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MD3002 Week 8 > 12. Reproductive pathology/ male > Flashcards

12. Reproductive pathology/ male Flashcards

1
Q

Describe the features of benign prostatic hyperplasia and prostatic carcinoma
 Describe the common lesions of the urethra  Describe the features of cystic lesions of the
testis, and of orchitis
 Describe the pathological features of tumours of the testis
 Describe the main causes of male infertility  Describe the common abnormalities of the
epididymis and spermatic cord

A

-

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2
Q

Frequent disorders of the prostate

A

Benign prostatic hyperplasia
Carcinoma
Prostatitis

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3
Q 
Describe the features of benign prostatic hyperplasia (BPH):
Cause?
What is it?
Premalignant?
Consequences?
A

Cause: Non-neoplastic. is it associated with hormonal imbalance

What is it?

  • Nodular hyperplasia of glands and stroma
  • Involves transition zone of prostate plus peri-urehtral glands
  • Not premalignant

Consequences:

  • Obstructs urine flow
  • Associated with infection
  • Compress and elongate urethra
  • Involvement of peri-urethral zone interferes with urethral sphincter
  • Urinary retention: Acute = painful, chronic = painless and gradual
  • Treatable
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4
Q

Complication of BPH?

A 
Compression of urethra
Nodular enlargement of prostate gland
Trabeculation
Muscular hypertrophy
Renal: Infection, failure, calculi, secticaemia, bilateral hydronephrosis
Bilateral hydroureter
Diverticulum
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5
Q

Do you palpate the para-aortic lymph nodes when there is a testicular mass?

A

No although that’s where the lymph drainage is it

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6
Q

Differences between BPH and prostate carcinoma?

A

BPH:

  • Hyperplasia of peri-urethral zone
  • Median groove palpable on rectal examination

Carcinoma of prostate:

  • Subcapsular focus of carcinoma
  • Median groove obliteration by carcinoma arising in posterior subcapsular zone i.e. invasion of the capsule
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7
Q

Prostate cancer:

  • Precursor?
  • Position/shape of the adenocarcinoma?
  • Adenocarcinoma metastasise?
  • Epidemiology of latent or incidental carcinoma?
A

Precursor: Prostatic intraepithelial neoplasia

Position/shape of the adenocarcinoma: Posterior subscapular area, Asymmetric firm enlargement

Adenocarcinoma metastasise: Yes, to bone **

Epidemiology of latent or incidental carcinoma:

  • Old age
  • Are dormant
  • Metastases in 30% after 10yrs
  • Microscopic incidental focus
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8
Q

What is a gleason score?

A

Process of assessing the differentiation and distrubution of tumours in prostate cancer
Stage TN: Direct, via lymphatics, via blood

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9
Q

Presentation of prostate carcinoma?

A

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

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10
Q

Challenges presented by prostate carcinoma?

A

Screening:

  • For PSA abnormalities
  • High level = cancer
  • Medium/normal levels = non-specific to inflammation, cancer, normal
  • Also do rec exam to confirm diagnosis
  • No representation if it’s latent, in situ, indolent, aggressive
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11
Q

Diagnosis of prostate carcinoma?

A 
Imaging
Ultrasound
Cystoscopy
Biochemistry: PSA
Haematology: Bone marrow involvement 
-Biopsy
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12
Q

treatment options for prostate carcinoma?

A 
Oestrogens
GnRH analogues
Orchidectomy 
Radiotherapy
Radical prostatectomy
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13
Q

Possible abnormalities found in the penis and scrotum?

A
  • Venereal infection
  • Congenital malformations
  • Inflammation and infections
  • Tumours
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14
Q

Examples of congenital malformations of the penis and scrotum?

A

Hypospadias: urethral opening on inferior aspect of penis

Epispadias: Urethral opening on upper penis aspect. Often accompanied by abnormal development of bladder

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15
Q

What is phimosis?

A

Congenital narrowing of foreskin so it cannot be retracted

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16
Q

what is Paraphimosis?

A

Foreskin is trapped behind the glans penis

17
Q

Examples of tumours of the penis and scrotum?

A

Bowen’s disease (non-invasive)

  • Occur anywhere on penis
  • Erythematous patch
  • Keratotic surface
  • Raised red plaque

Invasive squamous cell carcinoma

  • HPV
  • Glans penis or inner aspect of prepuce
  • Nodule or plaque
  • Metastasises to inguinal lymph node
18
Q

Features of bowen’s disease?

A

Bowen’s disease (non-invasive)

  • Occur anywhere on penis
  • Erythematous patch
  • Keratotic surface
  • Raised red plaque
19
Q

Features of Invasive squamous cell carcinoma?

A

Invasive squamous cell carcinoma

  • HPV
  • Glans penis or inner aspect of prepuce
  • Nodule or plaque
  • Metastasises to inguinal lymph node
20
Q

Abnormalities that can occur with the urethra?

A

Obstruction

  • Congenital valves
  • Rupture
  • Stricture

Urethritis

  • Gonococcal (bacteria that causes gonorrhoea)
  • Non-gonoccocal

Rupture

Tumours:

  • Warts
  • Transitional cell carcinoma
21
Q

Features of gonococcal urethritis?

A 
Later urethral stricture
Acute urethritis 
Prostatitis
Epididymitis 
Gram-negative diplococci in polymorphs
22
Q

3 different forms of testicular lesions?

A

Developmental and cystic lesions e.g. Undescended testis, hydrocele, haematocoele

Orchitis (testes inflammation) e.g.

  • Mumps orchitis
  • Idiopathic granulomatous orchitis
  • Syphilitic orchitis

Testicular tumours

23
Q

Main 3 forms of testicular tumours?

A

Teratoma
* Seminoma*
Lymphoma (in elderly)

24
Q

Presentation of testicular tumours?

A

Testicular tumors may present with
Painless unilateral enlargement of testis
Secondary hydrocele
Symptoms from metastases Retroperitoneal mass Gynaecomastia

25
Q

Features of seminoma?

A 
Commonest type of testicular tumour
Germ cell origin
Peak incidence 30-50yrs
Types:
-Classical
-Spermatocytic
-Anaplastic (with syncytiotrophoblast giant cells)
-Combined
26
Q

Features of a teratoma?

A

-Germ cell origin
-Peak incidence 20-30yrs
-More aggressive than seminoma. Never completely benign
-Types:
Differentiated
Intermediated
Undifferentiated
Trophoblastic
Markers: beta-hCH and alpha=fetoprotein

27
Q

Name 4 non-germ cell tumours of the testis?

A

Malignant lymphoma: Common in elderly men
Leydig cell tumour: May produce androgens
Sertoli cell tumorus
Metastatic tumours

28
Q

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

29
Q

3 causes of male infertility

A

Endocrine disorders e.g. GnRH deficiency, oestrogen excess

Testicular lesions e.g. cryptorchidism, abnormal spermatogenesis

Post-testicular lesions e.g. obstruction of efferent ducts

30
Q

Potential abnormalities of the epididymis and spermatic cord?

A 
Congenital abnormalities
Epididymal cysts and spermatocoeles 
Varicocoele
Torsion of the spermatic cord and testis
Inflammatory lesions – Epididymo-orchiti
Tumours - rare

MD3002 Week 8 (13 decks)

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