Exam 4 - Chapter 17 Flashcards
Cryptorchidism
Cause
• Testis do not descend normally into scrotum
• Usually retained in abdominal cavity; sometimes in inguinal canal
• Germ cells require a lower-than-normal body temperature
• Interstitial cells function normally at body temperature
Manifestations
• Germ cells destroyed at higher intra-abdominal temperature, Interstitial cells function normally
• Undescended testis more prone to developing testicular cancer
Treatment : Surgically replace testis in scrotum
Hypospadias and Epispadias
Development of penis takes place between 9 and 12 weeks of pregnancy occurs in 1 out of every 150-300 boys. It is a condition where the urethral opening does not form completely at the tip of the penis, instead it can be located anywhere along the penis
- Hypospadias is an anomaly in which the urethral meatus opens on the ventral surface of the penis
- Epispadias is an anomaly in which the urethral meatus opens on the dorsal surface of the penis. It is less common than hypospadias
Causes: Less androgen production, No conversion of DHT from Testosterone, Androgen receptor deficiency
Treatment: Never circumcise a child without checking for hypospadias because the foreskin is essential for the repair. It can be corrected surgically using the foreskin.
Klinefelter’s Syndrome
It is a chromosomal disorder. Children are born with an extra sex chromosome (47, XXY), which is known as sex chromosome variations (SCV). These children present a significant speech and language delay, which requires formalized speech and language program
Symptoms:
•Individuals are male with different degree of 1o Hypogonadism
•Decrease secretion of gonadotropins (FSH & LH)
•Smaller size gonads, which affect the testicular function
•Gyaecomastia (breast development)
•Azoospermia (absence of sperm)
Common symptoms with school age Children: Curved 5th finger, decreased muscle tone, delayed pubertal development, delayed speech & language skills, long legs and arms, hand tremors and mild to severe developmental delays
Treatment: Hormone replacement therapy (HRT) with Testosterone (AndroGel)
Testicular Torsion
Cause
• Abnormal attachment of testis in scrotum
• Predisposes to rotary twisting of testis and spermatic cord
• Shutting off blood supply to testis
Manifestations and treatment
• Acute onset of testicular pain and swelling
• Leads to hemorrhagic infarction unless promptly untwisted
Scrotal Abnormalities
Hydrocele
• Excess fluid accumulates in tunica vaginalis of scrotum. Presents as nontender fullness of scrotum
• Treated by aspiration or resection of tunica vaginalis
Varicocele
• Varicose veins in spermatic cord, usually left side of scrotum involved
• Blood collection increases heat and results in infertility
• No treatment required unless varicocele causes discomfort or impairs infertility
Spermatocele
• Collection of sperm within the testes, usually at epididymis
• Usually asymptomatic
• No treatment necessary, just observation
Erectile Dysfunction (ED)
Risk factors:
- Drugs (β-Blockers) e.g. Digoxin
- Psychological problems
- Distortion of the penile arteries or tissue
- Alcohol related liver damage, which interferes with testosterone production
- Diabetic patients
- Smoking
STD’s and Pathogens
- Chancroid (Haemophilus ducreyi)
- Syphilis (Treponema pallidum)
- Gonorrhea (Neisseria gonorrhoeae)
- Chlamydia (Chlamydia trachomatis)
- Herpes (Herpesvirus)
- Granuloma Inguinale (Calymmatobacterium Granulomatis): Africa, Carribbean & India. Some cases in homosexual men
Chancroid
Haemophilus ducreyi
Presents as a soft, painful ulcer. This ulceration makes the site more prone to infection with other organisms or fungi, with the tendency to spread along the penis and groin areas
Syphilis
Treponema pallidum - gram negative
3 Stages
Primary stage: Painless, hard chancre (an indurated ulcer) often at the glans, or site of infection. Because this first stage is painless, the patient may not know he has the disease, and could proceed to infect other people
Secondary stage: largest number of organisms in the body, manifesting in a diffuse rash of small red macules, included on the palms, soles and membranes
Tertiary stage: gummas form (which are basically granulomas with giant cells, inflammation of the vessels and necrosis). If this stage is left untreated, the infection may progress to involve the heart and nervous system; occurs 2 to 20 years later
Diagnostic Tests: Demonstration of treponemas/spirochetes in chancre. Serologic tests (antigen-antibody reactions in a test tube)
Treatment: Antibiotics
Gonorrhea
Neisseria gonorrhoeae - gram negative (also a cause for pelvic inflammatory disease)
Symptoms:
- Urethritis (inflammation of passage through which urine is discharged from bladder)
- Cervicitis (inflammation of cervix)
- Pharyngitis (inflammation of pharynx)
- Infection of rectal mucosa (proctitis)
Diagnosis: Culture of organisms from sites of infection
Treatment: Antibiotics
Chlamydia
Chlamydia trachomatis - gram negative. Most common STD. #2 cause of PID
Symptoms: Cervitis & Urethritis. It can also cause epididymitis. Chlamydial infection should be suspected when bacteria are not demonstrated in a purulent urethral discharge
Diagnosis: Detection of chlamydial antigens in cervical/urethral secretions or Cultures
Treatment: Antibiotic
Herpes
Herpes Simplex Virus (HSV) type 2 infection accounts for the majority of genital herpes cases (although HSV type 1 is also capable of causing genital infections) and is spread by sexual contact
Symptoms: Small painful vesicles and shallow ulcers that can involve the penis, cervix, vagina, clitoris, vulva, urethra, and perianal skin
Pathology: Multinucleated giant cells with viral inclusions are found in cytologic smears from lesions. Three “Ms”: multinucleation, nuclear molding, and margination of the chromatin
Diagnosis: Tzanck smear
Treatment: Acyclovir, Valacyclovir, Famciclovir
Granuloma Inguinale
Calymmatobacterium (Donovania) granulomatis - gram negative
Donovan bodies, which are multiple organisms filling large histiocytes, are characteristic. An infection appears initially as a papule, which becomes superficially ulcerated. It progresses by adjacent lesions to form large genital or inguinal ulcerations, sometimes with lymphatic obstruction or genital distortion
Trichomoniasis (Yeast Infection)
Not an STD
Vulvovaginitis
Profuse, foul-smelling, purulent, frothy discharge
Orchitis
Inflammation of the Testes
- When bacterial, orchitis is often associated with epididymitis. Orchitis may be caused by syphilis
- When viral, orchitis is most often due to mumps virus. Bilateral, orchitis may result in sterility due to atrophy of the seminiferous tubules. Serum testosterone is decreased, whereas pituitary FSH and LH are increased.
Epididymitis
More common than orchitis. Causes most often include: Neisseria gonorrhoeae, Chlamydia trachomatis, Escherichia coli & Mycobacterium tuberculosis
Testicular Tumors
These are rare tumors but important because they affect men 25 to 45 years of age
• Most tumors are of germ cell origin
• Most tumors are malignant but can be successfully treated by surgery combined with chemotherapy or radiation therapy
• Mortality was high before, but now more than 90% of patients survive
Serum Markers for Testicular Cancer
- Human chorionic gonadotropin, or HCG, is usually synthesized and secreted by the placental syncytiotrophoblast
- Alpha-fetoprotein (AFP) is the major serum protein of the early fetus and is synthesized by the fetal gut, liver cells, and yolk sac. It is usually undetectable after the first year of life
- LDH (lactate dehydrogenase) is useful in following the tumor burden, since its level is proportional to the mass of tumor cells. However, it is produced in a number of tissues, so increased levels are not specific for testicular tumors
Seminoma
These are the most common type of germ cell tumor. The occurrence peaks in men in their 30s, and account for about half of the germ cell tumors
Pathology: Made of sheets of uniform cells. Better prognosis than NSGCT
Symptoms: Large tumors which can grow to ten times the size of a normal testicle. They do not secrete markers. It does not transiluminate on a flash light
Treatment: Radiotherapy, chemo
Embryonal Carcinoma
Second most common. These are more aggressive than seminomas and generally occur in 20-30 year olds
Pathology: Secretes hCG and AFP. Tubular cells
Symptoms: Painful mass often with metastasis
Treatment: Surgery, abdominal lymph node dissection and chemotherapy
Choriocarcinoma
Highly malignant form of testicular tumor that is composed of mixed germ cells. It is the most aggressive of the NSGCT
Pathology: These tumors are usually small and are found by palpation of a small testicular nodule
Symptoms: Testicular enlargement is rare, but hemorrhage & necrosis common
Treatment: Surgery, abdominal lymph node dissection and chemotherapy
Teratoma
Mature teratomas are found in adults and immature teratomas are found in children. 30% of all tumors
Pathology: Random arrangement of mesodermal (muscle, cartilage, adipose tissue), ectodermal (neural tissue, skin), and endodermal (gut, bronchial epithelium) tissue
Symptoms: Painful lump
Treatment: Surgery, abdominal lymph node dissection and chemotherapy
Testicular Cancer Stages
Stage I means the tumor is confined to the testis, epididymis, or spermatic cord
Stage II cancer means distant spread is limited to retroperitoneal lymph nodes below the diaphragm
Stage III cancer means there is metastasis outside the peritoneal nodes or above the diaphragm
Benign Prostate Hyperplasia (BPH)
BPH is the most frequent cause of urinary tract obstruction. BPH is extremely common (almost universal) in older men
Causes: Increase in estradiol levels
Pathology: BPH is directly related to the action of dihydrotestosterone (DHT), a testosterone metabolite. DHT is synthesized from testosterone by the action of 5 α-reductase, type 2, and inhibition of this enzyme is one approach to the treatment of BPH. Rubbery, nodular enlargement of the gland, affecting the inner groupings of glands (periurethral and transitional zones)
Diagnosis: Increased total PSA (prostate specific antigen) with proportional increase in free PSA
Symptoms: Polyuria, nocturia, dysuria
Treatment: Finasteride (5 α-reductase inhibitor) or Cialis,
α-blockers, Tamsulosin and TURP (Transurethral Resection of Prostate)
Prostate Carcinoma (General Information)
This is the most common cancer of internal organs in males—more than 100,000 new cases per year. This is the third most common cause of cancer-related deaths in males. It is a tumor of old age, and the prolongation of human life has been accompanied by an overall increased incidence of prostate carcinoma.
No effective treatment exists.
The cause remains unknown.
No major risk factors have been identified.
The course may be indolent or aggressive; this can be predicted by the very useful Gleason system of grading, based on differentiation
Prostate Cancer (Pathology, Diagnosis, and Treatment)
Pathology:
• The tumor is often well differentiated with small invasive glands with prominent nucleoli
• The tumor arises most often from the peripheral group of glands
Diagnosis:
• Done by rectal examination
• Prostate cancer is associated at an early stage with an increase in serum PSA. Elevations of PSA reflect a complexed form (bound to α1-anti-chymotrypsin), which becomes elevated with prostatic cancer, and a free form, which increases with BPH. Thus, an increased total PSA with a decreased fraction of free PSA suggests malignancy
• A number of other approaches to PSA measurement (e.g., serial PSA, PSA velocity, PSA density) are used to increase the predictive value of this procedure
• Prostate cancer is characterized by increased serum prostatic acid phosphatase when the tumor penetrates the capsule into adjacent tissues
Treatment: Prostatectomy, radiotherapy, da Vinci Si robotic system, GnRH analogues, anti-androgens and chemotherapy
Penile Carcinoma
This is rare in the United States, affecting 1 to 2 men per 100,000. It is more common in some parts of the world, like South America. Tumors are squamous cell carcinomas. Metastases occur first to inguinal lymph nodes. Prognosis depends on the stage of tumor. Treatment: Surgery
