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Pathology of the Male Reproductive System

Pathology of the Male Reproductive System. Testis and Epididymis. Failure of Testis to Descend. Testis are not always in scrotum at birth. Testes from in abdomen with kidneys Migrate to scrotum May get stuck in the inguinal canal Complications of not repairing Sterile

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Pathology of the Male Reproductive System

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  1. Pathology of the Male Reproductive System

  2. Testis and Epididymis

  3. Failure of Testis to Descend • Testis are not always in scrotum at birth. • Testes from in abdomen with kidneys • Migrate to scrotum • May get stuck in the inguinal canal • Complications of not repairing • Sterile • Increased risk of testicular tumors later. • Inguinal hernia

  4. Inflammation • Bug • Ascending infection in most cases. • GC • Mumps • TB • Syphilis • Autoimmune

  5. Epididmitis

  6. Vascular Related • Torsion • Venous compression • Hemorrhagic infarct • Young men • At night • Very painful • Can be reduced

  7. Scrotal Masses • Testicular • Tumors (solid) • Epididymal • Inflammatory (rubor, dolor, calor…) • Peritesticular • Hernia • Hydrocele (cystic, transilluminates) • Vascular in nature

  8. Testicular Tumors • Most are malignant • Excellent results with treatment. • Must look for ‘markers’ before removal • Germ line (actual reproductive cells) • Seminoma • Embryonal • Choriocarcinoma • Mixed pattern • Non-germ line • Specialized supportive cells • Leydig, may be hormonally active

  9. Tumor Markers • Some tumors produce agents measurable in the blood. • Embryonic tissue markers • Beta-HCG • Placental marker • We measure this in pregnancy tests • Alpha-feto protein • Marker associated with embryonic gut

  10. Seminoma • Most common type • Yong men • Curable • Arises from sperm producing cells • Several histologic types. • Lymphocytes • No markers

  11. Seminoma • Little fried egg looking cells. • Lymphocytes • No production of Bet-HCG or Alpha-fetoprotein

  12. Embryonal Carcinoma • Aggressive tumor • 20-30 years • Areas of hemorrhage and necrosis • Two histologically distinct cell types. • Markers +/- • Lance Armstrong

  13. Embryonal Ca • Two tissue types • Stroma • Glands • Metastasizes widely • Markers +/-

  14. Choriocarcinoma • Placental elements • Synciotrophoblasts • Make Beta-HCG • Typically part of a ‘mixed lineage’ tumor. • Highly aggressive • This element spreads early.

  15. Teratoma

  16. Teratoma • Aggressively malignant • Three germ lines • Ectoderm • Endoderm • Mesoderm • Makers +/-

  17. Leydig Cell Tumor • One of several so-called ‘specialized stromal tumors. • Non-germ line • Benign generally • Hormonally active • Androgens • Estrogens • Gynecomastia • Sometimes even corticosteroids

  18. Hydrocele

  19. Hydrocele • Fluid filled scrotal cyst. • Benign • Often with inguinal hernia • Transilluminates • Fluid will recollect if aspirated. • Can be large

  20. Prostatic Disease

  21. Prostatitis • Acute bacterial • Ascending • E. coli • Chronic bacterial • Low back pain • Dysuria • Suprapubic pain • Common bugs • ‘Abacterial’ • Chlamydia

  22. Benign Prostatic Hyperplasia • Very common • Androgen mediated growth (DHT). • Central zone proliferates • Stroma & • Glands • Minimal if any increased cancer risk

  23. Benign Prostatic Hyperplasia • Nodular growth pattern • Some chronic inflammation • Glands always have a double layer of epithelium • Columnar & • Reserve layer

  24. Benign Prostatic Hyperplasia

  25. Prostate Cancer • Very common • Blacks & • Whites • Rare in Asians • Incidence increases with age. • Peripheral zone • PSA • Family history

  26. Prostate Cancer • Adenocarcinoma • Single layer of epithelium • Gland-within-gland • LN and Bone mets • Osteoblastic & • Osteolytic • Treatment • Surgery & • Hormone manipulation

  27. Prostate Cancer

  28. Staging Prostate Cancer

  29. Bone Metastases • Spinal mets -> • Painful • May cause lots of reactive bone growth at the site of the met • Osteoblastic • May cause bone destruction • Osteolytic

  30. Pathology of the Penis

  31. Congenital Abnormalities • Hypospadius • Urethral opening on ventral surface of penis. • Epispadius • Urethral opening on dorsal surface of penis. • Both associated with undescended testis

  32. Circumcision, Yes or No • Maybe helpful in a small number. • In previous years it did make a difference. • Phimosis • Orifice of the prepuce is too small. • Paraphimosis, inflammation and cosntriction leads to urinary problems. • ? Risk of cancer

  33. Penile Tumors • Papillomas • HPV • Some are dangerous serotypes. • Cause unregulated epithelial growth

  34. Papilloma

  35. Squamous Carcinoma • In situ • Invasive • Ulcerative • HPV • 16 • 18 • Regional lymph nodes. • Metatasizes widely.

  36. Squamous Carcinoma

  37. Sexually Transmitted Diseases • HPV • Hepatitis B • Syphilis • Gonorrhea • HIV • Chlamydia

  38. Gonorrhea • Neisseria gonorrhea • Gram negative • Diplococcus • Mucosa • Acute inflammation! • Scarring • Sterility • Epididymitis

  39. Neisseria gonorrhea

  40. Syphilis • Spirochete • Treponema pallidum • Arteriole is target • Vasculitis • Three stages • Primary: chancre • Secondary: rash • Tertiary: systemic • CNS • Aorta • Congenital

  41. Treponema pallidum • Spirochete • Infects arterioles • Destroys them • Rash • Vasovasorum of aorta • Can’t culture • Serology • VDRL • Specific antibodies

  42. Secondary Syphilis

  43. Tertiary Syphilis

  44. Congenital Syphilis • Infected during pregnancy • Third trimester • Virtually all systems involved • Periosteal involvement leads to many skeletal deformities

  45. AIDS • Human immunodeficiency virus • Several strains • T-cells infected • Antibody regulation • Tumor and cell mediated response

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