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Nota Patho PDF
Nota Patho PDF
Lesions
Characteristics:
- accumulation
serous fluid w/in
T.Vaginalis
Causes:
- incomplete
closure processus
vaginalis
- 2ry to generalized
edema @ infected
HEMATOCELE
- accumulation
blood w/in
T.Vaginalis
CHYLOCELE
- accumulation
lymphatics w/in
T.Vaginalis
- 2ry to trauma,
torsion,
hemorrhage,
generalized
bleeding diathesis,
malignt. Invasion
- lymphatic
obstruction
SPERMATOCELE
- accumulation
semen w/in dilated
eff. Duct in head
epididymis
HYDROCELE
VARICOCELE
- obstruction in the
vas deferens
pampiniform
plexus elongated &
dilated
II.
Congenital anomalies
CRYPTORCHIDSM
Incidence:
- incomplete descent of testis to scrotum
- 0.7% of male population
- more in right
- 25% bilateral
Pathogenesis :
- testis remain in body at its temp (37C) inhibit spermatogenesis
- BUT, testosterone still present
There4: they are infantile but develop 2ry male characteristics
Causes(mostly idiopathic):
- hormonal abnorm. (decrease LHrh)
-genetic abnorm. (trisomy 13)
- short spermatic cord
- mechanicl obstruction in inguinal canal
Morphology:
Grossly: early life normal
Puberty atrophy
Micros: 6 yrs atrophy semin. Tubules, Leydig cell hyperplasia, interst. Fibrosis
Puberty hyalinization of semin. tubules. Regressive changes in othr
testis
Effects:
-asymptomatic
- discovered at puberty (aftr testicular atrophy)
- Bilateral infertility
- high incidence of malignancy compared to normal positioned testis
I. Testicular atrophy
Causes:
- 1ry Klienfelterss syn.
- 2ry because of:
cryptorchidism
vascular disease
inflammatory disease
hypopituitarism
malnutrition
obstruction semen outflow
increases female sex
hormones
persistant increase of FSH
radiation, chemotherapy
b) nonspecific
epididymitis &
orchitis
c) autoimmune
(granulomatous)
orchitis
d) specific
inflammation
Origin:
Start: epididymitis
with inflmmtn of
testis proper
(orchitis)
-1ry infection in
urinary tract
-2ry infction of
epididymis &
testis
i- gonorrhoeal
infection
- STD because of
N. Gonorrhea
ii- mumps
- viral infection
commonly affects
school age
-begins in
epididymis
-2ry involvement
of testis
- begins as orchitis
-2ry invlvmnt of
epididymis
* mostly orchitis
not assoc. With
epididymitis
iii- tuberculosis
iv- syphilis
Spread:
- through ascendg infection via vas deferens by:
lymphatics of spermatic cord
hematogenous
- congenital @ acquired
- reaction maybe:
localized (gamma)
diffuse (diffuse syphilitic granulation tissue)
1- seminoma
* confined to testis
* common
metastasize by
lymphatics to
paraaortic & iliac L.N
* radiosensitive
Pathogenesis:
- unknown
Risk factors:
1. cryptorchidism ( 10% testicular tumor )
2. testicular feminization & Klienfelters syndrome (XXY)
3. genetic factors
Incidence:
Morphology:
Grossly:
- large, soft, well
demarcated, graywhite, bulges from cut
surface of affected
testis
- large tumor contain
foci of coagulative
necrosis
- confined to testis
only by an intact T.
Albuginea
a.Embroyonal
carcinoma
-aggressive
than seminoma
- peak
incidence
20-30 years
b.yolk sac
tumor
- most
common in
infants &
children
-In adults,
occurs as
mixed
germ cell
neoplasm
c.choriocarcinoma
d.teratomas
- highly malignant
- hematogenous
metastasis to liver &
lung
- component of
mixed germ cell
tumor
- peak incidence
20-30 years
-differentiation of
endoderm, mesoderm,
ectoderm
- occur at any age
- uncommon
- occurs at any
age, mostly 20-60
yrs
- secretes
androgen,
estrogen,
corticosteroids
- uncommon
Grossly:
- firm consistency
- cut surface contain
cysts & cartilaginous
areas
- painless
testicular mass
with hormonal
changes
- gynecomastia in
adults
- precocious
puberty in children
- composed of Sertoli
cells @ mix. Sertoli &
granulose cells
- secretes androgen,
estrogen but
insufficient to
produce feminization
@ precocious
puberty
- mostly benign
- 10% only spread &
infiltrate
Microscopically:
1. classic (typical)
85%
- large cells with
distinc borders
- clear glycogen-rich
cytoplasm
- rounded nucleus
with prominent
nucleoli
- cells in small lobules
separated by fibrous
septae containg
lymphocytic infiltrate
- some cases contain
giant cells
2. anaplastic (10%)
3. spermatocytic (5%)
Testicular Lymphoma
- not 1ry tumor. Affected patient may present with
only testicular mass
- 5% of all testicular neoplasms
- most common tumor of testis in men over 60 yrs
- diffuse, large cells, non-Hodgkins lymphoma,
disseminates widely
- poor prognosis
Micros:
1. mature teratomas
common in children
(benign)
adult (malignant)
-fully differ. tissues:
-ectoderm (skin, neural
tissue)
-mesoderm (muscle,
cartilage, blood cells)
-ectoderm (gut,
bronchial epithelium)
2. immature teratomas
-incomplete stages of
differ.
-malignant esp. In
adults
3. teratomas with
malignant
transformation
-frank malignancy
develop in mature
teratoma
- occurs in adult
Clinical staging:
-achieved by physical exam. Radiographic
imaging, studying tumor markers.
Stage I: confined to testis
Stage II: metastases limited to retroperitoneal
nodes below diaphragm
Stage III: metastases outside peritoneal nodes
@ above diaphragm
Prognosis:
- 90% benign
excellent
prognosis
- 10% malignant
infiltrative &
spreading
tendency
DISEASES OF PROSTATE
I) Inflammation of prostate (prostatitis)
A- Acute prostatitis
- associated with acute
bacterial urinary tract
infection
Ex: E.coli, gram-ve rods,
enterococci, gonococci,
staph.aureus
- fever, chills, dysuria, low
backache
- prostate enlarged, tender,
spongy, soft
B- Chronic prostatitis
-bacterial @ non bacterial
-bacteria origin occur on top
of acute prostatitis @ -nonbacteria develop insidiously
w/out previous acute
infection
- asymptomatic but
chronic prostatitis may
serve as reservoir causing
urinary tract infection
clinically
etiology
morphology
Occur in 10% of cases. Almost all are lower urinary tract affection:
1. frequency, urgency, nocturia (due to urinary bladder irritation)
2. diff. In staring & stopping urinary system
3. painful distention of urinary bladder
4. infection (cystitis, pyelonephritis) due to residual urine in bladder & chronic obstruction
5. stone formation (due to stasis + infection)
6. hypertrophy, dilatation, urinary bladder diverticulae
7. bilateral hydronephrosis chronic renal failure
-uncertain (related to hormonal changes)
Old age androgen drop estrogens action unopposed estrogen increase sensitization of
androgen mainly at central portion of prostate increase sensitivity to dihydrotestosterone
Grossly:
- affects periurethral glands
- prostate enlarged
- cut surface shows multiple well circums. Nodules (solid @ contain cystic spaces)
- urethra compressed
- hypertrophied gland bulge in urinary bladder lumen as pedunculated mass ball-valve type
urethral obstruction
Microscopically:
- glands lined by 2 cell layer (inner tall columnar & outer flattened basal cells)
- glands show:
intraluminal papillae & cystically dilated gland
- others still contain proteinaceous material (corpora amylacia)
- glands separated each other by proliferated fibromuscular stroma
- in hugely enlarged cases areas of infarcts & sq. metaplasia
III) Carcinoma of the prostate (occult carcinoma----- small in size & hidden)
incidence
pathogenesis
morphology
Grading
(Gleason
system)
spread
staging
Clinical
features
diagnosis