Repro-Endo: Male Repro Pathology Flashcards
(34 cards)
1
Q
- Opening of the Urethra on the Inferior (Ventral) surface of Penis due to failure to close the Urethral folds
- Most common malformation of the Urethral groove
- Due to Failure of the Urethral folds to close
- A/w Father and previous male sibling w/ disease
- A/w Monozygotic twins and insufficient hCG by single placenta
- A/w Ventral curvature of penis –> Chordee
A
Hypospadias
2
Q
- Opening of Urethra on the Superiror (Dorsal) surface of Penis
- Abnormal positioning / Defect of the Genital tubercle
- A/w Bladder extrophy –> opening of the anterior wall of the Abdomen leading to Bladder exposure
A
Epispadias
3
Q
- Benign, Warty growth on Genital skin
- HPV 6 or HPV 11
- Characterized by Koilocytic change –> “Raisen” appearing nuclei
A
Condyloma Acuminatum
4
Q
- Necrotizing granulomatous inflammation of the Inguinal Lymphatics and Lymph nodes
- STDs a/w Chlamydia trachomatis (L1 -L3)
- Mucosal surface entering
- Obligate intracellular organism
- Eventually heals w/ fibrosis
- Perianal involvement may result in Rectal stricture
A
Lymphogranuloma Venereum
5
Q
- Malignant proliferation of Squamous cells of the Penile skin
- Circumcision protects against SCC
- SCC of Penis is most common cancer
- Men 40 - 70 y.o.
- A/w High risk HPV 16, 18, and HPV 31, 33
- Smoking tobacco may act as cocarcinogens / HPV
- Lack of Circumcision - Foreskin is Nidus for inflammation and irritation = Greatest Risk Factor
- Bowen Disease and Erythroplasia of Queyrat
- Metastasizes to Inguinal and Iliac nodes
A
Penile Squamous Cell Carcinoma
6
Q
- In situ Carcinoma of the Penis Shaft or Scrotom that presents w/ Leukoplakia (White plaque on the shaft of the Penis)
- > 35 y.o.
- HPV 16
- Precursor for Invasive SCC (~10%)
- A/w other types of Visceral Cancer
A
Bowen disease
7
Q
- In situ Carcinoma of the Glans of the Penis (Mucosal Surface) that presents as Erythroplakia
- Precursor for Invasive SCC of Penis
- HPV 16
A
Erythroplasia of Queyrat
8
Q
- In situ Carcinoma that presents as
- *Multiple Reddish-brown Papules**
- Seen in younger patients (40s) relative to Bowen disease and Erythroplasia of Queyrat
- HPV 16
- DOES NOT progress to invasive Carcinoma
A
Bowenoid papulosis
9
Q
- Failure of the Testicle to descend –> Scrotal sac
- Normally develop in abdomen and “descend” into the scrotal sac as Fetus grows Mullerian Inhibitory substance (MIS) is responsible for Transabdominal phase, Androgens and hCG - Inguinoscrotal phase
- Most common congenital male reproductive abnormality
- 30% Premature and 5% Full term Male infants
- A/w Androgen Insensivitivy Syn., Kallman syndrome, Cystic Fibrosis
- Resolve spontaneously (mostly), hCG therapy
- GnRH w/ Orchiopexy is Sx < 2 y.o.
- A/w Testicular atrophy and Infertility
- Increased risk of Seminoma (5-10x)
A
Cryptorchidism
10
Q
- Inflammation of the Testicle
- Chlamydia trachomatis (serotypes D-K)
- Neisseria gonorrhoeae
- Increased risk of sterility
- Libido is not affected because Leydig cells are spared
A
Orchitis of Young Adults < 35 y.o.
Tx: Ceftriaxone + Doxycycline
11
Q
- Inflammation of the Testicle
- Escherichia coli
- Pseudomonas
- A/w Urinary tract infection
- Pathogens spread to Reproductive tract
A
Orchitis of Older Adults > 35 y.o.
Tx: Ciprofloxacin Extended Release
12
Q
- Inflammation of the Testicle
- Mumps virus
- Increased risk of Infertility
- Testicular inflammation is usually not seen in Children < 10 y.o.
A
Orchitis of Teenage Males
13
Q
- Testicular Inflammation
- Characterized by Granulomas involving the Seminiferous tubules
A
Autoimmune Orchitis
14
Q
- Sudden Testicular pain w/ Absent Cremasteric reflex
- Twisting of the Spermatic cord, Violent, Physical Trauma
- 12 - 18 y.o. Males
- Thin-walled veins become obstructed leading to congestion and Hemorrhagic infarction
- Usually due to congenital failure of Testes to attach to the Inner lining of the Scrotum (via the Processus Vaginalis)
- Thick artery wraps around vein –> Blood in but not out
- 1/3 Resolve spontaneously
- Sx is imperative w/in 12 hours if it does not Resolve
A
Testicular Torsion
15
Q
- Dilation of the Spermatic vein due to Impaired drainage
- Presents as scrotal swelling w/ a “bag of worms” appearance
- 15 - 25 y.o. Males
- Usually Left Sided Scrotal enlargement
- Left testicular vein drains into the Left renal vein, while the Right testicular vein drains directly into the IVC
- A/w Left-sided Renal cell carcinoma: RCC often invades the Renal vein
- A/w a Large percentage of Infertile males
- Dx: Ultrasound
- Tx: Varicocelectomy, Embolization by Interventional Radiologist
A
Variococele
16
Q
- Scrotal Swelling that can be Transilluminated
-
Fluid collection w/in the Tunica vaginalis (FAILS TO CLOSE)
- Tunica vaginalis is a serous membrane that covers the Testicle as well as the Internal surface of the Scrotum
- A/w Incomplete closure of the Processus Vaginals
- -> Communication w/ the Peritoneal cavity (infants) or Blockage of Lymphatic drainage (adults)
- A/w Indirect Inguinal Hernia
A
Hydrocele
17
Q
- Arise from Germ cells or Sex cord-stroma
- 15 - 35 y.o.
- Whites > Blacks
- Presents as a Unilateral, Firm, Painless Testicular mass that CANNOT be Transilluminated
- NOT BIOPSID! –> risk of Seeding the Scrotum
- Removed via Radical Orchiectomy
- Most are Malignant Germ cell Tumors (Seminoma 40%)
- A/w Cryptorchid testicle, Androgen insensitivity syndrome, Klinefelter syndrome (XXY), Peutz-Jeghers syndrome, Inguinal hernia, Mumps orchitis
A
Basics of Testicular Tumors
18
Q
- Most common type of Testicular tumor (>95%)
- 15 - 40 y.o.s
- Risk factors: Cryptorchidism and Klinefelter syndrome
- (2) Types
- Seminoma - highly responsive to radiotherapy, metastasize late, excellent prognossis
- Nonseminoma - variable response to Tx and often metastasize early
A
Germ Cell Tumors
19
Q
- Malignant tumor comprised of Large cells w/ Clear cytoplasm and Central ‘Prominant’ nuclei (resemble spermatogonia), Stroma has a prominent lymphocytic infiltrate
- Forms a Homogeneous mass w/ no Hemorrhage or Necrosis
- Lymphatic metastasis before Hematogenous (lungs)
- Most common tumor (40%)
- Rare case produces β-hCG (10%)
- Resembles Ovarian dysgerminoma
- Good prognosis; Responds to Radiotherapy (Radiosensitive)
A
Germ Cell - Seminoma
20
Q
- Malignant tumor comprised of Immature, Primitive cells that MAY produce Glands
- 20 - 25 y.o.
- Bulky tumor w/ Hemorrhagic mass and Necrosis
- Aggressive w/ early Hematogenous spread before Lymphatic
- Chemotherapy may result in differentiation into another type of germ cell tumor (e.g. Teratoma)
- Increased AFP or β-hCG may be present (90% cases)
A
Embryonal Carcinoma
21
Q
- Malignant tumor that resembles Yolk sac elements
- Most common Testicular Tumor in Children (<4 y.o.)
- Schiller-Duval bodies (Glomerulus-like structures) are seen on Histology - “Glomeruloid-like structure”
- Increasesd AFP, elevated in all cases!
- Good prognosis
A
Yok sac Tumor
(Endodermal sinus)
22
Q
- Malignant Tumor of Trophoblastic Tissue: Syncytiotrophoblast and Cytotrophoblasts (placenta-like tissue, BUT the Vili are absent)
- 20 - 30 y.o.
- Spreads early via blood (Hematogenous) –> Lungs
- β-hCG is elevated –> Hyperthyroidism or Gynecomastia
- α-subunit of hCG is similar to that of FSH, LH, and TSH
- increased hCG in call cases
A
Choriocarcinoma
23
Q
- Tumor composed of Mature Fetal tissue derived from Two or Three embryonic layers
- Derivatives of Ectoderm, Endoderm, Mesoderm
- If Mixed w/ Embryonal carcinoma –> “Teratocarcinoma”
- Malingnant in Males of All Ages
- Benign in Children, Malignant in Adults (SCC)
- Bening in Females
- AFP or β-hCG may be increased (50% of cases)
A
Teratoma
24
Q
- Germ cell tumors are usually mixed
- Prognosis is based on Worst component
A
Mixed Germ Cell Tumors
25
* Tumors that resemble Sex cord-stromal tissues of the Testicle
* Usually benign
* Leydic cell tumor --\> Androgens --\> Precocious puberty in Children or Gynecomatia in Adults
* Sertoli cell tumor --\> comprised of Tubules --\> usually Clinically Silent
Sex Cord-Stromal Tumors
26
* **Most common** cause of **Testicular mass** in
* *Males \> 60 y.o.**
* Bilateral (Both Testes)
* Usually **Diffuse Large β-cell Type**
* **No Tumor Markers**
* **Prognosis is Poor**
Malignant Lymphoma
27
* **Acute inflammation of the Prostate**
* Intraprostate **Reflux of Urine** from **Posterior urethra** or **Urinary bladder**
* A/w Acute cystitis
* Usually due to Bacteria
* ***Chlamydia trachomatis* and *Neisseria gonorrhoeae*
- -\> Young Adults (\< 35 y.o.)**
* ***Escherichia coli* and *Pseudomonas*
- -\> Older Adults (\> 35 y.o.)**
* Dysuria w/ Fever and Chills
* Prostate is **Tender and Boggy** on **Digital Rectal Exam**
* **Prostatic secrtions show WBCs --\> Bacteria**
Acute Prostatitis
28
* **Chronic inflammation of the Prostate**
* **Dysuria w/ Pelvic** or **Lower Back Pain**
* Common in **Bicycle riders**
(Seat compression on the Prostate)
* Prostatic secretions show WBCs --\> Negative cultures
* **Abacterial**
Chronic Prostatitis
29
* **Hyperplasia of Prostatic Stroma** and **Glands**
* **Age-related** change (Men \> 60 y.o.)
* **NO increased risk for Cancer**
* **A/w Dihydrotestosterone (DHT)**
* **5α-reductase (Stromal cells)** converts **Testosterone** --\> **DHT in Stromal cells**
* **DHT** --\> Androgen receptor of Stromal and Epithelial cells --\> **Hyperplastic nodules**
* **Transitional (Glandular hyperplasia)** and **Central Periurethral zone (Stromal hyperplasia)** of the Prostate
* **Starting / Stoping urine stream** and **Dribbling**
* Impaired bladder empything --\> Infections and Hydronephrosis --\> **Postrenal Azotemia** --\> Renal Failure
* Hypertrophy of Bladder Smooth muscle --\> Diverticula
* Microscopic Hematuria, **Nocturia, Dysuria**
* PSA (prostate-specific-antigen) often elevated
Benign Prostatic Hyperplasia
| (BPH)
30
Treatment for Benign Prostatic Hyperplasia
Tx for BPH
* **Avoid Caffeine** or **Foods** that exacerbate symptoms
* **α1-antagonist** (Terazosin to relax Smooth muslce)
* Relaxes vascular Smooth Muscle Lower BP
* α1-antagonist (Tamsulosin) are used in Normotensive Individuals to avoid α1B effects on Blood vessels
* **5α-reductase inhibitor**
* Blocks conversion of Tesosterone --\> DHT
* Takes months to produce results
* Useful for Male pattern baldness
* S/E Gynecomastia and Sexual Dysfunction
* **Saw Palmetto**
31
* Malignant proliferation of Prostatic Glands
* Most common cancer in Men (2nd most cancer-death)
* Age, Race (Black \> White \>\> Asian), Diets in High Sat. Fat
* Most often Clinically silent
* Arises in the Peripheral-Posterior region --\> No urinary symptoms early on
* Screening begins at age 50 y.o. w/ DRE and PSA
* Normal serum PSA increases w/ age due to BPH (\>10)
* Decreased % free-PSA is suggestive of cancer
Prostate Adenocarcinoma
32
How do you Dx Prostate Adenocarcinoma?
* Prostatic biopsy is required to confirm the presence of Carcinoma
* Small, Invasive glands w/ prominant nucleoli
* Gleason grading system is based on Architecture alone and not by Nuclear atypia
* Two areas (1-5) are added to score (2-10)
* Higher = Worse prognosis
* Spread to Lumbar spine is common
- -\> Osteoblastic metastases
- -\> Lower Back Pain --\> Increased Serum Alkaline Phosphatase and Prostatic Acid Phosphate (PAP)
33
Testicular Tumor Markers?
* **α-Fetoprotein (AFP)**
* Yolk sac (enodermal sinus) tumor origin
* **Human chorionic gonadotropin (hCG)**
* Choriocarcinoma
* **Lactate Dehydrogenase**
* Nonspecific cancer enzyme
* Degree of elevation correlates w/ Tumor mass
34
Follicle-stimulating Hormone (FSH) in Male repro?
* Stimulates Spermatogenesis in the S
