What is hypospadias?
Opening of the urethra on inferior surface of the penis
- Due to failure of urethral folds to close:
What is epispadias?
Opening of the urethra on superior surface of the penis
- Due to abdnormal positioning of genital tubercle
- Associated with bladder extrophy
What is condyloma acuminatum?
Benign warty growth on genital skin
- Due to HPV 6 or 11
- characterized by koilocytic change ("raisin appearing" nuclei)
What is lymphogranuloma Venereum?
Necrotizing granulomatous inflammation of inguinal lymphatics and lymph nodes
- STI caused by Chlamydia trachomatis (L1-L3) - an obligate intracellular organism (can only grow inside another cell b/c can't create its own ATP)
- Eventually heals with fibrosis; perianal involvement may result in rectal strictures
What is the infectious form of Chlamydia trachomatis?
(they form reticular bodies as they replicate in the cell and release as infectious elementary bodies)
What are risk factors for squamous cell carcinoma of the penis?
HPV (2/3 cases)
Lack of circumcision (through improper maintenance of the foreskin)
What are possible precursor lesions to penile squamous cell carcinoma?
All forms of in situ carcinoma:
Bowen disease: leukoplakia on shaft of penis
Erythroplasia of Queyrat: erythroplakia on glans of penis
Bowenoid papulosis: reddish papules persist on penis
What is cryptoorchidism?
Failure of testicle to descend into the scrotal sac
*most common congenital male reproductive abnormality
- Most cases spontaneously resolve
--> if doesn't resolve by age of 2, surgeon will perform orchiopexy to put testicle into scrotal sac
What are the risks of cryptoorchidism?
Testicular atrophy with infertility
Increased risk for seminoma
What is orchitis? What can cause it?
Inflammation of the Testicle
- Chlamydia trachomatis (D-K) or Neisseria gonorrhoeae (typically younger adults - STIs)
- E. coli or Pseudomonas (typically older adults - typical UTI infections that can spread to reproductive tract)
- Mumps virus
- Autoimmune orchitis
What is testicular torsion?
- Twisting of spermatic cord: causes thin-walled vein to close, but thick-walled artery to persist, allowing blood in but not out
--> leads to hemorrhagic infarction
What can put a man at increased risk for testicular torsion?
Can be due to congenital failure of testes to attach to inner lining of scrotum
- present in adolescents with sudden testicular pain and absent cremasteric reflex
What is a varicocele? How does it present?
Dilation of spermatic vein due to impaired drainage
- Presents as scrotal swelling with 'bag of worms' appearance - veins become dilated and visible on scrotum
- Usually left-sided
- Associated with left-sided renal cell carcinioima as the carcinoima invades the renal vein and blocks the left spermatic vein
- Seen in large percentage of infertile males
What is a hydrocele? What does it present with?
Fluid collection within tunica vaginalis
- Associated with incomplete closure of processus vaginalis (infants) or blockage of lymphatic drainage (adults)
- Presents as scrotal swelling that can be transluminated
What are general characteristics of testicular tumors?
- Arise from germ cells or sex-cord stroma
- Presents as firm, painless testicular mass that cannot be transilluminated
- Not biopsied due to risk of seeding scrotum; removed via radial orchiectomy, also ~95% of testicular tumors are germ cell tumors and, thus, malignant and must be removed regardless
What is the most common type of testicular tumor?
What are common causes or risk factors?
Germ Cell Tumors
- Usually occur between 15-40 yrs of age
What are the different types of Testicular Germ Cell Tumors?
- Embryonal carcinoma: consisting of (c/o) anaplastic cells
- Mature teratoma: c/o tissue segments of cartilage, intestinal glands, and skin with epiderma/dermal components
- Yolk sac tumor: c/o cuboidal cells in reticular pattern
- Seminoma: c/o large cells with distinct cell borders, central nuclei and prominent nucleoli (better prognosis)
- Choriocarcinoma: c/o neoplastic cryptophoblastic and syncytiotrophoblastic cells admixed with hemorrhage
What are characterstics of a seminoma?
Malignant tumor of large cells with clear cytoplams and central nuclei
- Homogenous mass with no hemorrhage or necrosis
- rare cases may produce beta-hCG
- Good prognosis: responds to radiotherapy
What are characteristics of embryona carcinoma?
Malignant tumor of immature, primitive cells that may form glands
- Hemorrhage mass with necrosis
- Aggressive with early hematogenous spread
- Chemotherapy may result in differentiation into a different carcinoma (i.e. teratoma)
- Increased AFP (classically yolk-sac tumor) or beta-hCG (classically choriocarcinoima) may be present
What are characteristics of a yolk sac tumor?
Malignant tumor that resembles yolk sac elements
- Most common testicular tumor in children
- Alpha fetoprotein (AFP) is characteristically elevated
What is a histological sign of yolk sac tumors?
Also called a "glomeruloid-like" structure
What are characteristics of choriocarcinoma?
Malignant tumor of synctiotrophoblasts (make ß-hCG) and cytotrophoblasts --> mimics placental tissue w/o villi
- Spreads early via blood b/c s.blasts and c.blasts are genetically programmed to find blood vessels for implanatation of placenta into uterine wall
--> leads to tiny primary mass in testicles and large metastatic masses
- ß-hCG is characteristically elevated; may lead to hyperthyroidism or gynecomastia
What are characteristics of a teratoma?
Tumor of mature fetal tissue
- Derived from two or three embryonic layers
- Malignant in males (benign in females)
- AFP or ß-hCG may be expressed
What type of germ cell tumors are the vast majority of testicular germ cell tumors?
Mixed Germ Cell Tumors
- Prognosis based on worst component
What type of testicular tumors are NOT germ cell tumors?
Sex Cord-Stromal Tumors
- Usually benign
- Resemble sex cord-stromal tissues of testicle
Leydig cell tumors
Sertoli cell tumors
What are characteristics of leydig cell tumors?
Testicular tumor - usually benign
- Usually produces androgen
Can lead to precocious puberty in children or gynecomastia in adults
- Characteristic Reinke crystals seen on histology
What are characteristics of sertoli cell tumors?
Sex cord-stromal tumor of testicles
Comprised of tubules
Usually clinically silent
What is the most common cause of testicular mass in males >60?
Lymphoma (often bilateral)
- Usually diffuse large B-cell lymphoma
What is acute prostatitis? What casues it?
Acute inflammation of prostate, usually due to bacteria:
- C. trachomatis and N gonorrhoeaa (young adults)
- E coli and Pseudomonas (older adults)
What are symptoms of acute prostatitis?
Dysuria with fever and chills
- Prostate is tender and boggy on rectal exam
- Prostatic secretions show WBCs --> culture reveals bacteria
What is chronic prostatitis? What are its symptoms?
Chronic inflammation of prostate
- Presents as dysuria with pelvic or low back pain
- Prostatic secretions show WBCs, but cultures are negative
What is Benign Prostatic Hypertrophy?
Hyperplasia of prostatic stroma and glands
- Age-related change, no increased risk for cancer
- related to DHT (Dihydrotestosterone)
- Occurs in perirurethral zone of prostate
What are clinical features of BPH?
- Problems starting/stopping urine stream
- Impaired bladder emptying
- Hypertrophy of bladder wall smooth muscle
- Microscopic hematuria
- PSA is often slightly elevated (due to increased prostatic glands) --> levels from 0-4
- can result in hydronephrosis
What are treatment options for BPH?
- a1-antagonist (terazosin) to relax smooth muscle (also benefits hypertensive patients)
- Selective a1A-antagonist (tamsulosin) in normotensive individuals
- 5a-reductase inhibitor (finasteride)
What are characteristics of Prostate Adenocarcinoma? Risk factors?
Malignant proliferation of prostatic glands
- Most common cancer in men; 2nd most common cause of cancer death
- Risk factors include:
diet high in saturated fats
What is the most common site for prostate adenocarcinoima?
Posterior periphery of prostate
- less likely to produce urinary symptoms until very late, high growth malignancies
How is screening for prostate adenocarcinoma accomplished?
- Begins at 50 with digital rectal exam (DRE) and prostate specific antigen (PSA)
- Normal serum PSA increases with age
- PSA > 10ng/dl is worrisome at any age (>4ng/dl, start considering adenocarcinoma)
- Look at levels of free PSA: decreased % free-PSA is suggestive of cancer (makes bound PSA)
- Prostatic biopsy is required to confirm the presence of carcinoma
What are histological signs of prostate adenocarcinoma from biopsy?
Prostatic cells with dark nucleoli
What is the Gleason Grading System?
System of grading prostatic adenocarcinoma
- Based on architecture, not nuclear atypia
- Completed by comparing two areas of biopsy
--> each pattern's scored from 1-5 and the scores are added to determine final score
What is a common site of metastases for prostate adenocarcinoma?
- Osteoblastic metastases (as opposed to lytic "punched out" lesions of multiple myeloma)
- Present as low back pain with increased alkaline phosphatase (bone is being laid down), PSA, and PAP
What treatments are available for prostate cancer?