Exam 4/lecture 4 Flashcards
(89 cards)
1
Q
Adult male reproductive tract is connected directly to what?
A
connected directly to the renal system and empties into the urethra below the bladder
2
Q
What are the four parts of the male reproductive system?
A
testes; ductal system; glands and; glans penis
3
Q
- Glans penis is organ of what?
- What do the gland consist of?
- What is the utethra lined by?
A
- Glans penis is organ of copulation & urination
- Consists of columns of erectile tissue with urethra in center of glans penis
- Urethra lined by pseudostratified columnar epithelium
4
Q
Glans Penis
Most common congenital malformations are what (2)?
A
hypospadias and epispadias
5
Q
Hypospadias:
* More or less common? What is it?
* Results in what?
* Incidence rate?
* treated how?
A
- Hypospadias, more common, abnormal opening of urethra along ventral surface of penis
- Results in irregular urine stream, urinary tract obstruction, increased risk for urinary tract infections, potential for infertility
- Occurs 1:200 male births
- Treated with reconstructive surgery
6
Q
Epispadias:
* What is it?
* What is the incidence?
* Associated with what?
* Treatment?
A
- Epispadias: urethral orifice on dorsal surface of penis which may promote urinary tract obstruction, urinary incontinence, infection, infertility
- 1:30,000 births
- Can be associated with bladder extrophy (protrusion of bladder through abdominal wall
- Surgically more difficult to correct than hypospadias, but does respond to surgery
7
Q
- Aphallia:
- Diphallia:
- Micophallus:
- Lateral penile curvature:
- Penscrotal transposition:
- Webbed penis:
- How is it treated?
A
- Aphallia: penile agenesis, congenital absence of penis
- Diphallia: penile duplication
- Micophallus: micropenis, normally formed, but abnormally short penis
- Lateral penile curvature: one sided hypertrophy of fibrous tissue leading to penile torsion (twisting)
- Penscrotal transposition: reversed penile & scrotal positions
- Webbed penis: web or fold of scrotal skin obscures penoscrotal angle
- Like hypo- & epispadias, most deformities can be corrected surgically
8
Q
What a circumcision?
A
oldest recognized surgery
* Surgical removal of foreskin of penis (to reduce risk of infection and/or inflammation)
9
Q
What is balanitis? What is the balanoposthitis?
A
- Balanitis: inflammation of glans penis
- Balanoposthitis: Balanitis involving foreskin + glans penis
10
Q
Poor hygiene in uncircumcised males increases risk for what?
A
increases risk for accumulation of infectious agents, sweat, desquamated epithelial cells, debris (smegma) causing irritation
11
Q
- How can phimosis happen? What is it?
- What happens with the foreskin at birth? one year old?
- Treatment?
A
- Phimosis can arise congenitally or secondary to balanoposthitis
- Uncircumcised men frequently have persistent inflammation of foreskin that may eventually cause it to contract and painfully compress the glans as phimosis (foreskin cannot be fully retracted)
- At birth: foreskin is adherent to glans penis
- At 1 yr: 50% males have non- retractile foreskin
- Treated surgically if needed
12
Q
Sexually Transmitted Diseases (STD):
* Evident where?
* Can infect who?
* Asending infection results in what?
* Infections can lead to what?
* Examples?
A
- Typically, evident on external genitalia
- Can infect all male components
- STDs affect males & females
- Ascending infection results acute prostatitis, epididymitis and, occasionally, orchitis
- Infections can lead to tissue/organ damage associated with infertility and/or renal dysfunction
- Examples: syphilis, gonorrhea, chlamydia, herpes, HPV
13
Q
Syphilis:
* Caused by what?
* How many cases in each year?
* What is the host for T. pallidum?
* Transmission through what?
* Once introduced, the organism spreads via what?
* What is the test for it?
* txt?
A
- Caused by spirochete Treponema pallidum: Gram negative bacterium
- 6000 new cases in US each yr, on the rise
- Humans are only host for T. pallidum
- Transmission is sexual through skin/mucous membranes or congenital via placenta
- Once introduced, organism spreads via lymphatics
- Serologic tests for syphilis involve testing for the presence of anti-treponemal antibodies in blood
- Can be successfully treated with antibiotics, but this will not reverse permanent tissue damage
14
Q
Syphilis: Primary syphilis
* How many days after infection? appears where?
* Primary syphilis is characterized by what?
* Chancre begins as a what and goes to what?
* Resolves when?
* Histology looks like what?
A
- 9-90 days after infection primary lesion appears at site of infection (penis, scrotum)
- Primary syphilis is characterized by ‘hard’ chancre lesion (this is not canker)
- Chancre lesions are full of spirochetes, highly infectious
- Chancre begins as a painless, small firm papule that progresses to well-defined indurated (hardened, raised) margins; ulcer with clean (clear) central pit
- Resolves by itself over 4-6 weeks to leave a scar
- Histology of ‘hard’ chancre ulcer consists of lymphocytic and plasmacytic inflammatory infiltrate, vascular endoarteritis (inflammation of endothelium, endothelial activation & proliferation)
15
Q
Syphilis: Secondary syphilis
* happens when?
* In secondary syphilis, spirochete does what?
* Characterized by what?
* Lesions can be what?
A
- About 2 months after primary syphilis resolves, secondary syphilis can appear
- In secondary syphilis, spirochete spreads and proliferates systemically
- Characterized by lymphadenopathy & multiple mucocutaneous lesions (erythematous rash) typically appear on hands & feet
- Lesions can be maculopapular, scaly or pustular
16
Q
Syphilis: Secondary syphilis
* Secondary syphilis lesion where?
* Histology of secondary syphilis lesion contains of what?
* Secondary syphilis lesions can what?
* Less common 2o syphilis manifestations include?
A
- Secondary syphilis lesion in moist skin areas (anogenital, inner thighs, axillae) can appear as condyloma lata (wart-like).
- Histology of secondary syphilis lesion contains proliferative endoarteritis & lympho-
plasmacytic inflammatory cells and spirochetes (highly infectious) - Secondary syphilis lesions can resolve on their own followed by latent phase
- Less common 2o syphilis manifestations include: hepatitis, renal disease, irititis, GI conditions
17
Q
Syphilis: Tertiary syphilis
* Tertiary syphilis lesions gradually develop in how much people?
* Occurs how many years after initial infection?
* Complications include what?
* Tertiary syphilis is characterized by appearance of what?
A
- Tertiary syphilis lesions gradually develop in about 15-30% of untreated patients
- Typically occurs 5-20 years after initial infection
- Complications include cardiovascular syphilis (80%; infection & inflammation of heart), neurosyphilis (10%; infection of brain or spinal cord)
- Tertiary syphilis is characterized by appearance of gummas
18
Q
Syphilis: Tertiary syphilis
* Gummas occur in what?
* Gummas are what?
* Histologically gummas present as what/
* Spirochetes present how?
A
- Gummas occur in bone, skin, mucous membranes of upper respiratory tract, mouth
- Gummas are irregular, firm mass of necrotic tissue surrounded by CT (granuloma)
- Histologically gummas present as central zone of coagulative necrosis, surrounded by lymphocytes, macrophages, plasma cells, occasional peripheral zone of fibrosis
- Spirochetes present locally and systemically
19
Q
Gonorrhea:
* Caused by what?
* How many cases?
* What is the natural reservoir?
* presents as?
A
- Caused by gram-negative bacterium, Neisseria gonorrhoeae
- Approximately 650,000 cases annually US
- Humans are only natural reservoir for N. gonorrhoeae
- Gonorrhea presents as dysuria, urinary frequency and a mucopurulent urethral exudate within 2-7 days of infection, congested urethra (block it)
20
Q
Gonorrhea:
* Bacteria can be found in what?
* Ascending infection results in what?
* Disseminated infection are what?
* Similar clinical manifestations in females, untreated can lead to what?
* Can have vertical transmission to who?
A
- Bacteria can be found in discharge, treated with antibiotics
- Ascending infection results acute prostatitis, epididymitis, orchitis
- Disseminated infection is rare
- Similar clinical manifestations in females, untreated can lead to obstruction of fallopian tube due to chronic, asymptomatic infection
- Can have vertical transmission to infant during passage in birth canal
21
Q
Chlamydia trachomatis:
* Most or least common?
* Intracellular bacteria taken up how? and differentiates into what?
* Reticulate bodies proliferate to what/
A
- Most common bacterial STD in US, treated with antibiotics
- Intracellular bacteria taken up by host cells in its elementary form which then differentiates into metabolically active form – reticulate body
- Reticulate bodies proliferate to generate elementary bodies
22
Q
- Chlamydia trachomatis has similar clinical manifestation of what?
- List the symptoms?
A
Similar clinical manifestations of chlamydia & gonorrhea include:
* Mucopurulent discharge with neutrophils
* Urethritis, epididymitis, prostatitis, pharyngitis, conjunctivitis
* Differences between clinical manifestations of chlamydia & gonorrhea:
* Bacteria may not be visible in discharge
* Chlamydia may be asymptomatic
23
Q
Herpes Simplex Virus (HSV):
* Which one dont cause cancer? Which ones do?
* What are cold sores and genital herpes? What are they associated with?
* Genital herpes require what?
* HSV-2 causes what?
* Primary infection associated with?
A
- HSV 1 & 2 don’t cause cancer, HSV8 associated with HIV/Kaposi sarcoma, EBV HSV4 with nasopharyneal carcinoma
- HSV-1 (cold sores) & HSV-2 (genital herpes) associated with oral & anogenital lesions, cannot be cured – just managed
- Genital herpes requires direct contact for transmission: sexual or maternal:fetal
- HSV-2 causes painful, erythemtous vesicles (clear fluid) on mucosa/genital skin
- Primary infection associated with mild symptoms of locally painful vesicular lesion, dysuria, urethral discharge, local lymph node enlargement & tenderness, fever, muscle ache, headache
24
Q
HSV:
* Primary phase typically lasts how long?
* HSV is shed when?
* When is it life threatening?
A
- Primary phase typically lasts several weeks, recurrence is common
- HSV is shed when 1o or recurrent lesions are present
- Life-threatening disease in neonates and immunosuppressed pt
25
Herpes Simplex Virus:
Histo?
* Histologically, HSV vesicles contain necrotic cells, fused multinucleate giant cells with intracellular inclusions (Cowdry type A)
* **Cowdry type A inclusions:** droplet masses of acidophilic material surrounded by clear halos within nuclei, with disruption of host chromatin (seen in HSV, Varicella- zoster virus, and Cytomegalovirus infection)
26
Human Papilloma Virus (HPV):
* How many types
* transmitted how?
* HPV causes what?
* Genital warts have what? What else can they be called?
* High risk HPVs cause what?
* 100 genetically distinct types of HPV
* HPV can be transmitted sexually and to fetus during birth
* HPV causes a number of squamous proliferative disorders in genital – both benign and pre-cancerous
* Genital warts have low malignant potential and are associated with l**ow-risk HPVs, HPV-6 and HPV-11**.
* Genital warts AKA **condyloma acuminatum**
– Can range from sessile(flat) to larg epapillary lesions
* H**igh-risk HPVs (types 16 and 18)** have been implicated in the genesis of several cancers, cervical, penile, oropharyngeal and anogenital SCC.
27
# Squamous cell carcinoma of penis & scrotum
* Venereal warts (condyloma acuminata) are caused by what?
* SCC can occur where?
* Arises from what?
* Histo?
* Related to what?
* Pronosis is associated with that?
* Venereal warts (**condyloma acuminata**) are caused by **HPV types 6 and 11**
* SCC can occur on any region of skin of external male genitalia (scrotum & penis)
* Arises from CIN
* Histologically demonstrates **keratinization**, epithelial **pearl formation**
* Related to poor hygiene in uncircumcised males, HPV 16 & 18 infection
* Prognosis is associated with** lymph node involvement**: 25% 5 yr survival with inguinal node involvement; 0% 5 yr survival with iliac node involvement
28
* Penile cancers comprise of how many US male cancers?
* How many cases a year?
* Penile cancers comprise 0.4% of US male cancers, higher in developing countries
* Scrotal squamous cell carcinoma: < 10 cases/yr in US
29
# Testes
* What are testes?
* Composed of waht?
* Seminiferous tubules converge onto what?
* Seminiferous tubules are lined by what? What do they have?
* **Testes**, paired organs in scrotal sac, production of spermatozoa & male sex hormones
* Composed of convoluted **seminiferous tubules (SE)**
* **Seminiferous tubules** converge onto rete testis from which 15-20 small ducts, **ductuli efferentes** carry sperm into ductus deferens - **epididymis**
* Seminiferous tubules are lined by stratified epithelium with germ cells in various stages of spermatogenesis & **Sertoli cells**
30
* What are sertoli cells and leydig cells?
* Testicular disorders are called what?
* **Sertoli cells** support & nourish developing spermatozoa, comprise blood-testis barrier
* **Leydig cells**, in interstitial spaces (I) between seminiferous tubules, produce and secrete
male sex hormones, principally testosterone
* Often testicular disorders are ‘**orchid**’ in nomenclature
31
# Congenital Anomalies of the Testis
* Most common congenital abnormality is what?
* 1% of male population, can confer what?
* Patients with cryptorchidism are also 3-5X predisposed to what?
* What is the treatment?
* Most common congenital abnormality is **cryptorchidism** (failure of testis to descend into scrotum from abdomen)
* 1% of male population, can confer **infertility**
* Patients with cryptorchidism are also **3-5X predisposed to testicular tumors.**
* Surgical correction (**orchiopexy**) restores testicular placement, reduces risk for cancer
32
* Inflammatory lesions of testis (_) typically following what?
* Nonspecific orchitis begins where?
* Orchitis arises from mumps infection in about 20% of adult males where affected testis is what?
* Severe mumps orchitis can lead to what?
* Inflammatory lesions of testis (**orchitis**) typically following inflammation of epididymis
* **Nonspecific orchitis begins urinary tract infection** traveling to testis so involved testis is swollen, tender & contains a neutrophilic inflammatory infiltrate.
* **Orchitis arises from mumps** infection in about 20% of adult males where affected testis is edematous, congested & contains a lymphoplasmacytic inflammatory infiltrate
* Severe mumps orchitis can lead to testicular atrophy, fibrosis and sterility
33
* Testicular torsion is what?
* Requires what?
* **Testicular torsion:** twisting of spermatic cord results in obstruction of venous drainage leading to potential venous congestion, infarction and ischemia
* Immediately painful
* Requires immediate surgical intervention to maintain testicular viability
34
# Male infertility
* Male reproductive years are not limited by what?
* 30-50% infertility among couples is what?
* Low sperm count it what?
* Examination of semen reveals what?
* Male reproductive years are not limited by age following puberty; continuous spermatogenesis results in 300 million sperm/ejaculate
* 30-50% infertility among couples is male infertility (**90% low sperm count/low sperm quality**)
* Low **sperm** count: <15 million sperm/ejaculate
* Examination of **semen** reveal **sperm disorders** based on sperm count, motility, viability, morphology:
35
* Aspermia:
* Azoospermia: (what are the two types)
* Oligospermia:
* Asthenozoospermia:
* Pyospermia/leukocytospermia:
* Necrospermia:
* Teratospermia:
* **Aspermia**: lack of semen
* **Azoospermia**: absence of sperm in semen
– Obstructive (OA) vs. Non-obstructive (NOA)
* **Oligospermia**: low sperm count
* **Asthenozoospermia**: poor motility
* **Pyospermia/leukocytospermia**: high levels of seminal fluid leukocytes-> infectious material
* **Necrospermia**: sperm are dead
* **Teratospermia**: abnormal morphology
36
Chromosomal causes for male infertility: Klinefelter Syndrome
* Y chromosome defines what? What does an extra X chromosome do?
* Arises from what?
* What are signs?
* What is reduced? what is increased?
* Rarely what?
* What is impair?
* Increase risk for what?
1
37
Steroid hormone synthesis pathway?
38
# 17-beta hydroxysteroid dehydrogenase deficiency
* What is the disease?
* What is delayed and present?
* Presence of what?
* Some, but incomplete development of what?
* Historically raised as what?
* **Rare autosomal recessive** disease in XY males (1:150,000 newborns) resulting in reduced/defective testosterone production
* Delays male sexual development, at birth present with **‘ambiguous genitalia’**, micropenis, hypospadias, undescended testes
* Presence of Wolffian duct derivatives (epididymis, vas deferens, seminal vesicles)
* Some, but incomplete development of secondary sex characteristics; infertile; gynecomastia
* Historically raised as females
39
# 3-Beta-hydroxysteroid dehydrogenase deficiency
* By converting pregnenolone to progesterone, DHEA to androstenedione, androstenediol to testosterone, 3B-HSD is important for what?
* Downstream products of progesterone also include what?
* By converting pregnenolone to progesterone, DHEA to androstenedione, androstenediol to testosterone, **3B-HSD** is important for production of androgens, estrogens
* Downstream products of progesterone also include
**corticosterone/aldosterone & cortisol**
40
# 3-Beta-hydroxysteroid dehydrogenase deficiency
* What is the type of disease?
* Enzyme involved in production of what?
* Deficiencies in 3B-HSD impact what?
* Males are what?
* Most serious conditions are what?
* Inherited **autosomal recessive** disorder affecting gonads and adrenal gland; rare disorder (<100 patients reported)
* Enzyme involved in production of **androgens, estrogens, cortisol & aldosterone**
* **Deficiencies in 3B-HSD impact reproductive, renal & metabolic function**
* **Males**: incompletely masculinized at birth, hypospadias, unpalpable testes; gynecomastia in pubertal males
* Most serious conditions are male or female newborns with adrenal glucocorticoid & mineralocorticoid insufficiency resulting in circulatory collapse, low serum sodium (**salt- wasting disease/fatal**), high serum K+
41
# Neoplasms of the Testis
* Occur as what?
* Sex-cord stromal tumors are what?
* Germ cell tumors are what?
* Present in who?
* Are what?
* How many cases a year?
* Occur as **germ cell tumors** (from spermatogonia) or **sex-cord stromal tumors** (from Sertoli or Leydig cells)
* **Sex-cord stromal tumors**: rare, generally benign
* Germ cell tumors: malignant, account for 95% of post-pubertal testicular cancers, AKA **testicular cancers**
* Most present in young men (**15-34 yr, range from 1.5->65 yrs**)
* Are unilateral, **not initially painful**
* 8000 new cases/yr US with only 400 deaths
42
# Neoplasms of the Testis
* Usual therapy is what?
* Good prognosis for all types except what?
* Risks for testicular cancer include what?
* Underlying cause is unknown, but germ cell tumors contain what?
* Usual therapy is **orchiectomy** & chemotherapy
* Good prognosis for all types except **choriocarcinomas**
* Risks for testicular cancer include **cryptorchidism, familial history**
* Underlying cause is unknown, but germ cell tumors contain an **isochromosome of chr 12**p (extra copies of 12p)
43
# Germ Cell Tumors of the Testis
* Germ cell tumors arise in boys/men in what?
* Classified as what?
* Seminomas and non-seminomas?
* Germ cell tumors arise in boys/men in **spermatogonium cells**
* Classified as seminomas or non-seminomas germ cell tumors:
* **Seminomas**: pure seminoma & spermatocytic seminoma
* **Non-seminomas**: embryonal carcinoma, yolk sac tumor, choriocarcinoma, teratoma
44
Germ Cell Tumors of the Testis:
* Gross appearance?
* Present or absence of serum what?
* Related and unique what?
45
# Proliferation & differentiation of embryonic cells
Fertilized egg (_) grow and differentiate into what?
Fertilized egg (**oocyte + sperm – originally from diploid stem cell**) grow and differentiate into fetus, placenta, embryonic membranes.
46
Testicular germ cell tumor subtypes represent developmental elements of what?
47
Pure Seminomas:
* Typical patient age is what?
* Appear grossly as what?
* Rare areas of what?
* 10-30% patients with seminomas may have what?
* Most are cured by?
* Typical patient age **40-50 yrs**
* Appear grossly as **firm, well-demarcated gray-white** tumors on testicular surface
* Rare areas of coagulative necrosis
* 10-30% patients with seminomas may have **mild serum elevations of hCG**
* Most are cured by radical **orchiectomy**
48
Pure Seminomas:
* Often confined to what?
* Even in patients with widely metastatic seminoma, cure rates are what?
* Overall good or bad prognosis?
* Often **confined to testis for long periods**, but can metastasize via iliac & para- aortic lymph nodes
* Even in patients with widely metastatic seminoma, cure rates are very high with conventional chemotherapy, since most pure seminomas are especially s**ensitive to radiation therapy or chemotherapy**
* Overall good prognosis
49
Pure Seminomas:
* Tumor cells correspond to what?
* Tumor cells are what?
* Occasional what?
* Usually infiltrated by what?
* Tumor cells correspond to **gondal cell lineage** differentiation (i.e. spermatogonial stem cells)
* Homogenous tumor cells (red arrow)
* Tumor cells are **large, uniform**, distinct cell borders, glycogen rich clear cytoplasm, round nucleus with prominent nucleoli
* **Occasional syncytiotrophoblasts** (black arrow)
* Usually infiltrated by small lymphocytes (few to many lymphocytes)
50
Spermatocytic Seminomas:
* Pts are what?
* Appear grossly as what?
* Areas of what may be present?
* Most are cured by what?
* Often confined to what?
* Generally do not what?
* Pts are **>65 yrs**
* Appear grossly as **firm, yellowish cystic** tumors on testicular surface
* Areas of coagulative necrosis & hemorrhage may be present
* **Do not produce hCG** (different to pure)
* Most are cured by radical orchiectomy
* Often **confined to testis for long periods**, but can metastasize via iliac & para- aortic lymph nodes
* Generally **do not metastasize**, cure rates are very high with conventional chemotherapy, since most seminomas are especially **sensitive to radiation therapy or chemotherapy**
* Overall good prognosis
51
Spermatocytic Seminomas:
* Tumor cells correspond to what?
* Tumors consist of what?
* Tumors lack what?
* Tumor cells correspond to **gondal cell lineage** differentiation (i.e. spermatogonial stem cells)
* Tumors consist of **varying sizes of polygonal tumor cells** arranged in nodules or sheets
* Tumors **lack lymphocytic infiltration and syncytiotrophoblasts** present in pure (true) seminomas
52
# Nonseminomatous Germ Cell Tumors
* Nonseminomatous germ cell tumors are what? (compared to seminomas)
* Metastasize?
* Nonseminomatous germ cell tumors are more differentiated & aggressive than seminomas
* **Metastasize earlier** than seminomas, commonly spread to lungs & liver, spread by lymphatic and hematologic routes
53
Nonseminomatous germ cell tumors recapitulate different embryonic and postembryonic structures:
– **Embryonal carcinoma** corresponds to undifferentiated, pluripotent stem **cells of fetus**
– **Yolk sac tumor** corresponds to **primitive blood-forming organs**
– Choriocarcinoma corresponds to **placental** trophoblast
– **Teratoma** corresponds to tumors with **somatic tissues from all three embryonic layers**: skin/nervous (ectoderm); muscle/bone/blood (mesoderm); GI (endoderm) corresponds to fetal gonadal/spermatogonium cells
54
Non-seminoma Germ Cell Tumors: Embryonal Carcinoma
* Peak age is what?
* Typically presents as what?
* Tumor borders as waht?
* Negative for what?
* Cured by what?
* Can metastazise via what?
* Respond to ?
* Peak age of incidence is **20-30 years** of age
* Typically presents as a **hemorrhagic mass with necrosis**
* Tumor borders are ill-defined
* **Negative for serum tumor markers**
* Most are cured by radical **orchiectomy**
* Can metastasize via iliac & para-aortic lymph nodes
* **Respond well to surgery & chemotherapy** so overall good prognosis
55
# Non-seminoma Germ Cell Tumors: Embryonal Carcinoma
* Tumor cells correspond to what?
* Tumor cells are what?
* Cells can form what?
* Tumor cells correspond to **fetal stem cells** (i.e. totipotent stem cells)
* Tumor cells are **large and undifferentiated** with basophilic cytoplasm, **indistinct cell borders**, large prominent nucleoli
* Cells can **form irregular epithelial-like structures (red arrow)**
56
# Nonseminomatous Germ Cell Tumors: Yolk Sac Tumors
Yolk sac tumors are most common germ
* cell tumor in pts?
* Grossly?
* What is present?
* What is produced?
* Preoperative measurement of serum tumor marker levels is important for what?
* Patients respond well to what?
* Yolk sac tumors are most common germ cell tumor in pts **< 3 yrs of age**
* Grossly, yolk sac tumors have smooth, glistening appearance contains cystic **structures**
* **Some hemorrhaging present**
* **Frequently produce α-fetoprotein (AFP)** **that is elevated in serum**
* Preoperative measurement of serum tumor marker levels is important for managing patients postoperatively
* Patients **respond well to surgery & chemotherapy**
* Very good prognosis
57
# Nonseminomatous Germ Cell Tumors: Yolk Sac Tumors
* Tumor cells correspond to what?
* Composed of what?
* Characterized by presence of what?
* Tumor cells correspond to **blood stem cells** (i.e. bone marrow cells) Composed of **low cuboidal to columnar epithelial cells** forming cysts, lacelike patterns, sheets or papillae
* Characterized by presence of **Schiller-Duvall bodies** (rosette in center of photo) that resemble glomerular
58
# Nonseminomatous Germ Cell Tumors: Choriocarcinoma
* Presents in who?
* Tumors are what?
* All choriocarcinomas produce what?
* Highly what?
* Usually what?
* Presents in adolescents or young adults (**20-30 yrs age**)
* Tumors are small in size, but are **hemorrhagic and necrotic**
* All choriocarcinomas produce **high levels of serum hCG**
* Highly **malignant, prone to metastasize, poor prognosis**
* Usually fatal
59
# Nonseminomatous Germ Cell Tumors: Choriocarcinoma
* Tumor cells correspond to what?
* Similar to placenta, but what?
* Composed of what?
* Tumor cells correspond to **placental tissue**
* Similar to placenta, but no villous structures are not formed
* Composed of **cytotrophoblastic and syncytiotrophoblastic cells** (arrow)
60
# Nonseminomatous Germ Cell Tumors: Teratomas
* What are the types?
* Occur when?
* Negative for what?
* represent neoplastic growth of what?
* Patients respond well to what?
* Benign (**mature**) & malignant (**immature**) teratomas
* Occur at **any age**, most cases of malignant teratomas occur in adults
* **Negative for serum biomarkers**
* Represent neoplastic growth of germ cells along all three germ layers
* Patients respond well to surgery & chemotherapy
* Very good prognosis
61
Teratomas Benign vs malignant?
62
Nonseminomatous Germ Cell Tumors: Teratomas
* Teratomas represent differentiation of what?
* What is the histo appearance?
* Teratomas represent differentiation of neoplastic germ cells along all three germ layers
* Heterogeneous histologic appearance
63
# Vas deferens
* Common inflammatory/infections conditions of vas deferens related what?
* Cystic fibrosis contributes to what?
* Conditions of vas deferens typically confer what?
* What is a vasectomy?
* Common inflammatory/infections conditions of vas deferens related to **blockage**
* Cystic fibrosis contributes to congenital absence of vas deferens bz mucus clogs vas deferens during development so they deteriorate prior to birth
* Conditions of vas deferens typically confer infertility
* Vasectomy: ligation of vas deferens
64
* Adult prostate weighs how much?
* What does it encircle?
* Composed of what?
* What is prominent in prostatic hyperplasia?
* Epithelial cells produce what?
* Glandular products drain into what?
* Surrounding connective tissue consists of what?
* Adult male prostate weighs approximately 20 grams
* Encircles neck of bladder and urethra
* Composed of gland & stroma
* **Basal epithelial cells** are prominent in **prostatic hyperplasia**
* Epithelial cells produce 30-50% seminal fluid & prostate specific antigen
* Glandular products drain into urethra
* Surrounding connective tissue consists of smooth muscle (controls urine flow/ejaculation) and fibrous tissue
65
What does the central zone of prostate surround? What cannot be done?
* Central zone surrounds ejaculatory duct
* Bz zone farthest from rectum, this zone cannot be felt during a digital rectal exam (DRE)
| Closest to uretha
66
Where is the peropheral zone located ? What is usually here?
* Peripheral zone extends around gland
* Closest to rectum so can be **palpated by DRE**
* Majority of **prostate tumors** (approximately 75%) are found in the peripheral zone
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* Where is the transition zone of prostate located?
* With age, transition zone enlarges due to what?
* As transition zone enlarges, it does what?
* **Transition zone** between peripheral and central zones, surrounds the urethra
* With age, transition zone enlarges due to **benign prostatic hyperplasia (BPH)**, until it becomes largest area of prostate
* As transition zone enlarges, it pushes peripheral zone toward rectum so enlarged prostate can be palpated
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What is the anterior zone of prostate made up of and what does it surround?
* Anterior zone is composed of fibromuscular tissue, devoid of glandular elements
* Surrounds apex of prostate
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What are some prostatic conditions?
Both benign (**prostatitis, benign prostatic hyperplasia** – BPH) or malignant prostatic **carcinoma** can enlarge prostate
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When prostate enlarges, it can constrict the urethra and produce one or more of these clinical symptoms:
* Need to urinate frequently during the day or night (**nocturia**)
* **Sudden urgent need** to urinate
* Difficulty initiating urinary stream
* Feeling like you still need to urinate even though you recently urinated
* Feeling like you need to push or strain to empty your bladder (**urinary** **hesitancy**)
* Decrease in force of urine stream
* Loss of small amounts of urine (**dribbling** urine)
* Pain during urination (**dysuria**)
* Abdominal/pelvic **pain**
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# Inflammatory Conditions of the Prostate: Prostatitis
* Makes up of how much prostate conditions?
* Can be what?
* Infectious prostatitis is associated with what?
* Prostatitis accounts for about 8% of prostate conditions
* Can be infectious or non-infectious cause
* Infectious prostatitis associated with urinary tract infections
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Prostatitis can be what (4)?
* asymptomic inflammatory prostatitis (?%)
* acute bacterial (2-5%)
* chronic bacterial (2-5%),
* chronic non-bacterial (chronic pelvic pain syndrome – 90-95%)
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Acute prostatitis:
* How many cases of prostatitis?
* Patients present with what?
* What is the prostate?
* Characterized by what?
* Acute: 2-5% of all cases of prostatitis
* Patients present with fever, chills, **dysuria**
* Palpated prostate is tender, swollen
* Characterized by **neutrophilic** inflammatory infiltrate & stromal edema
* Treated with antibiotics
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# Asymptomatic inflammatory prostatitis:
* Inflammation of prostate with presence of what?
* What is not present?
* Usually detected when?
* Limited to what?
* **Inflammation of prostate with presence of leukocytes** in semen
* **Without genitourinary symptoms, no pain, no evidence of infection**
* Estimate of incidence is under reported bz it’s asymptomatic
* Usually detected secondarily – i.e. may occur with benign prostatic hyperplasia
* Limited response to antibiotics/anti-inflammatory agents
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Chronic prostatitis:
* How many cases of prostatitis?
* May follow after what?
* Typically associated with what?
* Can present as what?
* With disease progession, what happens?
* What is there a varying amounts of?
* Chronic prostatitis may serve as what?
* Responds to what?
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Chronic Non-Bacterial Prostatitis:
* Also called what?
* Up to how many prostatitis cases?
* What is not present?
* Requires what?
* Presents with what?
* (AKA: Chronic pelvic pain syndrome)
* Up to 95% of all prostatitis cases
* Difficult to diagnosis, no known etiology, no infectious agent present
* Requires physical examination and ruling out presence of infection
* Presents with **lower back pain, perineal and/or pelvic pain, dysuria, pain with ejaculation, reduced urine output, tender & enlarged prostate.**
* No adequate therapies, does not respond to antibiotics
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Benign Prostatic Hyperplasia:
* Enlarged prostate to?
* BPS affects how many people?
* Arises from where?
* impinges what?
* Cause?
* Treatment?
* No risk for what?
* BPH **enlarges prostate** to 60-100g (normal size 7-11g = 4 pennies)
* BPH affects 70% of US men 60–69 years of age and 80% of those 70 years of age or older
* Arises from **inner transitional zone**
* Impinges urinary & sperm output
* Cause is unknown, but is **dihydrotestosterone** (DHT)-dependent for growth
* Treatment: alpha-blockers to relax muscle, **anti-androgen ** therapy and/or surgery
* However, **surgery is problematic** due to anatomical investment of prostatic glandular tissue into urethra
* **No risk for progression to prostatic cancer**
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histologic appearance of BPH:
* BPH is characterized by?
* hyperplastic glands are what?
* what is there a formation of?
* BPH associated with what?
* Glandular lumina often contain what?
* What is produced?
* BPH characterized by proliferation of epithelial & stromal elements
* Hyperplastic glands are **2 cell layers thick, lined by tall, columnar
secretory epithelial cells & a basal layer of flat-cuboidal basal cells**
* Formation of **papillary projections in some glands**
* BPH usually associated with chronic inflammatory cell infiltrate
* Glandular lumina often contain proteinaceous material = **corpora amylacea**
* Hyperplastic epithelial cells can produce **PSA**
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# Prostate Carcinoma
How many males experience prostatic problems?
How many are male cancer deaths?
Present as what?
* 75% males experience prostatic problems by 70 years of age
* 9% all male cancer deaths (31,620/321,670 cancer deaths)
* Present as firm, gray-white lesions with ill-defined borders, infiltrate glandular elements
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What are the risk factors of prostate carcinoma?
* **Age**: Average age of diagnosis 72 years old
* **Family history/hereditary** of disease in first degree relatives (father, brothers); BRCA2 mutations
* **Race/ethnicity**: More common African Americans
* **Environment/lifestyle:** smoking, diet high in saturated fats
* **Acquired somatic mutations**: 40-50% prostate cancer acquire translocation of androgen promoter to ETS gene (**TPRSS2- ETS**) which drives PI3K/AKT signaling pathway for cellular proliferation
* **NOT BPH**
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# Prostate Carcinoma: Clinical Presentation
* Arise where?
* Non initally associated with what?
* What is elevated?
* Where does it metastasize to?
* Respond to what?
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Prostate Adenocarcinoma: Histological appearance
* Prostate adenocarcinomas from prostatic glandular epithelial cells
* Adenocarcinomas lined **by single layer of cuboidal to columnar epithelial cells**
* Glandular elements **lack branching, papillary structures (vs BPH)**
* **PIN** found present in 85% prostatic adenocarcinomas, but does not cause elevated serum PSA levels on its own & cannot be detected by DRE or ultrasound (imaging)
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What is the gleason score?
* Most prostate cancers contains areas of differing tumor grade (heterogenous grade)
* Gleason grading score based on glandular histological, pattern & degree of differentiation with categories from 1 to 5
* Gleason score is **sum of grades of most prominent pattern & minority pattern of tumor gland** formation and infiltration
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* Gleason grades 1 and 2 tumors are usually what?
* Grade 3 are what?
* Grade 4 and 5?
* Gleason grades 1 and 2 tumors are usually indolent and rarely cause death.
* Grade 3 tumors are the most common grade tumor
* Gleason grades 4 & 5 tumors are aggressive & associated with lymph node and bone metastases
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# ```
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Histopathology of Gleason Scores
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What grades are these?
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What grades are these?
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* Overall prostate carcinomas are typically scored by what?
* What is the survival rate?
* Treatment choices depend on what?
* Overall prostate carcinomas are typically scored by combination of **PSA levels, Gleason score & TNM score** (T2N0M0/PSA <20/Gleason 7)
* Survival rates: 5-yr is 99%; 10-yr is 91%; 15-yr is 76%
* Patient age, co-morbidities, PSA levels, Gleason score, metastasis, urinary symptoms, tumor size
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What are the different treatments of prostate cancer?
