Ch 14 Pathoma Male Genital System

Question 1

Hypospadias is opening of the __ on the __ surface of the penis. It is due to the failure of ___.

Answer 1

urethra; inferior surface; urethral folds to close

Question 2

Epispadias is opening of the __ on the __ surface of the penis. Due to abnormal ___. Associated with ___.

Answer 2

urethra; superior; positioning of the genital tubercle; bladder exstrophy (complete exposure of bladder wall) Rarer than hypospadias

Question 3

Condyloma acuminatum are benign/malignant __ growth on __ skin. Due to __. Characterized by __.

Answer 3

benign; warty; genital; HPV type 6 or 11; koilocytic change

Question 4

Lymphogranuloma venerum is ___ inflammation of the __ and __. It is a sexually transmitted disease caused by ___ (serotypes __). Eventually heals with __. Perianal involvement may result in ___.

Answer 4

necrotizing granulomatous; inguinal lymphatics; lymph nodes; Chlamydia trachomatis; L1-L3; fibrosis; rectal stricture

Question 5

Squamous cell carcinoma of the penis is a benign/malignant proliferation of __ cells of __ skin. Risk factors include ___ (2/3 of cases) and __ (__ acts as a nidus for inflammation and irritation if not properly maintained)

Answer 5

malignant; squamous; penile; high risk HPV (16, 18, 31, 33); lack of circumcision; foreskin

Question 6

Name the 3 precursor in situ lesions of squamous cell carcinoma of the penis

Answer 6

1) Bowen disease; 2) Erythroplasia of Queyrat; 3) Bowenoid papulosis

Question 7

Bowen disease is ___ of the penile __ or __ that presents as ___. It is a precursor of squamous cell carcinoma of the penis.

Answer 7

in situ carcinoma; shaft; scrotum; leukoplakia

Question 8

Erythroplasia of Queyrat is ___ on the __ that presents as ___. It is a precursor of squamous cell carcinoma of the penis.

Answer 8

in situ carcinoma; glans; erythroplakia

Question 9

Bowenoid papulosis is __ that presents as multiple __. Seen in older/younger pts relative to Bowen disease and erythroplasia of Queyrat. Does/does not progress to invasive carcinoma.

Answer 9

in situ carcinoma; reddish papules; younger (40s); does not

Question 10

Of the 3 precursor in situ carcinomas of squamous cell carcinoma of the penis, which one presents as leukoplakia? multiple reddish papules? erythroplakia? seen in younger pts? presents on the glans? on the scrotum? does not progress to invasive carcinoma?

Answer 10

Bowen disease; Bowenoid papulosis; erythroplasia of Queyrat; BP; EoQ; scrotum = BD; BP

Question 11

Cryptorchidism is the failure of ___. Testicles normally develop in the __ and then __ into the __ as the fetus grows. Seen in __% of male infants. Most cases resolve spontaneously, otherwise, __ is performed before __ yrs of age.

Answer 11

testicle to descend into scrotal sac; abdomen; descends; scrotal sac; 1; orchiopexy; 2

Question 12

Complications of cryptocorchidism include __ and __.

Answer 12

testicular atrophy with infertility; increased risk for seminoma

Question 13

What is the most common congenital male reproductive abnormality?

Answer 13

cryptorchidism

Question 14

Orchitis is __ of the __. Name 4 causes.

Answer 14

inflammation; testicle; 1) Chlamydia/Gonorrhoeae; 2) E coli/pseudomonas; 3) mumps virus; 4) autoimmune orchitis

Question 15

Chlamydia trachomatis (serotypes ___) or Neisseria gonorrhoaea causes orchitis in ___. Increased risk of __, but __ is not affected because __ are spared.

Answer 15

D-K; young adults; sterility; libido; Leydig cells

Question 16

E coli and pseudomonas causes orchitis seen in __. __ pathogens spread into the ___. Autoimmune orchitis is characterized by __ involving the ___.

Answer 16

older adults; urinary tract infection; reproductive tract; granulomas; seminiferous tubules

Question 17

Mumps virus causes orchitis seen in __. It increases risk for __. Testicular inflammation is usually not seen in ___. Mumps virus can cause inflammation of these 4 areas.

Answer 17

teenage males; infertility; children less than 10; parotid gland, meninges, pancreatitis, and orchitis

Question 18

Testicular torsion is twisting of the __. Thin walled __ become obstructed leading to __ and __. Usually due to congenital failure of ___ to attach to the inner lining of the __ (via the __). Presents in __ with sudden __ and absent __.

Answer 18

spermatic cord; veins; congestion; hemorrhagic infarction; testes; scortum; processus vaginalis; adolescents; testicular pain; cremasteric reflex

Question 19

Varicocele is dilation of the __ due to __. Presents as __ with a ‘___’ appearance. Usually right/left sided, because the __ testicular vein drains in to the __ renal vein, while the __ testicular vein drains in to the IVC. Associated with __, since it usually invades the renal vein. Varicocele is seen in a large percentage of ___.

Answer 19

spermatic vein; impaired drainage; scrotal swelling; bag of worms; left; left; left; right; left-sided RCC; infertile males (extra blood near testicle might increase temp leading to infertility)

Question 20

Hydrocele is a __ collection within the ___, which is a serous membrane that covers the __ as well as the inner surface of the __.

Answer 20

fluid; tunica vaginalis; testicle; scrotum

Question 21

Hydrocele is associated with incomplete closure of the __ leading to communication with the __ (infants) or blockage of ___ (adults). It presents as __ that can be __.

Answer 21

processus vaginalis; peritoneal cavity; lymphatic drainage; scrotal swelling; transilluminated (pass strong light through in order to detect disease or abnormality)

Question 22

Testicular tumors arise from __ or __. They present as a firm, painful/painless testicular mass that can/cannot be transilluminated. Usually not __ due to risk of seeding the ___. Removed via ___. Most are ___.

Answer 22

germ cells; sex cord-stroma; painless; cannot (different from hydrocele); biopsied; scrotum; radical orchiectomy; malignant germ cell tumors

Question 23

What is the most common type of testicular tumor? What is the most common testicular tumor? Most common in children? Most common cause of a testicular mass in males greater than 60?

Answer 23

germ cell (greater than 95% of cases); seminoma; yolk sac tumor; lymphoma

Question 24

Germ cell tumors usually occur btwn __ yrs of age. Risk factors include __ and __. They are divided into __ and __.

Answer 24

15-40; cryptorchidism; Klinefelter syndrome; seminoma; non-seminoma

Question 25

Seminomas (55% of cases) and non-seminomas (45%) are germ cell tumors. Which is highly responsive to radiotherapy? which shows variable response? Which metastasizes late? Which early? Which has excellent prognosis?

Answer 25

seminoma; nonseminoma; S; NS; S

Question 26

Seminoma is a benign/malignant tumor comprised of __ with __ cytoplasm and central/peripheral nuclei (resemble spermatogonia). They form a __ mass with/without hemorrhage or necrosis.

Answer 26

malignant; large cells; clear; central; homogenous; without

Question 27

Testicular seminoma resembles an ovarian \_\_\_. In rare cases, it may produce \_\_\_. Has a good/poor prognosis and responds/is refractory to radiotherapy

Answer 27

dysgerminoma; B-hCG; good; responds

Question 28

Name 5 non-seminoma testicular tumors

Answer 28

1) embryonal carcinoma; 2) yolk sac tumor; 3) choriocarcinoma; 4) teratoma; 5) mixed germ cell tumors

Question 29

Embryonal carcinoma is a benign/malignant tumor comprised of __ that may produce \_\_\_. Forms a __ mass with \_\_\_. It is aggressive with early \_\_\_. __ may result in differentiation into another type of germ cell tumor (e.g. teratoma). Increased __ or __ may be present.

Answer 29

malignant; immature, primitive cells; glands; hemorrhagic; necrosis; hematogenous spread (embryo like, so its made to be aggressive); chemotherapy; AFP (usually think yolk sac tumor); B-hCG (usually think choriocarcinoma)

Question 30

Yolk sac (\_\_\_) tumor is a benign/malignant tumor that resembles yolk sac elements. Most common testicular tumor in \_\_\_. ___ (glomerulus like structures) are seen on histology. __ is characteristically elevated.

Answer 30

endodermal sinus; malignant; children; Schiller-Duval bodies; AFP

Question 31

Choriocarcinoma is a benign/malignant tumor of __ and __ (\_\_-like tissue, but __ are absent). Spreads early/late via \_\_. __ is characteristically elevated, and may lead to __ or \_\_, since the __ subunit of it is similar to that of these 3 hormones).

Answer 31

malignant; syncytiotrophoblasts; cytotrophoblasts; placenta; villi; early; blood (trophoblasts are programmed to find bv's); B-hCG; hyperthyroidism; gynecomastia; alpha; FSH, LH, and TSH

Question 32

Teratoma is a tumor composed of ___ derived from \_\_\_. It is benign/malignant in males (as opposed to females). __ or __ may be increased.

Answer 32

mature fetal tissue; 2 or 3 embryonic layers; malignant; AFP; B-hCG

Question 33

Mixed germ cell tumors: germ cell tumors are usually \_\_\_. Prognosis is based on the ___ component.

Answer 33

mixed; worst

Question 34

Sex cord-stromal tumors are tumors that resemble sex cord-stromal tissues of the testicle. Usually benign/malignant. Name two types of tumors.

Answer 34

benign; Leydig cell tumor; Sertoli cell tumor

Question 35

Leydig cell tumor usually produces \_\_\_, causing ___ in children or __ in adults. Characteristic __ may be seen on histology. Sertoli cell tumor is comprised of __ and is usually \_\_\_.

Answer 35

androgen; precocious puberty; gynecomastia; Reinke crystals; tubules; clinically silent

Question 36

Lymphoma is the most common cause of a testicular mass in males ___ years old. Often unilateral/bilateral. Usually of ___ type.

Answer 36

greater than 60; bilateral; diffuse large B-cell type

Question 37

Prostate is a small round organ that lies at the base of the __ encircling the \_\_. It sits anterior to the \_\_. The posterior aspect of prostate is palpable by \_\_. Prostate consists of __ and \_\_.

Answer 37

bladder; urethra; rectum; digital rectal exam (DRE); glands and stroma

Question 38

The glands of the prostate are composed of an inner layer of __ and an outer layer of \_\_. They secrete acidic/alkaline __ that is added to sperm and __ fluid to make \_\_. Glands and stroma are maintained by \_\_.

Answer 38

luminal cells; basal cells; alkaline; milky; seminal vesicle; semen; androgens

Question 39

Acute prostatitis is acute __ of the prostate, usually due to \_\_\_. ___ are the most common causes in young adults, and __ are the most common causes in older adults.

Answer 39

inflammation; bacteria; Chlamydia trachomatis and Neisseria gonorrhoeae; Escherichia coli and Pseudomonas

Question 40

Acute prostatitis presents as __ with __ and \_\_. Prostate is __ and __ on digital rectal exam. Prostatic secretions show \_\_. Culture reveals \_\_.

Answer 40

dysuria; fever; chills; tender; boggy; WBCs; bacteria

Question 41

Chronic prostatitis is chronic __ of the prostate. Presents as __ with __ or \_\_. Prostatic secretions show \_\_\_. Culture reveals \_\_.

Answer 41

inflammation; dysuria; pelvic or low back pain; WBCs; negative

Question 42

Benign prostatic hyperplasia (BPH) is hyperplasia of prostatic __ and \_\_. It is a \_\_-related change, with increased/no increased risk for cancer. It occurs in the __ zone of the prostate.

Answer 42

stroma and glands; age (present in most men by age 60); no increased; central periurethral

Question 43

BPH is related to \_\_\_. Testosterone is converted to __ by __ in __ cells. __ acts on the androgen receptor of __ and __ cells resulting in __ nodules.

Answer 43

dihydrotestosterone (DHT); DHT; 5-alpha reductase; stromal; DHT; stromal and epithelial; hyperplastic

Question 44

Name 6 clinical features of BPH

Answer 44

1) problems startng/stopping urine stream; 2) impaired bladder emptying w/inc risk for infxn and hydronephrosis; 3) dribbling; 4) hypertrophy of bladder wall smooth muscle (inc risk for bladder diverticula); 5) microscopic hematuria; 6) PSA slightly elevated

Question 45

Impaired bladder emptying can occur due to BPH and can increase risk for __ and \_\_. Hypertrophy of bladder wall smooth muscle can occur due to BPH and can increase risk for \_\_.

Answer 45

infection; hydronephrosis; bladder diverticula

Question 46

PSA is often slightly elevated in BPH (usually less than \_\_ng/ml) due to increased \_\_. PSA is made by __ and liquefies semen.

Answer 46

10; number of glands; prostatic glands

Question 47

BPH can be treated with __ or \_\_. __ is used to relax smooth muscle, and also relaxes vascular smooth muscle lowering \_\_\_. Selective __ (e.g. \_\_) are used in normotensive individuals to avoid __ effects on bv's.

Answer 47

alpha 1 antagonists or 5-alpha reductase inhibitors; alpha 1 antagonists (terazosin); blood pressure; alpha 1A antagonists (tamulosin); alpha1B

Question 48

5-alpha reductase inhibitors block conversion of __ to \_\_, and is used in the treatment of BPH. Takes days/weeks/months to produce results. Also useful for \_\_\_. Side effects are __ and \_\_.

Answer 48

testosterone; DHT; months; male pattern baldness; gynecomastia; sexual dysfunction

Question 49

What is the most common cancer in men?

Answer 49

Prostate cancer

Question 50

Prostate adenocarcinoma is a benign/malignant proliferation of \_\_\_. It is the 1st/2nd/3rd most common cause of cancer-related deaths. Risk factors include these 3.

Answer 50

malignant; prostatic glands; 2nd (lung is first); 1) age; 2) race (african americans \> caucasians \> asians); 3) diet high in saturated fats

Question 51

Prostate carcinoma is most often clinically \_\_. Usually arises in the __ region of the prostate and, hence, does not produce __ symptoms early on. Screening for prostate cancer begins at age __ with __ and \_\_.

Answer 51

silent; peripheral, posterior; urinary; 50; PSA; DRE (digital rectal exam)

Question 52

Normal serum PSA increases with age due to __ (\_\_ for ages 40-49 vs __ for ages 70-79). A PSA greater than __ is highly worrisome at any age. Increased/decreased % free-PSA is suggestive of cancer (cancer makes bound/free PSA).

Answer 52

BPH; 2.5 ng/mL; 7.5; 10; decreased; bound

Question 53

Prostatic __ is required to confirm the presence of carcinoma. It shows large/small, invasive __ with prominent \_\_. Gleason grading system is based on __ alone (and not on \_\_). Multiple regions are assessed. A score of (\_\_) is assigned for 2 distinct areas and then added to produce a final score (\_\_). Higher score suggests better/worse prognosis).

Answer 53

biopsy; small; glands; nucleoli; architecture; nuclear atypia; 1-5; 2-10; worse

Question 54

Prostate cancer spread to the __ or __ is common. It results in osteoblastic/osteolytic metastases that present as __ and increased serum \_\_, __ and \_\_.

Answer 54

lumbar spine; pelvis; osteoblastic; low back pain; alkaline phosphate (sign of osteoblastic activity - laying down bone); PSA; prostatic acid phosphatase (PAP) (the last two are serum tumor markers)

Question 55

In prostate cancer, __ is performed for localized disease. Advanced disease is treated with __ to reduce __ and \_\_. Continuous/pulsatile __ analogs (e.g. \_\_) shut down the anterior pituitary gonadotrophs (LH and FSH are reduced). __ acts as a competitive androgen receptor inhibitor.

Answer 55

prostatectomy; hormone suppression; testosterone; DHT; continuous; GnRH; leuprolide; flutamide (Leu's Flute)