Tworney: Male Reproductive Pathology Flashcards by Sarah Carlson

is there a true capsule around the prostate?

No just a fibromuscular area

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most cases of BPH occur here

transitional zone

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most carcinomas occur here

peripheral zone

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5-10% of all carcinomas

central zone

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gram negative rods (same orgs as UTIS)–older male
fever chills dysuria
VERY uncomfortable
extremly tender and boggy on exam

Prostatitis: Acute bacterial

dx: urine and clinical features

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low back pain, dysuria, perineal pain or asymptomatic

chronic bacterial prostatitis

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dx of chronic bacterial prostatis

+ prostatic massage > 10 leukocytes/HPF in prostatic field

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MC form of prostatitis today

chronic abacterial

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sexually active men w/ prostatitis sx, culture negative

chronic abacterial

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chlamydia, mycoplasma, ureaplasma

chronic abacterial

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how does prostatitis affect PSA

can increase or decrease it (30% have decreased)

don’t screen for prostate cancer when someone has prostatitis…but we don’t do that anymore anyway

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what percent of men w/ BPH are symptomatic

50% (most ppl are 70 or older)

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BPH cause

Androgens (dihydrotestosterone)>
increase in prostate stromal cells w/ aging>
stimulates growth

estrogen/Estradiol levels also increase in men w/ aging>
induce an increase in adrogen receptors in prostate

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usual location of BPH

TZ and peri-ureth (nodular proliferation of both gland and stroma)

NOT pre-malignant

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hesitancy
urgency
frequency
decreased stream size
nocturia*** (2-3x w/ BPH)
terminal dribbling

BPH

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complications of BPH

obstruction> bladder has to push harder to get passed enlarged prostatic urethra> hypertrophy of bladder
incomplete bladder emptying> increases frequency
infection
infarction> prostate outgrows blood supply

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Finasteride

TAmsulosin

drugs used to tx BPH

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inhibits conversion of testosterone to DHT

5 alpha reductase inhibitor

Finasteride

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Finasteride affect on PSA

50% reduction

X2.3 if taking 1mg/d > 4 years

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smooth muscle relaxant used to tx BPH

alpha 1 blocker

Tamsulosin

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biggest SE of alpha 1 blocker

orthostatic hypoTN

*concern in elderly men, not the best choice

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surgery for BPH

TURP- not great

first line:
cryotherapy
microwave
laser
US

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which side are you more likely to see a varicocele

LEFT!

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where do testes drain typically

para-aortic or illiac

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penile tumor/scrotal skin infection

superficial groin nodes

controls testicular descent to lower abdomen/pelvic brim (phase I)

Mullerian inhibiting substance transabdominal

Controls testicular descent through the inguinal canal and into scotum (phase 2)

androgen dependent Inguinoscrotal

percent of premature infants w/ cryptochid testis

25%

cause of cryptorchid testis

not understood | asymptomatic--but don't get normal maturation of sperms

MC site for cryptorchid testis

1. high in scrotum 2. inguinal canal 3. intra-abdominal

histological findings seen w/ cryptorchid testis

germ cell arrest basement membrane thickening/hyalinization decreased germ cells in contralateral testis (looks normal, but germ cells aren't normal) **usually unilateral

sterility if bilateral or if unilateral infertility accompanying hernia increased risk for crush injuries

Cryptorchid testis

oncogenic complication of cryptorchid testis

5-10 fold increase in GERM cell tumor

Tx for cryptorchid testis

orchiopexy (bring testis down and tack'em down) BEFORE 2 years to increase chancer for fertility, before 10 for neoplasm

deficient spermatogenesis is seen in what percent of pt w/ cryptorchid testis

10-60%

stage where you go from 46 to 23

secondary spermatocyte

causes of testicular infertility

atherosclerosis malnutrition/cachexia irradiation female sex hormones

working up a male, and everything is normal then....

reduced/absent sperm production - sertoli only syndrome (10-20%) - chromosomal abnormalities (klinefelter's, DS)

sertoli only syndrome

germ cell aplasia--no germ cells ALL sertoli cells small to nml size testes w/ azoosp

infertility w/ oligospermia

20,0000,000

MC site of obstruction leading to oligospermia

epidiymis absence of vas obstruction of vas/ejaculatory ducts

what % of male infertility is idiopathic

40% can't find the cause

baterial causes of epididymo-orchitis

1. related to UTIS> spread through vas or lymphatics (older men) 2. under 35 y/o> sexually transmitted (G/C, mycoplasma, treponema pallidum) 3. Older than 35 assoc. w/ recurrent UTI/BPH

ganulomatous epididymo-orchitis

TB (caseating granulomas--fungal TB)

virally caused epidiymo-orchitis

mumps * not usually involved pre-pubertal * usually unilateral

violent motion/trauma, usually in setting of abnormal anatomy that leads to testicular torsion can lead to...

hemorrhagic infarction--> surgical repair required w/in 4 hrs to save fxn venous> arterial

dilation of veins in pampiniform plexus

varicocele (up to 25% of adults) MC on left side *can cause infertility

``` Seminoma embryonal carcinoma yolk sac tumor teratoma choriocarcinoma ```

germ cell tumors (when ppl think of testicular cancer)

sertoli cell tumor leydig cell tumor granulosa cell tumor mixed

sex cord stromal tumors (benign, almost never see these)

accounts for 30% of malignancies in 20-34

testicular (leukemias, lymphomas are others) * higher risk for whites than balcks * non-familial, no major gene linkages

precursor to testicular cancer

germ cell neoplasia (study in denmark)

androgen insensitivity syndrome

second stage of testicular descent is dependent on androgens, without them the testicles don't descend. these men have vaginas instead of penises--phenotypically look female but are XY genetically and internally

progressive painless testicular enlargement

testicular cancer *lymphoma is the most likely cause in older men

MC germ cell tumor that peaks in 30s (or beyond)

Seminoma RARE in children *typical seminoima MC

fleshy tumor mass that encompasses the whole testicle, mostly homogenous "fish flesh tumor"

seminoma

water CLEAR cytoplasm, central round nuclei, fibrous tissue crosses through tumor

seminoma *frequently also have non-caseating granulomas

syncitiotrophoblast in seminoma

good news! hCG in blood> you have a tumor marker! you can follow pt for recurrence

2nd MC form of pure GCT

embryonal carcinoma

cancer in 20-30 y/o--RARE after 50 | more aggressive than seminoma

embryonal carcinoma **smaller than seminoma

tumor that doesn't encompass entire testes, lots of bleeding, nerosis, variated

embryonal carcinoma

MC testicular tumor in infants/under 3 years old

yolk sac tumor

clear cells that recapitulate endodermal sinus

yolk sac tumor

schiller duval bodies

yolk sac tumor * kinda looks like a glomerulus * may see collecitons of AFP

marker for yolk sac tumor

aFP

highly malignant tumor w/ trophoblastic elements

choriocarcinoma

marker for choriocarcinoma

bHCG

common presenting sx at dx of choriocarcinoma

distant metastases (brain tumor + testicular tumor)

tumor that has all three germ cell layers (>1) seen in infancy to adulthood

teratoma * never benign in adult males * pure form in infancy, benign

tumor w/ cystic spaces, brain, cartilage, bone

teratoma

MC non seminoma tumor

mixed tumor (60%)

MC mixed tumors

teratoma embyronal yolk sac syncitiotrophoblast *prognosis worsens w/ inclusion of more aggressive forms

seminoma metasteses

lymphatic spread * ipsilateral para-aortic nodes * mediastinal and supraclavicular nodes (window to viscera)

hematogenous metastesis

non seminomas lung, brian, liver

what component of mixed tumors usually doesn't metastasize

seminomatous

stage I

confined to the testis

stage II

retroperitoneal lymphatics

stage III

parenchymal metasteses (liver/lung)

tumor that often remains localized (stage I)

seminoma | homogenous, better prog, >30s, encompass whole testes

tumor that often presents in stage II and II

NSGCT

prognosis for testicular cancer

greater than 90%

major serum protein of early fetus, syntehsized in gut, liver yolk sac, produced by yolk sac tumors also elevated in hepatocellular carcinoma

AFP

biological marker in choriocarcinoma or syncitiotrophoblast

HCG

Treatmentn for seminomas

radiosensitive

Stage I seminoma tx

orchiectomy w/ WW

stage II seminoma tx

orchiectomy and pelvic/paraortic LN, and single agent CISPLATIN

NSGCT tx

chemo and possible RPLND

tumors that present w/ gynecomastia

sertoli and leydig cell tumors

tumor in adults > 60, w/ large cell histology and systemic disease

Testicular lymphoma

Mestateses to testis usually comes form

lung/prostate

failure to obliterate inguinal canal

mesentery can push down into scrotum> herina

inguinal hernia

open communication to peritoneal cavity

cystic space obliterated on each end

hydrocele

cystic mass arising from efferent ducts, lumen filled w/ sperm

spermatocele

testicular tumor vs hydrocele