Clinical Pathology: Reproductive

Phimosis

foreskin can't be retracted

Paraphimosis

foreskin retracted but can't be reduced

-constricts blood flow; edema of glans (necrosis; emergent)

Phimosis and paraphimosis are often from

poor hygiene and chronic infection

-circumcision often needed after infection treated

-higher incidence of penile CA with uncircumcised likely due to chronic infection/poor hygiene

Peyronie disease

fibrotic tissue that causes curvature.

develops slowly and often in middle aged men; associated with dupuytren contracture

priapism

A prolonged and painful erection

-urologic emergency

balanitis

inflammation of penis associated with poor hygiene and phimosis

balanitis is most often with

poorly controlled diabetes and candidiasis

Penile cancers

rare

95% of them are squamous cell CA

Tumors include benign condyloma acuminatum

risk factors of penile carcinoma

HPV, AIDS, smoking, phimosis

-circumcision at birth decreases risk

biopsy for penile carcinoma diagnosis is called a

penectomy

Erectile dysfunction

psychogenic in young men

Decreased testosterone

Vascular insufficeny is most common cause in men 50 years or older

Neurologic disease - MS

medications (diuretics, antihypertensives, antihistamines, antidepressants)

endocrine disease (DM, hypothyroidism)

penile disorders

Infertitlity causes

-decreased sperm count: leydig cell dysfunction, seminiferous tubule dysfunction, pituitary dysfunction, hypothalamus dysfunction

-end organ dysfunction: obstruction of vas deferens, dysfunction of accessory sex organs, dysfunction of ejaculation

infertility testing

semen analysis and serum hormone levels

Varicocele

abnormal dilation of veins

"bag of worms"

common scrotal abnormality and common finding in infertile men

Hydroceole

Collection of fluid

infection, trauma, torsion, recent scrotal surgery, testicular cancer

watch/wait (many resolve), aspiration, surgery

Spermatocele

cyst between testes + epididymis

-filled with milky fluid and sperm

cryptochidism

testes fails to descend completely

-one or both testes (one is more common)

-might remain in abdomen or stop in inguinal canal

-associated with infertility

-significantly increases risk of testicular cancer

Torsion

rotation of testes

Surgery in <6 hours to preserve function

Is testicular torsion a surgical emergency?

yes < 6 hours to preserve function

orchitis

inflammation of the testes

-usually extension of epididymitis

Testicular cancer

highly treatable and usually curable

Benign prostatic hypertrophy (BPH) AKA

benign prostatic hyperplasia

BPH

-enlargement of prostate

-problem when compresses urethra

-age dependent change (hyperplasia begins 40-45 and continues until death)

_____ of 80 year old males have BPH

80%

BPH pathology

nodules: yellow-pink, soft/rubbery

locations: around urethra in transitional zone and periurethral zone

prostate enlarges as: nodules form/grow (nodular hyperplasia) and glandular cells enlarge (hypertrophy)

Cause of BPH

unclear; aging, levels/ratios of endocrine factors (androgens and estrogens), chronic inflammation

BPH symptoms

-urge to urinate often

-decreased force of stream

-delay starting stream

-long term: urine retention and longer to initiate and empty

Complications of BPH

-hematuria

-bladder/kidney infection

-bladder calculi

-hydroureter

-hydronephrosis

most common non skin cancer in adult males in US

prostate (if males live long enough, they will get prostate cancer)

prostate cancer risk factors

-age

-genetics

-environment/diet

-hormones and growth factors: androgens are involved in progression of cancer --> DHT

Prostate cancer are mostly

adenocarcinomas

prostate cancer organ invasion

bladder and seminal vesicles

Prostate diagnosis

DRE/ PSA yearly after 50 years old

PSA > 10 suggest cancer

Prostate cancer treatment

watchful waiting, total prostatectomy, radiation, radioactive seeds, etc.

complications of prostate cancer treatment

incontinence and sexual functioning affected

Gynecomastia

overdevelopment of breast tissue

Usually from hormonal imbalances

Breast cancer in males

Very rare

risk factors of breast cancer in males

klinefelter syndrome

BRCA

obesity

orchitis, cryptorchidisim, orchiectomy

dysmenorrhea

painful menses

dysmenorrhea primary vs secondary type

primary: excessive (increased prostaglandins) and increased uterine contractions

secondary: pathology conditions usually later in reproductive years; occurs at any time in menstrual cycle

abnormal uterine bleeding

abnormal bleeding due to duration, volume, frequency, regularity

abnormal uterine bleeding can be associated with

hormone imbalances and/or possible anatomic causes

the standard classification for patterns of abnormal uterine bleeding recognizes 7 different patterns

1. menorrhagia

2. hypomenorrhea

3. metrorrhagia

4. menometrorrhagia

5. polymenorrhea

6. oligomenorrhea

7. contact bleeding (AKA postcoital bleeding)

menorrhagia

-regular normal intervals with excessive flow and duration

-excessive clots

-most common

hypomenorrhea

regular normal intervals with decreased amount of bleeding

metrorrhagia

irregular intervals

menometrorrhagia

heavy, irregular, prolonged bleeding during menstruation and between periods

polymenorrhea

-most frequent periods

-menses at intervals <21 days

oligomenorrhea

infrequent periods; menses at intervals >35 days

contact bleeding

intercourse

Amenorrhea

lack of monthly menstrual flow

primary amenorrhea

never started menstruation; in a girl who is 13 and hasn't had any secondary sexual development, or a girl who is 15 and has not menstruated but does have a secondary sexual development

secondary amenorrhea

this would occur in a women who has already started menstruation (gone through menarche) and has not menstruated for 3 cycle intervals or 6 consecutive months

Patho of amenorrhea

-hypothalamic or pituitary disorder: decreased LH and FSH synthesis (decreased estrogen and progesterone)

-ovarian disorder

-anatomic defect

pelvic inflammatory disease (PID)

acute inflammation process caused by infection

-may involve uterus, fallopian tubes, ovaries, and entire peritoneal cavity

inflammation of the fallopian tubes

salpingitis

ovaritis

inflammation of ovaries

risk factors of pelvic inflammatory disease

previous untreated STI

multiple sex partners

previous PID

IUD, spontaneous or induced abortions, surgical procedures

Main cause of pelvic inflammatory disease

Gonorrhea and chlamydia (infect vagina and cervix)

pelvic inflammatory disease clinical manifestations

-range from asymptomatic to sudden, severe abdomen pain with fever

-often low bilateral abdomen pain (dull and steady)

-pain may worsen with walking, jumping, intercourse

-dysuria, dyparunia, irregular bleeding

pelvic inflammatory disease treatment

quick; broad range antibiotic (later complications with increased risk of ectopic pregnancy)

Cervical Cancer

HUGE decline after 1975 with increase in Pap test usage

cervical cancer arises from

cervical epithelium, triggered by HPV

HPV (16/18) is almost exclusively the cause of

cervical cancer

Adenomyosis

endometrial tissue -> lining shed -> grows into myometrium (muscle)

Adenomyosis complications

abnormal menstrual bldg, anemia, dysmenorrhea, uterine enlargement, uterine tenderness, during menstruation, chronic pelvic pain, infertility

endometriosis

endometrial tissue located outside the uterus

Cause of infertility; assoc w/ higher risk of ovarian CA

endometriosis gross appearance

-reddened flame like patches

-cystic dark blue, brown or black appearance

-surface may look scarred or puckered

-dense fibrous adhesions

leiomyoma

benign tumor of smooth muscle

The most common benign tumor of the uterus

Esttrogen and progesterone sensitive

Can cause abnormal vaginal bleeding and pain

Most common benign tumor of uterus

leiomyoma

Endometrial cancer

cancerous tumor forms in lining of uterus

Post menopausal

Ovarian cysts

collections of fluid within a sacs (cysts) in the ovary contains all 3 germ layers and contain mature tissue (skin, hair, teeth, sweat glands, muscle thyroid, brain etc)

Polycystic ovarian syndrome

A hormonal disorder causing enlarged ovaries with small cysts on the outer edges.

oligomenorrhea

obesity

infertility

diabetes

vaginal bleeding

Due to inappropriate secretion of gonadotropins

PCOS diagnosis

Requires 2 of 3

1. Irregular ovulation

2. Elevates testosterone

3. Polycystic ovaries on US

PCOS treatment

oral contraceptives or weight loss

PCOS pathology

inappropriate secretion of gonadotropins, excessive androgen production, hormonal imbalance prevents ovulation and causes cystic ovaries, excessive endometrial proliferation, hirsutism

Ovarian cancer

silent cancer

difficult to diagnose

lack of early symptomt

Pathologic development of ovarian cancer 2 main hypotheses

Incessant ovulation: repeated ovulation results in minor trauma to the ovarian epithelium, which in turn can lead to malignant transformations

Exposure to gonadotropins: persistent ovarian exposure to gonadotropins and elevated estradiol concentrations may be carcinogenic

Fibroadenoma

solid, benign tumor containing glandular and fibrous tissue persistent during reproductive years

Hormonal ( 15 - 35 years)

Diagnose using US or mammogram

Signs and symptoms of breast cancer

Pain, lump, thickening, nipple discharge, skin changes, nipple and Areolar changes, edema, erythema, dimpling

Inflammatory breast cancer

Rare but highly deadly

Paget's Carcinoma

Itching or burning nipple

Phyllodes tumor

Fibroadenoma like tumor with overgrowth of fibrous component

Surgical treatment of breast cancer

lumpectomy, mastectomy

lumpectomy

excision of a small primary breast tumor and some of the normal tissue that surrounds it

mastectomy

surgical removal of a breast