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pathoma > Male Genital System > Flashcards

Male Genital System Flashcards

1
Q

Hypospadias

A

opening urethra - inferior surface

failure of urethral folds to close

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2
Q

Epispadias

A

Opening urethra - superior surface
Abnormal positioning of genital tubercle
Bladder exstrophy

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3
Q

Lymphogranuloma venereum

A

Necrotizing granulomatous inflammation - inguinal lymphatics/nodes
Chlamydia trachomatis (L1-L3)
Heals with fibrosis - may lead to rectal stricture

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4
Q

Bowen dz - precursor in situ lesion

A

In situ carcinoma - penile shaft/scrotum presents as luekoplakia

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5
Q

Erythroplasia of Queyrat - precursor in situ lesion

A

In situ carcinoma - glans presents as erythroplakia

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6
Q

Bowenoid papulosis - precursor in situ lesion

A

in situ carcinoma - multiple reddish papules
Younger pt (40s) - relative of Bowen dz and erythroplasia of Queyrat
Doesn’t progress to invasive carcinoma

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7
Q

Most common congenital male reproductive abnormality

A

Cryptorchidism

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8
Q

Complications of undescended testicles

A

Testicular atrophy w/ infertility

Increase risk of seminoma

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9
Q

Orchitis causes (4)

A
  1. Young: Chlamydia trachomatis (D-K), Neisseria gonorrhoea
  2. Old: E coli & pseudomonas
    3: Mumps - increased risk for infertility,inflammation usually not seen
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10
Q

Testicular torsion - involves what & cause

A

spermatic cord

caused by congenital failure of testes to attach to inner lining of scrotum (via processus vaginalis)

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11
Q

Pathology of testicular torsion

A

Congestion & hemorrhagic infarction

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12
Q

Varicocele seen on what side - related to what carcinoma

A

Left side (SV drains to RV before IVC)
Related to Renal cell carcinoma
Dilation of spermatic cord
Large % infertile males

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13
Q

Hydrocele

A

Fluid in tunica vaginalis
Assoc w/ incomplete closure of processus vaginalis - leading to communication with peritoneal cavity (infants) or blockage of lymphatic drainage (adults)

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14
Q

Male testicular tumors arise from

A

germ cells or sex cord stoma

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15
Q

Are most testicular tumors benign or maligant?

A

Maligant (which is why we don’t biopsy - also because of seeding into scrotum)

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16
Q

Germ cell tumors classified as:

& risk factors

A

Seminoma vs nonseminoma

Risk factors: cryptorchidism & Klinefelter syndrome

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17
Q

Germ cell tumors in males most common age

A

15-40

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18
Q

Seminoma characteristics

A 
highly responsive to chemo
metastasize late
excellent prognosis
large cell w/ clear cytoplasm & central nuclei
Homogenous mass - no hemorrhage/necrosis
Rare cases produce Beta-hCG
19
Q

Non-seminoma characteristic

A

Metastasize early

20
Q

5 nonseminoma carcinomas

A
  1. Embryonal
  2. Yolk sac
  3. Choriocarcioma
  4. Teratoma
  5. Mixed germ cell
21
Q

Embryonal carcinoma

A

Malignant
Immature, primitive cells - may produce glands
Hemorrhagic mass w/ necrosis
Aggressive - early hematogenous spread
Chemo - can result in tumor differentiation into another cell line
AFP or Beta-hCG

22
Q

What nonseminoma tumor can differentiate when treated with chemo?

A

Embryonal carcinoma

23
Q

Yolk sak

A

Most common testicular tumor in children
Schiller Duval bodies - glomerular like structure
AFP elevated

24
Q

Choriocarcinoma

A

Syncytiotrophoblast & cytotrophoblasts malignant tumor
Placenta like but no villi!!
Beta-hCG (can lead to hyperthyroidism/gynecomastia)

25
Q

What is the alpha-subunit of beta-hCG similar to (3)?

A

FHS, LH, TSH

26
Q

Teratoma

A

mature fetal tissue of 2-3 embryonic layers
Malignant in males
AFP or beta-hCG elevated

27
Q

Who are teratomas malignant in? Men or women?

A

Men

28
Q

Mixed germ cell tumor

A

most germ cell tumors are mixed

Prognosis based on worst component

29
Q

Sex-cord stromal tumors can be from what two cell types

A

Leydig or Sertoli

30
Q

Sex cord stromal cells

A

resemble sex cord stromal
Leydig: produce androgen - precocious puberty (children) or gynecomastia (adults) - characteristic Reinke crystals
Sertoli: tubules - clinically silent

31
Q

Leydig sex cord stromal turmors

A

produce androgen - precocious puberty (children) or gynecomastia (adults) - characteristic Reinke crystals

32
Q

What type of testicular cancer seen in men >60?

A

Lymphoma
bilateral
diffuse large B cell type

33
Q

Acute prostatitis

A 
Young: Chlamydia trachomatis and neisseria gonorrhoeae
Old: E coli and Pseudomonas
Dysuria w/ fever & chills
Prostate tender and boggy
Prostate secretion show WBC
culture shows bacteria
34
Q

Chronic prostatitis

A

Dysuria w/ pelvic/low back pain
Prostate secretion show WBC
Culture - no bacteria

35
Q

BPH

A

Hyperplasia of prostatic stroma and glands
No increased risk of cancer
DHT - testosterone converted to DHT by 5-alpha reductase in stromal cells - results in hyperplastic nodules
Occurs peripheral zone

36
Q

Clinical problems BPH

A

Problems w/ starting/stopping urine
Impaired bladder emptying w/ increased risk for infection & hydronephrosis
Dribbling
Hypertrophy of bladder wall smooth m, increased risk for bladder diverticuli
Microscopic hematuria (maybe)
PSA (less than 10)

37
Q

Treatment of BPH

A

Alpha1 antagonist: “zosin” - relax smooth muscle
Lower BP
Selective alpha1A antagonists used in normotensive individuals to avoid alpha1B effects on BP

5alpha reductase inhibitor
Blocks testosterone to DHT
SE: gynecomastia & sexual dysfunction

38
Q

Prostate adenocarcinoma

A

Malignant proliferation of prostatic glands
Most common cancer in men, 2nd most common cause of cancer related death
Usually clinically silent
Arises in peripheral, posterior region

39
Q

Screening for Prostate adenocarcinoma

A

DRE & PSA at 50
PSA > 10 is worrisome
Decreased % free PSA suggestive of cancer

40
Q

What is necessary to confirm Prostate adenocarcinoma?

A

Biopsy

41
Q

what is grading for biopsy of Prostate adenocarcinoma?

A

Gleason scoring scale - based on ARCHITECTURE

NOT: nuclear atypia

42
Q

What is used to treat localized Prostate adenocarcinoma

A

Prostatectomy

43
Q

what is used to treat metastasized Prostate adenocarcinoma?

A

Continous GnRH analog (leuprolide) - shut down ant pit gonadotrophs (LF/FSH reduced)
Flutamide - competitive inhibitor at androgen receptor

pathoma (12 decks)

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