Pathology of the male genital system Flashcards
Malformations of the penis
Hypospadia: urethra opens along the vental surface
Epispadia: urethra opens along the dorsal surface
Phimosis: prepuce cannot be easily retracted
Inflammatory lesions of the penis
- Balanitis: inflammation of the glans penis; usually due to poor hygiene leading to secondary bacterial infections and HHV2 infections
- Condyloma acuminatum (warts): related to HPV
- Urethritis: UTI, bacterial infections
- Chancer: painless eroded papule due to syphilis
- Chancroid (soft chancre): ulcerative lesions with inguinal lymphadenopathy
- Lymphogranuloma venereum
Diseases of the scrotum
- Inflammations: jock itch (tinea cruris), candidiasis, eczema, elephantiasis
- Contact dermatitis
- Neoplasms: squamous cell cc
- Hydrocele: accumulation of serous fluid in the tunica vaginalis
- Spermatocele: retention cyst in the head of epididymis
- Sebaceous cyst
- Inguinal hernia
Diseases of the spermatic cord
- Spermatic cord torsion: produces arterial and venous ischemia
- Variocele: abnormal dilation of veins in the pampiniform plexus, probably due to insufficiency of the venous valves
Classification of prostatits
- Acute bacterial: causative agents are those seen in UTIs; associated with infection of the urethra and urinary bladder; causes fever, dysuria and lower back pain
- Chronic bacterial: caused by uropathogens
- Chronic non-bacterial prostatitis (chronic pelvic pain syndrome)
- Asymptomatic inflammatory prostatits
Benign prostate hyperplasia: pathogenesis
Excessive androgen (DHT) stimulation. This is the basis for the use of 5alpha-reductase inhibitors as treatment.
Benign prostate hyperplasia: morphology
- Occurs in the inner transitional zone
- Forms well circumscribe nodules, which are solid and contain cystic spaces
- Proliferation of stromal and epithelial cells -> gland enlargement
Prostate adenocarcinoma: etiology
- Hormonal influence: androgens (DHT); hence, does not occur in castrated males
- Heridetary influence: has a familial influence; more common in American blacks
- Environmental influence: certain industrial settings and geographic differences
- Genetic influences: fusion gene (TMPRS2 gene encoding and androgen-regulated promoter and ETS family transcription factor) and activation of the oncogenic P13K/AKT signalling pathway
Prostate adenocarcinoma: morphology
- Produces well-defined glands with atypical epithelium
- Firm, grey-white with ill-defined margins
Prostate adenocarcinoma: grading
Uses the Gleason grading system: 5 grades based on glandular pattern of differentiation
- Grade 1: most differentiated
- Grade 5: no glandular differentiation
Prostate adenocarcinoma: clinical features
- Most arise in the peripheral region, thus aren’t recognized at routine rectal examination
- Hard, irregular nodules and fixed prostate
- More aggressive carcinomas might only be found due to metastases, especially to the bone where it causes osteolytic or osteoblastic lesions
Inflammatory lesions of the testis and epididymis
- Non-specific epididymitis: from primary UTI ascending through the vas deferens or lymphatics
- Non-specific orchitis: same as for epididymitis; caused by the same STDs or by E.coli; symptoms include ejaculation of blood, hematuria, pain and swelling
- Mumps orchitis: mumps belong to the rubulavirus; infected testis is edematous and congested
- Granulomatous orchitis: can be caused by syphilis, tuberculosis, sarcoidosis etc.; granulomatous inflammation and caseous necrosis; benign, but may be associated with seminomas
Cryptorchidism
- Testes fail to descend into the scrotum
- Possible causes: hormonal abnormalities, intrinsic testicular abnormalities, mechanical problems
- Seen in i.e. Prader-Willi syndrome
- On histology: hyalinization and thickening of the tubular BM
- Bilateral form causes sterility
- Other complications include trauma, torsion and inguinal hernia
- Also related to malignancy
Pre-testicular causes of infertility
- Extragonadal endocrine disorders: hypothalamic, pituitary, adrenal
- Drugs, alcohol, smoking
- Strenous riding
- Medications
Testicular causes of infertility
Testes produce semen of low quantitiy and poor quality
- Age
- Genetic defects on the Y chromosome
- Cryptorchidism
- Hydrocele: serous fluid accumulation
