostate rather that smooth and elastic subcapsular invasion asymmetry
what problems do clinicians have with prostatic cancer
hard to tell whether it is indolent or aggressive so hard to know how to treat
tend to underestimate the extent of the disease with needle biopsy
false positives and negatives with PSA
what is the biggest risk factor for testicular cancer
cryptorchidism, 10 x risk
what is a common cause of orchitis
mumps
what age group tend to get testicular cancer
under 35s and old men
what are the two types of germ cell testicular tumour
teratoma(always malignant features in males) and seminoma (most common)
what are the features of seminoma
cells look like spermatagonia
low level of necrosis usually
peak age approx 40
lumpy and white
what are the features of male teratomas
germ cell origin
more agressive than seminoma
may be differentiated, undifferentiated or trophoblastic (placenta like)
may secrete hCG- tumour marker
what chemical is an important cancer biomarker
Alpha fetoprotein (AFP)
what are the histological features of BPH
transitional zone of prostate plus peri urethral glands (glands around the urethra) nodules of glands and stroma compression and elongation of urethra interferes with urethral sphincter palpable median groove
what are the complications of BPH
Bilateral hydronephrosis hydroureter pyelonephritis calculi septicaemia bladder:diverticulum, hypertrophy, trabeculation, urethral compression nodular enlargement acute or chronic urinary retention
what is the precursor to prostate cancer
prostatic intraepithelial neoplasia
what age group usually get prostate adenocarcinoma
over 50 years
what are the features of prostate cancer
adenocarcinoma often metastasises to bone
latent carcinoma: microscopic, common in old age, dormant lesions, 30% rate of metastases after 10 years
what is the gleason score
way of measuring differentiation in prostate cancer -1 to5 score
what does prostate cancer present with
urinary symptoms
incidental findings on rectal exam
bone metastases
lymph node metastases
how is prostate cancer diagnosed
imaging, cytology, biochemistry(PSA), haematology, bone marrow involvement, biopsy
how is prostate cancer treated
oestrogens, gnrh analogues, orchidectomy, radiotherapy, radical prostatectomy
what is hypospadias and epispadias
hypo- urethral opening on inferior aspect
epi- opening on superior aspect and often accompanied by bladder malformations
what is phimosis
a congenital narrowing of the opening of the foreskin so that it cannot be retracted
what is a paraphimosis
foreskin becomes trapped behind the glans penis and cannot be reduced
what is Bowen’s disease
early form of skin cancer which is easily treatable
may affect the penis
persistent red scaly patch on the skin , may be sore and red
intraepithelial carcinoma
keratotic surface
what skin diseases can affect the penis and scrotum
Bowen’s disease and squamous cell carcinoma
what is Peyronie’s disease
bent penis and pain when errect due to scar tissue
may occur with Dupytren’s
what can cause invasive squamous cell carcinomas of the penis
HPV
what are the features of SCC of the penis
glans penis or prepuce
nodule or plaque
metastasises to inguinal lymph nodes
what is fournier gangrene
a type of necrotising fasciitis or gangrene that affects the perineum
what is balantitis
inflammation of the head of the penis
what is scrotal carcinoma
nodular ulcerated mass
spreads to inguinal nodes
what might causes urethral obstruction
rupture
stricture
congenital valves
what might causes urethritis
gonorrhoea
non gonococcal
what can gonococcal urethritis cause
urethral stricture
epididymitis
prostatitis
what is a haematocele
collection of blood in the tunica vaginalis usually caused by trauma
what testicular cancers affect which age groups
teratoma- 30 yrs
seminoma- 40 yrs
lymphoma- 70yrs
what are the symptoms of testicular tumours
painless unilateral enlargement
hydrocele
metastatic disease
gynaecomastia
name some other germ cell tumours
intratubular germ cell neoplasia
yolk sac tumour (children)
combined germ cell tumour
name some non germ cell tumours
malignant lymphoma
leydig cell tumour
sertoli cell
metastatic tumour
what is stage 1 testicular tumour
confined to testes and coverings
what is stage 2 testicular tumour
testis and para aortic lymph nodes
what is stage 3 testicular cancer
lymph nodes in mediastinum and/ or supraclavicular region
what is stage 4 testicular cancer
visceral metastases
what can cause male infertility
endocrine gnrh deficiency oestrogen excess cryptorchidism abnormal spermatogenesis obstruction of efferent ducts
what can affect the epididymis and spermatic cord
Congenital abnormalities Epididymal cysts and spermatocoeles Varicocoele Torsion of the spermatic cord and testis Inflammatory lesions – Epididymo-orchitis Tumours - rare
what marker might a teratoma secrete
hCG
