Download Pathology of Reproductive Systems

Pathology of Reproductive
Systems
Dr. Donald Allen
University of Mary
copyright 2000
Functions of Reproductive
Systems
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Production of germ cells
Sexual Reproduction
Pregnancy
Support of Neonate
Female Reproductive Anatomy
Male Reproductive Anatomy
Production of Germ Cells
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Ovaries - production of oocytes
Fallopian tubes - transport of oocytes,
site of fertilization
Testes - production of sperm
Epididymus - maturation of sperm
Ductus deferens - transport of sperm
Sexual Function
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Vagina
Uterus - menstrual cycle
Penis
Prostate gland - production of seminal
fluid
Pregnancy
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Uterus
Support of Neonate
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Breast
Pathology of the Reproductive
Systems
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Infertility
Infections and Inflammation
Tumors
Special Aspects with Regard to
Pathology
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Organs are open to the environment
Tissues produce tumors
Tumors responsive to hormones
Pathology of the Male
Reproductive System
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Congenital abnormalities
Infection and Inflammation
Tumors
Congenital Abnormalities
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Cryptoorchidism
Testicular torsion
Cryptoorchidism
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Most common congenital defect
In most boys, the testes are completely
descended by birth
Malpositioning of the testes outside the
scrotum
Unilateral or bilateral – if unilateral more
common on right
Treatment is by surgery
Complications
Complications of
Cryptoorchidism
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Sterility if untreated
Increased risk of testicular cancer
Testicular Torsion
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Abnormal twisting of the spermatic cord
Infrequent cause of testicular enlargement
SURGICAL EMERGENCY
Often associated with congenital
abnormalities
Can occur after heavy physical activity
Most often in men 8-18 y.o., rarely after age
30
Testicular Torsion Manifestations
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Rapid onset of scrotal pain and swelling
Pain may extend into inguinal region
Possible nausea, vomiting and
tachycardia
Testis - firm and tender, often
positioned high in scrotum
Scrotal erythema and edema
Testicular Torsion - Treatment
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If untreated, may result in atrophy,
abscess and infertility
Emergency surgery
If < 3 hours before surgery, 80%
salvage of testis
If > 12 hours, 20% salvage
Infection and Inflammation
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Orchiditis - testes
Epididymitis
Prostatitis
Orchiditis
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Bacterial or Viral Cause
Complication of Mumps
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18-35% of men with mumps, primarily
adults
Mumps virus excreted in the urine
Often secondary to UTI
Orchiditis – Manifestations
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Severe testicular pain
Pain may occur in lower abdominal region
Swelling
Chills
Fever
Testes appears swollen and tender, swollen
and red scrotum
Usually no signs of urinary dysfunction
Epididymitis
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Risk factors
Manifestations
Complications
Epididymitis
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Caused by bacterial pathogens
Necrosis and fibrosis may occlude the
genital ducts and produce infertility
Epididymitis – Manifestations
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Fever
Chills
When bacteriuria is present, Urinary
frequency and urgency and dysuria may
occur
Pain – unilateral scrotal pain is common
May also have pain in lower abdominal,
groin or hip adductor regions
Prostatitis
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Acute or chronic, bacterial or nonbacterial (Table 16-1)
PTs most likely to encounter chronic
prostatitis
Risk factors
Pathogenesis
Manifestations
Acute Bacterial Prostatitis
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Urinary frequency and urgency
Dysuria
Urethral discharge
High fever – chills
Malaise
Myalgia
Arthralgia
Pain – rectal and or sacral
Chronic Bacterial Prostatitis
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May be asymptomatic
Urinary frequency and urgency
Dysuria
Nocturia
Low grade fever
Pain: Low back, rectal
Nonbacterial Prostatitis
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Most common kind
Urinary frequency and urgency
Dysuria
Impotence, decreased libido
Pain: low back, rectal, scrotal
May be related to excessive alcohol or
caffeine intake
Tumors
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Testicular Tumors
Benign Prostatic Hyperplasia
Prostate Cancer
Testicular Cancer - Incidence
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Relatively rare
3% of male urogenital cancers
Most common cancer of men 15-35 y.o.
Testicular Cancer – Risk
Factors
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Cryptoorchidism – 35X higher incidence
Mother taking exogenous estrogen
during pregnancy –2-6% higher
History of infertility, scrotal trauma, or
infection
Testicular Cancer Manifestations
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Enlargement of the testis – most
common initial sign
Enlargement may be accompanied by
ache in abdomen or scrotum, or heavy
feeling in the scrotum
May metastasize with little or no change
in scrotum
Testicular Cancer Manifestations
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Signs of metastasis
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Back pain – may be primary presenting
complaint (21% of men with germ cell
cancer, Cantwell et al., 1987)
Abdominal mass
Hemoptysis
Neck or supraclavicular adenopathy
Testicular Cancer – Treatment
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Orchidectomy
Chemotherapy
Radiation therapy
Peritoneal lymphatic dissection
Testicular Cancer – Treatment
side effects
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Changes in posture
Changes in movement mechanics of
trunk, pelvis and hip
Sexual dysfunction
Benign Prostatic Hyperplasia
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Non-malignant tumor
Related to changes that occur with
aging
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Changes in estrogen and testosterone
levels
BPH - Risk Factors
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Age
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Geography
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75% of men over 50 y.o. have signs of
prostatic enlargement
More common in North America and
Western Europe
Race
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More common in African-Americans
BPH - Pathogenesis
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Proliferation of epithelial cells, smooth
muscle cells and fibroblasts in the
prostate gland
Usually initially in the periurethral part
of gland (Fig 16-2)
Narrowing of the lumen of the urethra
BPH - Clinical Manifestations
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Secondary to narrowing of urethra
Urinary flow obstruction - difficulties in
initiation and force
Increased risk of UTI
Dysuria, hematuria
Marked bladder distension
Renal failure --> death
BPH - Treatment
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If mild, monitor condition
Surgery
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Side effects: Impotence
Drugs
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Side effects: Impotence, loss of libido,
gynecomastia, drowsiness, dizziness,
tachycardia, postural hypotension
Prostatic Cancer
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Most common cancer in men
Usually develops in the periphery of the
gland
Treatment
Complications of treatments
Prostatic Cancer - Risk Factors
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Age, > 50 y.o.
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25% of men 60-69
40% of men 70-79
>50% of men 80 and above
Black race
Geography (US and Scandinavian
countries)
Prostatic Cancer - Risk Factors
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Family history
Environmental exposure to cadmium
Diet - high fat intake
Venereal disease
Black race
Prostatic Cancer Manifestations
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Usually asymptomatic in early stages
Early symptoms are usually those due
to urinary obstruction symptoms – by
this time the tumor has often
metastasizes
Pain
Constitutional symptoms
Prostatic Cancer – Pain
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Pain in rectal region
Pain in sacral or lumbar spine regions
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Associated with bony metastasis
Pain in thoracic or shoulder girdle
regions
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Associated with lymphatic spread or bony
metastasis
Prostatic Cancer –
Constitutional Symptoms
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Due to metastatic spread of the cancer
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Fatigue
Anemia
Weight loss
Dyspnea
Prostatic Cancer - Treatments
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Surgery: Side effects: infection, incontinence,
impotence
Radiation: Side effects: diarrhea, GI or
urinary bleeding
Hormonal treatments: Side effects: loss of
libido, impotence, hot flashes, gynecomastia,
bloating and pedal edema, nausea and
vomiting, diarrhea, MI, CVA, deep venous
thrombus
Pathology of the Female
Reproductive Tract
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Hormonal disorders
Infections
Benign or malignant tumors
Disorders related to pregnancy
Endometriosis
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Abnormal localization of endometrial
tissue
Can be located in myometrium or in
sites outside the uterus
Endometrial tissue is functional and
responds to hormonal stimulation
Endometriosis – Risk Factors
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Woman of childbearing years (10-15%)
More common in women who postpone
pregnancy
Early menarche
Menstrual cycles 27 days or less
Menstrual periods lasting 7 days or
longer
Endometriosis – Signs and
Symptoms
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Depend on location of endometrial
tissue
Low abdominal or pelvic pain associated
with menstrual period
Uterine involvement – dyspareunia
Bladder involvement – dysuria
Rectal – pain on defecation
May produce false positive findings
Ectopic Pregnancy
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Fertilized ovum implants outside the
uterus – usually the fallopian tubes
One of the major causes of maternal
death in the US
Ectopic Pregnancy – Risk
Factors
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Pelvic inflammatory disease
Prior tubal surgery
Ruptured appendix
Endometriosis
Previous ectopic pregnancy
Infertility
Pathogenesis
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Implantation in fallopian tube
Bleeding occurs during implantation –
may be perceived as menstruation
Pregnancy outgrows blood supply –
resulting in termination of pregnancy
If termination does not occur, rupture of
tube occurs by 12th week - emergency
Clinical Manifestations
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Amenorrhea or irregular bleeding
Lower abdominal quadrant or back pain
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Can be diffuse and aching or localized
Will progress to sharper pain due to leakage of
blood into abdominal and pelvic cavities
Pain may refer to shoulder if blood reaches high in
abdominal cavity
Pelvic mass
S & S of normal pregnancy
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Fatigue, nausea, breast tenderness, urinary
frequency
Amenorrhea
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Primary – failure to begin menstrual
cycles
Secondary – failure after a variable
period of normal function
Amenorrhea – causes
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Physiological
Anatomical
Genetic
Endocrinological
Constitutional
Psychogenic
In athletes
Toxic Shock Syndrome
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Caused by bacterial toxin
Most common in women under 30 who
use tampons
Also linked to barrier contraceptives,
burns, IV drug use, insect bites, surgical
and non-surgical wounds, postpartum
and gynecological infections, vaginitis
and lung abscesses
TSS – Manifestations
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Sudden elevated temperature
Vomiting and diarrhea
Erythematous macular rash
Renal dysfunction
Hypotension and shock may develop
Pelvic Inflammatory Disease
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General term of infection of upper
reproductive tract
Risk factors
Symptoms
Complications
Ovarian Cancer
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2nd most common urogenital cancer
1st in number of deaths
Difficult to diagnose
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At diagnosis, 60-70% metastasis
Ovarian Cancer – Risk Factors
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Age – peak incidence 40-60
Geography – NW Europe, US and
Canada
Race – White and Hawaiian
Nulliparity
Family history
History of infertility
Ovarian Cancer – Protective
Factors
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1 or more full term pregnancies
History of breastfeeding
Use of oral contraceptives
Native American women
Ovarian Cancer – Clinical
Manifestation
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Asymptomatic or vague
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Abdominal bloating
Flatulence
Abnormal vaginal bleeding – not common
Local pelvic pain – a late sign
Ovarian Cancer – Clinical
Manifestation
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Metastasis
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Unexplained weight loss
Cachexia
Weakness
Ascites
Shoulder girdle or thoracic pain
Breast Diseases
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Infections
Hormonally-induced changes
Tumors
Inflammation – Acute Mastitis
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Usually occurs in lactating women
Can form a localized abscess or spread
through entire breast
Signs
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Swelling
Redness
Painful area – sensitive to palpation
Hormonally-induced changes
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Normal changes
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Breast enlargement during puberty
After menopause, the breasts undergo
atrophy – can be prevented by exogenous
estrogens
Hormonally-induced changes
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Fibrocystic change – fibrosis and cysts that
occur in the breasts
About 50% by biopsy or autopsy
Only 10-15% of women have symptoms
May or may not be painful
Usually affects both breasts, but symptoms
may be asymmetrical
Pain, fine nodules in breast tissue, tenderness
Benign tumors Fibroadenoma
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Usually well encapsulated
Usually 2-5 cm in diameter
Usually affect young women – peak
incidence in 20’s
Malignant tumors
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2nd most common tumor in women
Causes are hormonal and genetic
Risk factors
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Gender – 100X more often in women
Genetic predisposition
Hormonal factors
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Early menarche - <12
Late menopause > 50
Nulliparous women or late first pregnancy
Presence of other cancers
Premalignant fibrocystic change
Risk factors
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Age
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Rare before puberty
Increased incidence after 35
Peaks in postmenopausal women about 60
y.o.
Race – White
Diabetes
Obesity
Potential Risk Factors
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Oral contraceptives
Hormone therapy
High-fat diet
Alcohol consumption
Breast Cancer Manifestations
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Tumors usually surrounded by dense
connective tissue
Pulls on adjacent tissue – causing puckering
of the skin and retraction of the nipple
Tumors are firm, but do not have sharp
margins
Most tumors are in upper lateral breast
quadrant (45%)
Typically not painful
Breast Cancer Manifestations
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Most tumors metastasize into the axillary
lymph nodes
Distant metastasizes common in liver, bones,
brain, and adrenals
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S & S – upper extremity edema, bone pain,
jaundice, weight loss
Most breast cancers are detected by selfexamination, examination by a doctor, or
mammography
Role of PT
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Awareness of non-muscular tissues in
shoulder and shoulder girdle
Lymph nodes – 50% of women have
metastasis to axillary nodes at time of
diagnosis
Menopause
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Cessation of menstruation
Average age 50
Complete when there are no menstrual
periods for 1 year
Also occurs after surgical removal of
ovaries
Physiological Changes
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Hot flashes
Changes in reproductive organs
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Dryness and atrophy
Dyspareunia, stress incontinence, vaginal
itching and burning
Osteoporosis
Cardiovascular diseases
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Hypertension, stroke, heart disease
Psychological Changes
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Nervousness
Depression and feelings of worthlessness and
hopelessness
Headache
Insomnia
Decreased sex drive
Memory loss
Vertigo