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Sdxxxxy MRP
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PATHOLOGY
MALE GU
SEX DISORDERS
GENETIC SEX
TURNER SYNDROME: XO genotype.
MIXED GONADAL DYSGENESIS: 1 defined gonad plus a
contralateral streak gonad. Increased incidence of germ cell
tumors.
TRUE HERMAPHRODITE: Both ovarian and testicular tissue
present.
PHENOTYPIC SEX:
MALE PSEUDOHERMAPHRODITISM: Testicular Feminization
Syndrome, insensitivity to testosterone ------> phenotypic female
with primary amenorrhea.
FEMALE PSEUDOHERMAPHRODITISM: Androgenital
Syndrome, due to adrenal hypersecretion of androgens.
SYMPTOMS: Infertility.
5-35X Risk of developing germ-cell tumors in untreated
Cryptorchidism.
TREATMENT: Orchidopexy = repositioning of testes into scrotum
surgically. Should treat as early as possible (less than 1 yr old) to prevent
occurrence of germ-cell tumor.
ORCHITIS
GERM-CELL TUMORS:
1. SEMINOMA: Adults.
EPIDEMIOLOGY: Seminoma accounts for 40% of all testicular
tumors. It has a peak incidence in the 35-45 years age group.
SUBTYPES:
CLASSIC SEMINOMA: Most common type. Can
metastasize to regional lymph nodes.
5-15% of tumors contain scattered
syncytiotrophoblast cells that secrete hCG.
ANAPLASTIC SEMINOMA: Different histologically, but
same picture clinically as classic seminoma.
SPERMATOCYTIC SEMINOMA: The only testicular
cancer to occur in elderly men. Is not known to
metastasize.
PATHOLOGY: Polygonal neoplastic cells that have clear
cytoplasm, contain glycogen and resemble fetal gonocytes.
Syncytiotrophoblastic Differentiation: Seminomas often
secrete hCG (80% of time) because they show some
differentiation into syncytiotrophoblast. This is not a
choriocarcinoma because that would require both
syncitio- and trophoblasts.
Gross: Yellow, no necrosis.
Lymphocytic Inflammation: the tumor cells are arranged
into solid nests surrounded by fibrous septa that are
infiltrated with lymphocytes.
Cancer cells are clear and contain glycogen, which stains
PAS positive.
Granulomas can be formed in response to seminomas, as a
response to tumor antigens.
TREATMENT: The tumor is radiosensitive and can be cured in
over 90% of cases.
DDx = LYMPHOMA of TESTIS: In an older male, you must
consider lymphoma as well as seminoma for any tumor in testis. In
a younger male, it is mostly likely a seminoma.
2. EMBRYONAL CARCINOMA: Usually occurs in conjunction with
seminomas. It would be rare to see it by itself.
EPIDEMIOLOGY: The tumor has a peak incidence in the 25-35
year age group. Pure embryonal carcinomas are rare accounting
for about 10-15% of all germ cell tumors.
3
STROMAL TUMORS
4
TESTICULAR ADNEXAE
TESTICULAR TUNICS:
VASITIS NODOSA:
LIPOMAS: Typically benign and usually occur in spermatic cord.
SARCOMAS:
PROSTATE
5
ANATOMY:
PROSTATITIS
GRANULOMATOUS PROSTATITIS:
1. EPIDEMIOLOGY: 75% of men have it by age 80. Some people say even
higher. Especially common in African American men.
2. PATHOGENESIS: Several theories
BPH may result from a combination of decreased testosterone
and increased estrogen, occurring with old age. This may cause an
increased sensitivity to DHT in the prostate.
3. PATHOLOGY: Both glands and stroma proliferate, with a significant (5:1)
stromal component.
Gross:
Hyperplasia appears nodular, with even proliferation of
stroma and glandular components.
Hyperplasia nearly always occurs in the transitional zone
of the prostate, beginning around the prostatic urethra,
and going out peripherally.
4. SYMPTOMS: Bladder-outlet obstruction. Hesitancy, dysuria, urgency,
feeling of incomplete stream.
Rectal Exam: BPH feels like a soft padding over the base of the
thumb. Cancer is rock-hard.
5. TREATMENT:
5-alpha-Reductase Inhibitors: Finasteride (Proscar) inhibits the
peripheral conversion of testosterone to DHT, thereby blocking
the growth-effect of DHT on the prostate.
Clinical Trials have shown it effective in reducing
prostate size and alleviating symptoms.
Trans-Urethral Resection (TUR): Core out middle part of the
urethra, to open up the lumen. This results in prostatic chips
which can be sent into Surg.Path. for analysis.
PROSTATIC ADENOCARCINOMA
CANCER of PENIS