Histopathology Male Genital System 1 and 2 Flashcards Preview

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Flashcards in Histopathology Male Genital System 1 and 2 Deck (87):
1

Spermatoceole

Benign epithelial cyst of epididimus

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Varicocoele

Dilated blood vessels (tortuous)

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Hydrocoele

Accumulation of serous fluid in body cavity (ascites or testicular)

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Cryptochidism → Definition

Permanent retention of testis outside the scrotum

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Cryptochidism → Prevalence

Occurs in 1% of boys

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Cryptochidism → Presentation

Must are idiopathic and unilateral
If bilateral, can results in sterility

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Cryptochidism → Risks associated

30-4- x more risk of developing GCT
If a cryptorchid testis is surgically placed in the scrotum, it may still develop a germ cell neoplasm especially if operated after 6 years of age

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Atrophy →Can be secondary to

• Cryptochidism
• Inflammation – mumps
• Oestrogens (Cirrhosis and hormonal therapy for PCa)
• Chemotherapy, particularly cyclophosphamide (cause cell death as rapidly dividing cells)
• Radiation exposure
• Testicular regression syndrome (possibly secondary to infarction in-utero)

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Male Infertility → Causes can be grouped into three categories

• Pre testicular – extra-testicular endocrine disorder
• Testicular – all the causes of atrophy
• Post testicular – obstruction of the ducts – can be located by surgery

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Mumps Orchitis → Epi

Mumps usually occurs in children involving parotid gland.
In adults, about 25% of the cases are complicated by orchitis

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Mumps Orchitis → Definition

The testis is enlarged and very tender due to stretching of the tunica albugenia
In many cases, however the testis becomes atrophic and if bilateral can lead to infertility.

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Mumps Orchitis → Types

Idiopathic Granulomatous Orchitis
Syphillic Orchitis

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Mumps Orchitis → Idiopathic Granulomatous Orchitis

Uncommon causes of unilateral testicular enlargement in middle-aged men

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Mumps Orchitis → Idiopathic Granulomatous Orchitis microscopically

Granulomas are centred on the tubules and into the interstitium

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Mumps Orchitis → Idiopathic Granulomatous Orchitis possible aetiology

Includes reaction to estravasated sperms (Rupture of seminiferous tubules stimulates an immune response.

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Mumps Orchitis → Syphillic Orchitis

Now rarely seen
Was common site of development of Gumma
M/s granulomatous inflammation with central necrosis

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Mumps Orchitis → Features

1o Ulcer
2ndry Wafty lesions mucocutaneous junction
3 o Involves CVS – artic aneurysm/spial dorsal column → neurosyphilis

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Testicular Tumours → Peak incidence

15-34 years
Most common tumour of male in this age group
Accounts for less than 1% of all cancer deaths in UK

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Testicular Tumours → Can be classified into:

1. Germ cell tumour (90%)
2. Sex-cord stromal tumours (sertoli and leydig cells)
3. Mixed germ cell sex cord stromal tumours
4. Primary tumours not specific to the testis e.g. lymphoma
5. Metastatic tumours

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Germ Cell Tumours → Description

Most testicular GCT are malignant

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Germ Cell Tumours → Derived from

Germ cells, therefore able to differentiate towards any embryonic or extraembryonic tissue.

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Germ Cell Tumours → Can present with

• Painless unilateral enlargement of testis
• Secondary hydrocele
• Symptoms from metasteses
• Retroperitoneal mass
• Gynaecomastia

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Germ Cell Tumours → Risk Factors

• Cryptorchidism – higher the location greater the risk

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Germ Cell Tumours → Genetic predisposition

• Sibs have 10-fold high risk
• Blacks in Africa have very low incidence

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Germ Cell Tumours → Testicular dysgenesis

Testicular feminisation
Klinefelter syndrome

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Germ Cell Tumours → Cytogenic changes

Involving chromosome 12 and 1 (isochromosome of short arm of chromosome 12 – in 90%)

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Germ Cell Tumours → Classification

In situ
Invasive

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Germ Cell Tumours → In situ

Intratubular Germ cell Neoplasia

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Germ Cell Tumours → Invasive

Seminoma
Non seminomatous Germ cell Tumours
Mixed

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Germ Cell Tumours → Non seminomatous germ cell tumours types

Embryonal Carcinoma
Yolk sac tumour
Choriocarcinoma
Teratoma

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Germ Cell Tumours → Intratubular germ cell Neoplasia

• In situ stage
• Proliferation of neoplastic germ cells within seminiferous tubules
• Upto 80% of GCT show ITGCN in the adjacent tissue.
• Sometimes seen in the biopsy performed for the study of infertility or cryptochidism

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Germ Cell Tumours → Seminoma

• Commonest type of germ cell tumour
• Main sub-types includes
→ Classical 95%
→ Spermocytic

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Germ Cell Tumours → Classical seminoma with histological appearance

Commonest sub-type
Peak in 4th decade
m/s sheets of rounded cells with clear cytoplasm and variable lymphocytic infiltrate in the stroma

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Spermatocytic Seminoma

Accounts for 3-5% of all seminomas
Occurs in older age group
M/s mixed population of small intermediate and giant cells with increased mitotic rate

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Spermatocytic Seminoma prognosis

Excellent

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Embryonal Carcinoma: Epi

Mostly in 20-30 years age group

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Embryonal Carcinoma: Description

More aggressive than seminoma

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Embryonal Carcinoma: M/S

The cells are anaplastic and arranged in glandular, alveolar, solid or papillary growth patterns.

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Embryonal Carcinoma: Usually associated with

Other germ cell tumour, pure form constitutes only 3% of GCT

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Yolk sac Tumours → Epi

In children pure form, most common GCT in infants and children up to 3 yrs of age, good prognosis.

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Yolk sac Tumours → In adults associated with

Embryonal carcinoma

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Yolk sac Tumours → Characteristic structures

Schiller-Duval bodies formed by a perivascular layer of tumour cells.

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Yolk sac Tumours → Serum shows

Levels of AFP are raised and the neoplastic cells are positive for AFP

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Choriocarcinoma: Incidence

Only 0.3% occurs in pure form whereas 1.5% of NSGCT tumours habe choriocarcinoma component.

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Choriocarcinoma: Composed of both

Cyto and syncitiotrophoblasts – multinucleated

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Choriocarcinoma: Serum

Raised serum HCG levels

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Choriocarcinoma: Prognosis

Highly malignant

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Teratoma → Differentiation

Can differentiate into any of the three germ cell layers

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Teratoma → These tumours can have

Mature 9adult type) tissue – TD
Immature (foetal type) tissue

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Teratoma → Pure teratoma (TD) 2nd common in children prognosis

Good

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Teratoma → Adult poor form prognosis

Only 2-3% treated as malignant as they have metastatic potential.

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Mixed Tumours → Prevalence

14% of all testicular GCT

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Mixed Tumours → Description

Various combination occurs including seminoma and NSGCT

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Mixed Tumours → Treated as

NSGCT

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Dissemination → Description

Direct spread to rete testis and epididymis

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Dissemination → Spread via

• The Lymphatics to para-aortic lymph nodes and then to mediastonal lymph nodes.
• Blood to lung, liver and bone (teratoma).

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Dissemination → Prognosis of Germ cell Tumour

Seminoma v/s NSGCT

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Dissemination → Stage 1

Confined to the testis

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Dissemination → Stage II

Testis + para-aortic lymph nodes

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Dissemination → Stage III

Testis + mediastinal and/or supraclavicular LNs

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Dissemination → Stage IV

Visceral metastasis

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Prostate → Anatomy

Surrounds the bladder neck and proximal urethra

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Prostate → Normal weight

Approx. 20 mg

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Prostate → Also divded into

Inner (periurethral) and the outer (cortical) zone

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Prostate →Inner Zone

Nodular hyperplasia

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Prostate → Outer zone

Carcinoma

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Prostate → M/s

The glandular component is divided into ducts and acini

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Prostate → Glandular component cellular component

Two cell layers

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Prostate → The Stroma is

Fibromuscular

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Prostrate Inflammation →Acute and Chronic bacterial prostatitis

Occurs secondary to UTI
Prostatic secretions are positive for bacterial culture
Difficult to treat chronic prostatitis

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Prostrate Inflammation → Chronic abacterial prostatisis

Most common form
Prostatic secretion contains leukocytes but negative for bacterial culture

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Nodular Hyperplasia → Prevalence

Extremely common in men over the age of 50 years (70% by the age of 60 years)

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Nodular Hyperplasia → Involves

Periurethral region of the prostate

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Nodular Hyperplasia → Results in

Urinary Retention

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Nodular Hyperplasia → Caused by

Androgens (dihydrotestosterone DHT)

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Nodular Hyperplasia → Increased weight

60 to 100 mgs

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Nodular Hyperplasia →M/s

There is increase in glandular and stromal component in both

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Nodular Hyperplasia → 5 alpha reductase

Testosterone converted to DHT (more potent)

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Carcinoma of Prostate →Prevalence

Commonest form of cancer in males but second commonest cause of death – die w/ cancer not because of it.

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Carcinoma of Prostate → Incidence

Increased incidence after the age of 50 years

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Carcinoma of Prostate →Incidence

Blacks> Whites> Asian

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Carcinoma of Prostate → Etiology

Multifactorial
• Hormone – androgen receptor (large no. of receptors in these cells)
• Genetic, susceptibility genes 1q24-25, 1st degree relatives
• Fat consumption
• Lycopene in tomatoes (protective)

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Premalignant lesions associated with Carcinoma of prostate

59-100% of prostatic adenocarcinoma in radical prostatectomy specimens

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Carcinoma of Prostate → M/S

Adenocarcinoma i.e. tumour forms small glandular structures lined by layer of cells

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Carcinoma of Prostate → Grading

Glessons score depending up to the growth patterns.

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Carcinoma of Prostate → Prevalence Staging

A: not palpable
Stage B Palpable, confined to prostate
Stage C Extracapsular extension
Stage D Metastatic

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Carcinoma of Prostate → Diagnosis

Raised PSA level, range according to the age
Digital PR examination
Imaging Biopsy

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