L 68 - Path of Male Genital tract

Question 1

define the following:

Hypospadia

Epispadias

Phimosis

Paraphymosis

Balanopsthitis

Answer 1

Hypospadia – urethral opening on the ventral surface

Epispadias – urethral opening on the dorsal surface

Phimosis - orifice of the foreskin prepuce is too small to permit

Paraphymosis – retraction of a phimosis but it gets stuck

Balanopsthitis – infection of the glans and prepuce of foreskin

Question 2

Penile Neoplasms: Condyloma Acuminatum

caused by what virus

course?

Answer 2

HPV 6 and 11

recur, but do not evolve into cancers

Question 3

SCC of penis –

due to what virus?

Answer 3

a/w HPV 16 and 18

Question 4

most common cancer in men

Answer 4

Prostate adenomacarcinoma

Question 5

precursor lesion to prostate cancer

what is seen hist

Answer 5

Prostatic IntraEpithelial Neoplasia (PIN)

Question 6

histology of prostatic adenocarcinoma

Answer 6

Small glands infiltrating through normal tissue
Composed exclusively of Malignant cells; Glands Lack basal cells

Enlarged nuclei with prominent nucleoli

Question 7

What zone of the prostate is the site of the neoplasia?

where does prostatic adenomcarcinoma like to metastasize to?

Answer 7

The Peripheral Zone

Bones

Question 8

treatment options for prostate cancer

Answer 8

Surgery -- Radical prostatectomy
		Radiation
		Hormonal therapies
		Watchful waiting
		Chemotherapy if mets

Question 9

Cryptorchidism

what is it?
when does it need to be addressed by?
increased risk of…

Answer 9

Failure of testes to descend into the scrotal sac (usually unilateral)

Irreversible injury around 2 years of age

50x risk of tersticular cancer

Question 10

name 4 bugs prone to causing Epididymitis and Orchitis

Answer 10

Gonorrhea, Mumps, Tuberculosis, Syphilis

Question 11

Testes Torsion

who is prone to this?
treatment?

Answer 11

surgical emergency

usually due to congenital failure of testes or in teenagers

Question 12

95% of tumors of the testes are of what cell origin

Answer 12

Germ cell tumors

Question 13

broad division of germ cell tumors of the testes

what is the most common testes tumor type overall

Answer 13

seminomatous vs non seminomatous

Mixed Non seminomatous

Question 14

histology, treamtnet and prognosis of classic seminoma

Answer 14

Histo – polygonal cells, clear cytoplasma; Cords of cells divided by fiborus stroma with LYMPHOCYTE INVASION

Prognosis – Present at stage 1; 95% cure with orchiectomy and adjuvant chemo rads

Question 15

Differentiate between classic seminoma and spermatic seminoma —

which is PLAP postiive?

which does not require chemorads?

Answer 15

Classic Seminoma – PLAP positive

Spermatic – PLAP negative
no Chemo rads

Question 16

adults are more likely to have _____ non seminomatous tumors, peds are more likely to have ______,

Answer 16

adult: Mixed

Peds: Pure

Question 17

Histology of a pure teratoma:

if this occurs in a child its more likely to be _______; if this occurs in a post pubertal male its more likely to be_______

Answer 17

Components from more than 1 germ cell layer (hair, skin, collagen, lung etc..)

Mature teratoma: fetal and adult tissue

Immature teratoma: embryonal tissue

Child: benign
Post Puberty: Malignant

Question 18

Schiller duval bodies + AFP positive =

Answer 18

Yolk Sac Tumor

Question 19

highly malignant germ cell tumor with Positive HCG:

Answer 19

Choriocarcinoma

Question 20

difference in histo between Embryonal carcinoma and classic seminomatous ?

Answer 20

Forms Epithelial structures – Alveolar or Tubular pattern growth
Forms primitive Glands and tubules
Pockets of necrotic debris

Prominent nuclei

NO LYMPHOCYTE SEPTAE

Question 21

Seminoma Vs Nonseminomatous

what stage do each present at?
How do they metastasize
best treatment for each
outcomes for each

Answer 21

Seminoma -- 
70% stage 1 
Later mets 
Mets through LNs 
radiosensitive
95% cure 

Non Seminomatous 
60% stage II and III 
Met Earlier
Hematogenous Spread
Aggressive Chemo
90% remission