Lack of MIF and Testosterone

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Lack of MIF and Testosterone

• MALE pseudohermaphrodite

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Female Pseudohermaphrodite arises from

• Excess Androgen Exposure
• Usu d/t 21-Hydroxylase Deficiency

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23 y.o Female complains of amenorrhea. During PE,
it is noted that she has scant pubic hair.

• Androgen Insensitivity Disorder
• XY Genotype
• Female Phenotype
• Vagina ends blindly
• Nml puberty growth with scant pubic hair, no
  menses.
• Caused by defective androgen receptor

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Female Breast Pathology
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Most common breast disorder

• FIBROCYSTIC DISEASE

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27 y.o. Female presents with breast mass

• Fibrocystic Disease
• Most common cause of palpable breast mass in
  women 25-50 y.o

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19 y.o Female presents with breast mass that
feels firm, rubbery, but painless. Most likely
cause

• Fibroadenoma
• Most common cause of breast tumor in pts lt 25 y.o

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Benign tumor of the lactiferous ducts

• Intraductal Papilloma

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Benign but may present with serous or bloody
discharge from the nipple

• Adenoma of the nipple
• Intraductal papilloma

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Large bulky mass with ulceration of underlying
skin Characteristic cystic spaces.

• Phyllodes Tumor

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Most Common Carcinoma of the Breast

• Invasive Intraductal Carcinoma

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Bloody discharge from nipple Indian File

• Lobular Carcinoma

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Breast Mass with Dense Fibrous Stroma

• Invasive Ductal Carcinoma

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Breast Mass withScant stroma

• Medullary Carcinoma

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Breast Mass withGelatinous Consistency

• Mucinous Carcinoma

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Breast Mass Histo showslymphocytic infiltrate

• Medullary Carcinoma

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Breast MassSoft, Fleshy Consistency

• Medullary Carcinoma

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Female presents with red, hot, swollen skin over
breast area

• Inflammatory Carcinoma
• Poor Prognosis

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Female presents with an eczematoid lesion of the
nipple

• Paget Disease of the Breast

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Breast MassCheese-like Consistency

• Comedocarcinoma

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Mammogram Negative

• Medullary Carcinoma

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Male Repro Pathology
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Inflammation of the GLANS PENIS

• BALANTITIS

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Opening on the DORSAL surface of the penis

• EPISPADIAS

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Occurs in older age group Subcutaneous fibrosis
of the dorsum of the penis

• PYERONIE DISEASE

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Gonorrhea most often manifest in males as

• Acute purulent urethritis

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Lymphomagranuloma venereumetiology

• Chlamydia trachomatis
• vesicular ulcerating lesions
• Inclusion bodies in epithelium
• Suppuration
• Scaring
• Asymptomatic, localized, progressive, or
  elephatiasis

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25 y.o sexually active Male presents with
urethritis. No bacteria is demonstrated in the
purulent urethral discharge.

• Chlamydial infxn is sexually transmitted.

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ELEMENTARY BODIES are associated with?

• CHLAMYDIA
• - Affecting columnar or metaplastic cell more
  than squamous cells

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Hard, nontender, ulcerated Chancre

• Syphilis

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How do you culture Nesseria?

• Thayer-Martin Medium

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25 y.o. Male presents with a shallow ulcer on his
penis and also swollen draining nodes.

• CHANCROID

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Necrotic, tender, soft chancre

• CHANCHROID
• Haemophilus ducreyi

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Increased incidence of infxn of Haemophilius
ducreyi in what countries?

• Orient
• West Indies
• Africa

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Donovan Bodies in Macrophages

• Granuloma inguinale
• Calymmatobacterium granulomatis
• Creeping genital ulcers disabling and deforming

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Suspected Genital Herpes??? Test

• Tzanck Test
• Multinucleated epithelial cells with inclusions

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Bowenoid PapulosisAge Group

• lt 30 y.o.

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Bowen Disease Age group

• gt 35 years old

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Erythroplasia of Queyrat Age group

• Median Incidence in the 5th decade

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Condyloma Acuminatum HPV??

• HPV 6, 11

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Carcinoma in Situ HPV ??

• HPV 16

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Squamous Cell CarcinomaHPV???

• HPV 16, 18, 31, 33

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LEUKOPLAKIA assoc with?

• Bowen Disease

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Which carcinoma in situ is assoc with incr risk
of visceral CA?

• Bowen Disease

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Presents with papular shaft lesions that have
features of malignancy BUT limited to epithelial
cells.

• BOWENOID Papulosis
• Tend to regress

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Primary causes of Testicular Atrophy

• Klinefelter Syndrome
• Testicular Feminization (androgen insensitivity)

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Secondary causes of Testicular Atrophy

• Hypogonadotrophic hypogonadisms
• Artherosclerosis (old age)
• Orchitis
• Irradiation

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Cryptoorchidismeffects on spermatic tubules

• HYALINIZATION of spermatic tubules

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Tuberculosis may cause ??? in males

• EPIDYDIMITIS/scar

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Most common germ cell tumor

• SEMINOMA

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()??? In Seminoma

• Placental alkaline phosphatase

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Describe histo of Seminoma

• Sheets of polygonal germ cells with clear
  cytoplasm and round nuclei cells.
• Lymphocytes, granulomas, and giant cells may be
  seen.

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Foci of Hemorrhage and Necrosis

• EMBRYONAL CA
• May be HCG and AFP

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Seminoma usu affects this Age group

• 30s

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Embryonal CAAge group

• 20-30 age range

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Describe type of tumor that is seen in infancy
and early childhood.

• YOLK SAC TUMOR nonencapsulated, yellow-white
  mucinous.
• goodprog

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Marker of Yolk Sac Tumor

• Alpha-fetoprotein (AFP)

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Schiller-Duval bodies

• YOLK SAC TUMOR

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Proliferation of synctiotrophoblasts and
cytotrophoblasts

• CHORIOCARCINOMA
• hCG

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A testicular mass is found to have embryonal
tissue components.

• IMMATURE TERATOMA
• Malignant
• Can metastasize

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Typical staging of Seminoma

• STAGE 1
• Tend to be localized

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TYPICAL STAGING of nonseminomatous germ cell
tumors (NSGCT)

• Stage II or III
• Systemic spread lung, liver, brain, bones

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These usually arise from mesothelial lining of
Tunica Vaginalis

• Adenomatoid Tumors
• (benign mesothelioma of epididymis)

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Seen in Adults with a Leydig Cell Tumor

• GYNECOMASTIA
• FEMINIZATION

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Testicular LYMPHOMAAge group

• gt 60 y.o.

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T/F Both Sertoli Cell Tumor and Leydig Cell
tumor show endocrine manifestations d/t incr
androgen production.

• FALSE.
• Leydig cell char. by low levels of estrogens or
  androgens.

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Crystalloids of Reinke

• LEYDIG-CELL tumor

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Seen in Kids with Leydig Cell tumors

• PRECOCIOUS PUBERTY

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Males with Recurrent UTI

• Chronic Bacterial Prostatitis
• culture of secretions
• Incr WBC PMNs, lymphocytes, plasma cells,
  macrophages
• (vs. Acute Prostatitis PMNs)

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gt 10-15 WBCs, culture negative NO history of
UTI.

• CHRONIC ABACTERIAL PROSTATITIS
• C. Trachomatis
• Ureaplsma urealyticum
• Myucoplasma hominis

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Typical symptoms assoc with Benign Prostatic
Hyperplasia

• Difficulty in urinating
• Urine retention
• UTI
• Renal Infection

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Common condition in MALES gt 50 y.o.

• Nodular Hyperplasia (BPH)

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What stimulates growth factors that initiate
prostatic hyperplasia?

• DIHYROTESTOSTERONE (DHT)
• Testosterone ? DHT
• via 5a-Reductase

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BPH vs Prostate CASpecial stain

• High Molecular Keratin for Basal Cells
• - Absent basal cells CA

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Often indicative of bony osteoblastic metastasis

• Incr in serum ALKALINE PHOSPHATASE

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Describe cells of Low grade and High grade
Prostatic Intraepithelial Neoplasia (PIN).

• Low grade crowding of cell w/ incr chromatin
• High grade enlarged nuclei, prominent nucleoili

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