L67

Question 1

What is hypospadias

Answer 1

Urethra opens on bottom of penis (ventral - bottom = ventral when erect)

Question 2

What is epispadias

Answer 2

Urethra opens on top of penis (dorsal)

Question 3

Complications of untreated hypo/epispadias

Answer 3

Obstruction/UTI

Problems ejaculating -> sterile

Question 4

What is phimosis? Cause? Complications?

Answer 4

Foreskin too small to tract over glans
Cause: after repeated infections -> scar
↑s risk for infection

Question 5

What is paraphimosis?

Answer 5

Foreskin gets stuck retracted
PAIN
Medical emergency - causes urine retention

Question 6

What is balanoposthitis? Cause/pt pop?

Answer 6

Glans + foreskin = infected 
Uncircumcised
Causes:
- Candida
- Anaerobics 
- Gardnerella

Question 7

What is condyloma acuminatum? Cause?

Answer 7

Benign neoplasm = genital warts
Aka NOT going to progress to cancer
HPV 6 + 11

Question 8

Histo condyloma acuminatum

Answer 8

Poly/finger like shapes - almost vili like
Lined by squamous epi
Nuclei = big w/ clear space (viral accum)

Question 9

What is squamous carcinoma in situ of the penis? Benign vs malignant? Cause? Treat?

Answer 9

Malignant change @ epithelium
NO invasion (in situ)
Cause = HPV 16
Surgically remove w/ clear margins

Question 10

Cause + pt pop for penis squamous cell cancer. Histo + most common site for mets

Answer 10

SCC - see keratin invading on histo
Uncircumcised middle aged men
HPV 16 + 18
Met to inguinal + iliac LNs

Question 11

What are the 3 things that can cause inflammation of the prostate - think generally

Answer 11

Bacteria - bacterial prostatitis
Abacterial 
Granulomatous 
1. Post-BCG treatment of bladder cancer
2. Fungal
3. TB

Question 12

Describe normal prostate histo

Answer 12

Glands w/ 2 layers epithelium lining

SM surrounds glands

Question 13

Histo changes in BPH

Answer 13

Hyperplasia prostate stroma + SM -> into nodules

Question 14

What is the most common type of prostate cancer?

Answer 14

Adenocarcinoma

Question 15

3 features of prostate adenocarcinoma histo

Answer 15

1. Small glands infiltrate normal tissue
2. Malignant epi - glands have only 1 layer epi
3. Large nuclei + prominent nucleoli

Question 16

What is prostatic intraepi neoplasia?

Answer 16

“Adenocarcinoma precursor”
Aka abnormalities in normal glands
vs adenocarcinoma = entire glands are abnormal

Question 17

Do you treat PIN?

Answer 17

Nah - freq repeat biopsies for progression check

Question 18

TESTQ: what is the basis of grading prostate cancer? (Gleason score)

Answer 18

ARCHITECTURE
NOT nuclei (normal grading criteria)

Question 19

Where will prostate adenocarcinoma met to?

Answer 19

Inguinal LN

BONE - L vertebrae: look for sclerotic nodules within the vertebrae

Question 20

Options to treat prostate carcinoma

Answer 20

Surg - remove it
Radiotherapy - brachy or external beam
Hormonal
Chemo for mets

Question 21

What is cryptorchidism? Treat?

Answer 21

Undescended testicles

If don’t descend on own before 2, surgery to prevent infertility + cancer

Question 22

Describe normal testicle histo

Answer 22

Seminiferous tubules - germ cells at base, prolif as move into lumen as mature sperm
Sertoli cells here = nurturing
Leydig cells between tubules to provide androgens

Question 23

What inflammatory diseases of the testes?

Answer 23

Epididymo-orchitis: acute vs tuberculous (will see granulomas in the testes!)

Question 24

What is testicular torsion? Pt pop

Answer 24

Testes twist in sac - collapse the thin walled vein
Blood still entering through the artery
Painful + hemorrhagic infarct
EMERGENCY
Peaks during 1 yo + puberty

Question 25

Pt population and presentation of germ cell tumors

Answer 25

White, young pts (15-30) | Painless testicular mass

Question 26

What is a seminoma? Gross appearance + treat

Answer 26

Pure germ cell tumor Homogen gray/white mass Treat = sen to rad + chemo

Question 27

Histo seminoma

Answer 27

Looks like the germ cells: 1. Clear cytoplasm + large nucelus w/ nucleoli 2. Cell divided by fibrous stroma w/ lymphocytes

Question 28

What lab value is positive in seminomas?

Answer 28

PLAP = placental alk phos +

Question 29

What is a spermatocytic seminoma?

Answer 29

NOT A SEMINOMA TUMOR 1. No lymphocytes 2. PLAP neg 3. 55 yo + 4. Treat by removing testicle - no chemo/rad

Question 30

What are non-seminomatous germ cell tumors?

Answer 30

Tumors of germ cells in different stages of development to mature sperm Usually mixed for this reason Might have seminoma component - just starts at an earlier step (no change treat)

Question 31

What is unique about non-sem germ cell tumor mets?

Answer 31

Met can be different cell type than the 1ary tumor

Question 32

Name the 4 non-sem germ cell tumors

Answer 32

``` Teratoma Embryonal carcinoma Yolk sac Choricarcinoma *Since most tumors are mixed, think about these types together in 1 tumor* ```

Question 33

What is a teratoma? Pt age

Answer 33

From multiple (all 3) germ layers (neuro, ecto, endoderm) Tissue can be either embryonal (immature) or fetal/adult (mature) Kids - benign Post-puberty men - MALIGNANT (vs adult women = benign) *TESTQ*

Question 34

What is an embryonal carcinoma? Stain used?

Answer 34

Embryonal tissue aka very dysmorphic Cells form epithelial structures - tubules or sheets of cells Stain w/ cytokeratin

Question 35

What is a yolk sac tumor? Pt age? Marker

Answer 35

Endoderm - homog yellow/white timor *INFANTS - 3 YO* Elevated AFP

Question 36

TESTQ: the presentation is a testicular mass with elevated AFP. How does the ddx change if pt is 0-3 yo vs 20 yo?

Answer 36

``` 0-3 = pure yolk sac tumor 20 = mixed tumor w/ yolk sac component ```

Question 37

Yolk sac histo

Answer 37

Schiller Duval bodies = papillae w/ central vascular core (looks like flower) Eosinophilic globules = pink dot

Question 38

What is a choriocarcinoma? What is the serum/tissue marker?

Answer 38

V MALIGNANT - 1ary tumor is small, more likely to find the met first Cyto + syncytio-trophoblast High bHCG

Question 39

If you get a testicular mass with +bHCG, what should you be thinking?

Answer 39

Chorio | OR mixed w/ chorio component

Question 40

What are intratubular germ cell neoplasia?

Answer 40

Look for atypical cells in base of steroli tubules Precursor of germ cell tumors Look like seminoma, but are in the normal location for sertoli cells aka base of tubule

Question 41

Common mets for germ cell tumors + exception

Answer 41

Met to LN - retroperitoneal, aortic, mediastinal, supraclav Via blood to organs Exception = chorio, earlier mets than all others!!

Question 42

Stage 1 vs 2 vs 3 testicular tumors

Answer 42

``` 1 = in testis 2 = mets below diaphragm 3 = mets above ```

Question 43

Treat germ cell tumors

Answer 43

Remove tesicle Adj - chemo/rad No adj for spermatocytic seminoma or teratomas in kids

Question 44

Compare seminoma vs non-sem 1. Local vs met 2. Stage at presentation 3. Route of mets 4. Treament

Answer 44

``` Seminoma = localized for long time, present st 1, met to local LN, v radiosens w/ good cure rate Non-sem = met early via blood, therefore st 2/3 at presentation, need aggressive chemo, good remission rates ```