Male Genital System Pathology

Front 1

Hypospadias

Back 1

• Opening of urethra on inferior surface of penis
• Due to failure of urethral folds to close

Front 2

Epispadias

Back 2

• Opening of urethra on superior surface of penis
• Due to abnormal positioning of genital tubercle
• Associated with bladder exstrophy

Front 3

Condyloma Acuminatum

Back 3

• Benign warty growth on genital skin
• Due to HPV type 6 or 11
• Characterized by koilocytic change

Front 4

Lymphogranuloma venereum

Back 4

• Necrotizing granulomatous inflammation of the inguinal lymphatics and lymph nodes
• STD caused by Chlamydia
• Eventually heals with fibrosis; perianal involvement may results in rectal stricture

Front 5

Risk factors for squamous cell carcinoma of penis

Back 5

• High risk HPV (2/3 of cases)
• Lack of circumcision - foreskin acts as a nidus for inflammation and irritation if not properly maintained

Front 6

Bowen disease

Back 6

In situ carcinoma of penile shaft or scrotum that presents as leukoplakia

Front 7

Erythroplasia of Queyrat

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in situ carcinoma on the glans that presents as erythroplakia

Front 8

Bowenoid papulosis

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• in situ carcinoma that presents as multiple reddish papules
• Seen in younger patients (40s) relative to Bowen disease and erythroplasia of Queyrat
• does not progress to invasive carcinoma

Front 9

Most common congenital male reproductive abnormality

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Cryptochordism (1% of male infants)

• most cases resolve spontaneously; otherwise orchiopexy is performed before 2 years of age

Front 10

Causes of orchitis

Back 10

• Chlamydia trachomatis (serotypes D-K) or N. gonorrhoeae - young adults; increased risk of sterility
• E. coli and Pseudomonas - older adults; UTI pathogens spread to repro tract
• Mumps virus - teens, increased risk for infertility
• Autoimmune orchitis

Front 11

What characterizes autoimmune orchitis?

Back 11

Granulomas involving the seminiferous tubules

Front 12

Usual cause of testicular torsion

Back 12

Congenital failure of testes to attach to inner lining of scrotum (via the processes vaginalis)

Front 13

How does testicular torsion usually present?

Back 13

In adolescents with sudden testicular pain and absent cremasteric reflex

Front 14

Varicocele

Back 14

• Dilation of spermatic vein due to impaired drainage
• Presents as scrotal swelling with 'bag of worms' appearance
• Seen in large percentage of infertile males

Front 15

Which side does varicocele usually occur on?

Back 15

• Usually left sided
• Left testicular vein drains into left renal vein, while right testicular vein drains directly into IVC
• Associated with left-sided renal cell carcinoma, which often invades the renal vein

Front 16

Hydrocele

Back 16

• Fluid collection within the tunica vaginalis
• Associated with incomplete closure of processus vaginalis leading to communication with the peritoneal cavity (infants) or blockage of lymphatic drainage (adults)
• Presents as scrotal swelling that can be transilluminated

Front 17

How do testicular tumors usually present?

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As firm, painless masses that cannot be transilluminated

Front 18

Most common type of testicular tumor (>95%)

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• Germ cell tumor
• Usually occurs between 15 and 40 years of age
• Divided into seminomas and nonseminomas

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Risk factors for germ cell tumors

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Cryptochordism and Klinefelter syndrome

Front 20

Seminoma

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• Malignant tumor comprised of large cells with clear cytoplasm and central nuclei (resemble spermatogonia)
• Forms homogenous max with no hemorrhage or necrosis
• Most common testicular tumor (55% of germ cell tumors)
• Resembles ovarian dysgerminoma
• rare cases may produce B-hCG

Front 21

prognosis of seminoma

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Excellent - high responsive to radiotherapy, metastasize late

Front 22

Prognosis of nonseminomas

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Show variable response to treatment and often metastasize early

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Embryonal carcinoma

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• Malignant tumor comprised of immature, primitive cells that may produce glands
• Forms hemorrhagic mass with necrosis
• Aggressive with early hematogenous spread
• Chemo may result in differentiation into another type of germ cell tumor (e.g. teratoma)
• Increased AFP or B-hCG may be present

Front 24

Yolk sac (endodermal sinus) tumor

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• Malignant tumor that resembles yolk sac elements
• Most common testicular tumor in children
• Schiller-Duval bodes seen on histo
• AFP characteristically elevated

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Choriocarcinoma

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• Malignant tumor of syncytiotrophoblasts and cytotrophoblasts (placenta-like tissue but villi absent)
• Spreads early via blood
• B-hCG is characteristically elevated: may lead to hyperthyroidism or gynecomastia (a-subunit of hCG is similar to that of FSH, LH, and TSH)

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Teratoma

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• Tumor composed of mature fetal tissue derived from two or three embryonic layers
• Malignant in males (as opposed to females)
• AFP or B-hCG may be increased

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Mixed germ cell tumors

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

Front 28

Leydig cell tumor

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• Sex cord-stromal tumor
• Usually produces androgen, causing precocious puberty in children or gynecomastia in adults
• Reinke crystals may be seen on histo

Front 29

Sertoli cell tumor

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• Sex cord-stromal tumor
• Composed of tubules and is usually clinically silent

Front 30

Most common cause of testicular mass in males > 60 years old

Back 30

Lymphoma

• often bilateral
• usually of diffuse large B-cell type

Front 31

Acute prostatitis

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Acute inflammation of prostate usually due to bacteria (Chlamydia and gonorrhoeae in young adults; E. coli and Pseudomonas in older adults)

Front 32

How does acute prostatitis present?

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• Dysuria with fever and chills
• Prostate is tender and boggy on DRE
• Prostatic secretions show WBCs; culture reveals bacteria

Front 33

Chronic prostatitis

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• Chronic inflammation
• Presents as dysuria with pelvic or low back pain
• Prostatic secretions show WBCs but cultures are negative

Front 34

Where does BPH occur?

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central periurethral zone of the prostate

Front 35

Which hormone is BPH related to?

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DHT, which acts on the androgen receptor of stromal and epithelial cells resulting in hyperplastic nodules

Front 36

Effect of BPH on bladder

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Hypertrophy of bladder wall smooth muscle; increased risk for bladder diverticula

Front 37

Treatment for BPH

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α1-antagonist or 5α-reductase inhibitor

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α1-antagonist (eg terazosin)

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• Relaxes smooth muscle
• Also relaxes vascular smooth muscle lowering blood pressure
• Selective α1A-antagonist (eg tamsulosin) are used in normotensive individuals to avoid α1B-antagonist effects on blood vessels

Front 39

5α-reductase inhibitor

Back 39

• Blocks conversion of testosterone to DHT
• Takes months to produce results
• Also useful for male pattern baldness
• Side effects are gynecomastia and sexual dysfunction

Front 40

Most common cancer in men (and 2nd most common cause of cancer-related death)

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Prostate adenocarcinoma

Front 41

Risk factors for prostate adenocarcinoma

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Age, race (black > white > asians) and diet high in saturated fats

Front 42

Why is prostate adenocarcinoma often clinically silent?

Back 42

Usually arises in the peripheral, posterior region of the prostate and, hence, does not produce urinary symptoms early on

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Screening for prostate cancer

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• Begins at age 50 with DRE and PSA
• Normal serum PSA increases with age due to BPH but a level > 10 ng/mL is highly worrisome
• Decreased % free-PSA is suggestive of cancer (cancer makes bound PSA)

Front 44

What is seen in prostatic biopsy when cancer is present?

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Small, invasive glands with prominent nucleoli

Front 45

Gleason grading system

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• Based on architecture alone (and not nuclear atypic)
• Multiple regions of tumor are assessed because architecture varies from area to area
• A score (1-5) is assigned for two distinct areas and then added to produce a final score (2-10)
• Higher score suggests worse prognosis

Front 46

Where is spread of prostate cancer common?

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To lumbar spine or pelvis; results in osteoblastic metastases that present as low back pain and increased serum alkaline phosphatase, PSA, and prostatic acid phosphatase (PAP)

Front 47

How is prostate cancer treated?

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• Prostatectomy is performed for localized disease
• Advanced disease is treated with hormone suppression to reduce testosterone and DHT

Front 48

Hormone suppression in prostate cancer treatment

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• Continuous GnRH analogs (eg leuprolide) shut down the anterior pituitary gonadotrophs (LH and FSH and reduced)
• Flutamide acts as a competitive inhibitor at the androgen receptor

Back 49

hemorrhagic infarction in testicular torsion

Back 50

hydrocele

Front 51

Why aren't testicular tumors biopsied?

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Because there is a risk of seeding the scrotum and most testicular tumors are germ cells tumors (which means they're malignant anyways)

Back 52

seminoma

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seminoma (homogenous mass with no hemorrhage or necrosis)

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embryonal carcinoma (gland is circled)

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embryonal carcinoma (N for the portion that is normal)

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Schiller-Duval body in a yolk sac tumor

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Choriocarcinoma (cytotrophoblasts smaller, syncytiotrophoblasts larger)

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normal prostate

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hydronephrosis

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prostate adenocarcinoma (note prominent nucleoli)

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Osteoblastic metastasis involving lumbar spine