Male Reproductive System (Ia) Flashcards
————- : Abnormal opening of the urethra on the ventral aspect of the penis, anywhere along the shaft
Hypospadias
Complications of Hypospadias
Constriction → Urinary tract obstruction →
Increased risk for urinary tract infections
—————-: Abnormal opening of the urethra on the dorsal aspect of the
penis
Epispadias
———-: Inflammation of the glans penis
Balanitis
* happens normally in uncircumcised males
———– : Inflammation of the overlying prepuce (foreskin)
Balanoposthitis
causes of Blanoposthitis
1) Poor hygeine -> formation of smegma (shedding of skin)
2) Bacterial infection –> Candida albicans, anaerobic and pyogenic bacteria
Complication of Blanoposthitis?
Phimosis
* Phimosis –> tight foreskin (caused by scarring of the prepuce)
The most common Penile Neoplasm?
Squamous cell carcinoma >95%
Epi of Sqamous cell carcinoma (of the penis)
Associated w/ uncircumcised men >40yrs and HPV (16/18)
Squamous cell carcinoma is aka?
Bowen disease
Macroscopic Features:
* Solitary plaque on the penis’ shaft
Microscopic Findings:
* Malignant cells within the epidermis, without invasion of the underlying stroma
* Large pale keratinocytes with abundant ground cytoplasm (“pagetoid cells”)
* lymphocytic infiltrates
features of?
Bowen disease (SCC)
*SCC: squamous cell carcinoma in situ
Macroscopic Features:
* Gray, crusted, papular lesion; Occasionally, ulcerated with irregular margins
Microscopic Findings:
* Keratin pearls
features of?
Invasive squamous cell carcinoma
Microscopic Findings:
* Bulbous (rounded), pushing deep margins, and no atypia
* Thin fibrovascular cores
* Thick acanthotic epithelium
features of?
Verrucous carcinoma
* Varient of SCC (papillary architecture)
Progression of Verrucous Carcinoma
Local invasion, but no metastatic potential
———- : Accumulation of serous fluid within the tunica vaginalis
Hydrocele
———— : Accumulation of blood within the tunica vaginalis
Haematocele
———-: Accumulation of lymphatic fluid within the tunica vaginalis
Chylocele
Causes of Hydrocele
Neighbouring infections, Tumours
What Condition is caused by lymphatic obstruction (e.g. Filariasis) which results in → Marked enlargement of the scrotum and lower extremities ?
Elephantiasis
———– : Failure of testicular descent into the scrotum
Cryptorchidism
Epi of Cryptorchidism
- 1% of male population (by 1 year of age)
- ~10% of cases, bilateral involvement (Can be uni-/ bilateral)
Complications of Cryptorchidism
1) Sterility (impaired spermatogenesis)
2) 3-5-fold increased risk for development of testicular cancer
Microscopic Findings:
* Tubular atrophy (age: 5-6yrs); Hyalinisation (puberty)
* Foci of Intratubular Germ Cell Neoplasia (IGCN)
features of?
Cryptorchidism
Microscopic features:
* Small spermatic tubules
* Thickened basement membrane
* Atypical germ cells with clear cytoplasm
* Interstitial fibrosis
features of?
TESTICULAR ATROPHY & IGCN
* IGCN–> Intratubular Germ Cell Neoplasia
Causes of Epididymitis?
* inflammation of the epididymis
- Children–> Coliforms
- Young men –> Neisseria gonorrhoeae and Chlamydia trachomatis
- Older men –> E. coli and Pseudomonas
Pathogenesis of Epididymitis
Primary urinary tract infection → Vas deferens or the lymphatics of the spermatic cord → Spread to the Testis
Macroscopic Findings:
* Swollen and tender organ (Epididymus)
* Creamy fibrino-purulent exudate
Microscopic Findings:
* Neutrophilic inflammatory infiltrate
features of?
Epididymitis
cause of Orchitis
* Inflammation of the testis
Mumps virus
Macroscopic Features:
* Oedematous and congested testes
Microscopic Findings:
* Lympho-plasmacytic inflammatory infiltrate
* Extensive necrosis, atrophy, fibrosis and sterility (severe cases)
features of?
Mumps Orchitis
*Lympho-plasmacytic infiltrates = Virus
Pathogenesis of Tuberculous Epididymo-Orchitis
Initially, Tuberculous Epididymitis → Extension to the
Testis →Tuberculous Orchitis
Microscopic Findings:
* Granulomatous inflammation with caseous necrosis
* Giant cells
features of?
Tuberculous Epididymo-Orchitis
Cause of Spermatic Cord Torsion in Adults
Failure of normal posterior anchoring (positioning) of the gubernaculum testis (“scrotal ligament”), epididymis and testis (bell clapper deformity) → Increased mobility of testes
CF of Torsion of the Spermatic cord
Sudden onset of testicular pain
Complications of Spermatic Cord Torsion
Obstruction of testicular venous drainage → Vascular engorgement & Venous infarction
- Urologic Emergency!!
Epi of testicular Neoplasms
- Peak incidence: 15-35 years
- Germ cell tumours account for 95% of testicular tumours in post-pubertal males
Risk factors of Testicular tumours
- History of Cryptorchidism
- Brothers of males with Germ Cell Tumours –> 8-10-fold increased risk
Pathogenesis of Testicular Neoplasms
Intratubular Germ Cell Neoplasia (IGCN) –> in situ lesion of Germ Cell Tumours
Calssification of Testicular Neoplasms
1) Germ Cell Tumours
2) Sex Cord-Stromal tumours
Germ cell Tumours examples
1) Seminomas (“Classic” Seminomas, Spermatocytic Seminoma)
2) Non-seminomatous Germ Cell Tumours (i.Embryonal Carcinomas, ii. Yolk-Sac Tumours, iii. Choriocarcinomas, iv.Teratomas)
Sex Cord-Stromal Tumours
- Sertoli-Cell Tumours
- Leydig-Cell Tumours
Macroscopic Features:
* Soft, well-demarcated, gray-white lesions (on the surface of the testicle)
* Large tumours: Foci of coagulation necrosis
* Lobular pattern
Microscopic Findings:
* Large, uniform cells with distinct cell borders
* Clear, glycogen-rich cytoplasm
* Round nuclei, with prominent nucleoli
* Arrangement of cells in small lobules, separated by fibrous septa
* Usually, lymphocytic infiltrates
* Sometimes, accompanying ill-defined granulomatous reaction
* Presence of syncytiotrophoblastic giant cells in 15% of cases;
feature of?
Seminomas
* Germ Cell tumour (Testicular neoplasm)
what Hormon levels are elevated in Seminomas?
β-hCG (10% of patients) and PALP
* beta-human chorionic gonadotropin
* Germ cell tumour
Epi of Spermatic Seminoma
> 65 years
Microscopic Findings:
* Polygonal cells of variable size (i.e. lymphocyte-like cells, intermediate cells and giant cells)
* Arrangement of cells in nodules or sheets
* Absent lymphocytic infiltrates, granulomas and syncytiotroph.
* No association to Intratubular Germ Cell Neoplasia (IGCN)
* No metastatic potential
features of?
Spermatocytic Seminoma
* Gram cell tumour
Epi of Embryonal Testicular carcinomas
RAREE
Microscopic Findings:
* Small, ill-defined, invasive lesions
* Presence of haemorrhagic and necrotic foci
* Large, primitive looking cells
* Basophilic cytoplasm
* Large nuclei with prominent nucleoli
* Indistinct cell borders
* Arrangement of cells in solid sheets
* Presence of primitive glandular structures
* Admixtures with cells of other Germ Cell Tumours
features of?,
EMBRYONAL CARCINOMAS
Epi of Yolk Sac Tumour
- Most common primary testicular neoplasm in children <3yrs of age
- In adults, these tumours are admixed with Embryonal Carcinoma
Macroscopic Features:
* Large and well-demarcated lesions
* Low cuboidal to columnar cells
* Formation of microcysts, sheets, glands and papillae
* Schiller-Duvall bodies: Structures resembling primitive glomeruli
* Identification of PAS positive eosinophilic hyaline globules
features of?
Yolk Sac Tumours
What Hormones are Elevated in Yolk Sac Tumours?
α1-antitrypsin and AFP (90% of patients)
Macroscopic Features:
* Small, non palpable lesions
* lobulated and Haemorrhagic and necrotic lesions
Microscopic Findings:
* Sheets of small cuboidal cells, admixed with cytotrophoblast and syncytiotrophoblast-like cells
features of?
Choriocarcinomas
Hormone levels elevated in Choriocarcinomas
hCG (+) in syncytiotrophoblast-like
cells
(100% of patients)
Epi of Teratomas
Pure forms: Common in infants and children; Rare in adults (only 2-3% of Germ Cell Tumours)
Microscopic Findings:
* Heterogenous collection of differentiated cells or organoid structures (e.g. neural tissue, muscle bundles, foci of cartilage and thyroid resembling tissue, brain substance, etc.) within a fibrous or myxoid stroma
* tissues may be mature (resembling adult tissues) or immature (resembling fetal tissues)
features of?
Teratomas
List the 4 types of Teratomas
A. Neural (Ectodermal)
B. Glandular (Endodermal)
C. Cartilage (Mesodermal)
D. Squamous Epithelial
Prognosis of Seminomas
Excellent prognosis (>90%)
Prognosis of Non-seminomatous tumours
Excellent prognosis
(~90% of patients –> Complete remission and cure, with aggressive chemotherapy )
Prognosis of Pure Choriocarcinoma
Poor prognosis
CF of Seminomas and non-seminomatous tumours
Painless testicular mass