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Pathology > Male Genital Tract > Flashcards

Male Genital Tract Flashcards

0
Q

clinical significance of penile congenital anomalies

A

ascending UT

sterility

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1
Q

most important pathology of male gential tract

A

inflammation

tumors

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2
Q

more common congenital anomaly

A

hypospadias

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3
Q

malformation of urethral groove and urethral canal on the dorsal surface

A

epispadias

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4
Q

abnormal small opening which prevents normal retraction of the prepuce

A

phimosis

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5
Q

phimosis is prone tto

A

repeated infection

carcinoma

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6
Q

when phismotic prepuce is foribly retracted over glans penis

A

paraphimosis

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7
Q

infections of the glans and prepuce caused by a wide variety of organisms

A

balanoposthisis

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8
Q

common agents of balanoposthisis

A

candida albicans
anaerobe
gardenerella
pyogenic bacteria

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9
Q

accumulation of desquamated epithelial cells, sweat, debris

A

smegma

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10
Q

common cause of phimosis

A

inflammation

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11
Q

most frequent penile neoplasms are

A

condyloma acuminata

SCC

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12
Q

cause of condyloma acuminata

A

HPV

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13
Q

agents of condyloma acuminata

A

HPV 6,11

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14
Q

transmission of HPV 6,11

A

skin contact

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15
Q

gross feature of condyloma acuminatum

A

single or multiple sessile or pedunculated, red papillary excrescences

coronal sulcus, prepuce

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16
Q

histo condylomata acuminatum

A 
papillary ct stroma like proliferation
koilocytosis (perinuclear vacuolization) 
acanthosis
degenerative atypia
basement membrane intact
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17
Q

in situ malignant penile tumor

A

Bowen’s disease, bowenoid papulosis

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18
Q

invasive malignant penile tumor

A

SCC

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19
Q

Bowen’s dse occurs in

A

35

male, female

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20
Q

gross Bowen’s disease

A

solitary thickened gray white opaque plaque with shallow ulcerations and crustin

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21
Q

histo Bowen’s disease

A

mitoses in epidermis
dysplastic, hyperchromatic nuclei
lack of orderly maturation
sharply demarcated bm

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22
Q

occurs in sexually active adult

multiple reddish brown lesions

A

Bowenoid papulosis

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23
Q

Bowenoid papulosis agent

A

HPV 16

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24
Q

prognosis of Bowenoid papulosis

A

good

spontaneously regress

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25
Q

culprit of invasive carcinoma

A

HPV 16, 18

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26
Q

invasive papilloma begins on the

A

glans

inner surface of the prepuce near the coronal sulcus

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27
Q

gross invasive CA of penis

A

papillary
flat
graying fissuring of mucosal surface
ulcerated papule

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28
Q

histo invasive penile ca

A

similar with SCC with varying differentiation

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29
Q

most common form of cryptorchidism

A

unilateral

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30
Q

cryptorchidism may be accompanied by

A

with GUT abnormalities like hypospadias

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31
Q

histo of cryptorchidism

A

hyalinization and thicken of BM of spermatic tubules

prominent leydig cells

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32
Q

causes of testicular atrophy

A 
atherosclerosis
orchitis
cryptorchidism
hypopituitarism
cachexia
irradiation
antiandrogen chronic use
exhaustion atrophy
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33
Q

histo of testicular atrophy

A

fibrosis or ghosting of spermatic tubules

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34
Q

atrophy as a primary genetic failure

A

Klinefelter syndrome

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35
Q

other patterns associated with decreased fertility

A

hyposprematogenesis
maturation arrest
vas deferens obstruction

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36
Q

syphilis first affects the

A

testis

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37
Q

<35 year old nonspecific epididymitis and orchitis

A

chlamydia

neisseria

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38
Q

> 35 y/o nonspecific epididymitis and orchitis

A

E coli

Pseudomonas

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39
Q

testicular mumps

A

edema
congestion
chronic inflammatory infiltrate
cause atrophy and sterility

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40
Q

TB testicular inflammation

A

granulomatous inflammation
caseous necrosis
begins in the epididymis to testis

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41
Q

painful testicular mass mimicking testicular tumor

A

autoimmune granulomatous orchitis

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42
Q

histology of autoimmune granulomatous orchitis

A

plasma cells

granuloma at spermatic tubules

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43
Q

twisting of spermaticord

A

testicular torsion

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44
Q

twisted testis is viable within

A

6 hours

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45
Q

neonatal torsion occrs

A

in utero
shortly after birth

no anatomic defect

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46
Q

adult torsion

A

adolescents presenting as sudden onset

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47
Q

adult torsion results from bilateral anatomic defect where the testis has increased mobility

A

bell-clamper abnormality

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48
Q

most common cause of painless enlargement of testis

A

testicular neoplasm

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49
Q

peak incidence of testicular neoplasms

A

15-34

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50
Q

testicular neoplasms are associated with

A

germ cell maldevelopment

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51
Q

suspect neoplasm in patients with

A 
cryptorchidism
testicular dysgenesis (xxy)
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52
Q

genetic common finding of testicular neoplasms

A

isochromosome 12, i(2p)

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53
Q

testicular Neoplasms are offen

A

benign

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54
Q

5% o pf testicular neoplasms are secondary to

A

non Hodgkin’s lymphoma

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55
Q

most common testicular neoplasm in men regardless of age

A

diffuse large B cell lymphoma

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56
Q

testicular tumor with best prognosis because it is radiosensitive

A

seminomas

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57
Q

nonseminomas undergo

A

totipotential differentiation

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58
Q

germ cell precursor undergo gonadal differentiation

A

seminoma

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59
Q

embryonal neoplasm undergo trophoblastic differentiation

A

choriocarcinoma

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60
Q

emryonal CA undergoes yolk sac differentiation

A

yolk sac tumor

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61
Q

in choriocarcinoma, there is an increase in

A

beta-hCG

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62
Q

yolk sac tumor is common in

A

infancts and children less than 3 years old

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63
Q

yolk sac tumor is positive in

A

alpha feto protein

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64
Q

seminomas in females are called

A

dysgerminoma

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65
Q

gross seminoma

A 
bulky mass
pale homogenous surface 
gray white 
lobulated
no hemorrhage or necrosis
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66
Q

micro seminoma

A

clear seminoma cells or germ cells
delicate septa
lymphocytic infiltrates

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67
Q

prognosis of seminoma

A

good

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68
Q

most common in all testicular neoplasms

A

seminoma

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69
Q

peak incidence of seminomas

A

30-50

70
Q

in seminoma this part is not penetrated

A

tunica albuginea

71
Q

seminoma may extend to

A

epididymis
spermatic cord
scrotal sac

72
Q

microscopic seminoma

A

large, round, polyhedral and has a distinct cell membrane
clear or watery appearing cytoplasm
large nuclei

73
Q

embryonal carcinoma gross

A 
hemorrhagic
necrotic
alveolar or tubular patterns
smaller 
doesnt replace entire testis
poorly demarcated at the margins with punctated foci of hemorrhage or necrosis
tunica albuginiea to epididymis or cord
74
Q

histology embryonal carcinoma

A 
alveolar or tubular patters
papillary convulsions
undifferentiated lesions➡️ sheets of cells
epithelial appearance, large, anaplastic
hyperchromatic nuclei
75
Q

highly malignant carcinoma that presents as small palpable nodule

A

choriocarcinoma

76
Q

gross of choriocarcinoma

A

small palpable nodule
hemorrhage
necrosis
less than 5 cm in diameter

77
Q

histo of choriocarcinoma

A

syncitiotrophoblast

cytotrophoblast

78
Q

large, have many irregular or lobular hyperchromatic nuclei and abundant eosinophilic vacuolated cytoplasm

A

syncytiotrophoblast

79
Q

more regular, tend to be polygonal with distinct borders and clear cytoplasm

A

cytotrophoblastic cells

80
Q

cytotrophoblastic cells pattern of growth

A

cords and masses

single fairly uniform nucleus

81
Q

yolk sac tumor aka

A

endodermal sinus tumor

82
Q

yolk sac tumor usually affects

A

infants and children up to 3,y/o

83
Q

gross yolk sac tumor

A

nonencapsulated

yellow white mucinous appearance

84
Q

yolk sac histo

A

lacelike reticular network of medium sized cuboidal or flattened cells
SCHIVER-DUVAL bodies
arranged in a central capillary
mesodemal core with central papillary and visceral- resemble primitive glomeruli

85
Q

tumors in yolk sac contain

A

AFP

alha trypsin

86
Q

conglomeration of tissue arising from the ectoderm, mesoderm, endoderm

A

teratoma

87
Q

teratoma in females

A

mature-malignant

immature

88
Q

male teratomas

A

postpubertal- malignant, bad prognosis

89
Q

gross teratoma

A

heterogenous with solid cartilaginous and cystic areas

90
Q

teratoma of testis

A

disorganized collection of glands, smooth muscle, immature stroma

91
Q

sex cord or gonadal tumors incidence

A

rare

92
Q

sex cord tumor that may elaborate androgens or some both androgens and estrogens even corticosteroids

A

leydig cell tumor

93
Q

onset of testicular tumor

A

20-60

124
Q

glandular epithelial and stromal nodular hyperplasia

A

BPH

125
Q

bph is associated with

A 
old age
urinary obstruction
frequency
bladder hypertrophy
bladder trabeculations
126
Q

is BPH a premalignant lesion?

A

NOOOO

127
Q

BPH is an extremely common dse in

A

men over 50

128
Q

main component of hyperplastic process in BPH

A

impaired cell death

129
Q

major trophic factor mediating prostatic hyperplasia

A

dihydrotestosterone

130
Q

markedly reduces DHT content of the prostate

decrease in prostatic volume and urinary obstruction

A

therapy with 5 alpha reductase inh

131
Q

morphology of BPH

A

60-100 gms
transition zone
first nodule stromal cells- epithelial cells
median lobe hypertrophy

132
Q

median lobe hypertrophy

BPH

A

projects into the floor of the urethra as a hemispheric mass directly beneath the mucosa of the urethra

133
Q

gross BPH more pronounced in

A

lateral lobes

134
Q

primary glandular involvement BPH

A

yellow pink tissue with a soft consistency and milky white prostatic fluid oozes out

135
Q

primarily fibromuscular involvement BPH

A

each nodule is pale gray tough, does not exude fluid and less demarcated surrounding prostatic nodule

136
Q

frequently performed operation for symptomatic nodular hyperplasia

A

transurethral resection - ruberry prostatic chips

137
Q

histo- more prominently involved in BPH

A

glandular rather than stroma

138
Q

histo BPH

A

larger glands
more complex infolding
double layer of uniform columnar cells and basal cuboidal cells with no atypia
dilatation and prolif of acini

139
Q

3 conditions in BPH histo that favor benign process

A

absent nucleoli
basal nuclei
glands separated by thin fibrous tissue- not back to back

140
Q

micro BPH hallmark

A

nodularity due to glandular proliferation or dilatation and to fibrous or muscular proliferation of the stroma

141
Q

other histo changes associated with BPH

A

foci of squamous metaplasia

small areas of infarction

142
Q

squamous metaplasia in BPH tend to occur in, confused with

A

margins of the foci of infarctions as nests of metaplastic reactive squamous cells

adenoca or urothelial ca

143
Q

clinical course of BPH

A 
compression of urethra with difficulty in urination 
retention of urine 
distention and hypertrophy of bladder
infection the urine
devt of cystitis
renal infections
144
Q

most common cancer in men

A

prostate carcinoma

145
Q

screening age for prostate carcinoma

A

40

146
Q

race preference of prostate cancer

A

uncommon in asians

frequent in blacks

147
Q

prostate ca hormonal factors

A

does not occur in eunuch
orchiectomy, estrogen inh growth
prostatectomy including testes inh spread

148
Q

prostate CA genetic factors

A

increased risk of first order relatives
symptomatic CA (blacks>whites)
hypermethylation of glutathione S transferase gene promoter

149
Q

GSTP1 is located on

A

chromosome 11q13

150
Q

prostate CA environmental factors

A

geographic differences

change of incidence with migration

151
Q

prostate CA clinical course

A 
clinically silent
DRE
PSA >4 ng/ml, free PSA <25%
transrectal ultrasound
needle biopsy
prostatism
metastasis - osteoblastic
152
Q

gross prostate CA

A

irregular yellowish nodules
peripheral zone- posterior
gritty and firm *diff when embedded

153
Q

histo adenoCA

A

prostate CA glands are smaller than BPH glands
small, irregular, crowded
no intervening stroma
presence of NUCLEOLI- malignancy

154
Q

perineural invasion of prostatic adenoCA

A

prostate gland cells surround nerve spaces- malignancy

pain

155
Q

hematogenous spread on the axia skeleton of prostateCA

A

white cannonball lesions

156
Q

gleason score

A 
predominant pattern (1-5)
secondary pattern (1-5)
157
Q

best score gleason score

A

2

158
Q

gleason score 10

A

ze worst

159
Q

gleason grade ranges

A

1-5

160
Q

gleason score ranges

A

2-10

161
Q

grade 1 prostate CA

A

most well- differentiated neoplastic glands are uniform

round in apperance, packed, well-circumscribed

162
Q

Grade 5

A

no glandular diff

tumor cells infiltrate the stroma in the form of cords, sheets, nests

163
Q

well diff gleason score

A

2-4

164
Q

intermediate gleason score

A

5-6

165
Q

moderate-poorly differentiated

A

7

166
Q

high grade cancer

A

8-10

167
Q

staging- microscopic only

A

A T1

168
Q

macroscopic staging (palpable)

A

B T2

169
Q

staging- extracapsular

A

C T3, T4

170
Q

staging- metastatic

A

D N1-3, M1

171
Q

prognosis of prostate CA is dependent on

A

stage

histologic grade

172
Q

10 year survival for A&B

A T1 microscopic
B T2 macroscopic

A

prognosis 90%

173
Q

10 year survival for C, D

C T3,4 extracapsular
D N1-3, M1 metastatic

A

10-40%

238
Q

gynecomastia may be the first symptom of this disorder

testicular swelling

A

leydig cell tumor

239
Q

pimary manifestation of leydig cell tumor in children

A

hormonal

sexual precocity

240
Q

leydig cell tumor gross

A

form circumscribed nodules
less than 5 cm in diamete
distinct golden brown, homogenous cut surface

241
Q

leydig cell tumor histology

A

similar to normal counterparts
large and round or polygonal
abundant granular eosinophilic cytoplasm with a round central nucleus
cytoplasm: lipid granules, vacuoles or lipofuscin pigment
RODSHAPED crystalloids of REINKE 25%
10% are invasive, produce metastases

242
Q

sex cord tumor that is hormonally silent and present as a testicular mass

A

Sertoli cell tumor

243
Q

sertoli cell tumor gross

A

firm small nodules with a homogenous gray-white to yellow surface

244
Q

sertoli cell tumor histology

A

distinctive trabeculae that tend to form cordlike structures and tubules
benign but 10% become malignant

245
Q

tumor confined to the testis, epididymis, or spermatic cord

A

stage 1 testicular tumor

246
Q

distant distant spread confined to retroperitoneal nodes below the diaphragm

A

stage 2 rtesticular tumor

247
Q

metastases outside the retroperitoneal nodes or above the diaphragm

A

stage 3 testicular tumor

248
Q

prostate normal weight

A

20g

249
Q

shape of prostate

A

pearl or chestnut shaped

250
Q

normal histology of prostate

A

basal layer of low cuboidal epith covered by a layer of columnal secretory cells

251
Q

control the growth and survival of prostatic cells

A

testicular androgens

252
Q

most prostate carcinomas arise from the

palpable during the rectal digital exam

A

peripheral glands

253
Q

arise from the more centrally situated glands and more likely to produce obstruction than CA

A

nodular hyperplasia

254
Q

normal prostate zones

A

central
peripheral
transitional
periurethral

255
Q

usual site of hyperplasia, BPH

A

transitional zone

256
Q

acute bacterial prostatitis agents

A

E coli
gram - rods
enterococci
staphylococci

257
Q

seeding of acute bacterial prostatitis

A

usually from distant foci or infection

implanted in the prostate intraprostatic reflux or urine from posterior urethra or bladder

258
Q

diagnosis of acute bacterial prostatitis

A

urine culture

clinical features

259
Q

morphology of acute bacterial prostatitis

A

minute discemminated abscess
large coalescent focal areas of necrosis
diffuse edema, congestion and boggy suppuration of entire gland

260
Q

clinical symtoms of chronic bacterial prostatitis

A

low back oain
dysuria
perineal and suprapubic discomfort

261
Q

prostatitis usually presents with

A

cystitis

urethritis

262
Q

diagnosis of chronic bacterial prostatitis

A

leukocytosis in the expressed prostatic secretions
positive bacterial culture
appears insidiously without obvious provocation

263
Q

most common diagnose chronic prostatitis

A

chronic abacterial prostatitis

264
Q

diagnosis of chronic abacterial prostatitis

A

expressed prostatic secretions >10 leukocytes/high power field
- bacterial cultures

265
Q

most common cause of granulomatous prostatitis in the US

A

instillation of BCG within the bladder for treatment of —

266
Q

types of granulomatous prostatitis

A

specific or nonspecific

fungal or idiopathic

267
Q

diagnosis of relatively common granulomatous prostatitis

A

secretions from ruptured ducts or acini

no bacteria seen but some have recent urinary tract infection

Pathology (5 decks)

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