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REGUB - Pathology of Male GUT (ii) (Cryptorchidism (problems (atrophy +…
REGUB - Pathology of Male GUT (ii)
Prostate cancer prognosis
clinical TNM staging
T1: too small to be seen on imaging/felt on DRE (incidental)
T2: confined to prostate gland
T3: has broken through capsule - extraprostatic
T4: local mets - adjacent organ
N0/N1: regional nodes (iliac 1st - facilitate bone mets)
M0/M1: distant sites
note: pathological vs clinical T staging are slightly different
Gleason grade
based purely on gland pattern
1-2: rarely found
3: single well-formed glands
4: poorly formed/fused glands
5: no glands - single cells, sheets, rows
often a mixed of 2 patterns, so add them (more predictive)
gleason score = predominant pattern + 2nd pattern (e.g. 3+3=6 - good prognosis, 5+5=10 - worst prognosis)
in theory gleason score could be 2-10 but in reality almost all dxed are 6-10
high risk prostate cancers
15% of those dxed
clinical stage: T3
gleason score > 8
PSA > 10
Testis anatomy
tunica vaginalis: serous fluid pouch
seminiferous tubules in testicular lobules
Leydig cells: produce testosterone
Sertoli cells: supportive
Germinal cells
Cryptorchidism
failure of testis to descend into scrotum
cause usually unknown
can be mechanical in some cases
seen in some congenital syndromes (e.g. Prader-Willi)
problems
atrophy + infertility (even if unilat)
increased risk of germ cell tumour (incl in contralat testis)
Tx = orchidopexy before puberty
Benign cysts + 'celes'
varicocele
dilated tortuous veins in spermatic cord ('varices')
can lead to fertility problems
hydrocele
fluid collection in tunica vaginalis
often unknown cause but can be due infection, hernia etc
epididymal cyst + spermatocele
dilation of duct
orchitis/epididymo-orchitis
mumps in adult males (hence MMR vaccine NB)
STDs
other causes incl idiopathic
inflamm
Torsion of testis
twisting of spermatic cord + testis
haemorrhagic infarct
most common @ birth + around puberty
confident dx: severe pain + surgical emergency
Penis/scrotal pathology
congenital abnormal urethral openings
hypospadia (most common)
epispadia
phimosis
inability to retract foreskin from glans penis
NB normal until puberty
can be due to chronic inflamm, congenital, poor hygiene, lichen sclerosis (aka balanitis xerotica obliterans, creates patchy white skin that's thinner than normal)
inflamm
HSV + syphilis
gonorrhoea + chlamydia tend to cause urethral inflamm not ext genital problems
genital warts (condyloma accuminatum)
a/w HPV
increased risk of penile cancer
Scrotal calcinosis
rare benign entity
presence of multiple calcified nodules within the scrotal skin
penile cancer
rare in Ire (<20 cases/yr)
almost all are SCC
usually > 55y/o
aetiology
infection
HPV
hx of genital warts
HIV
poor hygiene (+/- phimosis)
lichen sclerosis slightly increases risk
TNM staging
Tis: in situ
T1: invasion of sub epithelial tissue
T2: invasion of corpus spongiosum
T3: invasion of corpus cavernous
T4: invasion of adjacent structures
usually spreads to nodes in a predictable fashion - inguinal 1st