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My Pathoma Unit 5 > Chapter 14 Male genital System > Flashcards

Chapter 14 Male genital System Flashcards

1
Q

What is hypospadia and what is it due to?

A

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

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2
Q

What is Epispadia and what is it due to and associated with?

A

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

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3
Q

What is condyloma acuminatum? what is it due to and what is it characterized by?

A

Benign warty growth on genital skin. Due to HPV type 6 or 11; characterized by koilocytic change

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4
Q

What is lymphogranuloma venereum?

A

Necrotizing granulomatous inflammation of the inguinal lymphatics and lymph nodes

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5
Q

What causes lymphogranuloma venereum?

A

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

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6
Q

What is the end result of lymphogranuloma venereum?

A

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

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7
Q

What does the following serotypes of chlamydia trachomatis cause?
A-C
D-K
L

A

A-C trachoma
D-K Urogenital infections and conjuctivitis
L Lymphogranuloma venereum

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8
Q

What is Squamous cell carcinoma on the penis?

A

Malignant proliferation of squamous cells of penile skin

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9
Q

What are 2 risk factors for squamous cell carcinoma of the penis?

A

1 high risk HPV (2/3 of causes)

2 Lack of circumcision - foreskin acts as nidus for inflammation and irritation if not properly maintained

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10
Q

What are 3 precursor in situ lesions of squamous cell carcinoma of the male genitals?

A

1 Bowen Disease
2 Erythoplasia of Queyrat
3 Bowenoid papulosis

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11
Q

What is Bowen Disease?

A

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

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12
Q

What is erythroplasia of Queyrat?

A

in situ carcinoma on the glans that presents as erythroplakie

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13
Q

What is Bowenoid papulosis? What age range does it effect, and describe its local activity.

A

in situ carcinoma that presents as multiple reddish papules. seen in young patients (40s) relative to bowen disease and erythroplasia of queyrat. Does not progress to invasive carcinoma.

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14
Q

What is cryptorchidism?

A

Failure of testicle to descend into the scrotal sac

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15
Q

What is the normal developmental path of the testicle?

A

Testicles normally develop in the abdomen and then “descend” into the scrotal sac as the fetus growths

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16
Q

What is the most common congenital male reproductive abnormality?

A

Cryptorchidism seen in 1% of male infants.

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17
Q

What is the course of most cases of cryptorchidism?

A

Most cases resolve spontaneously; otherwise, orchiopexy (tack down testicle to scrotal sac to avoid damage to gem cells) is performed before 2 years of age

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18
Q

What doe complications of cryptorchidism include?

A

testicular atrophy with infertility and increased risk for seminoma

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19
Q

What is orchitis?

A

inflammation of the testicle

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20
Q

What are 4 causes of orchitis

A

1 Chlamydia trachomatis (Serotypes D-K)
2 E. coli and pseudomonas
3 Mumps Virus (teenage males)
4 Autoimmune

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21
Q

Who is orchitis due to chlamydia trach seen in and what does it increase risk for?

A

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

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22
Q

Who is orchitis due to e. cole and psuedomonas seen in and how does it occur?

A

Older adults; UTI pathogens spread into the reproductive tract

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23
Q

Who is orchitis due to mumps virus seen in and what does it increase the risk for?

A

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

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24
Q

Describe orchitis caused by autoimmune processes?

A

characterized by granulomas (not necrotizing) involving the seminiferous tubules (must differentiated form TB)

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25
What is testicular torsion?
Twisting of the spermatic cord; thin walled veins become obstructed leading to congestion and hemorrhagic infarction (Artery is nor obstructed)
26
What is testicular torsion usually due to?
congenital failure of testes to attach to the inner lining of the scrotum (via the processus vaginalis)
27
How does testicular torsion present?
presents in adolescents with sudden testicular pain and absent cremasteric reflex
28
What is a varicocele?
Dilation of the spermatic vein due to impaired drainage
29
How does a varicocele present?
Presents as scrotal swelling with a "bag of worms" appearance on the surface
30
What side are varicoceles usually seen on, why, what are they associated with?
Usually left sided; left testicular vein drains into the left renal vein, while the right testicular vein drains directly into IVC. Associated with left sided renal cell carcinoma; RCC often invades the renal vein.
31
What population are a large percent of varicoceles seen in?
Seeni in a large percentage of infertile males possible due to damage by warm blood temperature
32
What is a hydrocele?
Fluid collection within the tunica vaginalis
33
What is the tunica vaginalis?
serous membrane that covers the testicle as well as the internal surface of the scrotum.
34
What are hydrocele associated with?
Incomplete closure of the processus vaginalis leading to communication with the peritoneal cavity (infants) or blockage of lymphatic drainage (Adults)
35
How does a hydrocele present?
Presents as scrotal swelling that can be transluminated
36
Where doe testicular tumors arise from?
germ cells or sex cord stroma
37
How doe testicular tumors present?
Present as firm, painless testicular mass that cannot be transilluminated
38
Are testicular tumors biopsied? why?
NO. due to risk of seeding the scrotum; removed via radical orchiectomy
39
What type of tumor are most testicular tumors?
malignant germ cell tumors
40
What percentage of testicular tumors are germ cell tumors?
95%
41
What ages germ cell tumors usually arise?
15-40
42
What are the risk factors for germ cell tumors?
cryptorchidism and klinefelter syndrome
43
What two categories are germ cell tumors separated into?
Seminoma and non seminoma
44
What is the difference between a seminoma and a non seminoma and what percentage of germ cell tumors do each represent?
Seminomas (55% of cases) are highly responsive to radiotherapy, metastasize late, and have an excellent prognosis. Non-seminomas (45% of case) show variable response to treatment and often metastasize early.
45
Describe a seminoma? Histological and gross appearance.
malignant tumor comprised of large cells with clear cytoplasm and central nuclei (resembles spermatogonia); forms a homogeneous mass with NO hemorrhage or necrosis
46
What other type of cancer does a seminoma resemble?
ovarian dysgerminoma
47
In rare cases what serum marker does a seminoma produce?
Beta-Hcg
48
What is the prognosis and treatment of a seminoma?
Good prognosis, responds to radiotherapy
49
What is an embryonal carcinoma and what does it consist of?
Malignant tumor comprised of immature, primitive cells that may produce glands; forms a hemorrhagic mass with necrosis (because it is a primitive tumor and rapidly growing)
50
Describe the level of aggressiveness and spread of embryonal carcinoma?
Aggressive with early hematogenous spread
51
What may result from chemotherapy of an embryonal carcinoma?
differentiation into another type of germ cell tumor (eg teratoma)
52
What serum markers MAY be present in embryonal carcinoma?
AFP (Classically seen in yolk sac tumor) | Beta-Hcg (Classically seen on choriocarcinoma)
53
What is a yolk sac (endodermal sinus) tumor?
malignant tumor that resembles yolk sac
54
What is the most common testicular tumor in children?
Yolk sac tumor
55
What is seen on histology of a yolk sac tumor?
Schiller duval bodies (glomerulus like structures)
56
What is characteristically elevated in a yolk sac tumor?
serum AFP
57
What is a choriocarcinoma?
malignant tumor of syncytiotrophoblasts and cytotrophoblasts (Placenta like tissue but villi are ABSENT)
58
What cell in a choriocarcinoma produces Beta-hcg
Syncytiotrophoblasts
59
how does a choriocarcinoma spread and what does this result in?
early through the blood results in tiny primary and large secondaries
60
What is characteristically elevated in choriocarcinoma and what may it lead to?
Beta-hCG; may lead to hyperthyroidism or gynecomastia (alpha subunit of hCG is similar to that of FSH, LH, and TSH)
61
What is a teratoma?
A tumor composed of mature fetal tissue derived from two or three embryonic layers
62
Are teratomas in males malignant or benign?
Malignant
63
What two markers MAY be present in a male teratoma?
AFP or Beta hCG
64
What are mixed germ cell tumors and what is the prognosis based on?
germ cell tumors are usually mixed and the prognosis is based on the worst compopnent
65
What are sex cord stromal tumors? are they usually benign or malignant?
tumors that resemble sex cord stromal tissues of the testicle; usually benign
66
What does a leydig cell tumor usually produce and what does it cause? What is characteristically seen on histology?
Usually produces androgen, causing precocious puberty in children or gynecomastia in adults. Characteristic Reinke crystals may be seen on histology
67
What is a sertoli cell tumor composed of and how does it present?
comprised of tubules and is usually clinically silent
68
What is the most common cause of a testicular mass in males >60 years old?
Lymphoma
69
are lymphomas usually bilateral or unilateral?
bilateral
70
What type are lymphomas of the male genitals usually?
Diffuse Large B-cell type
71
What is the prostate and where does it sit?
Small, round organ that lies at the base of the bladder encircling the urethra. Sits anterior to the rectume; posterior aspect of the prostate is palpable by DRE
72
What does the prostate consist of?
Glands and stroma
73
What are the glands of the prostate composed of? what does it produce?
Inner layer of luminal cells and an outer layer of basal cells; secrete alkaline, milky fluid that is added to sperm and seminal vesicle fluid to make semen
74
What maintains the glands and stroma of the prostate?
androgens
75
What is acute prostatitis and what is it usually due to?
Acute inflammation of the prostate; usually due to bacteria
76
What are the common causes of acute prostatitis in young adults?
Chlamydia and N. gonorrhoeae
77
What are the common causes of acute prostatitis in older adults?
E. Coli and pseudomonas
78
How does acute prostatitis present?
as dysuria with fever and chills
79
What is apparent in a DRE with acute prostatitis?
prostate is tender and boggy
80
What do prostatic secretions and cultures reveal in acute prostatitis?
prostatic secretion show WBCs; culture reveal bacteria
81
What is chronic prostatitis?
chronic inflammation of the prostate
82
How does chronic prostatitis present?
dysuria with pelvic or low back pain
83
What doe prostatic secretions and cultures show in chronic prostatitis?
Prostatic secretions show WBCs but cultures are NEGATIVE
84
What is benign prostatic hyperplasia?
Hyperplasia of prostatic stroma and glands
85
What type of change is BPH and what is the risk for cancer?
Age-related change (present in most men by the age of 60); no increased risk for cancer
86
What is BPH related to?
dihydroxytestosterone (DHT)
87
Where is DHT created?
Testosterone is converted to DHT by 5alpha reductase in stromal cells
88
What does DHT do in the prostate?
Acts on the androgen receptor of stromal and epithelial cells resulting in hyperplastic nodules
89
What zone of the prostate does BPH arise in?
The central periurethral zone
90
What doe clinical features of BPH include? 6
Problems starting and stopping peeing 2 impaired bladder emptying with increased risk for infection and hydronephrosis 3 dribbling 4 hypertrophy of the bladder wall smooth muscle' increased risk for bladder diverticula 5 microscopic hematuria may be present 6 PSA is often SLIGHTLY elevated (usually less than 10) due to increased number of glands; PSA is made by the prostatic glands and liquefies semen
91
What is hydronephrosis?
dilation of the kidney
92
What are the 2 treatments for BPH?
1 alpha 1 antagonist (terazosin) to relax smooth muscle | 2 5 alpha reductase inhibitor
93
How does an alpha 1 antagonist work in BPH treatment?
Relaxes smooth muscle. Also relaxes vascular smooth muscle lowering BP. Selective alpha 1A antagonists (tramsulosin) are used in normotensive individuals to avoid alpha 1B affects on blood vessels
94
How do 5alpha reductase inhibitors work in BPH treatment? what are some side effects?
Block the conversion of testosterone to DHT. Takes months to produce results. Also useful for male pattern baldness. Side effects are gynecomastia and sexual dysfunction
95
What is prostate adenocarcinoma?
malignant proliferation of prostatic glands. Most common cancer in men; 2nd most common cause of cancer related death
96
What do risk factors for prostate adenocarcinoma include?
age, race (African american>caucasian>asian), and diet high in saturated fats
97
How does prostatic carcinoma present and where does it arise.
Most often is clinically silent. Usually arises in the peripheral, posterior region of the prostate and, hence, does not produce urinary symptoms early on.
98
What does screen begin for prostate cancer and what does it include?
Screening begins at the age of 50 with DRE and PSA
99
Describe what is normal for PSA levels and what is seen in prostate cancer?
normal serum PSA increases with age due to BPH (2.5 ng/mL for 40-49, vs 7.5 for 70-79) PSA>10 is highly worrisome at any age. Decreased % of free PSA is suggestive of cancer (which makes bound PSA)
100
What is required for diagnosis of prostatic carcinoma?
Biopsy
101
What does biopsy show in prostatic carcinoma?
Small, invasive glands with prominent (dark) nucleoli
102
Describe the Gleason Grading system?
based on ARCHITECTURE ALONE (not nuclear atypia). Multiple regions of the tumor are assessed because architecture varies from area to area. A core (1-5) is assigned for two distinct areas and then added to produce a final score (2-10). Higher score suggests worse prognosis.
103
Where is a common place for prostate cancer to spread and what does it cause? what markers are elevated
Spread to lumbar spine or pelvis is common; results in osteoblastic (sclerotic) metastases that present as low back pain and increased serum alkaline phosphatase, PSA, and prostatic acid phosphatase
104
How is prostate cancer treated?
Prostectomy is performed for localized disease; advanced disease is treated with hormone suppression to reduce testosterone and DHT.
105
What are two homone suppression therapies for prostate cancer?
1 continusous GnRH analogs (e.g. Leuprolide) shut down that anterior pituitary gonadotrophs (LH and FSH are reduced) 2 Flutamide acts as a competitive inhibitor at the androgen receptor.

My Pathoma Unit 5 (4 decks)

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