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Flashcards in Male Path 2 Deck (33):
1

Hypospadias

urethra opening on the ventral surface (1 in 300)

2

Epispadias

urethral opening on the dorsal surface

3

Phimosis

prepuce can not be retracted

poor hygiene--infection--phimosis--infection--?carcinoma

4

Paraphimosis

phimotic prepuce is forcibly retracted
-constriction and swelling--pain--acute urinary retention

5

What are complications of gonorrhea?

urethritis-urethral strictures-sterility- and ectopic pregnancies

6

Who is more likely to get chlamydia non gonorrheal urethritis male or female?

male

7

chlamydia lymphogranuloma venereum

small epidermal vesicle--ulcer---inguinal and rectal lymphadenopathy

8

chlamydia trachomatis

chronic keratoconjuntivitis

9

reiter syndrome

can pee cant see cant climb a tree
-conjunctivitis, polyarthritis and genital infection

10

What is 1,2,3 syphilis?

1 (3 weeks)- chancre
2 (2-10 weeks)-palmar, solar rash, lymphadenopathy, arthritis, headache, fever, condyloma latum
3 (years)- neurosyphilis, aortitis, gummas

11

Condyloma Acuminatum

HPV 6,11
Gross: single or multiple sessile or pedunculated, red papillary excrescencies, one-several mm

Micro: papillary proliferation of squamous cells. koilocytosis- clear vacuolization of cytoplasm

12

Squamous cell carcinoma of the penis
Risk factors
HPV type
Gross
Micro

poor hygiene and phimosis-accumulation of smegma, and history of genital warts
-circumcision confers protection
HPV types 16 and 18

13

Cryptorchisidism

Undescended testis
-majority idiopathic, trisomy 13
-unilateral, 25%-bilateral
-complications-infertility and germ cell neoplasia

Gross: small, firm testicles
Micro: tubular atrophy

14

Testicular Torsion

twisting of the cord--thick walled arteries patent--vascular engorgement--infarction
-sudden severe pain
-congestion, edema, hemorrhage---hemorrhagic infarct--fibrosis

-surgery within 8 hrs--80% slalvage
-after 10 hours--20 % salvage

UROLOGIC EMERGENCY

15

What is the epidemiology of testicular tumors?

15-34 most common tumor in men
bimodal
young and old
young-germ cell
old-lymphoma
white: african american 5:1

16

Germ cell tumors can be split up into seminomas and nonseminomatous germ cell tumors, what is the difference?

Seminoma
-localized to testis for long time
-70% stage 1 (at presentation)
-metastasis to lymph nodes
-RADIOSENSITIVE
-95% cured

NSGCT
-more aggressive
-60% stage 2 and 3
- hematogenous spread (lungs and liver)
- radioresistant
-90% complete remission and cure with aggressive chemotherapy

17

What are risk factors for testicular tumors?

-Cryptorchidism-higher the testis location, higher the risk of cancer (R>L)
-gonadal dysgenesis with Y chromosome
-testicular feminization
-presence of ITGCN
-HIV infection
***Trauma is not a risk factor

18

What is a molecular risk factor for invasive testicular tumors regardless of the histological type?

isochromosome of the short arm of chromosome 12
90% of invasive tumors

19

What are the clinical features of germ cell tumors?

1. Painless enlargement of testis
2. Lymphatic spread-retroperitoneal, para aortic, mediastinal, supraclavicular LN
3. Hematogenous spread-lungs, liver, brain

AFP-yolk sac tumor
HCG-chroiocarcinoma

20

ITGCN
Intratubular germ cell neoplasia

seen often associated with malignant germ cell tumors

Intratubular proliferation of malignant gem cells

Large atypical cells, abundant clear cytoplasm, central nucleus, prominent nucleoli "fried egg appearance"

21

Seminoma

most common germ cell tumor
peak 30-40 years old
gross: homogenous gray-white cut surface
micro:
-sheets of uniform large cells with distinct cell membrane clear cytoplasm, large central nucleolus
-fibrous septae infiltrated with lymphocytes
-serum bHCG could be high in 10% of cases, AFP is normal

22

Embryonal carcinoma

peak 20-30 old

gross-variegated poorly demarcated, foci of necrosis and hemorrhage

micro-large anaplastic cells with prominent nucleoli with indistinct borders arranged in solid, glandular, tubular, papillary patterns

23

yolk sac tumor

two peaks: 1 infants(good prognosis) and young adults (mixed tumors)

most common testicular tomor in infants up to 3 Y**

micro: reticular network of cuboidal cells, papillary and solid patterns (Schiller-Duval or glomeruloid bodies) and hyaline-like globules (AFP and alpha 1 antitrypsin)

24

choriocarcinoma

Metastasis at presentation, highly aggressive
-Pure form

25

teratoma

Random admixture of tissue derived from ectoderm, endoderm and mesoderm

-From infancy (pure) to adulthood (mixed germ cell tumors)

-Mature, immature, with malignant transformations

-NO BENIGN TERATOMAS IN POST PUBERTAL MALES **

26

Leydig cell tumor

common sex cord-stromal tumor
-any age 20-60s
-usually unilateral
-testicular enlargement, endocrine manifestations

Gross: well circumscribed ~3-4 cm nodule with homogenous, golden-brown cut surface

Micro: solid growth of large, polygonal cells with abundant granular cytoplasm and singe, round, centrally located nuclei with prominent nucleoli

CRYSTALLOIDS of REINKE***

27

lymphoma

Usually secondary
Most common- large b cell lymphoma

>60 MOST COMMON testicular neoplasm (the second-metastasis to testes)

-prognosis-poor

Gross-fleshy, white gray to pink, usually replace testicular parenchyma

28

Most common testicular tumor in adults

seminoma

29

most common bilateral primary testicular tumor

seminoma

30

most common bilateral testicular tumor

lymphoma

31

Most common testicular cancer in infants and children?

yolk sac tumor

32

Most common non germ cell tumor of the testes?

leydig cell tumor

33

Which are more common in the testis-mixed or pure histological tumor types?

mixed