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My Pathoma Unit 5 > Chapter 14 Male genital System > Flashcards

Chapter 14 Male genital System Flashcards

1
Q

What is hypospadia and what is it due to?

A

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

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2
Q

What is Epispadia and what is it due to and associated with?

A

Opening of the urethra on superior surface of penis due to abnormal positioning of the genital tubercle. Associated with bladder exstrophy

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3
Q

What is condyloma acuminatum? what is it due to and what is it characterized by?

A

Benign warty growth on genital skin. Due to HPV type 6 or 11; characterized by koilocytic change

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4
Q

What is lymphogranuloma venereum?

A

Necrotizing granulomatous inflammation of the inguinal lymphatics and lymph nodes

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5
Q

What causes lymphogranuloma venereum?

A

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

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6
Q

What is the end result of lymphogranuloma venereum?

A

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

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7
Q

What does the following serotypes of chlamydia trachomatis cause?
A-C
D-K
L

A

A-C trachoma
D-K Urogenital infections and conjuctivitis
L Lymphogranuloma venereum

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8
Q

What is Squamous cell carcinoma on the penis?

A

Malignant proliferation of squamous cells of penile skin

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9
Q

What are 2 risk factors for squamous cell carcinoma of the penis?

A

1 high risk HPV (2/3 of causes)

2 Lack of circumcision - foreskin acts as nidus for inflammation and irritation if not properly maintained

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10
Q

What are 3 precursor in situ lesions of squamous cell carcinoma of the male genitals?

A

1 Bowen Disease
2 Erythoplasia of Queyrat
3 Bowenoid papulosis

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11
Q

What is Bowen Disease?

A

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

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12
Q

What is erythroplasia of Queyrat?

A

in situ carcinoma on the glans that presents as erythroplakie

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13
Q

What is Bowenoid papulosis? What age range does it effect, and describe its local activity.

A

in situ carcinoma that presents as multiple reddish papules. seen in young patients (40s) relative to bowen disease and erythroplasia of queyrat. Does not progress to invasive carcinoma.

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14
Q

What is cryptorchidism?

A

Failure of testicle to descend into the scrotal sac

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15
Q

What is the normal developmental path of the testicle?

A

Testicles normally develop in the abdomen and then “descend” into the scrotal sac as the fetus growths

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16
Q

What is the most common congenital male reproductive abnormality?

A

Cryptorchidism seen in 1% of male infants.

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17
Q

What is the course of most cases of cryptorchidism?

A

Most cases resolve spontaneously; otherwise, orchiopexy (tack down testicle to scrotal sac to avoid damage to gem cells) is performed before 2 years of age

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18
Q

What doe complications of cryptorchidism include?

A

testicular atrophy with infertility and increased risk for seminoma

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19
Q

What is orchitis?

A

inflammation of the testicle

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20
Q

What are 4 causes of orchitis

A

1 Chlamydia trachomatis (Serotypes D-K)
2 E. coli and pseudomonas
3 Mumps Virus (teenage males)
4 Autoimmune

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21
Q

Who is orchitis due to chlamydia trach seen in and what does it increase risk for?

A

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

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22
Q

Who is orchitis due to e. cole and psuedomonas seen in and how does it occur?

A

Older adults; UTI pathogens spread into the reproductive tract

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23
Q

Who is orchitis due to mumps virus seen in and what does it increase the risk for?

A

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

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24
Q

Describe orchitis caused by autoimmune processes?

A

characterized by granulomas (not necrotizing) involving the seminiferous tubules (must differentiated form TB)

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25
Q

What is testicular torsion?

A

Twisting of the spermatic cord; thin walled veins become obstructed leading to congestion and hemorrhagic infarction (Artery is nor obstructed)

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26
Q

What is testicular torsion usually due to?

A

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

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27
Q

How does testicular torsion present?

A

presents in adolescents with sudden testicular pain and absent cremasteric reflex

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28
Q

What is a varicocele?

A

Dilation of the spermatic vein due to impaired drainage

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29
Q

How does a varicocele present?

A

Presents as scrotal swelling with a “bag of worms” appearance on the surface

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30
Q

What side are varicoceles usually seen on, why, what are they associated with?

A

Usually left sided; left testicular vein drains into the left renal vein, while the right testicular vein drains directly into IVC. Associated with left sided renal cell carcinoma; RCC often invades the renal vein.

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31
Q

What population are a large percent of varicoceles seen in?

A

Seeni in a large percentage of infertile males possible due to damage by warm blood temperature

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32
Q

What is a hydrocele?

A

Fluid collection within the tunica vaginalis

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33
Q

What is the tunica vaginalis?

A

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

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34
Q

What are hydrocele associated with?

A

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

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35
Q

How does a hydrocele present?

A

Presents as scrotal swelling that can be transluminated

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36
Q

Where doe testicular tumors arise from?

A

germ cells or sex cord stroma

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37
Q

How doe testicular tumors present?

A

Present as firm, painless testicular mass that cannot be transilluminated

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38
Q

Are testicular tumors biopsied? why?

A

NO. due to risk of seeding the scrotum; removed via radical orchiectomy

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39
Q

What type of tumor are most testicular tumors?

A

malignant germ cell tumors

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40
Q

What percentage of testicular tumors are germ cell tumors?

A

95%

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41
Q

What ages germ cell tumors usually arise?

A

15-40

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42
Q

What are the risk factors for germ cell tumors?

A

cryptorchidism and klinefelter syndrome

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43
Q

What two categories are germ cell tumors separated into?

A

Seminoma and non seminoma

44
Q

What is the difference between a seminoma and a non seminoma and what percentage of germ cell tumors do each represent?

A

Seminomas (55% of cases) are highly responsive to radiotherapy, metastasize late, and have an excellent prognosis. Non-seminomas (45% of case) show variable response to treatment and often metastasize early.

45
Q

Describe a seminoma? Histological and gross appearance.

A

malignant tumor comprised of large cells with clear cytoplasm and central nuclei (resembles spermatogonia); forms a homogeneous mass with NO hemorrhage or necrosis

46
Q

What other type of cancer does a seminoma resemble?

A

ovarian dysgerminoma

47
Q

In rare cases what serum marker does a seminoma produce?

A

Beta-Hcg

48
Q

What is the prognosis and treatment of a seminoma?

A

Good prognosis, responds to radiotherapy

49
Q

What is an embryonal carcinoma and what does it consist of?

A

Malignant tumor comprised of immature, primitive cells that may produce glands; forms a hemorrhagic mass with necrosis (because it is a primitive tumor and rapidly growing)

50
Q

Describe the level of aggressiveness and spread of embryonal carcinoma?

A

Aggressive with early hematogenous spread

51
Q

What may result from chemotherapy of an embryonal carcinoma?

A

differentiation into another type of germ cell tumor (eg teratoma)

52
Q

What serum markers MAY be present in embryonal carcinoma?

A

AFP (Classically seen in yolk sac tumor)

Beta-Hcg (Classically seen on choriocarcinoma)

53
Q

What is a yolk sac (endodermal sinus) tumor?

A

malignant tumor that resembles yolk sac

54
Q

What is the most common testicular tumor in children?

A

Yolk sac tumor

55
Q

What is seen on histology of a yolk sac tumor?

A

Schiller duval bodies (glomerulus like structures)

56
Q

What is characteristically elevated in a yolk sac tumor?

A

serum AFP

57
Q

What is a choriocarcinoma?

A

malignant tumor of syncytiotrophoblasts and cytotrophoblasts (Placenta like tissue but villi are ABSENT)

58
Q

What cell in a choriocarcinoma produces Beta-hcg

A

Syncytiotrophoblasts

59
Q

how does a choriocarcinoma spread and what does this result in?

A

early through the blood results in tiny primary and large secondaries

60
Q

What is characteristically elevated in choriocarcinoma and what may it lead to?

A

Beta-hCG; may lead to hyperthyroidism or gynecomastia (alpha subunit of hCG is similar to that of FSH, LH, and TSH)

61
Q

What is a teratoma?

A

A tumor composed of mature fetal tissue derived from two or three embryonic layers

62
Q

Are teratomas in males malignant or benign?

A

Malignant

63
Q

What two markers MAY be present in a male teratoma?

A

AFP or Beta hCG

64
Q

What are mixed germ cell tumors and what is the prognosis based on?

A

germ cell tumors are usually mixed and the prognosis is based on the worst compopnent

65
Q

What are sex cord stromal tumors? are they usually benign or malignant?

A

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

66
Q

What does a leydig cell tumor usually produce and what does it cause? What is characteristically seen on histology?

A

Usually produces androgen, causing precocious puberty in children or gynecomastia in adults. Characteristic Reinke crystals may be seen on histology

67
Q

What is a sertoli cell tumor composed of and how does it present?

A

comprised of tubules and is usually clinically silent

68
Q

What is the most common cause of a testicular mass in males >60 years old?

A

Lymphoma

69
Q

are lymphomas usually bilateral or unilateral?

A

bilateral

70
Q

What type are lymphomas of the male genitals usually?

A

Diffuse Large B-cell type

71
Q

What is the prostate and where does it sit?

A

Small, round organ that lies at the base of the bladder encircling the urethra. Sits anterior to the rectume; posterior aspect of the prostate is palpable by DRE

72
Q

What does the prostate consist of?

A

Glands and stroma

73
Q

What are the glands of the prostate composed of? what does it produce?

A

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

74
Q

What maintains the glands and stroma of the prostate?

A

androgens

75
Q

What is acute prostatitis and what is it usually due to?

A

Acute inflammation of the prostate; usually due to bacteria

76
Q

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

A

Chlamydia and N. gonorrhoeae

77
Q

What are the common causes of acute prostatitis in older adults?

A

E. Coli and pseudomonas

78
Q

How does acute prostatitis present?

A

as dysuria with fever and chills

79
Q

What is apparent in a DRE with acute prostatitis?

A

prostate is tender and boggy

80
Q

What do prostatic secretions and cultures reveal in acute prostatitis?

A

prostatic secretion show WBCs; culture reveal bacteria

81
Q

What is chronic prostatitis?

A

chronic inflammation of the prostate

82
Q

How does chronic prostatitis present?

A

dysuria with pelvic or low back pain

83
Q

What doe prostatic secretions and cultures show in chronic prostatitis?

A

Prostatic secretions show WBCs but cultures are NEGATIVE

84
Q

What is benign prostatic hyperplasia?

A

Hyperplasia of prostatic stroma and glands

85
Q

What type of change is BPH and what is the risk for cancer?

A

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

86
Q

What is BPH related to?

A

dihydroxytestosterone (DHT)

87
Q

Where is DHT created?

A

Testosterone is converted to DHT by 5alpha reductase in stromal cells

88
Q

What does DHT do in the prostate?

A

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

89
Q

What zone of the prostate does BPH arise in?

A

The central periurethral zone

90
Q

What doe clinical features of BPH include? 6

A

Problems starting and stopping peeing
2 impaired bladder emptying with increased risk for infection and hydronephrosis
3 dribbling
4 hypertrophy of the bladder wall smooth muscle’ increased risk for bladder diverticula
5 microscopic hematuria may be present
6 PSA is often SLIGHTLY elevated (usually less than 10) due to increased number of glands; PSA is made by the prostatic glands and liquefies semen

91
Q

What is hydronephrosis?

A

dilation of the kidney

92
Q

What are the 2 treatments for BPH?

A

1 alpha 1 antagonist (terazosin) to relax smooth muscle

2 5 alpha reductase inhibitor

93
Q

How does an alpha 1 antagonist work in BPH treatment?

A

Relaxes smooth muscle. Also relaxes vascular smooth muscle lowering BP. Selective alpha 1A antagonists (tramsulosin) are used in normotensive individuals to avoid alpha 1B affects on blood vessels

94
Q

How do 5alpha reductase inhibitors work in BPH treatment? what are some side effects?

A

Block the conversion of testosterone to DHT. Takes months to produce results. Also useful for male pattern baldness. Side effects are gynecomastia and sexual dysfunction

95
Q

What is prostate adenocarcinoma?

A

malignant proliferation of prostatic glands. Most common cancer in men; 2nd most common cause of cancer related death

96
Q

What do risk factors for prostate adenocarcinoma include?

A

age, race (African american>caucasian>asian), and diet high in saturated fats

97
Q

How does prostatic carcinoma present and where does it arise.

A

Most often is clinically silent. Usually arises in the peripheral, posterior region of the prostate and, hence, does not produce urinary symptoms early on.

98
Q

What does screen begin for prostate cancer and what does it include?

A

Screening begins at the age of 50 with DRE and PSA

99
Q

Describe what is normal for PSA levels and what is seen in prostate cancer?

A

normal serum PSA increases with age due to BPH (2.5 ng/mL for 40-49, vs 7.5 for 70-79) PSA>10 is highly worrisome at any age. Decreased % of free PSA is suggestive of cancer (which makes bound PSA)

100
Q

What is required for diagnosis of prostatic carcinoma?

A

Biopsy

101
Q

What does biopsy show in prostatic carcinoma?

A

Small, invasive glands with prominent (dark) nucleoli

102
Q

Describe the Gleason Grading system?

A

based on ARCHITECTURE ALONE (not nuclear atypia). Multiple regions of the tumor are assessed because architecture varies from area to area. A core (1-5) is assigned for two distinct areas and then added to produce a final score (2-10). Higher score suggests worse prognosis.

103
Q

Where is a common place for prostate cancer to spread and what does it cause? what markers are elevated

A

Spread to lumbar spine or pelvis is common; results in osteoblastic (sclerotic) metastases that present as low back pain and increased serum alkaline phosphatase, PSA, and prostatic acid phosphatase

104
Q

How is prostate cancer treated?

A

Prostectomy is performed for localized disease; advanced disease is treated with hormone suppression to reduce testosterone and DHT.

105
Q

What are two homone suppression therapies for prostate cancer?

A

1 continusous GnRH analogs (e.g. Leuprolide) shut down that anterior pituitary gonadotrophs (LH and FSH are reduced)
2 Flutamide acts as a competitive inhibitor at the androgen receptor.

My Pathoma Unit 5 (4 decks)

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