Penis and Scrotum Pathology - Iczkowski Flashcards Preview

M2 Endo/Repro > Penis and Scrotum Pathology - Iczkowski > Flashcards

Flashcards in Penis and Scrotum Pathology - Iczkowski Deck (33):

What is the medical term for the foreskin of the penis?



  1. What is Hypospadias? What is it caused by?
  2. What is Epispadias? What is it caused by?

  1. Hypospadias
    • Abnormal opening of the urethra on the ventral surface of the penis
    • Due to faulty closure of the urethral folds
  2. Epispadias
    1. Abnormal opening on the dorsal surface of the penis
    2. Due to a defect in the genital tubercle (developmental structure that forms [at least part of] the actual phallus)
  • N.B. The ventral side of the penis is the "underside". It can be (humorously) helpful to think of the penis as being erect when in in the anatomic position.


Is hypospadias or epispadias more common?

Hypospadias (ventral surface, problem of urethral folds) is more common, and in fact is the most common penile malformation.


Where along the ventral surface of the penis can a hypospadic opening occur?

Anywhere, really:

  • Glanular hypospadias
  • Coronal hypospadias
  • Penile shaft hypospadias
  • Perineal hypospadias


  1. What is phimosis?
  2. What problems can it cause?
  3. What is the most common cause of phimosis?
  4. How is it treated?

  1. When the orifice of the prepuce is too small to retract over the head of the penis.
  2. Can cause trouble with urination or sexual functions
  3. Prepuce scarring from a prior infection
  4. Surgical circumcision

(N.B. Wiki says "At birth, the foreskin is fused to the glans and is not retractable. Huntley et al. state that "non-retractability can be considered normal for males up to and including adolescence.")


  1. What is balanitis?
  2. What is balanoposthitis?
  3. What type of patient do these conditions typically affect?

  1. Inflammation / infection of the glans
  2. Inflammation / infection of both the glans and prepuce
  3. Uncircumsized males with poor hygeine


What tpyes of pathogens commonly cause balanitis / balanoposthitis?

  • Candida
  • Pyogenic bacteria
  • Anaerobic bacteria


What do balanitis / balanoposthitis need to be distinguished from?

Ammoniacal dermatitis

The "normal" redness seen in boys still in diapers.


What is Balanitis Xerotica Obliterans (BXO, also previously called Lichen Sclerosis et Atrophicus)?

How does it appear?

  • A dermatological disease of unknown cause
    • Proposed factors include infection, autoimmunity, and genetics
  • Affects mainly the glans and prepuce of the penis
  • Appears as atrophic white patches, often featuring a whitish ring of hardened tissue near the tip
  • Histologically:
    • Thin epidermis
    • "Glassy" appearing dermis
    • Inflammatory infiltrates within the dermis


  1. What type of disease is Peyronie's Disease?
  2. How does it present?
  3. What is a notable complication?
  4. How is it treated?

  1. A fibromatosis
  2. Painful contractures of the penis. Wiki: causes "pain, abnormal curvature, erectile dysfunction, indentation, loss of girth and shortening"
  3. Infertility
  4. Surgical correction


Name 3 diseases that feature squamous cell carcinoma in situ (CIS) on the penis.

Which of these diseases can progress to an invasive carcinoma?

  • Bowen's Disease - 10% become invasive
  • Eryhtroplasia of Queyrat - can become invasive
  • Bowenoid Papulosis - does not become invasive


Bowen's Disease

  1. What parts of the male genitalia does it occur on?
  2. How old is the typical patient?
  3. Does it have any association with HPV?
  4. Is it associated with other malignancies?

Bowen's Disease

  1. Shaft of the penis & scrotum
  2. >35 years old
  3. HPV 16 & 18 associations
  4. 10% progress to invasive squamous cell carcinoma; also has association with other visceral cancers


Erythroplasia of Queyrat

  • How does it appear? What parts of the genitalia are affected?
  • HPV association?
  • Invasive?

Erythroplasia of Queyrat

  • Redness on the mucosal surface of the glans and prepuce
  • HPV 16
  • Can progress to invasive squamous cell carcinoma


Bowenoid Papulosis

  • How does it appear? What parts of the genitalia are affected?
  • HPV association?
  • Invasive?

Bowenoid Papulosis​

  • Multiple pigmented reddish brown papules; can be anwhere on the external genitalia
  • HPV 16
  • No predisposition for invasion


How does HPV infection alter the appearance of individual epithelial cells?

  • Nuclear Enlargement (2-3x)
  • Irregular nuclear membrane contour
  • Hyperchromasia (darker-staining)
  • Perinuclear halo

Recall (trivia): HPV-infected squamous epithelial cells are called Koilocytes


Invasive Squamous Cell Carcinoma

  • How common is it among penile cancers?
  • How old is the typical patient?
  • What are the most common sites on the penis?

Invasive Squamous Cell Carcinoma

  • Most common cancer of the penis
  • 40-70 years old
  • Glans or mucosal surface of prepuce


Invasive Squamous Cell Carcinoma

Name five risk factors.

Invasive Squamous Cell Carcinoma

  1. HPV 16 & 18 - 2/3 of cases
  2. Bowen's Disease

  3. Erythroplasia of Queyrat

  4. Smoking
  5. Lack of circumcision


Which lymph nodes does invasive squamous cell carcinoma metastasize to?

  • Inguinal
  • Iliac


In the staging of penile squamous cell carcinoma, invasion into what tissue is very important? Why?

Corpus spongiosum / cavernosum invasion

These tissues contain abundant blood vessels that facilitate spread of the cancer.



Describe the following stages of penile squamous cell carcinoma [may be low-yield]:

  • Tis
  • Ta
  • T1
  • T2
  • T3
  • T4

  • Tis: Carcinoma in situ - no invasion
  • Ta: Noninvasive, verrucous wart-like carcinoma
  • T1: Invasion into the subepithelial connective tissue
  • T2: Invasion into the corpus spongiosum/cavernosum
  • T3: Invasion into the urethra
  • T4: Invasion into other (i.e., more distal?) structures


How is penile squamous cell carcinoma treated?

Partial or Total Penectomy

Partial required at stage T1.

Total required at stage T2 or above.

(Wiki says that depending on staging, rad/chemo may be used, as well as several other surgeries that can be more sparing of healthy tissue.)


What is the most common cause of skin afflictions of the scrotum?

  • Contact with affected penile skin
  • Include HPV infection and squamous cell carcinoma


What is a varicocele?

What is a hydrocele?

Varicocele: Abnormal enlargement of the vein in the scrotum that is draining the testicles.

Hydrocele: Accumulation of fluid around the testis


Which side of the scrotum is more susceptible to developing a varicocele, and why?

Knowing the previous answer, what non-reproductive tract pathology can often cause a varicocele?


Left side

While the right spermatic vein drains directly into the vena cava, the left spermatic vein drains into the smaller left renal vein (increased resistance to blood flow.)

Renal cell carcinoma that invades the renal vein can cause a varicocele


What is a very common consequence of varicocele, and why?

Infertility - excess heat (from the pooled blood) decreases spermatogenesis


Compare the appearance of a varicocele with that of a hydrocele.

Varicocele: "Bag of Worms"

Hydrocele: General scrotal enlargement; feels like a smooth, fluid-filled balloon inside the scrotum


What space is the fluid actually accumulating in a hydrocele testis?

What is the origin of this space?

Fluid is secreted into a potential space called the tunica vaginalis (TV).

TV is derived from an extension of the peritoneum, wrapped around the testis (recall the development and migration of the testes during development, the inguinal canal, etc.)


What is the most common cause of scrotal enlargement?



What population is hydrocele a common problem for?

Bike riders


Name an example of pathology that would cause a right-sided varicocele.

Retroperitoneal fibrosis causing blockage of the right spermatic vein before it reaches the inferior vena cava.


How is a hydrocele diagnosed?


Distinguishes fluid in the TV versus a testicular mass as the source of scrotal enlargement


What is a hematocele?

A spermatocele?

Hematocele: Accumulation of blood in the TV.

Spermatocele: Fluid in the TV contains sperm.


How is a hydrocele or other fluid accumulation in the TV treated?


Removal of TV

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