Pathology 3

Question 1

normal structure of penis?

Answer 1

corpus cavernosum - erectile tissue (network of vessels)
corpus spongiosum (contains urethra, does not expand during an erection)

Question 2

tumour in what part of the penis is more likely to metastasise?

Answer 2

cavernosum (access to blood vessels)

Question 3

how are skin and penis related?

Answer 3

virtually all skin pathology can be seen on the penis

Question 4

what is balanitis xerotic obliterans/lichen sclerosus?

Answer 4

usually in young people (primary schools kids)
presents with phimosis/paraphimosis
- can cause pain, problems voiding urine
- phimosis = cant retract foreskin
- paraphimosis = can retract foreskin but cant pull it back down
similar to lichen planus on the skin (chronic inflammation with band of pink hyaline tissue underneath, can lead to scarring and fibrosis etc)

Question 5

which HPV causes genital warts/papilloma?

Answer 5

HPV 6 and 11

Question 6

high risk HPV types?

Answer 6

16 and 18

Question 7

pre-malignant penile cancer?

Answer 7

PEiN (penile intraepithelial neoplasia)

same as CIN but not split into 3 categories, just PEiN

Question 8

what are the 2 types of PEiN?

Answer 8

differentiated - non HPV

dedifferentiated - HPV related

Question 9

what can cause penile cancer?

Answer 9

chronic inflammation

HPV

Question 10

how is serious penile cancer managed?

Answer 10

removal of penis

Question 11

testicular pathology?

Answer 11

lumps and bumps
paratesticular swellings
testicular swellings
orchitis
torsion

Question 12

normal testicle?

Answer 12

functional unit = seminiferous tubules (site of sperm generation)
- edge of tubule = germ cells (produce immature sperm) and sertoli cells (stimulated by FSH to trigger spermatogenesis and control environment within tubules)
leidig cells (pink and fluffy)

Question 13

what does it indicate if only sertoli cells are present?

Answer 13

infertility, cant produce sperm

Question 14

what is contained in seminiferous tubules?

Answer 14

germ cells
sertoli cells
maturing sperm

Question 15

what cells are found in interstitium and what do they do?

Answer 15

leydig cells
under control of LH
produce dehydrorepiandrosterone (DHEA) converted to testosterone

Question 16

common causes of lumps and bumps in testes?

Answer 16

hernia
cystocele
hydrocele
spermatocoele

Question 17

rarer causes of testicular lumps?

Answer 17

adenomatoid tumour
mesothelioma
liposarcoma

Question 18

what is hydrocele?

Answer 18

most common testicular lump
accumulation of fluid around testes between layers of tunica vaginalis (mesothelial lining)
unicystic, smooth, fluid filled

Question 19

what is spermatocele?

Answer 19

cystic change within the vas of the epididymis
usually asymptomatic, just feel a lump and present after self examination
may feel a fullness

Question 20

what is variocele?

Answer 20

varicosities of venous plexus that drains the testis
usually asymptomatic and people present after feeling a lump
looks like a bag of worms

Question 21

examination of testes lump?

Answer 21

is it in testes or separate?
epididymal or other?
can you get above it? (hernia if you cant)
solid or cystic?
painful?

Question 22

what is torsion?

Answer 22

testis and cord rotate around the arterial blood supply
causes severe pain
testicle dies within 4-6 hrs if not surgically fixed (irreversible)

Question 23

what causes torsion?

Answer 23

bell clapper deformity
testis swings too freely in the scrotum
the insertion of the tunica vaginalis is too high meaning the testicle can rotate and can sit laterally in the sac

Question 24

how does torsion present?

Answer 24

extreme pain
no particular precipitating factors (just as likely while in bed as while playing sports etc)
common in neonates and adolescents

Question 25

how does a testicular neoplasia present?

Answer 25

lump inside the testis, not separate

commoner in younger age groups

Question 26

testicular neoplasia prognosis?

Answer 26

good

Question 27

2 groups of testicular tumour?

Answer 27

seminomatous
non seminomatous
(both are germ cell tumours)

Question 28

describe seminoma

Answer 28

potato tumour (looks like a potato when cut open - white, homogenous)
most common
slightly older age range (around 40)
risk = undescended testes
equal risk in other testicle

Question 29

how is seminoma managed?

Answer 29

95% cure rate

extremely responsive to radiotherapy

Question 30

describe non-seminoma

Answer 30

less common
rarely exist as a “Pure” tumour
often have lots of different types within the one tumour
usually occurs around age 30
far more aggressive and very fast to metastatic

Question 31

how is non-seminoma managed?

Answer 31

very responsible to chemotherapy but have to treat early (within days)

Question 32

4 sub-types of non-seminmatous cancer?

Answer 32

yolk sac - can produce alpha feto protein
embryonal - aggressive form, looks high grade and is associated with mets
trophoblast - wacky looking cells, positive for HCG (causes a positive pregnancy test) - “choriocarcinoma”
teratoma