Post on 01-Nov-2014
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Male Genital Tract(short version)
• Penis: Congenital, Inflammation, Tumors
• Testis/Epididymis: Congenital, Regressive, Inflammation, Vascular diseases, Tumors
• Prostate: Inflammation, Benign Enlargement, Malignancy
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Male Genital Tract(short version)
• Testis/Epididymis: – Congenital– Regressive – Inflammation – Vascular diseases – Tumors
www.freelivedoctor.com
Male Genital Tract(short version)
• Testis/Epididymis: – Congenital: Cryptorchidism 1%– Regressive: Atrophy– Inflammation: Mumps, GC, Chlamydia, E. Coli,
Pseudomonas, TB– Vascular diseases: Torsion– Tumors: Benign/Malig, Germ Cell/non-Germ Cell
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Cryptorchidism
• 1% of all births• 25% bilateral• Associated with significantly increased incidence of
germ cell tumors
www.freelivedoctor.com
Male Genital Tract(short version)
• Testis/Epididymis: – Congenital: Cryptorchidism 1%– Regressive: Atrophy– Inflammation: Mumps, GC, Chlamydia, E. Coli,
Pseudomonas, TB– Vascular diseases: Torsion– Tumors: Benign/Malig, Germ Cell/non-Germ Cell
www.freelivedoctor.com
Testicular Atrophy
• atherosclerotic narrowing of the blood supply in old age
• the end stage of an inflammatory orchitis, whatever the etiologic agent
• cryptorchidism• hypopituitarism• generalized malnutrition or cachexia• irradiation• prolonged administration of female sex hormones, as in treatment of
patients with carcinoma of the prostate; and cirrhosis
www.freelivedoctor.com
www.freelivedoctor.com
Male Genital Tract(short version)
• Testis/Epididymis: – Congenital: Cryptorchidism 1%– Regressive: Atrophy– Inflammation: Mumps, GC, Chlamydia, E.
Coli, Pseudomonas, TB– Vascular diseases: Torsion– Tumors: Benign/Malig, Germ Cell/non-
Germ Cell
www.freelivedoctor.com
www.freelivedoctor.com
Male Genital Tract(short version)
• Testis/Epididymis:
– Congenital: Cryptorchidism 1%– Regressive: Atrophy– Inflammation: Mumps, TB, GC, Chlamydia,
E. Coli, Pseudomonas– Vascular diseases: Torsion– Tumors: Benign/Malig, Germ Cell/non-
Germ Cell
www.freelivedoctor.com
www.freelivedoctor.com
Male Genital Tract(short version)
• Testis/Epididymis: – Congenital: Cryptorchidism 1%– Regressive: Atrophy– Inflammation: Mumps, GC, Chlamydia, E.
Coli, Pseudomonas, TB– Vascular diseases: Torsion– Tumors: Benign/Malig, Germ Cell/non-
Germ Cell
www.freelivedoctor.com
Testicular TUMORS
• GERM CELL (malig.)– SEMINOMA– EMBRYONAL– CHORIOCARCINOMA– YOLK SAC– TERATOMA
– MIXED, 60%
• NON-GERM (benign)• CELL, i.e., “sex cord”
– LEYDIG– SERTOLI
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Seminoma
(look for germ cells and lymphs)
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Embryonal Carcinoma,
Formerly called “adeno”carcinoma, so look for “glands” and AFP!!!)
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CHORIOCARCINOMAlook for “trophoblast”, and HCG!!
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YOLK SAC TUMOR, aka “endodermal sinus tumor”
Schiller-Duvall Bodywww.freelivedoctor.com
TERATOMAMALIGNANT TERATOMA
TERATOCARCINOMA
neural tissue
retina
muscle bundles
islands of cartilage
clusters of squamous epithelium
structures reminiscent of thyroid gland
bronchial or bronchiolar epithelium
bits of intestinal wall or brain substance
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SEX Cord Tumors
• Leydig, tumor cells look like Leydig cells
• Sertoli , tumor cells look like sertoli cells
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STAGING• Stage I: Tumor confined to the testis,
epididymis, or spermatic cord • Stage II: Distant spread confined to
retroperitoneal nodes below the diaphragm • Stage III: Metastases outside the
retroperitoneal nodes or above the diaphragm
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PROSTATE• INFLAMMATIONS
• BENIGN ENLARGEMENT
• MALIGNANT TUMORS
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CZ = CENTRAL
TZ = TRANSITIONAL
PZ = PERIPHAL
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PROSTATE• INFLAMMATIONS
• BENIGN ENLARGEMENT
• MALIGNANT TUMORS
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PROSTATITIS• ACUTE, usually same as Urinary Tract
Pathogens
• CHRONIC, usually A-bacterial, but also often recurrent or persistent from acute
• GRANULOMATOUS, non-TB or TB
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“BENIGN” Enlargement• BPH• BPH• Glandular and Stromal Hyperplasia• “Nodular” Hyperplasia• Associated with old age• Associated with urinary obstruction, frequency,
bladder hypertrophy and bladder trabeculations• By itself, it is NOT premalignant, however….
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P.I.N.www.freelivedoctor.com
NUCLEOLI, NUCLEOLI, NUCLEOLINUCLEOLI, NUCLEOLI, NUCLEOLIwww.freelivedoctor.com
PERINEURAL INVASION www.freelivedoctor.com
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BIOLOGIC BEHAVIOR
• NORMAL PROSTATE • HYPERPLASIA
• P.I.N. (Prostatic Intraepithelial Neoplasia), is like “dysplasia leading to adenocarcinoma-in situ
• INFILTRATION of “stroma” • CAPSULE • LYMPH NODES • DISTANT, especially BONE
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GRADING• GLEASON SCORE = Predominant
pattern (1-5) + Secondary pattern (1-5)
• Best Score = 2, Worst Score = 10
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STAGING
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TID-BITS• Prostate is #1 most common malignancy in men but NOT
#1 killer. WHY?• 80% over 80• Every elderly male presenting with widespread bone
metastases is carcinoma of the prostate until proven otherwise
• PSA (Prostate Specific Antigen) has been controversial as a screening test but is GREAT for follow up of a known prostate cancer
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