Male Reproductive System Lecture

Question 1

What does ultrasound help differentiate in scrotal swellings?

Answer 1

Cystic vs. solid swellings and detection of small lesions.

Question 2

What is the purpose of the transillumination test?

Answer 2

To determine if a lesion is fluid-filled (cystic) or solid; fluid-filled lesions transmit light.

Question 3

When does transillumination typically indicate a cystic lesion?

Answer 3

When the fluid is clear (serous), not purulent or bloody.

Question 4

What is the use of a needle or catheter in evaluating swellings?

Answer 4

To aspirate or sample fluid from cystic lesions (paracentesis).

Question 5

Name key serum biomarkers used in testicular tumour evaluation.

Answer 5

AFP (alpha-fetoprotein), beta-hCG, LDH (lactate dehydrogenase).

Question 6

What are serum tumour markers used for?

Answer 6

Tumour classification, staging, assessing tumour burden, and monitoring therapy response.

Question 7

Why is biopsy generally avoided in solid testicular masses?

Answer 7

Risk of tumour cell seeding/spread due to vascular injury during biopsy.

Question 8

What is the standard management approach for a testicular mass?

Answer 8

Consider it malignant; perform radical orchiectomy.

Question 9

What confirms the diagnosis of a testicular mass?

Answer 9

Pathological examination of the removed testicle post-orchiectomy.

Question 10

What is a hydrocoele?

Answer 10

Clear fluid collection in the tunica vaginalis; presents as painless swelling with positive transillumination.

Question 11

What causes congenital hydrocoele?

Answer 11

Patent processus vaginalis allowing peritoneal fluid into the scrotum. (Communicating type)

Question 12

What causes acquired hydrocoele?

Answer 12

Trauma, infection, tumour, surgery, or impaired fluid absorption. (Non-communicating type).

Question 13

What is the most common cause of testicular swelling?

Answer 13

Hydrocoele.

Question 14

What is a pyocoele?

Answer 14

Pus collection in the tunica vaginalis (abscess).

Question 15

What is a haematocoele?

Answer 15

Blood collection in the tunica vaginalis, usually from trauma.

Question 16

What is a spermatocoele?

Answer 16

A cystic swelling in the epididymis.

Question 17

What is a varicocoele?

Answer 17

Dilation of pampiniform plexus veins; feels like a “bag of worms”.

Question 18

What is a lymphocoele?

Answer 18

Lymphatic obstruction causing fluid collection.

Question 19

What is cryptorchidism?

Answer 19

Undescended testicle; should descend by 6 months of age.

Question 20

What risk is increased in cryptorchidism?

Answer 20

3–5× increased risk of testicular cancer, even in the contralateral descended testicle.

Question 21

What is the pathological consequence of cryptorchidism on seminiferous tubules?

Answer 21

Atrophy and possible development of GCNIS (germ cell neoplasia in situ).

Question 22

What is the name of the surgery to correct cryptorchidism?

Answer 22

Orchiopexy.

Question 23

What is testicular torsion?

Answer 23

Twisting of the spermatic cord, leading to obstruction of venous drainage, ischaemia, and potentially haemorrhagic necrosis of the testicle.

Question 24

Why are veins more affected than arteries in torsion?

Answer 24

Veins are thinner-walled and more easily compressed, leading to blood engorgement and ischaemia despite patent arteries.

Question 25

What is the visual appearance of a necrotic testicle due to torsion?

Answer 25

Dark or black due to haemorrhagic necrosis.

Question 26

What is the critical time window for testicle salvage in torsion?

Answer 26

Ideally within 6 hours of onset.

Question 27

What is extravaginal torsion and when does it occur?

Answer 27

Torsion that occurs prenatally, before the testicle descends into the scrotum.

Question 28

What is intravaginal torsion and who is affected?

Answer 28

Torsion within the tunica vaginalis; typically affects post-pubertal boys, peak age 13–14 years.

Question 29

What condition predisposes to intravaginal torsion?

Answer 29

Bell Clapper Syndrome—failure of tunica vaginalis to anchor the testicle, allowing it to twist freely.

Question 30

What age group is most commonly affected by testicular tumours?

Answer 30

Males aged 15–34 years.

Question 31

What is the usual presentation of a testicular tumour?

Answer 31

Painless testicular mass.

Question 32

List key risk factors for testicular tumours.

Answer 32

Cryptorchidism, family history, intersex syndromes, environmental factors (especially in utero).

Question 33

What percentage of testicular tumours are Germ Cell Tumours (GCTs)?

Answer 33

Approximately 95%.

Question 34

What is the precursor lesion of GCTs?

Answer 34

Germ Cell Neoplasia in Situ (GCNIS).

Question 35

What is the multistep model of GCT pathogenesis?

Answer 35

Normal → Atrophy (e.g., cryptorchidism) → GCNIS → Invasive cancer.

Question 36

What is the most common type of GCT?

Answer 36

Seminoma.

Question 37

What age group is most affected by seminoma?

Answer 37

30–40 years.

Question 38

What is the histological appearance of seminoma?

Answer 38

Large cells with “fried egg” appearance, tumour nests with lymphocytes.

Question 39

What serum marker is often elevated in seminoma?

Answer 39

PLAP (Placental Alkaline Phosphatase); may have β-hCG if mixed with choriocarcinoma.

Question 40

What is the general behaviour of non-seminomatous GCTs?

Answer 40

More aggressive and likely to spread.

Question 41

What tumour is associated with elevated AFP and Schiller-Duval bodies?

Answer 41

Yolk Sac Tumour.

Question 42

What tumour contains cytotrophoblasts and syncytiotrophoblasts?

Answer 42

Choriocarcinoma.

Question 43

What marker is elevated in choriocarcinoma?

Answer 43

Beta-hCG.

Question 44

What are the features of a teratoma?

Answer 44

Tumour with tissues from endoderm, mesoderm, and ectoderm; can be solid-cystic and heterogeneous.

Question 45

Identify.

Answer 45

Seminoma.

Question 46

Identify.

Answer 46

Choriocarcinoma.

Question 47

Identify.

Answer 47

Teratoma.

Question 48

Identify.

Answer 48

Yolk Sac.

Question 49

Identify.

Answer 49

Seminoma.

Question 50

Identify.

Answer 50

Choriocarcinoma.

Question 51

Identify.

Answer 51

Yolk Sac.

Question 52

Identify.

Answer 52

Teratoma.

Question 53

Are prepubertal teratomas malignant?

Answer 53

Generally benign.

Question 54

Are postpubertal teratomas malignant?

Answer 54

Yes, they can metastasise.

Question 55

What are mixed tumours?

Answer 55

Tumours containing multiple GCT types (e.g., seminoma + choriocarcinoma).

Question 56

Name two types of sex chord stromal tumours.

Answer 56

Sertoli cell tumour and Leydig cell tumour.

Question 57

What hormones do Leydig cell tumours produce?

Answer 57

Primarily produce testosterone, although they can also produce other androgens or oestrogens.

Question 58

What is a possible symptom of a Leydig cell tumour?

Answer 58

Gynaecomastia due to hormone production.

Question 59

What is the typical behaviour of Sertoli cell tumours?

Answer 59

Usually non-functional and benign; 10% are malignant.

Question 60

What is the role of LDH in GCTs?

Answer 60

Non-specific marker of tumour burden.

Question 61

What does persistent elevation of AFP, hCG, or LDH after orchiectomy suggest?

Answer 61

Metastatic disease.

Question 62

Describe the basic staging of testicular GCTs.

Answer 62

Stage 1: Confined to testis Stage 2: Lymph nodes below diaphragm Stage 3: Above diaphragm/distant organs No Stage 4.

Question 63

Answer 63

Seminoma.

Question 64

Answer 64

Choriocarcinoma.

Question 65

Answer 65

Yolk Sac Tumour.

Question 66

Answer 66

Teratoma.

Question 67

What is the most common origin zone of BPH?

Answer 67

Transitional Zone of the prostate.

Question 68

What are classic LUTS symptoms in BPH?

Answer 68

Urinary hesitancy, urgency, nocturia, weak stream.

Question 69

What hormone drives BPH?

Answer 69

DHT (dihydrotestosterone).

Question 70

What enzyme converts testosterone to DHT?

Answer 70

5α-reductase.

Question 71

What are common bladder complications of BPH?

Answer 71

Bladder hypertrophy, diverticulae, infection, stones.

Question 72

Is BPH a precursor to prostate cancer?

Answer 72

No.

Question 73

What is the histological appearance of BPH?

Answer 73

Question 74

What medication class treats BPH by reducing DHT?

Answer 74

5α-reductase inhibitors (e.g., finasteride).

Question 75

Where does prostate cancer typically arise?

Answer 75

Peripheral Zone.

Question 76

What precursor lesion is associated with prostate cancer?

Answer 76

Prostatic Intraepithelial Neoplasia (PIN).

Question 77

What is the role of PSA in diagnosis?

Answer 77

Screening and monitoring; elevated PSA may suggest cancer, but is non-specific.

Question 78

What are limitations of PSA testing?

Answer 78

False positives (BPH, prostatitis, DRE), and false negatives (some cancers do not raise PSA).

Question 79

What is the Gleason scoring system used for?

Answer 79

Grading prostate cancer based on gland architecture (score 2–10). Higher score = worse prognosis.

Question 80

What are the main cancer types driven by HPV?

Answer 80

Anal (~90%) Cervical (~90%) Oropharyngeal (70%) Penile (63%) Vaginal (75%) Vulvar (69%)

Question 81

What are the different types of HPV based on risk?

Answer 81

Low-risk: 6, 11 → warts High-risk: 16, 18, 31, 33, etc. → cancers; 16 & 18 most oncogenic

Question 82

What type of bone metastasis is typical in prostate cancer?

Answer 82

Osteoblastic (bone-forming) lesions.

Question 83

What gene mutation increases hereditary prostate cancer risk?

Answer 83

BRCA2 mutation.

Question 84

What is the most common cause of testicular swelling?

Answer 84

Hydrocele

Question 85

What is the medical term for an undescended testicle?

Answer 85

Cryptorchidism

Question 86

Which hormone plays a key role in the pathogenesis of benign prostatic hyperplasia (BPH)?

Answer 86

Dihydrotestosterone (DHT)

Question 87

What is a common metastatic site for disseminated prostate cancer?

Answer 87

Bone

Question 88

Are bone lesions from prostate cancer typically osteolytic or osteoblastic?

Answer 88

Osteoblastic

Question 89

Name a common pharmaceutical treatment for BPH.

Answer 89

Tamsulosin or Finasteride

Question 90

Which enzyme converts testosterone to DHT?

Answer 90

5-alpha-reductase

Question 91

What is the predominant proliferative cell type in the stroma of BPH?

Answer 91

Fibroblast

Question 92

What grading system is used to assess the behavior of prostate cancer?

Answer 92

Gleason grading system

Question 93

What is the most common type of penile cancer?

Answer 93

Squamous cell carcinoma (SCC)

Question 94

Name a non-specific biomarker used in prostate cancer diagnosis.

Answer 94

Prostate-Specific Antigen (PSA)

Question 95

Which testicular tumor is associated with elevated alpha-fetoprotein (AFP)?

Answer 95

Yolk sac tumor (Endodermal sinus tumor)

Question 96

What is the most common benign tumor in the female breast?

Answer 96

Fibroadenoma

Question 97

Which gene is most frequently mutated in cancer and targeted by HPV early proteins?

Answer 97

TP53

Question 98

What type of breast cancer shares features with diffuse gastric carcinoma?

Answer 98

Invasive lobular carcinoma

Question 99

What surgical procedure is used to correct an undescended testicle?

Answer 99

Orchidopexy

Question 100

What is the precursor lesion for invasive prostate cancer?

Answer 100

Prostatic intraepithelial neoplasia (PIN)

Question 101

Which germ cell tumor contains mixed tissue lineages?

Answer 101

Teratoma

Question 102

A major risk factor for penile cancer is infection with what virus?

Answer 102

Human papillomavirus (HPV)

Question 103

What is the name of a cystic lesion in the epididymis?

Answer 103

Spermatocele

Question 104

Which aggressive testicular germ cell tumor is associated with elevated beta-hCG?

Answer 104

Choriocarcinoma

Question 105

What is a classic histological feature of squamous cell carcinoma?

Answer 105

Keratin pearls

Question 106

What is the testicular counterpart to ovarian dysgerminoma?

Answer 106

Seminoma

Question 107

Name a non-specific serum marker of testicular tumor burden.

Answer 107

Lactate dehydrogenase (LDH)

Question 108

Teratomas in prepubertal boys are typically considered what?

Answer 108

Benign

Question 109

Which germline mutation increases familial risk for prostate cancer?

Answer 109

BRCA2