L67 Flashcards
What is hypospadias
Urethra opens on bottom of penis (ventral - bottom = ventral when erect)
What is epispadias
Urethra opens on top of penis (dorsal)
Complications of untreated hypo/epispadias
Obstruction/UTI
Problems ejaculating -> sterile
What is phimosis? Cause? Complications?
Foreskin too small to tract over glans
Cause: after repeated infections -> scar
↑s risk for infection
What is paraphimosis?
Foreskin gets stuck retracted
PAIN
Medical emergency - causes urine retention
What is balanoposthitis? Cause/pt pop?
Glans + foreskin = infected Uncircumcised Causes: - Candida - Anaerobics - Gardnerella
What is condyloma acuminatum? Cause?
Benign neoplasm = genital warts
Aka NOT going to progress to cancer
HPV 6 + 11
Histo condyloma acuminatum
Poly/finger like shapes - almost vili like
Lined by squamous epi
Nuclei = big w/ clear space (viral accum)
What is squamous carcinoma in situ of the penis? Benign vs malignant? Cause? Treat?
Malignant change @ epithelium NO invasion (in situ) Cause = HPV 16 Surgically remove w/ clear margins
Cause + pt pop for penis squamous cell cancer. Histo + most common site for mets
SCC - see keratin invading on histo
Uncircumcised middle aged men
HPV 16 + 18
Met to inguinal + iliac LNs
What are the 3 things that can cause inflammation of the prostate - think generally
Bacteria - bacterial prostatitis Abacterial Granulomatous 1. Post-BCG treatment of bladder cancer 2. Fungal 3. TB
Describe normal prostate histo
Glands w/ 2 layers epithelium lining
SM surrounds glands
Histo changes in BPH
Hyperplasia prostate stroma + SM -> into nodules
What is the most common type of prostate cancer?
Adenocarcinoma
3 features of prostate adenocarcinoma histo
- Small glands infiltrate normal tissue
- Malignant epi - glands have only 1 layer epi
- Large nuclei + prominent nucleoli
What is prostatic intraepi neoplasia?
“Adenocarcinoma precursor”
Aka abnormalities in normal glands
vs adenocarcinoma = entire glands are abnormal
Do you treat PIN?
Nah - freq repeat biopsies for progression check
TESTQ: what is the basis of grading prostate cancer? (Gleason score)
ARCHITECTURE NOT nuclei (normal grading criteria)
Where will prostate adenocarcinoma met to?
Inguinal LN
BONE - L vertebrae: look for sclerotic nodules within the vertebrae
Options to treat prostate carcinoma
Surg - remove it
Radiotherapy - brachy or external beam
Hormonal
Chemo for mets
What is cryptorchidism? Treat?
Undescended testicles
If don’t descend on own before 2, surgery to prevent infertility + cancer
Describe normal testicle histo
Seminiferous tubules - germ cells at base, prolif as move into lumen as mature sperm
Sertoli cells here = nurturing
Leydig cells between tubules to provide androgens
What inflammatory diseases of the testes?
Epididymo-orchitis: acute vs tuberculous (will see granulomas in the testes!)
What is testicular torsion? Pt pop
Testes twist in sac - collapse the thin walled vein Blood still entering through the artery Painful + hemorrhagic infarct EMERGENCY Peaks during 1 yo + puberty
Pt population and presentation of germ cell tumors
White, young pts (15-30)
Painless testicular mass
What is a seminoma? Gross appearance + treat
Pure germ cell tumor
Homogen gray/white mass
Treat = sen to rad + chemo
Histo seminoma
Looks like the germ cells:
- Clear cytoplasm + large nucelus w/ nucleoli
- Cell divided by fibrous stroma w/ lymphocytes
What lab value is positive in seminomas?
PLAP = placental alk phos +
What is a spermatocytic seminoma?
NOT A SEMINOMA TUMOR
- No lymphocytes
- PLAP neg
- 55 yo +
- Treat by removing testicle - no chemo/rad
What are non-seminomatous germ cell tumors?
Tumors of germ cells in different stages of development to mature sperm
Usually mixed for this reason
Might have seminoma component - just starts at an earlier step (no change treat)
What is unique about non-sem germ cell tumor mets?
Met can be different cell type than the 1ary tumor
Name the 4 non-sem germ cell tumors
Teratoma Embryonal carcinoma Yolk sac Choricarcinoma *Since most tumors are mixed, think about these types together in 1 tumor*
What is a teratoma? Pt age
From multiple (all 3) germ layers (neuro, ecto, endoderm)
Tissue can be either embryonal (immature) or fetal/adult (mature)
Kids - benign
Post-puberty men - MALIGNANT (vs adult women = benign) TESTQ
What is an embryonal carcinoma? Stain used?
Embryonal tissue aka very dysmorphic
Cells form epithelial structures - tubules or sheets of cells
Stain w/ cytokeratin
What is a yolk sac tumor? Pt age? Marker
Endoderm - homog yellow/white timor
INFANTS - 3 YO
Elevated AFP
TESTQ: the presentation is a testicular mass with elevated AFP. How does the ddx change if pt is 0-3 yo vs 20 yo?
0-3 = pure yolk sac tumor 20 = mixed tumor w/ yolk sac component
Yolk sac histo
Schiller Duval bodies = papillae w/ central vascular core (looks like flower)
Eosinophilic globules = pink dot
What is a choriocarcinoma? What is the serum/tissue marker?
V MALIGNANT - 1ary tumor is small, more likely to find the met first
Cyto + syncytio-trophoblast
High bHCG
If you get a testicular mass with +bHCG, what should you be thinking?
Chorio
OR mixed w/ chorio component
What are intratubular germ cell neoplasia?
Look for atypical cells in base of steroli tubules
Precursor of germ cell tumors
Look like seminoma, but are in the normal location for sertoli cells aka base of tubule
Common mets for germ cell tumors + exception
Met to LN - retroperitoneal, aortic, mediastinal, supraclav
Via blood to organs
Exception = chorio, earlier mets than all others!!
Stage 1 vs 2 vs 3 testicular tumors
1 = in testis 2 = mets below diaphragm 3 = mets above
Treat germ cell tumors
Remove tesicle
Adj - chemo/rad
No adj for spermatocytic seminoma or teratomas in kids
Compare seminoma vs non-sem
- Local vs met
- Stage at presentation
- Route of mets
- Treament
Seminoma = localized for long time, present st 1, met to local LN, v radiosens w/ good cure rate Non-sem = met early via blood, therefore st 2/3 at presentation, need aggressive chemo, good remission rates
