Endocrine Disease

Prostate zones

• Central zone (wrapped around urethra)

• Transition Zone

• Peripheral Zone

Prostatitis types and subtypes

1) Bacterial : Acute or chronic

2) Abacterial : Chronic pelvic pain syndrome, inflammatory and non inflammatory cases

SX DX AND TX of bacterial prostatitis

Sx : Sudden (acute) fever / recurrent UTI (chronic), dysuria, perineal pain

Dx : Urine and blood test, Digital Rectal Examination

Tx : Antibiotics

Chronic pelvic pain syndrome SX TX Dx

Sx : Chronic pain in perineum, suprapubic area and penis

Dx : by exclusion

Tx : Empiric

BPH cause and morphology

Cause : Unkiwn but androgens like dht play major role

Morphology : Capillary structure in gland + Nodularity (proliferation in TZ) causing partial or complete obstruction of urethra

BPH Sx Dx Tx

Sx : urinary tract obstruction, nocturia, dysuria (in 10% of all cases)

Dx : DRE

Tx : 5a reductase i, a1 adrenoreceptors, TURPs (surgery)

Prostate carcinoma morphology and microscopy

Undifferentiated white mass usually in peripheral zone

small glands, enlarged promknent nuclei w dark cytoplasm + outer basal layer absent

Prostatic intraepithelial neoplasia what and microscopy

Hyperplasia of gland wo imvading prostate

increased nuclear-cytoplasmic ratio

Gleason system to grade PCa

Gleason grade of differentiation from grade 1 (well) to 5 (poor)

gleason score by sum of 2 commenest pattern used for tx and prognosis

PCa staging

T : size and extent if primary tumour

N : spread to regional LN

M : metastases

PCa clinical features, Dx

Sx : Asymptomatic until late state, then occasion lower back pain

Dx : PSA test (x2 positive as non specific for cancer) then DRE

Tx : Surveillance (not severe) / Surgey + radiotherapy (confined) / chemo if not confined

Scrotal swelling causes

• accumulation

• infection (epididymis / testis)

• Tumours

• Hernias

4 Examples of scrotal swelling by accumulation

• hydrocele : collection of serous fluid in tunica vaginalis

• haematocele : collection of glood in tunica vaginalis

• spermatocele : cystic dilation of ducts of epididymis

• varicocele : varicosity of pampinifprm plexus around spermatic cord

Cryptochidism what, tx and microscopy

Incomplete descend of testes, normally bilateral (from abdomen to scrotum)

tx by orchiopexy around 18months as can resolve by itself

tubular atrophy and leydig cell hyperplasia

Torsion what types and tx

Twisting of spermatic cord rssulting in venous drainage

neonatal torsion or adult torsion due to bell clapper abnormality

Orchiopexy around 6 hours to prevent atrophy and necrosis

Germ cell tumours of testicle types and feature

Malignant tumours w risk in pt w cryptochidism, intersex syndrome and FH

Extra copy of short arm of chr 12

seminoma (localised) or non seminomatous (easy to metastasise)

Seminoma pathology (gross and micro)

Gross : grey, cream/pale pink, soft lobulated +well demarcated mass

micro : large uniform cell w distinct cell border, demarcated by fibrous septa + lymphocytic infiltration

Non seminomatous tumour types

• embryonal carcinoma

• yolk sav tumour

• teratoma

• choriocarcinoma

embryonal carcinoma pathology

gross: ill defined invasive mass, foci of haemorrhage and necrosis

micro : large tumour cells with basophilic cytoplasm

Yolk sac tumour pathology and biomarker

gross : large and well demarcated

micro : variable architecture with schiller duval bodies (resembling primitive glomeruli)

biomarker : AFP

Teratoma what and pathologies

Neoplastic germ cells differentiating along multiple somatic cell lineages

solid and multicystic

hetergenous collection of differentiated cells immersed in stroma

choriocarcinoma micro and biomarker

malignant pluripotent neoplastic cells that resemble cytotrophoblast/synctiotrophiblas like cells

HCg biomarker

Sex cord stromal tumours types

1) leydig cell tumours

2) sertoli cell tumours