[08.19b] Pathology of the Male Genital System Part 2 V2.2.pdf

Leydig Cell Tumor

What type of sex cord-gonadal stromal tumor may elaborate androgens or a combination of androgens and estrogen?

20 to 60 years

In what age range do most Leydig cell tumors arise?

Gynecomastia

What clinical manifestation of Leydig cell tumors is characterized by enlargement of the breasts?

Elevation in estrogen levels

What causes gynecomastia in patients with Leydig cell tumors?

Sexual precocity

What dominant feature is observed in children with Leydig cell tumors due to hormonal effects?

Benign

Are most Leydig cell tumors benign or malignant?

10 percent

What percentage of Leydig cell tumors in adults become invasive and produce metastases?

Granular eosinophilic cytoplasm

What is the appearance of the cytoplasm in Leydig cell tumor cells?

Lipid granules, vacuoles, or lipofuscin

What three items can be found within the cytoplasm of a Leydig cell tumor?

Yellow wear-and-tear pigments

What are lipofuscin pigments?

Crystalloids of Reinke

Which rod-shaped structures are found in approximately 25 percent of Leydig cell tumors?

Humans

In which species are Crystalloids of Reinke exclusive?

Interstitial cells of Leydig

In which specific cell type are Reinke crystals found?

Androblastoma

What is another name for a Sertoli cell tumor?

Inside seminiferous tubules

Where are Sertoli cells normally located?

Supporting cells

What is the primary role of Sertoli cells for developing germ cells?

Resemble immature seminiferous tubules

What histological tendency do Sertoli cell tumors exhibit?

Basement membrane

In a Sertoli cell tumor, neoplastic cells are arranged in tubules surrounded by what?

Intratubular germ cell neoplasia (ITGCN)

What is the carcinoma in situ stage that precedes most testicular germ cell tumors?

Germ cells

From what cell type do 95 percent of testicular tumors originate?

Seminomas

Which category of adult testicular germ cell tumors accounts for 40 to 50 percent of cases?

Nonseminomatous germ cell tumors (NSGCTs)

Which category of adult testicular germ cell tumors accounts for 35 percent of cases?

Yolk sac tumor, teratoma, embryonal carcinoma, and choriocarcinoma

List the four main types of NSGCTs.

Mixed cell tumors

What is the term for testicular tumors where seminomatous elements are intermixed with NSGCTs?

15 percent

In what percentage of cases do mixed cell tumors occur?

Yolk sac tumor of childhood, childhood teratomas, and spermatocytic seminomas

Which three mixed cell tumors develop without passing through a pre-invasive ITGCN stage?

5 percent

What percentage of testicular tumors originate from sex cord-gonadal stromal cells?

Adenomatoid tumor

What is the most common benign paratesticular tumor?

Mesothelial cells of the tunica vaginalis

From which cells is an adenomatoid tumor derived?

Non-Hodgkin Lymphoma

What type of lymphoma accounts for 5 percent of testicular neoplasms?

Men older than 60

In which population is testicular lymphoma the most common form of testicular tumor?

Diffuse large B cell lymphoma

What is the most common histologic type of testicular lymphoma?

CD19 or CD20

Which immunohistochemical markers identify B-cell lymphoma?

CD3

Which immunohistochemical marker identifies T-cell lymphoma?

Extremely poor

What is the prognosis for testicular lymphoma?

Disseminated disease

What is usually already present at the time a testicular lymphoma mass is detected?

Hydrocele

What is the most common cause of scrotal enlargement?

Serous fluid

What substance accumulates within the tunica vaginalis in a hydrocele?

Transillumination

What technique involves shining a light through the scrotum to differentiate a hydrocele from a tumor?

Hematocele

What is the accumulation of blood within the tunica vaginalis called?

Chylocele

What is the accumulation of lymphatic fluid within the tunica vaginalis called?

Elephantiasis

In what condition, often caused by filariasis, are chyloceles found?

Lymphatic obstruction

What is the primary cause of elephantiasis?

Spermatocele

What is the cystic accumulation of semen in the efferent ducts or rete testis called?

Mediastinum testis

In what specific location is the rete testis found?

Varicocele

What is the term for a dilated vein in the spermatic cord?

Infertility

Varicoceles are implicated as a contributing factor for what condition?

Surgical repair

How is a varicocele typically corrected?

20 grams

What is the normal weight of a human prostate?

Retroperitoneal

In what anatomical space is the prostate located?

Encircles the neck of the bladder and urethra

What is the anatomical position of the prostate relative to the bladder?

Peripheral, central, transitional, and anterior fibromuscular stroma

List the four zones of the prostate.

Transitional zone

In which prostate zone does most hyperplasia originate?

Peripheral zone

In which prostate zone do most carcinomas originate?

Hard

How does the prostate feel during a Digital Rectal Exam in cases of carcinoma?

Compound tubuloalveolar

What is the histological classification of the prostate organ?

Basal cuboidal layer and columnar secretory layer

What are the two layers of cells lining the prostatic glands?

Myoepithelial cells

What is another term for the basal layer cells in the prostate?

Fibromuscular stroma

What substance separates the prostatic glands?

Ejaculation

The prostate contracts during which physiological process?

Acute bacterial prostatitis

Which inflammation results from UTI-causing bacteria like E. coli or staphylococci?

Intraprostatic reflux of urine

What is the most common way infectious agents are implanted in acute bacterial prostatitis?

Posterior urethra or urinary bladder

From where does the urine reflux in acute bacterial prostatitis?

Minute abscesses or large focal necrosis

List two potential histological appearances of acute bacterial prostatitis.

Tender and boggy

How is the prostate described during a DRE in acute bacterial prostatitis?

Urine culture

What is the primary diagnostic for acute bacterial prostatitis?

Chronic bacterial prostatitis

Which condition is characterized by a history of recurrent UTIs caused by the same organism?

Antibiotics penetrate the prostate poorly

Why is chronic bacterial prostatitis difficult to treat?

Parenchyma

Where do bacteria find a safe haven in chronic bacterial prostatitis?

Chronic abacterial prostatitis

What is the most common form of prostatitis seen clinically?

Negative

What is the status of bacterial cultures in chronic abacterial prostatitis?

More than 10 WBCs per hpf

What diagnostic finding in prostatic secretions indicates chronic abacterial prostatitis?

Granulomatous prostatitis

What form of inflammation can be caused by the instillation of BCG for bladder cancer?

Bacillus Calmette-Guerin

What does BCG stand for?

Superficial bladder cancer

BCG is used for the treatment of what condition?

Local cell-mediated immune reaction

How does BCG work to destroy tumor cells?

Immunocompromised patients

In what population is fungal granulomatous prostatitis typically seen?

Reaction to secretions from ruptured ducts and acini

What causes non-specific granulomatous prostatitis?

Nodular hyperplasia (NPH)

What is another name for Benign Prostatic Hyperplasia?

Men over the age of 50

In what population is BPH most common?

50 percent

What percentage of men with microscopic evidence of NPH actually develop symptoms?

Periurethral region

In which specific region of the transition zone do the nodules form in BPH?

Narrowing of the urethral canal

What is the direct mechanical effect of BPH nodules?

Slit-like lumen

What shape does the prostatic urethra take when compressed by BPH?

Dribbling, hesitancy, frequency, and incomplete voiding

List four classic urinary symptoms of BPH.

Androgen action

Prostate enlargement in BPH is related to the action of what?

Dihydrotestosterone (DHT)

What is the ultimate mediator of prostatic growth?

Type 2 5-alpha reductase

Which enzyme converts testosterone to DHT in the prostate?

Stromal cells

In which cells is type 2 5-alpha reductase primarily found?

Growth factors

DHT stimulates the transcription of genes resulting in increased production of what?

Increases stromal cell proliferation and decreases epithelial cell death

What are the two effects of DHT-induced growth factors?

10 times

How much more potent is DHT compared to testosterone?

DHT dissociates from the receptor more slowly

Why is DHT more potent than testosterone?

Alpha-1 adrenoreceptor

Which receptor in the stroma mediates smooth muscle contraction in the prostate?

Alpha-adrenergic receptor antagonists

What class of medication is used to relieve urinary obstruction in BPH?

60 to 100 grams

What is the typical weight of a prostate with BPH?

Yellow-pink and soft

What is the appearance of nodules characterized by glandular proliferation?

Pale gray, tough, and hard

What is the appearance of nodules characterized by fibromuscular proliferation?

Papillary epithelial infoldings

In NPH, hyperplastic glands often show what type of internal histological structures?

Corpora amylacea

What prostatic concretions are associated with age and seen in the lumens of hyperplastic glands?