CH14 - Male Genital System Pathology Flashcards Preview

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Flashcards in CH14 - Male Genital System Pathology Deck (136)
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1

What is the hypospadias?

Opening of urethra on inferior surface of penis

2

What is hypospadias due to?

failure of the urethral folds to dose

3

What is epispadias?

opening of urethra on superior surface of penis

4

What is epispadias due to?

abnormal positioning of the genital tubercle

5

What is epispadias associated with?

bladder exstrophy

6

What is condyloma acuminatum?

Benign warty growth on genital skin

7

What is condyloma acuminatum due to?

HPV type 6 or 11; characterized by koilocytic change

8

What is lymphogranuloma venereum?

Necrotizing granulomatous inflammation of the inguinal lymphatics and lymph nodes

9

What is lymphogranuloma venereum caused by?

sexually transmitted disease caused by Chlamydia trachomatis (serotypes L1-L3)

10

What eventually happens to lymphogranuloma venereum?

it heals with fibrosis; perianal involvement may result in rectal stricture

11

What is squamous cell carcinoma for the penis?

Malignant proliferation of squamous cells of penile skin

12

What are the risk factors for squamous cell carcinoma of the penis?

1) high risk HPV (2/3 of cases) 2) Lack of circumcision

13

Why is a lack of circumcision a risk factor for squamous cell carcinoma of the penis?

foreskin acts as a nidus for inflammation and irritation if not properly maintained

14


In squamous cell carcinoma of the penis what are the precursor in situ lesions?



1) Bowen disease 2) Erythroplasia of Queyrat 3) Bowenoid papulosis (only CIS with no predisposition for invasion)


15

What is Bowen disease?

in situ carcinoma of the penile shaft or scrotum that presents as leukoplakia

16

What is erythroplasia of queyrat?

in situ carcinoma on the glans that presents as erythroplakia

17

What is bowenoid papulosis?

in situ carcinoma that presents as multiple reddish papules

18

In whom is bowenoid papulosis seen?

Seen in younger patients (40s) relative to Bowen disease and erythroplasia of Queyrat

19

How invasive is bowenoid papulosis?

Does not progress to invasive carcinoma

20

What is cryptorchidism?

Failure of testicle to descend into the scrotal sac

21

Where do the testicles normally develop?

in the abdomen and then descend into the scrotal sac as the fetus grows.

22

What is the most common congenital male reproductive abnormality and how often is it seen?

Cryptorchidism and is seen in 1% of male infants

23

What is orchiopexy?

Operation to bring undescended testicle into scrotum

24

What happens in most cases of cryptorchidism?

most cases resolve spontaneously; otherwise, orchiopexy is performed before 2 years of age.

25

What are the complications for cryptorchidism?

they include testicular atrophy with infertility and increased risk for seminoma.

26

What is orchitis?

Inflammation of the testicle

27

What are the causes for orchitis?

1) Chlamydia trachomatis (serotypes D-K) or Neisseria gonorrhoeae 2) Escherichia coli and Pseadomonas 3) mumps virus 4) autoimmune orchitis

28

In whom is orchitis caused by Chlamydia trachomatis (serotypes D-K) or Neisseria gonorrhoeae seen in and what happens as a result?

young adults. Increased risk of sterility, but libido is not affected because Leydig cells are spared.

29

In whom is orchitis caused by Escherichia coli and Pseadomonas seen in and what happens as a result?

older adults and what results is that urinary tract infection pathogens spread into the reproductive tract.

30

In whom is orchitis caused by the mumps virus seen and what is the result?

Seen in teenage males and there is an increased risk for infertility; testicular inflammation is usually not seen in children < 10 years old.

31

What is autoimmune orchitis characterized by?

granulomas involving the seminiferous tubules

32

What is testicular torsion?

twisting of the spermatic cord; thin-walled veins become obstructed leading to congestion and hemorrhagic infarction

33

What is testicular torsion usually due to?

congenital failure of testes to attach to the inner lining of the scrotum via the processus vaginalis

34

How does testicular torsion present?

in adolescents with sudden testicular pain and absent cremasteric reflex

35

What is a varicocele?

dilation of the spermatic vein due to impaired drainage

36

What does a varicocele present as?

scrotal swelling with a bag of worms appearance

37

To what side does the varicocele present?

usually left sided;

38

Why does a varicocele present as left sided?

Because the left testicular vein drains into the left renal vein, while the right testicular vein drains directly into the IVC.

39

What is the varicocele associated with?

left-sided renal cell carcinoma; RCC often invades the renal vein.

40

In whom is the varicocele seen?

in a large percentage of infertile males

41

What is a hydrocele?

Fluid collection within the tunica vaginalis

42

What is the tunica vaginalis?

it is a serous membrane that covers the testicle as well as the internal surface of the scrotum.

43

What is the tunica vaginalis associated with?

incomplete closure of the processus vaginalis leading to communication with the peritoneal cavity (infants) or blockage of lymphatic drainage (adults)

44

How does the hydrocele present?

as scrotal swelling that can be transluminated

45

From where do testicular tumors arise?

from germ cells or sex cord-stroma

46

What do testicular tumors present as?

a firm, painless testicular mass that cannot be transluminated

47

When are testicular tumors biopsied?

usually not biopsied due to risk of seeding the scrotum; removed via radical orchiectomy

48

Are testicular tumors benign or malignant?

Most testicular tumors are malignant germ cell tumors.

49

What are the testicular germ cell tumors?

Seminoma, Nonseminoma, embryonal carcinoma, Volc sac tumor, choriocarcinoma, teratoma, milted germ cells

50

What is the most common type of testicular tumor?

Germ cell tumors (> 95% of cases)

51

In whom do the most common type of testicular tumor usually occur?

between 15-40 years of age

52

What are the risk factors for germ cell testicular tumors?

include cryptorchidism and Klinefelter syndrome

53

What are germ cell testicular tumors divided into?

seminoma and nonseminoma

54

What are seminomas?

It is 55% of testicular tumor cases and are highly responsive to radiotherapy, metastasize late, and have an excellent prognosis,

55

What is the prognosis for seminomas?

Excellent prognosis

56

What are nonseminomas?

It is 45% of cases and show variable response to treatment and often metastasize early.

57

What is seminoma?

it is a malignant tumor comprised of large cells with clear cytoplasm and central nuclei (resemble spermatogonia); forms a homogeneous mass with no hemorrhage or necrosis

58

What is the most common testicular tumor?

Seminoma; resembles ovarian dysgerminoma

59

In rare cases of seminoma what may be produced?

Beta-hCG

60

What is the prognosis for seminoma?

Its good and responds to radiotherapy

61

What is embryonal carcinoma?

it is a malignant tumor comprised of immature, primitive cells that may produce glands, forms a hemorrhagic mass with necrosis

62

Describe embryonal carcinoma.

It is aggressive, with early hematogenous spread

63

What is the reaction of embryonal carcinoma to chemotherapy?

It may result in differentiation into another type of germ cell tumor (e.g., teratoma).

64

What increased levels may be present in embryonal carcinoma?

Increased AFP or beta-hCG may be present

65

What is yolk sac tumor?

It?s a germ cell tumor. (endodermal sinus) tumor is a malignant tumor that resembles yolk sac elements.

66

What is the most common testicular tumor in children?

Volk sac (endodermal sinus)

67

What is seen on histology for embryonal carcinoma?

Schiller-Duval bodies (glomerulus-like structures) are seen on histology

68

In embryonal carcinoma what levels are characteristically elevated?

AFP

69

For germ cell testicular tumors, what is choriocarcinoma?

It is a malignant tumor of syncyliotrophohlasts and cytotrophoblasts

70

What are cytotrophoblasts?

placenta-like tissue, but villi are absent

71

How does choriocarcinoma spread?

It spreads early via blood

72

What are syncyliotrophoblasts?

They are the epithelial covering of highly vascular embryonic placental villi

73

What levels are elevated in syncyliotrophoblasts?

beta-hCG is characteristically elevated and may lead to hyperthyroidism or gynecomastia (beta-subunit of hCG is similar to that of FSH, LH, and TSH)

74

What is a teratoma?

it is a tumor composed of mature fetal tissue derived from two or three embryonic layers

75

How is a teratoma in males different from a teratoma in females?

It is malignant in males (as opposed to females)

76

What levels may be increased in a teratoma?

AFP or beta-hCG may be increased

77

What happens in a milted germ cell testicular tumor?

Germ cell tumors are usually mixed.

78

What is the prognosis for a milted germ cell tumor?

Prognosis is based on the worst component of the mixed germ cell tumor

79

What are sexcord stromal tumors?

Tumors that resemble sex cord-stromal tissues of the testicle; usually benign

80

What are leydig cell tumors?

they usually produce androgen, causing precocious puberty in children or gynecomastia in adults,

81

In leydig cell tumors, what may be seen on histology?

Reinke crystals

82

What are sertoli cell tumors comprised of?

tubules and is usually clinically silent.

83

What is lymphoma (testicle)?

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

84

What cell type is usually involved with lymphoma of the testicle?

It?s usually of diffuse large B-cell type

85

What is the prostate?

Small, round organ that lies at the base of the bladder encircling the urethra

86

What is the location of the prostate?

anterior to the rectum;

87

What is palpated in a DRE?

posterior aspect of prostate is palpable by digital rectal exam (DRE),

88

What does the prostate consist of?

glands and stroma

89

What are the glands of the prostate composed of?

an inner layer of luminal cells and an outer layer of basal cells; secretes alkaline, milky fluid that is added to sperm and seminal vesicle fluid to make semen.

90

How are the glands and stroma of the prostate maintained?

by androgens.

91

What is acute prostatitis?

Its acute inflammation of the prostate; usually due to bacteria

92

What are the most common causes of acute prostatitis in young adults?

Chlamydia trachomatis and Neisseria gonorrhoeae

93

What are common causes of acute prostatitis in older adults?

Escherichia coli and Pseudomonas

94

How does acute prostatitis present?

Presents as dysuria with fever and chills

95

How does the prostate present with acute prostatitis?

it is lender and boggy on digital rectal exam

96

In acute prostatitis what does the prostatic secretions show?

Prostatic secretions show WBCs; culture reveals bacteria.

97

What is chronic prostatitis?

Chronic inflammation of prostate

98

How does chronic prostatitis present?

It presents as dysuria with pelvic or low back pain

99

What do prostatic secretions in chronic prostatitis show?

WBCs, but cultures are negative,

100

What is benigin prostatic hyperplasia?

It is hyperplasia of prostatic stroma and glands

101

What is the probability of BPH resulting in cancer?

Age-related change (present in most men by the age of 60 years); no increased risk for cancer

102

What is BPH related to?

dihydrotestosterone (DHT)

103

What is testosterone converted to? Where? By what?

Converted to DHT by 5 alpha-reductase in stromal cells

104

What does DHT act on?

the androgen receptor of stromal and epithelial cells resulting in hyperplastic nodules

105

Where does BPH occur?

in the central periurethral zone of the prostate

106

What are the clinical features for BPH?

They include 1. Problems starting and stopping urine stream 2. Impaired bladder emptying with increased risk for infection and hydronephrosis 3. Dribbling 4. Hypertrophy of bladder wall smooth muscle; increased risk for bladder diverticula 5. Microscopic hematuria may be present. 6. Prostate-specific antigen (PSA) is often slightly elevated (usually less than 4 ng/mL) due to the increased number of glands;

107

Why is PSA elevated in BPH, and what is the effect of this?

Because PSA is made by prostatic glands and liquefies semen

108

What is the range for PSA in patients with BPH?

4-10ng/ml

109

What is the treatment for BPH?

Alpha 1-antagonist (e.g., terazosin) to relax smooth muscle and 5 alpha reductase inhibitor

110

For BPH, what must be considered as a side effect of the treatment?

The alpha-1 antagonist also relaxes vascular smooth muscle lowering blood pressure

111

How is the side effect for the treatment of BPH taken into consideration?

Selective alpha 1A-antagonists (e.g., tamsulosin) are used in normotensive individuals to avoid effects on blood vessels

112

What does 5a-reductase inhibitor do for BPH?

It blocks the conversion of testosterone to DHT

113

How long does it take to produce results in treating BPH with 5 alpha reductase?

Takes months to produce results

114

What other effects does 5 alpha reductase have when treating BPH?

Its also useful for male pattern baldness and has side effects are gynecomastia and sexual dysfunction

115

What is prostate adenocarcinoma?

malignant proliferation of prostatic glands

116

What is the most common cancer in men?

Prostate adenocarcinoma

117

What is the 2nd most common cause of cancer-related death?

Prostate adenocarcinoma

118

What are the risk factors for prostate adenocarcinoma?

they include age, race (African Americans > Caucasians > Asians), and diet high in saturated fats.

119

How does prostatic carcinoma most often present clinically?

silent

120

Where does prostate carcinoma usually arise?

in the peripheral, posterior region of the prostate and, hence, does not produce urinary symptoms early on

121

When does screening for prostate adenocarcinoma begin?

at the age of 50 years with DRE and PSA

122

What are normal serum PSA levels?

it increases with age due to BPH (2.5 ng/mL for ages 40-49 years vs. 7.5 ng/mL for ages 70 - 79 years)

123

What levels of PSA would be worrisome at any age?

> 10 ng/dL is highly worrisome at any age

124

What aspect of PSA might be suggestive of cancer?

Decreased % free-PSA is suggestive of cancer (cancer makes bound PSA)

125

What is required to confirm prostatic carcinoma?

Prostatic biopsy is required to confirm the presence of carcinoma

126

What does prostate carcinoma show?

small, invasive glands with prominent nucleoli

127

What is the grading system for prostate carcinoma?

Gleason grading system is based on architecture alone (and not nuclear atypia)

128

What is the Gleason grading system?

1. Multiple regions of the tumor are assessed because architecture varies from area to area. 2. A score (1-5) is assigned for two distinct areas and then added to produce a final score (2-10). 3. Higher score suggests worse prognosis.

129

In prostate carcinoma spread to what areas are common?

lumbar spine or pelvis is common;

130

The spread of prostate carcinoma to the lumbar spine or pelvis results in what?

osteoblastic metastases

131

For osteoblastic metastases or prostate carcinoma to the lumbar spine or pelvis, how does it present?

it presents as low back pain and increased serum alkaline phosphatase, PSA, and prostatic acid phosphatase (PAP)

132

When is prostatectomy performed?

it is performed for localized disease

133

What is advanced prostate carcinoma treated with?

hormone suppression to reduce testosterone and DHT

134

What are used in hormone suppression for the treatment of advanced prostate carcinoma?

Continuous GnRH analogs (e.g., leuprolide) and flutamide

135

What does continuous GnRH analog (used in hormone suppression treatment of prostate carcinoma) do?

it shuts down the hypothalamus (LH and FSH are reduced)

136

What does flutamide (used in hormone suppression treatment of prostate carcinoma) do?

it acts as a competitive inhibitor at the androgen receptor