227b genital disorders

Question 1

hernia

Answer 1

indirect - patent tunica vaginlanis

direct - weakness of inguinal floor,

femoral - subinguinal?

Question 2

torsion

Answer 2

bilateral - always fix both sides

undescended testes undergo torsion + cancer

Question 3

testes cancer

Answer 3

15 -35 years old

very rare in AA

Question 4

germ cell tumor

Answer 4

extra copies of short arm of chromosome 12
gene for cyclin D –> g1/s checkpoint –> tumor grows quickly

LDH is also on 12qp so cancer marker

Question 5

testes cancer signs and symptoms

Answer 5

mass
ppain
hydrocele
gynecomasta (hCG)

won’t transilluminate

hypoecogenic (except teratoma)

Question 6

tumor markers for testicular cancer

Answer 6

b-hCG - from syncytiotrophoblasts
seminoma + non-seminoma
presence doesn’t mean choriocarcinoma (but is very high in choriocardcinoma)

AFP - yolk sack, Never high in pure seminoma

LDH - most often seminomas

Question 7

operation

Answer 7

need to get rid of cord –> inguinal decision

don’t want to violate inguinal lymphatics

never through scrotum

Question 8

seminoma

Answer 8

pure never has AFP

b-hcg + LDH can be expressed

lots of lymphocytes

Question 9

non-seminoma

Answer 9

can express any markers

Question 10

testicular cancer spreading?

Answer 10

aortic/IVC lymph nodes
right - IVC
left - aortic

inguinal nodes generally have nothing to do with cancer unless someone did an operation through the scrotum

Question 11

seminoma - rx

Answer 11

radiation sensitive (unlike others)

Question 12

teratoma

Answer 12

chemo and radiation resistance

must remove masses

Question 13

> 60 testicular cancer - what is it?

Answer 13

lymphoma

Question 14

penile cancer

Answer 14

95% SCC
HPV 16/18
poor hygiene, smegma, smoking, lichen sclerosis

Question 15

what causes chondyloma ccuminatum

Answer 15

HPV 6/ 11

NOT 16/18

Question 16

penile cancer spread?

Answer 16

inguinal nodes are enlarged

infection or metasis

be aggressive with lymph node dissection

Question 17

invasive penis cancer?

Answer 17

corpus invasion (cavernouses or spongiosous)

once it leaves the groin, it kills patients

Question 18

penile cancer presenting with bulking nodes

Answer 18

systemic chemo then salvage surgery if possible

Question 19

urethra cancer

Answer 19

women>men

SCC

distal/anterior = good, inguinal nodes

posterior = bad, pelvic nodes (deep)

no prophylatic node dissection unless palpable