What is cryptorchidism, and how does it present clinically?
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)
Explain the pathogenesis of infections, such as balanitis, urethritis, prostatitis, eppididymitis, and orchitis.
Balanitis: inflammation of glans
- HSV = vesicles, shallow ulcers
- syphilis = ulcers
- 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
Compare genital herpes simplex infection and gonorrhea with nongonococcal urethritis.
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
What are the pathologic and clinical features of primary, secondary, and tertiary syphilis?
- 1 to 12 weeks after exposure, painless indurated ulcer
- chancre heals spontaneously 4-6 weeks
- 2mo to 2yrs
- systemic fever, malais, macular rash, lymphadenopathy
- papules (condyloma latum)
- granulomas (gummas)
- tabes dorsalis
- tertiary is incurable
How common are testicular tumors and in which age group are they most often encountered?
90% occur 25-45 years
90% are germ cell
90% are malignant
Classify testicular germ cell tumors.
yolk sac carcinoma
What is the difference between teratoma and teratocarcinoma?
Teratoma = ALL the embryonic cells differentiate into mature tissue
Teratocarcinoma = EC cells and somatic tissues
Which serologic tumor markers are useful for diagnosing testicular tumors?
hCG is secreted by trophoblasts; strong indicator of a germ cell tumor
AFP is secreted by yolk sac
How are testicular germ cell tumors treated, and what is the usual outcome of such treatment?
What is the difference between seminoma and nonseminomatous germ cell tumors?
Nonseminomatous have EC cells . . .
Compare Leydig cell tumors and sertoli cell tumors.
Leydig: produce testosterone or estrogen
Sertoli: benign, secrete inhibin and sex hormones
What is BPH and what are its causes?
Reactive enlargement of the periurethral portion of the prostate and median lobe.
Correlate pathologic and clinical findings in benign prostatic hyperplasia.
Hyperplastic glands surrounded by an increased amount of fibromuscular stroma.
How common is carcinoma of the prostate?
Most common cancer in males
3rd most common cause of cancer related deaths
Discuss the possible role of hormones in the pathogenesis of prostatic carcinoma.
Testosterone receptors have been found; however, testosterone levels are not elevated
Antitestosterone drugs retard tumor growth
Correlate the pathologic and clinical findings of prostatic carcinoma.
Most are adenocarcinoma
Symptoms begin when tumor enlarges >> pain (nerve invasion), dysuria, hematuria, constipation, intestinal obstruction
What is the value of prostate-specific antigen in the diagnosis of prostatic carcinoma?
Prostate cancer and normal cells produce
-nl = 4 ng/mL
-cx typically >10ng/mL
**Alk phosphatase may elevate (osteoblasts) with metastases
What is the outcome of treatment of prostatic carcinoma?
(extensive + radiation)
5 year survival with tumor limited to prostate = 75%
Spread = 35-50%
On what does the prognosis of prostatic carcinoma depend?
Most significant = extent of tumor
Correlate the pathologic and clinical features of carcinoma of the penis.
smegma = produce of penile coronal glands, admixed to desquamated cells and bacteria >> carcinogenic influence
Almost all are located on the glans