4Penile pathology Cryptorchidism Varicocele Extragonadal germ cell tumors Scrotal masses Testicular germ cell tumors Testicular non–germ cell tumors Benign prostatic hyperplasia Prostatitis Prostatic adenocarcinoma Flashcards Preview

αναπαραγωγικο > 4Penile pathology Cryptorchidism Varicocele Extragonadal germ cell tumors Scrotal masses Testicular germ cell tumors Testicular non–germ cell tumors Benign prostatic hyperplasia Prostatitis Prostatic adenocarcinoma > Flashcards

Flashcards in 4Penile pathology Cryptorchidism Varicocele Extragonadal germ cell tumors Scrotal masses Testicular germ cell tumors Testicular non–germ cell tumors Benign prostatic hyperplasia Prostatitis Prostatic adenocarcinoma Deck (95):
1

A 65-year-old man used sildenafil over 4 hours ago. He has had a painful erection. What else can cause this pathology?

Trazodone, trauma, and sickle cell disease (sickled RBCs get trapped in vascular channels) (this is priapism [sustained erection >4 hours])

2

A 65-year-old man used sildenafil over 4 hours ago. He has had a painful erection. What else can cause this pathology?

Trazodone, trauma, and sickle cell disease (sickled RBCs get trapped in vascular channels) (this is priapism [sustained erection >4 hours])

3

A man comes in with a sustained erection for over 5 hours. Why must this be treated right away? Name three treatment options.

Immediate treatment needed to prevent ischemia; options are corporal aspiration, intracavernosal phenylephrine, or surgical decompression

4

Name two risk factors associated with an increased rate of penile squamous cell carcinoma.

Lack of circumcision and human papillomavirus infection

5

Geographically, where is penile squamous cell carcinoma most common?

More common in Asia, Africa, and South America compared to Europe and the U.S.

6

What are three precursor in situ lesions for penile squamous cell carcinoma?

Bowen disease (in penile shaft, leukoplakia), Bowenoid papulosis (red papules), erythroplasia of Queyrat (cancer of glans, erythroplakia)

7

A man has erectile dysfunction and pain. His penis is curved and there are fibrous plaques within his tunica albuginea. Treatment?

Consider treating surgically once curvature stabilizes (this is Peyronie disease

8

How does Peyronie disease differ from a penile fracture (usually occurs during intercourse)?

Penile fracture involves rupture of corpora cavernosa from forced bending, and Peyronie disease is abnormal curvature due to fibrous plaques

9

On a male newborn exam, you fail to palpate testicles in the scrotum. Name one risk factor and two complications of this condition.

Risk factor for cryptorchidism (undescended testis, one or both) = premature birth, may develop infertility or testicular (germ cell) tumor

10

A newborn is diagnosed with cryptorchidism. Why does this cause infertility?

The increased temperature of the testes when they are close to the body leads to impaired spermatogenesis (sperm develop best at

11

How does cryptorchidism affect the levels of inhibin, follicle-stimulating hormone (FSH), luteinizing hormone (LH), and testosterone?

Decreased inhibin, increased FSH, normal LH, normal testosterone if unilateral and decreased testosterone if bilateral

12

How is Leydig cell function affected in cryptorchidism?

Leydig cell function is unaffected by increased testicular temperature seen in cryptorchidism (therefore, testosterone levels may be normal)

13

A 25-year-old man presents with painless left scrotal swelling that looks like a bag of worms. What testing do you order for your work-up?

Order (diagnose by) ultrasound with Doppler (this is varicocele, the most common cause of scrotal enlargement in men)

14

What is the pathophysiology of a varicocele? How do you treat it?

Increased venous pressure causes dilation of pampiniform plexus; treatment is varicocelectomy or embolization by interventional radiologist

15

Varicoceles are more common on the ____ (left/right) side. Why?

Left; the left gonadal vein drains into the left renal vein, which is a path of higher resistance and therefore venous pressure is increased

16

What are the most common locations of extragonadal germ cell tumors in adults versus infants/children?

All are midline (adults = retroperitoneum, mediastinum, pineal, and suprasellar regions, kids = sacrococcygeal teratomas)

17

An infant is found to have a sacrococcygeal teratoma. What is the classification of this tumor?

An extragonadal germ cell tumor (most common kinds in infants/children)

18

How can you tell if a scrotal mass is benign or malignant?

Benign ones can be transilluminated with light, whereas malignant ones are usually solid tumors

19

An infant has scrotal swelling. What is the most likely mechanism?

Incomplete obliteration of processus vaginalis leading to a congenital hydrocele

20

A man with groin trauma comes in complaining of a scrotal fluid collection. The fluid is bloody. What is the diagnosis?

An hematocele (hydrocele is a benign scrotal fluid collection usually secondary to infection, trauma, or tumor)

21

A patient has a paratesticular fluctuant nodule. What is the pathophysiology behind this nodule?

A cyst due to dilated epididymal duct or rete testis (this is likely a spermatocele)

22

What type of testicular tumor is more common: germ cell tumors or non-germ cell tumors?

Germ cell tumors make up 95% of testicular tumors; non-germ cell tumors account for 5%

23

A man has gynecomastia and a testicular mass. Pathology shows disordered syncytiotrophoblasts and cytotrophoblasts. Serum marker to check?

Human chorionic gonadotropin (hCG) (these findings are consistent with choriocarcinoma, hCG is an analog of LH and can cause gynecomastia

24

Most germ cell tumors of the testicle are ____ (benign/malignant), whereas non-germ cell tumors usually are ____ (benign/malignant).

Malignant, benign

25

A 25-year-old man has a painless testicular mass. Biopsy shows lobules of large cells with a fried-egg appearance. Prognosis?

Seminoma is malignant but has an excellent prognosis (only metastasizes late in its course and is the most common testicular cancer)

26

In men, mature teratomas are ____ (benign/malignant); in women, they are ____ (benign/malignant).

Malignant (but benign in children); benign

27

What is the most common testicular tumor? What treatment can be used in a patient diagnosed with this tumor?

Seminoma (most common in third decade [never in infancy] and extremely radiosensitive, has increased placental ALP); radiation therapy

28

What malignant painful testicular germ cell tumor typically has glandular histopathology and can be mixed with other tumor types? Prognosis?

Embryonal carcinoma (pure embryonal carcinoma is rare); prognosis is worse than with seminoma

29

A patient has a hemorrhagic, necrotic testicular tumor with mixed glandular/papillary morphology. What is the likely diagnosis?

Embryonal carcinoma, which is a type of malignant testicular germ cell tumor

30

A 35-year-old man presents with a testicular mass. On exam, the mass does not transilluminate. What are you worried about?

Testicular cancer should be in the differential for any testicular mass that does not transilluminate

31

How does embryonal carcinoma affect levels of human chorionic gonadotropin (hCG) and α-fetoprotein (AFP)?

• hCG is increased, whereas AFP is normal in pure embryonal carcinoma (rare), and elevated when mixed with other tumor types (most common)

32

Biopsy of a boy's testicular germ cell tumor shows Schiller-Duval bodies. There are increased α-fetoprotein levels. Guess the boy's age.

33

A boy is found to have a yolk sac tumor. What tumor marker is elevated? What do you expect to see on histology?

Increased α-fetoprotein; Schiller-Duval bodies (resemble primitive glomeruli)

34

A patient has a testicular mass and elevated human chorionic gonadotropin (hCG) and α-fetoprotein (AFP) levels. Possible diagnoses?

Mixed embryonal carcinoma (pure tumors do not have high AFP) or mature teratoma (all teratomas have high hCG, about 50% and high AFP)

35

Testicular germ cell tumors, which most often occur in young men, are associated with which risk factors?

Cryptorchidism and Klinefelter syndrome

36

A patient has a firm, painless swelling in his testicle. Biopsy shows a yellow, mucinous testicular germ cell tumor. Prognosis?

Yolk sac (endodermal sinus) tumor is aggressive (analogous to ovarian yolk sac tumor) and thus has a poorer prognosis

37

A man exhibits hemorrhagic stroke. Tumor metastases were found in his lungs and brain. Which testicular germ cell tumor can result in this?

Choriocarcinoma (can have hematogenous metastases to lungs and brain, and can result in hemorrhagic stroke due to bleeding into metastases)

38

A man was diagnosed recently with choriocarcinoma in the testes. He has increased hCG levels. This finding can result in what symptoms?

Patients may present with gynecomastia or symptoms of hyperthyroidism (hCG is an LH, FSH, and TSH analog)

39

On histology, Reinke crystals (eosinophilic cytoplasmic inclusions) are found in a 10-year-old boy. What symptoms would you expect to see?

Precocious puberty and gynecomastia (this is a Leydig cell tumor)

40

What symptoms would you expect to see in a child with a testicular Leydig cell tumor? An adult? What color are they?

This androgen-producing tumor will result in precocious puberty in boys and often causes gynecomastia in adult men; golden brown

41

What is the most common testicular cancer among older men? Is it aggressive or indolent?

Testicular lymphoma (it is not a primary tumor but arises when lymphoma metastasizes to the testes); aggressive

42

Where do Sertoli cell tumors derive from?

Sex cord stroma (also called androblastoma)

43

Testicular non-germ cell tumors (5% of all testicular tumors) are mostly ____ (benign/malignant).

Benign

44

A man comes in with a sustained erection for over 5 hours. Why must this be treated right away? Name three treatment options.

Immediate treatment needed to prevent ischemia; options are corporal aspiration, intracavernosal phenylephrine, or surgical decompression

45

Name two risk factors associated with an increased rate of penile squamous cell carcinoma.

Lack of circumcision and human papillomavirus infection

46

Geographically, where is penile squamous cell carcinoma most common?

More common in Asia, Africa, and South America compared to Europe and the U.S.

47

What are three precursor in situ lesions for penile squamous cell carcinoma?

Bowen disease (in penile shaft, leukoplakia), Bowenoid papulosis (red papules), erythroplasia of Queyrat (cancer of glans, erythroplakia)

48

A man has erectile dysfunction and pain. His penis is curved and there are fibrous plaques within his tunica albuginea. Treatment?

Consider treating surgically once curvature stabilizes (this is Peyronie disease

49

How does Peyronie disease differ from a penile fracture (usually occurs during intercourse)?

Penile fracture involves rupture of corpora cavernosa from forced bending, and Peyronie disease is abnormal curvature due to fibrous plaques

50

On a male newborn exam, you fail to palpate testicles in the scrotum. Name one risk factor and two complications of this condition.

Risk factor for cryptorchidism (undescended testis, one or both) = premature birth, may develop infertility or testicular (germ cell) tumor

51

A newborn is diagnosed with cryptorchidism. Why does this cause infertility?

The increased temperature of the testes when they are close to the body leads to impaired spermatogenesis (sperm develop best at

52

How does cryptorchidism affect the levels of inhibin, follicle-stimulating hormone (FSH), luteinizing hormone (LH), and testosterone?

Decreased inhibin, increased FSH, normal LH, normal testosterone if unilateral and decreased testosterone if bilateral

53

How is Leydig cell function affected in cryptorchidism?

Leydig cell function is unaffected by increased testicular temperature seen in cryptorchidism (therefore, testosterone levels may be normal)

54

A 25-year-old man presents with painless left scrotal swelling that looks like a bag of worms. What testing do you order for your work-up?

Order (diagnose by) ultrasound with Doppler (this is varicocele, the most common cause of scrotal enlargement in men)

55

What is the pathophysiology of a varicocele? How do you treat it?

Increased venous pressure causes dilation of pampiniform plexus; treatment is varicocelectomy or embolization by interventional radiologist

56

Varicoceles are more common on the ____ (left/right) side. Why?

Left; the left gonadal vein drains into the left renal vein, which is a path of higher resistance and therefore venous pressure is increased

57

What are the most common locations of extragonadal germ cell tumors in adults versus infants/children?

All are midline (adults = retroperitoneum, mediastinum, pineal, and suprasellar regions, kids = sacrococcygeal teratomas)

58

An infant is found to have a sacrococcygeal teratoma. What is the classification of this tumor?

An extragonadal germ cell tumor (most common kinds in infants/children)

59

How can you tell if a scrotal mass is benign or malignant?

Benign ones can be transilluminated with light, whereas malignant ones are usually solid tumors

60

An infant has scrotal swelling. What is the most likely mechanism?

Incomplete obliteration of processus vaginalis leading to a congenital hydrocele

61

A man with groin trauma comes in complaining of a scrotal fluid collection. The fluid is bloody. What is the diagnosis?

An hematocele (hydrocele is a benign scrotal fluid collection usually secondary to infection, trauma, or tumor)

62

A patient has a paratesticular fluctuant nodule. What is the pathophysiology behind this nodule?

A cyst due to dilated epididymal duct or rete testis (this is likely a spermatocele)

63

What type of testicular tumor is more common: germ cell tumors or non-germ cell tumors?

Germ cell tumors make up 95% of testicular tumors; non-germ cell tumors account for 5%

64

A man has gynecomastia and a testicular mass. Pathology shows disordered syncytiotrophoblasts and cytotrophoblasts. Serum marker to check?

Human chorionic gonadotropin (hCG) (these findings are consistent with choriocarcinoma, hCG is an analog of LH and can cause gynecomastia

65

Most germ cell tumors of the testicle are ____ (benign/malignant), whereas non-germ cell tumors usually are ____ (benign/malignant).

Malignant, benign

66

A 25-year-old man has a painless testicular mass. Biopsy shows lobules of large cells with a fried-egg appearance. Prognosis?

Seminoma is malignant but has an excellent prognosis (only metastasizes late in its course and is the most common testicular cancer)

67

In men, mature teratomas are ____ (benign/malignant); in women, they are ____ (benign/malignant).

Malignant (but benign in children); benign

68

What is the most common testicular tumor? What treatment can be used in a patient diagnosed with this tumor?

Seminoma (most common in third decade [never in infancy] and extremely radiosensitive, has increased placental ALP); radiation therapy

69

What malignant painful testicular germ cell tumor typically has glandular histopathology and can be mixed with other tumor types? Prognosis?

Embryonal carcinoma (pure embryonal carcinoma is rare); prognosis is worse than with seminoma

70

A patient has a hemorrhagic, necrotic testicular tumor with mixed glandular/papillary morphology. What is the likely diagnosis?

Embryonal carcinoma, which is a type of malignant testicular germ cell tumor

71

A 35-year-old man presents with a testicular mass. On exam, the mass does not transilluminate. What are you worried about?

Testicular cancer should be in the differential for any testicular mass that does not transilluminate

72

How does embryonal carcinoma affect levels of human chorionic gonadotropin (hCG) and α-fetoprotein (AFP)?

• hCG is increased, whereas AFP is normal in pure embryonal carcinoma (rare), and elevated when mixed with other tumor types (most common)

73

Biopsy of a boy's testicular germ cell tumor shows Schiller-Duval bodies. There are increased α-fetoprotein levels. Guess the boy's age.

74

A boy is found to have a yolk sac tumor. What tumor marker is elevated? What do you expect to see on histology?

Increased α-fetoprotein; Schiller-Duval bodies (resemble primitive glomeruli)

75

A patient has a testicular mass and elevated human chorionic gonadotropin (hCG) and α-fetoprotein (AFP) levels. Possible diagnoses?

Mixed embryonal carcinoma (pure tumors do not have high AFP) or mature teratoma (all teratomas have high hCG, about 50% and high AFP)

76

Testicular germ cell tumors, which most often occur in young men, are associated with which risk factors?

Cryptorchidism and Klinefelter syndrome

77

A patient has a firm, painless swelling in his testicle. Biopsy shows a yellow, mucinous testicular germ cell tumor. Prognosis?

Yolk sac (endodermal sinus) tumor is aggressive (analogous to ovarian yolk sac tumor) and thus has a poorer prognosis

78

A man exhibits hemorrhagic stroke. Tumor metastases were found in his lungs and brain. Which testicular germ cell tumor can result in this?

Choriocarcinoma (can have hematogenous metastases to lungs and brain, and can result in hemorrhagic stroke due to bleeding into metastases)

79

A man was diagnosed recently with choriocarcinoma in the testes. He has increased hCG levels. This finding can result in what symptoms?

Patients may present with gynecomastia or symptoms of hyperthyroidism (hCG is an LH, FSH, and TSH analog)

80

On histology, Reinke crystals (eosinophilic cytoplasmic inclusions) are found in a 10-year-old boy. What symptoms would you expect to see?

Precocious puberty and gynecomastia (this is a Leydig cell tumor)

81

What symptoms would you expect to see in a child with a testicular Leydig cell tumor? An adult? What color are they?

This androgen-producing tumor will result in precocious puberty in boys and often causes gynecomastia in adult men; golden brown

82

What is the most common testicular cancer among older men? Is it aggressive or indolent?

Testicular lymphoma (it is not a primary tumor but arises when lymphoma metastasizes to the testes); aggressive

83

Where do Sertoli cell tumors derive from?

Sex cord stroma (also called androblastoma)

84

Testicular non-germ cell tumors (5% of all testicular tumors) are mostly ____ (benign/malignant).

Benign

85

A 65-year-old man presents with increased urinary frequency, nocturia, and difficulty starting/stopping his stream. Treatment options?

Treat with α1-antagonists (terazosin/tamsulosin), 5α-reductase inhibitors (finasteride), PDE-5 inhibitors

86

How can α1-antagonists help to treat prostatic hyperplasia?

• α1-antagonists such as terazosin and tamsulosin relax prostate smooth muscle

87

What three serious complications can arise in a patient with benign prostatic hyperplasia?

Distention or hypertrophy of the bladder, hydronephrosis, and urinary tract infection (there is no increased risk for malignancy)

88

Free prostate-specific antigen (PSA) levels can be elevated in men with what two conditions?

Benign prostatic hyperplasia and prostate cancer

89

An old man has dysuria, increased urinary frequency and urgency, and lower back pain. What is the diagnosis? What physical exam is useful?

Prostatitis; rectal/prostate exam

90

What species is the most common etiology of bacterial prostatitis?

E. coli (acute prostatitis is usually bacterial)

91

What's the main difference between acute versus chronic prostatitis?

Acute is usually bacterial, whereas chronic may be bacterial or abacterial

92

Name two useful tumor markers for prostatic adenocarcinoma

Prostatic acid phosphatase and prostate-specific antigen (PSA) (total PSA increases, but the fraction of free PSA decreases)

93

Prostatic adenocarcinoma is common among men in what age group?

Men older than 50 years

94

An elderly man has back pain, a hard nodule on prostate exam, and elevated PSA and ALP levels. Why does his back most likely hurt?

He likely has prostate adenocarcinoma with bone metastases (osteoblastic lesions) to his back, causing back pain

95

What is the most common way to diagnose prostatic adenocarcinoma?

Measurement of PSA levels followed by subsequent needle core biopsies