Pathology of Male Reproductive System 4

Pathology of Male Reproductive System 4

Professor dr Ali Hassan Altimimi
Professor of pathology & histology MSc, PHD, MD(UK)

Hydrocele
- fluid in the tunica vaginalis; usually idiopathic, a hydrocele may contain 100cc or more of serous fluid
- you can distinguish a hydrocele from a tumor mass by transilluminating it with a bright light in a dark room
- hematocele - blood in the tunica vaginalis

Varicocele
- variscosities of the pampiniform plexus, usually on the left side
- common in young men, may cause fertility problems by warming the testes
- spermatocele - a cystic lesion up to 1 cm or so in the area of the rete testis, filled with fluid and dead sperms

Prostatitis
- acute and chronic prostatitis are uncomfortable problems, and are common in men who catch sexually-transmitted urethritis or lower urinary tract infections
- e. coli is the most common agent
- in acute prostatitis the gland is exquisitely tender; gonorrhea is an important cause
- in chronic prostatitis the gland is somewhat tender and the prostatic fluid you express contain WBC s and grows bacteria
- prostatodynia is a stress-related pain syndrome in which there are no WBC s in the prostatic fluid
- granulomatous prostatitis may be due to TB or idiopathic

Prostatic Hyperplasia
- something that happens to most intact men over about age 50; 10% men will need surgery
- the increased tissue is nodular overgrowth of periurethral glands and stroma
- the hyperplasia most often involves the lateral and median lobes
- the posterior lobe is the most common site for the development of prostatic adenocarcinoma
- median lobe hyperplasia by itself produces a median bar, obstruction without an enlarged gland
- prostatic hyperplasia casuses many problems, though most pts are are asymptomatic
- frequency, difficulty starting and stopping urination, incontinence, dysuria, hernias, acute urinary retention
- hematuria, bladder hypertrophy and trabeculation, bladder diverticula, bladder stones, hydronephrosis, renal failure
- residual urine accumulates in an enlarged bladder behind the prostate gland

Prostate Cancer
- adenocarcinoma of the subcapsular glands
- the second most common cancer in men, and the third leading cancer killer of men
- a disease of men over 50
- majority arise in the posterior lobes
- the etiology is essentially unknown
- early castration prevents the development of adenocarcinoma
- probably no link to infection or prostatic hyperplasia, or lack of sexual activity
- industrial exposure to cadmium
- cancer of the prostate preents as a painless lump in the gland
- almost all are prostate type adenocarcinomas: to diagnose you need one of the following
- prominent nucleoli in large nuclei with marginated chromatin
- invasion
- obvious distortion of architecture
- most prostate cancers, even the ones that have metastasized, are fairly well-differentiated adenocarcinomas
- cancer of the prostate seldom causes problems unless it spreads:
- rectal exam is the most effective method of diagnosis
- prostate cancer is often indolent even when it has metastasized, but some prostate cancers are very aggressive
- prostate cancer typically metastasizes to the axial skeleton, eventually causing miserable bone pain
- serum acid phosphatase is a classic tumor marker for prostate cancer
- surgery and/or radiation are useful for localized disease; conventional chemotherapy is of limited usefulness in prostate cancer, but protocols do exist
- usually quite responsive to endocrine manipulations
- one new important agent is leuprolide, a GnRH agonist
- another is anti-androgen flutamide, which shrinks prostate cancer supposedly without causing impotence
- ketoconazole is also an anti-prostatic drug