Male pathology Flashcards
(94 cards)
1
Q
Benign prostatic hyperplasia - age
A
common in over 50
2
Q
Benign prostatic hyperplasia - appearance/result
A
smooth elastic, firm nodular enlargement (HYPERPLASIA, not hypertrophy) of periurethral (lateral and middle lobes) –> compress urethra into a vertical slit
3
Q
Benign prostatic hyperplasia - hyperplasia or hypertrophy
A
hyperplasia
4
Q
Benign prostatic hyperplasia - location of hyperplasia
A
periurethral - lateral and middle lobes
5
Q
Benign prostatic hyperplasia - cancer
A
not premalignant
6
Q
Benign prostatic hyperplasia - presentation
A
- increased frequencey of urination
- nocturia
- difficulty starting and stoping urine stream
- dysuria
7
Q
Benign prostatic hyperplasia - complications
A
may lead to distention and hypertrophy of bladder, hydronephrosis, UTIs
8
Q
Benign prostatic hyperplasia - markers
A
increased PSA
9
Q
Benign prostatic hyperplasia - treatment (and mechanism)
A
- a1 antagonists (terazosin, tamsulosin) –> relaxation of SMC
- 5α-reductase inhibitors (eg. finasteride
- tadalafil (PDE-5 inhibitor)
10
Q
Prostatitis - divided to/due to
A
- acute: bacterial (eg. E.coli)
2. chronic (bacterial or abacterial)
11
Q
Prostatitis - symptoms
A
- dysuria
- frequency
- urgency
- low back pain
12
Q
Prostatitis - physical examination
A
warm, tender, enlarged prostate
13
Q
Prostatic adenocarcinoma - age/location
A
men over 50
often posterior lobe (peripheral zone) of prostate gland
14
Q
Prostatic adenocarcinoma - diagnosis
A
increased PSA and suvsequent needle core biopsies
15
Q
Prostatic adenocarcinoma - markers
A
Prostatic acid phosphate (PAP)
PSA
16
Q
PSA - in Prostatic adenocarcinoma
A
increased total with decreased fraction of free
17
Q
PSA - normal range
A
- increases in age by BPH
- under 2.5 ng/ml in 40-49
- under 7.5 ng/ml in 70-79
18
Q
Prostatic adenocarcinoma - complication
A
osteoblastic metastasis (late stages)
19
Q
Prostatic adenocarcinoma - osteoblastic metastasis - sympotms/labs
A
- lower back pain
2. increased ALP and PSA
20
Q
Tunica albuginea?
A
- penis –>connective tissue that surrounds the corpora cavernosa
- testicles –> connective tissue covering the testicles
- ovaries –>the connective tissue covering of the ovaries
21
Q
Penile pathology - 3 diseases
A
- Peyronie disease
- iscemic priapism
- SCC
- penile fracture
22
Q
Peyronie disease - definition/mechanism
A
abnormal curvature of penis due to fibrous plaque within tunica albuginea (goes up)
23
Q
Peyronie disease - symptoms
A
- pain
- anxiety
- erectile dysfunction
24
Q
Peyronie disease - treatment
A
surgical repair once curvature stabilizes
25
penile fracture - definition/mechanism
rupture of corpora carvenosa due to force bending
26
Ischemic priapism - definitim
painful sustained erection lasting more than 4 hours
27
causes of ischemic priapism
1 sickle cell anemia (trapped RBCs in vascular channels)
| 2. drugs (sildenafil, trazodone)
28
ischemic priapism - management
treat immediately with corporal aspiration, intracavernosal phenylephrine, or surgical decompression to prevent ischemia
29
SCC of penis - epidimiology
more common in Asiam Africa, South America
30
SCC of penis - precursor in situ lesions
1. Bowen disease
2. erythroplasia Queyrat
3. Bowenoid papulosis
31
SCC of penis - risk factors
1. HPV
| 2. lack of circumcision
32
Bowen disease?
leukoplakia in penile shaft
33
erythroplasia Queyrat?
cancer of glans (IN SITU), presents as erythroplakia
34
Bowenoid populosis?
carcinoma in situ of unclear malignant protention, presenting as redish papules
35
SCC of penis - precursor in situ lesions/and their definition
1. Bowen disease --> leukoplakia in penile shaft
2. erythroplasia Queyrat --> in situ carcinoma of glans, presents as erythroplakia
3. Bowenoid papulosis --> carcinoma in situ of unclear malignant protention, presenting as redish papules
36
Cryptorchidism - definition
undescended testis (one or both)
37
Cryptorchidism - sperm vs testosterone - mechanism
- impaired spermatogenesis: sperm develops best at less than 37. sertoli are Q sensitive
- normal Testosterone levels (Leyding unaffected to Q)
38
Cryptorchidism - complication
high risk of germ cell tumors
39
Cryptorchidism - risk factor
1. prematurity
| 2. Hypospandias
40
Cryptorchidism - endocrine profile
low inhibin B, High FSH and LH
| testosterone low in bilateral, normal in unilateral
41
MCC of scrotal enlargement in adult males
Varicocele
42
Varicocele - definition
dilated veins in pampiniform plexus due to hug venous pressure
43
The pampiniform plexus is a
network of many small veins found in the human male spermatic cord.
44
Varicocele - location
Most often on left because of high resistance to flow from left gonadal vein drainage into left renal vein
45
Varicocele - complication
infertility because of high temperature
46
Varicocele - diagnosis
1. standing clinical exam (distention on inspection and bag of worms
2. US with Doppler
3. does not transilluminate
47
Varicocele - treatment
1. varicocelectomy
| 2. embolization
48
Testicular tumors are divided to (proportions and behavioural)
1. germ cell (95%) --> Mostly malignant, children mature teratoma benign
2. non-germ cell (5%) --> mostly benign, but lymphoma is aggressive
49
Testicular non-germ cell tumors - types and aggressiveness
Mostly benign
1. Leydig cells
2 Sertoli cells
3. Testicular lymphoma (aggressive)
50
Sertoli cell tumor?
androblastoma from sex cord stroma
51
Leydig celll tumor - appearance
- golden brown color
| - contains Reinke crystal (eosnophilic cytoplasmic inclusion)
52
Leydig celll tumor - presentation mechanism)
produce androgens or estrogens --> gynecomastia in men. precosious puberty in boys
53
MC testicular cancer in older men
Testicular lymphoma
54
Testicular lymphoma - characteristics
- Not 1ry --> arises from metastatic lymphoma to testes
| - Aggressive
55
Testicular germ cell tumors - epidemiology
Most often in young men
56
Testicular germ cell tumors - risk factors
1. Cryptorchidism
| 2. Klinefelter syndrome
57
Testicular germ cell tumors - characteristics
- can resent as a mixed germ cell tumor
| - does not transilluminate
58
Testicular germ cell tumors - types
1. Seminoma
2. Yolk sac (endodermal sinus) tumor
3. Chroriocarcinoma
4. Teratoma
5. Embryonal carcinoma
59
MC testicular tumor
seminoma
60
seminoma - behavior/age
malignant
| not in infancy
61
seminoma - clinical characteristics
painless, homogenous testicular enlargment
62
seminoma - prognonis (why)
excellent --> 1. Radiosensitive 2. late matastasis
63
seminoma - marker
high placental ALP
64
seminoma - histology
large cells in lobules with watery cytoplasm and fried egg appearance
65
tests - Yolk sac (endodermal sinus) - behavioral
aggressive malignancy
66
tests - Yolk sac (endodermal sinus) - appearance
- yellow mucinous
| - Schiller Duval bodies resemble primitive glomeruli
67
tests - Yolk sac (endodermal sinus) - marker
high AFP is highly characetristic
68
MC testicular in boys under 3
yolk sac
69
MC tumor in male infants
yolk sac
70
male teratoma - behaviour
unlkie in females. mature teratoma in adults males may be maligntn. Benign in children
71
testicular choriocarcinoma - marker
high hCG
72
testicular choriocarcinoma - histology
disordered syncytiotrophoblastic and cytotrphoblastic elemetns
73
testicular choriocarcinoma - spreading
lungs and brain (heterogeneously)
74
testicular choriocarcinoma - presentation
gynecomastia
symptoms of hyperthyroidism
(hCG is stracturally simillar to LH, FSH, TSH)
75
testicular cancer that is painful
Embryonal carcinoma
76
Embryonal carcinoma - special clinical characteristic
PAINFUL
77
Embryonal carcinoma - gross appearance
hemorrhagic mass with necrosis
78
Embryonal carcinoma - prognosis
worse than seminoma
79
Embryonal carcinoma - histology
glandular papillary morphology
80
Embryonal carcinoma - markers
```
if pure (rare) --> high hCG, normal AFP
if mixed with other tumors --> high hCG, increased AFP
```
81
Scrotal masses?
benign scrotal lesions presents as testicular maasses thatn cen be transilluminated
82
Scrotal masses vs solid testicular tumors according to transillumination
only scrotal can be transilluminated
83
Scrotal masses - types
1. congenital hydrocele
2. Acquired hydrocele
3. Spermatocele
84
congenital hydrocele?
Common cause of scrotal swelling in infants due to incomplete obliteration of processus vaginalis
85
Acquired hydrocele?
scrotal fluid collection usually 2ry to infection, trauma, tumor (if bloody --> hematocele)
86
bloody hydrocele -->
hematocele
87
Spermatocele?
cyst due to dilated epididymal duct or rete testis --> paratesticular fluctuant nodule
88
Extragonadal germ cell tumors - location
MIDLINE location:
- adults --> MC retroperitoneum, ediastinum, pineal, suprasellar regions
- young childrens: sacroccygeal teratomas are MC
89
Extragonadal germ cell tumors - adults vs young children according to location
- adults --> MC retroperitoneum, ediastinum, pineal, suprasellar regions
- young childrens: sacroccygeal teratomas are MC
90
Painful testicular tumor and its markers
embryonal carcinoma
if pure (rare) --> high hCG, normal AFP
if mixed with other tumors --> high hCG, increased AFP
91
testicular tumor with Reinke crystals (and what is that)
Leyding cells tumor --> eosinophilic cytoplasmic inclusions
92
testicular germ cell tumors can present as
mixed germ cell tumor
93
seminoma in female
dysgerminoma (but rarer
94
Paratesticular fluctant nodule
Spermatocele
