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This Concept Map, created with IHMC CmapTools, has information related to: Male Genital Tract, TUMORS GERM CELL TUMORS -most common CA 15-34yo -WHITE>black YOLK SAC TUMOR(endodermal sinus) (infantile embryonal CA) -most common testic tumor ɛyo -adults-pure form is rare -often mixed in w/ embryonal MORPH-nonencapsulated -homogeneous, mucinous, yel-wht -reticular LACELIKE-cub cells PAS+ eosinophilic inclusions 50%-endodermal sinuses seen AFP, alpha-1 antitrypsin found, Inflammation NONSPECIFIC EPIDIDYMITIS, ORCHITIS -related to UTIs->vas def->epid OR UTI->lymphs in sperm cord->epid នyo - Chlamydia, N. gonorrhoeae ᡛyo - E. coli, Pseudomonas MORPH- interstit CT->tubules -acute inflam->abscess->necrosis ->testis ->fibrous scarring->sterility -Leydig fine, so sexual activity okay -can->chronic Specific Inflammations GRANULOMATOUS ORCHITIS (AUTOIMMUNE) -middle-aged men -unilateral testic enlargement CLINICAL-moderately tender, fever - could be painless and mimic tumor MORPH-granulomas w/in sperm tubs, intertub CT - mimic tubercles -but w/ plasma cells, PMNs in outer rim, Male Genital Tract Prostate -retroperitoneal BENIGN PROSTATIC HYPERTROPHY (Nodular Hyperplasia) ᡪyo ~NL -more stromal, epith cells, gland dilation ->nodules->obstruction Pathogenesis-dihydrotestosterone (DHT) testost->DHT in stromal cells ->autocrine, paracrine (endoth cells) ->growth NOT PREMALIGNANT MORPH-1st-transitional zone (epith nods) 2nd-periurethral (stromal nodules) -stromal predominates mostly -epith-bilayered lining, papillary buds -inner columnar, outer cuboidal -can have some Sq metaplasia, infarction -if more glandular-yellow, secrete fluid -if more stromal-firm, fibromusc, gray CLINICAL- 1. compression-frequency, diff start/stop ->dribbling, nocturia, dysuria 2. urine retention->infx, bladder dilation, trabeculation, diverticula, hydroneph, 2ndary UTI, azotemia, Male Genital Tract Testis, Epididymus Regressive Changes ATROPHY via -narrowed blood supply -end-stage inflammation -cryptorchidism -hypopituitarism -malnutrition, cachexia -obstructed semen outflow -irradiation -female sex hormones-prostate CA -exhaution atrophy after lost of FSH -Klinefelter syndrome - XXY MORPH-increased interstit stroma -Leydig cells okay -tubules ->dense cords -thickened BM, hyalinization -small, firm due to fibrosis -paucity of germ cells, TUMORS GERM CELL TUMORS -most common CA 15-34yo -WHITE>black CHORIOCARCINOMA, also in females -highly malignant, mets easily -cytotroph+syncytiotrophoblast -c:polygonal, clear cyto, grow in sheets -s:lobular, dark nuclei, vacuol cyto +HCG, large cells -rare in pure form, mostly mixed MORPH-small lesions, small nodule -may outgrow blood supply->scar -but already mets -HEMORRHAGE, NECROSIS, Male Genital Tract Penis CARCINOMA IN SITU-ass'd w/ HPV-16 -can -> malignancy Bowen Dz-men, women ᡛyo -intact BM, numerous mitoses -solitary, gray-white, ulcer, crusting -to describe skin Erythroplasia of Queyrat- for glans penis -single, multiple shiny red, velvety Bowenoid Papulosis-younger pts -multiple reddish-brown papules -can look like Condy Acumin -same histo as Bowen Dz -NEVER -> CA, CLINICAL Stage I-only in testis, epid or sperm cord II-confined to retroperitoneal nodes III-mets about diaphragm SPREAD->retroperit para-Ao nodes ->mediastinal, supraclavic Hematogenous->lungs, liver, brain, bones -can forward or backward diff'ate w/ mets Comparison SEMINOMAS-usually pure -stay in testes for awhile-70% at Stage I -mets later, via LNs; hematogenous later -extremely radiosensitive INCREASED LDH, PLAP for most w/ adv dz no AFP, rare HCG+ little keratin+ staining, Male Genital Tract Penis Inflammations - -involve glans, prepuce Syphilis, Gonorrhea, Chancroid, granuloma inguinale, lymphopathia venerea, genital herpes BALANOPOSTHITIS-infx -C. albicans, anaerobes, Gardnerella, pyogenic bac -via poor hygiene in uncircumcised -smegma-accum of junk->irritant -can->PHIMOSIS, Male Genital Tract Testis, Epididymus Tunica Vaginalis Lesions -can be involved in any testes or epid lesion HYDROCELE-serous fluid HEMATOCELE-blood CHYLOCELE-w/ lymph -in elephantiasis w/ lymph obstruction, TUMORS TESTICULAR LYMPHOMA 5% OF TESTIC NEOPLASMS -present w/ testic mass -most common testic CA ᡴyo -like diffuse large cell lymphoma POOR Px-prob already spread before nodule present, Male Genital Tract Testis, Epididymus Inflammation NONSPECIFIC EPIDIDYMITIS, ORCHITIS -related to UTIs->vas def->epid OR UTI->lymphs in sperm cord->epid នyo - Chlamydia, N. gonorrhoeae ᡛyo - E. coli, Pseudomonas MORPH- interstit CT->tubules -acute inflam->abscess->necrosis ->testis ->fibrous scarring->sterility -Leydig fine, so sexual activity okay -can->chronic, CARCINOMA-most common male CA -2nd leading CA COD; 99% ᡪyo -BLACKS>white>asian -via androgens? Genetics-germ-line inheritance in 10% -1/3-Chromosome 1q24-25 -2x risk w/ 1 1st deg fam member -5x risk w/ 2 1st deg MORPH-70%-PERIPHERAL zone -palpable by rectal exam -mostly well-diff'd adenoCA -monolayered glands-cuboidal -back-to-back glands -papillary/cribriform if larger -vacuolated nuclei, not pleomorphic Less-diff'd-grow in sheets INVASION of capsule w/ lymph, blood PERINEURIAL involvement Prostatic Intraepith Neoplasia in 80% -foci w/ anaplasia, no invasion -due to loss of heterozygosity ->invasive CA w/in 10 yrs Extension->sem vesicles, bladder base Hematogenous->bones (vert)-BLASTIC -lumbar>femur>pelvis>thoracic>ribs Lymphatic spread before hematogenous ->FATAL CLINICAL Incidental in 70% of men ᢈyo -25% progress -no urinary Sx b/c periph zone -only in advanced dz -OSTEOBLASTIC BONE LESIONS-Dx ->fatal -Bx to confirm Dx PSA-prostate epith-NLɜng/mL -not specific to CA though ->use PSA Density=PSA/gland size -or rate of change, or age-specific Tx-surgery, XRT, hormonal (estrogen) -ᡇyrs -most common-radical prostatectomy Adv, mets CA-endocrine, Male Genital Tract Prostate -retroperitoneal Inflammations-PROSTATITIS -no pyuria, but ᡂ WBCs in massage ACUTE BACTERIAL - like UTI-E.coli, gram(-) rods, enterococci, staph -sometimes iatrogenic MORPH-small, disseminated abscesses, focal necrosis, OR edema thruout -will->scarring or plugs->chronic Clinical-fever, chills, dysuria -tender, boggy on rectal exam CHRONIC BACTERIAL-same orgs as acute Clinical-low back pain, dysuria, perineal, suprapubic discomfort -h/o recurrent UTIs by same organism -ABX don't get to prostate-bac stays CHRONIC ABACTERIAL - most common -came clinically as CBP, but no UTIs -perhaps STIs-many pts sexually active MORPH-many lymphos, plasma cells, macs, neutrophils in prostatic substance (lymphos can be present in NL aging), Male Genital Tract Prostate -retroperitoneal CARCINOMA-most common male CA -2nd leading CA COD; 99% ᡪyo -BLACKS>white>asian -via androgens? Genetics-germ-line inheritance in 10% -1/3-Chromosome 1q24-25 -2x risk w/ 1 1st deg fam member -5x risk w/ 2 1st deg MORPH-70%-PERIPHERAL zone -palpable by rectal exam -mostly well-diff'd adenoCA -monolayered glands-cuboidal -back-to-back glands -papillary/cribriform if larger -vacuolated nuclei, not pleomorphic Less-diff'd-grow in sheets INVASION of capsule w/ lymph, blood PERINEURIAL involvement Prostatic Intraepith Neoplasia in 80% -foci w/ anaplasia, no invasion -due to loss of heterozygosity ->invasive CA w/in 10 yrs Extension->sem vesicles, bladder base Hematogenous->bones (vert)-BLASTIC -lumbar>femur>pelvis>thoracic>ribs Lymphatic spread before hematogenous ->FATAL, TUMORS GERM CELL TUMORS -most common CA 15-34yo -WHITE>black MIXED TUMORS-60% -most common (14%) -teratoma+emb+yolk sac+syncytio, Male Genital Tract Testis, Epididymus Spermatic cord SPERMATOCELE -sperm accum in cord VARICOCELE -dilated vein in cord, Male Genital Tract Testis, Epididymus Vascular TORSION -usually no aa, but vv ->venous infarction->necrosis -large, soft, necrotic sac, TUMORS GERM CELL TUMORS -most common CA 15-34yo -WHITE>black CLINICAL Stage I-only in testis, epid or sperm cord II-confined to retroperitoneal nodes III-mets about diaphragm SPREAD->retroperit para-Ao nodes ->mediastinal, supraclavic Hematogenous->lungs, liver, brain, bones -can forward or backward diff'ate w/ mets, Male Genital Tract Penis CONDYLOMA ACUMINATUM-benign tumor -caused by HPV-6, 11 MORPH-on penis or perineal -single or many sessile or pedunc'd -villous, papillary, hyperkeratosis -vacuolization of prickle cells -recurrent, but not invasive, TUMORS GERM CELL TUMORS -most common CA 15-34yo -WHITE>black SPERMATOCYTIC SEMINOMA-1-2% GCC -doesnt' arise from intratub GC neoplasm (nor do kids' teratomas) yo - slow-growing, no mets, GOOD Px! MORPH-3 cell pop'ns-medium, small, giant -resemble spermatocytic maturation