6. Endo/Repro - Pathology: Male reproductive System

what does the following define?

Complete or partial failure of testes to descend into scrotal sac

cryptorchidism

Describe the two phases of testicular descent in development

• 1st phase:

abdomen to lower pelvis by the 3rd month of gestation

• 2nd phase:

inguinal canal to scrotum within the last 2 months intrauterine

T or F: the testes usually arrest in one specific area in cryptorchidism

FALSE

- Testes may arrest anywhere along the pathway of descent

- most common = inguinal canal

what is the most common site of testicular arrest in cryptorchidism?

inguinal canal

is cryptorchidism most unilateral or bilateral?

unilateral in most cases

- bilateral in 25% of cases

in what percentage of cases is cryptorchidism bilateral?

25%

T or F: there are symptoms associated w/ cryptorchidism

FALSE

- it is asymptomatic

At what age can diagnosis of cryptorchidism be established? Why?

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

why can cryptorchidism cause sterility in the case of bilateral cryptorchidism?

undescended testes become atrophic

- can also be unilateral with atrophy of the descended testis as well

What pathology includes a 3-5x increased risk for testicular cancer?

cryptorchidism

how is cryptorchidism corrected and when is the recommended time to perform the correction?

- corrected with surgery

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

inflammation of the testes is more common in ________ than in the ________ ________, especially in gonorrhea & TB

epididymis

testis proper

Syphilis affects what organ first?

testis

what is the cause of epididymitis in childhood?

congenital abnormality or infection with gram-negative rods

what is the cause of epididymitis in men younger than 35?

sexually transmitted gonorrhea & chlamydia

what is the cause of epididymitis in men older than 35?

urinary tract pathogens- E. coli & pseudomonas

inflammation of one or both testicles is known as....

Orchitis

what is caused by mumps in 20-30% of cases?

orchitis

is sterility possible in orchtiis?

YES

what usually begins as a UTI that spread to the testes via the spermatic cord?

Nonspecific epididymitis and orchitis

mumps commonly affects what group?

school aged children

T or F: mumps is a viral systemic infection

TRUE

T or F: in the case of mumps, testicular involvement is common in children

FASLE

- Testicular involvement is rare in children

- Post pubertal males get orchitis more often (20-30% of cases)

Who gets orchitis more often?

post pubertal males

viral orchitis from mumps develops how long after swelling of the parotid glands?

1 week

mumps is transmitted viz...

saliva andrespiratory droplets

what is the prevalence of testicular tumors?

6/100,000 males

what are the 3 main categories of testicular tumors?

- gram cell tumors

- sex-cord-stromal tumors

the following describe what main category of testicular tumors?

• Two sub-categories: Seminomas and non-seminomatous

• 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

what category of testicular tumor makes up 95% of testicular tumors in post-pubertal males with nearly all being malignant?

germ cell tumors

what category of testicular tumor has the following characteristic?

Brothers of patients with a germ cell tumor have an 8-10x increased risk

germ cell tumor

what category of testicular tumor has the following characteristic?

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

germ cell tumor

what category of testicular tumor has the following characteristic?

Two sub-categories: Seminomas and non-seminomatous

germ cell tumor

what are the two subcategories of the germ cell category of testicular tumors?

Seminomas and non-seminomatous

what category of testicular tumor arises from Sertoli and Leydig cells?

sex-cord-stromal tumors

T or F: sex-cord-stromal tumors are common

FALSE

- they are uncommon

Are sex-cord-stromal tumors usually malignant?

NO

- they are usually benign

what is the most common type of germ cell tumor?

seminoma

- makes up 50% of all germ cell neoplasms

what makes up 50% of all germ cell neoplasms?

seminoma

- most common type of germ cell tumor

are seminomas malignant?

YES

Do seminomas occur in infants?

NO

- never

when is the peak incidence for seminomas?

4th decade of life

what pathology produces a bulky mass?

seminoma

what pathology features a gross appearance of homogenous, gray-white cut surface?

seminoma

which pathology has the following histopathological appearance?

Cells are large and round with distinct cell membrane, large central nucleus with prominent nucleoli

seminoma

what pathology?

• Most common type of germ cell tumor (make up 50% of all germ cell neoplasm

• Malignant

• Never occurs in infants

• Peak incidence-4th decade

• Produces bulky mass

• Gross appearance

---• Homogenous, gray-white cut surface•

Histopathology

---• Cells are large and round with distinct cell membrane, large central nucleus with prominent nucleoli

seminoma

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

yolk sac tumor

what pathology is described as a malignant, nonseminomatous germ cell tumor?

yolk sac tumor

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

embryonal carcinoma or other germ cell conditions

what pathology features increased serum alpha fetoprotein?

yolk sac tumor

what pathology features the following histopathology?

Have Schiller-Duvall bodies (resembleprimitive glomeruli)

yolk sac tumor

what pathology?

• Malignant, nonseminomatous germ cell tumor

• Most common testicular tumor in infants & children up to 3 years old

---• Good prognosis in this age group

• Post pubertal yolk sac tumor more frequently occurs in combination with embryonal carcinoma or other germ cell conditions

• Increased serum alpha fetoprotein

• Histopathology

---• Have Schiller-Duval bodies (resemble primitive glomeruli)

yolk sac tumor

what age group has the best prognosis for yolk sac tumor?

infants and children up the 3 years old

what are the 2 types of sex-cord tumors?

• Leydig cell tumor

• Sertoli cell tumor

what type of sex-cord tumor?

• Occurs between ages of 20-60

• 5-10% are malignant

• Testicular swelling and/or gynecomastia

• Increase in androgens, estrogens, corticosteroids

leydig cell tumor

what type of sex-cord tumor?

• Presents as a testicular mass

• Can have gynecomastia as initial finding

• Up to 10% can be malignant

sertoli cell tumor

the prostate gland is divided zones:

• PZ = PERIPHERAL ZONE

• TZ = TRANSITIONAL ZONE

• CZ = CENTRAL ZONE

• PUZ = PERIURETHRAL ZONE

most hyperplastic lesions occur in which zone of the prostate?

transitional

most carcinomas occur in what zone of the prostate?

peripheral

is there differing treatment for acute and chronic prostatitis?

No

- both are treated with antibiotics

what is the most common bacteria associated with prostatitis?

E. coli

which prostatitis?

• Can cause urinary tract infections

• Associated with fever, chills, dysuria

• Prostate is tender & boggy

acute bacterial

which prostatitis?

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

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

chronic bacterial

Chronic pelvic pain syndrome is also known as...

Chronic abacterial prostatitis

what 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)

the following are characteristics of what pathology?

• Histologic evidence of BPH is found in up to 90% of men by the age of 80

• Proliferation of stromal and glandular structures

• Common cause of prostate enlargement

• Cause of urinary obstruction

• Not premalignant

• Large discrete nodules on periurethral region

• Can encroach on lateral walls of urethra to compress to a slit-like orifice

benign prostatic hyperplasia (BPH)

is benign prostatic hyperplasia (BPH) premalignant?

NO

what is a common cause of prostate enlargement?

benign prostatic hyperplasia (BPH)

Etiology of benign prostatic hyperplasia (BPH)

Unknown but studies show androgens may play a role (DHT-androgen derived from testosterone)

where does benign prostatic hyperplasia (BPH) begin?

transition zone

the following are symptoms of...

• Increased urinary frequency

• Nocturia

• Dysuria

• Difficulty starting and stopping

benign prostatic hyperplasia (BPH)

the following is the histopathology of what?

• Hyperplastic acini

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

• Sometimes irregular papillary folds of epithelium

benign prostatic hyperplasia (BPH)

Most common cancer in men, but second in cancer-related deaths (lung cancer-first)?

prostate cancer - adenocarcinoma

for what pathology does incidence increase as one gets older?

prostate cancer - adenocarcinoma

the following is a feature of what pathology?

Arise in peripheral zone-posterior aspect-can be palpated on rectal examination

prostate cancer - adenocarcinoma

the following is the histopathology of what?

• 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 - adenocarcinoma

T or F: prostate cancer - adenocarcinoma can metastasize via the lymphatics and hematogenous spread- bones especially axial skeleton, can be seen in mandible/maxilla

TRUE

which pathology can metastasize via hematogenous spread- bones especially axial skeleton, can be seen in mandible/maxilla?

prostate cancer - adenocarcinoma

what pathology is graded using the Gleason system (based on glandular pattern of differentiation)?

prostate cancer - adenocarcinoma

compare grade 1 prostate cancer - adenocarcinoma to grade 5

• Grade 1-most well-differentiated

• Grade 5-poorly-differentiated-no glandular differentiation

in prostate cancer - adenocarcinoma the measure of what can help with diagnosis and management?

prostate specific antigen (PSA)

how is prostate cancer - adenocarcinoma treated?

Surgery, radiation, hormonal manipulation

prostate cancer - adenocarcinoma with more than one pattern is given 2 scores, what does the first number indicate?

the most dominant pattern

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

hypospadias

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

epispadios

congenital anomalies of the penis can be associated with what other congenital abnormalities?

• failure of normal descent of testes

• inguinal hernia

the following is possible in the case of what pathology?

Abnormal openings are sometimes constricted resulting in urinary tract obstruction and increased risk of UTIs

congenital anomalies of the penis

Local inflammation of the glans penis and overlying prepuce, respectively

Balanitis and Balanoposthitis

- inflammation of the penis

what is caused by candida albicans, anaerobic bacteria, pyogenic bacteria?

Balanitis and Balanoposthitis (inflammation of the penis)

most cases of Balanitis and Balanoposthitis (inflammation of the penis) result from...

poor hygiene in uncircumcised males

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

differentiated and undifferentiated

which type of penile intraepithelial neoplasia (carcinoma in situ of penis)?

• Associated with high-risk HPV, most commonly HPV 16

• Bowen disease/(penile high grade squamous intraepithelial lesion)

undifferentiated

which type of penile intraepithelial neoplasia (carcinoma in situ of penis) is NOT associated with HPV?

differentiated

which penile intraepithelial neoplasia (carcinoma in situ of penis) is associated with HPV?

undifferentiated

Penile high grade squamous intraepithelial lesion or Bowen disease?

• Involves sexually active adults

• Affects younger age than Bowen disease

• Presents as multiple, reddish-brown papules

• small number develops into squamous cell carcinoma

• Usually regresses spontaneously

Penile high grade squamous intraepithelial lesion

Penile high grade squamous intraepithelial lesion or Bowen disease?

• Affects older males

• Affects shaft or scrotum• Presents as solitary, thickened gray-white plaque

• 10% can transform into squamous cell carcinoma

Bowen disease

most cases of squamous cell carcinoma are in which population of men?

uncircumsized

is squamous cell carcinoma common in the US?

NO

- uncommon in the US - 0.4% of all cancer in males

the following are risk factors for what pathology?

• Poor genital hygiene

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

• Most pts are over 40

• Cigarette smoking elevates risk

squamous cell carcinoma

is squamous cell carcinoma symptomatic from the beginning?

NO

- asymptomatic until ulcerated