Male Reproductive System

Question 1

What is cryptorchidism, and how does it present clinically?

Answer 1

Incomplete descent of the testes

In 3-4%, the inguinal canal remains open, therefore the cremaster muscle pulls the testes back into the abdominal cavity

10x greater risk for malignant transformation
(surgical correction decreases, but does not eliminate)

Question 2

Explain the pathogenesis of infections, such as balanitis, urethritis, prostatitis, eppididymitis, and orchitis.

Answer 2

Balanitis: inflammation of glans

• HSV = vesicles, shallow ulcers
• syphilis = ulcers

**Urethritis: **urethra

• Gonorrhea = purulent exudate
• mycoplasma = no exudate
• chlamydia = urethritis, uveitis, arthritis (Reiter’s)

**Prostatitis: **stagnation of urine

• gram negatives = pain, urgency, fever

**Epididymitis: **ascending infection

• young = gonorrhea, chlamydia
• old = obstruction, surgery

**Orchitis: **isolated or complication of epididymitis

Question 3

Compare genital herpes simplex infection and gonorrhea with nongonococcal urethritis.

Answer 3

HSV2 >> blisters >> travel along axons of peripheral nerves >> ganglia >> reactivation

Gonorrhea >> purulent urethritis

Chlamydial >> most common cause of bacterial urethritis in men >> urethral pain, NO discharge

Question 4

What are the pathologic and clinical features of primary, secondary, and tertiary syphilis?

Answer 4

Primary

• 1 to 12 weeks after exposure, painless indurated ulcer
• chancre heals spontaneously 4-6 weeks

Secondary

• 2mo to 2yrs
• systemic fever, malais, macular rash, lymphadenopathy
• papules (condyloma latum)

Tertiary

• granulomas (gummas)
• aneurysms
• tabes dorsalis
• tertiary is incurable

Question 5

How common are testicular tumors and in which age group are they most often encountered?

Answer 5

90% occur 25-45 years

90% are germ cell

90% are malignant

90% curable

Question 6

Classify testicular germ cell tumors.

Answer 6

Seminoma

Nonseminomatous

embryonal carcinoma

teratocarcinoma

choriocarcinoma

yolk sac carcinoma

Question 7

What is the difference between teratoma and teratocarcinoma?

Answer 7

Teratoma = ALL the embryonic cells differentiate into mature tissue

Teratocarcinoma = EC cells and somatic tissues

Question 8

Which serologic tumor markers are useful for diagnosing testicular tumors?

Answer 8

hCG is secreted by trophoblasts; strong indicator of a germ cell tumor

AFP is secreted by yolk sac

Question 9

How are testicular germ cell tumors treated, and what is the usual outcome of such treatment?

Question 10

What is the difference between seminoma and nonseminomatous germ cell tumors?

Answer 10

Nonseminomatous have EC cells . . .

Question 11

Compare Leydig cell tumors and sertoli cell tumors.

Answer 11

Leydig: produce testosterone or estrogen

Sertoli: benign, secrete inhibin and sex hormones

Question 12

What is BPH and what are its causes?

Answer 12

Reactive enlargement of the periurethral portion of the prostate and median lobe.

Question 13

Correlate pathologic and clinical findings in benign prostatic hyperplasia.

Answer 13

Hyperplastic glands surrounded by an increased amount of fibromuscular stroma.

Question 14

How common is carcinoma of the prostate?

Answer 14

Most common cancer in males

3rd most common cause of cancer related deaths

Question 15

Discuss the possible role of hormones in the pathogenesis of prostatic carcinoma.

Answer 15

Testosterone receptors have been found; however, testosterone levels are not elevated

Antitestosterone drugs retard tumor growth

Question 16

Correlate the pathologic and clinical findings of prostatic carcinoma.

Answer 16

Most are adenocarcinoma

Symptoms begin when tumor enlarges >> pain (nerve invasion), dysuria, hematuria, constipation, intestinal obstruction

Question 17

What is the value of prostate-specific antigen in the diagnosis of prostatic carcinoma?

Answer 17

Prostate cancer and normal cells produce

• nl = 4 ng/mL
• cx typically >10ng/mL

**Alk phosphatase may elevate (osteoblasts) with metastases

Question 18

What is the outcome of treatment of prostatic carcinoma?

Answer 18

Surgical resection

(extensive + radiation)

5 year survival with tumor limited to prostate = 75%

Spread = 35-50%

Question 19

On what does the prognosis of prostatic carcinoma depend?

Answer 19

Histology grade

Most significant = extent of tumor

Question 20

Correlate the pathologic and clinical features of carcinoma of the penis.

Answer 20

smegma = produce of penile coronal glands, admixed to desquamated cells and bacteria >> carcinogenic influence

Almost all are located on the glans