Male Genital Diseases Pathology PDF

Pathology of Male Uro-Genital System Pathology of the Prostate Nodular Hyperplasia “BPH” Carcinoma of Prostate Pathology of the Testis 1. Congenital lesions cryptorchidism 2. vascular torsi...

Pathology of Male Uro-Genital System Pathology of the Prostate Nodular Hyperplasia “BPH” Carcinoma of Prostate Pathology of the Testis 1. Congenital lesions cryptorchidism 2. vascular torsion August 15, 2024 3. Inflammations 10:30 am - 11:15 pm specific infections non-specific infections Prof F. Lai 4. Tumors ([email protected]) Dpt of A&C Pathology germ cell tumors sex-cord stromal tumors Pathology of the Prostate Nodular Hyperplasia “BPH” (hyperplasia of glands & fibromuscular stromal) common after 50 dysuria, frequency, nocturia… unknown cause nar – nuclear androgen receptor hormonal dependence (androgens) testosterone estrogen 5α-reductase DHT (dihydrotestosterone) DHT- nar 3α-androstenadiol FGF, TGF-β,… “BPH” Pathology of the Prostate Nodular Hyperplasia “BPH” macroscopy: nodular enlargement (TZ,CZ median lobe) microscopy: hyperplasia of glands & fibromuscular stroma treatments: α-blockers, 5α-reductase-Inhibitors surgical treatments: TURP (transurethral resection) ultrasound, laser,.. no association with carcinoma Pathology of the Prostate Carcinoma of Prostate most common cancer in male peak incidence after 65 prostatism, silent in 20% pathogenesis: age, hereditary (family, ethnics..) environment (carcinogens, western diet..) hormonal dependence: androgen deprivation > regression resistance by anr gene amplification genetic & epigenetic alterations: TMPRSS2-ETS fusion gene in 50% CaP * amplification of Myc oncogene * deletion of PTEN tumor suppressor * deletion & mutation of p53 * hypermethylation of GSTP1  PZ Pathology of the Prostate Carcinoma of the Prostate diagnosis: serum PSA (prostate specific antigen) DRE (digital rectal examination) ultrasound or imaging macroscopy: peripheral zone infiltrating, seldom conspicuous microscopy: acinar carcinoma 90% varying degree of differentiation Gleason grading Gleason score other types 10% ductal carcinoma, small cell ca, …. low-grade intermediate-grade high-grade  Gleason Grading 1966 1 2 3 4 Donald Gleason (1920 -2008) physician and pathologist 5 tumor grading & Gleason score  ISUP CaP Grading (WHO 2016) (International Society of Urological Pathology) Gleason score 3 + 3 = 6 ISUP grade group 1 Gleason score 3 + 4 = 7 ISUP grade group 2 Gleason score 4 + 3 = 7 ISUP grade group 3 Gleason score 4+4/3+5 = 8 ISUP grade group 4 Gleason score 4+5//5+5 = 9,10 ISUP grade group 5 G3 G4 G5 Carcinoma of the Prostate Prognostic factor 2 - Staging T1 NM T2 NM (non palpable) (palpable) bladder or rectum T3 NM T4 N1 M Pathology of the Prostate Carcinoma of the Prostate treatment: hormonal block (medical castration) surgery, radiation follow-up: serum PSA (nl < 4ng/ml) precursor lesion: PIN Pathology of the Prostate PIN (Prostate Intraepithelial Neoplasm) proliferation of atypical cells (nuclear enlargement, overlapping, hyperchromatism, prominent nucleoli) same incidence as carcinoma same distribution as carcinoma similar cellular features precursor of carcinoma 70% associated with carcinoma  Pathology of the Testis epididymis 1. Congenital lesions cryptorchidism 2. vascular torsion 3. Inflammations specific infections non-specific infections 4. Tumors germ cell tumors vaginalis sex-cord stromal tumors albuginea Pathology of the Testis 1. Congenital lesion: cryptorchidism testes fails to descent 1% of population cause unknown in most cases bilateral in 10-15% of patients tubular atrophy, germ cells deficiency risks - infertility, cancer (3-5 folds) atrophy & infertility Pathology of the Testis 2. Vascular lesion: torsion acute vascular event traumatic, cryptorchid,.. thrombosis, hemorrhage, infarction often requires orchidectomy Pathology of the Testis 2. Inflammations epididymitis specific infections N. gonorrhea, mumps, tuberculosis non-specific secondary to bacterial UTI (urinary tract infection) orchitis  Testicular Tumors painless mass, 5/100,000 males, 15-35 years Germ cell tumors Sex cord-stromal tumors 95% 5% seminoma Leydig cell tumor non-seminomas: Sertoli cell tumor - embryonal carcinoma - yolk sac tumor - choriocarcinoma - teratoma - mixed  Testicular Tumors Germ cell tumors 95% testicular neoplasms 10% cancer death young adult risk factors: cryptorchid, gonadal dysgenesis precursor: intratubular germ cell neoplasia isochromosome in chr.12p seminoma vs non-seminomatous (NSGCTs)  Germ Cell Tumors Seminoma NSGCTs embryonal carcinoma yolk sac tumor choriocarcinoma teratoma painless mass painless mass present in early stage present in later stages spread through lymphatics spread through blood radiosensitive radioresistance absence of markers serum HCG, AFP 90% curable by surgery & chemotherapy Testicular Tumors Seminoma most common germ cell tumor male at their 40’s white-yellow “potato” tumor clear cell in sheets or tubules lymphocytes, granulomas markers: PLAP, C-kit, Oct-4 (placental alkaline phosphatase, CD117,..) lymphatic spread surgery, radiosensitive Testicular Tumors NSGCT – embryonal carcinoma 30’s, 50% mixed immature glands markers: PLAP, Oct-4, CD30 variegated tumors Testicular Tumors NSGCT - yolk sac tumor most often children Schiller-Duval bodies markers: AFP (alpha-feto protein) (tissue hyaline droplets & serum) Testicular Tumors NSGCT - choriocarcinoma trophoblastic differentiation markers: HCG in cells & serum (human chorionic gonadotropin) highly malignant Testicular Tumors NSGCT - teratoma adults & infants, 50% mixed multipotential differentiations: ectoderm skin, neural tissues.. endoderm intestines, bronchial, thyroid.. mesoderm cartilage, adipose tissues.. types mature teratoma immature malignant  Testicular Tumors Leydig Sex cord-stromal tumors rare, usually benign Leydig cell tumor produces sex hormones gynecomastia, sexual precocity tan-brown tumor eosinophilic cells, Reinke crystals Sertoli cell tumor may produce hormones white-yellow tumor forming tubular structures  Testicular Tumors III staging diaphragm II I testis, epididymis, cord II lymph nodes below diaphragm I III lymph nodes above diaphragm T. vaginalis T. albuginea Pathology of the Male Genital System Robbins and Kumar BASIC PATHOLOGIC 11th edition 2023 Tumors of the Prostate p. 587-591 Tumors of Testis p. 583-587