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Reproductive Pathology > Male Genital Pathology > Flashcards

Male Genital Pathology Flashcards

1
Q

What are the two malformations of urethral placement in the penis?

  • which is more commmon?
  • what are some conditions that commonly occur concurrently with these malformation?
A

Hypospadius (MOST COMMON)
urethra on the ventral (bottom) aspect of the penis
- often associated with cryptorchism and **Inguinal Hernia

Epispadius**
(less common)
urethra on the top (dorsal) aspect of the penis
- often associated with abdominal wall defects like BLADDER EXTROPHY and abnormal placement of the genital tubercle

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2
Q

What are 5 common inflammatory lesions of the penis?

A

Balanitis
Balanoposthitis
Phimosis
Paraphimosis
Fibromatosis (doesn’t really seem inflammatory)

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3
Q

Differentiate balanitis and balanoposthitis?

A
  • *Balanitis** - inflammation of the glans penis
  • *Balanoposthitis** - inflammation of the prepuce and glans
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4
Q

What are some common organitms to cause Balanoposthtis?
- common cause?

A

Inflammation of the prepuce is often caused by Candida, Gardnella, and pyogenic bacteria

  • Most often this is due to poor hygiene in an uncircumcised male
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5
Q

Contrast Phimosis and Paraphimosis?

A

Phimosis
prepuce cannot retract over the glans

Paraphimosis
prepuce gets STUCK on the the glans and chokes it out

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6
Q

What tissues does fibromatosis of the penis often occur in?
- symptoms?

A

Most often due to fibrosis of the tunica albicans that surrounds the corpus cavernosum (ventral aspect) of the penis

Often asymptomatic, but can cause pain

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7
Q

What are the 3 penile neoplasms?

  • what invasive cancer do they almost always progress to?
  • which are most likely to progress to invasive cancer?
A

3 Penile Neoplasms

  • Bowden Disease (10% progress to SCC)
  • Bowenoid Papulosis (low risk of SCC)
  • Erythroplasia of Querat (HIGH risk of SCC)

**If these penile intraepithelial neoplasias (PINs) progress to cancer its almost always SCC**

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8
Q

Contrast the appearance of Bowden’s Disease, Bowenoid papulosis, and Erythroplasia of Querat on physical exam.
*what is the umbrella term for these lesions?

A

Penile Intraepithelial Neoplasias (variable risk of progression to cancer)

  • *Bowden’s Disease**
  • *Leukoplakia** (white lesions) on the shaft or scrotum, that are single or mulitiple.
  • *Bowenoid Papulosis**
  • *Multiple small red, brown, flesh-colored spots** or patches on the genitals of males and females
  • *Erythroplasia of Querat**
  • *Erythroplakia** of theGLANS penis
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9
Q

Diffentiate Bowden disease and Bowenoid papulosis on the patient they typically present in?

  • which type is associated with HPV?
  • What HPV type?
  • Risk of Cancer?
A

Bowden Disease - 10% CA risk
Typically presents in older men (w/ leukoplakia)

Bowenoid Papulosis - low CA risk
Typically presents in younger men (w/ red/brown/fleshy spots)
**Associated with HPV 16

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10
Q

Who often presents with invasive cancer of the penis?

  • most common cancer type?
  • gross appearance?
A

Typical Presentation:
Man between 60 and 80 who is uncircumcised and has a Red lesion on his penis
- Histo will usually show that this is Squamous Cell Carcinoma

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11
Q

What should you look for on histology of Squamous Cell Carcinoma of the penis?
*what should you associate Penile neoplasma with?
*where will these neoplasms metastasize to?

A

Histology:
Full thickness atypia with penetration of the basement membrane and potentially keratin pearls

These old men typically have long standing HPV 16 or 18 infections

Metastasis of External Genitalia goes to INGUINAL Lymph nodes

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12
Q

What is the most important prognostic indicator in a male with SCC of the penis/

A

Inguinal Lymph Node Involvment

NO involvment - 66% 5 yr survival
Nodes involved - 27% 5 yr survival

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13
Q

When is Cryptorchisdism/Testicular Atrophy typically diagnosed?

  • who is this most commonly see in?
  • risk associations with this condition?
A

Cryptorchisdism is typically diagnosed AFTER the age of one. This typically gives time for the mini-puberty to occur which may lead to decent of the testis.

WHO HAS THIS?
- Premature babies and infants with Kleinfelters (XXY) may have problems with this

RISK:
3-5x risk of testicular cancer
Torsion and Trauma

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14
Q

How common is cryptorchism?
Treatment?

A

Cryptoorchism occurs in 1/100 male births

Treated with orchiopexy (places testical into the scrotum)

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15
Q

What are some causes of testicular inflammation?

  • viral, bacterial?
  • variation in cause with age?
A

Inflammatory Lesions:
Epidydidmus gets infected from travel of infection from the urethra through the vas deferens

Orchitis can have many causes:
Viral:
Mumps (paramyovirus - ss linear neg. sense RNA, helical, enveloped) causes ORCHITIS IN ADULTS more often than children

Bacterial:
Old: E.coli, Pseudomonas a.
Young: Gonorrhea, Chlamydia

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16
Q

What effects does getting infected with Chlamydia trachomatis D-K and N. gonorrhea have on fertility and libido?

A

These patients will have decreased fertility with the same libido because leydig cells typically are not infected

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17
Q

Differentiate the causes of torsion in neonates and adults.

  • Aside from differences in pain, how do signs and symptoms of these conditions differ?
  • which is associated with an underlying anatomical defect?
A

Neonates:
- Typically occurs right after birth and there is NO ANATOMIC DEFECT, these kids have a normal Cremasteric Reflex

Adults:

  • BILATERAL ANATOMIC DEFECT of the testes not being attached to the tunica vaginalis
  • Adolescents often present with an absent cremasteric reflex (full grown people typically have lost the cremasteric reflex regardless)
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18
Q

If you see left sided varicocele of the testes, what should you consider as a potential cause?

A

Varicocele is potentially caused by SUPERIOR MESENTERIC SYNDROME or some blockage of the renal vein
**Consider Renal Cell Carcinoma - remember the association of this with VHL

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19
Q

Where does fluid collect in hydrocele?

A

Under the tunica vaginalis

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20
Q

Into which two categories can we divide Testicular Neoplasms into?
**What patient typically presents with either of these?
**Chances of the tumor being malignant?

A

Seminomas and Non-seminomas (both of these subsets are considered germ cell carcinomas)

Typicall Testicular Cancer Presentation:
White males between 15-34 (most often 20 y/o) and the tumor is almost ALWAYS MALIGNANT (95%)

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21
Q

Seminomas

  • prognosis?
  • Risk of Metastatsis?
  • Histology?
  • Serum markers?
A

Prognosis:
- Seminomas have a good prognosis and a LOW risk of metastasis

Histo:
- Proliferation of cells resembling spermatogonia => polygonal cells with fried egg appearance and lymphocytic inflitration.

Serum:
in 15% of cases, hCG (from synciotiotrophoblasts) will be elevated (most associated with Choriocarcinomas though and some association with Embryonal carcinoma)

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22
Q

T or F: in seminomas you are likely to Hemorrhage and necrosis on gross exam of the excised testicle.

A

FALSE, these tumors are pretty indolent

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23
Q

What are the Key Risk factors for Testicular Neoplasms?

A
  1. Cryptorchism
  2. Kleinfelter’s
24
Q

What 4 types of non-seminous germ cell tumors of the testes are there?

A
  1. Embryonal Carcinoma
  2. Yolk-sac tumor
  3. Choriocarcinoma
  4. Teratomas
25
Q
  • *Embryonal Carcinoma (Germ cell/Non-seminoma)**
  • Histology
  • Gross
  • Key Markers
  • Prognosis (if metastasis occurs, how?)
A

Embryonal Carcinoma (Germ cell/Non-seminoma)

HISTO:
large hyperchromatic nuclei and sheets of undifferentiated cells and primative gland-like structures

Gross:
Hemorrhage and Necrosis

Key Markers:
AFP and beta-hCG possibly present

Prognosis:
POOR these tend to have early HEMOTOGENOUS SPREAD.

26
Q

Who most commonly presents with a yolk-sac tumor in the testes?
- prognosis?

A

Young children (often under 3)
GOOD PROGNOSIS

27
Q

Yolk-sac Tumor (Germ cell/non-seminoma)

  • Histology
  • Key Markers
A

Yolk-sac Tumor

HISTO:
Schiller Duval Bodies (pseudoglomerulus) is a dead giveaway in both males and females. Pink (esosinophilic) globules may be seen in the cells due to alpha1-antitrypsin

Key Markers:

  • **alpha1-antitrypsin
  • AFP**
28
Q
  • *Choriocarcinoma (Germ cell/Non-seminoma)**
  • Histology
  • Gross
  • Key Markers
  • Prognosis (if metastasis occurs, how?)
A

Histology:
Overall appears extremely Pleomorphic and Hyperchromatic

2 cell types:

  • Choriotrophoblasts - cells with central nucleus
  • Syncytiotrophoblasts - hCG secreting cells, by name you know they are sheet-like (giant cells)

Gross:
Hemorrhage and Necrosis

Key markers:
VERY HIGH beta-hCG from Syncytiotrophoblasts

29
Q

A male is known to have choriocarcinoma of the testes, what hormone would you expect to see in the serum?
- what symptoms may come as a consequence?

A

hCG is is secreted from chroiocarcinomas

Symptoms:
- hCG can act on the LH, FSH, and TSH receptors so you may see a combination of low T and Hypothyroid symptoms (gynecomastia, lethargy, wt. gain etc.)

30
Q
  • *Teratomas (Germ Cell/Non-seminous)**
  • subtypes
  • Histology
  • Prognosis on the basis of subype and age
  • Key markers
A

Teratomas
- Adult and Embryonal Subtypes

Histology:
2 or 3 different tissues of the endoderm, mesoderm, and ectodoerrm pressent.

Gross:

  • *Adult = Better prognosiss than embryonal**
  • *Pre-pubertal** then more likely to be benign
  • *Post Puberty** - more likely maligant

Markers:
AFP or hCG can be elevated

31
Q

A man in his 60’s presents with what appears to be bilateral cancer in the testes.

  • what is the most likely cause?
  • Histology?
  • key Markers?
A

Diffuse Large B-cell Lymphoma is the most likely cause

Histology:
Abundant monomorphic cells that are abundent and individual causing wide spacing between semineferous tubules

Maker:
IHC: CD20 (for B cell), CD45 (general lympha)

32
Q

Benign Prostatic Hypertrophy an Postsatic Carcinoma

  • compare location
  • compare histology
  • special stains
A

BPH
Typically occurs in the periurethral region of the prostate.
May appear similar to thyroid with intraluminal secretions and also may appear that there are islands of tissue inside the glands. BOTH GLANDS AND STROMA ARE INCREASED.

Prostate Carcinoma
Typically occurs in the posterior region of the prostate.
Glands invade the stroma and increase in size. This cancer also really likes to wrap around nerves.
- Positive for Racemase (Red color)
- Negative for Basal Cells

33
Q

BPH and Prostatic Carcinoma
Compare the feeling on palpation.

A

BPH:
Nodularity won’t really be palpable from the rectum, but may feel enlarged

Prostate Cancer:
Typically harder and in the posterior aspect

34
Q

Someone present with fever, pelvic pain, dysuria, and pain on palpation of the prostate.

  • Causative agent? (variation with age?)
  • Laboratory Findings?
A

Causative Agent

  • Young pts: Gonorrhea, Chlamydia
  • Old pts: E. coli, Pseudomonas a.

Laboratory Findings
- Neutrophils in the urine (typically not biopsied), if cultured you may see bacteria if acute, but probably not if chronic

**Pain is key here because cancer and BPH is typically not painful**

35
Q

A 65 y/o man presents with hesistancy, urgency, nocturia, and weak urinary stream.
- what is a key mediator in the development of this disease?

A

DHT is key in mediating prostatic hypertrophy

36
Q

A biopsy of the prostate is performed and sheets of pleomorphic cells are seen.
- what is the prognosis of this patient?

A

VERY poor prognosis, when prostate cancer loses it glandular architecture and becomes sheetlike its likely grade 5.

37
Q

Where in the urinary tract can the transitional epithelium be found?
- what does normal transitional epithelium look like?

A

Renal Pelvis
Ureters
Bladder
Urethra (top portion)

Transitional Epithelium:
- Looks like multi-layers ovoid cells with overlying stretched out “umbrella” cells

38
Q

Uretopelivic Obstructions

  • where do they typically occur?
  • What are some causes of uretopelvic obstructions in newborns?
  • what is the problem with these in newborns?
A

Where:
at the Uretopelvic Junction (its in the name)

Newborns:

  • Abnormal Smooth muscle organization in the ureter
  • Collagen deposition at the UPJ
  • Mechanical Obstructions may also happen in newborns but these are rare

Complications:

  • #1 cause of Hydronephrosis in newborns and children
  • Often accompanied by other congenital abnormalities
39
Q

Uretal Diverticulum
- complications?

A

Often these people are asymptomatic, but statis in this region predisposes these people to infection.

40
Q
  • *Urothelial Carcinomas**
  • who do these typically present in?
  • symptoms?
  • associated with what other Cancers?
A

Typically this in a patient that is in there 60’s or 70’s and will present as a urethral obstruction (pain, hydronephrosis, etc.)

You should look for concurrent urothelial neoplasma in the Renal Pelvis and Bladder.

41
Q

Obstructive Lesions of the Ureter
- 3 main complications?

A
  • *Hydronephros** (MAJOR PROBLEM) - look for oligouria
  • post renal azotemia so BUN/Cr is over 15 in the acute phase because lack of renal blood flow Prevents Excretion of BUN
  • Long standing Hydronephros leads to kidney damage and BUN/Cr drops below 15 becasue uria, which is freely filtered is **not reabsorbed.

Hydroureter

Pyelonephros**

42
Q

Differential for Intrinsic and Extrinsic cause of ureter obstruction.

A

Intrinsic:
- Calculi, Stictures, Clots, Neurologic, Tumors

Extrinsic:
- Pregnancy, Periuretal inflammation, endometriosis, tumors

43
Q

What uretal obstuction might you expect in someone with IgG4 disease?

  • who does this typically present in?
  • Histology of this disease?
  • what non-genitourinary diseases may this person also have?
A

Sclerosing Retroperitoneal Fibrosis
- typically present in middle aged males with oligouria (still very rare)

Histology: Lymphoplasmacytic infiltrate with Eosinophils Possible

Riedel’s Fibrosis Thyroiditis is associated with IgG4 disease

44
Q

What problems are associated with vesicoureteral reflux?
- is this a common condition?

A

vesicoureteral reflus is a VERY COMMON and very serious condition because it can lead to recurrent pyelonephrosis

**remember that pyelonephrosis may present with fever, flank pain, WBC casts, and leukocytosis + symptoms of cystitis

45
Q

What causes extrophy of the bladder?

A
  • Failure of the anterior abdominal wall to close.
46
Q

What is the Urachus?
- what happens if complete or partial persistence occurs?

A

Urachus connects the fetal bladder and the allantois during pregnancy

Complete Persistence:
- Urine is eliminated out of the umbilicus

Partial Persistence:
- Urachial cyst that is predisposed to carcinoma

47
Q

You look into someone’s bladder to find the etiology of Cystitis and find a ulcerative plaque that consists of raised mucosa. Histology Shows Macrophages and Lymphocytes.

  • What is this condition called?
  • what other Pathognomonic histological feature might you look for?
A

Condition:
MALAKOPLAKIA

Histology is characterized by macrophages filled with bacteria/multinucleated giant cells and lymphocytes. Mineralized (purple) concretions are called MICHAELIS-GUTMANN bodies and they are pathognomonic for this lesion.

Wikipedia says:
Malakoplakia is associated with patients with a history of immunosuppression due to lymphoma, diabetes mellitus, renal transplantation, or because of long-term therapy with systemic corticosteroids

48
Q

Bladder Neoplasia
- Risk Factors (name 3)

A

Cigarettes
Occupational Carcinogens
Schistosoma Haematobium (worms)

49
Q

Schistosoma haematobium

  • what is it?
  • how is it transmitted?
  • What does it cause?
  • How is it treated?
A

What is it:
Trematode (fluke)/worm

Transmission:
Snails Host the infection and cercariae (free-swimming larva) penetrate the skin of humans

Diseases:

  • Cause Hepatosplenomegaly with fibrosis and inflammation
  • From the liver it can get transmitted to the venous plexus of the bladder to cause SCC

Treatment:
Praziquantel

50
Q

Do you expect carcinoma in situ of the bladder to papillary or flat?
- Histology?

A

CIS of the Bladder Uroepithelium can be EITHER papillary or flat

Histology:
- Basement membrane is in tact but the overlying cells show full thickness hyperchromasia and pleomorphism with loss of overlying umbrella cells and sloughing of cells into the lumen.

51
Q

Compare and contrast the histology of Low grade and High grade Urothelial Cancer?

A

BOTH:
- LOSS OF THE BASEMENT MEMBRANE

Low Grade:
- Full Thickness atypia but the tissue as a whole still resembles urothelium

High Grade:
- Cells become somwhat squamous in a appearance with increased mitosis and pleomorphism. They also stop sticking together.

52
Q

Invasion of what structure may lead you to believe bladder cancer has metastasized by the time you caught it?

A

Invasion into the detrussor suggest possible metastasis

53
Q

Congenital Syphillis
- effects on conception, infancy, childhood?

A

Conception:
May result in frequent stillbirth or miscarriage

Infancy:
May see rash, osteochonritis, perositits, liver and lung fibrosis

Childhood:
Interstitial keratosis, Hutchinson teeth, 8th nerve Deafness

54
Q

What would you see on the histology of gummas?

A

**3 Layers:
Innermost: Central Zone of Coagulative Necrosis

Middle:**mixed lymphocytic infiltrates of lymphocytes, PLASMA CELLS, and activated macrophages.

Outer: Peripheral zone of fibrous tissue**

55
Q

What do you want to see in histology to feel more confident that syphillis is the correct diagnosis?

A

Plasmacytic Infiltration or the parenchyma

56
Q

What should you see on histology of herpes infected cells?

A

Margination - darker cell edges from chromatin that has gotten pushed to the edge (remember Herpes lives in the nucleus)

Molding - cells pushed together

Multinucleation

Glassy Inclusions

Reproductive Pathology (6 decks)

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