Reproductive Pathology

Question 1

cryptorchism

Answer 1

absence of one or both testicles

- most common congenital defect

Question 2

hypospadias

Answer 2

urethra opens on ventral aspect of shaft to the junction of penis and scrotum or perineum

• very common (2nd to cryptorchism)
• never do a circumcision, b/c you need the skin to fix the hole

Question 3

epispadias

Answer 3

urethra opens on dorsal aspect of penis

Question 4

small, bifid phallus with bladder exstrophy are severe defects associated with…

Answer 4

epispadias (assoc. severe defect)

Question 5

tx for cryptorchism

Answer 5

orchioplexy - surgical placement of UDT into scrotum before puberty; decr. likelihood of atrophy, ca, and infertility

Question 6

varicocele

Answer 6

abnormal enlargement of vein draining the testicles

sometimes seen as a tortuous mass on the surface of scrotum or dilated veins of spermaic cord

Question 7

epididymitis

Answer 7

inflammation of epididymis usually d/t bacterial infection (gonorrhea, chlamydia)

Question 8

hydrocele

Answer 8

accumulation of fluids around testicle

d/t

• fluid secretion by tunica vaginalis
• trauma, hernia, orchiis, CA
• plugged inguinal lymphatic system (repeat infections, particularly parasitic origin)

pe: transilluminate, area should turn red to indicate fluid

Question 9

urethritis

Answer 9

inflammation of urethra (gonococcal or NGU)

culprits -
gonococcal: Neisseria gonorrhoeae (g- diplococci)
NGU: chlamydia

Question 10

reactive arthritis (aka Reiter’s syndrome)

Answer 10

• associated with Reiter’s syndrome
  “can’t see, can’t pee, can’t dance with me”

triad: uveitis or conjunctivitis, reactive arthritis, and urethritis (or cervicitis in women)

• balantis circinata
• keratoderma blennorrhagica

lab dx: RF-seronegative, HLA-B27-linked spondyloarthropathy

Question 11

balantis circinata

Answer 11

serpiginous annular dermatitis of glans penis (inflammation)

c/b yeast or autoimmunity

Question 12

keratoderma blennorrhagica

Answer 12

skin lesions on palms and soles (can spread to scrotum and trunk, looks like psoriasis)

Question 13

primary syphilis

Answer 13

occurs 10-90 days after contact with infected individual

male: glans penis
female: vulva or cervix

PAINLESS lesions: raised, firm, red papules (several cm) -> ulcerative crater with slightly elevated edges

regional NT LAD

usually heals in 4-8 wks with or w/o tx

Question 14

secondary syphilis

Answer 14

skin lesions w/i 2-10 wks after primary chancre
- localized or diffuse mucocutaneous rash (nonpruritic, bilateral)

generalized NT LAD

constitutional sxs:

• malaise
• h/a
• nausea
• anorexia
• bone pain
• fatigue
• fever
• stiff neck

Question 15

tertiary syphilis

Answer 15

“the great imitator”
- gummas (soft, non-CA growth), neuro and cardiac sxs

slow progression and can affect any organ, but not infectious

• impaired balance, parasthesia, incontinence, impotence
• sensoneural hearing and vision loss
• chest pain, back pain, stridor, sxs similar to aortic aneurysm
• dizziness, h/a, blurred vision

gummatous 3-syphillis: 3-10 yrs after infection

Question 16

HPV

Answer 16

human papilloma virus

condyloma acuminata: genital warts d/t HPV stains 6 & 11

Question 17

testicular torsion

Answer 17

spermatic cord twists and cuts off blood supply to testicle

> > > diffuse testicular pain
decreased cremasteric reflex (stroking inner thigh to retract testicle)

90% due to congenital malformation, but can rarely be caused by trauma (usually young boys)

Question 18

congenital testicular torsion

Answer 18

“bell-clapper deformity” accounts for 90% of TT

mesorchium terminates early and testis is free floating in tunica vaginalis d/t insufficient tethering to spermatic cord, testis becomes entangled

i.e. intravaginal TT

Question 19

After age ___, TT has a greater association with testicular malignancy

Answer 19

25

Question 20

Testicular CA Types (%)

Answer 20

primary tumor is most common CA in men. ages 20-40 (avg ~30)

• mixed forms (40%)
• seminoma (35%)
• embryonal (20%)
• teratoma (5%)

Question 21

seminoma

Answer 21

may be felt on testicular self-exam

dx at 40 y/o

PE:
10-14% cases
- masses not-palpable or
- testicular atrophy might be present

histology:

• sheet-like, locular pattern, fibrous stromal network
• tumors have pale pink cytoplasm w/ abundant glycogen

Question 22

serum markers:

• placental alkaline phosphatase (PLAP): elevated in 50% of cases
• human chrionic gonadotropin (hCG): sometimes elevated

serum alpha fetoprotein (AFP) NOT elevated

Answer 22

seminoma

Question 23

embryonal carcinoma

Answer 23

germ cell tumor in ovaries or testes

dx at 30 y/o

PE: testicular lump, potentially painful

stats:

• 10% of all testicular germ cell tumors
• presents as part of 90% of MIXED non-seminoma GC tumors
• 1/5 to 2/3 dx as metastasis

Question 24

serum markers:

- elevated hCG and AFP

Answer 24

embryonal carcinoma

Question 25

serum alpha fetoprotein (AFP)

Answer 25

indicative of hepatocellular carcinoma, germ cell tumors, and metastatic liver CA

Question 26

histology: - primitive tubules - sheets, glands, papillar structures composed of primitive epithelial cells with distinctive, crowded, pleomorphic nuclei - nuclear atypia, nucleoli prominent, nuclei overlap, mitoses common

Answer 26

embryonal carcinoma

Question 27

teratoma

Answer 27

encapsulated tumor with tissues/organ components resembling normal derivatives of all three germ layers mesoderm: immature CT endoderm: GI lining cells/glands ectoderm: epidermis with keratin common form: well-circumscribed complex or anechoic cystic masses

Question 28

benign prostatic hyperplasia (BPH)

Answer 28

hyperplasia of prostatic stromal and epithelial cells --> large, fairly discrete nodules in periurethral region of prostate causes partial or complete obstruction of urethra i.e. dec urine flow DOES NOT inc. risk of CA

Question 29

- urinary hesitancy, frequency, retention - dysuria - inc. risk of UTI

Answer 29

BPH Tx: transurethral resection of prostate (TURP)

Question 30

prostatitis

Answer 30

inflammation of prostate may also present with cystitis or urethritis serum PSA may be elevated, but transrectal ultrasonograph or non-contrast CT needed to rule out prostatic abscess

Question 31

histology: | - numerous, small dark, blue lymphocytes seen in stroma between glands

Answer 31

prostatitis

Question 32

prostate CA

Answer 32

develops in men > 50 yo, rare in men

Question 33

poorly differentiated glandular cells with enlarged nuclei and mitotic figures

Answer 33

prostatic adenocarcinoma

Question 34

latent syphilis

Answer 34

may be latent from infection to 25 years, before onset of 3-syphilis - asymptomatic, but can be detected serologically - pt may recall sxs of 1-syphilis or 2-syphilis early latent: first year after resolution of 1 or 2-syphilis, can test + after - sero test late latent: not infectious, but in females can be transmitted in utero

Question 35

congenital syphilis

Answer 35

early CS: occurs w/i first 2 years of life - rhinitis, f/b cutaneous lesions late CS: children > 2yo - problems with hearing and language development - vision - facial/dental abnormalities