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USMLE > Reproductive - Male Pathology > Flashcards

Reproductive - Male Pathology Flashcards

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1
Q

Hypospadias: Mechanism and Presentation

A

Failure of urethral folds to close leading to opening of urethra on inferior surface of penis

May be associated with androgen dysfunction

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2
Q

What is the most common malformation of urethral grove?

A

Hypospadias

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3
Q

Why treat hypospadias?

A

Prevent UTI

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4
Q

Epispadias: Mechanism and Presentation

A

Opening of urethra on superior surface of penis

Due to faulty positioning of genital tubercle

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5
Q

What is episapdias associated with?

A

Extrophy of bladder

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6
Q

Condyloma acuminatum: Mechanism and Cause

A

Benign warty growth on genital skin

Due to HPV type 6, 11; koilocytic changes

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7
Q

Lymphogranuloma venereum: Presentation

A

Necrotizing granulomatous inflammation of inguinal lymphatics and lymph nodes (Chlamydia L1-L3)

Heals with fibrosis; perianal involvement may result in rectal stricture

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8
Q

Squamous Cell Carcinoma of Penis: Risk factors

A

high risk HPV, lack of circumcision

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9
Q

Squamous Cell Carcinoma of Penis: Epidemiology

A

More common in Asia, Africa, South American

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10
Q

What are the precursor lesions of Squamous Cell Carcinoma of Penis?

A

Bowen disease
Erythroplasia of Queryrat
Bowenoid papulosis (not precursor)

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11
Q

Bowen disease

A

In situ carcinoma of penile shaft or scrotum with leukoplakia

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12
Q

Erythroplasia of Queyrat

A

In situa carcinoma on glans that presents as erythroplakia

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13
Q

Bowenoid papulosis

A

In situa carcinoma with multiple reddish papules in younger patients (40s)

Does not progress to invasive carcinoma

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14
Q

Peyronie’s disease

A

Bent penis due to acquired fibrous tissue formation

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15
Q

Priapism

A

Painful sustained erection not associated with sexual stimulation or desire

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16
Q

Priapism: Causes

A

trauma

sickle-cell disease (sickled RBCs trapped in vascular channels)

medications (anticoagulants, PDE5 inhibitors, antidepressants, alpha-blockers, cocaine)

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17
Q

Cryptorchidism

A

Failure to testicle to descend into scrotal sac

If not resolve spontaneously, orchipexy before age 2

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18
Q

Cryptorchidism: Complications

A

testicular atrophy with infertility (impaired spermatogenesis); increased risk of seminoma

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19
Q

Cryptorchidism: Levels of sex hormones

A

Normal testosterone level (Leydig cells unaffected by temperature)

High FSH, LH, low inhibin
Low testosterone if bilateral

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20
Q

Cryptorchidism: Risk factor

A

Prematurity

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21
Q

What is the most common congenital male reproductive abnormality? (1%)

A

Cryptorchidism

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22
Q

Orchitis

A

Inflammation of testicle

increased risk of sterility but libido unaffected

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23
Q

Orchitis: Causes

A

Young adults: chlamydia trachomatis (DK) or Neisseria gonorrhoeae

Older adults: E. coli and pseudomonas (UTI pathogens)

Mumps virus (teenage): infertility - not seen in < 10 yo

Autoimmune orchitis: granulomas involving seminiferous tubules

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24
Q

Testicular torsion: Presentation and Mechanism

A

Adolescent with sudden testicular pain and absent cremasteric reflex
(Congenital failure of testes to attach to inner lining of scrotum)

Twisting of spermatic cord; thin-walled veins obstructed -> congestion and hemorrhagic infarction

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25
Varicocele: Presentation
Left-sided scrotal swelling with "bag of worms" appearance"
26
Varicocele: Mechanism
Dilation of veins in pampiniform plexus due to impaired drainage (increased venous pressure) Left side affected - drains into left renal vein
27
What is left-sided varicocele associated with?
Left sided renal cell carcinoma (RCC invades renal vein)
28
Varicocele: Complications
Infertility (increased temperature)
29
Varicocele: Diagnosis and Treatment
Diagnosis: ultrasound Treatment: Varicocelectomy, ebolization
30
Hydrocele: Presentation and Mechansim
Scrotal swelling that can be transilluminated Fluid collection within tunica vaginalis (serous membrane that covers testicles and internal surface of scrotum)
31
What is hydrocele associated with in children? In adults?
Children: incomplete closure of processus vaginalis leading to communications with peritoneal cavity Adults: blockage of lymphatic drainage
32
Testicular tumors: Presentations
Firm, painless testicular mass; not transilluminated | Germ cells or sex cord-stroma
33
Testicular tumors: Diagnosis
Usually not biopsied - risk of seeding to scrotum - most are malignant germ cell tumors
34
What are the two types of testicular tumors?
Divided to seminoma (responsive to radiotherapy), and nonseminoma (early metastasis)
35
Testicular tumors: risk factors
cryptochidism, kleinfelter syndrome
36
Seminoma: Histology
Homogeneous mass with no hemorrhage or necrosis Malignant tumor of large cells with clear cytoplasm and central nuclei (resembles ovarian dysgerminoma)
37
Seminoma: Lab
beta-hCG
38
Seminoma: Metastasis and Prognosis
Good prognosis, late metastasis; respond to radiotherapy
39
Seminoma: Age group
Males 15-35 yo
40
Embryonal carcinoma (Male): Histology
Painful, hemorrhagic mass with necrosis | Immature, primitive cells that may produce glands/papillary; most are mixed
41
Embryonal carcinoma (Male): Metastasis and Prognosis
Aggressive with early hematogenous spread Chemotherapy may result in differentiation into another type of germ cell tumor
42
Embryonal carcinoma (Male): Lab
Increased AFP (mixed)/beta-hCG
43
Endodermal sinus tumor (Male): Presentation and Histology
Yolk sac, yellow mucinous tumor in children | Schiller-duval bodies (glomerulus-like structures)
44
Endodermal sinus tumor (Male): Lab
Elevated AFP
45
Choriocarcinoma (Male): Histology
Malignant tumor of synctiotrophoblasts (high beta HCG) and cytotrophoblasts (placental-like tissue without villi)
46
Choriocarcinoma (Male): Lab
High beta-HCG can lead to hyperthyroidism or gynecomastic (alpha subunit similar to FSH/LH/TSH)
47
Choriocarcinoma (Male): Metastasis
Hematogenous metastasis to lungs
48
Teratoma (Male): Histology
Mature fetal tissue tumors with 2-3 embryonic layers
49
Teratoma (Male): Prognosis
Malignant in males (benign in females, children)
50
Teratoma (Male): Lab
Increased hCG and/or AFP in 50% of cases
51
Mixed germ cell tumors (Male)
Most germ cell tumors are mixed | prognosis based on worst component
52
Leydig cell tumor (Male): Histology
Golden brown color; Reinke crystals
53
Leydig cell tumor (Male): Presentation
Produces androgen (precocious puberty in children; gynecomastia in adults)
54
Sertoli cell tumor
Sex cord-stromal tumor with tubules | usually clinically silent
55
Lymphoma (testicular tumor)
Testicular mass in males > 60 yo | Often bilateral and aggressive; diffuse large B-cell type
56
Prostate: histology
Glands and stroma Glands: inner layer of luminal cells and outer layers of basal cells (make alkaline, milky fluid added to sperm and seminal vesical fluid to make semen) Glands and stroma are maintained by androgens
57
Acute prostatitis: Presentation and Mechanism
Acute inflammation Dysuria with fever, chills Prostate tender and boggy on digital rectal exam
58
Acute prostatitis: Causes
Young adults - chlamydia, neisseria | Old adults - E. coli, pseudomonas
59
Acute prostatitis: Diagnosis
Prostatic secretions show WBCs; culture reveals bacteria
60
Chronic prostatitis: Presentation and Diagnosis
Chronic inflammation Dysuria with pelvic or low back pain WBCs but no culture
61
Benign prostatic hyperplasia (BPH): Presentations (6)
1. Impaired bladder emptying (increased risk of infection/hydronephrosis) 2. Dribbling 3. Problem with urine stream 4. hypertrophy of bladder wall smooth muscle (bladder diverticula) 5. microscopic hematuria 6. Slightly elevated PSA (increased number of glands)
62
Benign prostatic hyperplasia (BPH): Presentation
Hyperplasia of prostatic stroma and glands | In central periurethral zone of prostate (lateral and middle lobes)
63
Benign prostatic hyperplasia (BPH): Risk and Associations
Associated with DHT (from testosterone by 5alpha-reductase in stromal cells) Increased with age; no increased risk of cancer
64
Benign prostatic hyperplasia (BPH): Treatment
1. alpha-1 antagonist (terazosin) to relax smooth muscle (also for blood pressure) Tamsulosin (alpha-1A antagonist) - no effect of alpha-1B on blood vessels 2. 5 alpha reductase inhibitor (block conversion to DHT) Tox: gynecomastia, sexual dysfunction
65
Prostate adenocarcinoma: Epidemiology
Malignant proliferation of prostatic gland Risk factors: African Americans > Caucasians > Asians; saturated fat diet Most common cancer in men; 2nd most common cause of cancer death
66
Prostate adenocarcinoma: Presentation
Most often clinically silent Arise in peripheral, posterior region - not produce urinary symptoms early on
67
Prostate adenocarcinoma: Screening Protocol
Screening 50 yo with DRE and PSA (decreased %free-PSA worrisome for cancer)
68
Prostate adeocarcinoma: Histology
Biopsy required for confirmation | Invasive glands with prominent nucleoli
69
Prostate adeocarcinoma: Grading system
Gleason grading system - architecture alone
70
Prostate adeocarcinoma: Metastasis
Can spread to lumbar spine/pelvis (osteoblastic - elevated alkaline phosphatase, PSA, prostatic acid phosphatase PAP)
71
Prostate adeocarcinoma: Treatment
Prostatectomy for localized disease | Advance: hormone suppression (leuprolide; flutamide)
72
Tunica vaginalis lesions
Lesions in serous covering of testis as masses that can be transilluminated Hydrocele and Spermatocele
73
Spermatocele
Dilated epididymal duct

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