Male Genital Pathology

Question 1

Most common penile congenital abnormalities?

Answer 1

Epispadias and hypospadias

abn openings of urethra on dorsal or ventral penis; due to malformation of urethral canal

Question 2

What is the clinical importance of a urethral abnormality?

Answer 2

urethral obstruction or failure of normal ejaculatory function

Question 3

Inflammation of the penis is most commonly related to:

Answer 3

• -phimosis (inability to easily retract the foreskin)

- -venereal disease

Question 4

Inflammatory condition most commonly related to poor hygiene:

Answer 4

balanoposthitis

glans inflammation = balanitis; foreskin inflammation = posthitis

Question 5

Neoplasm that occurs almost exclusively in the uncircumcised:

Answer 5

Squamous carcinoma of the penis

Question 6

What are condyloma acuminata?

Answer 6

cauliflower like growths which occur primarily in the anogenital region; recurrent despite vigorous therapy

Question 7

What causes condyloma acuminata, and how it it transmitted?

Answer 7

HPV 6 or 11

sexually

Question 8

Hisopath of condyloma acuminata?

Answer 8

Orderly, exuberant exophytic (growing outward) growth pattern of papillary lesion

very few mitoses

no necrosis

Question 9

Squamous carcinoma in situ on the penile skin is called:

Answer 9

Bowen disease

Question 10

Squamous carcinoma in situ on the glans is called :

Answer 10

erythroplasia of Queyrat

Question 11

What causes squamous carcinoma in situ of the penis/glans?

Answer 11

HPV, usually type 16 (80%)

Question 12

Why should you treat squamous carcinoma in situ of the penis/glans?

Answer 12

if untreated roughly 10% will progress to squamous carcinoma

Question 13

What is the clinical manifestation of squamous carcinoma in situ of the penis/glans?

Answer 13

red, slightly raised, rough, painless, nonulcerated lesions

Question 14

Histopath of squamous carcinoma in situ of the penis/glans?

Answer 14

hyperkeratosis with disordered maturation + elongation of rete ridges

thickening of epidermis

Question 15

50% of the time, squamous carcinoma of the penis is caused by:

Answer 15

HPV (usually 16 and 18)

Question 16

Lifestyle risk factors for squamous carcinoma of the penis?

Answer 16

poor hygiene and cigarette smoking

Question 17

What is Cryptorchidism?

Answer 17

Failure of descent of testis from abdomen to scrotum, present in 1% of 1yr old boys

Question 18

If a failure occurs during the Transabdominal phase, where are testes stuck?

Answer 18

between abd and brim of pelvis

Question 19

What signaling molecule is important during the Transabdominal phase?

Answer 19

Mullerian inhibiting substance

Question 20

If a failure occurs during the Inguinoscrotal phase, where are testes stuck?

Answer 20

between brim of pelvis and scrotum

Question 21

What signaling molecule is important during the Inguinoscrotal phase?

Answer 21

Androgen-induced calcitonin-gene related peptide

Question 22

During what phase of testes droppin’ do abnormalities more commonly occur?

Answer 22

Inguinoscrotal (90-95% of cases)

Question 23

Complications associated with Cryptorchidism:

Answer 23

1. increased susceptibility to trauma, if Inguinal
2. Sterility
3. Decreased spermatogenesis in BOTH testes in unilateral cryptorchidism
4. Malignant neoplasms (5-10 fold increased risk; some increased risk in normal testis, too)

Question 24

What improves (but does not guarantee) chances of normal spermatogenesis in Cryptorchidism?

Answer 24

Orchiopexy before age 2

Question 25

What reduces (not eliminates) cancer risk in Cryptorchidism?

Answer 25

orchiopexy

Question 26

What histopath is associated with Kleinfelter's?

Answer 26

Small hyalinized seminiferous tubules Pseudoadenomatous clusters of Leydig cells (only look increased in # due to decreased testicular volume)

Question 27

What conditions are associated with Kleinfelter's (increased incidence)?

Answer 27

extragonadal germ cell tumors (mediastinum > pineal gland, CNS, retroperitoneum) hypopituitarism

Question 28

What reproductive abn are associated with Kleinfelter's?

Answer 28

1. small to normal-sized, well developed testes (**the picture above it says they're less dev) 2. Incomplete virilization (infertility) 3. gynecomastia

Question 29

How does tertiary syphilis spread?

Answer 29

testis first, then the epididymis

Question 30

How does gonorrhea spread?

Answer 30

retrograde from the urethra to the prostate, seminal vesicles, epididymis

Question 31

What is the most common infectious cause of focal atrophy of the testicular tubules? What are some other causes?

Answer 31

mumps orchitis echovirus, lymphocytic choriomeningitis virus, influenza virus, Coxsackie virus, and arboviruse

Question 32

How does mumps affect testicular tubules?

Answer 32

unilateral and patchy orchitis (thus, sterility uncommon)

Question 33

What are the symptoms of epididymitis?

Answer 33

scrotal pain and swelling

Question 34

What are common causes of epididymitis in younger males?

Answer 34

sexually transmissible diseases: Chlamydia trachomatis Neisseria gonorrheae (can also be disseminated TB)

Question 35

What are common causes of epididymitis in older males?

Answer 35

gram negative bacteria from UTI | can also be disseminated TB

Question 36

Idiopathic granulomatous orchitis is an uncommon diffuse inflammatory testicular lesion that occurs following:

Answer 36

gram negative urinary tract infection (usually)

Question 37

Idiopathic granulomatous orchitis occurs in what age group?

Answer 37

50-60 y/o men | most commonly

Question 38

What is a differential dx for Idiopathic granulomatous orchitis, and why?

Answer 38

testicular neoplasm may present as a localized nodular lesion

Question 39

What parts may be involved in Idiopathic granulomatous orchitis?

Answer 39

testicles, epididymis and spermatic cord

Question 40

Histopath of Idiopathic granulomatous orchitis?

Answer 40

predominantly intratubular inflammation cellular infiltrate containing histiocytes (majority), lymphocytes, plasma cells, +/- giant cells Note: histiocytes give appearance of granulomas, but they aren't actually present

Question 41

Is necrosis present in granulomatous orchitis?

Answer 41

NO!

Question 42

How is granulomatous orchitis distinguished from infectious orchitis or sarcoid?

Answer 42

intratubular localization of inflammation in granulomatous orchitis

Question 43

What is autoimmune orchitis?

Answer 43

rapid onset granulomatous testicular enlargement in middle aged men (may be associated with a febrile illness)

Question 44

What are the causes of testicular regression/atrophy (in general, and according to his mnemonic)?

Answer 44

Vascular (varicoceles = atrophy on side of dilated veins) Inflammation (mumps orchitis, epidydimoorchitis) Neoplasms (atrophy occurs in estrogen trx of prostatic carcinoma) Degenerative (atrophy resulting from aging) Intoxication (chronic alcoholism, Laennec cirrhosis, hemochromatosis, X-ray) Congenital (undescended testes and torsion) Trauma (atrophy following vasectomy and accidental ligation of the blood supply during hernia repair) Endocrine (hypopituitarism, Klinefelter and other eunuchoidal states) VINDICaTE

Question 45

What can occur in the testes following torsion?

Answer 45

ischemia + venous stasis

Question 46

Why is torsion a urologic emergency?

Answer 46

surgery within 4-6 hours may save the testis if not, hemorrhagic infarction with obliteration of the testis is inevitable