Chapter 14 Flashcards by Shane Hagen

What is the difference between epispadias and hypospadias?

Hypospadias is the abnormal opening of the urethra on the inferior surface of the penis due to failure of closure of the urethral folds while epispadias is the abnormal superior opening of the urethra due to abnormal positioning of the genital tubercle (associated with bladder exstrophy)

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What is this?

condyloma acuminatum of the penis caused by HPV 6/11 (koilocyte change on histo)

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What is this?

Lymphogranuloma venereum, a necrotizing granulomatous inflammation of inguinal lymphatics and lymph nodes caused by Chlaymdra trachomatis serotypes L1-L3

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What are the main risk factors for squamous cell carcinoma of the penis?

High risk HPV (2/3 of cases)

Lack of circumcision- the foreskin acts as a nidus for inflammation

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What is this?

Bowen disease- in situ carcinoma of the penile shat or scrotum that presents as leukoplakia

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What is this?

Erythroplasia of Queyrate- in situ carcinoma on the glans that presens as erythroplakia

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What is this?

Bowen papulosis- an in situ carcinoma that presents as multiple reddish papules on the penis

Seen most in younger pts (40s) and does NOT progresss to invasive carcinoma

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What is cryptorchidism?

Failure of the teticle to descend into the scortal sac (most cases resolve spontaneously but if not, orchioplexy is perfromed before 2 yrs of age)

Complications include testicular atrophy with infertility and increased risk for a seminoma

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What is orchitis?

Inflammatio of the testicle

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What are the most common causes of orchitis?

Chlamydia trachomatis (serotypes D-k) or Neisseria gonorrhoeae- increased risk of steriliy but libido is not affected because Leydig cells are spared

E. Coli and Pseudomonas- seen in older adults as UTIs that spread into the repro tract

Mumps

Autoimmune orchitis- granulomas involving the seminiferous tubules

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What is testicular torsion?

Twisting of the spermatic cord, in which thin-walled veins become osbtructed leading to congestion or infarction

Usually due to congenital failure of the testes to attach to the inner lining of the scrotum vi the processus vaginalis

Cremasteric reflex is usually absent

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Dilation of the spermatic vein due to impaired drainage is known as _______

Varicocele- presenting as a bag of worms appearance (usually left-sided due to the left testicular vein draining into the left renal vein, while the RTV drains directly into the IVC)

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What is hydrocele?

Fluid collection within the tunica vaginalis that is associated with incomplete closure of the processus vaginalis leading to communication with the peritoneal cavity in infants or blockage of lymp drainage in adults

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Basics of testicular tumors

Can arise from germ cells or sex cord-stroma

Typically presents as a firm painless testicular mass that cannot be transilluminated

usually not biopsied for risk fo seeding the scrotum; removed via radical orchiectomy

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What are the most common types of testicular cancer?

Germ cell tumors (95%)

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Describe Germ cell tumors of the testicle

These usually occur in pts 15-40 yo with risk factors including cryptorchidism and Klinefelter syndrome

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What are the main types of Germ cell tumors?

seminoma and nonseminomas

Describe seminomas

(55% of cases)- highly responsive to radiotherapy, MET late, and have an excellent prognosis (in contrast, nonseminomas show variable response to tx and often MET earlier)

Seminomas are malignany tumors comprised of large cells with CLEAR CYTOPLASM and a central nuclei that form a homogeneous mass with no hemorrhage or necrosis (most common testicular tumor and resembles ovarian dysgerminoma)

rare cases may produce B-hCG

Good prognosis and responds to radiotherapy

Describe embryonal carcinomas

Malignant tumor comprised of immature, primitive cells that may produce glands and form a hemorrhagic mass with necrosis (aggresive with early heme spread)

Chemo may result in differentiation into another type of germ cell tumor such as a teratoma

increased AFP or B-hCG may be present

Describe yolk sac tumors

Aka endoderal sinus tumor, a malignant tumor that resembles yolk sac elements (most common testicular tumor in children)

Marked by Schiller-Duval bodies

AFP is classically elevated

Describe choriocarcinomas

malignant tumor of syncytiotrophoblasts and cytotrophoblasts that spreads early via blood

B-hCG is classically elevated and may lead to hyperthyroidism or gynecomastia (a-subunit of hCG is similar to that of FSH, LH, and TSH)

What are sex cord-stromal tumors?

Tumors that resemble sex cord-stromal tissues of the testicle

Below: Normal testicular histology

What are the main sex cord-stromal tumors?

Leydig cell tumor- usually produces androgens and can cause precocious puberty in children or gynecomastia in adults (classic Reinke crystals on histo)

Sertoli cell tumor- comprised of tubules and is usually clinically silent

Reinke crystals

What is the most common cause of a testicular mass in males 60+ yo?

Lymphoma (often bilateral)- usually **diffuse large B-cell type**

Normal prostate histology- consists of glands and stroma. Glands are composed of an inner layer of luminal cells and an outer layer of basal cells; secrete alkaline fluid that is added to sperm and seminal vesicle fluid to make semen Maintained by androgens

What are the most common causes of acute prostatitis?

Usually due to bacteria such as Chlamydia trachomatis and Neisseria gonorhoeae in young adults and E. Coli and Pseudomonas in older adults Presents as dysuria with fever and chills and a 'tender and boggy' prostate on digital rectal exam

T or F. BPH carries no increased risk of cancer

What causes BPH?

DHT action- occurring in the CENTRAL PERIURETHRAL ZONE of the prostate

How might BPH present?

problems urinating, impaired bladder emptying with increased risk of infection Dribbling Hypertropy of the bladder wall smooth muscle - increases the risk for bladder diverticula

Is PSA elevated with BPH?

Yes, often slightly due to the increased no. of glands

How is BPH tx?

a1-antagonists (e.g. terazosin) to relax smooth muscle 5a-reductase inhibitors (takes months to produce reults)

What is prostate adenocarcinoma?

A malignany proliferation fo prostate glands (most common cancer in men and 2nd most common cause of cancer-related death behind lung)

What are the risk factors for prostate adenocarcinoma?

Age race (AA \> white \> Asians) diet high in saturated fats

How does prostate adenocarcinoma present?

Often clinically silent- usually arises in the peripheral, psoterior region of the prostate and thus may not produce urinary issues

How is prostate adenocarcinoma screened for?

Screening begins at 50 yo with DRE and PSA Normal PSA increased with age due to BPH (2.5ng/mL for ages 40-49 and 7.5ng/mL for ages 70-79) PSA \> 10 ng/mL is worrisome at any age Decreased % free-PSA is suggestive of cancer

How is prostate adenocarcinoma diagnosed?

biopsy showing small, invasive glands with prominent nucleoli

What is the grading system for prostate adenocarcinoma?

Gleason grading system- based on architecture alone (ant not nuclear atypia)- multiple regions must be assessed because architecture varies from area to area (a score of 1-5 is assigned for two distinct areas and then added to produce a final score- high score is worse)

Where do prostate adenocarcinomas like to spread to?

LUMBAR spine or pelvis, resulting is osteoblastic METs that present as low back pain and icnreased serum Alk Phos, PSA, and prostatic acid phosphatase (PAP)

How is prostate adenocarcinoma tx?

Prostatectomy is performed for localized disease; advanced diseased is tx with hormone suppression to reduce testosterone and DHT Continuous GnRH analogs (e.g. leuprolide) shut down the anterior pituitary gonadotrophs (LH and FSH are reduced) Flutamide can also be used and acts as a competitive inhibitor at the androgen receptor