Pathology of the Male Reproductive Tract

Question 1

Common disorders fo the prostate

Answer 1

– Benign prostatic hyperplasia
– Carcinoma
– Prostatitis

Question 2

Benign Nodular Hyperplasia

Answer 2

• Non-neoplastic–associated with hormonal imbalance
• Nodular hyperplasia of glands and stroma
• Not premalignant
• Obstructs urine flow
• Associated with infection
• Treatable

Question 3

where does benign prostatic hyperplasia

Answer 3

• Involves transition zone of prostate plus peri-urethral glands
• Nodulesofglandsandstroma
• Compresses and elongates urethra
• Involvement of peri-urethral zone interferes with urethral sphincter

Question 4

symptoms of benign prostatic hyperplasia

Answer 4

• Causes urinary retention
– Acute retention: painful
– Chronic retention: painless, more gradual

Question 5

complications of BPH

Answer 5

• bilateral hydronephrosis
• bilateral hydroureter
• infection
• renal failure
• calculi
• septicaemia
• muscular hypertrophy
• diverticulum
• trabeculation
• compression of urethra
• nodular enlargement of prostate

Question 6

BPH vs Prostate Carcinoma

Answer 6

prostate cancer is more posterior and can often be assymptomatic as it grows posteriorly

Question 7

what is a precursor from prostatic cancer

Answer 7

Prostatic intraepithelial neoplasia

Question 8

Adenocarcinoma usually occurs when and where

Answer 8

> 50 years Posterior subcapsular area

• Asymmetric firm enlargement
• Metastasises (especially to bone)

Question 9

– Latent or indolent (incidental) carcinoma

Answer 9

Microscopic incidental focus
Common: incidence high in old age
Lesions dormant; metastases in 30% after 10 years

Question 10

Spread and Clinical Features of prostate carcinoma

Answer 10

Gleason score: differentiation and distribution
Stage TN – Direct
– Via lymphatics 
– Via blood
 • Presents with
– Urinary symptoms
– Incidental finding on rectal examination 
– Bone metastases
– Lymph node metastases

Question 11

Diagnosis

Answer 11

– Imaging - ultrasound, X-rays, isotope bone scan
– Cystoscopy - ? cytology
– Biochemistry PSA
– Haematological - bone marrow involvement – Biopsy - ? cytology

Question 12

Treatment

Answer 12

– Oestrogenic
– GnRH analogues
– Orchidectomy
– Radiotherapy
– Radical prostatectomy

Question 13

Penis and Scrotum tumours

Answer 13

– Bowen’s disease (non-invasive)

– Invasive squamous cell carcinoma

Question 14

inflammation and infection of the penis and scrotum

Answer 14

• phimosis, paraphimosis

Question 15

Congenital malformations of the penis and scrotum

Answer 15

– Hypospadias - urethral opening on inferior aspect

– Epispadias - often accompanied by abnormal development of bladder

Question 16

obstruction of the urethra

Answer 16

– Congenital valves
– rare in males
– Rupture
– Stricture

Question 17

Urethritis

Answer 17

– Gonococcal

– Non-gonococcal (non-specific)

Question 18

tumours of the urethra

Answer 18

– Warts

– Transitional cell carcinoma

Question 19

common bacteria that infects the urinary tract

Answer 19

Gonococcal Urethritis

Question 20

Developmental and cystic lesions of the testes

Answer 20

– Undescended testis (cryptorchidism)
– Hydrocoele
– Haematocoele

Question 21

Orchitis

Answer 21

– Mumps orchitis
– Idiopathic granulomatous orchitis
– Syphilitic orchitis

Question 22

Testicular Tumours

Answer 22

• Occur in young men (commonest tumor <35yrs) and old men
• Aetiology unknown but undescended testis is predisposing factor (x10
risk)
• In situ neoplasia does occur and is a precursor

Question 23

two types of testicular tumour

Answer 23

teratoma

seminoma

Question 24

Presentation of Testicular Tumours

Answer 24

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

Question 25

Seminoma

Answer 25

``` • Commonest type of testicular tumour • Germ cell origin • Peak incidence 30 - 50 years • Types – Classical – Spermatocytic – Anaplastic – With syncytiotrophoblast giant cells (may present with gynaecomastia) – Combined ```

Question 26

Teratoma

Answer 26

* Germ cell origin * Peak incidence 20-30y * More aggressive than seminoma * Categories * Differentiated * Intermediate * Undifferentiated * Trophoblastic * Beta HCG and AFP may eb useful markers

Question 27

Other Germ Cell Tumours

Answer 27

``` • Intratubular germcell neoplasia – Precursor lesion • Yolk sac tumour - children – AFP useful marker – Extra-embryonic differentiation • Combined germ cell tumours ```

Question 28

what can be used as a tumour marker

Answer 28

AFP

Question 29

Non-Germ Cell Tumours

Answer 29

• Malignant lymphoma – Elderly men • Leydig cell tumour – May produce androgens • Sertoli cell tumour • Metastatic tumours

Question 30

Staging of Testicular Tumours

Answer 30

* 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

Question 31

Male Infertility

Answer 31

``` • Causes – Endocrine disorders • GnRH deficiency • Oestrogen excess – Testicular lesions e.g. • Cryptorchidism • Abnormal spermatogenesis – Post-testicular lesions • Obstruction of efferent ducts ```

Question 32

Epididymis and Spermatic Cord

Answer 32

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