Male Genitalia Pathology

what is the Complete or partial failure of testes to descend into scrotal sac?

CRYPTORCHIDISM

• Unilateral in most cases, 25% bilateral

• Asymptomatic

cryptorchidism descent of testes occurs in 2 phases. what are the 2 phases?

• phase 1: abdomen to lower pelvis by the 3rd month of gestation

• phase 2: inguinal canal to scrotum within the last 2 months intrauterine

in cryptorchidism, the testes may arrest anywhere along the pathway of descent but the most common site is…?

inguinal canal

when can cryptorchidism be diagnosed?

Diagnosis can only be established with certainty after 1 year of age because descent is not always complete at birth

what cases of cryptochordism can cause sterility?

bilateral (as undescended testes become atrophic)

• can still be sterile if unilateral (atrophy of descended gonad can also occur)

in cryptochordism there is a 3-5x increased risk for what type of cancer?

testicular (even if unilatera, contralateral testis is also at risk)

what is the treatment for cryptochordism?

Can be corrected with surgery

• Recommended by 18 months to decrease likelihood of atrophy, infertility, and testicular cancer

where is inflammation of testes most common?

More common in epididymis than in the testis proper (esp gonorrhea and TB)

what STD affects the testis first?

syphilis

what causes epididymitis in childhood?

congenital abnormality or infection with gram-negative rods

what causes epididymitis in men under 35?

sexually transmitted gonorrhea & chlamydia

what causes epididymitis in men over 35?

urinary tract pathogens- E. coli & pseudomonas

what is the inflammation of 1 or both testicles?

orchitis

what can cause orchitis?

mumps (20-30% of cases)

Nonspecific epididymitis and orchitis usually begin as ____ that spread to the testes via the ______

UTI; spermatic cord

is sterility possible in orchitis?

yes

what is a systemic viral infection that commonly affects school aged children?

mumps

is testicular involvement common in children with mumps?

no (post puberal males get orchitis more often)

viral orchitis from mumps develops 1 week after what initial symptom?

swelling of parotid glands

how is mumps virus transmitted?

saliva and respiratory droplets

testicular tumors occur in __ per 100,000 males

6

what are the 2 main categories of testicular tumors?

1. germ cell tumors

   1. seminomas

   2. non-seminomatous

2. sex-cord-stromal tumors

what category of testicular tumor is described below?

• Arise from Sertoli and Leydig cells

• Uncommon

• Usually benign

sex-cord-stromal tumors

what category of testicular tumor is described below?

• 95% of testicular tumors in post-pubertal males and almost all are malignant

• Family hx. is important

  • Brothers of patients have an 8-10x increased risk

• Lifetime risk is highest in Northern Europe and New Zealand and lowest in Africa and Asia

germ cell tumors

what is the most common type of germ cell tumor?

seminoma (50% of all germ cell neoplasms)

what sub-category of germ cell tumor is described below:

• Malignant

• Never occurs in infants

• Peak incidence-4th decade

• Produces bulky mass

• Gross appearance → Homogenous, gray-white cut surface

seminoma

seminoma

• Histopathology of SEMINOMA → Cells are large and round with distinct cell membrane, large central nucleus with prominent nucleo

what is the most common testicular tumor in infants and children up to 3 years old?

yolk sac tumor (but good prognosis in this age group)

what is a malignant, non-seminomatous germ cell tumor?

yolk sac tumor

Post pubertal yolk sac tumor more frequently occurs in combination with …?

embryonal carcinoma or other germ cell conditions

in yolk sac tumors, there is an increased/decreased serum alpha fetoprotein

increased

yolk sac tumor

• Have Schiller-Duvall bodies (resemble primitive glomeruli)

what are the 2 types of sex-cord tumors?

1. Leydig cell tumor

2. Sertoli cell tumor

what sub-cateogry of sex-cord tumors is described below?

• Occurs between ages of 20-60

• 5-10% are malignant

• Testicular swelling and/or gynecomastia

• Increase in androgens, estrogens, corticosteroids

Leydig cell tumor

what sub-cateogry of sex-cord tumors is described below?

• Presents as a testicular mass

• Can have gynecomastia as initial finding

• Up to 10% can be malignant

Sertoli cell tumor

what are the 4 zones of the prostate gland?

• PZ = PERIPHERAL ZONE

• TZ = TRANSITIONAL ZONE

• CZ = CENTRAL ZONE

• PUZ = PERIURETHRAL ZONE

in which zone of the prostate gland do most hyperplastic lesions occur?

transitional zone

in which zone of the prostate gland do most carcinomas occur?

peripheral zone

what is the most common bacteria that causes prostatitis?

E. coli

acute or chronic prostatitis?

• Can cause urinary tract infections

• Associated with fever, chills, dysuria

• Prostate is tender & boggy

acute

acute or chronic prostatitis?

• Usually associated with recurrent urinary tract infections bracketed by asymptomatic periods

• Presenting symptoms include low back pain, dysuria, and perineal and suprapubic discomfort

chronic

both acute and chronic prostatitis is treated with…?

antibiotics

the following are signs of what type of prostatitis?

• Signs and symptoms same as chronic bacterial

• No history of recurrent urinary tract infections

• Etiology is unknown, unsure if prostate is even related

• Prominent finding - pain during or after ejaculation

• Diagnosis of exclusion

Chronic abacterial prostatitis (Chronic pelvic pain syndrome)

what does diagnosis of exclusion mean?

a medical diagnosis made when all other possible causes of a patient's symptoms have been ruled out

histologic evidence of benign prostatic hyperplasia (BPH) is found in up to % of men by the age of 80

90%

benign prostatic hyperplasia (BPH) is a common cause of ….?

prostate enlargement and urinary obstruction

benign prostatic hyperplasia (BPH) can be a proliferation of what structures?

stromal or glandular strucutres

is benign prostatic hyperplasia (BPH) premalignant?

not premalignant

the etiology of benign prostatic hyperplasia (BPH) is unknown but studies show _________ may play a role

androgens (DHT-androgen derived from testosterone)

in which zone of the prostate does benign prostatic hyperplasia (BPH) begin?

transition zone (but can encroach on lateral walls of urethra to compress slit-like orifice)

what are symptoms of benign prostatic hyperplasia (BPH)?

• increased urinary frequency

• nocturia

• dysuria

• difficulty starting/stopping urinary stream

large discrete nodules on periurethral region leading to difficulty urinating are signs of…?

benign prostatic hyperplasia (BPH)

the following histopathology are signs of…?

• Hyperplastic acini

• Tightly packed, tall columnar epithelial cells with small basal nuclei

• Sometimes irregular papillary folds of epithelium

benign prostatic hyperplasia (BPH)

what is the most common cancer in men, but second in cancer-related deaths?

prostate cancer (adenomacarcinoma)

*side note: lung cancer is first in cancer-related deaths in men

does incidence of prostate cancer increase or decrease as one gets older?

increases (20%-in 50s, 70%-in 70s & 80s)

prostate cancer adenomocarcinoma arises in which zone of the prostate?

peripheral zone (posterior aspect)

*can be palpated on rectal examination

the following are various etiology of what condition?

• Age

• Race

• Family history

• Hormones

• Environment

• Androgens play role

prostate cancer adenomocarcinoma

the following describes the histopathology of what condition?

• Adenocarcinoma- glandular formation, lined by single layer of cuboidal or columnar epithelium

• Glands are smaller & crowded than benign prostate

• Basal cells not seen

prostate cancer adenomocarcinoma

how can prostate cancer adenomocarcinoma metastasize?

• via lymphatics

• via hematogenous spread (bone esp axial skeleton, mandible/maxila)

what are treatment options for prostate cancer adenocarcinoma?

surgery, radiation, hormonal manipulation

what can be measured to help with diagnosis and management of prostate cancer adenocarcinoma?

prostate specific antigen (PSA)

how is prostate cancer graded?

how well-differentiated the cells are

what congenital anomaly of penis is described:

Abnormal urethral opening on ventral surface of penis due to malformation of urethral groove/canal

Hypospadias

what congenital anomaly of penis is described:

Abnormal urethral opening on dorsal surface of penis due to malformation of urethral groove/canal

Epispadias

prostate cancer

Abnormal openings of the penis are sometimes constricted resulting in urinary tract obstruction and increased risk of ___

UTIs

congenital anomalies of the penis like hypospadias and epispadias can be associated with other congenital abnormalities like…?

• failure of normal descent of testes

• inguinal hernia

what condition is described:

local inflammation of glans penis

balantiis

what condition is described:

local inflammation of overlying prepuce

balanoposthitis

balantiis and balanoposthitis are caused by…?

• candida albicans

• anaerobic bacteria

• pyogenic bacteria

most cases of balantiis and balanoposthitis are a result of…?

poor hygiene in uncircumcised males

what is the accumulation of desquamated epithelial cells, sweat, debris?

smegma

what are the 2 types of penile intraepithelial neoplasia? (carcinoma in situ of penis)

1. Undifferentiated penile intraepithelial neoplasia

2. Differentiated penile intraepithelial neoplasia

which type of penile intraepithelial neoplasia is associated with HPV?

undifferentiated (most commonly HPV 16)

is carcinoma in situ cancer?

no

• cancer = cells where they are NOT supposed to be

• carcinoma in situ = abnormal cells but where they are supposed to be

squamous cell carcinoma

is squamous cell carcinoma common in the US?

no (uncommon only 0.4% of all cancers in males)

most cases of squamous cell carcinoma are in what groups of men?

uncircumcised

what are risk factors of squamous cell carcinoma?

• Poor genital hygiene

• Infection with HPV, especially high-risk types 16 and 18

• Most pts are over 40

• Cigarette smoking elevates risk

the following describes what condition:

• Slow growing; affects glans penis or prepuce

• Asymptomatic until ulcerated

• May have cauliflower appearance, can be ulcerated

• Metastasis to inguinal lymph nodes can occur early on

squamous cell carcinoma

the following describes what condition:

• Involves sexually active adults

• Affects younger age than Bowen disease

• Presents as multiple, reddish-brown papules

• Small number may transform into SCC

• Usually regresses spontaneously

Penile high grade squamous intraepithelial lesion

the following describes what condition:

• Affects older males

• Affects shaft or scrotum

• Presents as solitary, thickened gray-white plaque

• 10% can transform into squamous cell carcinoma

Bowen disease

what are 2 types of undifferentiated carcinoma in situ of penis (penile intraepithelial neoplasia)?

• penile high grade squamous intraepithelial lesion

• Bowen disease

% of Bowen disease cases can transform into squamous cell carcinoma

10%