Lower Male GU Tract Pathology Flashcards
Hypospadias vs. Epispadias
What can also occur in pts. with these anomalies?
Which is more common?
Both result from the malformation of the urethral groove, and urethral canal may create an abnormal urethral opening either on the ventral surface of the penis (hypospadias) or dorsal surface of the penis (epispadias).
Failure of testicular descent and urinary malformations.
Hypospadias is more common, approx. 1/300 live births.
What is Phimosis?
A condition noted when the orifice of the prepuce is too small to permit normal retraction.
What areas of the penis are most commonly inflamed?
What is the most common reason for penile inflammation?
Glans and prepuce (Balanoposthitis)
Poor hygiene.
Condyloma Acuminatum
How does it present upon exam?
What does it look like?
Condyloma Acuminatum - benign tumor of the penis transmitted by HPV type 6 and 11.
Moist mucocutaneous surface of the external genitalia.
Single or multi sessile or pedunculated red papillary excrescences.
Peyronie Disease is what? What does it result in?
Benign tumor of the penis.
Results in fibrous bands involving the corpus cavernosum.
What is Bowden disease?
How old are patients that present?
Where does it present on the penis?
A form of genital CIS (M and F) with a high association with HPV type 16.
Over age 35.
Skin of shaft and scrotum.
How is Bowenoid papulosis different than Bowden disease?
How does it look on histology compared to Bowenoid? Does it metastasize?
It presents in slightly younger patients and presents as multiple reddish-brown papular lesions.
It is non-distinguishable from Bowenoid papulosis on histology, but very rarely metastasizes.
Invasive carcinoma (SCC) of the penis is associated with what 2 things?
How old are these pts.?
What confers protection?
What is the survival rate?
HPV infections and poor hygiene
40-70 y/o
Circumcision (more common in Jews and Muslims)
66% survival rate at 5-years without LN mets, 27% if LN mets.
What is Verrucous carcinoma?
An exophytic well-differentiated variant of penile SCC that are locally invasive, but rarely metastasize.
What is Koilocytosis?
Where are they commonly found?
A venereal wart from cytoplasmic vacuolization of squamous cells, characteristic of HPV infection.
Common in Condylomata acuminatum (rarely progresses into CIS or invasive CA).
What us Cryptorchidism?
What does it confer a greater risk for?
How common is it?
Does it occur with other anomalies?
Complete or partial failure of intra-abdominal testes to descend into the scrotum.
It confers a significantly higher risk of testicular cancers.
1% of 1 y/o boys
Usually occurs in isolation, but can occur among other abnormalities.
What are 8 causes of testicular atrophy?
Atherosclerotic narrowing of blood supply End stage inflammatory orchitis Cryptorchidism Hypopituitarism Malnutrition Radiation Androgen use Exhaustion atrophy
What is testicular atrophy referred to?
Regressive changes
How does epididymitis/orchitis occur?
What are common bugs known to cause it in young, sexually active men?
What about in older men (>35 y/o)?
They are urinary infections that reach epididymis and testes through the vas deferens or lymphatics of the spermatic cord.
Chlamydia and Gonorrhea
E coli and Pseudomonas
What is granulomatous orchitis?
What does it look like?
Where is the inflammation?
An autoimmune orchitis of unknown cause (idiopathic) that presents in middle-aged men with sudden fever.
Painless mass that looks tumor-like.
Throughout the testes and confined to the seminiferous tubules.
Tract of a Gonorrheal infection of the testes/epididymis
In severe cases, what can occur?
Comes from posterior urethra to the prostate, SVs and then to epididymis.
Abscesses which leads to destruction and scarring
Mumps can have orchitis in what population?
When does it present?
Post-pubertal males (20-30% of cases)
Approx 1 wk after parotid swelling
What does Tb cause in the testes/epididymis?
Caseating granulomatous inflammation
What are the 2 morphological forms Syphilis can take?
- Production of gummas
2. Diffuse interstitial inflammation that leads to obliterative endarteritis
What is a testicular torsion?
What ages is it seen?
How much time does a pt. have to remedy the problem?
Twisting of the spermatic cord cuts off blood supply to the testes. If untreated, it can cause testicular infarction.
In utero/shortly after birth or adolescence.
6 hrs to untwist it for it to remain viable.
What is a bell-clapper abnormality?
An abnormality in adult torsions from a BL anatomical defect that increases testicular mobility.
What are the 2 main categories of testicular neoplasms?
Germ cell tumors and Sex cord-stromal tumors
What are the 2 categories of Germ cell tumors?
Seminous and Non-seminous
Most common tumor in 15-34 y/o males:
Germ cell tumors
What genetic loci have been linked to Germ cell tumors?
KIT and BAK
Seminous tumors are composed of:
Non-seminous tumors are composed of:
Cells resembling primordial germ cells or early gonadocytes.
Undifferentiated cells that resemble embryonic stem cells.
What is the precursor lesion of a Germ cell tumor?
Intratubular germ cell neoplsia (ITGCN)
What chromosomal abnormality is found in Germ cell tumors?
12p duplication
What percentage of Germ cell tumors are Seminomas?
50%
What is a Spermatocytic seminoma?
A rare, slow growing germ cell tumor mostly affecting older men
Embryonal carcinoma is found in which age group?
What is the aggressiveness of it?
Malignancies in 20-30 y/o men and are more aggressive than seminomas.
Considered “non-seminomatous”.
Yolk sac tumors are common in which age group?
What is the prognosis?
What other tumor/CA can they occur in?
Children < 3 y/o
Excellent
Embryonal carcinomas
Choriocarcinoma is how aggressive?
Is it common?
Highly aggressive (cannon-ball mets)
Uncommon, 1% of all germ cell tumors
Which tumors are considered Non-seminomatous? (5)
Embryonal carcinoma Yolk sac tumors Choriocarcinoma Teratoma Mixed tumors
What ages are teratomas common?
Infants and children (2nd to yolk sac tumors), but very rare in adults
What cancers is HCG elevated?
**Choriocarcinomas (most) and Seminomas
What us elaborated in Yolk sac tumors?
alpha-fetoprotein
Seminomas vs. NSGCT: metastasis
Seminomas remain localized mostly and present in stage I.
NSGCTs are more likely to present in advanced stage (stage II/III)
Seminomas vs. NSGCT: route of spread
Seminomas: LNs
NSGCTs: hematogenous spread
Seminomas vs. NSGCT: prognosis
NSGCTs worse
When do patients present with Leydig cell tumors?
What do they elaborate?
Presenting complaints? (2)
20-60 y/o
Androgens
Testicular swelling, gynecomastia
Most Sertoli cell tumors are:
Benign, 10% malignant
What is a Gonadoblastoma?
Can it become malignant?
Rare neoplasm of mixed germ cells and gonadal stromal elements.
The germ cell component can become malignant and lead to Seminomas
Testicular lymphomas are found in what age?
Presentation?
What system to testicular lymphomas have ahigher propensity to?
Over 60 y/o
Testicular mass, similar to other tumors
CNS
What is a hydrocele?
Hematocele?
Chylocele?
Spermatocele?
Varicocele?
Accumulation of fluid in the tunica vaginalis
Accumulation of blood in TV
Lymph
Semen
Dilated vein (ASX, some assoc. with infertility)
