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Boards Pathology > Male GU > Flashcards

Male GU Flashcards

1
Q

Opening of urethra on inferior surface of penis due to failure of urethral folds to close

A

Hypospadias

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2
Q

Epispadias is the opening of urethra on superior surface of the penis. What is the difference in etiology between hypospadias and epispadias?

A

Hypospadias = failure of urethral folds to close

Epispadias = abnormal positioning of genital tubercle

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3
Q

Additional clinical feature associated with epispadias

A

Bladder exstrophy

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4
Q

Necrotizing granulomatous inflammation of inguinal lymphatics and LNs caused C.trachomatis L1-L3; eventually heals with fibrosis; perianal involvement may result in rectal strictures

A

Lymphogranuloma venereum

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5
Q

2 major risk factors for SCC of the penis

A

High risk HPV (2/3 of cases)

Lack of circumcision

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6
Q

3 Precursor lesions of SCC of the penis (shaft vs. glans vs. reddish papules)

A

Bowen disease = shaft

Erythroplasia of Queyrat = glans

Bowenoid papulosis = reddish papules; similar to bowen disease but does not tend to invade

[these are all considered in situ carcinoma]

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7
Q

Most cases of cryptoorchidism resolve spontaneously by the age of 2. If they do not, complications include testicular atrophy with infertility and increased risk for what type of cancer?

A

Seminoma

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8
Q

Causes of orchitis

A

Chlamydia trachomitis (D-K) or N.gonorrhoeae

E.coli and Pseudomonas (older adults with UTI)

Mumps virus

Autoimmune orchitis (granulomatous inflammation of tubules — ddx includes TB which can be differentiated with AFB stain)

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9
Q

Testicular torsion is twisting of the spermatic cord leading to _____ infarction. It is due to congenital failure of testes to attach to the inner lining of the scrotum. Presents in adolescents with sudden testicular pain and absent ______ reflex

A

Hemorrhagic; cremasteric

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10
Q

A varicocele is a dilation of the spermatic vein due to impaired drainage; presents as scrotal swelling with bag of worms appearance. Usually left sided, seen in a large population of infertile males, and is associated with what malignancy?

A

Left-sided renal cell carcinoma

[RCC loves to invade the renal vein]

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11
Q

Hydrocele = fluid accumulation within the _____ _____; presents as scrotal swelling that can be transluminated

A

Tunica vaginalis

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12
Q

Etiology of hydrocele in infants vs adults

A

Infants — incomplete closure of processus vaginalis

Adults — blockage of lymphatic drainage

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13
Q

The 2 basic types of testicular tumors arise from germ cells or sex-cord stroma. Typical presentation is a firm, painless testicular mass that cannot be transilluminated.

T/F: gold standard for testicular tumor diagnosis is biopsy

A

False — not biopsied due to risk of seeding scrotum; instead they are just removed via radial orchiectomy

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14
Q

Most common type of testicular tumors

A

Germ cell tumors

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15
Q

Germ cell testicular tumors usually occur between ages of 15-40 and are divided into seminoma and non-seminoma. Risk factors include ______ and _______ ______

A

Cryptorchidism; Klinefelter syndrome

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16
Q

Malignant tumor of large cells with clear cytoplasm and central nuclei; composed of a homogenous mass with no hemorrhage or necrosis and rare cases may produce beta hCG

A

Seminoma

[similar to dysgerminoma of ovary]

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17
Q

Prognosis of seminoma

A

Good prognosis; responds to radiotherapy

18
Q

Malignant tumor of immature, primitive cells that may form glands; composed of hemorrhagic mass with necrosis

A

Embryonal carcinoma

19
Q

Embryonal carcinomas are non-seminomas that are considered aggressive with early ______ spread. Chemotherapy may result in ________. In addition, increased _____ or _____ may be present

A

Hematogenous; differentiation; AFP; beta hCG

[differentiation to something like teratoma]

20
Q

Most common testicular tumor in children; AFP is characteristically elevated

A

Yolk sac tumor

[similar to yolk sac tumors in females — have schiller duvall bodies that appear as glomeruloid-like structures]

21
Q

Choriocarcinoma of the testicle is a malignant tumor of _____ and ______ that spreads early via the ______ route. Of note is that there is characteristic ABSENCE of villi

A

Syncytiotrophoblasts; cytotrophoblasts; hematogenous

22
Q

_______ is characteristically elevated in choriocarcinoma due to production from syncytiotrophoblasts, which may lead to symptoms of ______ or ______

A

Beta hCG; hyperthyroidism; gynecomastia

[beta hCG can activate TSH receptors leading to hyperthyroidism, or it can activate FSH/LH receptors leading to gynecomastia]

23
Q

T/F: Teratomas in males are composed of mature fetal tissue derived from 2-3 embryonic layers, may produce AFP or beta hCG, and are ALWAYS considered malignant

A

True

[benign in females, malignant in males]

24
Q

T/F: The vast majority of germ cell tumors are usually mixed; the prognosis is based on the worst component

A

True

25
Q

Sex cord-stromal tumors of the testicle are usually benign. Which type of sex cord-stromal tumor usually produces androgen and presents with precocious puberty in children or gynecomastia in adults with characteristic Reinke crystals seen on histology?

A

Leydig cell tumor

26
Q

Sex cord stromal tumor of the testicle comprised of tubules; usually clinically silent

A

Sertoli cell tumor

27
Q

Most common cause of testicular mass in males > 60; often bilateral

A

Lymphoma

[usually diffuse large B-cell type]

28
Q

Acute prostatitis etiologies in young adults vs. older adults

A

Young adults = C trachomatis; N gonorrhoeae

Older adults = E coli; Pseudomonas

[same as orchitis!]

29
Q

Acute prostatitis presents as dysuria with fever and chills; the prostate will be tender and boggy on DRE. Prostatic secretions show _____ and culture reveals ______

A

WBCs; bacteria

30
Q

Chronic prostatitis presents as dysuria with pelvic or low-back pain. How do the prostatic secretions in chronic prostatitis differ from acute prostatitis?

A

Chronic = prostatic secretions show WBCs but cultures are negative

Acute = prostatic secretions show WBCs and bacteria on culture

31
Q

BPH is hyperplasia of prostatic ____ and _____. It is an age-related change with no increased risk of cancer.

It is primarily related to the hormone _______ and occurs in the ______ zone of the prostate

A

Glands; stroma

DHT; periurethral

32
Q

Clinical features of BPH include problems starting and stopping urine stream, impaired bladder emptying, dribbling, _______ of bladder wall smooth muscle and possible associated diverticuli, microscopic hematuria, and slight elevation in ______

A

Hypertrophy; PSA (4-10)

33
Q

3 possible pharmacologic treatments for BPH

A

Alpha 1-antagonist (terazosin) to relax smooth muscle

Selective alpha 1a-antagonists (tamsulosin) in normotensive individuals

5 alpha-reductase inhibitors (finasteride) — only one that decreases size of prostate because this is the enzyme that converts testosterone to DHT - the hormone driving prostate enlargement

34
Q

Most common cancer in men; 2nd most common cause of cancer death

A

Prostate adenocarcinoma (malignant proliferation of prostatic glands)

35
Q

3 major risk factors for prostate adenocarcinoma

A

Increasing age

Race — african americans > caucasians > asians

Diet high in saturated fats

36
Q

T/F: prostatic adenocarcinoma typically presents early with urinary symptoms

A

False — since it arises at the posterior periphery of the prostate, it does not affect the urethra until very late

37
Q

Screening for prostate cancer begins at age 50 with DRE and PSA. Normal serum PSA increases with age, but a PSA > _____ ng/dL is worrisome at any age. A ______ (increased/decreased?) percent free-PSA in the serum is suggestive of cancer

A

10; decreased

[a decreased percent free PSA is suggestive of cancer because cancer makes bound PSA]

38
Q

T/F: A prostatic biopsy is required to confirm the presence of prostatic adenocarcinoma

A

True

[cannot confirm carcinoma just based on DRE and/or PSA]

39
Q

How is prostate adenocarcinoma graded?

A

Gleason grading system — based on architecture, NOT nuclear atypia

[requires looking at multiple regions of prostate, since cancer varies across the prostate gland — higher score = worse prognosis]

40
Q

Prostate cancer often spreads to the lumbar spine, which is considered _______ metastasis, presenting as low back pain with increased alkaline phosphatase, PSA, and prostatic acid phosphatase

A

Osteoblastic

[alkaline phosphatase is a marker of osteoblastic activity]

41
Q

3 treatment options for prostate cancer

A

Prostatectomy (local disease)

Continuous GnRH analogs (leuprolide)

Androgen receptor inhibitor (flutamide)

Boards Pathology (19 decks)

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