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Title:

MALE GENITAL SYSTEM

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... COMMON (1/250 LIVE MALE BIRTHS) EPISPADIAS (DORSAL ASPECT) ... CAN INVOLVE ENTIRE MALE EXTERNAL GENITALIA. INFLAMMATORY ... IN MALES CASTRATED ... – PowerPoint PPT presentation

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Title: MALE GENITAL SYSTEM


1
MALE GENITAL SYSTEM
  • PENIS
  • SCROTUM, TESTIS, EPIDIDYMIS
  • PROSTATE
  • Robbins Basic Pathology
  • KUMAR, Abbas, Fausto, and Mitchell
  • 8th Edition, CH 18

2
PENIS
  • MALFORMATIONS
  • INFLAMMATORY LESIONS
  • NEOPLASMS

3
MALFORMATIONS OF THE PENIS
  • ABNORMAL LOCATION OF URETHRAL ORIFICE ALONG
    PENILE SHAFT
  • HYPOSPADIAS (VENTRAL ASPECT)
  • MOST COMMON (1/250 LIVE MALE BIRTHS)
  • EPISPADIAS (DORSAL ASPECT)

4
Hypospadias (ventral)
5
Epispadias (dorsal)
6
HYPOSPADIAS AND EPISPADIAS
  • MAY BE ASSOCIATED WITH OTHER GENITAL
    ABNORMALITIES
  • INGUINAL HERNIAS
  • UNDESCENDED TESTES
  • CLINICAL CONSEQUENCES
  • CONSTRICTION OF ORIFICE
  • URINARY TRACT OBSTRUCTION
  • URINARY TRACT INFECTION
  • IMPAIRED REPRODUCTIVE FUNCTION

7
INFLAMMATORY LESIONS OF THE PENIS
  • SEXUALLY TRANSMITTED DISEASES
  • BALANITIS (BALANOPOSTHITIS)
  • INFLAMMATION OF THE GLANS (PLUS PREPUCE)
  • ASSOCIATED WITH POOR LOCAL HYGIENE IN
    UNCIRCUMCISED MEN
  • SMEGMA
  • DISTAL PENIS IS RED, SWOLLEN, TENDER
  • /- PURULENT DISCHARGE

8
INFLAMMATORY LESIONS OF THE PENIS
  • PHIMOSIS
  • PREPUCE CANNOT BE EASILY RETRACTED OVER GLANS
  • MAY BE CONGENITAL
  • USUALLY ASSOCIATED WITH BALANOPOSTHITIS AND
    SCARRING
  • PARAPHIMOSIS (TRAPPED GLANS)
  • URETHRAL CONSTRICTION

9
INFLAMMATORY LESIONS OF THE PENIS
  • FUNGAL INFECTIONS
  • CANDIDIASIS
  • ESPECIALLY IN DIABETICS
  • EROSIVE, PAINFUL, PRURITIC
  • CAN INVOLVE ENTIRE MALE EXTERNAL GENITALIA

10
NEOPLASMS OF THE PENIS
  • SQUAMOUS CELL CARCINOMA (SCC)
  • EPIDEMIOLOGY
  • UNCOMMON LESS THAN 1 OF CA IN US MEN
  • UNCIRCUMCISED MEN BETWEEN 40 AND 70
  • PATHOGENESIS
  • POOR HYGIENE, SMEGMA, SMOKING
  • HUMAN PAPILLOMA VIRUS (16 AND 18)
  • CIS FIRST, THEN PROGRESSION TO INVASIVE SQUAMOUS
    CELL CARCINOMA

11
Squamous Cell Carcinoma
12
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13
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14
SCC OF THE PENIS
  • CLINICAL COURSE
  • USUALLY INDOLENT
  • LOCALLY INVASIVE
  • HAS SPREAD TO INGUINAL LYMPH NODES IN 25 OF
    CASES AT PRESENTATION
  • DISTANT METS RARE
  • 5 YR SURVIVAL
  • 70 WITHOUT LN METS
  • 27 WITH LN METS

15
LESIONS INVOLVING THE SCROTUM
  • INFLAMMATION
  • TINEA CRURIS (JOCK ITCH)
  • SUPERFICIAL DERMATOPHYTE INFECTION
  • SCALY, RED, ANNULAR PLAQUES, PRURITIC
  • INGUINAL CREASE TO UPPER THIGH
  • SQUAMOUS CELL CARCINOMA
  • HISTORICAL SIGNIFICANCE
  • SIR PERCIVAL POTT, 18TH CENTURY ENGLISH PHYSICIAN
  • CHIMNEY SWEEPS

16
LESIONS INVOLVING THE SCROTUM
  • SCROTAL ENLARGEMENT
  • HYDROCELE - MOST COMMON CAUSE
  • ACCUMULATION OF SEROUS FLUID WITHIN TUNICA
    VAGINALIS
  • INFECTIONS, TUMOR, IDIOPATHIC
  • HEMATOCELE
  • CHYLOCELE
  • FILIARIASIS - ELEPHANTIASIS
  • TESTICULAR DISEASE

17
Hydrocele
18
LESIONS OF THE TESTES
  • CONGENITAL
  • INFLAMMATORY
  • NEOPLASTIC

19
CRYPTORCHIDISM AND TESTICULAR ATROPHY
  • FAILURE OF TESTICULAR DESCENT
  • EPIDEMIOLOGY
  • ABOUT 1 OF MALES (AT 1 YR)
  • RIGHT gt LEFT, 10 BILATERAL
  • PATHOGENESIS
  • HORMONAL ABNORMALITIES
  • TESTICULAR ABNORMALITIES
  • MECHANICAL PROBLEMS

20
Atrophic testes secondary to cryporchidism
21
CRYPTORCHIDISM AND TESTICULAR ATROPHY
  • CLINICAL COURSE
  • WHEN UNILATERAL, MAY SEE ATROPHY IN CONTRALATERAL
    TESTIS
  • STERILITY
  • INCREASED RISK OF MALIGNANCY (3-5X)
  • ORCHIOPEXY
  • MAY HELP PREVENT ATROPHY
  • MAY NOT ELIMINATE RISK OF MALIGNANCY

22
OTHER CAUSES OF TESTICULAR ATROPHY
  • CHRONIC ISCHEMIA
  • INFLAMMATION OR TRAUMA
  • HYPOPITUITARISM
  • EXCESS FEMALE SEX HORMONES
  • THERAPEUTIC ADMINISTRATION
  • CIRRHOSIS
  • MALNUTRITION
  • IRRADIATION
  • CHEMOTHERAPY

23
INFLAMMATORY LESIONS OF THE TESTIS
  • USUALLY INVOLVE THE EPIDIDYMIS FIRST
  • SEXUALLY TRANSMITTED DISEASES
  • NONSPECIFIC EPIDIDYMITIS AND ORCHITIS
  • SECONDARY TO UTI
  • BACTERIAL AND NON-BACTERIAL
  • SWELLING, TENDERNESS
  • ACUTE INFLAMMATORY INFILTRATE

24
INFLAMMATORY LESIONS OF THE TESTIS
  • MUMPS
  • 20 OF ADULT MALES WITH MUMPS
  • EDEMA AND CONGESTION
  • CHRONIC INFLAMMATORY INFILTRATE
  • MAY CAUSE ATROPHY AND STERILITY
  • TUBERCULOSIS
  • GRANULOMATOUS INFLAMMATION
  • CASEOUS NECROSIS
  • AUTOIMMUNE GRANULOMATOUS ORCHITIS
  • RARE FINDING IN MIDDLE AGED MEN

25
TESTICULAR NEOPLASMS
  • EPIDEMIOLOGY
  • MOST IMPORTANT CAUSE OF PAINLESS ENLARGEMENT OF
    TESTIS
  • 5/100,000 MALES, WHITES gt BLACKS (US)
  • INCREASED FREQUENCY IN SIBLINGS
  • PEAK INCIDENCE 20-34 YRS
  • MOST ARE MALIGNANT
  • ASSOCIATED WITH GERM CELL MALDEVELOPMENT
  • CRYPTORCHIDISM (10)
  • TESTICULAR DYSGENESIS(XXY)

26
TESTICULAR NEOPLASMS
  • PATHOGENESIS
  • 95 ARISE FROM GERM CELLS
  • ISOCHROMOSOME 12, i(12p), IS A COMMON FINDING
  • INTRATUBULAR GERM CELL NEOPLASMS
  • RARELY ARISE FROM SERTOLI CELLS OR LEYDIG CELLS
  • THESE ARE OFTEN BENIGN
  • Lymphoma
  • men gt 60 yo

27
WHO CLASSIFICATION OF TESTICULAR TUMORS
  • ONE HISTOLOGIC PATTERN (60)
  • SEMINOMAS (50)
  • EMBRYONAL CARCINOMA
  • YOLK SAC TUMOR
  • CHORIOCARCINOMA
  • TERATOMA
  • MULTIPLE HISTOLOGIC PATTERNS (40)
  • EMBRYONAL CA TERATOMA
  • CHORIOCARCINOMA OTHER
  • OTHER COMBINATIONS

28
HISTOGENESIS OF TESTICULAR NEOPLASMS (PEAK
INCIDENCE)
GERM CELL PRECURSOR
GONADAL DIFFERENTIATION
TOTIPOTENTIAL DIFFERENTIATION (NONSEMINOMA)
SEMINOMA (40-50 Y)
EMBRYONAL CA (UNDIFFERENTIATED) (20-30 Y)
SOMATIC DIFFERENTIATION
TROPHOBLASTIC DIFFERENTIATION
YOLK SAC DIFF
TERATOMA (ALL AGES)
MATURE IMMATURE MALIGNANT TX
YOLK SAC TUMOR (lt 3 Y) AFP
CHORIOCARCINOMA (20-30 Y) hCG
29
Seminoma, with focal hemorrhage and necrosis
30
Normal testicular tissue
31
Seminoma
32
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33
Seminoma
Syncytiotrophoblast
34
Dermoid Cyst
35
Immature Teratoma
With Embryonal Carcinoma
36
CLINICAL COURSE OF TESTICULAR TUMORS
  • USUALLY PRESENT WITH PAINLESS ENLARGEMENT OF
    TESTIS
  • MAY PRESENT WITH METASTASES
  • NONSEMINOMAS (MORE COMMON)
  • LYMPH NODES, LIVER AND LUNGS
  • SEMINOMAS
  • USUALLY JUST REGIONAL LYMPH NODES
  • TUMOR MARKERS (hCG AND AFP)
  • TREATMENT SUCCESS DEPENDS ON HISTOLOGY AND STAGE
  • SEMINOMAS VERY SENSITIVE TO BOTH RADIO- AND
    CHEMOTHERAPY

37
DISEASES OF THE PROSTATE
  • PROSTATITIS
  • NODULAR HYPERPLASIA
  • CANCER

38
PROSTATITIS
  • ACUTE BACTERIAL PROSTATITIS
  • CHRONIC BACTERIAL PROSTATITIS
  • CHRONIC ABACTERIAL PROSTATITIS

39
ACUTE BACTERIAL PROSTATITIS
  • ETIOLOGY
  • SAME ORGANISMS THAT CAUSE UTI
  • E coli, OTHER GNR
  • PATHOGENESIS
  • ORGANISMS ASCEND FROM URETHRA AND URINARY BLADDER
  • RARELY, HEMATOGENOUS SPREAD

40
ACUTE BACTERIAL PROSTATITIS
  • MORPHOLOGY
  • ACUTE INFLAMMATION, ESPECIALLY IN THE GLANDS,
    WITH MICROABSESSES
  • CONGESTION, EDEMA
  • CLINICAL COURSE
  • DYSURIA, FREQUENCY, LOW BACK PAIN, PELVIC PAIN
  • ENLARGED, EXQUISITELY TENDER
  • /- FEVER OR LEUKOCYTOSIS
  • USUALLY RESOLVES WITH WITH AB RX

41
CHRONIC PROSTATITIS
  • ETIOLOGY
  • MAY FOLLOW ACUTE PROSTATITIS
  • MAY DEVELOP INSIDIOUSLY
  • CULTURE POSITIVE (BACTERIAL)
  • SAME ORGANISMS THAT CAUSE AP
  • CULTURE NEGATIVE (ABACTERIAL)
  • MAY BE RELATED TO
  • CHLAMYDIA TRACHOMATIS
  • UREAPLASMA UREALYTICUM
  • MOST COMMON FORM OF CP

42
CHRONIC PROSTATITIS
  • MORPHOLOGY
  • LYMPHOCYTIC INFILTRATE
  • NEUTROPHILS AND MACROPHAGES
  • SOME EVIDENCE OF TISSUE DESTRUCTION
  • CLINICAL COURSE
  • SIMILAR TO AP
  • LESS ACUTE SYMPTOMS
  • MORE RESISTANT TO AB RX
  • CBP OFTEN ASSOCIATED WITH RECURRENT UTI

43
PROLIFERATIVE LESIONS OF THE PROSTATE
PERIURETHRAL AND TRANSITIONAL ZONES
URETHRA
PERIPHERAL ZONE
NORMAL PROSTATE
NODULAR HYPERPLASIA
CARCINOMA
44
NODULAR HYPERPLASIA
  • OTHER TERMS USED
  • GLANDULAR AND STROMAL HYPERPLASIA
  • BENIGN PROSTATIC HYPERTROPHY (HYPERPLASIA)
  • EPIDEMIOLOGY
  • OCCURS IN 20 OF MEN OVER 40
  • OCCURS IN 90 OF MEN OVER 70

45
PATHOGENESIS OF NODULAR HYPERPLASIA
  • PROLIFERATION OF BOTH EPITHELIAL AND STROMAL
    ELEMENTS
  • BOTH ANDROGENS AND ESTROGENS MAY PLAY A ROLE
  • NOT SEEN IN MALES CASTRATED BEFORE PUBERTY
  • INHIBITORS OF TESTOSTERONE METABOLISM USEFUL IN
    TREATMENT
  • RELATIVE INCREASE IN ESTROGENS IN OLDER MEN MAY
    INCREASE DHT RECEPTORS IN PROSTATE

46
CLINICAL COURSE OF NODULAR HYPERPLASIA
  • SYMPTOMS OCCUR IN ONLY 10 OF MEN WITH NODULAR
    HYPERPLASIA
  • HESITANCY
  • URINARY RETENTION
  • URGENCY, FREQUENCY, NOCTURIA, UTI
  • TREATMENT
  • MEDICAL
  • SURGICAL
  • COMMON CAUSE FOR ELEVATED PROSTATE SPECIFIC
    ANTIGEN (PSA)

47
CARCINOMA OF THE PROSTATE
  • EPIDEMIOLOGY
  • MOST COMMON VISCERAL CANCER
  • ABOUT 70/100,000 MEN IN US
  • 200,000 NEW CASES/YR IN US
  • 20 ARE LETHAL
  • SECOND MOST COMMON CAUSE OF CANCER DEATH IN MEN
  • PEAK INCIDENCE OF CLINICAL CANCER IS 65-75 YO
  • LATENT CA IS EVEN MORE PREVALENT
  • gt50 IN MEN gt 80 YO

48
CARCINOMA OF THE PROSTATE
  • PATHOGENESIS
  • HORMONAL FACTORS
  • DOES NOT OCCUR IN EUNUCHS
  • ORCHIECTOMY AND/OR ESTROGEN TREATMENT INHIBITS
    GROWTH
  • GENETIC FACTORS
  • INCREASED RISK IN FIRST ORDER RELATIVES
  • BLACKS gt WHITES (SYMPTOMATIC CA)
  • ENVIRONMENTAL FACTORS
  • GEOGRAPHIC DIFFERENCES IN INCIDENCE OF CLINICAL
    CANCER (NOT OF LATENT CA)
  • CHANGE IN INCIDENCE WITH MIGRATION

49
CARCINOMA OF THE PROSTATE
  • CLINICAL COURSE
  • OFTEN CLINICALLY SILENT
  • DIGITAL RECTAL EXAM (DRE)
  • PROSTATE SPECIFIC ANTIGEN (PSA)
  • gt 4 ng/ml IN PERIPHERAL BLOOD
  • FREE PSA lt 25
  • TRANSRECTAL ULTRASOUND
  • NEEDLE BIOPSY
  • PROSTATISM (LIKE BPH)
  • METASTASES
  • OSTEOBLASTIC
  • TREATMENT- SURGERY, RADIATION, HORMONES, CHEMO

50
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51
Needle bx of prostate
52
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53
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54
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55
CARCINOMA OF THE PROSTATE
  • STAGING
  • A (T1) MICROSCOPIC ONLY
  • B(T2) MACROSCOPIC (PALPABLE)
  • C(T3 T4) EXTRACAPSULAR
  • D(N1-3,M1) METASTATIC
  • PROGNOSIS DEPENDENT ON STAGE AND HISTOLOGIC GRADE
  • 90 10 YR SURVIVAL FOR A AND B
  • 10-40 10 YR SURVIVAL FOR C AND D

56
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57
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59
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60
Hydronephrosis
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