Male Genital System

Question 1

Hypospadias

Answer 1

Opening of urethra on inferior surface of penis

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
Assoiciated with BLADDER EXYSTROPHY

Question 3

Condyloma Acuminatum

Answer 3

Benign warty growth on genital skin
Due to HPV 6 and 11.
See KOILOCYTIC change

Question 4

Lyphogranuloma Venerum

Answer 4

Necrotizing granulomatous inflammation of the inguinal lymphatics and lymph nodes
STD from chlamydie trachomatis (serotypes L1-3)
Eventually heals with fibrosis but perianal involvement may result in rectal strictures

Question 5

Squamous Cell Carcinoma

Answer 5

Malignant proliferation of squamous cells of penile skin.
Risk factors are HPV 16, 18, 31, 33 or lack of circumcision
Precuros Lesions
1) Bowen Disease = in situ carcinoma of penil shaft or scrotum that presents as leukoplakia
2) Erythoplasia of Queyrat = in situ carcinoma on the glans that presents as erythroplakia
3) Bowenoid Papulosis = in situ carcinoma that presents as multiple reddish papules. Seen in younger patients (40s) and does not progress to invasive carcinoma

Question 6

Bowen Disease

Answer 6

precursor of squamous cell carcinoma = in situ carcinoma of penil shaft or scrotum that presents as leukoplakia

Question 7

Erythoplasia of Queyrat

Answer 7

precursor of squamous cell carcinoma = in situ carcinoma on the glans that presents as erythroplakia

Question 8

Bowenoid Papulosis

Answer 8

precursor of squamous cell carcinoma = in situ carcinoma that presents as multiple reddish papules. Seen in younger patients (40s) and does not progress to invasive carcinoma

Question 9

Cryptorchidism

Answer 9

Failure of the testicle to descend fro mthe abdomen into the scrotal sac.
Most common congenital male reproductive abnormality
Usually resolves spontaneously but if doesnt then perform orchiopexy before age 2 or else their is risk of testicular atrophy with infertility and increased risk of seminoma

Question 10

Orchitis

Answer 10

Inflammation of the testicle
Causes include
1) Chlamydia trachomatis (serotypes D-K) or Neisseira gonnorhea = increased risk of sterility
2) E coli or pseudomonas = UTI infection spreads to reproductive path
3) Mumps Virus = see in males after 10yrs. Can cause orchitis, aseptic meningitis, and pancreatitis
4) Autoimmune Orchitis = granulomas involving the seminferous tubules

Question 11

Testicular Torsion

Answer 11

Twisting of the spermatic cord, veins become obstructed leading to congestion and hemmorhagic infarction.
Usually due to failure of testes to attach to inner lining of the scrotum via the processus vaginalis
Prestns as sudden testicular pain with absent creasteric reflex

Question 12

Varicocele

Answer 12

Dilation of the spermatic vein due to impaired drainage.
Presents as scrotal swelling with a “bag of worms” appearance.
Usually left sided and associated with left sided renal cell carcinoma

Question 13

Hydrocele

Answer 13

Fluid collection within the tunica vaginalis ssociated with incomplete closure of the processus vaginalis leading to communication with the peritoneal cavity (infants) or blockage of lymphatic drainage (adults).
Presents as scrotal swelling that can be tranilluminated

Question 14

Testicular tumors

Answer 14

firm, painless mass that cannot be transilluminated

Not biopsied due to risk of seeding the scrotum

Question 15

Germ Cell tumors

Answer 15

Most common type of testicular tumos.
Usually occur between 15-40
Risk factors include cryptochidism and Klinefleter Syndrome

Question 16

Seminoma vs nonseminomas

Answer 16

Seminoma = high responsive to radiotherap, met late, excellent prognosis
Nonseminoma = variable response to treatment and often met early

Question 17

Seminoma

Answer 17

Malignant tumor comprised of large cells with clear cytoplasm and central nuclei.
for a HOMOGENOUS mass with NO HEMMORHAGE and NO NECROSIS
Resmbles ovarian dysgerminoma and is most common testicular tumor
Rare cases may produce beta-hCG
Good prognosis as it responds well to radiotherapy

Question 18

Embryonal Carcinoma

Answer 18

Malignant tumor comprised of immature, primitive cells that may produce glands
forms a HEMORRHAGIC MASS with NECROSIS
Agressive with early hematogenous spread
Chemo may cause it to differntiate into another germ cell tumor
Increased AFP or beta-hCG

Question 19

Yolk Sac/endodermal sinus tumor

Answer 19

Malignant tumor that resembles yolk sac elements
most common in CHILDREN
HAve shiller-duval bodies on histology that resembles a glomerulus
AFP is characteristically elevated

Question 20

Choriocarcinoma

Answer 20

Malignant tumor of synctiotrophoblasts and cytotrophoblasts (placenta like but villi are absent)
Spreads early via blood
beta-hCG is characteristically elevated and may lead to hyperthyroidism or gynecomastia since alpa subunit of hCG is similar to that of FSH, LH, and TSH

Question 21

Teratoma

Answer 21

Tumor comprised of mature fetal tissue derived from two or three embryonic layers but unlike in women it is is malignant
AFP and beta-hCG may be increased

Question 22

Mixed Germ Cell tumors

Answer 22

Germ cell tumors are usually a mix of cells of different tumor types and prognosis is based off the worst component

Question 23

Leydig Cell Tumors

Answer 23

Usually produces androgen causing precocious puberty in children or gynecomastia in adults.
REINKE crystals

Question 24

Sertoli Cell Tumor

Answer 24

Comprised of tubules and is usually clinically silent

Question 25

Lymphoma

Answer 25

Most common cause of testicular mass in males OVER 60.
often bilateral
usually of diffuse large B-cell type

Question 26

Acute Prostatitis

Answer 26

Acute inflammation of the prostate, usually due to bacteria
Chlamydia trachomatis and neisseria gonorrhoae in young adults or e coli and pseudomonas in older adults
Presents as dysuria with fever and chills
prostate is TENDER AND BOGGYY on dre
Prostatic secretions show WBCs and culture reveals bacteria

Question 27

Chronic Prostatitis

Answer 27

Chronic inflammation of the prostate
Presents as dysuria with pelvic or low back pain
Prostatic secretions show WBCs but cultures are negative

Question 28

Benign Prostatic Hyperplasia

physiology and symptoms

Answer 28

Hyperplasia of prostatic stroma and glands
Age related change but no increased risk of cancer
Related to Dihydrotestosterone (testosterone is converted to DHT by 5alpha reductase in stromal cells and DHT acts on androgen receptors of stromal and epithelial cells resulting in hyperplastic nodules.
Occurs in the central periurethral zone of the prostate compressing the urethra and causing problems such starting and stopping urination, imparied bladder empyting making it more likely to be infected, dribbling, hypertrophy of the bladder wall smooth muscle, microscopic hematuria, PSA often elevated.

Question 29

Treatment of BPH

Answer 29

alpha1 antagonists (terazosin) to relax smooth muscle.  Also relaxes vascular smooth muscle so has benefit of lowering BP.  use selective alpha1 antagonists (tamsuolsin) in normotensive
5alpha-reductase inhibitor to block conversion of testosterone to DHT, takes months to show results, helps prevent balding but can cause gynecomastia and sexual dysfunction

Question 30

Prostate Adenocarcinoma

Answer 30

Malignant proliferation of the prostatic glands
Most common cancer in men
Risk factors include old age, race (africa>white>asian) and diet high in saturated fats
Often clinically silent since it arises in peripheral, posterior region of the prostate and so doesnt present with urinary symptoms. Also the reason why start screening with DRE or PSA after age of 50. PSA>10 is worrisome and decreased % of free-PSA is suggestive of cancer
Must be confirmed by biopsy. Will notice small invasvie glands with prominent nucleoli.
Grading system is based on architecture alone
Spreads to lumbar spine or pelvis creating osteoblastic mets that present as low back pain and increased serum alkaline phosphatase, PSA and prostatic acid phosphatase
Prostatectomy is performed for localized disease, advanced disease is treated with hormone supression to reduce testosterone and DHT. (continuous GnRH analogs like leuprolide shut down antieror pituitart LH and FSH. Flutamide competitively inhibits at androgen receptors