Pathology: Male Genital System Flashcards
What is hypospadias?
Opening of the urethra on inferior surface of the penis
- Due to failure of urethral folds to close:
What is epispadias?
Opening of the urethra on superior surface of the penis
- Due to abdnormal positioning of genital tubercle
- Associated with bladder extrophy
What is condyloma acuminatum?
Benign warty growth on genital skin
- Due to HPV 6 or 11
- characterized by koilocytic change (“raisin appearing” nuclei)
What is lymphogranuloma Venereum?
Necrotizing granulomatous inflammation of inguinal lymphatics and lymph nodes
- STI caused by Chlamydia trachomatis (L1-L3) - an obligate intracellular organism (can only grow inside another cell b/c can’t create its own ATP)
- Eventually heals with fibrosis; perianal involvement may result in rectal strictures
What is the infectious form of Chlamydia trachomatis?
Elementary bodies
(they form reticular bodies as they replicate in the cell and release as infectious elementary bodies)
What are risk factors for squamous cell carcinoma of the penis?
HPV (2/3 cases)
Lack of circumcision (through improper maintenance of the foreskin)
What are possible precursor lesions to penile squamous cell carcinoma?
All forms of in situ carcinoma:
Bowen disease: leukoplakia on shaft of penis
Erythroplasia of Queyrat: erythroplakia on glans of penis
Bowenoid papulosis: reddish papules persist on penis
What is cryptoorchidism?
Failure of testicle to descend into the scrotal sac
*most common congenital male reproductive abnormality
- Most cases spontaneously resolve
- -> if doesn’t resolve by age of 2, surgeon will perform orchiopexy to put testicle into scrotal sac
What are the risks of cryptoorchidism?
Testicular atrophy with infertility
Increased risk for seminoma
What is orchitis? What can cause it?
Inflammation of the Testicle
- *Causes:**
- Chlamydia trachomatis (D-K) or Neisseria gonorrhoeae (typically younger adults - STIs)
- E. coli or Pseudomonas (typically older adults - typical UTI infections that can spread to reproductive tract)
- Mumps virus
- Autoimmune orchitis
What is testicular torsion?
- Twisting of spermatic cord: causes thin-walled vein to close, but thick-walled artery to persist, allowing blood in but not out
–> leads to hemorrhagic infarction
What can put a man at increased risk for testicular torsion?
Can be due to congenital failure of testes to attach to inner lining of scrotum
- present in adolescents with sudden testicular pain and absent cremasteric reflex
What is a varicocele? How does it present?
Dilation of spermatic vein due to impaired drainage
- Presents as scrotal swelling with ‘bag of worms’ appearance - veins become dilated and visible on scrotum
- Usually left-sided
- Associated with left-sided renal cell carcinioima as the carcinoima invades the renal vein and blocks the left spermatic vein
- Seen in large percentage of infertile males
What is a hydrocele? What does it present with?
Fluid collection within tunica vaginalis
- Associated with incomplete closure of processus vaginalis (infants) or blockage of lymphatic drainage (adults)
- Presents as scrotal swelling that can be transluminated
What are general characteristics of testicular tumors?
- Arise from germ cells or sex-cord stroma
- Presents as firm, painless testicular mass that cannot be transilluminated
- Not biopsied due to risk of seeding scrotum; removed via radial orchiectomy, also ~95% of testicular tumors are germ cell tumors and, thus, malignant and must be removed regardless
What is the most common type of testicular tumor?
What are common causes or risk factors?
Germ Cell Tumors
- Usually occur between 15-40 yrs of age
Risk factors:
Cryptorchidism
Klinefelter syndrome
What are the different types of Testicular Germ Cell Tumors?
- Embryonal carcinoma: consisting of (c/o) anaplastic cells
- Mature teratoma: c/o tissue segments of cartilage, intestinal glands, and skin with epiderma/dermal components
- Yolk sac tumor: c/o cuboidal cells in reticular pattern
- Seminoma:c/o large cells with distinct cell borders, central nuclei and prominent nucleoli (better prognosis)
- Choriocarcinoma: c/o neoplastic cryptophoblastic and syncytiotrophoblastic cells admixed with hemorrhage
What are characterstics of a seminoma?
Malignant tumor of large cells with clear cytoplams and central nuclei
- Homogenous mass with no hemorrhage or necrosis
- rare cases may produce beta-hCG
- Good prognosis: responds to radiotherapy
What are characteristics of embryona carcinoma?
Malignant tumor of immature, primitive cells that may form glands
- Hemorrhage mass with necrosis
- Aggressive with early hematogenous spread
- Chemotherapy may result in differentiation into a different carcinoma (i.e. teratoma)
- Increased AFP (classically yolk-sac tumor) or beta-hCG (classically choriocarcinoima) may be present
What are characteristics of a yolk sac tumor?
Malignant tumor that resembles yolk sac elements
- Most common testicular tumor in children
- Alpha fetoprotein (AFP) is characteristically elevated
What is a histological sign of yolk sac tumors?
Schiller-duval bodies
Also called a “glomeruloid-like” structure
What are characteristics of choriocarcinoma?
Malignant tumor of synctiotrophoblasts (make ß-hCG) and cytotrophoblasts –> mimics placental tissue w/o villi
- Spreads early via blood b/c s.blasts and c.blasts are genetically programmed to find blood vessels for implanatation of placenta into uterine wall
- -> leads to tiny primary mass in testicles and large metastatic masses
- ß-hCG is characteristically elevated; may lead to hyperthyroidism or gynecomastia
What are characteristics of a teratoma?
Tumor of mature fetal tissue
- Derived from two or three embryonic layers
- Malignant in males (benign in females)
- AFP or ß-hCG may be expressed
What type of germ cell tumors are the vast majority of testicular germ cell tumors?
Mixed Germ Cell Tumors
- Prognosis based on worst component
