Reproductive - Male Pathology Flashcards
Hypospadias: Mechanism and Presentation
Failure of urethral folds to close leading to opening of urethra on inferior surface of penis
May be associated with androgen dysfunction
What is the most common malformation of urethral grove?
Hypospadias
Why treat hypospadias?
Prevent UTI
Epispadias: Mechanism and Presentation
Opening of urethra on superior surface of penis
Due to faulty positioning of genital tubercle
What is episapdias associated with?
Extrophy of bladder
Condyloma acuminatum: Mechanism and Cause
Benign warty growth on genital skin
Due to HPV type 6, 11; koilocytic changes
Lymphogranuloma venereum: Presentation
Necrotizing granulomatous inflammation of inguinal lymphatics and lymph nodes (Chlamydia L1-L3)
Heals with fibrosis; perianal involvement may result in rectal stricture
Squamous Cell Carcinoma of Penis: Risk factors
high risk HPV, lack of circumcision
Squamous Cell Carcinoma of Penis: Epidemiology
More common in Asia, Africa, South American
What are the precursor lesions of Squamous Cell Carcinoma of Penis?
Bowen disease
Erythroplasia of Queryrat
Bowenoid papulosis (not precursor)
Bowen disease
In situ carcinoma of penile shaft or scrotum with leukoplakia
Erythroplasia of Queyrat
In situa carcinoma on glans that presents as erythroplakia
Bowenoid papulosis
In situa carcinoma with multiple reddish papules in younger patients (40s)
Does not progress to invasive carcinoma
Peyronie’s disease
Bent penis due to acquired fibrous tissue formation
Priapism
Painful sustained erection not associated with sexual stimulation or desire
Priapism: Causes
trauma
sickle-cell disease (sickled RBCs trapped in vascular channels)
medications (anticoagulants, PDE5 inhibitors, antidepressants, alpha-blockers, cocaine)
Cryptorchidism
Failure to testicle to descend into scrotal sac
If not resolve spontaneously, orchipexy before age 2
Cryptorchidism: Complications
testicular atrophy with infertility (impaired spermatogenesis); increased risk of seminoma
Cryptorchidism: Levels of sex hormones
Normal testosterone level (Leydig cells unaffected by temperature)
High FSH, LH, low inhibin
Low testosterone if bilateral
Cryptorchidism: Risk factor
Prematurity
What is the most common congenital male reproductive abnormality? (1%)
Cryptorchidism
Orchitis
Inflammation of testicle
increased risk of sterility but libido unaffected
Orchitis: Causes
Young adults: chlamydia trachomatis (DK) or Neisseria gonorrhoeae
Older adults: E. coli and pseudomonas (UTI pathogens)
Mumps virus (teenage): infertility - not seen in < 10 yo
Autoimmune orchitis: granulomas involving seminiferous tubules
Testicular torsion: Presentation and Mechanism
Adolescent with sudden testicular pain and absent cremasteric reflex
(Congenital failure of testes to attach to inner lining of scrotum)
Twisting of spermatic cord; thin-walled veins obstructed -> congestion and hemorrhagic infarction
Varicocele: Presentation
Left-sided scrotal swelling with “bag of worms” appearance”
Varicocele: Mechanism
Dilation of veins in pampiniform plexus due to impaired drainage (increased venous pressure)
Left side affected - drains into left renal vein
What is left-sided varicocele associated with?
Left sided renal cell carcinoma (RCC invades renal vein)
Varicocele: Complications
Infertility (increased temperature)
Varicocele: Diagnosis and Treatment
Diagnosis: ultrasound
Treatment: Varicocelectomy, ebolization
Hydrocele: Presentation and Mechansim
Scrotal swelling that can be transilluminated
Fluid collection within tunica vaginalis (serous membrane that covers testicles and internal surface of scrotum)
What is hydrocele associated with in children? In adults?
Children: incomplete closure of processus vaginalis leading to communications with peritoneal cavity
Adults: blockage of lymphatic drainage
Testicular tumors: Presentations
Firm, painless testicular mass; not transilluminated
Germ cells or sex cord-stroma
Testicular tumors: Diagnosis
Usually not biopsied
- risk of seeding to scrotum
- most are malignant germ cell tumors
What are the two types of testicular tumors?
Divided to seminoma (responsive to radiotherapy), and nonseminoma (early metastasis)
Testicular tumors: risk factors
cryptochidism, kleinfelter syndrome
Seminoma: Histology
Homogeneous mass with no hemorrhage or necrosis
Malignant tumor of large cells with clear cytoplasm and central nuclei (resembles ovarian dysgerminoma)
Seminoma: Lab
beta-hCG
Seminoma: Metastasis and Prognosis
Good prognosis, late metastasis; respond to radiotherapy
Seminoma: Age group
Males 15-35 yo
Embryonal carcinoma (Male): Histology
Painful, hemorrhagic mass with necrosis
Immature, primitive cells that may produce glands/papillary; most are mixed
Embryonal carcinoma (Male): Metastasis and Prognosis
Aggressive with early hematogenous spread
Chemotherapy may result in differentiation into another type of germ cell tumor
Embryonal carcinoma (Male): Lab
Increased AFP (mixed)/beta-hCG
Endodermal sinus tumor (Male): Presentation and Histology
Yolk sac, yellow mucinous tumor in children
Schiller-duval bodies (glomerulus-like structures)
Endodermal sinus tumor (Male): Lab
Elevated AFP
Choriocarcinoma (Male): Histology
Malignant tumor of synctiotrophoblasts (high beta HCG) and cytotrophoblasts (placental-like tissue without villi)
Choriocarcinoma (Male): Lab
High beta-HCG can lead to hyperthyroidism or gynecomastic (alpha subunit similar to FSH/LH/TSH)
Choriocarcinoma (Male): Metastasis
Hematogenous metastasis to lungs
Teratoma (Male): Histology
Mature fetal tissue tumors with 2-3 embryonic layers
Teratoma (Male): Prognosis
Malignant in males (benign in females, children)
Teratoma (Male): Lab
Increased hCG and/or AFP in 50% of cases
Mixed germ cell tumors (Male)
Most germ cell tumors are mixed
prognosis based on worst component
Leydig cell tumor (Male): Histology
Golden brown color; Reinke crystals
Leydig cell tumor (Male): Presentation
Produces androgen (precocious puberty in children; gynecomastia in adults)
Sertoli cell tumor
Sex cord-stromal tumor with tubules
usually clinically silent
Lymphoma (testicular tumor)
Testicular mass in males > 60 yo
Often bilateral and aggressive; diffuse large B-cell type
Prostate: histology
Glands and stroma
Glands: inner layer of luminal cells and outer layers of basal cells (make alkaline, milky fluid added to sperm and seminal vesical fluid to make semen)
Glands and stroma are maintained by androgens
Acute prostatitis: Presentation and Mechanism
Acute inflammation
Dysuria with fever, chills
Prostate tender and boggy on digital rectal exam
Acute prostatitis: Causes
Young adults - chlamydia, neisseria
Old adults - E. coli, pseudomonas
Acute prostatitis: Diagnosis
Prostatic secretions show WBCs; culture reveals bacteria
Chronic prostatitis: Presentation and Diagnosis
Chronic inflammation
Dysuria with pelvic or low back pain
WBCs but no culture
Benign prostatic hyperplasia (BPH): Presentations (6)
- Impaired bladder emptying (increased risk of infection/hydronephrosis)
- Dribbling
- Problem with urine stream
- hypertrophy of bladder wall smooth muscle (bladder diverticula)
- microscopic hematuria
- Slightly elevated PSA (increased number of glands)
Benign prostatic hyperplasia (BPH): Presentation
Hyperplasia of prostatic stroma and glands
In central periurethral zone of prostate (lateral and middle lobes)
Benign prostatic hyperplasia (BPH): Risk and Associations
Associated with DHT (from testosterone by 5alpha-reductase in stromal cells)
Increased with age; no increased risk of cancer
Benign prostatic hyperplasia (BPH): Treatment
- alpha-1 antagonist (terazosin) to relax smooth muscle
(also for blood pressure)
Tamsulosin (alpha-1A antagonist) - no effect of alpha-1B on blood vessels
- 5 alpha reductase inhibitor (block conversion to DHT)
Tox: gynecomastia, sexual dysfunction
Prostate adenocarcinoma: Epidemiology
Malignant proliferation of prostatic gland
Risk factors: African Americans > Caucasians > Asians; saturated fat diet
Most common cancer in men; 2nd most common cause of cancer death
Prostate adenocarcinoma: Presentation
Most often clinically silent
Arise in peripheral, posterior region - not produce urinary symptoms early on
Prostate adenocarcinoma: Screening Protocol
Screening 50 yo with DRE and PSA (decreased %free-PSA worrisome for cancer)
Prostate adeocarcinoma: Histology
Biopsy required for confirmation
Invasive glands with prominent nucleoli
Prostate adeocarcinoma: Grading system
Gleason grading system - architecture alone
Prostate adeocarcinoma: Metastasis
Can spread to lumbar spine/pelvis (osteoblastic - elevated alkaline phosphatase, PSA, prostatic acid phosphatase PAP)
Prostate adeocarcinoma: Treatment
Prostatectomy for localized disease
Advance: hormone suppression (leuprolide; flutamide)
Tunica vaginalis lesions
Lesions in serous covering of testis as masses that can be transilluminated
Hydrocele and Spermatocele
Spermatocele
Dilated epididymal duct
