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Pathoma > CH14 - Male Genital System Pathology > Flashcards

CH14 - Male Genital System Pathology Flashcards

1
Q

What is the hypospadias?

A

Opening of urethra on inferior surface of penis

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2
Q

What is hypospadias due to?

A

failure of the urethral folds to dose

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3
Q

What is epispadias?

A

opening of urethra on superior surface of penis

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4
Q

What is epispadias due to?

A

abnormal positioning of the genital tubercle

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5
Q

What is epispadias associated with?

A

bladder exstrophy

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6
Q

What is condyloma acuminatum?

A

Benign warty growth on genital skin

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7
Q

What is condyloma acuminatum due to?

A

HPV type 6 or 11; characterized by koilocytic change

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8
Q

What is lymphogranuloma venereum?

A

Necrotizing granulomatous inflammation of the inguinal lymphatics and lymph nodes

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9
Q

What is lymphogranuloma venereum caused by?

A

sexually transmitted disease caused by Chlamydia trachomatis (serotypes L1-L3)

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10
Q

What eventually happens to lymphogranuloma venereum?

A

it heals with fibrosis; perianal involvement may result in rectal stricture

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11
Q

What is squamous cell carcinoma for the penis?

A

Malignant proliferation of squamous cells of penile skin

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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

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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

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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>

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15
Q

What is Bowen disease?

A

in situ carcinoma of the penile shaft or scrotum that presents as leukoplakia

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16
Q

What is erythroplasia of queyrat?

A

in situ carcinoma on the glans that presents as erythroplakia

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17
Q

What is bowenoid papulosis?

A

in situ carcinoma that presents as multiple reddish papules

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18
Q

In whom is bowenoid papulosis seen?

A

Seen in younger patients (40s) relative to Bowen disease and erythroplasia of Queyrat

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19
Q

How invasive is bowenoid papulosis?

A

Does not progress to invasive carcinoma

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20
Q

What is cryptorchidism?

A

Failure of testicle to descend into the scrotal sac

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21
Q

Where do the testicles normally develop?

A

in the abdomen and then descend into the scrotal sac as the fetus grows.

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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

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23
Q

What is orchiopexy?

A

Operation to bring undescended testicle into scrotum

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24
Q

What happens in most cases of cryptorchidism?

A

most cases resolve spontaneously; otherwise, orchiopexy is performed before 2 years of age.

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25
Q

What are the complications for cryptorchidism?

A

they include testicular atrophy with infertility and increased risk for seminoma.

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26
Q

What is orchitis?

A

Inflammation of the testicle

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27
Q

What are the causes for orchitis?

A

1) Chlamydia trachomatis (serotypes D-K) or Neisseria gonorrhoeae 2) Escherichia coli and Pseadomonas 3) mumps virus 4) autoimmune orchitis

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28
Q

In whom is orchitis caused by Chlamydia trachomatis (serotypes D-K) or Neisseria gonorrhoeae seen in and what happens as a result?

A

young adults. Increased risk of sterility, but libido is not affected because Leydig cells are spared.

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29
Q

In whom is orchitis caused by Escherichia coli and Pseadomonas seen in and what happens as a result?

A

older adults and what results is that urinary tract infection pathogens spread into the reproductive tract.

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30
Q

In whom is orchitis caused by the mumps virus seen and what is the result?

A

Seen in teenage males and there is an increased risk for infertility; testicular inflammation is usually not seen in children < 10 years old.

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31
Q

What is autoimmune orchitis characterized by?

A

granulomas involving the seminiferous tubules

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32
Q

What is testicular torsion?

A

twisting of the spermatic cord; thin-walled veins become obstructed leading to congestion and hemorrhagic infarction

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33
Q

What is testicular torsion usually due to?

A

congenital failure of testes to attach to the inner lining of the scrotum via the processus vaginalis

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34
Q

How does testicular torsion present?

A

in adolescents with sudden testicular pain and absent cremasteric reflex

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35
Q

What is a varicocele?

A

dilation of the spermatic vein due to impaired drainage

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36
Q

What does a varicocele present as?

A

scrotal swelling with a bag of worms appearance

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37
Q

To what side does the varicocele present?

A

usually left sided;

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38
Q

Why does a varicocele present as left sided?

A

Because the left testicular vein drains into the left renal vein, while the right testicular vein drains directly into the IVC.

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39
Q

What is the varicocele associated with?

A

left-sided renal cell carcinoma; RCC often invades the renal vein.

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40
Q

In whom is the varicocele seen?

A

in a large percentage of infertile males

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41
Q

What is a hydrocele?

A

Fluid collection within the tunica vaginalis

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42
Q

What is the tunica vaginalis?

A

it is a serous membrane that covers the testicle as well as the internal surface of the scrotum.

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43
Q

What is the tunica vaginalis associated with?

A

incomplete closure of the processus vaginalis leading to communication with the peritoneal cavity (infants) or blockage of lymphatic drainage (adults)

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44
Q

How does the hydrocele present?

A

as scrotal swelling that can be transluminated

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45
Q

From where do testicular tumors arise?

A

from germ cells or sex cord-stroma

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46
Q

What do testicular tumors present as?

A

a firm, painless testicular mass that cannot be transluminated

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47
Q

When are testicular tumors biopsied?

A

usually not biopsied due to risk of seeding the scrotum; removed via radical orchiectomy

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48
Q

Are testicular tumors benign or malignant?

A

Most testicular tumors are malignant germ cell tumors.

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49
Q

What are the testicular germ cell tumors?

A

Seminoma, Nonseminoma, embryonal carcinoma, Volc sac tumor, choriocarcinoma, teratoma, milted germ cells

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50
Q

What is the most common type of testicular tumor?

A

Germ cell tumors (> 95% of cases)

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51
Q

In whom do the most common type of testicular tumor usually occur?

A

between 15-40 years of age

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52
Q

What are the risk factors for germ cell testicular tumors?

A

include cryptorchidism and Klinefelter syndrome

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53
Q

What are germ cell testicular tumors divided into?

A

seminoma and nonseminoma

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54
Q

What are seminomas?

A

It is 55% of testicular tumor cases and are highly responsive to radiotherapy, metastasize late, and have an excellent prognosis,

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55
Q

What is the prognosis for seminomas?

A

Excellent prognosis

56
Q

What are nonseminomas?

A

It is 45% of cases and show variable response to treatment and often metastasize early.

57
Q

What is seminoma?

A

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
Q

What is the most common testicular tumor?

A

Seminoma; resembles ovarian dysgerminoma

59
Q

In rare cases of seminoma what may be produced?

A

Beta-hCG

60
Q

What is the prognosis for seminoma?

A

Its good and responds to radiotherapy

61
Q

What is embryonal carcinoma?

A

it is a malignant tumor comprised of immature, primitive cells that may produce glands, forms a hemorrhagic mass with necrosis

62
Q

Describe embryonal carcinoma.

A

It is aggressive, with early hematogenous spread

63
Q

What is the reaction of embryonal carcinoma to chemotherapy?

A

It may result in differentiation into another type of germ cell tumor (e.g., teratoma).

64
Q

What increased levels may be present in embryonal carcinoma?

A

Increased AFP or beta-hCG may be present

65
Q

What is yolk sac tumor?

A

It?s a germ cell tumor. (endodermal sinus) tumor is a malignant tumor that resembles yolk sac elements.

66
Q

What is the most common testicular tumor in children?

A

Volk sac (endodermal sinus)

67
Q

What is seen on histology for embryonal carcinoma?

A

Schiller-Duval bodies (glomerulus-like structures) are seen on histology

68
Q

In embryonal carcinoma what levels are characteristically elevated?

A

AFP

69
Q

For germ cell testicular tumors, what is choriocarcinoma?

A

It is a malignant tumor of syncyliotrophohlasts and cytotrophoblasts

70
Q

What are cytotrophoblasts?

A

placenta-like tissue, but villi are absent

71
Q

How does choriocarcinoma spread?

A

It spreads early via blood

72
Q

What are syncyliotrophoblasts?

A

They are the epithelial covering of highly vascular embryonic placental villi

73
Q

What levels are elevated in syncyliotrophoblasts?

A

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
Q

What is a teratoma?

A

it is a tumor composed of mature fetal tissue derived from two or three embryonic layers

75
Q

How is a teratoma in males different from a teratoma in females?

A

It is malignant in males (as opposed to females)

76
Q

What levels may be increased in a teratoma?

A

AFP or beta-hCG may be increased

77
Q

What happens in a milted germ cell testicular tumor?

A

Germ cell tumors are usually mixed.

78
Q

What is the prognosis for a milted germ cell tumor?

A

Prognosis is based on the worst component of the mixed germ cell tumor

79
Q

What are sexcord stromal tumors?

A

Tumors that resemble sex cord-stromal tissues of the testicle; usually benign

80
Q

What are leydig cell tumors?

A

they usually produce androgen, causing precocious puberty in children or gynecomastia in adults,

81
Q

In leydig cell tumors, what may be seen on histology?

A

Reinke crystals

82
Q

What are sertoli cell tumors comprised of?

A

tubules and is usually clinically silent.

83
Q

What is lymphoma (testicle)?

A

Most common cause of a testicular mass in males > 60 years old; often bilateral

84
Q

What cell type is usually involved with lymphoma of the testicle?

A

It?s usually of diffuse large B-cell type

85
Q

What is the prostate?

A

Small, round organ that lies at the base of the bladder encircling the urethra

86
Q

What is the location of the prostate?

A

anterior to the rectum;

87
Q

What is palpated in a DRE?

A

posterior aspect of prostate is palpable by digital rectal exam (DRE),

88
Q

What does the prostate consist of?

A

glands and stroma

89
Q

What are the glands of the prostate composed of?

A

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
Q

How are the glands and stroma of the prostate maintained?

A

by androgens.

91
Q

What is acute prostatitis?

A

Its acute inflammation of the prostate; usually due to bacteria

92
Q

What are the most common causes of acute prostatitis in young adults?

A

Chlamydia trachomatis and Neisseria gonorrhoeae

93
Q

What are common causes of acute prostatitis in older adults?

A

Escherichia coli and Pseudomonas

94
Q

How does acute prostatitis present?

A

Presents as dysuria with fever and chills

95
Q

How does the prostate present with acute prostatitis?

A

it is lender and boggy on digital rectal exam

96
Q

In acute prostatitis what does the prostatic secretions show?

A

Prostatic secretions show WBCs; culture reveals bacteria.

97
Q

What is chronic prostatitis?

A

Chronic inflammation of prostate

98
Q

How does chronic prostatitis present?

A

It presents as dysuria with pelvic or low back pain

99
Q

What do prostatic secretions in chronic prostatitis show?

A

WBCs, but cultures are negative,

100
Q

What is benigin prostatic hyperplasia?

A

It is hyperplasia of prostatic stroma and glands

101
Q

What is the probability of BPH resulting in cancer?

A

Age-related change (present in most men by the age of 60 years); no increased risk for cancer

102
Q

What is BPH related to?

A

dihydrotestosterone (DHT)

103
Q

What is testosterone converted to? Where? By what?

A

Converted to DHT by 5 alpha-reductase in stromal cells

104
Q

What does DHT act on?

A

the androgen receptor of stromal and epithelial cells resulting in hyperplastic nodules

105
Q

Where does BPH occur?

A

in the central periurethral zone of the prostate

106
Q

What are the clinical features for BPH?

A

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
Q

Why is PSA elevated in BPH, and what is the effect of this?

A

Because PSA is made by prostatic glands and liquefies semen

108
Q

What is the range for PSA in patients with BPH?

A

4-10ng/ml

109
Q

What is the treatment for BPH?

A

Alpha 1-antagonist (e.g., terazosin) to relax smooth muscle and 5 alpha reductase inhibitor

110
Q

For BPH, what must be considered as a side effect of the treatment?

A

The alpha-1 antagonist also relaxes vascular smooth muscle lowering blood pressure

111
Q

How is the side effect for the treatment of BPH taken into consideration?

A

Selective alpha 1A-antagonists (e.g., tamsulosin) are used in normotensive individuals to avoid effects on blood vessels

112
Q

What does 5a-reductase inhibitor do for BPH?

A

It blocks the conversion of testosterone to DHT

113
Q

How long does it take to produce results in treating BPH with 5 alpha reductase?

A

Takes months to produce results

114
Q

What other effects does 5 alpha reductase have when treating BPH?

A

Its also useful for male pattern baldness and has side effects are gynecomastia and sexual dysfunction

115
Q

What is prostate adenocarcinoma?

A

malignant proliferation of prostatic glands

116
Q

What is the most common cancer in men?

A

Prostate adenocarcinoma

117
Q

What is the 2nd most common cause of cancer-related death?

A

Prostate adenocarcinoma

118
Q

What are the risk factors for prostate adenocarcinoma?

A

they include age, race (African Americans > Caucasians > Asians), and diet high in saturated fats.

119
Q

How does prostatic carcinoma most often present clinically?

A

silent

120
Q

Where does prostate carcinoma usually arise?

A

in the peripheral, posterior region of the prostate and, hence, does not produce urinary symptoms early on

121
Q

When does screening for prostate adenocarcinoma begin?

A

at the age of 50 years with DRE and PSA

122
Q

What are normal serum PSA levels?

A

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
Q

What levels of PSA would be worrisome at any age?

A

> 10 ng/dL is highly worrisome at any age

124
Q

What aspect of PSA might be suggestive of cancer?

A

Decreased % free-PSA is suggestive of cancer (cancer makes bound PSA)

125
Q

What is required to confirm prostatic carcinoma?

A

Prostatic biopsy is required to confirm the presence of carcinoma

126
Q

What does prostate carcinoma show?

A

small, invasive glands with prominent nucleoli

127
Q

What is the grading system for prostate carcinoma?

A

Gleason grading system is based on architecture alone (and not nuclear atypia)

128
Q

What is the Gleason grading system?

A
  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
Q

In prostate carcinoma spread to what areas are common?

A

lumbar spine or pelvis is common;

130
Q

The spread of prostate carcinoma to the lumbar spine or pelvis results in what?

A

osteoblastic metastases

131
Q

For osteoblastic metastases or prostate carcinoma to the lumbar spine or pelvis, how does it present?

A

it presents as low back pain and increased serum alkaline phosphatase, PSA, and prostatic acid phosphatase (PAP)

132
Q

When is prostatectomy performed?

A

it is performed for localized disease

133
Q

What is advanced prostate carcinoma treated with?

A

hormone suppression to reduce testosterone and DHT

134
Q

What are used in hormone suppression for the treatment of advanced prostate carcinoma?

A

Continuous GnRH analogs (e.g., leuprolide) and flutamide

135
Q

What does continuous GnRH analog (used in hormone suppression treatment of prostate carcinoma) do?

A

it shuts down the hypothalamus (LH and FSH are reduced)

136
Q

What does flutamide (used in hormone suppression treatment of prostate carcinoma) do?

A

it acts as a competitive inhibitor at the androgen receptor

Pathoma (19 decks)

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