Male Genital System

Question 1

Hypospadias

Answer 1

opening urethra - inferior surface

failure of urethral folds to close

Question 2

Epispadias

Answer 2

Opening urethra - superior surface
Abnormal positioning of genital tubercle
Bladder exstrophy

Question 3

Lymphogranuloma venereum

Answer 3

Necrotizing granulomatous inflammation - inguinal lymphatics/nodes
Chlamydia trachomatis (L1-L3)
Heals with fibrosis - may lead to rectal stricture

Question 4

Bowen dz - precursor in situ lesion

Answer 4

In situ carcinoma - penile shaft/scrotum presents as luekoplakia

Question 5

Erythroplasia of Queyrat - precursor in situ lesion

Answer 5

In situ carcinoma - glans presents as erythroplakia

Question 6

Bowenoid papulosis - precursor in situ lesion

Answer 6

in situ carcinoma - multiple reddish papules
Younger pt (40s) - relative of Bowen dz and erythroplasia of Queyrat
Doesn’t progress to invasive carcinoma

Question 7

Most common congenital male reproductive abnormality

Answer 7

Cryptorchidism

Question 8

Complications of undescended testicles

Answer 8

Testicular atrophy w/ infertility

Increase risk of seminoma

Question 9

Orchitis causes (4)

Answer 9

1. Young: Chlamydia trachomatis (D-K), Neisseria gonorrhoea
2. Old: E coli & pseudomonas
   3: Mumps - increased risk for infertility,inflammation usually not seen

Question 10

Testicular torsion - involves what & cause

Answer 10

spermatic cord

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

Question 11

Pathology of testicular torsion

Answer 11

Congestion & hemorrhagic infarction

Question 12

Varicocele seen on what side - related to what carcinoma

Answer 12

Left side (SV drains to RV before IVC)
Related to Renal cell carcinoma
Dilation of spermatic cord
Large % infertile males

Question 13

Hydrocele

Answer 13

Fluid in tunica vaginalis
Assoc w/ incomplete closure of processus vaginalis - leading to communication with peritoneal cavity (infants) or blockage of lymphatic drainage (adults)

Question 14

Male testicular tumors arise from

Answer 14

germ cells or sex cord stoma

Question 15

Are most testicular tumors benign or maligant?

Answer 15

Maligant (which is why we don’t biopsy - also because of seeding into scrotum)

Question 16

Germ cell tumors classified as:

& risk factors

Answer 16

Seminoma vs nonseminoma

Risk factors: cryptorchidism & Klinefelter syndrome

Question 17

Germ cell tumors in males most common age

Answer 17

15-40

Question 18

Seminoma characteristics

Answer 18

highly responsive to chemo
metastasize late
excellent prognosis
large cell w/ clear cytoplasm & central nuclei
Homogenous mass - no hemorrhage/necrosis
Rare cases produce Beta-hCG

Question 19

Non-seminoma characteristic

Answer 19

Metastasize early

Question 20

5 nonseminoma carcinomas

Answer 20

1. Embryonal
2. Yolk sac
3. Choriocarcioma
4. Teratoma
5. Mixed germ cell

Question 21

Embryonal carcinoma

Answer 21

Malignant
Immature, primitive cells - may produce glands
Hemorrhagic mass w/ necrosis
Aggressive - early hematogenous spread
Chemo - can result in tumor differentiation into another cell line
AFP or Beta-hCG

Question 22

What nonseminoma tumor can differentiate when treated with chemo?

Answer 22

Embryonal carcinoma

Question 23

Yolk sak

Answer 23

Most common testicular tumor in children
Schiller Duval bodies - glomerular like structure
AFP elevated

Question 24

Choriocarcinoma

Answer 24

Syncytiotrophoblast & cytotrophoblasts malignant tumor
Placenta like but no villi!!
Beta-hCG (can lead to hyperthyroidism/gynecomastia)

Question 25

What is the alpha-subunit of beta-hCG similar to (3)?

Answer 25

FHS, LH, TSH

Question 26

Teratoma

Answer 26

mature fetal tissue of 2-3 embryonic layers Malignant in males AFP or beta-hCG elevated

Question 27

Who are teratomas malignant in? Men or women?

Answer 27

Men

Question 28

Mixed germ cell tumor

Answer 28

most germ cell tumors are mixed | Prognosis based on worst component

Question 29

Sex-cord stromal tumors can be from what two cell types

Answer 29

Leydig or Sertoli

Question 30

Sex cord stromal cells

Answer 30

resemble sex cord stromal Leydig: produce androgen - precocious puberty (children) or gynecomastia (adults) - characteristic Reinke crystals Sertoli: tubules - clinically silent

Question 31

Leydig sex cord stromal turmors

Answer 31

produce androgen - precocious puberty (children) or gynecomastia (adults) - characteristic Reinke crystals

Question 32

What type of testicular cancer seen in men >60?

Answer 32

Lymphoma bilateral diffuse large B cell type

Question 33

Acute prostatitis

Answer 33

``` Young: Chlamydia trachomatis and neisseria gonorrhoeae Old: E coli and Pseudomonas Dysuria w/ fever & chills Prostate tender and boggy Prostate secretion show WBC culture shows bacteria ```

Question 34

Chronic prostatitis

Answer 34

Dysuria w/ pelvic/low back pain Prostate secretion show WBC Culture - no bacteria

Question 35

BPH

Answer 35

Hyperplasia of prostatic stroma and glands No increased risk of cancer DHT - testosterone converted to DHT by 5-alpha reductase in stromal cells - results in hyperplastic nodules Occurs peripheral zone

Question 36

Clinical problems BPH

Answer 36

Problems w/ starting/stopping urine Impaired bladder emptying w/ increased risk for infection & hydronephrosis Dribbling Hypertrophy of bladder wall smooth m, increased risk for bladder diverticuli Microscopic hematuria (maybe) PSA (less than 10)

Question 37

Treatment of BPH

Answer 37

Alpha1 antagonist: "zosin" - relax smooth muscle Lower BP Selective alpha1A antagonists used in normotensive individuals to avoid alpha1B effects on BP 5alpha reductase inhibitor Blocks testosterone to DHT SE: gynecomastia & sexual dysfunction

Question 38

Prostate adenocarcinoma

Answer 38

Malignant proliferation of prostatic glands Most common cancer in men, 2nd most common cause of cancer related death Usually clinically silent Arises in peripheral, posterior region

Question 39

Screening for Prostate adenocarcinoma

Answer 39

DRE & PSA at 50 PSA > 10 is worrisome Decreased % free PSA suggestive of cancer

Question 40

What is necessary to confirm Prostate adenocarcinoma?

Answer 40

Biopsy

Question 41

what is grading for biopsy of Prostate adenocarcinoma?

Answer 41

Gleason scoring scale - based on ARCHITECTURE | NOT: nuclear atypia

Question 42

What is used to treat localized Prostate adenocarcinoma

Answer 42

Prostatectomy

Question 43

what is used to treat metastasized Prostate adenocarcinoma?

Answer 43

Continous GnRH analog (leuprolide) - shut down ant pit gonadotrophs (LF/FSH reduced) Flutamide - competitive inhibitor at androgen receptor