Topic 90-94: Male genital tract Flashcards
list off the diseases of the penis
- malformations
- inflammatory lesions
- cancer
what are the 3 malformations of the penis?
- hypospadiac - urethra opens on the ventral surface of the penis shaft
- epispadia - opening on the dorsal surface
- phimosis - prepuce cannot retract
what are some inflammatory lesions of the penis? what are the 3 mechanisms in which this occurs?
- STDs
- Poor hygiene
- systemic disease
- -balanitis - glans penis inflammation due to poor hygiene.
- venereal warts
- urethritis
- chancre
what are the neoplasia of the penis? what cells do they originate from? what do they typically develop with?
- 95% from squamous epithelium
- most cases occur in uncircumcised men and HPV
- Bowen disease (erythroplasia of queyrat)- similar
- squamous cell carcinoma of the penis
what are some disease of the scrotum and the spermatic cord?
scrotum
- inflammation - infection, candida, eczema, jock itch
- contact dermatitis
- neoplasia
- hydrocele - most common, accumulation of serous fluid in tunica vaginalis
- vericocele
- spermatocele
- sebaceous cyst
- inguinal hernia
spermatic cord
-torsion - twisting of the spermatic cord so that the testicle rotates and cuts off circulation
What are the types of prostatitis? how common are they and what is their cause?
- acute bacterial - 5% of cases, ascending from UTI
- chronic bacterial - 5% of cases, due to urogenital dysfunction, catheters, recurrent UTI
- chronic nonbacterial - 90% of cases, no pathogen is discovered and simply high WBC count
- asymptomatic inflammatory - incidental discovery
what cells are associated with benign prostatic hyperplasia? where does hyperplasia typically develop? where does prostate cancer develop? what is the general morphology of the hyperplasia?
- the hyperplasia occurs in the prostatic acinar epithelium and stroma in the innermost transitional and central zones of the prostate. (most carcinomas are from the peripheral zones)
- generally the tissue forms nodules that contain cystic spaces and frequently corpora amylacea
How common is prostate hyperplasia? what is the general etiology?
- BPH occurs in 90% of men by 80 yo and most men by 40 yo
- hyperplasia correlates with androgen stimulation. DHT seems to affect it most in which is binds to nuclear receptor to increase growth factor production
- BPH doesn’t occur in castrated males or men with blocked androgen production
what is the main tumor of the prostate? how common is it? what are the four etiology influences?
2 cause of cancer related death/ 25% of men are affected!
Prostate adenocarcinoma
- hormones - androgens (castrated men do not get prostate adenocarcinoma)
- genetics - next card
- environment - certain factors such as western diet
- hereditary - familial
what mutations are responsible for prostate adenocarcinoma?
- a fusion gene of the androgen regulated promoter and the coding sequence of the ETS transcription factor
- – 40-50% of prostate cancers
- activation of the oncogenic p13K/akt signaling pathway
- – these mutations inactivate a tumor suppressor gene called PETN
what is the general morphology? what is the prostate cancer grading system?
- histologically the tumors form well defined glands with little pleomorphism. the epithelium is atypical cuboidal and crowded
- advanced lesions are firm nodules
-grade 1-5, grade 1 being most differentiated glandular structure and grade 5 being least
- gleason system tries to take into account all the histological patterns seen in the tissue by giving a grade (1-5) to the primary dominant pattern (more than 50% of tissue) and then a second one for the 2nd most prevalent growth pattern observed (less than 50% but more than 5%)
- –thus a score 2-10
Does prostate adenocarcinoma have certain clinical signs/complications? where does it typically metastasize? what are the anatomical staging levels?
– it can present as a hard, fixed nodule and does NOT present with urethral complications.
-bone metastases are common
T1 - T4 T1 - lesion not apparent clinically T2 - palpable lesion T3 - local prostatic extension T4 - invasion of other structures (bladder, ractum)
what are some specific and nonspecific inflammatory lesions that can occur in the testis and epididymis? how common is inflammation in either of these areas?
inflam is way more common in the epididymis than in the testis proper
Epididymis
-specific - STDs, mumps, TB
-nonspecific - ascending infection from UTI via vas deferens
testis (orchitis is enlargement and inflammation of testis)
-specific - mumps, syphilis (gumma) and TB (granuloma)
what is the condition in which the testicles fail to descend? what hormone controls this? how common is bilateral failure to descend? What are some causes?
cryptorchidism
-anti-mullerian hormones and then androgens cause the testis to descend into the scrotum (however cryptorchidism is not normally due to hormone abnormalities!)
-in 10% of cases, it is bilateral
- causes:
- hormone abnormalities, testicular abnormalities, mechanical abnormalities, congenital problems (prader willi), idiopathic (majority!!)
What are the complications of cryptorchidism? what does it look like histologically?
-histologically: atrophy of all other cells except for prominent leydig cells and hyperplastic sertoli cells
- sterility
- trauma, torsion and inguinal hernia
- 3-5x inc risk of seminoma (testicular malignancy), also inc risk of cancer in contralateral side
