PATHOLOGY OF REPRODUCTIVE SYSTEM 1.pdf

PATHOLOGY OF REPRODUCTIVE SYSTEM Dr (PhD) Izatus Shima Taib Biomedical Science Program REPRODUCTIVE SYSTEM Pathology of Male PATHOLOGY OF Reproductive System Pathology of Female Reproductive System...

PATHOLOGY OF REPRODUCTIVE SYSTEM Dr (PhD) Izatus Shima Taib Biomedical Science Program REPRODUCTIVE SYSTEM Pathology of Male PATHOLOGY OF Reproductive System Pathology of Female Reproductive System Infertility PATHOLOGY OF MALE REPRODUCTIVE Male Reproductive System I Common Male Reproductive Organs - Pathology  OUTLINE Prostate – prostatitis, BPH, Prostatic carcinoma Testis – developmental & cystic lesions, orchitis, tumor Other accessory organs PROSTATE GLAND DISEASE Common causes of urinary problems in men > 60 years old Prostatitis, BPH and prostatic carcinoma  a) Prostatitis Associated with specific infective cause i. Acute suppurative prostatitis – caused by colioforms, Staphylococcus or Neisseria gonorrhoea (gonococcus) ii. Chronic non-specific prostatitis iii. Granulomatous prostatitis – idiopathic, tuberculous, following transurethral resection/ allergic Symptoms: a) enlarged prostate b) pain during urination  Chronic Prostatitis Variable inflammatory infiltrate – seen in the prostatic stroma  b) Benign Prostatic Hyperplasia (BPH) Non-neoplastic enlargement of the prostate ↑ prostate weight / Enlarged Prostate 50% in 40-60 yrs 95% in > 70 yrs Severe – require surgery  b) BPH – Clinical features Early stage of BPH Experience few symptoms - the bladder muscles are strong enough to push urine through a narrowing urethra Prostate grows and BPH begins to restrict urine flow, patient may experience the following symptoms (urine flow): Leakage after Unable to empty Push the urine Intermittent Weak urination the bladder (need) urination completely (dribbling) Severe BPH – severe muscle thicken (hypertrophy – lost elasticity / unable to stretch Cannot hold much urine Nocturia  b) BPH - Gross B A) Solid Nodules and cysts – yellowish necrotic areas with haemorrhagic margin (obstruct blood supply) B) Nodules – solid (composed predominantly of stroma, also contain hyperplastic acini) b) BPH - Histology  b) BPH - Histology larger glands with tall epithelium lining (papillary projections) Normal Prostatitis BPH  b) BPH - diagnosis Digital rectal examination – size and firmness of the prostate Urinalysis & urine culture Prostate-specific antigen (PSA) test  b) BPH - Treatments Transurethral Resection of the Prostate (TURP)  c) Carcinoma of Prostate Common – malignant disease 2nd : male deaths Rare < 50 years old, peak 60 – 85 years old c) Carcinoma of Prostate (Etiology) Genetic Factors: Genetic mutations - BRCA1, BRCA2, and certain DNA repair genes, increase the risk of developing prostate cancer. These mutations can be inherited or acquired over time due to environmental factors or aging. Hormonal Factors: Androgens, particularly testosterone and dihydrotestosterone (DHT), are male hormones that stimulate the growth of prostate cells. Prostate cancer cells may become dependent on these hormones for their growth and survival. Hormonal imbalances or excessive androgen exposure can contribute to the development and progression of prostate cancer. Age: Prostate cancer is predominantly a disease of aging. The risk of developing prostate cancer increases with age, with the majority of cases diagnosed in men over the age of 65. Aging is associated with a higher likelihood of accumulating genetic mutations and alterations in hormone levels, which can promote cancer development. Inflammation: Chronic inflammation of the prostate gland, often resulting from infections or other causes, can contribute to the development of prostate cancer. Inflammatory processes within the prostate tissue can lead to DNA damage, cell proliferation, and tissue remodeling, creating an environment conducive to cancer initiation and progression. c) Carcinoma of Prostate (Etiology) Environmental Factors: Environmental factors, such as diet, lifestyle, exposure to carcinogens, and occupational hazards  increased risk of prostate cancer. Epigenetic Changes: Epigenetic alterations, such as changes in DNA methylation patterns and histone modifications, can affect gene expression and contribute to prostate cancer development. Tumor Microenvironment: The tumor microenvironment, consisting of various cell types, extracellular matrix components, and signaling molecules, plays a critical role in prostate cancer progression. Interactions between cancer cells and the surrounding stromal, immune, and endothelial cells can promote tumor growth, invasion, and metastasis.  c) Carcinoma of Prostate Etiology unknown associate with environmental factors hormonal influences same as BPH Pathology Gross: hard , irregular and ill-defined gray area Histology : adenocarcinomas in the glandular epithelium  c) Carcinoma of Prostate Clinical features Urinary symptoms > BPH Hard craggy prostate – rectal examination Bone metastases – pain, pathological fracture, anaemia Lymph nose metastasis  c) Carcinoma of Prostate Diagnosis Diagnostic imaging – ultrasound, skeletal X- rays, isotope bone scan Cytoscopy – transurethral resection Chemical pathology – serum acid and alkaline phosphatase and prostate-specific antigen (PSA) Haematology – leucoerythroblastic anemia Biopsy – transurethral resection, needle biopsy, fine-needle aspiration cytology  c) Carcinoma of Prostate Clinical Management Gonadorelin (GnRH) Orchidectomy - Cyproterone (anti- androgenic effects – DHT action) Radiotherapy  TESTICULAR LESIONS Non-neoplastic disorder Present with hydrocele, accumulation of fluid around the testis Incidence increase worldwide a) Developmental and Cystic Lesions 1. Undescended testis (cryptorchidism) a) Developmental and Cystic Lesions (Cont.) 2. Hydrocele accumulation of serous fluid within the tunica vaginalis of the testis a) Developmental and Cystic Lesions (Cont.) 3. Haematocele a) Developmental and Cystic Lesions (Cont.) 4. Testicular Tortion a) Developmental and Cystic Lesions (Cont.)  b) Orchitis Inflammatory condition of one or both testis viral or bacterial infection. Children ( 50 y/o with BPH Epididymo-orchitis  b) Orchitis - symptoms Rapid onset of pain and swelling which include: 1. Testicular swelling, redness, pain & tenderness 2. Fever and chills 3. Nausea 4. Malaise and fatigue 5. Headache 6. Body aches 7. Pain with urination  b) Orchitis - symptoms epididymo-orchitis symptoms may come on and progress more gradually localized area of pain and swelling on the back of the testicle for several days infection increases and spreads to involve the whole testicle Possible pain or burning before or after urination & Penile discharge  b) Orchitis - Diagnosis Established after a history and physical exam Ultrasound - exclude other conditions (for example, testicular torsion, abscess, or epididymitis) Rectal examination – check for – prostate gland infection Sample of discharge – – identify the infectious agent FBC & urinalysis – pts condition  c) Testicular Tumor Uncommon Occur in young man  c) Testicular Tumor (Cont.) Aetiology: Clinical features 1. undescended testis 2. in-situ neoplastic metastasis changes within Gynaecomastia seminiferous tubules Retroperitoneal mass Swelling of testis Secondary hydrocele c) Testicular Tumour – Classification the commonest type of testicular tumor, age 30 – 50 y/o germ cells origin, age 20 – 30 y/o seminoma teratoma c) Testicular Tumour - Diagnosis  OTHER MALE REPRODUCTIVE ORGANS Penis & scrotum - Congenital (hypospadias, Epispadias), inflammation & infections (Balanophosthitis, Phimosis, Paramiphosis, Syphilis etc.), tumor, carcinoma of the scrotum. Urethra – urethral obstruction, urethritis (gonorrhea), tumor Epididymis and cord – congenital, cysts, varicocele, inflammatory lesions, tumor