Diseases of Prostate, Testis, and Penis Flashcards Preview

Life Cycles: Unit 1 > Diseases of Prostate, Testis, and Penis > Flashcards

Flashcards in Diseases of Prostate, Testis, and Penis Deck (27)
Loading flashcards...
1

Causes of testicular atrophy

  • congenital
    • cryptorchidism
    • klinefelter's
  • acquired
    • atherosclerosis
    • inflammation
    • malnutrition
    • hypopituitarism
    • hormone therapy

2

Categories of causes of males infertility

  • disorders that affect spermatogenesis, sperm fxn, or ductal obstruction
  • congenital causes
  • acquired causes
  • Hormonal causes: FSH, LH, GnRH abnormalities
  • Klinefelter’s syndrome (47 XXY): sclerosing tubular degeneration

3

Congenital causes of male infertility

  • Cryptorchidism,
  • Immotile cilia syndrome
  • Anorchia (absence of both testes at birth),
  • Absent vas deferens

4

Acquired causes of male infertility

  • Torsion
    • Twisting of cords ==> blocks venous flow  ==> swelling and infarction
  • Infarction
  • Varicocele = varicose veins of the pampiniform plexus
    • Rare cause of infertility 
    • due to venous valve insufficiency
  • Obstruction
  • Inflammation

5

Nonspecific epididymitis or orchitis: causative organism

  • Kids: UTI bugs: gram (-) rods
  • Sexually active adults:
    • STDs: Chlamydia trachomatis, N. gonorrhoeae
  • Elderly: Enterobacteria
    • Also E. coli and P. aeruginosa per Goljan

6

 Nonspecific epididymitis or orchitis: basic morphology

  • Direct extension from urinary tract (vas deferens or lymphatics)
  • Tends to affect epididymis first with subsequent orchitis
  • Quick to form abscess due to cinching off of end artery blood supply

7

Mumps orchitis: cause/basic morphology

  • cause: mumps virus
  • Inflammatory infiltrate in poorly draining region causing atrophy:  
  •  Unilateral 70%, Mononuclear inflammatory
  •  infiltrate with interstitial edema +/- neutrophils,
  •  subsequent to parotid involvement

8

TB orchitis: cause/basic morphology

  • cause: Mycobacterium tuberculosis
  • morphology
    • Epididymis → Testis
    • Usually part of systemic disease
    • Caseating granulomas

9

Syphillis: cause/basic morphology

  • cause: Treponema pallidum
  • Testis → Epididymis
  • Congenital or acquired
  • Diffuse mononuclear interstitial inflammation rich in plasma cells
  • Obliterative endarteritis → downstream necrosis
  • +/- gummas (a characteristic tissue nodule found in the tertiary stage of syphilis)

10

Seminoma: 

Clinical Picture

Classification

Morphologic Findings

Staging and

Treatment

Epidemiology

  • clinical = 40-50yo
  • class = PLAP, but serum markers often negative
  • morphologic
    • Fish flesh appearance, rounded
    • lymphocytes + tumor cells
  • staging/tx
    • Good prognosis, radiosensitive + chemosensitive
  • epidemiology
    • Most common GCT 30-50%

11

Spermatocytic Seminoma: 

Clinical Picture

Classification

Morphologic Findings

Staging and

Treatment

Epidemiology

 

> 50 years old

Serum markers often negative

Mixture of cells resembling 1o and 2o spermatocytes in myxoid stroma (look like combo of spermatogonia + spermocytes)

Good prognosis

Older men, 1-2%

12

Embryonal carcinoma: 

Clinical Picture

Classification

Morphologic Findings

 

Staging and

Treatment

Epidemiology

 

Third decade

Markers variable: PLAP (Placental Alk Phos), placental lactogen, β hCG

Gross → looks ugly; lobulated, fibrosis. Anaplastic Histology: Apoptosisand a lot of mitotic activity. Grows fast, necrotic, rosettes, papillae.

Chemosensitive,High likelihood of metastasis, recurrence common

 

Pure → 3%

Mixed → 85%

13

Teratoma: 

Clinical Picture

Classification

Morphologic Findings

Staging and Treatment

Epidemiology

 

Infants and adults

Histology → look for mixed epithelial and cystic structures within mass.

Morphology: 

Mature or immature tissue.  Slow progression to malignant change.White cartilage

cysts → structures formed by mature epithelial cells (mixed type tissue: bronchial, pancreas, glandular, skeletal muscle, anything)

Staging and treatment

Malignant transformation (unlike mature teratoma in women).Chemoresistant tumor will regress but mature teratoma remains

Infants → 40%  of testicular tumors

Adult: Pure → 2-3%; Mixed → 45%

14

Yolk sac tumor:

Clinical Picture

Classification

Morphologic Findings

Staging and

Treatment

Epidemiology

 

Children and adults

Most common testicular tumor in kids

Produces α fetal protein (AFP)

Net-like with tears (i.e. holes)

Embryoid bodies

Schiller-Duval bodies

Fairly good prognosis

 

Pure common in kids,

Mixed common in adults

15

Choriocarcinoma:

Classification

Morphologic Findings

Staging and

Treatment

Epidemiology

 

Produces β hCG at high levels

Differentiating towards placenta

Looks like a placenta grossly and microscopically

“Placenta is designed to be an invasive organ”

Aggressive

Metastasizes

Chemosensitive but worse prognosis

Pure → 0.3%

Mixed → 10%

16

Zonal anatomy of prostate

Central zone – an inverted cone with its base forming the base of the prostate and its apex at verumontanum; ejaculatory ducts pass through central zone

Transition zone – two “lobes” that surround the prostatic urethra laterally and anteriorly; separated (more or less) by fibrous band from peripheral zone

Peripheral zone – major portion (~70%) of gland, which surrounds transition zone posteriorly, laterally, and apically

17

Characteristics of acute prostatitis

  • hour to days onset
  • Etiology
    • Infection from bladder, blood
    • Iatrogenic → Foley catheter
    • Usually associated with UTI: E. Coli or S. aureus
  • Histologic features
    • Neutrophil (PMN) inflammation,
    • Focal or diffuse

18

Characteristics of chronic prostatitis

  • Etiology:
    • Unknown  
    • Most men > 60 have  
    • Could be due to long standing bacterial infections or dietary factors (charred meat in mice)
  • Histologic features
    • Aggregates of lymphocytes, plasma cells, and macrophages within prostatic substance
    • Often associated with atrophy
    • Granulomatous form may occur as well
    • TB
    • Eroded corpora amylacea

19

Characterstics of Malakoplakia

  • Rare
  • Plaque-like regions of histiocytes (resident phagocytes) with calcified inclusions (Michaelis-Gutmann bodies) → due to malfunction of histiocytes
  • Occurs anywhere along urinary tract

20

Hyperplasia of the prostate: frequency & age distribution

  • Frequency
    • Most common prostatic disease of US males
    • Blacks > whites > asians
  • Age distribution
    • Rule of 10’s: Age group indicates percent that have it.
    • E.g. 50% of 50 yo men with histiological evidence.

21

Hyperplasia of the prostate: anatomical location & features

 

  • Limited to transition zone of prostate
  • No classical look. Stromal and epithelial components form nodules. Epithelial components look normal, but stromal has increased in mass.

22

Hyperplasia of the prostate: clinical sx, complication/prognosis, management

Lower urinary tract symptoms (LUTS): hesitancy, poor urine flow, incomplete voiding, ↑ frequency, urge incontinence, dribbling, nocturia

LUTS ↓ quality of life. Acute urinary retention, recurrent UTI and pyelonephritis, renal failure (due to pressure backflow), incontinence. No problems with ejaculation.

Management:

medical → Finasteride (5α reductase inhibitor)

minimally invasive therapy → microwave

surgery → Trans urethal resection of prostate (TURP)

23

Adenocarcinoma of the prostate: frequency, age distribution, anatomical location

  • Frequency
    • Most common non-skin cancer in adult males
    • Black > white > asian
    • > 200,000 new cases / year
    • 20% of all male cancer
    • ↑↑ prevalence in western countries
  • Age
    • Age is a strong risk factor
  • Location
    • Effect peripheral zone > transition zone

24

Adenocarcinoma of the prostate: features, clinical sx, complications/prognosis

  • Features
    • Gross: yellow mass, most of the time not evident from imaging etc, multifocal
    • Microscopic: multifocal, heterogeneous, abnormal collections of atypical glands lined by single layer - loss of bilayer (basal layer) -  of malignant cuboidal to columnar cells, prominent nucleoli, infiltrative pattern
  • Clinical: Asymptomatic or similar to BPH
  • Complications/Prognosis
    • Metastasis, death, etc.
    • More men die with prostate cancer than of it.

25

Dx of prostatic carcinoma

Diagnosis: digital rectal exam (15-20% sensitivity), Blind random biopsy: gold standard (only 50% sensitive) → most cancers detected not life threatening

Size of tumors decreasing (i.e. in regards to detection) which seems to be attributable to screening.

 

26

Tx of prostatic carcinoma

Localized: surgery, external beam radiation, or radioactive seeds (brachytherapy), cryotherapy

If progressive and metastasized tumors → Hormone ablation;  most will become androgen refractory with time

Anti-androgens

5α reductase inhibitors

GnRH inhibitors

Chemotherapy

27

Characteristics of prostatic intraepithelial neoplasia

  • Tufted, papillary or cribriform proliferations of atypical cells within ducts and acini surrounded by basal cell layer
  • High grade PIN often associated with adenocarcinomas elsewhere in prostate
  • Genetic and molecular changes similar to PCa
  • Increases with age, peak prevalence 5-10 yrs before PCa [Sakr 1993]
  • Finasteride (5α  reductase inhibitor) trial - to prevent progression to PCa.