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MD3002 > Reproductive pathology: male > Flashcards

Reproductive pathology: male Flashcards

1
Q

Identify some common presentations of reproductive pathologies in the male.

A

Dysuria
Secondary infection
Pain
Scrotal swelling

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2
Q

State the main cause of scrotal swelling.

A

Inguinal hernia

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3
Q

Describe the relationship between pathologies of the prostate and age.

A

Positive correlation between age and pathologies of the prostate

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4
Q

Which kinds of reproductive pathologies in the male may present with urinary symptoms ? Which do not ?

A

Pathologies of the prostate may, but not always (usually presents with urinary symptoms if benign, may not present with urinary symptoms if malignant)

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5
Q

Identify the main pathologies of the prostate.

A

– Benign prostatic hyperplasia
– Carcinoma (may present late)
– Prostatitis

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6
Q

Identify possible causes of prostatitis.

A
  • Secondary to BPH (because blockage of ducts, infection etc.)
  • Related to STIs
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7
Q

Identify any other names given to BPH.

A

Benign Nodular Hyperplasia

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8
Q

Is BPH related to prostate carcinoma ?

A

Non-neoplastic – associated with hormonal imbalance, and not premalignant

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9
Q

Describe the main features of BPH.

A
  • Nodular hyperplasia of glands and stroma
  • Involves transition zone of prostate plus peri-urethral glands
  • Associated with hormonal imbalance (non-neoplastic)
  • Obstructs urine flow (so commonest presentation: urinary obstruction, both acutely and chronically)
  • Elongates and compresses urethra
  • Associated with infection
  • Not pre-malignant
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10
Q

Does the presence of BPH in a patient exclude the presence of prostate carcinoma ?

A

No, the two conditions can co-exist so if BPH is found, the diagnosis of carcinoma should not be excluded, both can be there.

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11
Q

Can BPH be treated ? How so ?

A
  • Treatable: hormonal manipulation to suppress hyperplasia. Can choose to do that later once significant symptoms.
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12
Q

Which part of the prostate does BPH usually affect ? Link this to the symptoms presented with.

A

Usually, hyperplasia occurs in the middle of the gland (median lobe, around the urethra) so urinary symptoms occur early with less severe pathology, before get massive problem in terms of the size of the prostate.

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13
Q

Describe the effect of BPH on the urethra.

A
  • Urethra elongated, compressed (i.e. gets thinner), so flow gets decreased, which can lead to problems with sphincters in urethra, resulting in possible leakage.
  • Involvement of peri-urethral zone interferes with urethral sphincter
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14
Q

Distinguish between acute and chronic urinary retention resulting from BPH.

A

– Acute retention: painful (released with catheterisation) (e.g. if prostatitis and sudden closure of urethra, blocked and compressed)
– Chronic retention: painless, more gradual (because the bladder had time to adapt)

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15
Q

Identify possible complications of BPH.

A
  • Diverticulum (i.e. P in bladder causing divericiulum through wall of bladder, which can become a focus for infection, for stone formation)
  • If ureteric sphincter is not functional, then P in bladder will transmit to P through to ureter. Can get backflow and therefore get hydroureter. Can also get hydronephrosis. This can lead to susceptibility to infection, to calculi, and may eventually result in renal failure.
  • Muscular hypertrophy of the bladder and trabeculation (bladder attempts to squeeze out urine retained)
  • Chronic urinary retention because of prostate enlargement resulting in urethra stretched and narrowed
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16
Q

Where does prostate carcinoma usually occur ? Link this to the symptoms shown.

A
  • Cancer, often starts in posterior subcapsular area, so far from ureter. This can but not necessarily does present with urinary symptoms
  • Metastasis can occur before symptoms occur, because of location of the prostate carcinoma.
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17
Q

Can you feel a prostatic carcinoma though a rectal exam ? Why or why not ?

A

Fibromuscular tissue is very fibrous and very hard in cancer, so rectal exam to examine prostate can mean you can feel prostatic carcinoma.

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18
Q

Identify any precursors to prostatic carcinoma.

A
  • Prostatic intraepithelial neoplasia -precursor (BUT if have PIN, may also find invasive cancer)
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19
Q

Which type of cancer is prostate cancer ?

A

Adenocarcinoma, because affects glands

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20
Q

Describe the epidemiology of prostate carcinoma.

A

usually >50 years (common: incidence high in old age)

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21
Q

What is the most common metastasis of prostate carcinoma ? How does it most commonly metastasise ?

A

Bone (can get Adenocarcinoma Sclerotic Bone Metastases, i.e. dense CT with bony reaction around it, showing up as bright spot on X-ray)

Can metastasise directly, via blood, via lymphatics.

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22
Q

Describe the time frame of prostate carcinoma.

A

• It is a latent or indolent (incidental) carcinoma

  • Microscopic incidental focus
  • Lesions dormant (i.e. in situ); metastases in 30% after 10 years
  • Tends to be more aggressive in younger patients than older ones
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23
Q

What is the pattern of growth of prostate carcinoma ?

A

Asymmetric firm enlargement

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24
Q

Identify the main clinical features of prostate carcinoma.

A

– Urinary symptoms
– Incidental finding on rectal examination
– Bone metastases
– Lymph node metastases

25
Q

Define Gleason score.

A

In a biopsy, helps to know how invasive cancer is, based on their differentiation and distribution. If low Gleason, prognosis likely good, can be more conservative. If high, then likely metastasis.

26
Q

How do we treat prostate carcinoma ?

A

– Oestrogenic
– GnRH analogues
– Orchidectomy (remove testes)
– Radiotherapy (number 2 choice, often if local spread)
– Radical prostatectomy (number 1 choice)
– Chemo (number 3 choice)

Hormonal therapy to reduce any potential testosterone derived growth signal.

Can wait until it progress (since most of them are indolent and not gonna die from it), but risk of metastasis by then.

27
Q

How do we diagnose prostate carcinoma ?

A

– Imaging - ultrasound, X-rays, isotope bone scan
– Cytology not useful (nowhere near urethra)
– Biochemistry: PSA especially (BUT not everyone with prostatic cancer has PSA AND if someone has prostatitis, may have high PSA but v useful after diagnosis made, can use PSA to monitor progress of tumor size)
– Haematological - bone marrow involvement
– Biopsy (may use Gleason score to tell how invasive)

28
Q

Identify the main pathologies of the penis and scrotum.

A 
♦ Venereal infection
♦ Congenital malformations
– Hypospadias 
– Epispadias 
♦ Inflammation and Infections 
- phimosis 
- paraphimosis 
♦ Tumours
– Bowen’s disease 
– Invasive squamous cell carcinoma 
– Scrotal carcinoma
♦ Other 
– Peyronie's disease
– Fourier's necrotic gangrene
29
Q

Define hypospadias and epispadias.

A

Hypo- Urethral opening on inferior aspect (in children)
Epi- Absence of the upper wall of the urethra; with the urethral opening somewhere on the dorsum of the penis (often accompanied by abnormal development of bladder)

30
Q

Define phimosis and paraphimosis.

A
  • phimosis (“tightening of the foreskin of the penis that may close the opening of the penis”)
  • paraphimosis (“retraction of a phimotic foreskin, causing swelling of the glans”)
31
Q

Define Bowman’s disease.

A

=Intraepithelial carcinoma

  • Non-invasive, in situ squamous carcinoma of skin.
  • Can happen on penis, on scrotum.
  • Characterised by erythematous patch + Keratotic surface + raised red plaque
32
Q

How does invasive squamous cell carcinoma of the penis of the penis/scrotum occur ?

A
  • Affects glans penis or inner aspect of prepuce
  • Nodule, or plaque
  • Can be associated with viruses such as HPV
  • Metastasises to lymph nodes
33
Q

Define Peyronie’s disease. How is this treated ?

A

Condition characterized by a bent penis.

Treated through surgical procedure.

34
Q

Define Fourier’s necrotic gangrene.

A

“Type of necrotizing fasciitis or gangrene affecting the external genitalia “

35
Q

What are the main risk factors for scortal carcinoma ?

A
  • Chimney Sweeps

- Arsenic workers

36
Q

What are the main characteristics of scrotal carcinoma ?

A
  • Nodular ulcerated mass
  • Squamous carcinoma
  • Inguinal nodes – possible ulceration
37
Q

Identify the main pathologies of the urethra.

A

♦ Obstruction
– Congenital valves (rare in males) (can lead to strictures)
– Rupture
– Strictures
♦ Urethritis
– Gonococcal
– Non-gonococcal (non-specific)
♦ Rupture
♦ Tumours
– Warts (can present with problems fo dysuria, secondary inflammation, infections etc. Can be part of STIs )
– Transitional cell carcinoma (urothelial)

38
Q

How do Gonococcal urethritis occur ?

A

Common, often drug resistance chronically can lead to problems leading to scarring leading to differential diagnosis problems (so many possibilites)

39
Q

Where will penile, scrotal, and testicular tumors spread respectively ?

A

Penile- inguinal lymph nodes (external)
Scrotal- inguinal lymph nodes (external)
Testicular- para aortic lymph nodes (internal)

They spread to where they drain.

40
Q

Identify the main pathologies of the testicles.

A 
♦ Developmental and cystic lesions
– Undescended testis (cryptorchidism)
– Hydrocoele 
– Haematocoele
♦ Orchitis (inflammation of testicles) 
– Mumps orchitis (associated with testicular pain)
– Idiopathic granulomatous orchitis
– Syphilitic orchitis
♦ Testicular tumours (do not necessarily present with pain, but lump present)
41
Q

Define hydrocele.

A

A pathological accumulation of serous fluid in a bodily cavity, especially in the scrotal pouch.

42
Q

Define hematocele. How may this occur ?

A

A collection of blood in a body cavity that forms a cyst-like or tumour-like mass.

May occur due to trauma, may occur due to anti-coagulants with trauma.

43
Q

Why is it important to treat Undescended testis ?

A

1) Infertility

2) 10% change of malignancy arising in adulthood

44
Q

Testicular tumors

  • How common ? Treatable ?
  • Epidemiology
  • Aetiology
  • Precursor
A

♣ Uncommon (increasing incidence) but treatable
♣ 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

45
Q

Identify the main testicular tumors. Which is the commonest type ?

A
  • Seminoma (in younger group) (COMMONEST TYPE)
  • Teratoma (germ cell derived) (in younger group)
  • Lymphoma (particularly in older group, may arise in testes, or may be involvement of testes by lymphoma)
46
Q

Describe the clinical presentation of testicular tumors.

A

Testicular tumors may present with:

  • Painless unilateral enlargement of testis
  • Secondary hydrocele
  • Symptoms from Metastasis
  • Retroperitoneal mass (due to spread)
  • Gynaecomastia
47
Q

SEMINOMA

  • Cells of origin
  • Epidemiology
  • Types
  • Histology
A

SEMINOMA

  • Cells of origin: Germ cell origin
  • Epidemiology: Peak incidence 30 - 50 years
  • Types (spectrum, classified by aggressiveness):

• Classical (treatable, can be cured with surgery, chemo)
• Spermatocytic
• Anaplastic (more challenging treatment, may involve hemorrhage and necrosis)
- With syncytiotrophoblast giant cells (may present with gynaecomastia)
• Combined

-Histology: appearance of germ cells before they start undergoing meiosis. Lymphocytes around them. Some cells make express Human Chorionic Gonadotrophin.

48
Q

How do we treat a seminoma ? a teratoma ?

A

Seminoma: Treat with surgery and chemo
Teratoma: chemo does not always work

49
Q

TERATOMA

  • Cells of origin
  • Epidemiology
  • Types
  • Markers
A

TERATOMA

  • Cells of origin: Germ cell origin
  • Epidemiology: Peak incidence 20 -30 years. Outlook in male typically worse (more undifferentiated elements, always element of malignancy. No such thing as a truly benign teratoma in male, unlike in females)
  • Types:
  • Differentiated
  • Intermediate
  • Undifferentiated (histologically, necrotic, aggressive, poorly differentiated)
  • Trophoblastic (from placenta)

-Markers: beta-hCG and alpha-fetoprotein are useful markers (the more undiffer, the more likely you are to get these as tumor markers)

50
Q

Which of teratomas or seminomas is more aggressive ?

A

Teratomas more aggressive

51
Q

Describe the pattern of growth of trophoblastic teratoma.

A

Grows like tissue in the placenta.

Those kinds of cells have huge potential to spread. Behave as placental issue but without brake. In placenta,
needs to invade blood vessels to feed fetus, but if that takes place elsewhere, potential for metastasis through invasion of blood vessels.

52
Q

Identify germ cell tumors of the testicles other than seminomas and teratomas.

A

♦ Intratubular germ cell neoplasia
– Precursor lesion

♦ Yolk sac tumour - children
– AFP useful marker (Extra-embryonic differentiation)
– Schiller–Duval body seen microscopically

♦ Combined germ cell tumours

53
Q

Identify a tumor marker used for teratomas, and explain how it’s used.

A

Alpha-fetoprotein

Not guaranteed to produce diagnosis BUT can use as biomaker giving you a window on how much tumor bulk there is so if you know tumor produces this and treat tumor with chemo, may use alpha-fetoprotein to monitor progress following treatment (should decrease following therapy of teratoma, such as chemo or orchidectomy)

54
Q

Identify non-germ cells of the testicles.

A 
 Malignant lymphoma – Elderly men
 Leydig cell tumour
– May produce androgens (v hairy men)
 Sertoli cell tumour 
 Metastatic tumours
55
Q

Describe staging of Testicular Tumours.

A

 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

56
Q

Identify the main causes of male infertility.

A 
♦ Endocrine disorders
- GnRH deficiency 
- Oestrogen excess
♦ Testicular lesions e.g.
- Cryptorchidism
- Abnormal spermatogenesis
♦ Post-testicular lesions
- Obstruction of efferent ducts
57
Q

Identify the main pathologies of epididymis and spermatic Cord.

A 
• Congenital abnormalities
• Epididymal cysts and spermatocoeles 
• Varicocoele
• Hydrocele
• Torsion of the spermatic cord and testis
• Inflammatory lesions 
– Epididymo-orchitis (inflammation of the epididymis and testis)
• Tumours - rare
58
Q

Define spermatocoele.

A

A cystic distention of the epididymis or rete testis, containing spermatozoa (normal tunica vaginalis of testis).

59
Q

Define varicocoele.

A

A dilation of the pampiniform venous complex of the spermatic cord.

MD3002 (95 decks)

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