Repro - Pathology (Male Reproductive pathology) Flashcards Preview

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Flashcards in Repro - Pathology (Male Reproductive pathology) Deck (72):
1

What are 4 symptoms of prostatitis?

Prostatitis - (1) Dysuria (2) Frequency (3) Urgency (4) Low back pain

2

What is (are) the causes of acute versus chronic prostatitis? Which is most common?

ACUTE: bacterial (e.g., E. coli); CHRONIC: bacterial or abacterial (most common)

3

In what patient population is benign prostatic hyperplasia common?

Common in men > 50 years old.

4

Define the physiological change benign prostatic hyperplasia.

Hyperplasia (not hypertrophy) of the prostate gland

5

What physical findings characterize benign prostatic hyperplasia? Is it a premalignancy?

Characterized by a smooth, elastic, firm nodular enlargement of the periurethral (lateral and middle) lobes, which compress the urethra into a vertical slit. Not considered a premalignant lesion.

6

What are 4 signs/symptoms with which benign prostatic hyperplasia often presents?

Often presents with (1) increased frequency of urination, (2) nocturia, (3) difficulty starting and stopping the stream of urine, and (4) dysuria.

7

What are 3 conditions/complications that may result from benign prostatic hyperplasia?

May lead to (1) distention and hypertrophy of the bladder, (2) hydronephrosis, and (3) UTIs.

8

What key lab finding is associated with benign prostatic hyperplasia?

Increased free prostate specific antigen (PSA)

9

What are the treatment options for benign prostatic hyperplasia? What is the mechanism behind these treatments?

Treatment: alpha-1 antagonists (terazosin, tamsulosin), which cause relaxation of smooth muscle; Finasteride (5alpha-reductase inhibitor)

10

Draw a visual of the prostate, including and labeling the following: (1) Anterior lobe (2) Benign prostatic hyperplasia (boundaries) (3) Lateral lobe (4) Middle lobe (5) Posterior lobe (6) Prostate cancer (7) Urethra.

See p. 586 in First Aid 2014 for visual at bottom right of page

11

In what patient population is prostatic adenocarcinoma common? What other reproductive pathology is also notable for being common in this patient population?

Common in men > 50 years old; Benign prostatic hyperplasia

12

From where in the prostate gland does prostatic adenocarcinoma most often arise? How is it most frequently diagnosed?

Arises most often from the posterior lobe (peripheral zone) of the prostate gland and is most frequently diagnosed by increased PSA and subsequent needle core biopsies.

13

What are 2 useful tumor markers for prostatic adenocarcinoma?

Prostatic acid phosphatase (PAP) and PSA are useful tumor markers (increase total PSA, with decreased fraction of free PSA).

14

What complication may develop in late stages of prostatic adenocarcinoma? What 3 symptoms/signs indicate this?

Osteoblastic metastases in bone may develop in late stages, as indicated by lower back pain and an increase in serum ALP and PSA.

15

What histological finding(s) characterize(s) Prostatic adenocarcinoma?

Note the small neoplastic glands with prominent nucleoli amid normal prostate stroma

16

What is cryptorchidism?

Undescended testis (one or both)

17

What effect does cryptorchidism have on spermatogenesis and testosterone levels, and why?

Impaired spermatogenesis (since sperm develop best at temperatures < 37 C); can have normal testosterone levels (Leydig cells are unaffected by temperature)

18

Of what other pathology does cryptorchidism increase the risk?

Associated with increased risk of germ cell tumors

19

What increases the risk of cryptorchidism?

Prematurity increased the risk of cryptorchidism

20

What are the key hormonal changes in cryptorchidism? Which hormone level varies, and according to what?

Decreased inhibin, Increased FSH, and Increased LH; Testosterone decreases in bilateral cryptorchidism, normal in unilateral

21

What is Varicocele, and what causes it?

Dilated veins in pampiniform plexus as a result of increased venous pressure

22

What is the most common cause of scrotal enlargement in adult males?

Varicocele

23

On what side does varicocele most often occur, and why?

Most often on the left side because of increased resistance to flow from left gonadal vein drainage into the left renal vein

24

What effect can varicocele have on fertility, and why?

Can cause infertility because of increased temperature

25

How does varicocele appear?

"Bag of worms" appearance

26

How is varicocele diagnosed?

Diagnosed by ultrasound with Doppler

27

What are the treatment options for Varicocele?

Treatment: Varicocelectomy, Embolization by interventional radiologist

28

What percentage of testicular tumors are germ cell versus non-germ cell tumors?

Germ cell: ~95% of all testicular tumors; Non-germ cell: ~5% of all testicular tumors.

29

In what patient population do testicular germ cell tumors most often occur?

Most often occur in young men

30

What are 2 risk factors for testicular germ cell tumors?

Risk factors: (1) Cryptorchidism (2) Klinefelter syndrome

31

As what kind of tumor can testicular germ cell tumors present?

Can present as a mixed germ cell tumor

32

What is the differential diagnosis for testicular mass that does not transilluminate?

Differential diagnosis for testicular mass that does not transilluminate: cancer.

33

Are testicular non-germ cell tumors mostly benign or malignant?

Mostly benign

34

What are 5 types of testicular germ cell tumors?

(1) Seminoma (2) Yolk sac (endodermal sinus) tumor (3) Choriocarcinoma (4) Teratoma (5) Embryonal carcinoma

35

Is seminoma benign or malignant?

Malignant

36

What is the presentation of seminoma?

Painless, homogenous testicular enlargement

37

What is the most common testicular tumor?

Seminoma

38

When does seminoma most commonly present? When does it never present?

Most common in 3rd decade, Never in infancy

39

What characterizes seminoma on histology?

Large cells in lobules with watery cytoplasm and a "fried egg" appearance.

40

What lab finding is significant for a seminoma?

Increase placental ALP

41

Is seminoma sensitive or resistant to radiation?

Radiosensitive

42

When in the course of seminoma does metastasis occur? What is the prognosis of seminoma?

Late metastasis, Excellent prognosis

43

What is another name for yolk sac tumor? What physical traits characterize it?

Yolk sac (endodermal sinus) tumor; Yellow, mucinous

44

What part of the body is affected by a yolk sac tumor in males? Is it aggressive and/or malignant? To what tumor in females is it analogous?

Aggressive malignancy of testes, analogous to ovarian yolk sac tumor.

45

What is the name of the bodies associated with Yolk sac (endodermal sinus) tumor? What do they resemble?

Schiller-Duval bodies resemble primitive glomeruli

46

What is the most common testicular tumor in boys < 3 years old?

Yolk sac (endodermal sinus) tumor

47

Is choriocarcinoma benign or malignant? With what hormone level change is it associated?

Malignant, Increase hCG.

48

What mechanism/underlying change causes choriocarcinoma?

Disordered synctiotrophoblastic and cytotrophoblastic elements

49

How does choriocarcinoma metastasize, and to where? What complications may result from such metastases, and why?

Hematogenous metastases to lung and brain (may present with "hemorrhagic stroke" due to bleeding into the metastasis.

50

With what symptoms may choriocarcinoma present, and why?

May produce gynecomastia or symptoms of hyperthyroidism (hCG is an LH and TSH analog)

51

Are teratomas in (adult) males benign or malignant? How does this compare/contrast to teratomas in females? Are teratomas in benign or malignant in children?

Unlike in females, mature teratoma in adult males may be malignant; Benign in children

52

What are 2 hormone/factor changes that may occur in male teratomas, and in what percentage of cases does this occur?

Increased hCG and/or AFP in 50% of cases.

53

Is embryonal carcinoma benign or malignant? Describe the mass that presents. Compare/Contrast its prognosis to that of seminoma.

Malignant, hemorrhagic mass with necrosis; painful; worse prognosis than seminoma.

54

What kind of morphology does embryonal carcinoma often have?

Often glandular/papillary morphology

55

Briefly describe how embryonal carcinoma most commonly presents in terms of type(s) of cancer.

"Pure" embryonal carcinoma is rare; most commonly mixed with other tumor types

56

With what hormone/factor levels may embryonal carcinoma be associated? According to what can this vary, and how so?

May be associated with increased hCG and normal AFP levels when pure (increase AFP when mixed)

57

What are 3 types of testicular non-germ cell tumors?

(1) Leydig cell (2) Sertoli cell (3) Testicular lymphoma

58

What histological finding characterizes Leydig cell tumors? What color is the tumor?

Contains Reinke crystals; Golden brown color

59

What do Leydig cell tumors usually produce? How do they present in men versus boys?

Usually androgen producing, gynecomastia in men, precocious puberty in boys

60

What is a Sertoli cell tumor, and from where does it arise?

Androblastoma from sex cord stroma

61

What is the most common testicular cancer in older men? What is important to note about its progression?

Testicular lymphoma; Aggressive

62

Is testicular lymphoma due to a primary cancer or metastases?

Not a primary cancer, arises from lymphoma metastases to testes

63

What are tunica vaginalis lesions? How are they distinguished from testicular tumors?

Lesions in the serous covering of testis present as testicular masses that can be transilluminated (vs. testicular tumors)

64

What are 2 types of tunica vaginalis lesions?

(1) Hydrocele (2) Spermatocele

65

What causes hydrocele?

Hydrocele - increased fluid secondary to incomplete obliteration of processus vaginalis

66

What defines/causes spermatocele?

Spermatocele - dilated epididymal duct

67

On what 3 continents is squamous cell carcinoma of the penis more common?

More common in Asia, Africa, and South America

68

What are 3 precursor in situ lesions for penile squamous cell carcinoma? How does each present?

Precursor in situ lesions: (1) Bowen disease (in penile shaft, presents as leukoplakia) (2) Erythroplasia of Queyrat (cancer of glans, presents as erythroplakia) (3) Bowenoid papulosis (presents as reddish papules)

69

With what 2 factors/conditions is squamous cell carcinoma associated?

Associated with HPV, lack of circumcision

70

What is priapism?

Painful sustained erection not associated with sexual stimulation or desire

71

What are 3 factors/conditions associated with priapism?

Associated with (1) trauma, (2) sickle cell disease (sickled RBCs get trapped in vascular channels), (3) medications (anticoagulants, PDE-5 inhibitors, antidepressants, alpha-blockers, cocaine).

72

What are 5 examples of medications associated with priapism?

Medications (anticoagulants, PDE-5 inhibitors, antidepressants, alpha-blockers, cocaine)