Pathology Scrotum/Prostate

most common diseases of prostate

BPH (benign prostatic hyperplasia)

prostate cancer (2nd most common cancer in men)

prostatitis (inflammation/infection of prostate cause by bacteria)

once PSA is elevated, US used to screen for massed

prostate anatomy

largest accessory gland of male repro. system

base: closet to bladder, includes parts of all zones

mid gland: in middle, include peripheral & transitional zone

apex: most inferior part, mostly peripheral & some trans. zone

prostate zones

4 total

peripheral: 70%

central: 25%

transitional (2): 5%

mullerian duct cysts

most common cyst of pelvis

b/w bladder & rectum, large w/smooth borders

seminal vesicle cyst

rare w/incidence of 0.0005% of population

if found, kidneys should the be evaluated

smaller & more lateral than mullerian duct cysts

utricle cysts

associated w/undescended testicles & renal abnormalities

located midline

prostatic cyst

retention cysts are acquired cysts resulting in obstruction of glandular ductules causing dilation of the acini

prostate abscess

can develop secondary to prostatitis but is rare

calcification in seminal vesicle

extremely rare

diabetes & senile atrophy are most common reason for it

prostatic calcifications

common finding especially after 50, usually occur in clusters

thought to be associated w/prostatitis, chronic pelvic pain syndrome, & prostate cancer

BPH

benign prostatic hyperplasia

noncancerous enlargement of prostate & most common benign tumor in men

most common in transitional zone

Transurethral Resection (TURP)

used to treat BPH

cystoscope placed in urethra & guided into bladder. center of prostate identified & obstructing tissue is resected until all obstructing tissue is removed

prostatitis

inflammation/infection usually from bacteria

can affect all ages

acute or chronic

symptoms of pain

prostate cancer

most common non-skin cancer

PSA test is leading method of screening for it

prostate biopsy

2 methods:

transrectal: more common & less painful but greater infection risk

transperineal: generally for radiotherapy seed placement

brachytherapy seeds

seed implants are a form of low-dose radiation (LDR) therapy

most common & effective way of treating prostate cancer

infertility

azoospermia- absence of sperm

blockage of ejaculatory ducts

normal testes size

length = 3-5 cm in sag 2-3 cm in trans

cryptorchidism

undescended testes

usually in inguinal canal

associated w/infertility

seminoma

type of cancer that begins in germ cells in males (cells that form sperm)

undescended testes is major risk factor for germ cell tumors

acute painful scrotum

common clinical problem

causes: epididymitis, epididymo-orhcitis, testicular torsion, abscess, trauma

testicular torsion

20% of scrotal disease most often w/ ages 12-18

twisting of the spermatic cord resulting in venous congestion

early diagnosis crucial b/c surgical procedure is required

Longer you wait, lower chances of successful salvage

2 types of testicular torsion

intravaginal: occurs inside tunica vaginalis

extravaginal: occurs out of tunica vaginalis

Phase:

acute (w/in 24 hours)

subacute (1-10 days)

chronic ( >10 days)

acute testicular torsion

infected testis may be slightly enlarged

torsion of appendages

b/w 7-14 is peak

scrotal pain w/ no effect on vascularity

testicular rupture

when tunica albuginea is torn from trauma (a break in testicular parenchyma)

the tail is most affected region

associated w/ athletic injuries

early diagnosis is critical or could cause loss of spermatogenesis

usually results in hemorrhage

epididymitis

inflammation of epididymis cause by bacterial infection

commonly caused by chlamydia

swollen, red, warm scrotum, painful urination,

40% of post-vasectomy patients

epididymo-orchitis

inflammation of epididymis & testicle

can happen when epididymitis left untreated

can lead to fournier gangrene

most common cause of acute scrotal pain

fournier gangrene

acute necrotic infection of scrotum

thickening of scrotal skin

US detects gas bc it becomes palpable

prompt medical/surgical treatment

orchitis

isolated inflammation of testicle

rare usually from mumps or AIDS

testicular tuberculosis

rare form of TB

swelling & possible infertility

testicular cancer

1% of all cancer in men presents as painless lump or swelling

intratesticular solid mass: malignant until proven otherwise

extratesticular mass: mostly benign

hydrocele

non-painful scrotal mass

cystic mass w/snowflake echoes

epididymal cyst

throughout epididymis & contain serous fluid

most common epididymal lesion

spermatoceles

most common in epididymal head

sperm granuloma

chronic inflammatory reaction

most seen in patients with vasectomy

tubular ectasia of rete testis

common in men older than 50

dilated tubules, fluid-filled

associated w/epididymal cysts & spermatoceles

varicocele

dilation of pampiniform plexus > 2mm (in spermatic cord)

primary & secondary type

usually on left side

extra vascular

scrotal hernia

scrotal mass, abdominal pain, blood in stool

scrotal abscess

most common complication of untreated epididymo-orhcitis

usually painful, swollen

testicular hematoma

blood collection outside vessel

extratest.- blood collects beneath

intratest.- blood collects within

hematocele

accumulation of blood

from surgery, trauma, etc.

pyocele

accumulation of pus

tunica albuginea cyst

painless scrotal lump

small cysts

cyst with milk of calcium

hyperechoic cyst with calcium salts

extratesticular neoplasms

most are benign

common within epididymal tail

leiomyomas

rare, small, usually in tail

lipomas

most common extratesticular neoplasm involving spermatic cord

epidermoid cyst

most common benign testicular neoplasm

looks like onion ring

leydig tumors

can be benign or malignant

solid masses

intratubular testicular calcification

microcalcifications

increased risk for cancer

malignant neoplasms

testicular cancer: 90-95% start in germ cells

most are curable/treatable

things that can mimic neoplasms

abscess

hematima

focal orchitis

testicular infarcts

torsion

rhabdomyosarcomas

most common malignancy involving epididymis & spermatic cord

seminoma

most common pure germ cell tumor

embryonal cell carcinoma

2nd most common histological testicular tumor after seminoma

most aggressive

choriocarcinoma

rare germ cell with worst prognosis

teratomas

second most common testicular neoplasm in children

more commonly mature teratomas

contain multiple elements: soft tissue, bone, skin, cartilage

yolk sac tumor

80& of testicular tumors

babies under 2 years old

metastasis to testis

leukemia (most common)

lymphoma (5%)

prostate (most common solid tumor origin)