Chapter 14 - Male Genital System

Question 1

Hypospadias

Answer 1

Opening of urethra on inferior surface of penis due to failure of the urethral folds to close

Question 2

Epispadias

Answer 2

Opening of urethra on superior surface of penis due to abnormal positioning of the genital tubercle. Can be associated with bladder exstrophy.

Question 3

Lymphogranuloma venereum definition and cause.

Answer 3

Necrotizing granulomatous inflammation of the inguinal lymphatics and lymph nodes.

STD caused by Chlamydia trachomatis serotypes L1-L3.

Question 4

Risk factors for Squamous Cell Carcinoma of the Penis?

Answer 4

1. High risk HPV (16, 18, 31, 33)

2. Lack of circumcision.

Question 5

Bowen disease

Answer 5

Precursor lesion to SCC of the penis. In situ carcinoma of the penile shaft or scrotum that presents as LEUKOPLAKIA.

Question 6

Erythroplasia of Queyrat

Answer 6

Precursor lesion to SCC of the penis. In situ carcinoma of the glans that present as ERYTHROPLAKIA.

Question 7

Bowenoid papulosis

Answer 7

Precursor lesion to SCC of the penis. In situ carcinoma that presents as MULTIPLE REDDISH PAPULES. Does not progress to invasive carcinoma.

Question 8

Cryptorchidism

Answer 8

Failure of testicle to descend into the scrotal sac. Needs to be corrected by age of 2 or risk of infertility and seminoma

Question 9

Causes of Orchitis (inflammation of testicle) - 4

Answer 9

1. Chlamydia trachomatis (serotypes D-K) or N gonorrhoeae. See in young adults.
2. E coli and Pseudomonas - see in older adults via UTI
3. Mumps (teenagers)
4. Autoimmune orchitis- granulomas involving the seminiferous tubules.

Question 10

Clinical presentation of testicular torsion

Answer 10

Sudden testicular pain and absent cremasteric reflex.

Question 11

What side do you commonly see varicocele on and what is it associated with?

Answer 11

LEFT SIDE (as drains into left renal vein instead of directly into IVC). Associated with left-sided renal cell carcinoma.

Question 12

Hydrocele

Answer 12

Fluid collection within the tunica vaginalis of the scrotum. Associated with incomplete closure of the processus vaginalis (in infants) or blockage of lymphatic drainage (in adults)

Question 13

How do testicular tumors present, and what is done with them to diagnose?

Answer 13

Present as firm, painless testicular mass that CANNOT be transilluminated (as opposed to hydrocele).

DO NOT BIOPSY (as risk seeding the scrotum).

Question 14

Types of germ cell tumors in testicles? (5)

Answer 14

1. Seminoma (ala dysgerminoma in the ovary)
2. Embryonal carcionoma (immature, primative cells that may produce glands)
3. Yolk sac (endodermal sinus)
4. Choriocarcionoma
5. Teratoma

Question 15

Histologic findings of a seminoma (germ cell tumor)

Answer 15

Large cells with clear cytoplasm and central nuclei. Form a homogenous mass with no hemorrhage or necrosis. Good prognosis, as respond to radiotherapy.

Question 16

Histologic findings of an embryonal carcinoma (germ cell tumor)

Answer 16

Malignant tumor comprised of immature, primitive cells that may produce glands. Forms a hemorrhagic mass with necrosis.

Question 17

Treatment of embryonal carcinoma of the testicle and common serum markers

Answer 17

Treat with chemotherapy, but note that it may result in differentiation of the tumor into another type of germ cell tumor (esp. teratoma).

AFP or b-hCG may be elevated.

Question 18

What is the most common testicular tumor in children?

Answer 18

Yolk sac (endodermal sinus) germ cell tumor.

Question 19

Characteristic histologic finding of an endodermal sinus (yolk sac) tumor of the testicle and serum markers.

Answer 19

Schiller-Duval bodies (glomerulus like structures!). AFP characteristically elevated.

Question 20

What is Choriocarcinoma of the testicle?

Answer 20

Malignant tumor of syncytiotrophoblasts and cytotrophoblasts (placenta-like tissue W/O VILLI).

Question 21

What type of tissue makes b-hCG?

Answer 21

SYNCYTIOTROPHOBLAST

Question 22

Serum marker found in choriocarcinoma and side effects?

Answer 22

b-hCG elevated. May lead to hyperthyroidism or gynecomastia as a-subunit of hCG similar to that of FSH, LH, and TSH.

Question 23

How is a teratoma in males different than in females, and what marker is elevated

Answer 23

Malignant in males, benign in females. AFP or b-hCG may be elevated.

Question 24

Histologic findings of Leydig cell tumors (sex cord stromal tumors of testicle)?

Answer 24

Produce excess androgen, causing precocious puberty in children or gynecomastia in adults. Reinke crystals seen on histo.

Question 25

What is the most common cause of a testicular mass in males > 60 years of age?

Answer 25

Lymphoma (usually bilateral). Often diffuse large B-cell.

Question 26

is there an increased risk for cancer with benign prostatic hyperplasia?

Answer 26

NO

Question 27

where does BPH occur?

Answer 27

periurethral zone of prostate

Question 28

how to treat BPH?

Answer 28

a1-antagonists (eg terazosin) which relax smooth muscle or 5a-reductase inhibitors (take longer to kick in)

Question 29

what is the Gleason grading scale based on?

Answer 29

Prostate cancer architecture alone (not nuclear atypia)

Question 30

meds for prostate cancer?

Answer 30

Leuprolide (continuos GnRH analog) or Flutamide (competitive inhibitor of androgen receptor).