Lecture 28 - Male Genital System

Question 1

Pathway of spermatogenesis to ejaculation: Spermatogenesis begins in _______ ______ –> continues in _____ testis at the hilum –> then in efferent ductules at head of ________ –> then in ___ ______ –> sperm move into paired ejaculatory ducts that join to form a single duct –> merges at distal end with Urethra.

Answer 1

Seminiferous tubules

Rete testis

Epididymis

Vas deferens

Question 2

Hypospadias –> abnormal formation/location of the urethral meatus on the ______ side of the penis. ______ is the most common location (50% of cases), then _____ (30%), then posterior (20%).

Epispadias refers to the same issue but on the _____ side of the penis (much less common).

Answer 2

Ventral side

Anterior

Middle

Posterior

Dorsal

Question 3

_______ is the causative agent for genital warts (Condyloma acuminatum).

Which serotypes are lowest risk? (they form external warts but have low cancer risk)

Which are high risk?

Keep in mind Condylomas are considered low-grade dysplasia.

Answer 3

HPV

6, 11, 42, 44

16, 18, 31, 33

Question 4

The characteristeic cells of HPV infection are ______, which comes from the Greek for halo. Keep in mind these are much more abundant in ___-grade dysplasia (basically absent in ___-grade).

Why is this such a fitting term?

Answer 4

Koilocytes

This is a fitting term because there is a characteristic “halo” around the neuclei of koilocytes. Also, keep in mind the nucleus : cytoplasm ratio DOESN’T change much in koilocytes (normally it decreseases as normal/uninfected squamous cells mature).

Question 5

Carcinoma in-situ of the penis is ALWAYS caused by _____. Serotype ____ is the most carcinogenic of the high risk types. All penile carcinomas in-situ have potential to progress to _______ ____ carcinoma.

Answer 5

HPV

16

Squamous cell carcinoma

Question 6

Name this penile carcinoma in-situ and identify the demographic most affected.

Answer 6

Bowen’s disease

Most common in older patients

Question 7

This is _____ ______, a penile carcinoma in-situ most common in _____ patients.

Answer 7

Bowenoid Papulosis

Young

Question 8

This is termed _____ of _____ –> a single lesion on the glans at the meatus.

Answer 8

Erythroplasia of Queyrat

Question 9

High grade dysplasia differs from low-grade in that high-grade shows very few (or none at all) ______ (cell type).

Answer 9

Koilocytes

Question 10

_____ is protective against penile carcinoma. Why?

Answer 10

Circumcision

Excess foreskin provides a place for HPV to “hide” and multiply.

Question 11

Over-production of ______ by squamous cells is a defining feature of squamous cell carcinoma. This can help distinguish it from other cancer types.

Answer 11

Keratin

Question 12

Prostate cancer is a proliferation of ONLY the _____(inner or outer?) ______ cells.

Answer 12

Inner secratory

Question 13

Benign Prostatic Hyperplasia (BPH) is clinically detectable (imaging or digital rectal exam) in ___% of patients with microscopic evidence of BPH. Symptoms can be seen in about ____% of patients with clincal evidence of BPH. What are the clinical symptoms?

In which zones of the prostate is BPH most common?

Keep in mind it is NOT a risk factor for ProstatE Cancer!

Answer 13

50%

50%

Slow flow and incomplete emptying (enlaged prostate squeezes the prstatic urethra.)

Transitional and Central

Question 14

What characteristic feature does BPH show grossly and microscopically?

Answer 14

Nodules

Question 15

Unlike BPH, prostate cancer typically occurs in the _____ zone of the prostate, which lends to the utility of _____ _____ exam for diagnosis. Unfortunately, prostate cancer detectable by this exam is localized only about ___-___% of the time. Prostate cancer detected by _____, on the other hand, is lcoalized about 90% of the time. However, it can be elevated by other things (only about 2/3 of the time the elevation is related to prostate cancer.)

Answer 15

Peripheral

Digital rectal exam (DRE)

50-60%

PSA (remember that PSA velocity - comparing current levels to previous to see rate of increase over time - is much better than using a single measurement for diagnosis.)

Question 16

Describe the following Gleason prostate cancer grading stages:

1:

2:

3A+B+C:

4A+B:

5A+B:

Answer 16

Remember that Gleason grading is 2-fold: Primary (most abundant architecture) and Secondary (second most abundant architecture)

Also remember grade 3 is most common

Question 17

________ is the term that describes undescended testes. It occurs in about 3% of full-term births, but will descend on its own in 80% of these cases. It is a “true” case if the teste remains in the _____ _____ and is “ectopic” otherwise.

Answer 17

Cryporchidism

Inguinal canal

Question 18

Cryptorchidism is a predisposing factor for which type of cancer?

Answer 18

Seminomas (adenocarcinoma)

Question 19

90% of testicular torsion cases result from a congenital malformation in which the teste is insufficiently anchored to the ______ scrotal wall (“bell-clapper” deforminity). It is detected using ______. The teste has a 90% chance of being preserved if corrected within ____hrs; 50% after ____hrs; 10% after ____hrs.

Answer 19

Inner

Doppler

6hrs

12hrs

24hrs

Question 20

Testicular tumors are the most common type of testicular cancers and the most common type of cancer in men 15-34. They often metastasize to the ________ lymphnodes, which may result in a palpable abdominal mass.

Answer 20

Retroperitoneal lymphnodes

Question 21

95% of testicular tumors are _____ cell derived. Patients with _______ are at higher risk (the risk is proportional to height of the teste).

Answer 21

Germ cell derived

Cryptorchidism

Question 22

The most common type of germ cell tumor of the testes is the _______. In about 40% of patients, _______ will be elevated.

Answer 22

Seminoma

Placental Alkaline Phosphatase (PLAP)

Question 23

Notice the large nuclei and cytoplasm of cells in the seminoma. What are the abundant, smaller, dark staining cells infiltrating the area around the tumor?

Answer 23

Lymphocytes

Question 24

About 85% of Non-seminoma germ cell tumors have an _______ component (though tumors comprised purely of this cell type are rare). These tumors tend to be variegated and not well demarcated. Keep in mind 65% of patients with these tumors will have _____ at time of diagnosis.

Answer 24

Ebryonal

Mets

Question 25

_____ _____ tumors are another type of Non-seminoma germ cell tumor (NSGCT) that are rarely pure (like Embryonal). They have a characteristic Microcystic appearance on microscopy and occasionally exhibit _____-_____ bodies (ring of tumor cells around blood vessel).

Answer 25

Yolk Sac tumors

Schiller-Duval bodies

Question 26

Choriocarcinomas are another variety of NSGCT of the testes, and they stain positive for _____.

Answer 26

hCG

Question 27

______ are tumors derived from ectoderm, endoderm, and mesoderm. In children, they are usually _____ (pure or mixed?), associated with trisomy ____, ____, and other genetic issues, and are assumed to be _____ (benign or malignant?).

In Adults, they are usually _____ (pure or mixed?) and assumed to be ______ (benign or malignant?).

Answer 27

Teratomas

Pure

Trisomy 21

Klinefelter’s

Benign

Mixed

Malignant

Question 28

______ are localized (confined to the testes) in about 70% of cases. They are radiosensitive and have the best prognosis of testicular tumors (>95% of stage II and III can be cured).

Answer 28

Seminomas

Question 29

NSGCT are less radiosensitive than seminomas, and they often metastasize earlier than seminomas by ________ route. 90% can achieve remission with aggressive _______.

Answer 29

Hematogenous

Chemotherapy