Male Pathology Flashcards
(144 cards)
1
Q
Cryptorchidism is _
A
Cryptorchidism is failure of the testicles to descend into the scrotum
2
Q
The testes begin in the _ and descend through the inguinal canal and into the scrotum by month _ of life
A
The testes begin in the retroperitoneum and descend through the inguinal canal and into the scrotum by month 3-6 of life
3
Q
Complications of cryptorchidism include _ and _
A
Complications of cryptorchidism include infertility and cancer risk (seminomas)
4
Q
How does cryptorchidism lead to impaired testicular function/infertility?
A
Increased temperature damages cells in the testis
5
Q
(Sertoli/Leydig) cells are more temperature sensitive and at risk of damage from cryptochidism
A
Sertoli cells are more temperature sensitive and at risk of damage from cryptochidism
* Leydig cells are largely unaffected
6
Q
_ and _ are risk factors that increase the risk of cryptorchidism
A
Prematurity and Low birth weight are risk factors that increase the risk of cryptorchidism
7
Q
Cryptorchidism presents as _
A
Cryptorchidism presents as absence of one or both testes in the scrotum
8
Q
Cryptochidism will present with the following labs:
Sperm count
Inhibin
FSH
LH
Testosterone
A
Cryptochidism will present with the following labs:
Low Sperm count
Low Inhibin
High FSH
High LH
Low or normal Testosterone
9
Q
Bilateral cryptorchidism will cause _ testosterone levels
A
Bilateral cryptorchidism will cause low testosterone levels
* Unilateral will result in normal testosterone levels
10
Q
Cryptorchidism often resolves spontaneously but if persistent, _ should be performed between 6 months- 2 years of age
A
Cryptorchidism often resolves spontaneously but if persistent, orchiopexy should be performed between 6 months- 2 years of age
11
Q
The _ is an outpouching of pertitoneum that guides the testes down through the inguinal canal
A
The processus vaginalis is an outpouching of pertitoneum that guides the testes down through the inguinal canal
12
Q
Testicular torsion is an error of the _
A
Testicular torsion is an error of the processus vaginalis
* Failure of the testes to attach to the inner lining of the scrotum
13
Q
Testicular torsion is _
A
Testicular torsion is rotation of testicle around the spermatic cord
* Causes risk of testicular necrosis
14
Q
Testicular torsion is most common in _ population
A
Testicular torsion is most common in males 12-18 yo +/ groin trauma
* Population is very active (sports, etc)
* Horizontally aligned testicles is a risk factor
15
Q
Testicular torsion presents with acute and severe testicular pain with “high riding testicle” and absent _ relex
A
Testicular torsion presents with acute and severe testicular pain with “high riding testicle” and absent cremasteric reflex
* May also present with nausea, vomiting, abdominal pain
16
Q
In neonates, we might expect to see _ in testicular torsion
A
In neonates, we might expect to see blue unilateral scrotal mass in testicular torsion
17
Q
Testicular torsion pain is not relieved by manual elevation of the testicle; this is a negative _ sign
A
Testicular torsion pain is not relieved by manual elevation of the testicle; this is a negative Prehn sign
18
Q
We can diagnose testicular torsion via _
A
We can diagnose testicular torsion via ultrasound with doppler showing absence of testicular blood flow
19
Q
We manage testicular torsion with _
A
We manage testicular torsion with orchiopexy within 6 hours
* Manual detorsion if surgical intervention is not available
20
Q
Spermatocele is an accumulation of _
A
Spermatocele is an accumulation of sperm
21
Q
Spermatocele is caused by _
A
Spermatocele is caused by dilation of rete testis or epididymal ducts
* Sperm collects in these locations –> cyst formation
22
Q
A spermatocele presents as a fluctuant (tender/non-tender) paratesticular nodule
A
A spermatocele presents as a fluctuant non-tender paratesticular nodule
23
Q
A spermatocele will have a (positive/ negative) transillumination test
A
A spermatocele will have a positive transillumination test
24
Q
Congenital hydrocele is an incomplete obliteration of the _
A
Congenital hydrocele is an incomplete obliteration of the processus vaginalis
25
Congenital hydrocele is a scrotal accumulation of _
Congenital hydrocele is a scrotal accumulation of **peritoneal fluid**
26
The most common cause of scrotal swelling in infants is _
The most common cause of scrotal swelling in infants is **congenital hydrocele**
27
Congenital hydrocele will have a (positive/negative) transillumination test
Congenital hydrocele will have a **positive** transillumination test
28
How is congenital hydrocele managed?
Congenital hydrocele will **spontaneously resolve by age 1**
29
Acquired hydrocele is a fluid accumulation in the scrotum often caused by _
Acquired hydrocele is a fluid accumulation in the scrotum often caused by **infection, trauma, neoplastic activity**
30
Varicocele is _
Varicocele is **venous accumulation in the pampiniform plexus**
31
Varicocele results from a distal blockage of the _
Varicocele results from a distal blockage of the **testicular vein**
32
The most common cause of scrotal enlargement in adult males is _
The most common cause of scrotal enlargement in adult males is **varicocele**
33
(Left/Right) sided varicocele is more common
**Left-sided** varicocele is more common; due to the left renal vein architecture
34
The pampiniform dilation seen in varicocele is often called _
The pampiniform dilation seen in varicocele is often called **"bag of worms"**
* It is larger with standing/valsalva
35
Varicocele will have (positive/negative) transillumination test
Varicocele will have **negative** transillumination test
36
We can diagnose varicocele via _ and manage it with _
We can diagnose varicocele via **ultrasound showing pampiniform dilation** and manage it with **surgical ligation/embolization**
37
Distortion of the penile architecture due to fibrous scar tissue following trauma is called _
Distortion of the penile architecture due to fibrous scar tissue following trauma is called **peyronie's disease**
38
Peyronie's disease involves fibrous scar tissue deposition in the _
Peyronie's disease involves fibrous scar tissue deposition in the **tunica albuginea**
39
Peyronie's disease is most often induced by _ (etiology)
Peyronie's disease is most often induced by **repeated trauma during intercourse**
40
Peyronie's disease often presents with _
Peyronie's disease often presents with **curved penis + erectile dysfunction** (may or may not have pain)
41
Peyronie's disease can be managed with _
Peyronie's disease can be managed with **collagenase injections** or **surgical repair**
42
Prolonged erection resulting in penile ischemia is called _
Prolonged erection resulting in penile ischemia is called **ischemic priapism**
43
Explain the pathophysiology of ischemic priapism
* Continuous erection > 4 hours
* Mechanical obstruction of blood flow
* Penile ischemia
44
_ disease can be a cause of ischemic priapism
**Sickle cell disease** can be a cause of ischemic priapism
* Sickled RBCs block venous drainage
45
Medications that can cause ischemic priapism disease include _
Medications that can cause ischemic priapism include **sildenafil, trazodone**
46
Ischemic priapism presents as _
Ischemic priapism presents as **erection > 4 hours + pain**
47
How do we manage ischemic priapism?
* Corporal aspiration
* Intracavernosal phenylephrine
* Surgical decompression
48
Bowen disease is an in situ squamous cell carcinoma that involves _ precursor lesion
Bowen disease is an in situ squamous cell carcinoma that involves **leukoplakia (white plaques) of penile shaft**
49
Erythroplasia of Queyrat is an in situ squamous cell carcinoma that involves _ precursor lesion
Erythroplasia of Queyrat is an in situ squamous cell carcinoma that involves **erythroplakia (red plaque) of the penile glans/ foreskin**
50
Bowenoid papulosis is an in situ squamous cell carcinoma that involves _ precursor lesion
Bowenoid papulosis is an in situ squamous cell carcinoma that involves **reddish papules throughout entire penis**
51
Risk factors of squamous cell carcinoma of the penis include _ and _
Risk factors of squamous cell carcinoma of the penis include **HPV infection** and **uncircumcised males**
52
Benign prostatic hyperplasia is a hyperplasia of the _ and _ of the _ and _ lobes of the prostate
Benign prostatic hyperplasia is a hyperplasia of the **stromal** and **epithelial cells** of the **middle** and **lateral** lobes of the prostate
53
BPH is caused by high levels of _ (hormone)
BPH is caused by high levels of **DHT**
54
How does BPH present?
* Urinary frequency
* Dysuria
* Difficulty with initation and termination of urination
* Bladder distension, UTIs
55
Complications of BPH include:
Complications of BPH include:
* Hydronephrosis
* Bladder distension/hypertrophy
* UTIs
* Post-renal AKI
56
Hypospadias is an abnormal (ventral/dorsal) opening of the meatus
Hypospadias is an abnormal **ventral** opening of the meatus
* Meatus will more commonly be distal on the shaft/tip
57
Epispadias is an abnormal (ventral/dorsal) opening of the meatus
Epispadias is an abnormal **dorsal** opening of the meatus
58
Hypospadias is caused by failure of _
Hypospadias is caused by **failure of the urethral folds to fuse**
59
Hypospadias can be associated with _ testicular pathology
Hypospadias can be associated with **undecended testis**
60
Epispadias is caused by failure of _
Epispadias is caused by **failure of genital tubercle to attain correct position**
61
(Epispadias/ Hypospadias) is associated with bladder exstrophy (urologic malformation where the bladder is open on lower abdomen)
**Epispadias** is associated with bladder exstrophy (urologic malformation where the bladder is open on lower abdomen)
62
Peyronie's disease involves fibrous plaque deposition in the _
Peyronie's disease involves fibrous plaque deposition in the **tunica albuginea**
* Presents at the dorsal midline
* Often palpable mass
63
Peyronie's disease is associated with _ , abnormal thickening in the hand tissues resulting in contractures
Peyronie's disease is associated with **Dupuytren's contracture** , abnormal thickening in the hand tissues resulting in contractures
64
Risk factors of peyronie's disease includes _
Risk factors of peyronie's disease includes:
* Penile trauma
* Diabetes
* Smoking
65
Anterior urethral injuries involve the _ urethra to the _ urethra
Anterior urethral injuries involve the **penile urethra** to the **bulbar urethra**
66
Perineal straddle injuries, MVCs, penetrating trauma, penile fractures are more commonly associated with (anterior/posterior) urethral injuries
Perineal straddle injuries, MVCs, penetrating trauma, penile fractures are more commonly associated with **anterior injuries**
67
Pelvic fractures are more commonly associated with (anterior/posterior) urethral fractures
Pelvic fractures are more commonly associated with **posterior urethral injuries**
68
The posterior urethra involves the _ urethra to the _ urethra
The posterior urethra involves the **membranous urethra** to the **prostatic urethra**
69
Penile warts are also called _ and are most commonly caused by HPV
Penile warts are also called **penile condyloma** ; penile condyloma acuminatum are most commonly caused by HPV (mainly 6 and 11)
70
Epithelial cells that are transformed by HPV are called _ on histology
Epithelial cells that are transformed by HPV are called **koilocytes** on histology
71
"Large, dark, wrinkled, rasinoid nuclei"
"Large, dark, wrinkled, rasinoid nuclei" --> **Koilocytes**
72
The most common cancer of the penis is _
The most common cancer of the penis is **squamous cell carcinoma**
* About 60% is HPV-dependent
* HPV 16, 18, 31, 33
73
70% of males over age 60 have prostatic enlargement due to rapid replication of prostate cells, known as _
70% of males over age 60 have prostatic enlargement due to rapid replication of prostate cells, known as **benign prostatic hyperplasia (BPH)**
74
BPH is most common in _ and _ zones
BPH is most common in **transition zone** and **periurethral zone**
75
The prostatic growth in BPH is stimulated by _ hormone
The prostatic growth in BPH is stimulated by **DHT**
76
Weak stream, intermittency, sense of incomplete emptying, straining are signs of (obstructive/irritative) issues of the bladder
Weak stream, intermittency, sense of incomplete emptying, straining are signs of **obstructive** issues of the bladder
77
Frequency, urgency, urgency incontinence, and nocturia are signs of (obstructive/irritative) issues of the bladder
Frequency, urgency, urgency incontinence, and nocturia are signs of **irritative** issues of the bladder
78
Complications of BPH:
Complications of BPH:
* Urinary retention
* Gross hematuria
* UTI
* AKI
* Bladder stones
79
A normal prostate is _ grams, an enlarged prostate is _ grams or larger
A normal prostate is **20-25 grams**, an enlarged prostate is **30 grams** or larger
80
What is PSA?
PSA stands for **prostate-specific antigen** which is a protein secreted by prostatic epithelial cells
81
Terazosin, tamsulosin, and silodosin are _ drugs
Terazosin, tamsulosin, and silodosin are **alpha1 blockers**
* Can be used for BPH
* They relax smooth muscle at the prostate to relieve obstruction
82
Finasteride and dutasteride are _ drugs
Finasteride and dutasteride are **5alpha-reductase inhibitors**
* Inhibit enzyme that converts testosterone to DHT to reduce hyperplasia in the setting of BPH
* Can take 6-9 months to notice effect
83
Side effects of "-osins"
Side effects of "-osins"
* Orthostatic hypotension
* Dizziness
* Headache
* Nasal congestion
* Ejaculatory dysfunction
84
Side effects of "-erides" like finasteride
Side effects of "-erides" like finasteride
* Sexual dysfunction (reduced libido)
* Gynecomastia
* Depression
85
One surgical approach to treating BPH is TURP which is _
One surgical approach to treating BPH is TURP which is **transurethral resection of the prostate**
86
Prostatitis is _
Prostatitis is **inflammation of the prostate gland, usually due to infection**
87
Prostate feels tender and "boggy" on digital rectal exam
Prostate feels tender and "boggy" on digital rectal exam: **prostatitis**
88
Acute bacterial prostatitis is often caused by microbial infection by pathogens such as _
Acute bacterial prostatitis is often caused by microbial infection by pathogens such as **E.coli, proteus, klebsiella**
* Can result from prostate biopsy, catheterization
89
Symptoms and complications of acute bacterial prostatitis:
Symptoms and complications of acute bacterial prostatitis:
* Fever, chills
* Dysuria, frequency, urgency
* Pelvic, rectal, perineal pain/tenderness
* Complications: urinary retention, prostatic abscess
90
Diagnosis of acute bacterial prostatitis requires _ ; treatment involves _
Diagnosis of acute bacterial prostatitis requires **urinalysis, urine culture**; treatment involves **fluoroquinolones or TMP-SMX**
* Prostatic secretions show WBCs
* Culture reveals bacteria
91
Chronic colonization of the prostate gland (ie E.coli) can lead to _
Chronic colonization of the prostate gland (ie E.coli) can lead to **chronic bacterial prostatitis**
* Presents as dysuria with pelvic or low back pain
92
Risk factors for chronic bacterial prostatitis
Risk factors for chronic bacterial prostatitis:
* Cystitis
* Epididymitis
* Catheter placement
* Anal intercourse
93
Prostate cancer is the most common cancer in males in the US and the _ most common cause of cancer death
Prostate cancer is the most common cancer in males in the US and the **second mcc** of cancer death
94
The most common type of prostate cancer is _
The most common type of prostate cancer is **prostatic adenocarcinoma**
95
Risk factors for prostate cancer
Risk factors for prostate cancer:
* Age
* African American
* Family history
* Genetic factors (BRCA2)
96
Prostate cancer most often originates from the _ zone
Prostate cancer most often originates from the **posterior peripheral zone**, around the apex of the prostate
97
How does prostate cancer usually present?
Prostate cancer:
* Often asymptomatic
* Irregular nodularity on DRE
* Elevated PSA
98
Prostate cancer can be characterized by loss of _ on histology
Prostate cancer can be characterized by loss of **basal cell layer** on histology
99
Lymphogranuloma venereum is _
Lymphogranuloma venereum is **necrotizing granulomatous inflammation** of the inguinal lymphatics and lymph nodes
* Heals with fibrosis --> rectal strictures
100
Lymphogranuloma venereum is a sexually transmitted disease caused by _
Lymphogranuloma venereum is a sexually transmitted disease caused by ***Chlamydia trachomatis***
* Caused by serotypes L1-L3
101
Orchitis is _
Orchitis is **inflammation of the testicle**
102
Name (4) common causes of orchitis
Name (4) common causes of orchitis:
1. **Chlamydia trachomatis** (young adults)
2. **E.coli** and **Pseudomonas** (UTI that travels)
3. **Mumps** (teenagers)
4. **Autoimmune** (granulomas in seminiferous tubules)
103
Left sided renal cell carcinoma invading the renal vein puts a male at risk of _
Left sided renal cell carcinoma invading the renal vein puts a male at risk of **varicocele**
104
Two categories of testicular tumors include _ and _
Two categories of testicular tumors include **germ cells** and **sex cord-stroma**
105
Testicular tumors will be (positive/negative) on transillumination test
Testicular tumors will be **negative** on transillumination test
106
(True/False) testicular tumors must be biopsied for diagnosis
False; **we do not biopsy testicular tumors** for risk of seeding the scrotum
* We just remove the testis with radical orchiectomy
* Most testicular tumors are malignant germ cell tumors
107
95% of testicular tumors are _ tumors
95% of testicular tumors are **germ cell tumors**
* Usually occur between 15-40
108
(Seminomas/ Nonseminomas) respond better to radiotherapy, metastasize later, and have a better prognosis
**Seminomas** respond better to radiotherapy, metastasize later, and have a better prognosis
* About 55% are seminomas, 45% are nonseminomas
109
Seminomas resemble ovarian dysgerminomas, the tumor is comprised of cells with _
Seminomas resemble ovarian dysgerminomas, the tumor is comprised of **large cells with clear cytoplasm + central nuclei**
* Resemble spermatogonia
110
(Seminomas/nonseminomas) form homogenous masses with no hemorrhage or necrosis
**Seminomas** form homogenous masses with no hemorrhage or necrosis
111
_ is a malignant tumor of the testis comprised of immature, primitive cells that may produce glands; forming hemorrhagic mass with necrosis
**Embryonal carcinoma** is a malignant tumor of the testis comprised of immature, primitive cells that may produce glands; **forming hemorrhagic mass with necrosis**
112
If embryonal carcinoma is treated with chemotherapy there may be _
If embryonal carcinoma is treated with chemotherapy there may be **differentiation into another type of germ cell tumor (teratoma)**
113
The most common testicular tumor in children is the _ tumor
The most common testicular tumor in children (< 3) is the **yolk sac** tumor
114
Teratomas are (malignant/benign) in males
Teratomas are **malignant** in males (as opposed to females)
115
Types of nonseminomous tumors:
Types of nonseminomous tumors:
* Embryonal carcinoma
* Yolk sac
* Choriocarcinoma
* Teratoma
* Mixed germ cell
116
Leydig cell tumors cause _ in male children and _ in male adults
Leydig cell tumors cause **precocious puberty** in male children and **gynecomastia** in male adults
* Leydig cells produce excess androgen
117
Sertoli cell tumor is comprised of _ and usually has _ effect on males
Sertoli cell tumor is comprised of **tubules** and usually **clinically silent** in males
118
The most common cause of testicular mass in males > 60 years old is _
The most common cause of testicular mass in males > 60 years old is **lymphoma**
* Typically diffuse large B-cell
* Often bilateral
119
PSA > _ is worrisome at any age
**PSA > 10** is worrisome at any age
120
Decreased percent of free-PSA is indicative of _
Decreased percent of free-PSA is indicative of **cancer**
* Cancer makes bound PSA
121
Prostate cancer commonly spreads to the _ or _
Prostate cancer commonly spreads to the **lumbar spine** or **pelvis**
* Can present with low back pain
122
We expect _ bacteria on UA and culture for chronic prostatitis cases
We expect **no bacteria** on UA and culture for chronic prostatitis cases
* We have inflammation of the prostate without infection
* Due to normal flora, trauma, or autoimmune conditions
123
Three main types of urinary incontinence:
Three main types of urinary incontinence:
124
Overflow incontinence is a neurologic dysfunction of _
Overflow incontinence is a neurologic dysfunction of **detrusor underactivity**
125
Overflow incontinence is often caused by _
Overflow incontinence is often caused by **obstruction, stricture**
* Can be diagnosed ivia bladder US or bladder scan
126
Sress incontinence is due to _
Sress incontinence is due to **weak outlet**
* Common in individuals with a weak pelvic floor (vaginal deliveries, prostate surgery)
127
Leakage with increased abdominal pressure describes _ incontinence
Leakage with increased abdominal pressure describes **stress incontinence**
* Coughing, laughing, standing up
128
Urge incontinence is an issue of _
Urge incontinence is an issue of **bladder overactivity**
* The leakage is preceded by sense of urgency
129
The most common type of cancer arising in the bladder is _
The most common type of cancer arising in the bladder is **urothelial carcinoma**
* Can also have squamous cell carcinoma and adenocarcinoma of the bladder
130
The classic presentation of urothelial carcinoma is _
The classic presentation of urothelial carcinoma is **painless hematuria**
131
Urothelial carcinoma arises via two distinct pathways _ or _
Urothelial carcinoma arises via two distinct pathways **flat** or **papillary**
132
(Flat/papillary) urothelial carcinomas will develop as high-grade tumors that invade
**Flat** urothelial carcinomas will develop as high-grade tumors that invade
133
Flat urothelial carcinoma is aggressive and associated with early _ mutations
Flat urothelial carcinoma is aggressive and associated with **early p53** mutations
134
Urothelial carcinoma is strongly associated with environmental carcinogen exposure such as:
Urothelial carcinoma is strongly associated with environmental carcinogen exposure such as:
* **Smoking**
* Aromatic amines (dyes)
* Cyclophosphamide
135
Bladder cancer diagnosis (or work up for hematuria) includes _ imaging
Bladder cancer diagnosis (or work up for hematuria) includes **cytoscopy**
136
Invasive urothelial carcinoma invades into the _ into deeper layers like _
Invasive urothelial carcinoma invades into the **basement membrane** into deeper layers like **submucosa, muscularis propria**
137
Most papillary urothelial carcinomas are _
Most papillary urothelial carcinomas are **indolent** (low grade)
138
_ and _ are two risk factors for testicular cancer
**Cryptorchidism** and **Klinefelter** are two risk factors for testicular cancer
139
Seminoma:
* Sheets of malignant germ cells with clear cytoplasm giving "fried egg" appearance
140
_ is a germ cell tumor in males that is associated with high placental alkaline phosphatase (ALP) levels
**Seminoma** is a germ cell tumor in males that is associated with high **placental alkaline phosphatase (ALP)** levels
141
_ contain disordered syncytiotrophoblasts and cytotrophoblastic elements and metastasis to the _ and _
**Choriocarcinomas** contain disordered syncytiotrophoblasts and cytotrophoblastic elements and metastasis to the **lungs** and **brain**
142
_ is associated with an increased fraction of free PSA
**BPH** is associated with an increased fraction of free PSA
* Prostate adenocarcinoma will have low fraction free PSA
143
BPH/ prostate adenocarcinoma may cause a post-renal AKI with labs:
BPH/ prostate adenocarcinoma may cause a post-renal AKI with labs:
**High BUN**
**High Cr**
**BUN/Cr < 20**
144
Embryonal carcinoma 'cell markers'
**AFP** and **hCG**
