Genitourinary 2 Flashcards
What leads to nonfunctional testes?
lack of descent of testes into scrotum
When does the descent begin? When does the testes really start to move?
7 mos. of gestation
Where does the testes migrate down through and what is it guided by during its descent?
migrates through inguinal ring into scrotum, guided by gubernaculum
cryptorchidism
no descent into scrotum; maldescent of testes
percent of testes migration fails; arrested somewhere along the route
4%
where is the most common location where the testes arrests during maldescent?
inguinal ring/canal
What percent is the maldescent of testes unilateral (just one testes fails to descend)?
75%
What causes maldescent of testes?
genetic + environmental factors
Atrophy and sterility are common if testes don’t descend, unless it is corrected by what age?
age 2
even after surgical correction, greatly increased incidence of germ cell tumors (seminoma + embryonal carcinoma)
orchitis
infection of the testes
- if bilateral, may result in sterility
- often associated with infection from epididymis (epididymitis)
3 testes infections + a rare one
- acute bacterial epididymoorchitis
- viral orchitis
- TB epididymorchitis
- tertiary syphilis- rare, gumma formation
viral orchitis
forms mumps, occurs after puberty
-if bilateral after puberty, infertility and sterility possible
testicular tumors
high proportion seen in early adult life (20-45 years)
2 groups of testicular tumors
1 germ cell
2 sex cord stromal tumors
germ cell testicular tumors
malignant, 97 % more common, derived from multipotential germ cells of testes
sex cord stromal testicular tumors
3% of tumors, benign, from specialized support cells of testis
seminoma
common in mid 30s
- painless, progressive enlargement of ONE testes (rarely bilateral)
**what is the most common malignant testicular tumor (50% of malignant germ cell tumors?
seminoma
prostate anatomy
- peripheral zone- location of carcinomas
- transitional zone- location of hyperplasia
- central zone
- periurethral zone
prostate gland pathology
- benign prostate hypertrophy (BPH)
2. prostate cancer- adenocarcinoma
older men and Benign prostate hypertrophy
- almost always enlargement of prostate most commonly due to BPH
- obstruction of urinary flow in the prostatic part of the urethra
- rarely, the obstruction is caused by carcinoma
Benign prostatic hypertrophy (BPH)
- most common disorder of the prostate
- affects almost all men over 70 yrs
- more often, more severe in 45yr olds
- difficulty w/ micturation (frequency, hesitancy, dysuria) due to compression of prostatic urethra by the enlarged prostate gland
*What is the most frequent cause of urinary tract obstruction?
Benign Prostatic hypertrophy
What is the part of the prostate most sensitive to hormones
periurethral group of glands
not a risk factor for carcinoma, but can coexist w/ it
Benign Prostatic hypertrophy
Gross BPH
- rubbery, nodular enlargement especially the periurethral and transitional zones
- some cystic dilations that have calcifications causing corpora amylacea
urinary tract obstruction and does not relate to cancer
Benign prostate hypertrophy
prostate cancer (adenocarcinoma)
increasing frequency after age 55
- 70% of men > 70 yrs
- occurs in periphery zone- delays symptoms (difficulty w/ micturition) until tumor is well established
what is the 2nd most common type of cancer death in males?
prostate cancer (adenocarcinoma)
What approach to prostate cancer gives the most accurate finding?
transrectal approach b/c of local spread through the capsule before it infiltrates medially towards the urethra
preventative strategy for prostate cancer?
NO primary preventative strategy so screening is paramount
- latenet behavior= 90%= incidental findings are confined to the prostate
histology of prostate cancer
gleason system= usually well differentiated glandular pattern w/ epithelial cells w/ clear cytoplasm forming gland like spaces
-well differentiated glands are back to back
prostate cancer metastasis
1st manifestation is vertebral spread w/ spinal cord compression
most common location of prostate cancer metastasis?
BONE (radiodense + radioluscent)
tumor marker for prostate cancer
serum prostate specific antigens (PSA)
serum prostate specific antigens (PSA)
serum/tissue prostate specific phosphatase
- PSA is not specific= does not distinguish b/w aggressive and indolent types or other cancers
- PSA is low in some men w/ prostate cancer
Bowen disease
-single erythematous plaque
-shaft or scrotum
-usually uncircumsized
- median 5th decade
10% evolve into invasive carcinoma
Bowenoid papulosis
- carcinoma in situ
- multiple verrucoid lesoins resembling condyloma acuminatum (HPV 16)
- histologically resembles Bowen disease and erythroplasia of Queyrat, but younger age group affected
- *premalignant, but not reported to result in invasive carcinoma
squamous cell carcinoma
- most typical carcinoma of the entire genital region
- cauliflower appearance w/ bleeding
erythoplasia of queyrat
single erythematous plaque
- glans or prepuce
- usually uncircumcised
- median 5th decade
- 10% evolve into invasive carcinoma
