Flashcards in Ch 17: Male Reproductive System Deck (19)
You see a scrotal mass that can be transilluminated and is filled with clear, serous fluid. You astutely determine this is a hydrocele! What are the causes of congenital hydrocele? Acquired?
- Congenital: caused by a patent processsus vaginalis and associated with inguinal hernia, this is the most common scrotal swelling in infants
- Acquired: secondary to infection, tumor, or trauma
Condyloma acuminatum is associated with _____?
HPV 6 and 11 (DNA virus)
- appears as raised, circumscribed lesions on shaft of penis - do not confuse with verrucous carcinoma!
- microscopically: epidermal hyperkeratosis, parakeratosis, acanthosis, papillomatosis
What is balantis? Who gets it? What causes it? What are some possible complications?
- balantis: inflammation of the glans
- uncircumcised men
- caused by bacteria or fungi in the context of poor hygiene, immunosuppression, or diabetes
- complications: meatal stricture, phimosis, paraphimosis
Name 3 in situ lesions that can lead to squamous cell carcinoma of the penis. What are some characteristics of SCC?
1) Bowen disease - leukoplakia
2) erythroplasia of Queyrat - erythroplakia
3) Bowenoid papulosis - multiple papules in younger, sexually active men (** this one does not progress to invasive carcinoma)
- SCC associated with HPV 16/18, cells will show intercellular bridging
What is the most common cause of female pseudohermaphroditism?
- 21-hydroxylase deficiency
- these females are (46,XX) with normal ovaries and internal organs but virilization of external genitalia (fusion of vulva, clitoromegaly)
What is the most common cause of male pseudohermaphroditism?
- androgen insensitivity system aka testicular feminization syndrome
- these males are (46,XY) with cryptorchid testes but feminine external genitalia
1) Describe the most common testicular tumor in the first 4 years of life
2) Describe the most common testicular tumor from ages 4-12
1) Yolk sac tumor - glomeruloid Schiller-Duval bodies present, malignant, monitor alpha-fetoprotein levels for recurrence
2) Teratomas - mature somatic tissues, benign
A 30 yo male comes to you because he noticed a testicular mass. Purely based on chance, you suspect this most common testicular tumor, which is confirmed when it is resected as a homogenous mass with no hemorrhage or necrosis. What testicular tumor is this?
- Seminoma, a germ cell tumor and the most common testicular tumor.
- seminomas are most common between 30-40 yo
- microscopically, seminomas are equivalent to ovarian dysgerminomas (large clear cells with central nuclei)
- these tumors are highly radiosensitive and can usually be cured when this is combined with orchiectomy
A 38 yo male presents complaining of weight loss, intolerance to heat, and mood changes. You notice that he's tachycardic while resting, and upon exam there is gynecomastia present. While continuing your exam, you find a testicular mass. This sends your Rubin's senses into a tizzy... What is your diagnosis?
- Choriocarcinoma, a germ cell tumor of syncytiotrophoblasts and cytotrophoblasts
- since there is a proliferation of placenta-like tissue, hCG levels are elevated
- the alpha subunit of hCG is very similar to that of FSH, LH, and TSH --> hence, patients can have hyperthyroidism and gynecomastia
- microscopically, there are multinucleated giant cells associated with hemorrhage
What is the most common urologic condition requiring surgical treatment in male infants?
- cryptorchidism (undescended testis)
- descent may be arrested at any point along the path: abdominal, inguinal, or upper scrotal (or even the calf for the overachievers of the bunch)
- even if surgically corrected, associated with an increased risk of infertility and germ cell neoplasia (seminoma)
What is the most common cause of testicular masses in males older than 60?
- malignant lymphoma
Describe 2 testicular tumors of the sex cord stroma
1) Leydig cell tumors - produces androgen (causing precocious puberty in boys or gynecomastia in men), Reinke crystals on histology
2) Sertoli cell tumors - comprised of tubules and clinically silent
Come up with some buzzwords for the following causes of orchitis:
- Gram (-) bacterial
- Gram (-): C. trachomatis (D-K), N. gonorrhoeae, young adults, increased risk of sterility, Leydig cells spared which maintains libido so the wealth can be spread
- Syphilitic: interstitial (lymphocytes, plasma cells) or granulomatous (gummas)
- Mumps: unilateral, unvaccinated, increased risk for infertility
- Autoimmune: granulomas of seminiferous tubules
How can location help you differentiate BPH from prostate cancer?
BPH tends to develop in the central periurethral zone of the prostate (eliciting the typical urinary symptoms) whereas prostate cancer tends to arise in the peripheral posterior region (can be clnically silent until it grows)
- there is no evidence that BPH leads to adenocarcinoma of the prostate
What is the precursor lesion of prostatic adenocarcinoma?
- precursor: prostatic intrepithelial neoplasia (ducts lined with atypical cells and an overall decrease in basal cells)
- adenocarcinomas make up 98% of all prostate cancers and are classified according to the Gleason grading system
- tumor cells most likely exhibit androgen-dependent growth, which is theory for treating with GnRH analogs and androgen receptor inhibitors
This is due to failure of the urethral folds to close in a male embryo
- urethral opening/meatus is on inferior surface of penis
Result of protrusions of widened efferent ducts of rete testis or epididymis, presenting as a scrotal mass filled with milky fluid
Result of dilation of testicular veins, presenting as a nodularity on lateral scrotum. Buzzword "bag of worms"
- common cause of infertility
- more common on left, as testicular vein drains to renal vein (as opposed to right, where TV drains to IVC)