Male Genital Pathology Flashcards
Most common penile congenital abnormalities?
Epispadias and hypospadias
abn openings of urethra on dorsal or ventral penis; due to malformation of urethral canal
What is the clinical importance of a urethral abnormality?
urethral obstruction or failure of normal ejaculatory function
Inflammation of the penis is most commonly related to:
- -phimosis (inability to easily retract the foreskin)
- -venereal disease
Inflammatory condition most commonly related to poor hygiene:
balanoposthitis
glans inflammation = balanitis; foreskin inflammation = posthitis
Neoplasm that occurs almost exclusively in the uncircumcised:
Squamous carcinoma of the penis
What are condyloma acuminata?
cauliflower like growths which occur primarily in the anogenital region; recurrent despite vigorous therapy
What causes condyloma acuminata, and how it it transmitted?
HPV 6 or 11
sexually
Hisopath of condyloma acuminata?
Orderly, exuberant exophytic (growing outward) growth pattern of papillary lesion
very few mitoses
no necrosis
Squamous carcinoma in situ on the penile skin is called:
Bowen disease
Squamous carcinoma in situ on the glans is called :
erythroplasia of Queyrat
What causes squamous carcinoma in situ of the penis/glans?
HPV, usually type 16 (80%)
Why should you treat squamous carcinoma in situ of the penis/glans?
if untreated roughly 10% will progress to squamous carcinoma
What is the clinical manifestation of squamous carcinoma in situ of the penis/glans?
red, slightly raised, rough, painless, nonulcerated lesions
Histopath of squamous carcinoma in situ of the penis/glans?
hyperkeratosis with disordered maturation + elongation of rete ridges
thickening of epidermis
50% of the time, squamous carcinoma of the penis is caused by:
HPV (usually 16 and 18)
Lifestyle risk factors for squamous carcinoma of the penis?
poor hygiene and cigarette smoking
What is Cryptorchidism?
Failure of descent of testis from abdomen to scrotum, present in 1% of 1yr old boys
If a failure occurs during the Transabdominal phase, where are testes stuck?
between abd and brim of pelvis
What signaling molecule is important during the Transabdominal phase?
Mullerian inhibiting substance
If a failure occurs during the Inguinoscrotal phase, where are testes stuck?
between brim of pelvis and scrotum
What signaling molecule is important during the Inguinoscrotal phase?
Androgen-induced calcitonin-gene related peptide
During what phase of testes droppin’ do abnormalities more commonly occur?
Inguinoscrotal (90-95% of cases)
Complications associated with Cryptorchidism:
- increased susceptibility to trauma, if Inguinal
- Sterility
- Decreased spermatogenesis in BOTH testes in unilateral cryptorchidism
- Malignant neoplasms (5-10 fold increased risk; some increased risk in normal testis, too)
What improves (but does not guarantee) chances of normal spermatogenesis in Cryptorchidism?
Orchiopexy before age 2
What reduces (not eliminates) cancer risk in Cryptorchidism?
orchiopexy
What histopath is associated with Kleinfelter’s?
Small hyalinized seminiferous tubules
Pseudoadenomatous clusters of Leydig cells (only look increased in # due to decreased testicular volume)
What conditions are associated with Kleinfelter’s (increased incidence)?
extragonadal germ cell tumors (mediastinum > pineal gland, CNS, retroperitoneum)
hypopituitarism
What reproductive abn are associated with Kleinfelter’s?
- small to normal-sized, well developed testes (**the picture above it says they’re less dev)
- Incomplete virilization (infertility)
- gynecomastia
How does tertiary syphilis spread?
testis first, then the epididymis
How does gonorrhea spread?
retrograde from the urethra to the prostate, seminal vesicles, epididymis
What is the most common infectious cause of focal atrophy of the testicular tubules?
What are some other causes?
mumps orchitis
echovirus, lymphocytic choriomeningitis virus, influenza virus, Coxsackie virus, and arboviruse
How does mumps affect testicular tubules?
unilateral and patchy orchitis (thus, sterility uncommon)
What are the symptoms of epididymitis?
scrotal pain and swelling
What are common causes of epididymitis in younger males?
sexually transmissible diseases:
Chlamydia trachomatis
Neisseria gonorrheae
(can also be disseminated TB)
What are common causes of epididymitis in older males?
gram negative bacteria from UTI
can also be disseminated TB
Idiopathic granulomatous orchitis is an uncommon diffuse inflammatory testicular lesion that occurs following:
gram negative urinary tract infection (usually)
Idiopathic granulomatous orchitis occurs in what age group?
50-60 y/o men
most commonly
What is a differential dx for Idiopathic granulomatous orchitis, and why?
testicular neoplasm
may present as a localized nodular lesion
What parts may be involved in Idiopathic granulomatous orchitis?
testicles, epididymis and spermatic cord
Histopath of Idiopathic granulomatous orchitis?
predominantly intratubular inflammation
cellular infiltrate containing histiocytes (majority), lymphocytes, plasma cells, +/- giant cells
Note: histiocytes give appearance of granulomas, but they aren’t actually present
Is necrosis present in granulomatous orchitis?
NO!
How is granulomatous orchitis distinguished from infectious orchitis or sarcoid?
intratubular localization of inflammation in granulomatous orchitis
What is autoimmune orchitis?
rapid onset granulomatous testicular enlargement in middle aged men (may be associated with a febrile illness)
What are the causes of testicular regression/atrophy (in general, and according to his mnemonic)?
Vascular (varicoceles = atrophy on side of dilated veins)
Inflammation (mumps orchitis, epidydimoorchitis)
Neoplasms (atrophy occurs in estrogen trx of prostatic carcinoma)
Degenerative (atrophy resulting from aging)
Intoxication (chronic alcoholism, Laennec cirrhosis, hemochromatosis, X-ray)
Congenital (undescended testes and torsion)
Trauma (atrophy following vasectomy and accidental ligation of the blood supply during hernia repair)
Endocrine (hypopituitarism, Klinefelter and other eunuchoidal states)
VINDICaTE
What can occur in the testes following torsion?
ischemia + venous stasis
Why is torsion a urologic emergency?
surgery within 4-6 hours may save the testis
if not, hemorrhagic infarction with obliteration of the testis is inevitable
