Male Reproductive
I) Penis
A) Congenital
Ref: Robbins; Pathologic Basis of Dis
- hypospadias = opening on the ventral surface
- epispadias = opening on dorsal surface
- both associated with failure of testes to descend and other urinary malformat’s
B) PrepuceCircumcision or not?
- phimosis = orifice of prepuce is too small to retract; swelling; constriction of
glans = paraphimosis, leading to urinary retention
C) Inflammation
- balanoposthitis = inflammation of glans and prepuce, many bugs, fungi etc.
- may lead to scaring and restriction of urinary flow.
D) Tumors: remember HPV
Ref: Robbins; Pathologic Basis of Dis
- condyloma acuminatum = papilloma; HPV types 6 and 11
- carcinoma in situ:
- Bowen’s disease; shaft (men and women; other malignancies)
- Erythroplasia of Queyart; glans
- Bowenoid papulosis: pigmented-brown; in situ; both men and women; HPV 16
- invasive carcinoma
- squamous cell ca
- infections, irritation, HPV 16 and 18
- not too common, goes to local nodes
- white to grey and gritty
II) Testis and epididymis
A) congenital
- cryptorchid: undescended; position; unilateral; cancer; infertility; buserlin
- synorchism: fusion
B) atrophic changes; atherosclerosis; age; inflammation; crypt; hypopit; obstruction;
radiation and chemothrx; exhaustion atrophy
C) inflammation; bug, less often autoimmune
- rarely separate, ie epidid and testis; bug frequently from urinary tract; age
- GC; younger men; ascending infection
- mumps; rare in prepuberty; about 30% in post puberty; edema and mononuclear infiltrate
- TB; starts in epidid and spreads to testis; blood
- syphilis; testis first, then epidi; secondary phases of disease; end arteritis
D) Vascular and “mechanical”; torsion and infarction; HURTS
E) Scrotal masses
- Testicular
Tumors, i.e. neoplasia (Solid)
- Epididymal
Inflammatory (rubor, dolor, calor, TUMOR)
- Peritesticular
Hernia, hydrocele (transilluminates) vascular
F) tumors of testis; (1) germ cell = reproductive element; (2) non-germinal = supportive
- Tumor markers (measured in blood)
- Embryonic tissue signals
- Beta HCG
- Alpha-feto protein
- When to draw blood sample?
- germinal line; highly aggressive; wide spread; trx progress; histology classes; many are “mixed pattern”; mediastinum and supraclavicular nodes
- development; crypt; genetic, isochromosome I(12p), testicular dysgenesis
- seminoma; most common; three common patterns; no AFP or HCG
- watery clear cells with fibro ct stromal bands; lobules
- Embryonal carcinoma; aggressive; 20-30 yrs group
- fleshy with areas of hemorrhage and necrosis
- glandular and “alveolar” arrangements; embryonic
- often part of something else, rare as a single tumor
- +/- markers
- yolk sac; embryonic yolk sac looking; rare; AFP+
- choriocarcinoma; HCG+
Ref: Robbins; Pathologic Basis of Dis
- syncytium of pink staining cells like syncytial trophoblasts
- small primary with wide spread mets
-teratoma; three categories, most are malignant in males
- embryonic tissues types, look for cartilage, skin and bone
- markers +/-
- “mixed pattern”; most frequent; grade by most aggressive element
- general features of all forms of testicular malignancies
- painless enlargement
- distant spread
- mediastinum and supraclavicular nodes
- mediastinal primary (?)
- clinical stage is very important
- Stage I; testis
- Stage II: retroperitoneal mets bellow diaphragm
- Stage III: above diaphragm
- Markers always !!
- nongerm line: sex cord and gonadal stroma
- Leydig cell: stroma: androgens, estrogens and even corticosteroids
- testicular enlargement; maybe gynecomastia
- Sertoli cell tumor: sex cord; “androblastoma”; rarely hormonally active
- primary testicular lymphoma; rare
- non-neoplastic “tumors”
- hydrocele
- hematocele
- spermatocele
- varicocele
- chylocele (lymph obstruction, not really chyle as in GI)
III) Prostate: (1) inflammation; (2) hyperplastic enlargement and (3) cancer
Ref: Robbins; Pathologic Basis of Dis
A) inflammation; (1) acute and chronic bacterial and (2) “chronic prostatitis”
- acute bacterial: ascending; E. Coli; gram neg rods; enterococci
- catheter, surgical manipulation, TUR, “experimentation”
- dysuria, fever, chills
- chronic bacterial: low back pain, dysuria, suprapubic pain, common bugs
- chronic abacterial prostatitis: very much like chronic bacterial, but sterile cultures, Chlamydia,
Ureaplasma (?)
B) BPH, very common
- androgens; dihydrotestosterone (DHT), transitional zone of prostate, periutheral
- nodular enlargement with glandular hyperplasia; both glands and stroma
- urethral compression with secondary problems
- cancer risk (?) not much if any
Ref: Robbins; Pathologic Basis of Dis Ref: Robbins; Pathologic Basis of Dis.
C) Cancer, frequency increases with age; very common tumor, but not common cause of death
- not common in Asia
- risk factors; age; race; family hx; hormone levels; environmental
- adeno with various patterns; Gleason’s grading system
- sclerosis in many cases
- perineural involvement
- PIN
- Gleason is cyto grade: ‘Score’ and ‘Grade’
Score = 1 – 5, Grades is sum of best and worst
- stages = spread
- I (A1 and A2) microscopic, focal or diffuse, no spread out of cap
- II (B1 and B2) confined to prostate; +/- 1.5 cm
- III (C1 and C2) extracapsular spread, but confined to pelvis
- IV (D1) retroperitoneal nodes 3 or fewer
(D2) distant spread
- bone mets may be OSTEOBLASTIC OR LYTIC, but prostate is one of the few that will produce blastic mets
- PSA; made by both benign and malignant growths of prostate.
- Must now sizeof gland to accurately interpret.
- serine protease, liquefies seamen
- greater diffusion of PSA out of malignant cells, not more production
- Surgery , hormone manipulation and chemo
- synthetic analogs of LHRH
- Androgen refractory prostate cancer
IV Sexually transmitted diseases
- HPV
- Hepatitis B
- GC
- Syphilis
Primary
Secondary
Tertiary
Congenital
Testing; false positive VDRL
- HIV
- Chlamydia