Male Genital System

Question 1

Hypospadias

Answer 1

Opening of urethra on INFERIOR surface of penis
Due to failure of urethral folds to close

Question 2

Epispadias

Answer 2

Opening of urethra on SUPERIOR surface of penis
Due to abnormal positioning of genital tubercle

Associated w/ bladder exstrophy

(Embryo: Genital tubercle becomes glans of penis/clitoris)

Question 3

Condyloma Acuminatum

Answer 3

Benign warty growth on genital skin

Due to HPV 6 or 11
Koilocytic change; “Raisinoid nuclei”

Question 4

Lymphogranuloma Venereum

Answer 4

Granulomatous inflammation
= Immune cells clump into nodules to contain infection

Necrotizing granulomatous inflammation
= Tissue has died at these contained sites of infection

Necrotizing granulomatous inflammation of INGUINAL nodes b/c C. trach (L1-3) infection + Fibrosis +/- Rectal strictures

Question 5

Squamous Cell Carcinoma of Penis

Answer 5

HPV 16, 18, 31, 33
Lack of circumcision

Question 6

Precursor Lesions (Squamous Cell Carcinoma of Penis)

Answer 6

In-situ carcinomas…

Bowen Disease Leukoplakia: On shaft, will invade BM

Bowenoid Papulosis: Reddish papules, will NOT invade BM

Erythyroplasia of Queyrat: On glans

Question 7

Cryptorchidism

Answer 7

Testicle does not descend into scrotal sac

Resolve spontaneously OR orchiopexy at age 2

To prevent germ cell damage/ testicular atrophy with infertility, seminoma (germ cell tumor, malignant)

Question 8

Orchitis

Answer 8

Due to

C. trachomatis (D-K) or N. gonorrhoeae in young adults
E. coli or Pseudomonas in older adults
Mumps virus
Autoimmune w/ non-necrotizing granulomas

Question 9

Testicular Torsion

Answer 9

Twisted spermatic cord, including artery and vein (vein collapses) causing hemorrhagic infarction

Due to congenital failure, testes don’t attach to inner lining of scrotum

Seen in adolescents
Sudden testicular pain
ABSENT cremaster

Question 10

Varicocele

Answer 10

Dilated spermatic vein with “bag of worms” appearance, usually L-sided

Due to impaired venous drainage, seen in L-sided Renal Cell Carcinoma

Seen in infertile males, theory is pooling venous blood warms the testicle

Question 11

Hydrocele

Answer 11

Fluid in TUNICA vaginalis, transilluminated

Infants ~ Failed closure of PROCESSUS vaginalis

Adults ~ Blocked lymph drainage

Question 12

Testicular Tumors

Answer 12

Germ cell (Malignant, Seminoma/Non-Sem)
Sex-cord stroma (Benign)

Firm, painLESS mass

***NOT BIOPSIED, due to risk of seeding scrotum & because most are germ cell/ malignant

Radical orchiectomy

Question 13

Germ Cell Tumors

Answer 13

Malignant
Ages 15-40
Risk: Cryptorchidism, Klinefelter (XXY)

1. Seminoma ~ Additional germ cells
   -Metastasizes late & responds to radiation
   -Good prognosis

Non-seminoma Types ~ Opposite
2. Embryonal carcinoma ~ Embryo-like cells
3. Yolk sac tumor ~ Yolk sac
4. Choriocarcinoma ~ Placental tissue
5. Teratoma ~ Mature fetal tissue

Question 14

Seminoma

Answer 14

Malignant, Germ cell tumor

Large cells with clear cytoplasm, central nuclei

“Homogenous mass, no hemorrhage or necrosis” (C/c Embryonal carcinoma)

+/- b-hCG (~Choriocarcinoma)

Question 15

Embryonal Carcinoma

Answer 15

Primitive cells, may form glands***
Aggressive, early hematogenous spread

“Hemorrhagic mass with necrosis”

CTX may cause differentiation

+/- b-hCG (~Choriocarcinoma)
+/- AFP (~Yolk sac tumor)

Question 16

Yolk Sac Tumor

Answer 16

Seen in kids

Schiller-Duval bodies; “Glomeruloid-like structure”

+++AFP

Question 17

Choriocarcinoma

Answer 17

Trophoblasts, NO villi
Early hematogenous spread

+++b-hCG

Hyperthyroidism (b/c ~TSH)
Gynecomastia (b/c ~FSH/LH)

Question 18

Teratoma

Answer 18

Malignant in M
Mature fetal tissue, 2-3 embryonic layers

+/- b-hCG (~ Choriocarcinoma)
+/- AFP (~ Yolk sac tumor)

Question 19

Mixed Germ Cell Tumors

Answer 19

Prognosis based on worst component

Question 20

Sertoli Cell Tumors

Answer 20

Tubules
Clinically silent

Question 21

Leydig Cell Tumor

Answer 21

Produces androgen
-Precocious puberty (in kids)
-Gynecomastia (in adults)

Reinke crystals!

Question 22

Testicular Mass in M >60

Answer 22

Lymphoma, usually DLBL

Question 23

Prostate

Answer 23

Glands & stroma maintained by androgen

Glands
-Luminal & basal cells
-Secrete alkaline milky fluid

Question 24

Acute Prostatitis

(Same bacteria as orchitis)

Answer 24

C. trachomatis & N. gonorrhoeae in young adults
E. coli & Pseudomonas in older adults

Fever, chills, dysuria
Prostate is tender, boggy

Prostatic secretions +WBCs
Culture +bacteria

Question 25

Chronic Prostatitis

Answer 25

Dysuria, pelvic or low back pain

Prostatic secretions +WBCs
Culture NEG for bacteria

Question 26

Benign Prostatic Hyperplasia

Answer 26

Hyperplasia of stroma & glands in peri-urethral zone
Due to AGE-related increase in DHT

Urinary hesitancy & retention, dribbling, hypertrophy, hydronephrosis

+Microscopic hematuria
+PSA (<10)

TERAzosin
-Alpha1-antagonist to relax smooth muscle (dec BP too)

TAMSUlosin
-Selective Alpha1a-antagonists (for normotensive pt’s)

5alpha-Reductase Inhibitor
-To decrease conversion to DHT

Question 27

Prostatic Adenocarcinoma

Answer 27

Malignant proliferation of GLANDS, esp at posterior prostate

Risk: Older age, African American, Diet high in sat fats

Screen at 50 with DRE & PSA
PSA >10 or Decreased “Free-PSA”

Biopsy required! Small glands infiltrating normal tissue with “dark nucleoli”

Can spread to lumbar spine!
-Osteoblastic metastases
-Sclerotic lesions of bone
-Low back pain
-> +ALP, +PSA or +PAP

Gleason Grading by architecture, NOT nuclear atypia***

Local Disease: Prostatectomy

Advanced Disease:
-Leuprolide (GnRH analog)
-Flutamide (Androgen receptor inhibitor)