Pathology of the Male Reproductive Tract Flashcards
Common disorders fo the prostate
– Benign prostatic hyperplasia
– Carcinoma
– Prostatitis
Benign Nodular Hyperplasia
- Non-neoplastic–associated with hormonal imbalance
- Nodular hyperplasia of glands and stroma
- Not premalignant
- Obstructs urine flow
- Associated with infection
- Treatable
where does benign prostatic hyperplasia
- Involves transition zone of prostate plus peri-urethral glands
- Nodulesofglandsandstroma
- Compresses and elongates urethra
- Involvement of peri-urethral zone interferes with urethral sphincter
symptoms of benign prostatic hyperplasia
• Causes urinary retention
– Acute retention: painful
– Chronic retention: painless, more gradual
complications of BPH
- bilateral hydronephrosis
- bilateral hydroureter
- infection
- renal failure
- calculi
- septicaemia
- muscular hypertrophy
- diverticulum
- trabeculation
- compression of urethra
- nodular enlargement of prostate
BPH vs Prostate Carcinoma
prostate cancer is more posterior and can often be assymptomatic as it grows posteriorly
what is a precursor from prostatic cancer
Prostatic intraepithelial neoplasia
Adenocarcinoma usually occurs when and where
> 50 years Posterior subcapsular area
- Asymmetric firm enlargement
- Metastasises (especially to bone)
– Latent or indolent (incidental) carcinoma
Microscopic incidental focus
Common: incidence high in old age
Lesions dormant; metastases in 30% after 10 years
Spread and Clinical Features of prostate carcinoma
Gleason score: differentiation and distribution Stage TN – Direct – Via lymphatics – Via blood • Presents with – Urinary symptoms – Incidental finding on rectal examination – Bone metastases – Lymph node metastases
Diagnosis
– Imaging - ultrasound, X-rays, isotope bone scan
– Cystoscopy - ? cytology
– Biochemistry PSA
– Haematological - bone marrow involvement – Biopsy - ? cytology
Treatment
– Oestrogenic – GnRH analogues – Orchidectomy – Radiotherapy – Radical prostatectomy
Penis and Scrotum tumours
– Bowen’s disease (non-invasive)
– Invasive squamous cell carcinoma
inflammation and infection of the penis and scrotum
- phimosis, paraphimosis
Congenital malformations of the penis and scrotum
– Hypospadias - urethral opening on inferior aspect
– Epispadias - often accompanied by abnormal development of bladder
obstruction of the urethra
– Congenital valves
– rare in males
– Rupture
– Stricture
Urethritis
– Gonococcal
– Non-gonococcal (non-specific)
tumours of the urethra
– Warts
– Transitional cell carcinoma
common bacteria that infects the urinary tract
Gonococcal Urethritis
Developmental and cystic lesions of the testes
– Undescended testis (cryptorchidism)
– Hydrocoele
– Haematocoele
Orchitis
– Mumps orchitis
– Idiopathic granulomatous orchitis
– Syphilitic orchitis
Testicular Tumours
• Occur in young men (commonest tumor <35yrs) and old men
• Aetiology unknown but undescended testis is predisposing factor (x10
risk)
• In situ neoplasia does occur and is a precursor
two types of testicular tumour
teratoma
seminoma
Presentation of Testicular Tumours
Testicular tumors may present with Painless unilateral enlargement of testis Secondary hydrocele Symptoms from Mets Retroperitoneal mass Gynaecomastia
Seminoma
• Commonest type of testicular tumour • Germ cell origin • Peak incidence 30 - 50 years • Types – Classical – Spermatocytic – Anaplastic – With syncytiotrophoblast giant cells (may present with gynaecomastia) – Combined
Teratoma
- Germ cell origin
- Peak incidence 20-30y
- More aggressive than seminoma
- Categories
- Differentiated
- Intermediate
- Undifferentiated
- Trophoblastic
- Beta HCG and AFP may eb useful markers
Other Germ Cell Tumours
• Intratubular germcell neoplasia – Precursor lesion • Yolk sac tumour - children – AFP useful marker – Extra-embryonic differentiation • Combined germ cell tumours
what can be used as a tumour marker
AFP
Non-Germ Cell Tumours
• Malignant lymphoma – Elderly men
• Leydig cell tumour
– May produce androgens
• Sertoli cell tumour • Metastatic tumours
Staging of Testicular Tumours
- Stage I - confined to testis and its coverings
- Stage II - involves testis and para- aortic lymph nodes
- Stage III - involves lymph nodes in mediastinum and/or supraclavicular region
- Stage IV - visceral metastases
Male Infertility
• Causes – Endocrine disorders • GnRH deficiency • Oestrogen excess – Testicular lesions e.g. • Cryptorchidism • Abnormal spermatogenesis – Post-testicular lesions • Obstruction of efferent ducts
Epididymis and Spermatic Cord
- Congenital abnormalities
- Epididymal cysts and spermatocoeles
- Varicocoele
- Torsion of the spermatic cord and testis
- Inflammatory lesions – Epididymo-orchitis
- Tumours - rare
