Brs Pathology - Ch 18 Male Reproductive System

Front 1

define hypospadias

Back 1

- anomaly where the urethral meatus opens on the ventral surface of the penis

Front 2

define epispadias

Back 2

- anomaly where the uretral meatus opens on the dorsal surface of the penis
- less common than hypospadias

Front 3

define phimosis

Back 3

- abnormally tight foreskin that is difficult or impossible to retract over the glans
- can be congenital or result from inflammation or trauma

Front 4

define Peyronie disease

Back 4

- subcutaneous fibrosis of the dorsum of the penis
- older age group
- unknown etiology

Front 5

define priapism

Back 5

- intractable, often painful erection
- sometimes associated with venous thrombosis of the corpus cavernosa

Front 6

list the inflammatory diseases of the penis

Back 6

1. Balanitis
2. Syphilis
3. Gonorrhea
4. Chlamydia

Front 7

define Balanitis

Back 7

- inflammation of the glans penis
- associated with poor hygiene
- rare in circumcised men

Front 8

define Syphilis

Back 8

- caused by Treponema pallidum
- primary stage: chancre located on the glans penis or prepuce and heals in 2-6 wks
- without treatment, is followed by secondary or tertiary lues

Front 9

define Chancre

Back 9

- elevated, painless, superficially ulcerated, firm papule
- lasts 2-6 weeks

Front 10

Gonorrhea

Back 10

- caused by Nisseria gonorrhoeae (intracellular gram - diplococci)
- manifested by acute purulent urethritis
- can extend to the prostate and seminal vesicles
- can involve the epididymis
- rarely involves the testis

Front 11

n. gonorrhoeae

Back 11

- intracellular gram-neg diplococci

Front 12

chlamydia

Back 12

- common cause of nongonococcal urethritis
- can also cause epididymitis
- should be suspected when bacteria are not seen in the purulent erethral discharge

Front 13

list the neoplams of the penis

Back 13

1. Carcinoma in situ
- Bowen disease
- Erythroplasia of Queyrat
2. Bowenoid papulosis

Front 14

Bowen disease

Back 14

- Carcinoma in situ of the penis
- presents as a single erythematous plaque on the shaft or scrotum
- seen in uncircumsized men
- peak incidence: 50s
- evolves into invasive carcinoma in 10% of cases
- may also be associated with increased risk of visceral malignancy

Front 15

Erythroplasia of Queyrat

Back 15

- carcinoma in situ of the penis (like Bowen disease)
- single erythematous plaque seen on the glans or pepuce
- uncircumcized men in their 50s
- in 10% of cases, evolves inot invasive squamous cell carcinoma
- may be a variant of Bowen disease, but not associated with visceral malignancies

Front 16

Beowenoid papulosis

Back 16

- a neoplasm of the penis
- histologically resembles the carcinoma in situ diseases (Bowen & Ery. of Queyrat)
- presentation: multiple verrucoid lesions looking like condyloma acuminatum that contain HPV type 16 sequences
- affects younger men
- considered premalignant, but does not progress to invasive carcinoma

Front 17

carcinoma of the penis

Back 17

- penile cancer is most often squamous cell carcinoma
- disease is rare in circumcised men
- incidence is greatest in far east, africa, and central america
- associated with poor personal hygiene and veneral disease
- associated with HPV 16, 18, 31, 33

Front 18

define cryptorchidism

Back 18

- developmental failure of testes to descend
- assocaited with increased incidence of germ cell tumors, esp seminoma and embyronal carcinoma
- associated with testicular atrophy and sterility

Front 19

define torsion of the spermatic cord

Back 19

- compromises blood supply
- can result in testicular gangrene

Front 20

define hydrocele

Back 20

- serous fluid filling and distending the tunica vaginalis
- most often idiopathic (sometimes congenital)
- can be secondary to infection of lymphatic blockage by tumor
- can be differentiated from solid testicular tumors by transillumination

Front 21

how do you get a congenital hydrocele?

Back 21

- persistence of continuity of the tunica vaginalis with the peritoneal cavity

Front 22

hematocele

Back 22

- blood distending the tunica vaginalis
- caused by trauma
- sometimes due to tumor

Front 23

varicocele

Back 23

- varicose dilation of multiple veins of the spermatic cord

Front 24

spermatocele

Back 24

- sperm containing cyst
- often intratesticular

Front 25

testicular atrophy

Back 25

- etiology unknown
- can be associated with:
- orchitis, esp mumps orchitis
- trauma
- hormonal excess or deficiency
- cryptorchidism
- klinefelter syndrome
- chronic debilitating disease
- old age

Front 26

which hormonal disorders can cause testicular atrophy?

Back 26

- disorders of the hypothalamus or pit
- hormonal therapy (esp estrogens)
- cirrhosis of liver

Front 27

list the two inflammatory diseases of the testes

Back 27

- orchitis
- epididymitis

Front 28

orchitis

Back 28

- when bacterial, associated with epididymitis (can be caused by syphilis)
- when viral, due to mumps virus
- when bilateral, can result in sterility from atrophy of the seminiferous tubules. [Testosterone] decreased, but FSH and LH are increased

Front 29

epididymitis

Back 29

- more common than orchitis
- caused by:
- n. gonorrhoeae
- chlamydia trachomatis
- E. coli
- M. tub

Front 30

general description of testicular tumors

Back 30

- most often malignant
- more than 90% are of germ cell origin

Front 31

list the germ cell testicular tumors (of one histologic type)

Back 31

1. Seminoma
2. Spermatocytic seminoma
3. Embryonal carcinoma
4. Yolk sac tumor
5. Polyembryoma
6. Choriocarcinoma
7. Teratoma

Front 32

list the germ cell testicular tumors (of more than one histologic type)

Back 32

1. embryonal carcinoma and teratoma
2. choriocarcinoma and any other type
3. other combinations

Front 33

list the stromal sex-cord testicular tumors

Back 33

1. Well differentiated:
- leydig cell
- sertoli cell
- granulosa cell
2. Mixed forms
3. incompletely differentiated forms

Front 34

what percentage of testicular germ cell tumors are of one histologic type?

Back 34

- more than 90% of tumors are of germ cell origin

Front 35

Seminoma

Back 35

- MALIGNANT germ cell tumor
- analogus to dysgerminoma of the ovary
- msot frequent germ cell tumor (40% of G-C tumors)
- peak incidence: 30s
- painless enlargement of testis
- somtimes associated with increased hCG
- VERY RADIOSENSITIVE - can be cured even when there are metastasis to abdominal lymph nodes

Front 36

what is hCG associated with?

Back 36

- seminoma
- choriocarcinoma
- other germ cell tumors

Front 37

Embryonal carcinoma

Back 37

- MALIGNANT germ cell tumor
- analogous to embryonal carinoma of the ovary
- second most common germ cell tumor (20-30%)
- pain or metastasis on presentation
- increased serum hCG
- prognosis is much worse than seminoma

Front 38

Endodermal sinus (yolk sac) tumor

Back 38

- MALIGNANT germ cell tumor
- analogous to endodermal sinus tumor of the ovary
- peak incidence in infancy and early childhood
- increased serum a-fetoprotein

Front 39

what is a-fetoprotein associated with?

Back 39

- endodermal sinus tumor
- hepatocellular carcinoma

Front 40

Analogous tumors:
Male:
Seminoma
Embryonal carcinoma
Endodermal sinus

Back 40

Analogous tumors:
Female:
Dysgerminoma
Embryonal carcinoma
Endodermal sinus

Front 41

what are the three types of teratomas seen in testicular cancers?

Back 41

- mature: always malignant
- immature
- with malignant transformation (e.g. development of squamosu cell carcinoma within epidermoid compartment)

Front 42

teratomas

Back 42

- germ cell tumor derived from two ro more embryonic layers
- most frequently malignant
- contains many tissue types
- differentiated into mature, immature, and that with malignant transformation

Front 43

what are the tissue types seen in male teratomas?

Back 43

- cartilage islands
- ciliated epithelium
- liver cells
- neuroglia
- embryonic gut
- striated muscle

Front 44

mature teratoma

Back 44

- almost always malignant
- corresponding ovarian tumor (dermoid cyst) is always benign

Front 45

Choriocarcinoma

Back 45

- MALIGNANT germ cell tumor
- can occur as an element of other germ cell tumors
- analogous to choriocarcinoma of the ovary
- incidence peaks in 2nd to 3rd decades
- histology: cells that look like syncytiotrophoblasts and cytotrophoblasts; also secretes hCG

Front 46

syncytiotrophoblast

Back 46

multinucleated cells found in the placenta of human embryos.

They are the outer syncytial layer of the trophoblasts and actively invade the uterine wall.

They form the outermost fetal component of the placenta (also known as syntrophoblast) and massively increase the surface area available for nutrient exchange between the mother and the fetus.

Front 47

what does the syncytiotrophoblast secrete?

Back 47

hCG

Front 48

cytotrophoblast

Back 48

is the inner layer of the trophoblast, interior to the syncytiotrophoblast.

Cytotrophoblasts are stem cells in the chorionic villous. During differentiation, mononuclear cytotrophoblast fuse together into the multinucleated syncytiotrophoblasts.

Front 49

mixed germ cell tumors

Back 49

- varying combinations of germ cell tumor types
- variable prognosis det by the least mature element
- can be teratocarcinoma: a combo of teratoma and embryonal carcinoma associated with poor prognosis

Front 50

what are other combinations seen in mixed germ cell tumors?

Back 50

- teratoma, embryonal carcinoma, seminoma
- embryonal arcinoma and seminoma

Front 51

Leydig cell (interstitial) tumor

Back 51

- non-germ cell tumor derved from testicular stroma
- most often benign
- see intracytoplasmic Reinke crystals
- androgen producing (sometimes also estrogen and corticosteriod producing as well)
- associated with precocious puberty (children) and gynectomastia (adults)

Front 52

Sertoli cell tumor (androblastoma)

Back 52

- non-germ cell tumor derived from sex cord-stroma
- similar to sertoli-leydic cell tumor of the ovary
- usually benign
- doesn't have endocrine manifestations

Front 53

Reinke Crystals

Back 53

Rectangular, crystal-like inclusions, composed of protein, with pointed or rounded ends in the interstitial cells of the testis (Leydig cells) and hilus cells in the ovary. They are not found in the Leydig cells of other mammals.

Front 54

Anatomy of the prostate

Back 54

chestnut sized organ
- four groupings of glands: periurethral, transitional, central, peripheral

Front 55

periurethral, transitional, and central zones of the prostate

Back 55

- equivalent to the anterior, middle, and lateral lobes
- site of BPH

Front 56

peripheral zone of the prostate

Back 56

- peripheral zone of glands is equivalent to the posterior lobe
- site of carcinoma

Front 57

BPH

Back 57

- no relation to prostate cancer, although the two can coexist
- directly related to the action of DHT - a testosterone metabolite
- can be caused by age-related increase in estrogens
- hyperplasia of both glandular and fibromuscular stroma elements of prostate

Front 58

how is DHT synthesized?

Back 58

- 5a-reductase on testosterone
- inhibiting enzyme can treat BPH

Front 59

what happens to the uretha in BPH?

Back 59

- compressed on sides -> vertical slit

Front 60

what do you see with BPH?

Back 60

- distention and muscualr hypertorphy of the bladder
- can see bands of enlarged bladder muscle that form a characteristic trabeculae
- hydroureter adn hydronephrosis

Front 61

Adenocarcinoma of the prostate

Back 61

- very common
- occurs in older men
- use Gleason system of grading tumor
- arises from peripheral glands of prostate
- diagnosed by rectal exam
- adenocarcinoma can progress to bony osteoblastic metastasis

Front 62

what serum markers do you see with prostate cancer?

Back 62

- PSA- reflect a complexed form (bound to a1-antichemotrypsin) that is elevated in prostate cancer; the unbound form is increased with BPH
- can see increased prostatic acid phophatase when tumor penetrates the capsule into surrouding tissue

Front 63

what serum markers do you see when prostatic cancer progresses to bony osteoblastic metastasis?

Back 63

- increase in serum alkaline phosphatase
- an indicator of osteoblastic lesions
- virtually ensures that the osteoblastic tumors came from the prostate

Front 64

how do you treat disseminated prostate adenocarcinoma?

Back 64

- endocrine therapy, b/c tumor growth is related to androgen activity