Chapter 77 Diseases and Disorders of the Male Genitalia Flashcards
Circumcision has been adopted as a measure to reduce _____ transmission
Benefits of circumcision?
human immunode ciency virus (HIV)
- Reduced or abolished risk of penile cancer
- Decreased risk of cervical cancer in partners
- Protection from sexually transmitted infections, including HIV infection (controversial)
- Reduced risk of urinary tract infections (controversial)
- Reduced risk of inflammatory genital skin diseases
perineal area is abundant in_____ and _____, usually in association with hair follicles as pilosebaceous units but also occurring as free glands at some sites such as the ___________
eccrine and apocrine (some functionless) sweat glands and holocrine sebaceous glands
anal rim or around the coronal sulcus (Tyson glands)
The ____is a delicate, busy tissue that is in close contact with urine and exposed to sexual secretions, detergents, and infectious agents, especially opportunistic organisms and those that are sexually transmitted.
Of the latter, _____ is the most important known from the point of view of precancerous dermatoses and invasive squamous carcinoma.
foreskin human papillomavirus (HPV)
All these congenital and acquired factors can conspire to produce a dysfunctional foreskin, often clinically expressed as male sexual dysfunction in the form of ______
male dyspareunia
_____ - nonretractable foreskin
Causes of phimosis?
phimosis
Lichen sclerosus Nonspecific balanoposthitis (in diabetes) Lichen planus Hidradenitis suppurativa Crohn disease Cicatricial pemphigoid Chronic penile lymphoedema Kaposi sarcoma
_____ - foreskin fixed in retraction
- rarer and is usually an ____ presentation caused by vigorous sexual activity, acute contact urticaria, acute allergic contact dermatitis, and lichen sclerosus (LSc)
paraphimosis
acute emergency
_____ - inflammation of the glans penis _____ - inflammation of the prepuce
balanitis
posthitis
confusing terms, used to signify the end stage of all chronic cases of balanitis and posthitis (e.g., scarring dermatoses such as LP and cicatricial pemphigoid), but these conditions are usually due to LSc and are therefore considered synonymous by some
_______ - glans and shaft of penis ulcerated through the prepuce, which lies ventrally as an empty sleeve
- very rare and is caused by gross penile disease such as hidradenitis suppurativa, pyoderma gangrenosum, florid condylomata, chancroid, herpes simplex, idiopathic balanoposthitis, podophyllin misuse
dorsal perforation of the prepuce
Wood’s light examination is helpful in the clinical diagnosis of ____, ____, ____
vitiligo, erythrasma, and fungal infections
Examination of biopsy specimens should not be regarded as a substitute for clinical diagnosis. T/F?
It is safe and helpful to use small amounts of ______—the region is highly vascular
It is often necessary to suture a preputial punch biopsy site. T/F?
True
adrenaline
False (not often)
_______ which may be found in between 15% and 48% of men, are flesh-colored, smooth, rounded papules (1–3 mm) occurring predominantly around the _______, rarely on the glans.
Often there are rows or rings of the papules. They are commoner in the _____ and _____
_____ should suffice, but ____ and ____ treatment have been used
Pearly or pink penile papules coronal margin of the glans uncircumcised male and regress with age Reassurance cryotherapy and laser
________
common, normal variants of the skin of the scrotal sac and penile shaft, analogous to the situation on the vermillion of the lips
Sebaceous gland prominence, Tyson glands, sebaceous hyperplasia, and “ectopic” sebaceous glands (Fordyce condition)
Reassurance is usually adequate, but patients can be inordinately distressed
possible that nevi on the penis occur more frequently in patients with the ________
atypical nevus syndrome
______ are blue to purple, smooth, 2–5-mm papules on the scrotum, penile shaft, or glans. They generally appear and multiply during life but occasionally present as singletons
________ are smaller than common angiokeratomas, presenting as less hyperkeratotic pinhead lesions, and are found more extensively around the _____ and ______ from the navel to the knees
Electrocautery or laser ablation can be offered, but the lesions may recur
angiokeratomas
angiokeratomas of Fabry disease
lower limb girdle and upper thighs
________
tightly adherent to the skin because their mouth parts are embedded in perifollicular blood vessels. Sometimes gray–blue macules (________) are seen on the affected sites.
pediculosis pubis
tache bleu, maculae caeruleae
____ infection is a risk factor for anogenital cancer, particularly of the cervix and anus.
- associated with the clinical expressions of penile carcinoma in situ (PCIS), or Bowen disease of the penis, erythroplasia of Queyrat (EQ), or bowenoid papulosis (BP) and approximately 50% of cases of _______
high-grade dysplasia associated with high-risk types have been found in the urothelium and genital warts from HIV-positive individuals and the penis cancer risk is increased ______ (the anal cancer risk may be increased _______)
HPV
squamous carcinoma of the penis
three- to sixfold
by as much as 100
_________
Inflammation and purulence may be due to infection but are a common phenomenon when individual lesions spontaneously involute
Mollusca
Vitiligo has been reported after treatment of genital warts with ______.
An important rare differential diagnosis is depigmented ________
Phototherapy of vitiligo might lead to _____
imiquimod
extramammary Paget disease (EMPD)
squamous cell carcinoma (SCC)
________
nonspecific psoriasiform or eczematous balanitis or balanoposthitis is found in conjunction with classic symptoms and extragenital manifestations of the diathesis
In severe cases, such as with concomitant seborrheic folliculitis or in acquired immunode ciency syndrome (AIDS), treatment with an ______ might be indicated
seborrheic dermatitis
oral imidazole
Drugs such as _____, _____, _____, _____ may be responsible for the onset or exacerbation of psoriasis
In circumcised men, genital psoriasis presents with _________
On the glans or in the preputial sac of the uncircumcised patient, _________ because of the mucosal site
less commonly affected, the ______
lithium, β blockers, antimalarials, and angiotensin-converting enzyme inhibitors
variably itchy, silvery-scaled, erythematous patches or plaques
scale is absent from the patches or plaques
scrotum
_______ can be part of the spectrum of inverse-pattern psoriasis and may be associated with intertriginous disease of the axillae, intergluteal cleft, gluteal folds, and groin
________ might indicate superinfection, especially with Candida. _________ would make one suspect another derma- tosis such as an eczematized dermatitis or tinea
Psoriatic balanoposthitis
Soreness
Inordinate itch
Psoriasis
________ preparations should also therefore be avoided at this site because of the risk of genital cancer.
_____ application may lead to burning and so is usually avoided in this region. Vitamin D analogues and calcineurin inhibitors seem safe, but with the latter, the prescriber must _______
_______ is conventionally contraindicated because of the risk of anogenital cancer
Strong crude tar
Dithranol
be certain of the absence of PCIS
Phototherapy
_______ may affect the penis (like the mouth, vulva, and anus) in isolation as the cause or consequence of foreskin dysfunction (by ______) and so present as dyspareunia and a nonspecific dermatosis
Lichen planus
“koebnerization”
Although LP is self-limiting, some patients experience relapses and remissions. _____ can form. ________ can persist for months or years
Chronic mucosal erosive LP is associated with a risk of ___, although most reports linking the two concern oral LP.
_____ topical corticosteroids usually produce remission
________ are sometimes indicated for severely symptomatic disease, _____ orogenital involvement, and _________.
_____ may be necessary if there is phimosis and should be seriously considered in cases of refractory disease, especially the _____ form, because the removal of “koebnerizing” influences may allow the LP to remit
Adhesions
Postinflammatory hyperpigmentation
SCC
Potent or very potent Systemic corticosteroids erosive scarring of the scalp and nails Circumcision erosive
_______ is sometimes held simplistically and controversially to be a micropapular variant of LP.
It has an affinity for the penis and can be difficult to diagnose because the signs may be subtle, even when the lesions are widespread
Lichen nitidus
_______
Erythematous smooth, ovoid nodules of granuloma affecting the penis have been described.
They are perhaps related to trauma and koebnerization, because circumcision can be curative
granuloma annulare
_________ can be focalized to the male genitalia as a sore or painful annular erythematous eruption with a central glassy appearance and serpiginous border surrounded by scaling.
It is a characteristic cutaneous manifestation of the _______
Necrolytic migratory erythema
glucagonoma syndrome
Aphthae and idiopathic orogenital ulceration are more common and are worse, symptomatically and morphologically, in _______ individuals
_______ may be efficacious treatment
HIV-infected
thalidomide
To diagnose Behçet disease according to strict diagnostic criteria, ________ must be present; then patients must also either manifest _______ involvement or genital ulceration and__________
oral ulceration
genital ulceration and ophthalmic
skin signs (or a positive pathergy test result)
_________ is a rare disease that must be in the differential diagnosis of blistering, erosions, ulcers, transcoronal adhesions, scarring, and phimosis.
These manifestations can occur in isolation, but ____, _____, _____ lesions are more common than genital involvement
Mucous membrane (cicatricial) pemphigoid ophthalmic, oropharyngeal, and cutaneous
_______ may represent a pathergic reaction after urologic surgery or complicate IBD or leukemia
pyoderma gangrenosum
The penis is a classic site of predilection for ______
Ulceration due to ______ can occur when the drug is inadvertently injected subcutaneously for the treatment of erectile impotence.
______ have induced skin necrosis of the genitalia
_____has been reported to induce genital ulceration in patients with hematologic malignancy
______ can create genital ulceration in HIV-infected patients due to the high urinary concentrations of the drug
_____ is a newly-appreciated cause of anogenital and peristomal ulceration.
_____ has been associated with genital angioedema
fixed drug eruptions papaverine Heparin and warfarin All- trans retinoic acid Foscarnet Nicorandil Lisinopril
________ causing a perianal cellulitis is a recognized syndrome in children, but a similar clinical situation occasionally occurs in adults and might affect the genitalia alone
Streptococcal dermatitis
________ is relatively rare but can be associated with severe morbidity due to nocturia, dysuria, acute urinary retention, constipation, and fecal retention
Treatment in ______
Sacral herpes zoster
IV acyclovir
______ is not common, and when it occurs it is usually associated with crural disease.
Tinea of the penis or scrotum
_____ occur because of ova shed by worms that have entered the perineal vessels from the pelvic venous plexuses.
Papules and nodules may be itchy; may be skin-colored, pink, or brown; may be scattered or grouped; and may affect the penis and scrotum.
They can spread onto the perineum and around the anus and may develop into soft, warty, vegetating lesions but remain relatively asymptomatic.
Schistosomiasis
The dermatologic genital consequences of onchocerciasis are ____, ____, ____, ____, including “lizard skin” lichenification, “hanging groin,” and scrotal enlargement
pruritus, “leopard skin” hypopigmentation (on shins and scrotum),
nodules (on ileal crests, scrotum, and ribcage),
dermatitis
__________
Annular raised (double-rimmed) lesions have been found in the intergluteal cleft, on the scrotum, and on the penis, including the glans
____ and ____ can be used for treatment
Genital porokeratosis of Mibelli
Cryotherapy and topical 5-fluorouracil
______ can present as a dull red patch or plaque on the glans penis or in the preputial sac and can also affect the penile shaft, scrotum, and perianal skin - classic manifestations—purple, slightly scaly patches or plaques, nodules, and ulcerative lesions.
An engorged, “hypervascular” presentation has been described, as has ____, ____, ____
Kaposi sarcoma
penile lymphedema, acute phimosis, and rectourethral fistulation
____, ____, ____ can be associated with hematologic malignancy.
Although the groin is a classic site of involvement in _____, involvement of the penis is very rare.
Metastases to the penis and scrotum occur uncommonly - usually secondary to cancer of the ____ or ____ or complicate other common cancers such as those of the lung
Pyoderma gangrenosum, Pseudomonas infection, and Fournier gangrene
Langerhans cell histiocytosis
urogenital tract or gastrointestinal system (e.g., rectum)
Some if not all cases may represent PIH from previous disease or insult [e.g., phimosis, balanoposthitis, topical treatment, LSc, LP, circumcision]. It has been suggested that_______ is an essential element of the condition
possibility of Addison or Nelson syndrome should be entertained, as should the possibility of a lentiginosis syndrome [____, ____, ____, ____], although idiopathic lentigines of the penis are recognized
Laser treatment may be helpful
adjacent depigmentation
Peutz–Jeghers,
LAMB (lentigines, atrial myxoma, blue nevi), LEOPARD (multiple lentigines, elec- trocardiographic abnormalities, ocular hypertelorism, pulmonary stenosis, abnormalities of the genitalia, growth retardation, deafness), or
Bannayan–Riley–Ruvalcaba syndrome
________
Irritation is induced by__________ between two tightly apposed and infrequently and inadequately separated and/or infrequently or inappropriately bathed, commensally hypercolonized, desquamative, secretory epithelial surfaces
An________ with _______ is classic
Well-demarcated, glistening, moist, shiny, bright red, or autumn brown patches symmetrically involve the glans and inner prepuce, sparing the ______ or _____
histologic examination the epidermis is attenuated with absence of the _____ or _____, sparse dyskeratosis and spongiosis, and diamond- or lozenge-shaped ______. In the dermis there are variably seen a band of plasma cells infiltration, extravasated erythrocytes, hemosiderin, fibrosis, and vascular proliferation
Definitive curative treatment is _______
zoon balanitis
retention of urine and squames
asymptomatic presentation with little or no dyspareunia
keratinized penile shaft or foreskin
granular and horny layers
basal cell keratinocytes
surgical circumcision
The pathogenesis of LSc, particularly the role of autoimmunity. _________ have been found in the sera of male and female patients with genital LSc
The principal presentation in men is of ______.
The classic genital morphologic manifestations - atrophic white patches or plaques or lilac, slightly scaly patches with _____ and _____, like those of the classic clinical manifestations of extragenital LSc
_______ is the most worrying complication of LSc: the published risk is 2%–12.5% and the latent period may be _____.
________ acheive remission in 50%–60% and the majority of the remainder are cured by _____
Antiextracellular matrix protein 1 antibodies
dyspareunia
telangiectasia and sparse purpura
SCC of the penis
10–30 years
Very potent topical steroids
circumcision
________
diagnosis of exclusion or as a descriptive term that indicates the limitations of diagnostic acumen
______ may be the end stage situation including in diabetes.
_______ is the cause or consequence of probably all cases and many patients probably have ___ as the underlying morbid state
The ultimate recourse is _____, which is curative in most instances
Nonspecific balanoposthitis Phimosis Preputial dysfunction LSc circumcision
_______ should be considered when florid symptomatology is accompanied by a paucity or complete absence of any primary dermatologic signs
________ - persistent redness of the anterior half of the scrotum that may involve the base of the penis . . . usually accompanied by a persistent itching or burning sensation and hyperalgesia.” Accompanying the erythema there may be telangiectasia
Contact urticaria, irritant and contact dermatitis, and scrotal rosacea due to ______ application should be considered. ____ and ____are causes of odd sensory symptoms.
Some men with “idiopathic” anogenital pruritus may be found to have lumbosacral radiculopathy - significant improvement may be obtained by _______
Dermatologic nondisease
red or burning scrotum syndrome
topical steroid
Angiokeratoma corporis diffusum and multiple sclerosis
paravertebral injections of triamcinolone
Scrotal rosacea should be treated with ___________ may be effective in the red scrotum syndrome
oral tetracycline’s and these (e.g., doxycycline)
_________
Young men complain of penile spots or boils or blackheads and on examination have comedones, papules, pustules, and inflammatory nodules of the proximal penile shaft.
An important differential diagnosis of acneiform disease presenting at any site is ______ caused by occlusion of the skin with machine oil
penile acne
chloracne
_________
swelling and intercurrent attacks of cellulitis and lymphangitis of the penis, scrotum, and pelvic girdle
Chronic idiopathic penile edema
Long-term treatment with oral antibiotics such as erythromycin, clarithromycin, clindamycin, trimethoprim, cotrimoxazole, or ciprofloxacin is advocated
______ is a medical and surgical emergency.
Patients present with systemic upset and painful erythematous swelling of the____, ____ or ____ and may be in urinary retention.
An ominous black spot may appear on the _____. There is gross systemic toxicity (peculiarly, sometimes absent in children) and no suppuration
The process probably begins with ______, and polybacterial infection develops
Fournier gangrene
genital, perianal, or lower abdominal skin
scrotum
appendageal or urethral infection
Radical surgical débridement of all affected tissue is undertaken and broad systemic antibiotic therapy initiated
________
large, serpiginous, foul-smelling ulcers in uncircumcised men, associated in some with nontender inguinal lymphadenopathy. Treatment is with ____ or ____
Nonsyphilitic spirochetal ulcerative balanoposthitis
penicillin or metronidazole
________ rock-hard smooth
white papules or nodules on the scrotum, multiple or solitary
The differential diagnosis includes _____
scrotal calcinosis
epidermoid cyst
