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Pathoma > Male Genital System > Flashcards

Flashcards in Male Genital System Deck (30):
1

Hypospadias

Opening of urethra on inferior surface of penis
failure of URETHRAL FOLDS to close

2

Epispadias

Opening of urethra on superior surface of penis due to ABNORMAL positioning of GENITAL TUBERCLE
Assoiciated with BLADDER EXYSTROPHY

3

Condyloma Acuminatum

Benign warty growth on genital skin
Due to HPV 6 and 11.
See KOILOCYTIC change

4

Lyphogranuloma Venerum

Necrotizing granulomatous inflammation of the inguinal lymphatics and lymph nodes
STD from chlamydie trachomatis (serotypes L1-3)
Eventually heals with fibrosis but perianal involvement may result in rectal strictures

5

Squamous Cell Carcinoma

Malignant proliferation of squamous cells of penile skin.
Risk factors are HPV 16, 18, 31, 33 or lack of circumcision
Precuros Lesions
1) Bowen Disease = in situ carcinoma of penil shaft or scrotum that presents as leukoplakia
2) Erythoplasia of Queyrat = in situ carcinoma on the glans that presents as erythroplakia
3) Bowenoid Papulosis = in situ carcinoma that presents as multiple reddish papules. Seen in younger patients (40s) and does not progress to invasive carcinoma

6

Bowen Disease

precursor of squamous cell carcinoma = in situ carcinoma of penil shaft or scrotum that presents as leukoplakia

7

Erythoplasia of Queyrat

precursor of squamous cell carcinoma = in situ carcinoma on the glans that presents as erythroplakia

8

Bowenoid Papulosis

precursor of squamous cell carcinoma = in situ carcinoma that presents as multiple reddish papules. Seen in younger patients (40s) and does not progress to invasive carcinoma

9

Cryptorchidism

Failure of the testicle to descend fro mthe abdomen into the scrotal sac.
Most common congenital male reproductive abnormality
Usually resolves spontaneously but if doesnt then perform orchiopexy before age 2 or else their is risk of testicular atrophy with infertility and increased risk of seminoma

10

Orchitis

Inflammation of the testicle
Causes include
1) Chlamydia trachomatis (serotypes D-K) or Neisseira gonnorhea = increased risk of sterility
2) E coli or pseudomonas = UTI infection spreads to reproductive path
3) Mumps Virus = see in males after 10yrs. Can cause orchitis, aseptic meningitis, and pancreatitis
4) Autoimmune Orchitis = granulomas involving the seminferous tubules

11

Testicular Torsion

Twisting of the spermatic cord, veins become obstructed leading to congestion and hemmorhagic infarction.
Usually due to failure of testes to attach to inner lining of the scrotum via the processus vaginalis
Prestns as sudden testicular pain with absent creasteric reflex

12

Varicocele

Dilation of the spermatic vein due to impaired drainage.
Presents as scrotal swelling with a "bag of worms" appearance.
Usually left sided and associated with left sided renal cell carcinoma

13

Hydrocele

Fluid collection within the tunica vaginalis ssociated with incomplete closure of the processus vaginalis leading to communication with the peritoneal cavity (infants) or blockage of lymphatic drainage (adults).
Presents as scrotal swelling that can be tranilluminated

14

Testicular tumors

firm, painless mass that cannot be transilluminated
Not biopsied due to risk of seeding the scrotum

15

Germ Cell tumors

Most common type of testicular tumos.
Usually occur between 15-40
Risk factors include cryptochidism and Klinefleter Syndrome

16

Seminoma vs nonseminomas

Seminoma = high responsive to radiotherap, met late, excellent prognosis
Nonseminoma = variable response to treatment and often met early

17

Seminoma

Malignant tumor comprised of large cells with clear cytoplasm and central nuclei.
for a HOMOGENOUS mass with NO HEMMORHAGE and NO NECROSIS
Resmbles ovarian dysgerminoma and is most common testicular tumor
Rare cases may produce beta-hCG
Good prognosis as it responds well to radiotherapy

18

Embryonal Carcinoma

Malignant tumor comprised of immature, primitive cells that may produce glands
forms a HEMORRHAGIC MASS with NECROSIS
Agressive with early hematogenous spread
Chemo may cause it to differntiate into another germ cell tumor
Increased AFP or beta-hCG

19

Yolk Sac/endodermal sinus tumor

Malignant tumor that resembles yolk sac elements
most common in CHILDREN
HAve shiller-duval bodies on histology that resembles a glomerulus
AFP is characteristically elevated

20

Choriocarcinoma

Malignant tumor of synctiotrophoblasts and cytotrophoblasts (placenta like but villi are absent)
Spreads early via blood
beta-hCG is characteristically elevated and may lead to hyperthyroidism or gynecomastia since alpa subunit of hCG is similar to that of FSH, LH, and TSH

21

Teratoma

Tumor comprised of mature fetal tissue derived from two or three embryonic layers but unlike in women it is is malignant
AFP and beta-hCG may be increased

22

Mixed Germ Cell tumors

Germ cell tumors are usually a mix of cells of different tumor types and prognosis is based off the worst component

23

Leydig Cell Tumors

Usually produces androgen causing precocious puberty in children or gynecomastia in adults.
REINKE crystals

24

Sertoli Cell Tumor

Comprised of tubules and is usually clinically silent

25

Lymphoma

Most common cause of testicular mass in males OVER 60.
often bilateral
usually of diffuse large B-cell type

26

Acute Prostatitis

Acute inflammation of the prostate, usually due to bacteria
Chlamydia trachomatis and neisseria gonorrhoae in young adults or e coli and pseudomonas in older adults
Presents as dysuria with fever and chills
prostate is TENDER AND BOGGYY on dre
Prostatic secretions show WBCs and culture reveals bacteria

27

Chronic Prostatitis

Chronic inflammation of the prostate
Presents as dysuria with pelvic or low back pain
Prostatic secretions show WBCs but cultures are negative

28

Benign Prostatic Hyperplasia
physiology and symptoms

Hyperplasia of prostatic stroma and glands
Age related change but no increased risk of cancer
Related to Dihydrotestosterone (testosterone is converted to DHT by 5alpha reductase in stromal cells and DHT acts on androgen receptors of stromal and epithelial cells resulting in hyperplastic nodules.
Occurs in the central periurethral zone of the prostate compressing the urethra and causing problems such starting and stopping urination, imparied bladder empyting making it more likely to be infected, dribbling, hypertrophy of the bladder wall smooth muscle, microscopic hematuria, PSA often elevated.

29

Treatment of BPH

alpha1 antagonists (terazosin) to relax smooth muscle. Also relaxes vascular smooth muscle so has benefit of lowering BP. use selective alpha1 antagonists (tamsuolsin) in normotensive
5alpha-reductase inhibitor to block conversion of testosterone to DHT, takes months to show results, helps prevent balding but can cause gynecomastia and sexual dysfunction

30

Prostate Adenocarcinoma

Malignant proliferation of the prostatic glands
Most common cancer in men
Risk factors include old age, race (africa>white>asian) and diet high in saturated fats
Often clinically silent since it arises in peripheral, posterior region of the prostate and so doesnt present with urinary symptoms. Also the reason why start screening with DRE or PSA after age of 50. PSA>10 is worrisome and decreased % of free-PSA is suggestive of cancer
Must be confirmed by biopsy. Will notice small invasvie glands with prominent nucleoli.
Grading system is based on architecture alone
Spreads to lumbar spine or pelvis creating osteoblastic mets that present as low back pain and increased serum alkaline phosphatase, PSA and prostatic acid phosphatase
Prostatectomy is performed for localized disease, advanced disease is treated with hormone supression to reduce testosterone and DHT. (continuous GnRH analogs like leuprolide shut down antieror pituitart LH and FSH. Flutamide competitively inhibits at androgen receptors