Male Genital System Flashcards
Hypospadias
opening urethra - inferior surface
failure of urethral folds to close
Epispadias
Opening urethra - superior surface
Abnormal positioning of genital tubercle
Bladder exstrophy
Lymphogranuloma venereum
Necrotizing granulomatous inflammation - inguinal lymphatics/nodes
Chlamydia trachomatis (L1-L3)
Heals with fibrosis - may lead to rectal stricture
Bowen dz - precursor in situ lesion
In situ carcinoma - penile shaft/scrotum presents as luekoplakia
Erythroplasia of Queyrat - precursor in situ lesion
In situ carcinoma - glans presents as erythroplakia
Bowenoid papulosis - precursor in situ lesion
in situ carcinoma - multiple reddish papules
Younger pt (40s) - relative of Bowen dz and erythroplasia of Queyrat
Doesn’t progress to invasive carcinoma
Most common congenital male reproductive abnormality
Cryptorchidism
Complications of undescended testicles
Testicular atrophy w/ infertility
Increase risk of seminoma
Orchitis causes (4)
- Young: Chlamydia trachomatis (D-K), Neisseria gonorrhoea
- Old: E coli & pseudomonas
3: Mumps - increased risk for infertility,inflammation usually not seen
Testicular torsion - involves what & cause
spermatic cord
caused by congenital failure of testes to attach to inner lining of scrotum (via processus vaginalis)
Pathology of testicular torsion
Congestion & hemorrhagic infarction
Varicocele seen on what side - related to what carcinoma
Left side (SV drains to RV before IVC)
Related to Renal cell carcinoma
Dilation of spermatic cord
Large % infertile males
Hydrocele
Fluid in tunica vaginalis
Assoc w/ incomplete closure of processus vaginalis - leading to communication with peritoneal cavity (infants) or blockage of lymphatic drainage (adults)
Male testicular tumors arise from
germ cells or sex cord stoma
Are most testicular tumors benign or maligant?
Maligant (which is why we don’t biopsy - also because of seeding into scrotum)
Germ cell tumors classified as:
& risk factors
Seminoma vs nonseminoma
Risk factors: cryptorchidism & Klinefelter syndrome
Germ cell tumors in males most common age
15-40
Seminoma characteristics
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
Non-seminoma characteristic
Metastasize early
5 nonseminoma carcinomas
- Embryonal
- Yolk sac
- Choriocarcioma
- Teratoma
- Mixed germ cell
Embryonal carcinoma
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
What nonseminoma tumor can differentiate when treated with chemo?
Embryonal carcinoma
Yolk sak
Most common testicular tumor in children
Schiller Duval bodies - glomerular like structure
AFP elevated
Choriocarcinoma
Syncytiotrophoblast & cytotrophoblasts malignant tumor
Placenta like but no villi!!
Beta-hCG (can lead to hyperthyroidism/gynecomastia)
What is the alpha-subunit of beta-hCG similar to (3)?
FHS, LH, TSH
Teratoma
mature fetal tissue of 2-3 embryonic layers
Malignant in males
AFP or beta-hCG elevated
Who are teratomas malignant in? Men or women?
Men
Mixed germ cell tumor
most germ cell tumors are mixed
Prognosis based on worst component
Sex-cord stromal tumors can be from what two cell types
Leydig or Sertoli
Sex cord stromal cells
resemble sex cord stromal
Leydig: produce androgen - precocious puberty (children) or gynecomastia (adults) - characteristic Reinke crystals
Sertoli: tubules - clinically silent
Leydig sex cord stromal turmors
produce androgen - precocious puberty (children) or gynecomastia (adults) - characteristic Reinke crystals
What type of testicular cancer seen in men >60?
Lymphoma
bilateral
diffuse large B cell type
Acute prostatitis
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
Chronic prostatitis
Dysuria w/ pelvic/low back pain
Prostate secretion show WBC
Culture - no bacteria
BPH
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
Clinical problems BPH
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)
Treatment of BPH
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
Prostate adenocarcinoma
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
Screening for Prostate adenocarcinoma
DRE & PSA at 50
PSA > 10 is worrisome
Decreased % free PSA suggestive of cancer
What is necessary to confirm Prostate adenocarcinoma?
Biopsy
what is grading for biopsy of Prostate adenocarcinoma?
Gleason scoring scale - based on ARCHITECTURE
NOT: nuclear atypia
What is used to treat localized Prostate adenocarcinoma
Prostatectomy
what is used to treat metastasized Prostate adenocarcinoma?
Continous GnRH analog (leuprolide) - shut down ant pit gonadotrophs (LF/FSH reduced)
Flutamide - competitive inhibitor at androgen receptor
