Male Reproductive System (Ia) Flashcards by Elyaa Saleh

————- : Abnormal opening of the urethra on the ventral aspect of the penis, anywhere along the shaft

Hypospadias

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Complications of Hypospadias

Constriction → Urinary tract obstruction →
Increased risk for urinary tract infections

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—————-: Abnormal opening of the urethra on the dorsal aspect of the
penis

Epispadias

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———-: Inflammation of the glans penis

Balanitis

* happens normally in uncircumcised males

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———– : Inflammation of the overlying prepuce (foreskin)

Balanoposthitis

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causes of Blanoposthitis

1) Poor hygeine -> formation of smegma (shedding of skin)
2) Bacterial infection –> Candida albicans, anaerobic and pyogenic bacteria

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Complication of Blanoposthitis?

Phimosis

* Phimosis –> tight foreskin (caused by scarring of the prepuce)

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The most common Penile Neoplasm?

Squamous cell carcinoma >95%

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Epi of Sqamous cell carcinoma (of the penis)

Associated w/ uncircumcised men >40yrs and HPV (16/18)

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Squamous cell carcinoma is aka?

Bowen disease

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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

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Macroscopic Features:
* Gray, crusted, papular lesion; Occasionally, ulcerated with irregular margins
Microscopic Findings:
* Keratin pearls

features of?

Invasive squamous cell carcinoma

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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)

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Progression of Verrucous Carcinoma

Local invasion, but no metastatic potential

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———- : Accumulation of serous fluid within the tunica vaginalis

Hydrocele

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———— : Accumulation of blood within the tunica vaginalis

Haematocele

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———-: Accumulation of lymphatic fluid within the tunica vaginalis

Chylocele

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Causes of Hydrocele

Neighbouring infections, Tumours

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What Condition is caused by lymphatic obstruction (e.g. Filariasis) which results in → Marked enlargement of the scrotum and lower extremities ?

Elephantiasis

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———– : Failure of testicular descent into the scrotum

Cryptorchidism

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Epi of Cryptorchidism

1% of male population (by 1 year of age)
~10% of cases, bilateral involvement (Can be uni-/ bilateral)

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Complications of Cryptorchidism

1) Sterility (impaired spermatogenesis)
2) 3-5-fold increased risk for development of testicular cancer

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Microscopic Findings:
* Tubular atrophy (age: 5-6yrs); Hyalinisation (puberty)
* Foci of Intratubular Germ Cell Neoplasia (IGCN)

features of?

Cryptorchidism

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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