Immune diseases

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Male Reproductive System Kristine Krafts, M.D.
October 27, 2008
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Male Reproductive System Outline

• Testis
• Prostate
• Sexually transmitted diseases

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Male Reproductive System Outline

• Testis

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Testis Cryptorchidism

• Incomplete testicular descent into scrotum
• Present in 3 of newborns most descend by 6
  months.
• Associated with sterility and malignancy
• Orchiopexy may decrease risk (or just allow
  earlier detection)

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Testis Neoplasms
Things you must know

• The most common cancer in men aged 15-35
• Firm, painless enlargement of the testis
• Seminomas and non-seminomas
• Curable if detected early

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Testis Neoplasms
Clinical Features

• The most common cancer in men aged 15-35
• 5 cases per 100,00 males
• Firm, painless enlargement of the testis
• Some present with metastases
• Treatable curable! - if detected early

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Testicular self-examination
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Testis Neoplasms
Things to look for

• Small, painless lump
• Enlarged testicle
• Feeling of heaviness in testicle or groin
• Change in the way the testicle feels
• Accumulation of fluid

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Testis Neoplasms
Tumor classification

• Seminoma
• Non-seminoma
• Embryonal carcinoma
• Yolk sac tumor
• Choriocarcinoma
• Teratoma

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Testis Neoplasms
Seminoma

• Half of all testicular cancers
• Arise from germinal epithelium of seminiferous
  tubules
• Spermatocytic variant occurs in older patients
  better prognosis

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Seminoma
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Seminoma
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Testis Neoplasms
Nonseminomas

• Embryonal tumor (undifferentiated stem cells)
• Yolk sac tumor (yolk sac cells)
• Choriocarcinoma (immature placental cells)
• Teratoma (somatic tissue cells)

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Embryonal carcinoma
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Embryonal carcinoma
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Choriocarcinoma
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Teratoma
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Teratoma
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Testis Neoplasms
Tumor markers

• Important for staging and follow-up.
• Human chorionic gonadotropin (hCG)
• Normally made by placental cells
• ? in choriocarcinoma sometimes ? in seminoma
• Alpha-fetoprotein (AFP)
• Normally made by fetal yolk sac and other cells
• ? in yolk sac tumors and embryonal carcinoma

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Testis Neoplasms
Treatment

• Overall, prognosis is good
• If detected early, 90 cure rate
• 8000 new cases a year, only 400 deaths.
• Seminomas
• Often remain localized until large
• Metastasize locally first, then later, distantly
• VERY sensitive to radiation and chemotherapy
• Nonseminomas
• Metastasize earlier, farther
• Worse prognosis

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Testis Neoplasms
Lance Armstrong

• At age 25 (in 1996), diagnosed with aggressive
  testicular cancer
• Already metastatic to brain, abdomen, lungs
• Treated with surgery, chemotherapy
• Victories in 1999-2005 Tours de France!

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Male Reproductive System Outline

• Testis
• Prostate

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Prostate Nodular Hyperplasia
Things you must knowc

• Very common!
• Symptoms of urinary obstruction
• Benign proliferation of glands and stroma
• Caused by excessive androgens

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Prostate Nodular Hyperplasia

• Benign prostatic hypertrophy (misnomer)
• Very common! 90 of men have it by their 70s.
• Large prostate, with proliferation of stromal and
  epithelial elements
• Usually affects central zone of the prostate
• Symptoms (in 10 of patients) hesitancy,
  urgency, nocturia, poor urinary stream.
• Cause excessive androgen stimulation

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Nodular hyperplasia
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Nodular hyperplasia
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Nodular hyperplasia
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Prostate Carcinoma
Things you must know

• Common, deadly cancer
• Often asymptomatic, detected by PSA test
• Develops in peripheral zones of prostate
• Treatment, prognosis depend on stage, grade

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Prostate Carcinoma
Clinical features

• Most common, 2nd deadliest cancer in men
• Peak incidence 65-75
• Early on asymptomatic
• Later hard nodule by rectal exam
• Much later local pain and obstructive symptoms
• Some come to attention because of metastases

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Prostate Carcinoma
Morphology

• Most develop in peripheral zones of prostate
• Most prostate cancers are adenocarcinomas
• Better differentiated better prognosis

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Prostatic carcinoma
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Prostatic carcinoma
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Prostatic carcinoma
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Prostatic carcinoma
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Prostate Carcinoma
Prostate-specific antigen (PSA)

• Enzyme made by prostatic epithelial cells
• Malignant cells make more PSA than benign cells
• Used as a screening and monitoring test
• PSA lt4 is normal PSA gt10 suggests cancer
• But PSA can go up in benign disorders too
  (nodular hyperplasia, prostatitis)!
• So elevated PSA doesnt always mean cancer.

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Prostate Carcinoma
Cause

• Hormonal influences
• males castrated before puberty dont get it
• treatment with orchiectomy/estrogens works
• Genetic contributions
• increased risk in first-degree relatives
• earlier onset in blacks
• Environmental influences
• ? in Scandinavian countries, ? in Asia
• diet high in animal fat?

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Prostate Carcinoma
Prognosis

• Prognosis depends on stage (and grade)
• Treatment surgery, radiation, hormonal therapy
• Limited disease 90 survive 10 years
• Metastatic disease 10-40 survive 10 years

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Male Reproductive System Outline

• Testis
• Prostate
• Sexually transmitted diseases
• Syphilis
• Gonorrhea
• Non-gonococcal urethritis/cervicitis
• Herpes
• Human papillomavirus

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STDs

• 15 million cases per year worldwide
• Most in 15-24 year olds
• 5 of the top 10 infectious diseases requiring
  notification are STDs chlamydia, gonorrhea,
  AIDS, syphilis, hepatitis B
• In US top 2 STDs are herpes and HPV

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Syphilis

• Caused by Treponema pallidum
• 33,000 cases/year
• Primary painless chancre
• Secondary rash, lymphadenopathy
• Tertiary proximal aortitis, brain lesions

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Syphilitic plaques
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Syphilitic ulceration
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Syphilitic chancre
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Syphilitic rash
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Condylomata lata
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Gonorrhea

• Caused by Neisseria gonorrhoeae
• 300,000 cases/year
• Males severe, purulent urethritis (can spread to
  prostate, testis)
• Females cervicitis (can spread to tubes,
  ovaries)
• Can be transmitted during birth

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Gonorrhea
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Non-Gonococcal Urethritis and Cervicitis

• Caused by Chlamydia (mostly) and other bugs
• Chlamydia 900,000 cases/year
• Symptoms indistinguishable from gonorrhea
• Reiter syndrome
• Occurs mostly in people who are HLA-B27
• Urethritis, arthritis, conjunctivitis,
  mucocutaneous lesions

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Genital Herpes Simplex

• 50 million affected people in US
• Most cases caused by HSV-2 (HSV-1 more oral)
• Painful, erythematous vesicles on genital
  skin/mucosa
• Primary lesions plus lymphadenopathy, fever
• Recurrences milder, shorter
• May be fatal in immunocompromised patients and in
  neonates

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Human Papillomavirus

• Causes squamous proliferations in genital tract
• condylomata acuminata (venereal warts)
• precancerous lesions
• carcinomas
• Condylomata HPV 6, 11
• Carcinomas HPV 16, 18, others

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Condylomata acuminata