Pathology of the Male Reproductive Tract Flashcards
Benign Prostatic Hyperplasia
- Involves transition zone of prostate plus peri-urethral glands.
- Nodules of glands and stroma.
- Compresses and elongates urethra
- Involvement of peri-urethral zone interferes with urethral sphincter
- Causes urinary retention: acute - painful, chronic - painless, more gradual.
- Symptoms include polyuria, nocturia, hesitancy, weak or continuous stream of urine, terminal dribbling, cannot empty the bladder, haematuria, urinary incontinence and retention
Prostatic Carcinoma
- Prostatic intraepithelial neoplasia - precursor
- adenocarcinoma usually affects >50yrs. - posterior subcapsular area, asymmetric firm enlargement, metastases (esp. to bone).
- latent or indolent (incidental) carcinoma - microscopic incidental focus, incidence high in old age, lesions dormant; metastases in 30% after 10 years.
- Presents with urinary symptoms, incidental finding on rectal exam, bone metastases and lymph node metastases.
Benign Nodular Hyperplasia
- Common
- Non-neoplastic
- Nodular hyperplasia of glands and stroma
- Not premalignant
- Obstructs urine flow
- Associated with infection
- Treatable
Complications of Benign Prostatic Hyperplasia
Bilateral hydronephrosis, bilateral hydroureter, kidney infection, renal failure, kidney calculi, septicaemia, diverticulum in bladder, muscular hypertrophy of bladder, trabeculation of bladder, compression of urethra, nodular enlargement of prostate gland.
Differences between Benign Prostatic Hyperplasia and Prostatic Carcinoma
- BPH - hyperplasia of peri-urethral zone and median groove is palpable on rectal exam.
- Cancer - subscapular focus of carcinoma, median groove is obliterated by carcinoma arising in posterior subscapular zone - invasion of capsule.
Challenge of Prostatic Cancer
Identifying whether it is latent, in situ, indolent, aggressive.
Diagnosis of Prostatic Cancer
- Imaging - ultrasound, X-rays, isotope bone scan
- Cystoscopy - ? cytology (find out structure and function), biopsy - rule out bladder cancer
- Biochemistry - Prostate Specific Antigen
- Haematological - bone marrow involvement
- Biopsy - ? cytology - find out structure and function
Treatment of Prostatic Cancer
- Oestrogenic
- GnRH analogues
- Orchidectomy
- Radiotherapy - internal (brachytherapy) or external.
- Radical prostectomy
Venereal Infection
Venereal diseases, called sexually transmitted infections are infections caused by various bacteria, viruses, and parasites.
Hypospadias
Urethral opening on inferior aspect of the penis rather than the tip. This causes a downward curve of the penis and abnormal spraying during urination.
Epispadias
Rare congenital abnormality that involves the opening of the urethra, it opens at the superior aspect of the penis instead of the tip. The space between the opening and the tip looks like an open book (gutter). Often accompanied by abnormal development of bladder
Phimosis
Tightening of the foreskin which means it cannot be pulled back. Can be caused by previous infections leaving behind scar tissue.
Paraphimosis
Condition in which the foreskin becomes trapped behind the glans penis, and cannot be reduced. Often occurs in patients with an indwelling urethral catheter.
Bowen’s Disease
- non-invasive
- intraepithelial carcinoma
- occur anywhere on penis
- erythematous patch with keratotic surface
- raised red plaque
Invasive Squamous Cell Carcinoma
- rare in UK
- HPV
- glans penis or inner aspect of prepuce
- nodule or plaque
- metastasises to inguinal lymph nodes.
