Diseases of male genital system

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  • Testicular atrophy, ghosting or fibrosis of tubules, NO spermatogenesis, INCREASED interstitial cells of Leydig.
  • Often, Inflammations in the testicle ALSO involve the epididymis, and vice versa. Commonly urinart tract gram negatives infect BOTH. However, 1) Mumps and TB are the most common agents of primarily orchitis, and 2) CHLAMIDIA and TORSION are the most common causes of primarily epididymitis.
  • Infarcted testicle and epididymis due to “torsion”
  • Most testicular teratomas are malignant. Most ovarian teratomas are benign (e.g., dermoid cyst)
  • Wheras, most germ cell tumors are regarded as benign, most sex cord (NON germ cell) tumors are regarded as benign.
  • CZ is nearest the urethra, PZ is nearest the capsule. TZ is between the two.
  • Granulomatous prostatitis
  • Glandular hyperplasia, note ABSENCE of nucleoli.
  • PIN (Prostatic Intraepithelial Neoplasia) is the grey zone between BENIGN and MALIGNANT prostate glands. The can be LOW grade PIN, or HIGH grade PIN.
  • NUCLEOLI separate benign from malignant prostate glands!!!
  • Even if, theoretically, the prostate gland cells looked 100%, if they surround nerve spaces, they are malignant. Why?
  • TIP: Multiple bone metastases in males is usually carcinoma of the prostate.
  • Know this correct order of biologic behavior.
  • A Gleason’s final SCORE is the SUM of the predominant pattern (1-5) and the secondary pattern (1-5). So a Gleason GRADE ranges from 1-5, and a Gleason SCORE ranges from 2-10
  • Diseases of male genital system

    1. 1. Male Genital Tract (short version) <ul><li>Penis: Congenital, Inflammation, Tumors </li></ul><ul><li>Testis/Epididymis: Congenital, Regressive, Inflammation, Vascular diseases, Tumors </li></ul><ul><li>Prostate: Inflammation, Benign Enlargement, Malignancy </li></ul>www.freelivedoctor.com
    2. 2. Male Genital Tract (short version) <ul><li>Testis/Epididymis: </li></ul><ul><ul><li>Congenital </li></ul></ul><ul><ul><li>Regressive </li></ul></ul><ul><ul><li>Inflammation </li></ul></ul><ul><ul><li>Vascular diseases </li></ul></ul><ul><ul><li>Tumors </li></ul></ul>www.freelivedoctor.com
    3. 3. Male Genital Tract (short version) <ul><li>Testis/Epididymis: </li></ul><ul><ul><li>Congenital : Cryptorchidism 1% </li></ul></ul><ul><ul><li>Regressive: Atrophy </li></ul></ul><ul><ul><li>Inflammation: Mumps, GC, Chlamydia, E. Coli, Pseudomonas, TB </li></ul></ul><ul><ul><li>Vascular diseases: Torsion </li></ul></ul><ul><ul><li>Tumors: Benign/Malig, Germ Cell/non-Germ Cell </li></ul></ul>www.freelivedoctor.com
    4. 4. Cryptorchidism <ul><li>1% of all births </li></ul><ul><li>25% bilateral </li></ul><ul><li>Associated with significantly increased incidence of germ cell tumors </li></ul>www.freelivedoctor.com
    5. 5. Male Genital Tract (short version) <ul><li>Testis/Epididymis: </li></ul><ul><ul><li>Congenital : Cryptorchidism 1% </li></ul></ul><ul><ul><li>Regressive: Atrophy </li></ul></ul><ul><ul><li>Inflammation: Mumps, GC, Chlamydia, E. Coli, Pseudomonas, TB </li></ul></ul><ul><ul><li>Vascular diseases: Torsion </li></ul></ul><ul><ul><li>Tumors: Benign/Malig, Germ Cell/non-Germ Cell </li></ul></ul>www.freelivedoctor.com
    6. 6. Testicular Atrophy <ul><li>atherosclerotic narrowing of the blood supply in old age </li></ul><ul><li>the end stage of an inflammatory orchitis , whatever the etiologic agent </li></ul><ul><li>cryptorchidism </li></ul><ul><li>hypopituitarism </li></ul><ul><li>generalized malnutrition or cachexia </li></ul><ul><li>irradiation </li></ul><ul><li>prolonged administration of female sex hormones , as in treatment of patients with carcinoma of the prostate; and cirrhosis </li></ul>www.freelivedoctor.com
    7. 7. www.freelivedoctor.com
    8. 8. Male Genital Tract (short version) <ul><li>Testis/Epididymis : </li></ul><ul><ul><li>Congenital : Cryptorchidism 1% </li></ul></ul><ul><ul><li>Regressive: Atrophy </li></ul></ul><ul><ul><li>Inflammation: Mumps, GC, Chlamydia, E. Coli, Pseudomonas, TB </li></ul></ul><ul><ul><li>Vascular diseases: Torsion </li></ul></ul><ul><ul><li>Tumors: Benign/Malig, Germ Cell/non-Germ Cell </li></ul></ul>www.freelivedoctor.com
    9. 9. www.freelivedoctor.com
    10. 10. Male Genital Tract (short version) <ul><li>Testis/Epididymis: </li></ul><ul><ul><li>Congenital : Cryptorchidism 1% </li></ul></ul><ul><ul><li>Regressive: Atrophy </li></ul></ul><ul><ul><li>Inflammation: Mumps, TB, GC, Chlamydia, E. Coli, Pseudomonas </li></ul></ul><ul><ul><li>Vascular diseases: Torsion </li></ul></ul><ul><ul><li>Tumors: Benign/Malig, Germ Cell/non-Germ Cell </li></ul></ul>www.freelivedoctor.com
    11. 11. www.freelivedoctor.com
    12. 12. Male Genital Tract (short version) <ul><li>Testis/Epididymis: </li></ul><ul><ul><li>Congenital : Cryptorchidism 1% </li></ul></ul><ul><ul><li>Regressive: Atrophy </li></ul></ul><ul><ul><li>Inflammation: Mumps, GC, Chlamydia, E. Coli, Pseudomonas, TB </li></ul></ul><ul><ul><li>Vascular diseases: Torsion </li></ul></ul><ul><ul><li>Tumors: Benign/Malig, Germ Cell/non-Germ Cell </li></ul></ul>www.freelivedoctor.com
    13. 13. Testicular TUMORS <ul><li>GERM CELL (malig.) </li></ul><ul><ul><li>SEMINOMA </li></ul></ul><ul><ul><li>EMBRYONAL </li></ul></ul><ul><ul><li>CHORIOCARCINOMA </li></ul></ul><ul><ul><li>YOLK SAC </li></ul></ul><ul><ul><li>TERATOMA </li></ul></ul><ul><ul><li>MIXED, 60% </li></ul></ul><ul><li>NON-GERM (benign) </li></ul><ul><li>CELL, i.e., “sex cord” </li></ul><ul><ul><li>LEYDIG </li></ul></ul><ul><ul><li>SERTOLI </li></ul></ul>www.freelivedoctor.com
    14. 14. Seminoma (look for germ cells and lymphs ) www.freelivedoctor.com
    15. 15. Embryonal Carcinoma, Formerly called “adeno”carcinoma, so look for “glands” and AFP!!!) www.freelivedoctor.com
    16. 16. CHORIOCARCINOMA look for “trophoblast”, and HCG!! www.freelivedoctor.com
    17. 17. YOLK SAC TUMOR, aka “endodermal sinus tumor” Schiller-Duvall Body www.freelivedoctor.com
    18. 18. TERATOMA MALIGNANT 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 www.freelivedoctor.com
    19. 19. SEX Cord Tumors <ul><li>Leydig , tumor cells look like Leydig cells </li></ul><ul><li>Sertoli , tumor cells look like sertoli cells </li></ul>www.freelivedoctor.com
    20. 20. STAGING <ul><li>Stage I: Tumor confined to the testis, epididymis, or spermatic cord </li></ul><ul><li>Stage II: Distant spread confined to retroperitoneal nodes below the diaphragm </li></ul><ul><li>Stage III: Metastases outside the retroperitoneal nodes or above the diaphragm </li></ul>www.freelivedoctor.com
    21. 21. PROSTATE <ul><li>INFLAMMATIONS </li></ul><ul><li>BENIGN ENLARGEMENT </li></ul><ul><li>MALIGNANT TUMORS </li></ul>www.freelivedoctor.com
    22. 22. CZ = CENTRAL TZ = TRANSITIONAL PZ = PERIPHAL www.freelivedoctor.com
    23. 23. PROSTATE <ul><li>INFLAMMATIONS </li></ul><ul><li>BENIGN ENLARGEMENT </li></ul><ul><li>MALIGNANT TUMORS </li></ul>www.freelivedoctor.com
    24. 24. PROSTATITIS <ul><li>ACUTE, usually same as Urinary Tract Pathogens </li></ul><ul><li>CHRONIC, usually A-bacterial, but also often recurrent or persistent from acute </li></ul><ul><li>GRANULOMATOUS, non-TB or TB </li></ul>www.freelivedoctor.com
    25. 25. www.freelivedoctor.com
    26. 26. www.freelivedoctor.com
    27. 27. www.freelivedoctor.com
    28. 28. “ BENIGN” Enlargement <ul><li>BP H </li></ul><ul><li>BP H </li></ul><ul><li>Glandular and Stromal Hyperplasia </li></ul><ul><li>“ Nodular” Hyperplasia </li></ul><ul><li>Associated with old age </li></ul><ul><li>Associated with urinary obstruction, frequency, bladder hypertrophy and bladder trabeculations </li></ul><ul><li>By itself, it is NOT premalignant, however…. </li></ul>www.freelivedoctor.com
    29. 29. www.freelivedoctor.com
    30. 30. P.I.N. www.freelivedoctor.com
    31. 31. NUCLEOLI, NUCLEOLI, NUCLEOLI www.freelivedoctor.com
    32. 32. <ul><ul><li>PERINEURAL INVASION </li></ul></ul>www.freelivedoctor.com
    33. 33. www.freelivedoctor.com
    34. 34. BIOLOGIC BEHAVIOR <ul><li>NORMAL PROSTATE  </li></ul><ul><li>HYPERPLASIA  </li></ul><ul><li>P.I.N. ( P rostatic I ntraepithelial N eoplasia), is like “dysplasia leading to adenocarcinoma-in situ  </li></ul><ul><li>INFILTRATION of “stroma”  </li></ul><ul><li>CAPSULE  </li></ul><ul><li>LYMPH NODES  </li></ul><ul><li>DISTANT, especially BONE  </li></ul>www.freelivedoctor.com
    35. 35. GRADING <ul><li>GLEASON SCORE = Predominant pattern (1-5) + Secondary pattern (1-5) </li></ul><ul><li>Best Score = 2, Worst Score = 10 </li></ul>www.freelivedoctor.com
    36. 36. STAGING www.freelivedoctor.com
    37. 37. TID-BITS <ul><li>Prostate is #1 most common malignancy in men but NOT #1 killer. WHY? </li></ul><ul><li>80% over 80 </li></ul><ul><li>Every elderly male presenting with widespread bone metastases is carcinoma of the prostate until proven otherwise </li></ul><ul><li>PSA ( P rostate S pecific A ntigen) has been controversial as a screening test but is GREAT for follow up of a known prostate cancer </li></ul>www.freelivedoctor.com

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