Male Reproductive Pathology

Question 1

where do most cases of BPH occur?

Answer 1

Transitional Zone!!!

Question 2

where do most cases of carcinomas occur? and why?

Answer 2

Peripheral zone! 70% of gland mass

Question 3

what types of bacteria cause acute prostatitis?

Answer 3

mostly Gram-negative rods (same organisms as UTIs: Proteus and E.coli)

Question 4

what digital rectal exam finding do you find in acute bacterial prostatitis? what clinical symptoms are present?

Answer 4

extremely tender and boggy. fever, chills, dysuria, very painful

Question 5

what is the clinical presentation for chronic bacterial prostatitis?

Answer 5

non-specific: low back pain, dysuria, perineal pain.

Question 6

what is the most common form of prostatitis today? what does it consist of?

Answer 6

chronic Abacterial. STD organisms have been implicated (Chlamydia, mycoplasma, ureaplasma)

Question 7

when should you really use PSA testing?

Answer 7

male w/ strong family history

Question 8

is BPH pre-malignant?

Answer 8

NO. nodular proliferation of both glands and stroma.

Question 9

clinical features of BPH?

Answer 9

nocturia**

Question 10

BPH treatment?

Answer 10

5-alpha reductase inhibitory (finasteride) testoterone>DHT. multiply PSAx2.3 if taking 1mg/d >4yrs

Question 11

why is vericocele great on the left?

Answer 11

because drainage has to go through renal vein first before IVC on the LEFT.

Question 12

where does testicular cancer metastize?

Answer 12

nodes

Question 13

what is phase 1 (transabdominal) of testicular descent controlled by?

Answer 13

mullerian-inhibiting substance

Question 14

what is phase 2 (inguinoscrotal: descends through inguinal canal into scrotum) of testicular descent controlled by?

Answer 14

androgen dependent.

Question 15

Cryptorchid testis cases are 75% ____ (unilateral or bilateral)

Answer 15

unilateral.

Question 16

what happens if cryptorchid testis is bilateral and left uncorrected?

Answer 16

sterility!

Question 17

what type of tumors are you at an increased risk for with Cryptorchid testis?

Answer 17

5-10x increase in germ cell tumors! WHILE, 5-10% of testicular germ cell tumors occur in cryptorchid testes

Question 18

what is the treatment for cryptorchid testis?

Answer 18

orchiopexy (stitch down to prevent movement). before 2yrs old for fertility, 10 yrs for neoplasm. deficient spermatogenesis still in 10-60% even WHEN corrected & still SOME increased risk of cancer REMAINS

Question 19

what are examples of chromosomal abnormalities leading to testicular infertility?

Answer 19

Klinefelter’s syndrome (47 XXY- sterility is the defining feature). Down’s syndrome (trisomy 21).

Question 20

what are the causes of bacterial Epididymo-orchitis in patients under 35 yrs old?

Answer 20

most are sexually transmitted: N. gonorrheae, Chlamydia, Mycoplasma, Treponema Pallidum (primary syphillis)

Question 21

a male patient noticed his left testicle looking like a ‘bag of worms’. name that disorder! what is it a cause of? is this painless or painful?

Answer 21

Varicocele. Infertility (relative HYPERthermia). painLESS.

Question 22

what are the two main types of testicular neoplasms? what are their subcategories?

Answer 22

Germ cell tumors & Sex cord stromal tumors.
Germ cell: Seminoma, nonseminoma (Embryonal carcinoma, yolk sac tumor, choriocarcinoma).
Sex cord stromal: Sertoli cell, Leydig cell tumor, ganulosa cell tumor, mixed.

Question 23

Are Nonseminoma Germ Cell Tumors benign or metastatic? what about sex cord stromal tumors??

Answer 23

Nonseminoma: metastatic.

Sex cord stromal: rare, benign, small.

Question 24

What is the most common type of testicular tumor (solid)? PATHOMA

Answer 24

Germ Cell Tumors (95% of cases)

Question 25

_____ (of the Germ Cell Tumors) are highly responsive to radiotherapy, metastasize late and have an excellent prognosis? PATHOMA

Answer 25

seminomas

Question 26

___ (of Germ Cell Tumors) often metastasize early? PATHOMA

Answer 26

NONseminomas

Question 27

what is the most common testicular tumor in children? what is characteristically elevated? PATHOMA

Answer 27

Yolk Sac (endodermal sinus) tumor is a malignant tumor. Schiller-Duval bodies seen on histology. AFP is characteristically elevated

Question 28

what is the most common cause of a testicular mass in males > 60 yrs, often bilateral? PATHOMA

Answer 28

Lymphoma (usually diffuse large B-cell type)

Question 29

what is referred to as the 'fish flesh tumor'? large, fleshy, homogenous that encompasses entire testicle and has NO hemorrhage or necrosis.

Answer 29

Seminoma. non-caseating granuloma

Question 30

what type of tumor is a malignant tumor comprised of immature, primitive cells that may produce glands; forms HEMORRHAGIC mass with necrosis? what is the usual age group? PATHOMA

Answer 30

Embryonal carcinoma. 20-30 yrs. more aggressive than Seminoma.

Question 31

what is a malignant tumor of syncytiotrophoblasts and cytotrophoblasts? what is characteristically elevated?

Answer 31

Choriocarcinoma. beta-hCG

Question 32

_____ is a tumor composed of mature fetal tissue derived from two or more embryonic layers?

Answer 32

teratoma

Question 33

teratoma: is it malignant or benign in males? females?

Answer 33

malignant in males, benign in females.

Question 34

where does hematogenous spread lead to?

Answer 34

lung, brain, liver

Question 35

T or F: Seminomatous component of mixed tumors usually does not metastasize?

Answer 35

He said TRUE. however, that's confusing since PATHOMA says seminomatous tumor is malignant but metastasizes LATE

Question 36

A patient gets diagnosed with a testicular cancer and it is confined to the testis. What stage is it?

Answer 36

Ia. Ib: spread to adnexa. Ic: spread to scrotum (rare bc tunixa holds tumor in)

Question 37

what stage involves the retroperitoneal lymphatics in testicular cancer?

Answer 37

Stage II.

Question 38

T or F: Seminoma will often remain localized?

Answer 38

True. 70% stage I.

Question 39

what is the least favorable non-seminomatous element?

Answer 39

choriocarcinoma

Question 40

are you more likely to have mortality in a seminoma or non-seminoma category?

Answer 40

non-seminoma (more aggressive and spreads faster and is hemorrhagic and necrotic). seminoma- does spread, but very LATE and is nonhemorrhagic and does not show necrosis.

Question 41

what elevation are you looking for in choriocarcinoma or syncitiotrophoblast?

Answer 41

hCG

Question 42

____ are exquisitely radiosensitive?

Answer 42

Seminomas

Question 43

_____ tumor is comprised of tubules and is usually clinically silent. what is it associated with?

Answer 43

Sertoli cell tumor. Gynecomastia

Question 44

what do Leydig cell tumors cause ((1) in children (2) in adults) due to elaborate production of androgens and/or estrogens?

Answer 44

causing precocious puberty in children or gynecomastia in adults.

Question 45

what are the most common primary sites of metastatic tumors in older males ?

Answer 45

lung and prostate

Question 46

what is a hydrocele due to?

Answer 46

failure to obliterate the inguinal canal. filling of fluid in tunica vaginalis. associated with incomplete closure of processus vaginalis