hepatobilliary

1. MALE GENITAL TRACT Pathology: A Reviewer for the 3rd Practical Exams How to Use: Identify the images on the slide. Disease names, pathognomonic lesions, and other important info that may be asked in the projection part are on the next slide. Best viewed as a slide show 

2. REFERENCES Lecture ppt, manual’s CD, lab (gross and histo) peekchas

3. Male Genital Tract Diseases

4. PENIS

5. CONGENITAL ANOMALIES

6. Hypospadias Abnormal urethral orifices involving the VENTRAL aspect of the penis

8. Epispadias Abnormal urethral orifices involving the DORSAL aspect of the penis

10. Phimosis Abnormally small orifice in the prepuce Prepuce can’t be retracted

11. INFLAMMATIONS • can be specific or non-specific • specific usually refers to sexually transmitted infections

13. Balanoposthisis • Non-specific infection of the glans penis and prepuce • Causative factors • Candida • Anaerobes • Gardnerella • Pyogenic organisms • Role of smegma (white exudates) – chronic accumulation account for symptom

14. NEOPLASIA

15. CondylomaAcuminata • Sexually transmitted tumor caused by human papilloma virus (HPV type 6 and 11) • Gross: Thrives in any moist mucocutaneous surface of the external genitalia

17. CondylomaAcuminatum

18. Koilocytosis

19. CondylomaAcuminata • Micro: Koilocytosis or perinuclear vacuolization is the pathognomonic lesion for this disease. • Presence of nuclear atypia

21. Bowen’s Disease • Involves the skin of the shaft and scrotum • Gross: solitary, thickened grey-white, opaque plaque; can also be seen in the glans and prepuce as single or multiple shiny red, velvety plaques. • Micro: surface cells are not much different from the base cells, this is defined as a “loss of maturation” pattern, and is quite typical of squamous CIS everywhere

23. Invasive Squamous Cell Carcinoma • Risk in developing penile carcinoma is related to genital hygiene since exposure to carcinogens that may be concentrated in the smegma increases the likelihood of infection which may carry the potential oncogenic type HPV 16 which is detected in 50% of patients with penile carcinoma. • Cigarette smoking also elevates the risk of developing penile cancer.

25. Infiltrating Squamous Cell Carcinoma Flat lesions appear as areas of epithelial thickening accompanied by graying and fissuring of the mucosal surfacepapillary SCC

26. TESTIS and EPIDIDYMIS

27. REGRESSIVE CHANGES

28. Testicular Atrophy • Atherosclerotic narrowing of the blood supply in old age • The end stage of an inflammatory orchitis, whatever the etiologic agent. Possible causative factors: • cryptorchidism • hypopituitarism • generalized malnutrition or cachexia • irradiation • prolonged administration of female sex hormones, as in treatment of patients with carcinoma of the prostate • Cirrhosis • Normal testes (left) and atrophic testes (right). In testicular atrophy, there is ghosting or fibrosis of tubules, no spermatogenesis, and increased interstitial cells of Leydig.

30. Testicular Atrophy • Ghosting or fibrosis of tubules • NO spermatogenesis • INCREASED interstitial cells of Leydig

32. Hydrocoele of infected Testis

34. Acute epididymitis Caused by gonococcal infection The epididymis is replaced by abcess (seen on the left side)

35. VASCULAR DISEASES

36. Torsion • Twisting of the spermatic cord which typically cuts off the venous drainage of the testis • Bilateral anatomic defect where the testis has increased mobility giving rise to “bell-clapper” abnormality • Infracted testicle and epididymis due to torsion

37. TESTICULAR TUMORS

38. Seminoma • Typical seminomas produce bulky masses, sometimes 10 times the size of a normal testis. • It is homogenous, gray-white in color, lobulated cut surface, usually devoid of hemorrhage or necrosis. • Generall, the tunica albuginea is not penetrated, but occasionally, it extends to the epididymis, spermatic cord, and scrotal sac.

40. Seminoma • Sheets of uniform cells into poorly demarcated lobules by delicate septa of fibrous tissue. • Classic seminoma is large and round to polyhedral and has a distinct cell membrane, a clear or watery-appearing cytoplasm, and a large central nucleus with one or two prominent nucleoli. • Polygonal cells with distinct borders and clear cytoplasm due to glycogen content • Pathognomonic here is the lymphoid stroma.

42. Embryonal Carcinoma • Smaller than a seminoma. Does not replace the whole testis. • On cut surface, mass is variegated, poorly demarcated, and punctuated foci or hemorrhage or necrosis.

44. Embryonal Carcinoma • Cells grow in alveolar or tubular patterns, sometimes papillary convolutions • Undifferentiated sheets of cells may be appreciated. • Two cell lines: syncitio- and cyto-trophoblast • Syncitiotrophoblasts- bizaare looking; elaborates the tumor marker: HCG; Cytotrophoblasts- paler looking • Highly malignant form

46. Choriocarcinoma • Highly malignant form of testicular tumor comprised of both cytotrophoblasts and syncytiotrophoblasts • Syncytiotrophoblast appears as a large cell having many irregular or lobular hyperchromatic nuclei and an abundant eosinophilic vacuolated cytoplasm • Cytotrophoblasts are more regular and polygonal with distinct borders and clear cytoplasm.

48. Yolk Sac Tumor • The most common testicular tumor in infants and children up to 3 years with very good prognosis • Lace-like (reticular) network of medium-sized cuboidal or elongated cells. • Pathognomonic lesion is the presence of Schiller-Duval bodies, which resemble the primitive glomeruli and other endodermalsisuses (perivascular formation around tumor cells).

49. PROSTATE