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Male Genital Tract Flashcards

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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
prognosis of Bowenoid papulosis
good | spontaneously regress
25
culprit of invasive carcinoma
HPV 16, 18
26
invasive papilloma begins on the
glans | inner surface of the prepuce near the coronal sulcus
27
gross invasive CA of penis
papillary flat graying fissuring of mucosal surface ulcerated papule
28
histo invasive penile ca
similar with SCC with varying differentiation
29
most common form of cryptorchidism
unilateral
30
cryptorchidism may be accompanied by
with GUT abnormalities like hypospadias
31
histo of cryptorchidism
hyalinization and thicken of BM of spermatic tubules | prominent leydig cells
32
causes of testicular atrophy
``` atherosclerosis orchitis cryptorchidism hypopituitarism cachexia irradiation antiandrogen chronic use exhaustion atrophy ```
33
histo of testicular atrophy
fibrosis or ghosting of spermatic tubules
34
atrophy as a primary genetic failure
Klinefelter syndrome
35
other patterns associated with decreased fertility
hyposprematogenesis maturation arrest vas deferens obstruction
36
syphilis first affects the
testis
37
<35 year old nonspecific epididymitis and orchitis
chlamydia | neisseria
38
>35 y/o nonspecific epididymitis and orchitis
E coli | Pseudomonas
39
testicular mumps
edema congestion chronic inflammatory infiltrate cause atrophy and sterility
40
TB testicular inflammation
granulomatous inflammation caseous necrosis begins in the epididymis to testis
41
painful testicular mass mimicking testicular tumor
autoimmune granulomatous orchitis
42
histology of autoimmune granulomatous orchitis
plasma cells | granuloma at spermatic tubules
43
twisting of spermaticord
testicular torsion
44
twisted testis is viable within
6 hours
45
neonatal torsion occrs
in utero shortly after birth no anatomic defect
46
adult torsion
adolescents presenting as sudden onset
47
adult torsion results from bilateral anatomic defect where the testis has increased mobility
bell-clamper abnormality
48
most common cause of painless enlargement of testis
testicular neoplasm
49
peak incidence of testicular neoplasms
15-34
50
testicular neoplasms are associated with
germ cell maldevelopment
51
suspect neoplasm in patients with
``` cryptorchidism testicular dysgenesis (xxy) ```
52
genetic common finding of testicular neoplasms
isochromosome 12, i(2p)
53
testicular Neoplasms are offen
benign
54
5% o pf testicular neoplasms are secondary to
non Hodgkin's lymphoma
55
most common testicular neoplasm in men regardless of age
diffuse large B cell lymphoma
56
testicular tumor with best prognosis because it is radiosensitive
seminomas
57
nonseminomas undergo
totipotential differentiation
58
germ cell precursor undergo gonadal differentiation
seminoma
59
embryonal neoplasm undergo trophoblastic differentiation
choriocarcinoma
60
emryonal CA undergoes yolk sac differentiation
yolk sac tumor
61
in choriocarcinoma, there is an increase in
beta-hCG
62
yolk sac tumor is common in
infancts and children less than 3 years old
63
yolk sac tumor is positive in
alpha feto protein
64
seminomas in females are called
dysgerminoma
65
gross seminoma
``` bulky mass pale homogenous surface gray white lobulated no hemorrhage or necrosis ```
66
micro seminoma
clear seminoma cells or germ cells delicate septa lymphocytic infiltrates
67
prognosis of seminoma
good
68
most common in all testicular neoplasms
seminoma
69
peak incidence of seminomas
30-50
70
in seminoma this part is not penetrated
tunica albuginea
71
seminoma may extend to
epididymis spermatic cord scrotal sac
72
microscopic seminoma
large, round, polyhedral and has a distinct cell membrane clear or watery appearing cytoplasm large nuclei
73
embryonal carcinoma gross
``` 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
histology embryonal carcinoma
``` alveolar or tubular patters papillary convulsions undifferentiated lesions➡️ sheets of cells epithelial appearance, large, anaplastic hyperchromatic nuclei ```
75
highly malignant carcinoma that presents as small palpable nodule
choriocarcinoma
76
gross of choriocarcinoma
small palpable nodule hemorrhage necrosis less than 5 cm in diameter
77
histo of choriocarcinoma
syncitiotrophoblast | cytotrophoblast
78
large, have many irregular or lobular hyperchromatic nuclei and abundant eosinophilic vacuolated cytoplasm
syncytiotrophoblast
79
more regular, tend to be polygonal with distinct borders and clear cytoplasm
cytotrophoblastic cells
80
cytotrophoblastic cells pattern of growth
cords and masses | single fairly uniform nucleus
81
yolk sac tumor aka
endodermal sinus tumor
82
yolk sac tumor usually affects
infants and children up to 3,y/o
83
gross yolk sac tumor
nonencapsulated | yellow white mucinous appearance
84
yolk sac histo
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
tumors in yolk sac contain
AFP | alha trypsin
86
conglomeration of tissue arising from the ectoderm, mesoderm, endoderm
teratoma
87
teratoma in females
mature-malignant | immature
88
male teratomas
postpubertal- malignant, bad prognosis
89
gross teratoma
heterogenous with solid cartilaginous and cystic areas
90
teratoma of testis
disorganized collection of glands, smooth muscle, immature stroma
91
sex cord or gonadal tumors incidence
rare
92
sex cord tumor that may elaborate androgens or some both androgens and estrogens even corticosteroids
leydig cell tumor
93
onset of testicular tumor
20-60
124
glandular epithelial and stromal nodular hyperplasia
BPH
125
bph is associated with
``` old age urinary obstruction frequency bladder hypertrophy bladder trabeculations ```
126
is BPH a premalignant lesion?
NOOOO
127
BPH is an extremely common dse in
men over 50
128
main component of hyperplastic process in BPH
impaired cell death
129
major trophic factor mediating prostatic hyperplasia
dihydrotestosterone
130
markedly reduces DHT content of the prostate | decrease in prostatic volume and urinary obstruction
therapy with 5 alpha reductase inh
131
morphology of BPH
60-100 gms transition zone first nodule stromal cells- epithelial cells median lobe hypertrophy
132
median lobe hypertrophy | BPH
projects into the floor of the urethra as a hemispheric mass directly beneath the mucosa of the urethra
133
gross BPH more pronounced in
lateral lobes
134
primary glandular involvement BPH
yellow pink tissue with a soft consistency and milky white prostatic fluid oozes out
135
primarily fibromuscular involvement BPH
each nodule is pale gray tough, does not exude fluid and less demarcated surrounding prostatic nodule
136
frequently performed operation for symptomatic nodular hyperplasia
transurethral resection - ruberry prostatic chips
137
histo- more prominently involved in BPH
glandular rather than stroma
138
histo BPH
larger glands more complex infolding double layer of uniform columnar cells and basal cuboidal cells with no atypia dilatation and prolif of acini
139
3 conditions in BPH histo that favor benign process
absent nucleoli basal nuclei glands separated by thin fibrous tissue- not back to back
140
micro BPH hallmark
nodularity due to glandular proliferation or dilatation and to fibrous or muscular proliferation of the stroma
141
other histo changes associated with BPH
foci of squamous metaplasia | small areas of infarction
142
squamous metaplasia in BPH tend to occur in, confused with
margins of the foci of infarctions as nests of metaplastic reactive squamous cells adenoca or urothelial ca
143
clinical course of BPH
``` compression of urethra with difficulty in urination retention of urine distention and hypertrophy of bladder infection the urine devt of cystitis renal infections ```
144
most common cancer in men
prostate carcinoma
145
screening age for prostate carcinoma
40
146
race preference of prostate cancer
uncommon in asians | frequent in blacks
147
prostate ca hormonal factors
does not occur in eunuch orchiectomy, estrogen inh growth prostatectomy including testes inh spread
148
prostate CA genetic factors
increased risk of first order relatives symptomatic CA (blacks>whites) hypermethylation of glutathione S transferase gene promoter
149
GSTP1 is located on
chromosome 11q13
150
prostate CA environmental factors
geographic differences | change of incidence with migration
151
prostate CA clinical course
``` clinically silent DRE PSA >4 ng/ml, free PSA <25% transrectal ultrasound needle biopsy prostatism metastasis - osteoblastic ```
152
gross prostate CA
irregular yellowish nodules peripheral zone- posterior gritty and firm *diff when embedded
153
histo adenoCA
prostate CA glands are smaller than BPH glands small, irregular, crowded no intervening stroma presence of NUCLEOLI- malignancy
154
perineural invasion of prostatic adenoCA
prostate gland cells surround nerve spaces- malignancy | pain
155
hematogenous spread on the axia skeleton of prostateCA
white cannonball lesions
156
gleason score
``` predominant pattern (1-5) secondary pattern (1-5) ```
157
best score gleason score
2
158
gleason score 10
ze worst
159
gleason grade ranges
1-5
160
gleason score ranges
2-10
161
grade 1 prostate CA
most well- differentiated neoplastic glands are uniform | round in apperance, packed, well-circumscribed
162
Grade 5
no glandular diff | tumor cells infiltrate the stroma in the form of cords, sheets, nests
163
well diff gleason score
2-4
164
intermediate gleason score
5-6
165
moderate-poorly differentiated
7
166
high grade cancer
8-10
167
staging- microscopic only
A T1
168
macroscopic staging (palpable)
B T2
169
staging- extracapsular
C T3, T4
170
staging- metastatic
D N1-3, M1
171
prognosis of prostate CA is dependent on
stage | histologic grade
172
10 year survival for A&B A T1 microscopic B T2 macroscopic
prognosis 90%
173
10 year survival for C, D C T3,4 extracapsular D N1-3, M1 metastatic
10-40%
238
gynecomastia may be the first symptom of this disorder | testicular swelling
leydig cell tumor
239
pimary manifestation of leydig cell tumor in children
hormonal | sexual precocity
240
leydig cell tumor gross
form circumscribed nodules less than 5 cm in diamete distinct golden brown, homogenous cut surface
241
leydig cell tumor histology
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
sex cord tumor that is hormonally silent and present as a testicular mass
Sertoli cell tumor
243
sertoli cell tumor gross
firm small nodules with a homogenous gray-white to yellow surface
244
sertoli cell tumor histology
distinctive trabeculae that tend to form cordlike structures and tubules benign but 10% become malignant
245
tumor confined to the testis, epididymis, or spermatic cord
stage 1 testicular tumor
246
distant distant spread confined to retroperitoneal nodes below the diaphragm
stage 2 rtesticular tumor
247
metastases outside the retroperitoneal nodes or above the diaphragm
stage 3 testicular tumor
248
prostate normal weight
20g
249
shape of prostate
pearl or chestnut shaped
250
normal histology of prostate
basal layer of low cuboidal epith covered by a layer of columnal secretory cells
251
control the growth and survival of prostatic cells
testicular androgens
252
most prostate carcinomas arise from the | palpable during the rectal digital exam
peripheral glands
253
arise from the more centrally situated glands and more likely to produce obstruction than CA
nodular hyperplasia
254
normal prostate zones
central peripheral transitional periurethral
255
usual site of hyperplasia, BPH
transitional zone
256
acute bacterial prostatitis agents
E coli gram - rods enterococci staphylococci
257
seeding of acute bacterial prostatitis
usually from distant foci or infection implanted in the prostate intraprostatic reflux or urine from posterior urethra or bladder
258
diagnosis of acute bacterial prostatitis
urine culture | clinical features
259
morphology of acute bacterial prostatitis
minute discemminated abscess large coalescent focal areas of necrosis diffuse edema, congestion and boggy suppuration of entire gland
260
clinical symtoms of chronic bacterial prostatitis
low back oain dysuria perineal and suprapubic discomfort
261
prostatitis usually presents with
cystitis | urethritis
262
diagnosis of chronic bacterial prostatitis
leukocytosis in the expressed prostatic secretions positive bacterial culture appears insidiously without obvious provocation
263
most common diagnose chronic prostatitis
chronic abacterial prostatitis
264
diagnosis of chronic abacterial prostatitis
expressed prostatic secretions >10 leukocytes/high power field - bacterial cultures
265
most common cause of granulomatous prostatitis in the US
instillation of BCG within the bladder for treatment of ---
266
types of granulomatous prostatitis
specific or nonspecific | fungal or idiopathic
267
diagnosis of relatively common granulomatous prostatitis
secretions from ruptured ducts or acini | no bacteria seen but some have recent urinary tract infection

Pathology (5 decks)

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