Male Genitalia Flashcards
(128 cards)
1
Q
What are the 3 kinds of penile pathology?
A
Congenital disorders
Inflammatory lesions
Penile tumors
2
Q
What are the 2 types of congenital disorders of the penis?
A
Hypospasias and Epispadias
Phimoses & Paraphimosis
3
Q
What congenital disorder of the penis has a malformation of the urethral groove & urethral canal that results in an abnormal urethral opening anywhere along the shaft of the penis?
A
Hypospadias & Epispadias
4
Q
What is the difference between Hypospadias & Epispadias?
A
Hypoaspadias - opening is found in the ventral surface of the penis ; more comomon
Epispadias - opening is found in the dorsal surface of the penis
5
Q
What congenital disorder of the penis that has abnormal small opening of prepuce (foreskin) which prevents its normal refraction?
A
Phimosis
6
Q
What is the appearance of severe phimosis?
A
causes pain during urination, urinary retention, UTI
foreskin is too tight or narrow, unable to be pulled back to expose the head of the penis
7
Q
What congenital disorder of the penis is a condition wherein the phimotic prepuce is forcible retracted over the glans penis but cannot be rolled back?
A
Paraphimosis
8
Q
What is the usual site of inflammatory lesion in the penis?
A
Glans penis & Prepuce
9
Q
What are non-specific inflammatory lesions based on their anatomic location?
A
Balanitis - glans penis
Posthitis - prepuce
Balanoposthitis - both prepuce and glans
10
Q
What is the cause of non-infectious inflammation of the penis? What is the clin manifestation of this?
A
Poor hygiene
Red, swollen and tender distal penis
11
Q
What is a complication of non-infectious inflammation of the penis?
A
Inflammatory scarring and narrowing of preputial opening (phimosis)
12
Q
What part of the penis are affected in infectious inflammation of the penis?
A
Glans & prepuce
13
Q
What are the diff benign, premalignant, malignant penile tumors?
A
Benign - Condyloma cuminata
Premalignant - Premalignant penile intraepithlial neoplasia, Bowen’s disease, Bowenoid Papulosis
Malignant - squamous cell carcinoma
14
Q
What is the causative agent of Condyloma Acuminatum?
A
HPV strains ^&11
15
Q
What is a significant gross and histologic feature of Condyloma Acuminatum?
A
Gross: cauliflower appearance
Histo: Superficial keratosis, Koilocytes
16
Q
What is the causative agent of Penile Intraepithelial neoplasia?
A
HPV 16 & 18
17
Q
What condition has an ulcerated infiltrative lesion in the shaft of the penis at the distal area?
A
Penile Squamous Cell Carcinoma (Malignant)
18
Q
What are the 2 macroscopic lesions seen in Penile SCC?
A
Papillary lesion - simulates condylomata acuminata and may produce a CAULIFLOWER-like appearance
Flat lesion - epithelial thickening accompanied by graying and fissuring of the mucosal surface
19
Q
What are predisposing factors of Penile SCC?
A
poor genital hygiene and lack of circumcision
HPV 16&18
Smoking
Chronic inflammatory conditions
INC sexual partners
20
Q
what are the 4 categories of lesions of the testes
A
COngeniital (Cryptorchidism)
Regressive changes
21
Q
what are the 4 categories of lesions of the testes
A
Congenital (Cryptorchidism)
Regressive changes (Atrophy)
Inflammatory (Mumps, Gonococcal, Chlamydial, E. coli, Pseudomonas, and Tuberculosis)
Tumors (Benign or Malignant)
22
Q
What is the most common congenital anomaly of the male genital tract that has a complete or partial failure of the intra-abdominal testes to descend into the scrtoal sac?
A
Cryptorchidism
23
Q
What is the complication of Cryptorchidism that develops if a child under 2 y/o does not correct this?
A
Testicular atrophy
24
Q
what are the diff causes of testicular atrophy?
A
cryptorchidism
atherosclerotic narrowing of the blood supply in old age
end stage of an inflammatory orchitis
generalized malnutrition or cachexia
irradiation
hypopituitarism
prolonged tx with female sex hormones
25
What is the histologic feature of testicular atrophy?
focal atrophy of tubules with a patchy pattern
26
what are the sources of infections that develop into inflammaotry lesions?
ascending route from urethra & ductus deferens
Hematogenous spread from a distant source
27
what are the 4 inflammatory lesions of the testes?
epididymitis
mumps orchitis
tuberculous orchitis
autoimmune granulomatous orchitis
28
what condition has an inflammation in the testicle which involves the epididymis and related to mumps, TB, chlamydia and torsion?
Epididymis
29
what is the histologic feature of epididiymis?
predominance of neutrophils, congestion, edema, mixed inflammatory infiltrates
30
what is the histologic feature of mumps orchitis?
chronic inflammatory infiltrate may cause focal atrophy
31
what is the histologic feature of tuberculous orchitis?
Granulomatous inflammation and caseous necrosis
32
what cells are found in tuberculous orchitis?
Langhans GIant cells
33
What is an idiopathic granulomatous orchitiis that presents in middle age as moderate tender testicular mass of sudden onset?
Autoimmune granulomatous orchitis
34
What is the histologic feature of autoimmune granulomatous orchitis?
Non-caseating granulomatous inflammation
35
what is the most common testicular neoplasm in men >50yo that is a diffuse large cell lymphoma?
testicular tumors
36
What is a premalignant lesion of testicular tumors?
Intratubular germ cell neoplasia
37
what type of testicular tumor is malignant, painless enlargement of testes?
testicular germ cell tumor
38
What are the 2 major histological types of testicular germ cell tumor?
Seminomas - better prognosis
Non-seminomas - embryonal carcinoma, teratoma, yolk sac tumor, choriocarcinoma
39
What are the 2 kinds of differentiation germ cell tumors go through?
Gonadal differentiation - give rise to seminoma
Totipotential (non-seminoma) differentiation
40
What kinds of differentiation does Totipotential differentiation go through?
Trophoblastic differentiation --> choriocarcinomas
Yolk sac differentiation --> yolk sac tumors
Somatic differentiation --> teratomas
41
What are serum tumor markers of testicular cancer?
HcG, AFP (alpha-fetoprotein)
42
what are the 7 different testicular germ cell tumors?
Intratubular germ cell neoplasia
Seminoma
Embryonal carcinoma
Choriocarcinoma
Yolk Sac tumor
Teratoma
Mixed germ cell tumor
43
What is a precursor lesion of testicular germ cell tumor that is equivalent of carcinoma in situ in epithelial malignancies
intratubular germ cell neoplasia
44
Where is the alteration of intratubular germ cell neoplasia?
short arm of chromosome 12 in the form of isochorome i (12p)
45
What is the histologic feature of intratubular germ cell neoplasia?
Atypical primordial germ cells with large nuclei and clear cytoplasm that is 2x the normal size
46
What is the most common type of germ cell tumor that peaks incidence at the 4th decade of life?
Seminoma - excellen prognosis
47
What is the gross feature of seminoma?
bulky, well-circumscribed, pale, fleshy, homogenous, gray white lobulated mass without hemorrhage or necrosis
48
What is the histological feature of seminoma?
nests, solid sheets of uniform cells divided into poorly demarcated lobules by delicate fibrous septa containing a lymphocytic infilrtate
49
what is the 2nd most common germ cell tumor that presents with testicular mass accopanied by gynecomastia?
Embryonal carcinoma - poor prognosis
50
What is the gross morphology of embryonal carcinoma?
Variegated and with necrosis and hemorrhage
51
what is the histologic morphology of embryonal carcinoma?
highly pleomorphic tumor cells
Alveolar or tubular pattern
52
what kind of tumor germ cell tumor has synctiotrophoblast & cytotrophoblast and is the most aggressive of all GCT?
Choriocarcinoma
53
What is the gross morphology of Choriocarcinoma?
Hemorrhages and necrosis, no testicular enlargement, tumors are rarely >5cm
54
what is the histologic morphology of Choriocarcinoma?
Synctiotrophoblasts - abundant eosinophilic vacuolted cytoplasm containing hCG
Cytotrophoblasts - regular and tend to be polyglonal, cords or sheets, single, fairly uniform nucleus
55
What testicular germ cell tumor is aka Endodermal sinus tumor and is the most common testicular tumor in iNFANTS & YOUNG children?
Yolk sac tumor
56
what are the 2 age peaks of yolk sac tumor?
16-18 mons = pure YST --> good prognosis
25-35 yrs old = YST in mixed germ cell tumor
57
What is the marker for yolk sac tumor?
INC serum AFP
58
What is the gross appearance of yolk sac tumor?
Gray-white tumors w/ myxoid or gelatinous cut surface
Nonencapsulated with a homogenous yellow-white appearance
59
What is the histologic feature of yolk sac tumor?
Lacelike (reticular) network of medium-sized cuboidal or flattened cells
Schiller-Duval bodies (Glomeruloid bodies)
Eosinophilic, hyaline-like globules containing AFP & Alpha 1-antitrypsin
60
What is the 2nd most common tumor in pediatric patients occurring in a pure form?
Teratoma
61
What are the 2 age peaks of Teratoma occurence?
<4 yo = benign case
20-40yo = Post-pubertal, malignant case
62
What is the gross appearance of Teratoma?
Well-circumscribed, heterogenous, with solid & cystic features reflecting presence of multiple tissue types
63
What is the histologic appearance of Teratoma?
1 mature or immature somatic tissue derived from different germinal layers
64
What is a mature teratoma?
Ectoderm: Epidermis, Neuronal tissue
Endderm: GI/Respiratory mucosa & glands
Mesoderm: Cartilage, bone or msucles
65
What is an immature teratoma?
Undifferentiated spindle cells, primitive neuroectodermal tissue or blasternal tissue
66
what type of teratoma is chemoresistant to therapy?
Teratoma with somatic type malignancy
67
What is the second most comon germ cell tumor after seminoma?
Mixed germ cell tumor
68
Is the prognosis better if mixed germ cell tumor has predominant mature teratoma?
yes
69
What is the gross appearance of mixed germ cell tumor?
Heterogenous or variegated tumor
Necrosis & Hemorrhage
70
What are the 2 non-germ cell tumors?
Leydig cell tumor
Testicular lymphoma
71
What is the common clin presentation of non-germ cell tumors?
painless mass or hormone-related symptoms
metastasis - only reliable criterion for malignancy
72
What is the most common type of SCST and most of it is benign?
Leydig cell tumor
73
What are the 2 age peaks of Leydig cell tumor and what distinct features does it present?
5-10 y/o -> Precocious puberty (INC androgen)
30-35 yo -> Gynecomastia (INC estrogen)
74
What is the gross appearance of Leydig cell tumor?
Circumscribed golden brown nodules, usually <5cm in diameter
75
What is the histologic appearance of Leydig cell tumor?
Resembles normal Leydig cells
Crystalloids of Reinke (pathognomonic)
76
What is the most common non-germ cell tumor in men >60yo?
Testicular lymphoma
77
What is the clin presentation of testicular lymphoma?
Bilateral & involves the spermatic cord
78
what is the histologic appearance of testicular lymphoma?
Diffuse large B cell lymphoma
79
where do testicular tumors metastasize?
Peraortic nodes
80
What are the 3 stages of testicular tumors & its location?
Stage I - confined to testis, epididymis or spermatic cord
Stage II - Distant spread to retroperitoneal nodes below the diaphragm
Stage III - Metastases outside the retroperitoneal nodes or above the diaphragm
81
What are the roles of tumor markers?
Aid in initial screening and diagnosis
Assessing response tx
Monitoring recurrence or metastatic spread
Assess tumor burden
In staging of tumors
82
What are the serum biomarkers in germ cell tumor?
LDH
serum AFP or hCG levels
83
What serum biomarkers are positive for Seminoma, YST, Choriocarcinoma, Embryonal Carcinoma, & Teratoma?
Seminoma = (+) B-hCG; (++) LDH
YST = (+++) AFP; (+) B-hCG; (+) LDH
Choriocarcinoma = (+++) B-hCG; (+) LDH
Teratoma = none positive
84
What are the 3 prostate gland diseases?
Prostatitis
Benign Prostatic Hyperplasia
Prostatic Carcinoma
85
What is the inflammation of the prostate and 3rd most common urinary tract disease in men?
Prostatitis
86
What are the different conditions of Prostatitis?
Acute Bacterial Prostatitis
Chronic bacterial prostatitis
Chronic Abacterial prostatitis/Chronic pelvic pain syndrome
Granulomatous prostatitis
87
What is the histologic appearance of acute bacterial prostatitis?
Neutrophilic infiltration and some glands are destroyed
Purulent exudates in the lumen
88
What is the clin manifestation of chronic bacterial prostatitis?
Low back pain, dysuria, and perineal and suprapubic discomfort
89
What is the histologic appearance of chronic bacterial prostatitis?
predominance of lymphocytes in the stroma
demonsratation of leykocytosis
90
what is the most common form of Prostatitis and is inditinguishable from chronic bacterial prostatitis & is non-responsive to antibiotics?
chronic abacterial prostatitis/chronic pelvic pain syndrome
91
What is the cause of Granulomatous prostatitis?
Specific infectious agent of TB where there is a reflux of contaminated urine
spreads to the lymph and blood
92
What is the histological apperance of granulomatous prostatitis?
Aggregates of histiocytes
93
What is the clin presentation of Granulomatous prostatitis?
TB symptoms; seen in immunocompromised hosts
94
What condition of the prostate has non-neoplastic enlargement of the prostate & peri-urethral regions that are common in men >50 yo?
Benign prostatic hyperplasia
95
What is the gross appearance of Benign Prostatic Hyperplasia?
Normal prostate gland is about 3-4cm in diameter, smooth, no nodules, not enlarged
96
Where is the location of benign prostatic hyperplasia? WHat does it feel like during DRE?
Transition zone
Rubbery to firm prostate upon palpation
97
What are active androgen metabolites derived from testosterone that are major stimulus for proliferation?
5-a-dihydrotestosterone or dihydroxy-testosterone
98
What is the gross morphology of Benign Prostatic Hyperplasia?
Nodules vary in size, color, and consistency
Soft, yellow-pink to firm grey-white
99
What is an eosiphilic secretion secreted in both glands and stroma of Benign Prostatic hyperplasia?
Corpora Amylacea
100
What are the signs&symtoms of benign prostatic hyeprplasia?
INC resistance to urinary outflow --> bladder hypertrophy & distention + reservoir of residual urine that is a common source of infction
101
What is the tx of Benign prostatic hyperplasia?
a-adrenergic blockers
5-a-reductase inhibitors
102
What are the complications that can arise from BPH?
obstruction of urinary outflow leads to:
- bladder distention, accompanied by urine stasis
- residual urine causes irritative symptoms and increases the risk of urinary infection
103
What are the diff BPH complciaitons?
obstructive uropathy
bladder hypertrophy
trabeculation
diverticular formation
hydroureter-bilateral
Hydronephrosis
Lithiasis/stone
Secondary infection
104
What is the most common cancer in men in the US and 2nd most common cause of death in men?
Prostatic crcinoma
105
What are the predisposing factors of Prostatic carcnoma?
Advancing age
Race -> africa american
Hormonal: Androgen excess
Genetic factors
Environmental factors
106
What is the most common genetic alteration in prostatic carcinoma?
ETV1-TMPRSS2
107
What is used as a screenign test for Prostatic carcinoma?
Prostate specific antigen
108
Where is the location of Prostatic carcinoma?
A hard rock prostate
109
What are the risk zones in the prostate gland?
Peripheral zone - most
Central zone
Transitional zone - most comon for benign prostatic hyeprplasia
110
What is the gross morphology of Prostatic carcinoma?
Solid yellow or gray-white areas
111
What is the microscopic morphology of a benign gland?
2 layers lining the organ
-> 1 layer = inner columnar secretory cells
-> 1 layer - outer cuboidal to flattened basal cell layers
Lumens with papillary infoldings
112
What is the microscopic morphology of a malignant gland?
Small back to back glands
Single layer with absent outer basal cells
113
What is the cytologic Major criteria for diagnosis of Prostatic carcinoma?
Basal cells lost
Prominent nucleoli
Infiltrative growth pattern
114
What is the cytologic minor criteria for diagnosis of Prostatic carcinoma?
wispy blue mucin
nuclear hyperchromasia
and many more --> ito lang important to remember
115
What are other histologic features of prostatic carcinoma that is very important?
back to back small glands with little intervening stroma; glands with simplified round or oval lumens
116
What is a probable precursor lesion for prostate carcinoma?
high grade prostatitc intraepithelial neoplasia
117
What are the 4 major architectural patterns of high grade prostatic intraepithelial neoplasia?
Micropapilary, Cribriform, Tufted or Flat
118
What is the acquired genetic alterations in Prostatic carcinoma that is due to the fusion w/ androgen regulate TMPRSS2 promoted, the most common genetic alteration?
Andrgen-dependent over expression of ETS gene
119
Are most Prostatic carcinomas, adenocarcinomas?
YES
120
What is a pathognomonic diagnostic feature of Prostatic carcinomas?
Circumferential perineural or intraneural invasion
121
What is the Grading system for prostate cancer?
Grade 1, 2 --> well-differentiated, looks like healthy tissue
Grade 3,4 --> moderately differentiated
Grade 5 --> Poorly differentiated, looks like abnormal tissue
122
What does it indicate if the Gleason score for prostate cancer is 6-10?
Score <6 = Tumor looks similar to normal cells --> cancer is slowly growing
Score >7 = Intermediate risk for aggresive cancer
Score >8 = likely to spread more rapidly, poorly differentiated/ high grade
123
What are the clinical signs and symptoms of prostatic cancer in the early & late stage?
Early stage - usually no symptoms, may present with LUTS, hematuria
Late stage = bone pain with lumbar bone metastasis
Bone pain may present also with metastatic disases
124
What is the basis of staging of Prostatic tumors?
Extend and spread of the cancer
125
How does protastatic cancer spread?
1st = spreads to lymphatics --> obturator nodes then para-aortic nodes
2nd = signs of spinal cord compression
Hematogenous spread to the bones
126
What are the stages of prostatic cancer & its extent?
Stage I (T1) = Microscopic only
Stage II (T2) = Macroscopic (palpable)
Stage III (T3, T4) = Extracapsular spread
Stage IV (N1, N2, N3, M1) = Distant metastasis
127
What can indicate immediately that it is definitely protastitic cancer?
Multiple bones metastases in males
128
What can help confirm prostatic origin?
PSA immunostain
