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 - - 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 - - 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 are uncomfortable problems, and are common in men who catch sexually-transmitted urethritis or lower urinary tract - 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 - 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

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- prostatic hyperplasia casuses many problems, though most pts are are asymptomatic - frequency, difficulty starting and stopping urination, incontinence, , hernias, acute - hematuria, bladder hypertrophy and trabeculation, bladder diverticula, bladder stones, hydronephrosis, renal failure - residual urine accumulates in an enlarged bladder behind the 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 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 - 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

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- ketoconazole is also an anti-prostatic drug

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