CH14 - Male Genital System Pathology Flashcards
1
Q
What is the hypospadias?
A
Opening of urethra on inferior surface of penis
2
Q
What is hypospadias due to?
A
failure of the urethral folds to dose
3
Q
What is epispadias?
A
opening of urethra on superior surface of penis
4
Q
What is epispadias due to?
A
abnormal positioning of the genital tubercle
5
Q
What is epispadias associated with?
A
bladder exstrophy
6
Q
What is condyloma acuminatum?
A
Benign warty growth on genital skin
7
Q
What is condyloma acuminatum due to?
A
HPV type 6 or 11; characterized by koilocytic change
8
Q
What is lymphogranuloma venereum?
A
Necrotizing granulomatous inflammation of the inguinal lymphatics and lymph nodes
9
Q
What is lymphogranuloma venereum caused by?
A
sexually transmitted disease caused by Chlamydia trachomatis (serotypes L1-L3)
10
Q
What eventually happens to lymphogranuloma venereum?
A
it heals with fibrosis; perianal involvement may result in rectal stricture
11
Q
What is squamous cell carcinoma for the penis?
A
Malignant proliferation of squamous cells of penile skin
12
Q
What are the risk factors for squamous cell carcinoma of the penis?
A
1) high risk HPV (2/3 of cases) 2) Lack of circumcision
13
Q
Why is a lack of circumcision a risk factor for squamous cell carcinoma of the penis?
A
foreskin acts as a nidus for inflammation and irritation if not properly maintained
14
Q
<p>
| In squamous cell carcinoma of the penis what are the precursor in situ lesions?</p>
A
<p>
| 1) Bowen disease 2) Erythroplasia of Queyrat 3) Bowenoid papulosis (only CIS with no predisposition for invasion)</p>
15
Q
What is Bowen disease?
A
in situ carcinoma of the penile shaft or scrotum that presents as leukoplakia
16
Q
What is erythroplasia of queyrat?
A
in situ carcinoma on the glans that presents as erythroplakia
17
Q
What is bowenoid papulosis?
A
in situ carcinoma that presents as multiple reddish papules
18
Q
In whom is bowenoid papulosis seen?
A
Seen in younger patients (40s) relative to Bowen disease and erythroplasia of Queyrat
19
Q
How invasive is bowenoid papulosis?
A
Does not progress to invasive carcinoma
20
Q
What is cryptorchidism?
A
Failure of testicle to descend into the scrotal sac
21
Q
Where do the testicles normally develop?
A
in the abdomen and then descend into the scrotal sac as the fetus grows.
22
Q
What is the most common congenital male reproductive abnormality and how often is it seen?
A
Cryptorchidism and is seen in 1% of male infants
23
Q
What is orchiopexy?
A
Operation to bring undescended testicle into scrotum
24
Q
What happens in most cases of cryptorchidism?
A
most cases resolve spontaneously; otherwise, orchiopexy is performed before 2 years of age.
25
What are the complications for cryptorchidism?
they include testicular atrophy with infertility and increased risk for seminoma.
26
What is orchitis?
Inflammation of the testicle
27
What are the causes for orchitis?
1) Chlamydia trachomatis (serotypes D-K) or Neisseria gonorrhoeae 2) Escherichia coli and Pseadomonas 3) mumps virus 4) autoimmune orchitis
28
In whom is orchitis caused by Chlamydia trachomatis (serotypes D-K) or Neisseria gonorrhoeae seen in and what happens as a result?
young adults. Increased risk of sterility, but libido is not affected because Leydig cells are spared.
29
In whom is orchitis caused by Escherichia coli and Pseadomonas seen in and what happens as a result?
older adults and what results is that urinary tract infection pathogens spread into the reproductive tract.
30
In whom is orchitis caused by the mumps virus seen and what is the result?
Seen in teenage males and there is an increased risk for infertility; testicular inflammation is usually not seen in children < 10 years old.
31
What is autoimmune orchitis characterized by?
granulomas involving the seminiferous tubules
32
What is testicular torsion?
twisting of the spermatic cord; thin-walled veins become obstructed leading to congestion and hemorrhagic infarction
33
What is testicular torsion usually due to?
congenital failure of testes to attach to the inner lining of the scrotum via the processus vaginalis
34
How does testicular torsion present?
in adolescents with sudden testicular pain and absent cremasteric reflex
35
What is a varicocele?
dilation of the spermatic vein due to impaired drainage
36
What does a varicocele present as?
scrotal swelling with a bag of worms appearance
37
To what side does the varicocele present?
usually left sided;
38
Why does a varicocele present as left sided?
Because the left testicular vein drains into the left renal vein, while the right testicular vein drains directly into the IVC.
39
What is the varicocele associated with?
left-sided renal cell carcinoma; RCC often invades the renal vein.
40
In whom is the varicocele seen?
in a large percentage of infertile males
41
What is a hydrocele?
Fluid collection within the tunica vaginalis
42
What is the tunica vaginalis?
it is a serous membrane that covers the testicle as well as the internal surface of the scrotum.
43
What is the tunica vaginalis associated with?
incomplete closure of the processus vaginalis leading to communication with the peritoneal cavity (infants) or blockage of lymphatic drainage (adults)
44
How does the hydrocele present?
as scrotal swelling that can be transluminated
45
From where do testicular tumors arise?
from germ cells or sex cord-stroma
46
What do testicular tumors present as?
a firm, painless testicular mass that cannot be transluminated
47
When are testicular tumors biopsied?
usually not biopsied due to risk of seeding the scrotum; removed via radical orchiectomy
48
Are testicular tumors benign or malignant?
Most testicular tumors are malignant germ cell tumors.
49
What are the testicular germ cell tumors?
Seminoma, Nonseminoma, embryonal carcinoma, Volc sac tumor, choriocarcinoma, teratoma, milted germ cells
50
What is the most common type of testicular tumor?
Germ cell tumors (> 95% of cases)
51
In whom do the most common type of testicular tumor usually occur?
between 15-40 years of age
52
What are the risk factors for germ cell testicular tumors?
include cryptorchidism and Klinefelter syndrome
53
What are germ cell testicular tumors divided into?
seminoma and nonseminoma
54
What are seminomas?
It is 55% of testicular tumor cases and are highly responsive to radiotherapy, metastasize late, and have an excellent prognosis,
55
What is the prognosis for seminomas?
Excellent prognosis
56
What are nonseminomas?
It is 45% of cases and show variable response to treatment and often metastasize early.
57
What is seminoma?
it is a malignant tumor comprised of large cells with clear cytoplasm and central nuclei (resemble spermatogonia); forms a homogeneous mass with no hemorrhage or necrosis
58
What is the most common testicular tumor?
Seminoma; resembles ovarian dysgerminoma
59
In rare cases of seminoma what may be produced?
Beta-hCG
60
What is the prognosis for seminoma?
Its good and responds to radiotherapy
61
What is embryonal carcinoma?
it is a malignant tumor comprised of immature, primitive cells that may produce glands, forms a hemorrhagic mass with necrosis
62
Describe embryonal carcinoma.
It is aggressive, with early hematogenous spread
63
What is the reaction of embryonal carcinoma to chemotherapy?
It may result in differentiation into another type of germ cell tumor (e.g., teratoma).
64
What increased levels may be present in embryonal carcinoma?
Increased AFP or beta-hCG may be present
65
What is yolk sac tumor?
It?s a germ cell tumor. (endodermal sinus) tumor is a malignant tumor that resembles yolk sac elements.
66
What is the most common testicular tumor in children?
Volk sac (endodermal sinus)
67
What is seen on histology for embryonal carcinoma?
Schiller-Duval bodies (glomerulus-like structures) are seen on histology
68
In embryonal carcinoma what levels are characteristically elevated?
AFP
69
For germ cell testicular tumors, what is choriocarcinoma?
It is a malignant tumor of syncyliotrophohlasts and cytotrophoblasts
70
What are cytotrophoblasts?
placenta-like tissue, but villi are absent
71
How does choriocarcinoma spread?
It spreads early via blood
72
What are syncyliotrophoblasts?
They are the epithelial covering of highly vascular embryonic placental villi
73
What levels are elevated in syncyliotrophoblasts?
beta-hCG is characteristically elevated and may lead to hyperthyroidism or gynecomastia (beta-subunit of hCG is similar to that of FSH, LH, and TSH)
74
What is a teratoma?
it is a tumor composed of mature fetal tissue derived from two or three embryonic layers
75
How is a teratoma in males different from a teratoma in females?
It is malignant in males (as opposed to females)
76
What levels may be increased in a teratoma?
AFP or beta-hCG may be increased
77
What happens in a milted germ cell testicular tumor?
Germ cell tumors are usually mixed.
78
What is the prognosis for a milted germ cell tumor?
Prognosis is based on the worst component of the mixed germ cell tumor
79
What are sexcord stromal tumors?
Tumors that resemble sex cord-stromal tissues of the testicle; usually benign
80
What are leydig cell tumors?
they usually produce androgen, causing precocious puberty in children or gynecomastia in adults,
81
In leydig cell tumors, what may be seen on histology?
Reinke crystals
82
What are sertoli cell tumors comprised of?
tubules and is usually clinically silent.
83
What is lymphoma (testicle)?
Most common cause of a testicular mass in males > 60 years old; often bilateral
84
What cell type is usually involved with lymphoma of the testicle?
It?s usually of diffuse large B-cell type
85
What is the prostate?
Small, round organ that lies at the base of the bladder encircling the urethra
86
What is the location of the prostate?
anterior to the rectum;
87
What is palpated in a DRE?
posterior aspect of prostate is palpable by digital rectal exam (DRE),
88
What does the prostate consist of?
glands and stroma
89
What are the glands of the prostate composed of?
an inner layer of luminal cells and an outer layer of basal cells; secretes alkaline, milky fluid that is added to sperm and seminal vesicle fluid to make semen.
90
How are the glands and stroma of the prostate maintained?
by androgens.
91
What is acute prostatitis?
Its acute inflammation of the prostate; usually due to bacteria
92
What are the most common causes of acute prostatitis in young adults?
Chlamydia trachomatis and Neisseria gonorrhoeae
93
What are common causes of acute prostatitis in older adults?
Escherichia coli and Pseudomonas
94
How does acute prostatitis present?
Presents as dysuria with fever and chills
95
How does the prostate present with acute prostatitis?
it is lender and boggy on digital rectal exam
96
In acute prostatitis what does the prostatic secretions show?
Prostatic secretions show WBCs; culture reveals bacteria.
97
What is chronic prostatitis?
Chronic inflammation of prostate
98
How does chronic prostatitis present?
It presents as dysuria with pelvic or low back pain
99
What do prostatic secretions in chronic prostatitis show?
WBCs, but cultures are negative,
100
What is benigin prostatic hyperplasia?
It is hyperplasia of prostatic stroma and glands
101
What is the probability of BPH resulting in cancer?
Age-related change (present in most men by the age of 60 years); no increased risk for cancer
102
What is BPH related to?
dihydrotestosterone (DHT)
103
What is testosterone converted to? Where? By what?
Converted to DHT by 5 alpha-reductase in stromal cells
104
What does DHT act on?
the androgen receptor of stromal and epithelial cells resulting in hyperplastic nodules
105
Where does BPH occur?
in the central periurethral zone of the prostate
106
What are the clinical features for BPH?
They include 1. Problems starting and stopping urine stream 2. Impaired bladder emptying with increased risk for infection and hydronephrosis 3. Dribbling 4. Hypertrophy of bladder wall smooth muscle; increased risk for bladder diverticula 5. Microscopic hematuria may be present. 6. Prostate-specific antigen (PSA) is often slightly elevated (usually less than 4 ng/mL) due to the increased number of glands;
107
Why is PSA elevated in BPH, and what is the effect of this?
Because PSA is made by prostatic glands and liquefies semen
108
What is the range for PSA in patients with BPH?
4-10ng/ml
109
What is the treatment for BPH?
Alpha 1-antagonist (e.g., terazosin) to relax smooth muscle and 5 alpha reductase inhibitor
110
For BPH, what must be considered as a side effect of the treatment?
The alpha-1 antagonist also relaxes vascular smooth muscle lowering blood pressure
111
How is the side effect for the treatment of BPH taken into consideration?
Selective alpha 1A-antagonists (e.g., tamsulosin) are used in normotensive individuals to avoid effects on blood vessels
112
What does 5a-reductase inhibitor do for BPH?
It blocks the conversion of testosterone to DHT
113
How long does it take to produce results in treating BPH with 5 alpha reductase?
Takes months to produce results
114
What other effects does 5 alpha reductase have when treating BPH?
Its also useful for male pattern baldness and has side effects are gynecomastia and sexual dysfunction
115
What is prostate adenocarcinoma?
malignant proliferation of prostatic glands
116
What is the most common cancer in men?
Prostate adenocarcinoma
117
What is the 2nd most common cause of cancer-related death?
Prostate adenocarcinoma
118
What are the risk factors for prostate adenocarcinoma?
they include age, race (African Americans > Caucasians > Asians), and diet high in saturated fats.
119
How does prostatic carcinoma most often present clinically?
silent
120
Where does prostate carcinoma usually arise?
in the peripheral, posterior region of the prostate and, hence, does not produce urinary symptoms early on
121
When does screening for prostate adenocarcinoma begin?
at the age of 50 years with DRE and PSA
122
What are normal serum PSA levels?
it increases with age due to BPH (2.5 ng/mL for ages 40-49 years vs. 7.5 ng/mL for ages 70 - 79 years)
123
What levels of PSA would be worrisome at any age?
> 10 ng/dL is highly worrisome at any age
124
What aspect of PSA might be suggestive of cancer?
Decreased % free-PSA is suggestive of cancer (cancer makes bound PSA)
125
What is required to confirm prostatic carcinoma?
Prostatic biopsy is required to confirm the presence of carcinoma
126
What does prostate carcinoma show?
small, invasive glands with prominent nucleoli
127
What is the grading system for prostate carcinoma?
Gleason grading system is based on architecture alone (and not nuclear atypia)
128
What is the Gleason grading system?
1. Multiple regions of the tumor are assessed because architecture varies from area to area. 2. A score (1-5) is assigned for two distinct areas and then added to produce a final score (2-10). 3. Higher score suggests worse prognosis.
129
In prostate carcinoma spread to what areas are common?
lumbar spine or pelvis is common;
130
The spread of prostate carcinoma to the lumbar spine or pelvis results in what?
osteoblastic metastases
131
For osteoblastic metastases or prostate carcinoma to the lumbar spine or pelvis, how does it present?
it presents as low back pain and increased serum alkaline phosphatase, PSA, and prostatic acid phosphatase (PAP)
132
When is prostatectomy performed?
it is performed for localized disease
133
What is advanced prostate carcinoma treated with?
hormone suppression to reduce testosterone and DHT
134
What are used in hormone suppression for the treatment of advanced prostate carcinoma?
Continuous GnRH analogs (e.g., leuprolide) and flutamide
135
What does continuous GnRH analog (used in hormone suppression treatment of prostate carcinoma) do?
it shuts down the hypothalamus (LH and FSH are reduced)
136
What does flutamide (used in hormone suppression treatment of prostate carcinoma) do?
it acts as a competitive inhibitor at the androgen receptor
