Male Reproductive Pathology

• What are the 3 zones of the prostate?

  Peripheral - 70% (prostate cancers arise)

  Transition - 5% (gradually enlarges with age)

  Central - 25%
• Prostate function (brief)

  Seminal fluid production
• What is the main symptom of prostatic diseases?

  Urinary problems

  • impaired urine flow
  • increased risk of urinary infections
  • acute retention of urine -> requiring urgent relief by catheterisation
• 3 major prostate pathologies

  Prostatitis

  BPH

  Prostatic carcinoma
• RFs - prostate cancer

  Age

  FHx

  Race (African/Caribbean)

  Diet (red meat)
• Where is PSA produced?

  Prostatic ductal epithelium
• What are the common metastatic locations for prostate cancer?

  Bone

  Lungs

  Liver
• What are the risks of radical prostatectomy?

  Erectile dysfunction

  Impotence

  Urinary incontinence
• Function of Leydig cells

  Produce testosterone (in response to LH)
• What is cryptorchidism?

  Undescended testes (usually surgically descended prior to puberty)
• What is a hydrocele?

  Intrascrotal swelling of serous fluid in tunica vaginalis

  Can be due to acute inflammation, congenital or secondary inflammation (underlying testis or epididymis lesion (infection, orchitis, tumours))
• What is a haematocele?

  Intrascrotal haemorrhage into tunica vaginalis

  Causes: trauma, neoplasm

  Can be major or minor
• What is varicocele?

  Varicosity of pampiniform plexus of veins in spermatic cord

  Can be primary (no underlying cause, common in L testis) or secondary (venous obstruction, e.g. tumour)

  May cause subfertility
• Common causes of orchitis (inflammation of testes)

  Mumps

  Idiopathic granulomatous orchitis

  STI orchitis (gonorrhoea, chlamydia, syphilis)
• What is testicular torsion?

  Twisting of spermatic cord -> cuts off blood supply & prevents drainage of the testes

  Medical emergency -> 6 hours to save testicle

  Can occur w/o trauma
• Potential causes of testicular atrophy

  Hypopituitarism

  Generalised malnutrition/cachexia

  Irradiation

  Prolonged anti-androgens

  Alcoholism

  Old age
• What is the major RF for testicular cancer?

  Undescended testes
• Testicular cancer - clinical features

  Painless unilateral enlargement of testis

  Secondary hydrocele

  Symptoms from metastases

  Retroperitoneal mass

  Gynaecomastia
• Types of testicular tumour

  Paratesticular sarcoma

  Adenomatoid tumour

  Teratoma

  Seminoma

  Lymphoma

  Leydig cell tumour
• Seminoma testicular cancer - features

  Peak incidence = 30-50

  Testis enlarged by homogenous firm white solid tumour -> replaces all/part of body of the testis

  10% secrete HCG

  25% have c-KIT activating mutations
• Embryonal carcinoma - features

  20-30 yrs

  More aggressive than seminomas

  Epithelial cells = pleomorphic

  Nuclei = hyperchromatic nuclei
• Yolk sac tumour

  Most common testicular tumour in children up to 3 yrs

  Presentation = painless mass

  Treatment = chemo
• 60% of testicular tumours are mixed tumours.
• Testicular cancer - treatment

  Orchidectomy

  Chemotherapy

  Drugs (bleomycin or combination bleomycin etoposide cisplatin)