Male Genital System

Question 1

What causes hypospadias?

Answer 1

Failure of the urethral fold to close

Question 2

What causes epispadias? What is it associated with?

Answer 2

Abnormal positioning of the genital tubercle

Associated with bladder exstrophy

Question 3

Benign warty growth on genital skin caused by HPV (6+11)?

Answer 3

Condyloma acuminatum

Question 4

STD that causes lymphogranuloma venereum?

Where is the inflammation occurring?Complication?

Answer 4

Chlamydia trachomatis (L1-L3)
Necrotizing, granulomatous inflammation of the inguinal lymphatics and lymph nodes
Heals with fibrosis, perianal involvement may result in rectal stricture

Question 5

Risk factors for squamous cell carcinoma of the penis

Answer 5

High risk HPV (16, 18, 31, 33)

Lack of circumcision

Question 6

Precursor in situ lesions to squamous cell carcinoma of the penis (3 - location, presentation and what age group)

Answer 6

Bowen disease - penile shaft or scrotum, presents as leukoplakia

Erythroplasia of Queyrat - glans, presents as erythroplakia

Bowenoid papulosis - presents as multiple reddish papules, seen in younger (40s) patients

Question 7

Complications of cryptorchidism

Answer 7

Testicular atrophy, infertility and increased risk for seminoma

Question 8

Causes of orchitis

Answer 8

Chlamydia (D-K), Neisseria gonorrhoeae - young adults, risk for sterility but libido (Leydig cells) not affected
E. Coli and Pseudomonas - in older adults (UTIs)
Mumps - teens (<10), increased risk for infertility
Autoimmune orchitis - characterized by granulomas

Question 9

What type of infarction occurs with testicular torsion?

Answer 9

Hemorrhagic infarction (blood comes in but can’t get out)

Question 10

Are varicoceles usually left sided or right sided? Associated with what?

Answer 10

Left - left testicular vein drains into left renal vein (R goes into IVC)
Associated with left-sided RCC (often invades renal vein)

Question 11

Hydrocele is a collection of fluid where?

Answer 11

Tunica vaginalis (serous membrane that covers the testicle and internal surface of scrotum)

Question 12

Presentation of acute vs. chronic prostatitis? Differences on culture?

Answer 12

Acute - dysuria, fever and chills
Chronic - dysuria, pelvic or low back pain

Acute - prostatic secretions show WBCs, culture reveals bacteria
Chronic - prostatic secretions show WBCs, cultures are negative

Question 13

BPH is a hyperplasia of…

Answer 13

glands and stroma (DHT converted in the stromal cells acts on the androgen receptor of stromal and epithelial cells resulting in hyperplastic nodules). Occurs in the periurethral zone

Question 14

Is there an increased risk of prostatic cancer with BPH?

Answer 14

No

Question 15

Clinical features of BPH

Answer 15

• trouble starting and stopping urination
• dribbling
• impaired bladder emptying and hydronephrosis (obstruction)

Question 16

Prostate adenocarcinoma risk factors

Answer 16

Age, race (AA>whites>asians), diet high in saturated fats

Question 17

Prostate adenocarcinoma is usually located in the…

Answer 17

peripheral posterior region of the prostrate (DRE - prostate sits anterior to the rectum)

Question 18

PSA greater than what is worrisome at any age?

Answer 18

10 ng/mL

Question 19

How to confirm prostate cancer?

Answer 19

Biopsy is required!

Question 20

What will you see on a prostate biopsy w/ prostatic adenocarcinoma? How is it graded?

Answer 20

Small, invasive glands with prominent nuclei

Graded on the Gleason scale (based one architecture alone - multiple areas assessed)

Question 21

Where does prostate cancer typically spread? What kind of lesions?

Answer 21

Lumbar spine or pelvis
Osteoblastic lesions that present as low back pain and increased serum alkaline phosphatase, PSA and prostatic acid phosphatase (PAP)

Question 22

Risk factors for germ cell tumors

Answer 22

Cyptorchidism

Klinefelter sydnrome

Question 23

What is the most common testicular tumor? What does it look like? What does it secrete? Prognosis?

Answer 23

Seminoma - malignant tumor of large cells with clear cytoplasm with central nuclei (resemble spermatogonia) that forms a homogenous mass without hemorrhage or necrosis

Rarely secretes B-hCG

Good prognosis, responds to radiotherapy

Question 24

What is the most common testicular tumor in children? What does it resemble? What it characteristically elevated?

Answer 24

Yolk sac tumor - (endodermal sinus tumor) is a malignant tumor that resembles yolk sac elements
Schiller-Duval bodies (glomerulus-like structures) seen on histology
AFP is elevated

Question 25

Which tumor is associated with Shiller-Duval bodies?

Answer 25

Yolk sac tumor (looks like glomerulus)

Question 26

What is an embryonal carcinoma?

Answer 26

Malignant tumor comprised of immature, primitive cells that may produce glands. Forms a hemorrhagic mass with necrosis. Aggressive with early hematogenous spread. Chemotherapy may result in differentiation into another type of germ cell tumor (teratoma). Increased AFP or B-hCG may be present.

Question 27

What is the difference in teratoma between females and males? What is increased?

Answer 27

Mature fetal tissue tumor - malignant in males, benign in females. AFP or B-hCG may be increased.

Question 28

What is choriocarcinoma?

Answer 28

A malignant tumor of synctiotrophoblasts and cytotrophoblasts (placenta-like tissue, but villa are absent). Spreads early via blood. B-hCG is characteristically elevated but may lead to hyperthyroidism or gynecomastia (a-subunit of hCG is similar to FSH, LH and TSH).

Question 29

What tumor would you find testicular masses bilaterally in a male over 60 years of age?

Answer 29

Lymphoma - diffuse large B-cell type

Question 30

What are the two types of sex cord stromal cells?

Answer 30

Usually benign -

Leydig - produces androgen - precocious puberty in young males, asymptomatic or gynecomastia in adults. Reinke crystals seen on histology

Sertoli cells - comprised of tumor cells and clinically silent

Question 31

What do you see Reinke crystals with?

Answer 31

Leydig cell tumor (long, pink, thick)