Repro - Pathology (Male Reproductive pathology) Flashcards
Pg. 586-588 in First Aid 2014 Sections include: -Prostate pathology -Benign prostatic hyperplasia -Prostatic adenocarcinoma -Cryptorchidism -Varicocele -Testicular germ cell tumors -Testicular non-germ cell tumors -Tunica vaginalis lesions -Penile pathology
What are 4 symptoms of prostatitis?
Prostatitis - (1) Dysuria (2) Frequency (3) Urgency (4) Low back pain
What is (are) the causes of acute versus chronic prostatitis? Which is most common?
ACUTE: bacterial (e.g., E. coli); CHRONIC: bacterial or abacterial (most common)
In what patient population is benign prostatic hyperplasia common?
Common in men > 50 years old.
Define the physiological change benign prostatic hyperplasia.
Hyperplasia (not hypertrophy) of the prostate gland
What physical findings characterize benign prostatic hyperplasia? Is it a premalignancy?
Characterized by a smooth, elastic, firm nodular enlargement of the periurethral (lateral and middle) lobes, which compress the urethra into a vertical slit. Not considered a premalignant lesion.
What are 4 signs/symptoms with which benign prostatic hyperplasia often presents?
Often presents with (1) increased frequency of urination, (2) nocturia, (3) difficulty starting and stopping the stream of urine, and (4) dysuria.
What are 3 conditions/complications that may result from benign prostatic hyperplasia?
May lead to (1) distention and hypertrophy of the bladder, (2) hydronephrosis, and (3) UTIs.
What key lab finding is associated with benign prostatic hyperplasia?
Increased free prostate specific antigen (PSA)
What are the treatment options for benign prostatic hyperplasia? What is the mechanism behind these treatments?
Treatment: alpha-1 antagonists (terazosin, tamsulosin), which cause relaxation of smooth muscle; Finasteride (5alpha-reductase inhibitor)
Draw a visual of the prostate, including and labeling the following: (1) Anterior lobe (2) Benign prostatic hyperplasia (boundaries) (3) Lateral lobe (4) Middle lobe (5) Posterior lobe (6) Prostate cancer (7) Urethra.
See p. 586 in First Aid 2014 for visual at bottom right of page
In what patient population is prostatic adenocarcinoma common? What other reproductive pathology is also notable for being common in this patient population?
Common in men > 50 years old; Benign prostatic hyperplasia
From where in the prostate gland does prostatic adenocarcinoma most often arise? How is it most frequently diagnosed?
Arises most often from the posterior lobe (peripheral zone) of the prostate gland and is most frequently diagnosed by increased PSA and subsequent needle core biopsies.
What are 2 useful tumor markers for prostatic adenocarcinoma?
Prostatic acid phosphatase (PAP) and PSA are useful tumor markers (increase total PSA, with decreased fraction of free PSA).
What complication may develop in late stages of prostatic adenocarcinoma? What 3 symptoms/signs indicate this?
Osteoblastic metastases in bone may develop in late stages, as indicated by lower back pain and an increase in serum ALP and PSA.
What histological finding(s) characterize(s) Prostatic adenocarcinoma?
Note the small neoplastic glands with prominent nucleoli amid normal prostate stroma
What is cryptorchidism?
Undescended testis (one or both)
What effect does cryptorchidism have on spermatogenesis and testosterone levels, and why?
Impaired spermatogenesis (since sperm develop best at temperatures < 37 C); can have normal testosterone levels (Leydig cells are unaffected by temperature)
Of what other pathology does cryptorchidism increase the risk?
Associated with increased risk of germ cell tumors
What increases the risk of cryptorchidism?
Prematurity increased the risk of cryptorchidism
What are the key hormonal changes in cryptorchidism? Which hormone level varies, and according to what?
Decreased inhibin, Increased FSH, and Increased LH; Testosterone decreases in bilateral cryptorchidism, normal in unilateral
What is Varicocele, and what causes it?
Dilated veins in pampiniform plexus as a result of increased venous pressure
What is the most common cause of scrotal enlargement in adult males?
Varicocele
On what side does varicocele most often occur, and why?
Most often on the left side because of increased resistance to flow from left gonadal vein drainage into the left renal vein
What effect can varicocele have on fertility, and why?
Can cause infertility because of increased temperature
How does varicocele appear?
“Bag of worms” appearance
How is varicocele diagnosed?
Diagnosed by ultrasound with Doppler
What are the treatment options for Varicocele?
Treatment: Varicocelectomy, Embolization by interventional radiologist
What percentage of testicular tumors are germ cell versus non-germ cell tumors?
Germ cell: ~95% of all testicular tumors; Non-germ cell: ~5% of all testicular tumors.
In what patient population do testicular germ cell tumors most often occur?
Most often occur in young men
What are 2 risk factors for testicular germ cell tumors?
Risk factors: (1) Cryptorchidism (2) Klinefelter syndrome
As what kind of tumor can testicular germ cell tumors present?
Can present as a mixed germ cell tumor
What is the differential diagnosis for testicular mass that does not transilluminate?
Differential diagnosis for testicular mass that does not transilluminate: cancer.
Are testicular non-germ cell tumors mostly benign or malignant?
Mostly benign
What are 5 types of testicular germ cell tumors?
(1) Seminoma (2) Yolk sac (endodermal sinus) tumor (3) Choriocarcinoma (4) Teratoma (5) Embryonal carcinoma
Is seminoma benign or malignant?
Malignant
What is the presentation of seminoma?
Painless, homogenous testicular enlargement
What is the most common testicular tumor?
Seminoma
When does seminoma most commonly present? When does it never present?
Most common in 3rd decade, Never in infancy
What characterizes seminoma on histology?
Large cells in lobules with watery cytoplasm and a “fried egg” appearance.
What lab finding is significant for a seminoma?
Increase placental ALP
Is seminoma sensitive or resistant to radiation?
Radiosensitive
When in the course of seminoma does metastasis occur? What is the prognosis of seminoma?
Late metastasis, Excellent prognosis
What is another name for yolk sac tumor? What physical traits characterize it?
Yolk sac (endodermal sinus) tumor; Yellow, mucinous
What part of the body is affected by a yolk sac tumor in males? Is it aggressive and/or malignant? To what tumor in females is it analogous?
Aggressive malignancy of testes, analogous to ovarian yolk sac tumor.
What is the name of the bodies associated with Yolk sac (endodermal sinus) tumor? What do they resemble?
Schiller-Duval bodies resemble primitive glomeruli
What is the most common testicular tumor in boys < 3 years old?
Yolk sac (endodermal sinus) tumor
Is choriocarcinoma benign or malignant? With what hormone level change is it associated?
Malignant, Increase hCG.
What mechanism/underlying change causes choriocarcinoma?
Disordered synctiotrophoblastic and cytotrophoblastic elements
How does choriocarcinoma metastasize, and to where? What complications may result from such metastases, and why?
Hematogenous metastases to lung and brain (may present with “hemorrhagic stroke” due to bleeding into the metastasis.
With what symptoms may choriocarcinoma present, and why?
May produce gynecomastia or symptoms of hyperthyroidism (hCG is an LH and TSH analog)
Are teratomas in (adult) males benign or malignant? How does this compare/contrast to teratomas in females? Are teratomas in benign or malignant in children?
Unlike in females, mature teratoma in adult males may be malignant; Benign in children
What are 2 hormone/factor changes that may occur in male teratomas, and in what percentage of cases does this occur?
Increased hCG and/or AFP in 50% of cases.
Is embryonal carcinoma benign or malignant? Describe the mass that presents. Compare/Contrast its prognosis to that of seminoma.
Malignant, hemorrhagic mass with necrosis; painful; worse prognosis than seminoma.
What kind of morphology does embryonal carcinoma often have?
Often glandular/papillary morphology
Briefly describe how embryonal carcinoma most commonly presents in terms of type(s) of cancer.
“Pure” embryonal carcinoma is rare; most commonly mixed with other tumor types
With what hormone/factor levels may embryonal carcinoma be associated? According to what can this vary, and how so?
May be associated with increased hCG and normal AFP levels when pure (increase AFP when mixed)
What are 3 types of testicular non-germ cell tumors?
(1) Leydig cell (2) Sertoli cell (3) Testicular lymphoma
What histological finding characterizes Leydig cell tumors? What color is the tumor?
Contains Reinke crystals; Golden brown color
What do Leydig cell tumors usually produce? How do they present in men versus boys?
Usually androgen producing, gynecomastia in men, precocious puberty in boys
What is a Sertoli cell tumor, and from where does it arise?
Androblastoma from sex cord stroma
What is the most common testicular cancer in older men? What is important to note about its progression?
Testicular lymphoma; Aggressive
Is testicular lymphoma due to a primary cancer or metastases?
Not a primary cancer, arises from lymphoma metastases to testes
What are tunica vaginalis lesions? How are they distinguished from testicular tumors?
Lesions in the serous covering of testis present as testicular masses that can be transilluminated (vs. testicular tumors)
What are 2 types of tunica vaginalis lesions?
(1) Hydrocele (2) Spermatocele
What causes hydrocele?
Hydrocele - increased fluid secondary to incomplete obliteration of processus vaginalis
What defines/causes spermatocele?
Spermatocele - dilated epididymal duct
On what 3 continents is squamous cell carcinoma of the penis more common?
More common in Asia, Africa, and South America
What are 3 precursor in situ lesions for penile squamous cell carcinoma? How does each present?
Precursor in situ lesions: (1) Bowen disease (in penile shaft, presents as leukoplakia) (2) Erythroplasia of Queyrat (cancer of glans, presents as erythroplakia) (3) Bowenoid papulosis (presents as reddish papules)
With what 2 factors/conditions is squamous cell carcinoma associated?
Associated with HPV, lack of circumcision
What is priapism?
Painful sustained erection not associated with sexual stimulation or desire
What are 3 factors/conditions associated with priapism?
Associated with (1) trauma, (2) sickle cell disease (sickled RBCs get trapped in vascular channels), (3) medications (anticoagulants, PDE-5 inhibitors, antidepressants, alpha-blockers, cocaine).
What are 5 examples of medications associated with priapism?
Medications (anticoagulants, PDE-5 inhibitors, antidepressants, alpha-blockers, cocaine)
