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Diseases of the Penis Congenital Anomalies

Diseases of the Penis Congenital Anomalies. EPISPADIAS: Dorsal surface opening HYPOSPADIAS: Ventral surface opening MISCELLANEOUS PHIMOSIS: Small prepuce orifice secondary to repeated infections INFLAMMATIONS: Balanoposthitis, infection of glans and prepuce with smegma.

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Diseases of the Penis Congenital Anomalies

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  1. Diseases of the PenisCongenital Anomalies EPISPADIAS:Dorsal surface opening HYPOSPADIAS:Ventral surface opening MISCELLANEOUS PHIMOSIS:Small prepuce orifice secondary to repeated infections INFLAMMATIONS:Balanoposthitis, infection of glans and prepuce with smegma. Organisms: candida, anaerobes, pyogenic

  2. Tumors of the Penis BENIGN: 1.CONDYLOMA ACCUMINATUM: Human papilloma virus (HPV) Sexual transmission HPV types 6 - 11 associated with carcinoma CARCINOMA IN SITU: 3 types A.BOWEN DISEASE: Limited by basement membrane; mainly in shaft B.ERYTHROPLASIA OF QUEYRAT: Similar to Bowen’s but in glans-prepuce C.BOWENOID PAPULOSIS: Sexually active; pigmented lesions

  3. Tumors of the PenisMalignant SQUAMOUS CELL CARCINOMA HPV INFECTION:type 16 most common, also 18 40 - 70 years of age More common in uncircumcised populations Glans - inner surfer of prepuce Papillary or flat VERRUCOUS CARCINOMA:Giant condyloma(BUSCHKE-LOWENSTEIN TUMOR) Also HPV related types 6, 11 Invasive carcinoma metastasizes to inguinal-iliac LN 66% 5-year survival, if LN involved 27% 5-year survival

  4. SQUAMOUS CELL CARCINOMA

  5. Testis EpididymisCongenital anomalies CRYPTORCHIDISM:Undescended testis Descent in 2 phases: a. Transabdominal, to lower abdomen b. Inguino-scrotal, to scrotum(MOST COMMON DEFECT) Asymptomatic - bilateral 25% Testicular atrophy; prominent Leydig cells Complications: Sterility - cancer

  6. CRYPTORCHID

  7. Diseases of TestisInflammation TB, GONORRHEA:Epididymis, spreads to testis SYPHILIS:Testis involved first CHLAMYDIA:Epididymitis in sexually active E. COLI PSEUDOMONAS: Epididymitis in older than 35; may cause abscess, sterility MUMPS:Orchitis VASCULAR DISTURBANCES:Torsion due to trauma, incomplete descent, may cause hemorrhage-infarction

  8. GONORRHEA

  9. Testicular Tumors A.GERM CELL TUMORS B.NONGERMINAL CELL TUMORS (STROMA - SEX CORD)

  10. Germ Cell Tumors A. SEMINOMA: Typical, anaplastic, spermatocytic B. EMBRYONAL CARCINOMA C. YOLK SAC TUMOR D. POLYEMBRYOMA E. CHORIOCARCINOMA F. TERATOMA: Mature, immature, malignant G. MIXED: Teratocarcinoma (EMBRYONAL, CHORIOCARCINOMA)

  11. Testicular Tumors A.SEMINOMAS Morphology 1.TYPICAL:Grossly white-gray homogeneous. Microscopic: large, polyhedral cells with large central nucleus, nucleoli, by IP positive for Placenta like alkaline phosphatase(PLAP) ; lymphocytic reaction, granulomas 2.ANAPLASTIC:Large, irregular cells, frequent mitoses 3.SPERMATOCYTIC:Medium and large cells, giant cells

  12. SEMINOMA

  13. Testicular Tumors B.EMBRYONAL CARCINOMA:Hemorrhage - necrosis. Cells are large, hyperchromatic nuclei, nucleoli, arranged in glandular, alveolar or tubular patterns, with papillary convolutions. 20 - 30 years C.YOLK SAC TUMORS(INFANTILE EMBRYONAL OR ENDODERMAL SINUS TUMOR): Children up to 3 years Cuboidal or elongated cells, with papillary formation Endodermal sinus (50%): resemble primitive glomeruli, mesodermal core, central capillary lined by visceral and parietal layers Eosinophilic globules with alpha-fetoprotein

  14. EMBRYONAL CARCINOMA

  15. YOLK SAC TUMORS

  16. Testicular Tumors D.CHORIOCARCINOMA Aggressive, small tumors, metastasize widely Hemorrhage - necrosis common Syncytiotrophoblastic - Cytotrophoblastic components; positive for HCG

  17. CHORIOCARCINOMA

  18. Testicular Tumors E.TERATOMAS Common in child, rare in adults Gross: large(SOLID, CARTILAGINOUS, CYSTIC) Three histologic variants 1.MATURE:nerve, muscle, cartilage, thyroid, bronchial, intestinal, brain in myxoid or fibrous stroma. All well differentiated. 2.IMMATURE:poorly differentiated tissues, but identifiable. Glands, neuroblasts, cartilage 3.MALIGNANT TRANSFORMATION:squamous or adenocarcinoma, sarcoma

  19. Testicular TumorsMixed 60% e.g. teratomas - embryonal teratoma - yolk sac seminoma - embryonal or teratoma

  20. Teratocarcinoma Mixed: Embryonal and Choriocarcinoma HCG

  21. Testicular TumorsClinical Features CLINICALLY:Classified as seminomatous or nonseminomatous Painless masses LYMPHATIC SPREAD TO LYMPH NODES: Retroperitoneal, paraaortic, mediastinal, supraclavicular HEMATOGENOUS SPREAD: Lung, liver, bones, brain

  22. Testicular TumorsStaging STAGE 1:Confined to testis, epididymis, spermatic cord STAGE II:Retroperitoneal lymph nodes, below the diaphragm STAGE III: Metastases into lymph nodes above thediaphragm STAGE IV: Metastases into other organs: or lung, liver, brain, bones

  23. Testicular TumorsBiologic Markers 1. HUMAN CHORIONIC GONADOTROPHINS(HCG) choriocarcinomas 2.ALPHAFETOPROTEIN(AFP) yolk sac tumors 3.PLACENTA-LIKE ALKALINE PHOSPHATASE(PLAP) seminomas Others include placental lactogen, LDH Helpful in diagnosis, staging, monitoring testicular tumors

  24. Testicular TumorsSex Cord – Gonadal Stromal Tumors SEX CORD(SERTOLI) Estrogen or androgen producers Gynecomastia, precocious masculinization MORPHOLOGY: gray, white or yellow nodules Entirely Sertoli type or partly granulosa cells Cordlike structures, resembling seminiferoustubules Benign tumors; 10% malignant

  25. SERTOLI TUMOR

  26. Gonadal Stromal TumorsLeydig Cell Tumors May produce androgens, estrogens, corticosteroids Gynecomastia – sexual precocity in children Golden brown, homogeneous nodules Cells are large, round or polygonal Eosinophilic cytoplasm, central, round nucleus Reinke crystalloids in 25% of tumors Benign; 10% invasive

  27. Leydig Cell Tumor

  28. Tunica Vaginalis Hydrocele (FLUID ACCUMULATION) Hematocele (TRAUMA) Chylocele (ELEPHANTIASIS) Spermatocele Varicocele

  29. Prostate EMBRYO:5 lobes Posterior, middle, anterior, 2 laterals ADULT:4 lobes Peripheral, central, transitional, periurethral GLANDS: 2 cell layers: basal, columnar

  30. ProstateInflammation ACUTE BACTERIAL: Gram negative rods, staphylococci CHRONIC BACTERIAL:Same organisms CHRONIC ABACTERIAL: Most common type Sexual activity (CHLAMYDIA, MYCOPLASMA) MORPHOLOGY:Necrosis, later fibrosis, chronic with lymphocytes, neutrophils,lymphs, macrophages

  31. Prostate Inflammation ACUTE

  32. Prostate HYPERPLASIA: Glandular - stromal INCIDENCE:20% over age 40, 70% by age 60, 90% by age 70 ENLARGEMENT: Androgens stimulate growth(DHT) DHT synthesized in prostatic stromal cells DHT inhibitors cause decrease in volume MORPHOLOGY:Cellular nodules in transitional zone; later stromal periurethral nodules; compress urethra and prostate, creating cleavage (NOT CAPSULE). Nodules with squamous metaplasia or infarction.

  33. HYPERPLASIA: Glandular - stromal

  34. Carcinoma of Prostate Most common tumor in males 300,000 new cases / year – 69/100,000 20% 50 – 60 years 70% 70 – 80 years Highest rates in blacks

  35. Carcinoma of Prostate

  36. Carcinoma of Prostate ETIOLOGY: Unknown RISK FACTORS: Age – environmental Role of androgens Genetics Molecular

  37. Carcinoma of Prostate 70% arise in peripheral zone, posterior aspect Detectable by rectal examination May invade seminal vesicles, base of bladder HEMATOGENOUS METASTASES TO BONES: Lumbar spine, femur, pelvis, ribs (OSTEOBLASTIC) LYMPHATIC SPREAD TO LYMPH NODES: Obturator, perivesical, hypogastric, iliac, paraaortic

  38. Carcinoma of ProstateMorphology MICROSCOPIC:Well-defined small glands Uniform layer cuboidal or low columnar cells Occasionally larger with papillary or cribriform pattern Nuclei large, vacuolated, 1 – 2 nucleoli Mitoses uncommon GROWTH PATTERN:Rounded masses, back to back pattern UNDIFFERENTIATED:Cords, nests, sheets Tendency to invade capsule, lymphatic – vascular channel and nerves PREMALIGNANT LESION:PIN(PROSTATIC INTRAEPITHELIAL NEOPLASIA) DIFFERENCE:Presence of basal layer

  39. Carcinoma of ProstateClinical Features 70% incidence in men over 80 years, Stage A VISUAL COURSE: Non-progressive Stage A2 progresses (30 – 50%) Over 60% present with local disease Urinary symptoms are late DIAGNOSTIC APPROACH: Rectal exam, serum PSA, biopsy

  40. Carcinoma of ProstateGrading (Gleason System) GRADE 1: Closely packed single or separate uniform glands GRADE 2: Same as 1 with less uniformity, limited infiltration GRADE 3: Separate, irregular glands, cribriform pattern GRADE 4: Fused glands and cords, cribriform pattern GRADE 5: Sheets or cords; few or no glands

  41. GRADE 1: Closely packed single or separate uniform glands

  42. GRADE 3: Separate, irregular glands, cribriform pattern

  43. GRADE 5:Sheets or cords; few or no glands

  44. Carcinoma of ProstateProstate Specific Antigen(PSA) Serine protease produced by prostatic epithelium SERUM LEVEL: 4 ng/ml upper limit “Organ specific”, not “cancer specific” Elevated in BPH, prostatitis cancer BPH: 30% have elevated PSA CARCINOMA: 80% have elevated PSA, 20 – 40% have less than 4 ng/ml

  45. Prostatic Specific Antigen(PSA) TWO FORMS: a) Free b) Bound to alpha 1 antichymotrypsin Free PSA is lower in cancer than in BPH Specially important in values 4 – 10 ng/ml

  46. Carcinoma of ProstateTreatment SURGERY: Localized disease (Stages A – B) RADIATION: Localized disease (Stages A – B) HORMONAL TREATMENT: Metastatic disease (Stages C – D) (ESTROGEN THERAPY – ORCHIECTOMY)

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