Repro-Endo: Male Repro Pathology Flashcards Preview

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Flashcards in Repro-Endo: Male Repro Pathology Deck (34):
1

  • 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

Hypospadias

2

  • 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

Epispadias

3

  • Benign, Warty growth on Genital skin
  • HPV 6 or HPV 11
  • Characterized by Koilocytic change --> "Raisen" appearing nuclei

Condyloma Acuminatum

4

  • 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

Lymphogranuloma Venereum

5

  • 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

Penile Squamous Cell Carcinoma

6

  • 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

Bowen disease

7

  • In situ Carcinoma of the Glans of the Penis (Mucosal Surface) that presents as Erythroplakia
  • Precursor for Invasive SCC of Penis
  • HPV 16

Erythroplasia of Queyrat

8

  • 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

Bowenoid papulosis

9

  • 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)

Cryptorchidism

10

  • Inflammation of the Testicle
    • Chlamydia trachomatis (serotypes D-K)
    • Neisseria gonorrhoeae 
    • Increased risk of sterility
    • Libido is not affected because Leydig cells are spared

Orchitis of Young Adults < 35 y.o.

Tx: Ceftriaxone + Doxycycline 

11

  • Inflammation of the Testicle
    • Escherichia coli
    • Pseudomonas
    • A/w Urinary tract infection
    • Pathogens spread to Reproductive tract

Orchitis of Older Adults > 35 y.o.

Tx: Ciprofloxacin Extended Release

12

  • Inflammation of the Testicle
    • Mumps virus
    • Increased risk of Infertility
    • Testicular inflammation is usually not seen in Children < 10 y.o.

Orchitis of Teenage Males

13

  • Testicular Inflammation
    • Characterized by Granulomas involving the Seminiferous tubules

Autoimmune Orchitis

14

  • 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

Testicular Torsion

15

  • 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

Variococele

16

  • 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 

Hydrocele

17

  • 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 

Basics of Testicular Tumors

18

  • 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

Germ Cell Tumors

19

  • 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)

Germ Cell - Seminoma

20

  • 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)

Embryonal Carcinoma

21

  • 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

Yok sac Tumor

(Endodermal sinus)

22

  • 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

Choriocarcinoma

23

  • 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)

Teratoma

24

  • Germ cell tumors are usually mixed
  • Prognosis is based on Worst component

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