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MBBS II ERS > L24 - Pathology of the Male genital tract > Flashcards

L24 - Pathology of the Male genital tract Flashcards

1
Q

List 3 congenital anomalies of the penis?

A

Hypospadia and Epispadia

Congenital urethral valvular obstruction

Phimosis

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2
Q

Complications of hypospadia and epispadia?

A

Predispose to urinary tract infection

interfering with normal ejaculation

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3
Q

Describe the abnormality in Congenital urethral valvular obstruction?

A

Membranous flap in the prostatic urethra

> > cause urinary obstruction

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4
Q

Describe the abnormality in Phimosis?

A

orifice of the prepuce is too small for its normal retraction

congenital or produced after inflammatory scarring

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5
Q

List some nonspecific infections of the penis and causative agents?

A

prepuce (balanitis) and glans (prosthitis)

Candida albicans, Mumps, Tuberculosis

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6
Q

Tract the ascending route of STD infection?

A

urethra > prostate > vas deferens > epididymis > testis (atrophy, scarring)

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7
Q

Complications of chronic STD?

A

Persistent inflammation > Fibrosis in:

 Urethra: fistula, stricture
 Testis: atrophy, scarring

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8
Q

Systemic complication of STDs?

A

endocarditis (valves), arthritis

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9
Q

Causative agent of Condyloma acuminata (venereal warts) ?

A

Human Papilloma Virus (HPV) types 6 and 11

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10
Q

Most common non-gonorrhea infection?

A

Chlamydial infections

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11
Q

Gross appearance of venereal warts?

A
  • single or multiple warty papillary growth on penis/scrotum
  • may spread locally to involve anogenital region
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12
Q

Histological appearance of venereal warts?

A
  • fibroblastic branching stalk covered by acanthotic squamous epithelium
  • koilocytes: perinuclear halo + smudged nuclei
  • differentiated from squamous carcinoma by the mature epithelium
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13
Q

Most common malignant tumour of penis? Age of incidence?

A

Squamous cell carcinoma

50-70 years

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14
Q

Etiology of penile scc?

A
  • Not Circumcised
  • Poor hygiene and smegma
  • HPV infection
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15
Q

Gross, histological appearance of penile SCC and route of spread?

A

Gross: exophytic ulcerated growth or nodular plaques

Histology: squamous cell carcinoma

Course: regional lymph nodes metastasis

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16
Q

Gross appearance of penile carcinoma in-situ and disease progression?

A

Smooth, soft red plaques OR elevated, red scaly papules on the glans and penis.

May develop into invasive squamous cell carcinoma

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17
Q

Causative agents of acute and chronic prostatitis?

A

Nonspecific infection caused by coliform bacteria, gonococci or chlamydia

May Extend from the bladder or urethra

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18
Q

List 2 inflammatory diseases of the prostate?

A

Acute and chronic prostatitis

Granulomatous prostatitis

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19
Q

Causes of granulomatous protatitis?

A

1) specific infections such as tuberculosis or syphillis

2) inflammatory reaction to inspissated secretion/ autoimmune causation

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20
Q

What is the most common prostate disease?

A

Benign prostatic hyperplasia (BPH)

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21
Q

Gross morphology of BPH?

A

distinct circumscribed grey white nodules in the periurethral zone

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22
Q

Histological appearance of BPH?

A

glandular and fibromuscular stromal proliferation

+/- infarct, infection, squamous metaplasia

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23
Q

Clinical presentation of BPH?

A

(i) asymptomatic
(ii) compression of urethra-difficulty in urination, frequency or dribbling
(iii) retention of urine > hydronephrosis, hydroureters, bladder distention and hypertrophy

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24
Q

Complications of BPH?

A

retention of urine:

  • bladder distention and hypertrophy
  • hydroureters and hydronephrosis
  • chronic renal failure

superimposed infections-prostatitis or cystitis

25
Q

Etiology and tumour marker for prostatic carcinoma?

A

Androgen causing growth of the tumor

Prostatic specific antigen PSA

26
Q

Clinical presentation of prostatic carcinoma?

A

Prostatism: nocturia, frequency, urgency…etc

hard mass find during rectal examination/ Incidental finding during biopsy for BPH

signs and symptoms of metastasis (e.g. back pain due to vertebral metastasis)

27
Q

4 clinical uses for tumour marker PSA?

A

· Screening of occult prostate cancer

· Detection of recurrence

· Find distant metastasis

· Identify primary metastatic tumour/ ectopic tumour

28
Q

Gross and histological appearance of Prostatic carcinoma?

A

Gross = yellowish, hard, gritty tissue

Histological = · Adenocarcinoma with acini

29
Q

Mode of prostatic carcinoma spread?

A

· Local -causing prostatic urethra obstruction and infiltrate adjacent tissue

· Lymphatics -presacral in pelvis, iliac and paraaortic lymph nodes

· Blood/ Retrograde venous -vertebra, osteoblastic, widespread metastasis: Batson’s Plexus to spine**

30
Q

Treatment for prostatic carcinoma?

A

surgery +/- hormonal therapy

31
Q

Describe one congenital anomaly of the testes and epididymis?

A

Cryptorchidism(undescended testes)

failure of the intraabdominal testes to descend into the scrotal sac

32
Q

Complications of Cryptorchidism?

A

inguinal hernia, trauma, testicular atrophy (at and after puberty),

increased incidence of testicular tumor

Infetility (if bilateral)

33
Q

List 2 inflammatory diseases of testes and epididymis?

A

1) Granulomatous orchitis: due to extravasated sperm, tuberculous orchitis or testicular tumour

2) Infection:
- Gonorrhea, STI and TB&raquo_space; epididymitis
- Syphilis&raquo_space; orchitis
- Mumps

34
Q

Name and describe one vascular lesion of the testis?

A

Torsion = Twisting of spermatic cord

interferes with venous drainage and causes engorgement and hemorrhagic infarct of the testis.

35
Q

Describe the general origin of testicular tumours? Malignant or niot?

A

rare, nearly always malignant

90% of primary testicular tumours = germ cell origin;

5% from gonadal stroma;

rest from other components of the testis.

36
Q

Give examples of germ cell testicular tumours affecting newborn?

A

yolk sac tumour

Teratoma

37
Q

Examples of germ cell testicular tumours affecting young children? pattern of spread?

A 
Choriocarcinoma = blood
Teratoma = blood and lymphatic
38
Q

Germ cell testicular tumours affecting young adults? pattern of spread?

A 
Embryonal carcinoma (anaplastic)
Lymphatic and blood
39
Q

Germ cell testicular tumours affecting middle age men? Pattern of spread?

A

Seminoma

Lymphatic

40
Q

Germ cell testicular tumours affecting old age men?

A

Spermatocytic seminoma

41
Q

2 etiologies of germ cell testicular tumours?

A

Cryptochidism: may involve other normal testis

Strong genetic familial predisposition

42
Q

Presentation of testicular tumours?

A

Testicular enlargement or pain, Distant metastasis

43
Q

General Treatment of testicular cancer?

A

surgery, irradiation and chemotherapy.

44
Q

Define the histogenesis of yolk sac tumour and choriocarcinoma of testis?

A

Germ cell > embryonal carcinoma in extra-embryonic tissue:

cytotrophoblastic and syncytiotrophoblastic cells = choriocarcinoma

Yolk sac = yolk sac tumour

45
Q

Define the histogenesis of teratoma of testis?

A

Germ cell > embryonal carcinoma in embryonic tissue:

More than one of mesoderm, ectoderm, endoderm elements involved

> > teratoma

46
Q

Gross morphology of testicular seminoma?

A

Well-demarcated tan-white homogeneous mass

uniform cells in lobules separated by a fine stroma

47
Q

Histological appearance of testicular seminoma?

A

large, round, central hyperchromatic nucleus with prominent nucleoli

sharp cell border

48
Q

Treatment of seminoma?

A

orchidectomy and postsurgical irradiation.

49
Q

2 distinct features of yolk-sac tumour and name one 1 tumour marker?

A

1) distinctive perivascular structures
2) hyaline globules

alpha-fetoprotein

50
Q

Tumour marker for choriocarcinoma?

A

Serum and urinary Human chorionic gonadotrophin (hCG)

normally Secreted by sycytiotrophoblastic cells in the placenta

51
Q

Define the malignancy of testicular teratoma?

A

Differentiated mature teratomas = benign in infants and young children

Mature/ immature teratoma in postpubertal male = malignant

52
Q

Most common type of gonadal Stromal tumours in males?

A

Leydig cell tumours

53
Q

Most common non-germ cell testicular tumour in men over 60?

A

Testicular lymphoma

Mostly secondary

54
Q

Ddx scrotal mass.

A

Ø Testicular tumour
Ø Tumour-like conditions e.gg hydrocele and haematocele
Ø Hernia
Ø Orchitis
Ø Torsion
Ø Tumour and tumour-like conditions of spermatic cord and testicular appendages

55
Q

List 3 prognostic factors of testicular germ cell tumours?

A

All about cryptorchidism

  • Abdominal vs inguinal
  • Undescended vs contralateral descended
  • Orchipexy vs no orchipexy (correct cryptorchidism)
56
Q

Describe the pathohistological changes to undescended testis?

A

INTERSTITIAL FIBROSIS + SHRINK
NO spermatogenic cells
Progressive Degeneration

57
Q

Ddx raised Alpha-fetoprotein?

A

• Hepatocellular carcinoma, severe cirrhosis

• Germ cell tumour: testis:
–yolk sac tumour
–embryonal carcinoma

58
Q

Which testicular tumours have increased hCG?

A

Choriocarcinoma (most) ****
Embryonal carcinoma (some)
Seminoma (ST) (some)

MBBS II ERS (37 decks)

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