Male Genital system Flashcards
1
Q
- Diseases of penis, scrotum and funicular spermaticus:
HYPOSPADIA
A
- malformation of the penis
- 1/250 births
- urethra open on ventral side
- due to failure of fusion of urethral/genital folds
- associated with abnormal descent of testes, obstruction, UTIs and possibly infertility
2
Q
- Diseases of penis, scrotum and funicular spermaticus:
EPISPADIA
A
- malformation of penis
- 1/300 000 births
- urethra opens on dorsal surface of penis
- associated with abnormal descent of testes, obstruction, UTIs and infertility
3
Q
- Disease of penis, scrotum and funicular spermaticus:
PHIMOSIS
A
- prepuce cannot easily be retracted over glans penis
- due to congenital anomaly or scarring of prepuce secondary to balantoprosthitis
4
Q
- Disease of penis, scrotum and funicular spermaticus:
PARAPHIMOSIS
A
- compromised circulation to the glans due to retraction of stenotic prepuce over glans
- foreskin cannot be put back to normal position after retraction
⇒ pain, congestion, swelling of distal penis
5
Q
- Disease of penis, scrotum and funicular spermaticus:
INFLAMMATORY PROCESSES OF PENIS
A
- STDs
* candida albicans, anaerobic bacteria, Gardenella, pyogenic bacteria
* troponema pallidum ⇒ syphilis
* HPV/HHV
* HIV - local inflammatory processes
* poor hygiene
* Fournier’s gangrene - systemic inflammatory diseases
6
Q
- Disease of penis, scrotum and funicular spermaticus:
BALANTIS
A
- inflammatory lesion of glans penis
- Balantoprosthitis ⇒ prepuce involved
- cause: poor hygiene ⇒ accumulation of epithelial cells, sweat and smegma // congenital or acquired phimosis
- morphology: red, swollen, tender, purulent discharge
- types: simple, erosive, gangrenous
7
Q
- Diseases of penis, scrotum and funicular spermaticus:
VENEREAL WARTS
A
- inflammatory lesion of penis
- condyloma acuminatum
- cause: HPV (type 6 and 11)
8
Q
- Diseases of penis, scrotum and funicular spermaticus:
URETHRITIS
A
- inflammatory lesion of penis
- UTI - acute or subacute
- cause: N.gonorrhea, T.vaginalis. C.trachonatis
9
Q
- Diseases of penis, scrotum and funicular spermaticus:
CHANCRE
A
- inflammatory lesion of penis
- location: glans, penile body and scrotum
- cause: T.pallidum ⇒ syphilis
- morphology: painless eroded papule
10
Q
- Diseases of penis, scrotum and funicular spermaticus:
CHANCROID
A
- inflammatory lesion of penis
- ulcerative lesion with inguinal lymphadenopathy
- cause: H.ducreyi
11
Q
- Diseases of penis, scrotum and funicular spermaticus:
LYMPHOGRANULOMA VENEREUM
A
- inflammatory lesion of penis
- morphology: small papule ⇒ inguinal lymphadenitis ⇒ chronic persistent infection
- cause: C.traconatis
12
Q
- Diseases of penis, scrotum and funicular spermaticus:
NEOPLASMS OF PENIS GENERAL
A
- 95% from squamous epithelium
- occur in uncircumscribed men, older than 40 years
- risk factors:
- poor hygiene
- smoking
- HPV infection (16,18)
- carcinoma in situ ⇒ ulcerate
13
Q
- Diseases of penis, scrotum and funicular spermaticus:
BOWEN DISEASE
A
- squamous cell carcinoma in situ
- occurs in older uncircumcised men
- morphology: solitary, plaque like lesion on shaft of penis (skin, mucosal surface)
- can progress to invasive squamous cell carcinoma
- Erythoplasia of Queyrat:
- premalignant lesion of glans
- erythematous, raised velvety plaque
14
Q
- Diseases of penis, scrotum and funicular spermaticus:
SQUAMOUS CELL CARCINOMA OF THE PENIS
A
- morphology: gray, crusted, papular lesion ⇒ infiltrate ⇒ indurated, ulcerated lesion with irregular margins
⇒ metastasis to inguinal LN - treatment: amputation
- Verrucous carcinoma:
- variant type, papillary architecture. no cytological atypia, rounded
- local invasive, no metastasis
15
Q
- Diseases of penis, scrotum and funicular spermaticus:
INFLAMMATIONS OF SCROTUM
A
- Jock itch (Tinea cruris) ⇒ superficial fungal infection
- Candidiasis ⇒ C.albicans
- Eczema ⇒ allergic reaction, atopic dermatitis
- Elephantiasis ⇒ Wuchereria bancrofti
- Furuncle/Erysipelas ⇒ S.aureus, S.pyogenes
- Gangrene
16
Q
- Diseases of penis, scrotum and funicular spermaticus:
CONTACT DERMATITIS
A
- disease of the scrotum
- redness, burning, swelling, itching
- cause: soaps, solvents, detergents, natural irritants
17
Q
- Diseases of penis, scrotum and funicular spermaticus:
NEOPLASMS OF SCROTUM
A
- most common; squamous cell carcinoma
- rare tumors
18
Q
- Diseases of penis, scrotum and funicular spermaticus:
HYDROCELE
A
- scrotal enlargement
- accumulation of serous fluid within tunica vaginalis
- cause: infection, tumor, idiopathic
- hematocele / chylocele
19
Q
- Diseases of penis, scrotum and funicular spermaticus:
SPERMATOCELE
A
- retention cyst of the head of epididymis distended with milky fluid containing spermatozoa
20
Q
- Diseases of penis, scrotum and funicular spermaticus:
SEBACEOUS CYST / EPIDERMOID CYST
A
- cyst filled with fatty, white, semi-fluid material ⇒ sebum
- associated with swollen hair follicle + blocked gland in scrotum
- treatment: surgery
21
Q
- Diseases of penis, scrotum and funicular spermaticus:
INGUINAL HERNIA
A
- protrusion of abdominal wall through inguinal canal
- types:
- direct: superficial inguinal ring
- indirect: deep inguinal ring
22
Q
- Diseases of penis, scrotum and funicular spermaticus:
CONTENT OF SPERMATIC CORD
A
- Arteries:
- testicular
- deferential
- cremasteric - Nerves:
- cremaster muscle nerve
- testicular n. - Vas deference
- Pampiniform plexus
- Lymphatic vessels
- Tunica vaginalis
23
Q
- Diseases of penis, scrotum and funicular spermaticus:
TORSION
A
- twisting of spermatic cord ⇒ venous infarction
- types:
- neonatal torsion
- adult torsion (bilateral anatomical defect ⇒ bell clapper abnormality)
- Treatment: Orchiopexy
24
Q
- Diseases of penis, scrotum and funicular spermaticus:
VARICOCELE
A
- abnormal dilation and tortuosity of veins in pampiniform plexus
- due to insufficiency of venous valves
- associated with infertility
- morphology: thickening of venous walls with fibrosis, decreased spermatogenesis in tubules with germ cell degeneration, increased Leydig cells
- treatment: ligation or occlusion of left spermatic vein
25
91. Prostatitis, nodular hyperplasia of prostate:
| ACUTE BACTERIAL PROSTATITIS
```
CAUSE:
- staphylococci, Gram- bacteri, E.coli
PATHOGENESIS:
- associated infection of urethra and bladder ⇒ direct extension or through vascular channels
MORPHOLOGY:
- neutrophil infiltrate
- congestion of stroma
- microabscess
CLINICAL FEATURES:
- fever, dysuria, lower back pain, pelvic pain ⇒ sepsis
- prostate enlarged, tender
```
26
91. Prostatitis, nodular hyperplasia of prostate:
| CHRONIC BACTERIAL PROSTATITIS
```
CAUSE:
- after acute infection or insidiously
- uropathogens
PREDISPOSITION:
- catheter, UTIs, prolonged sexual activity, foreign objects in urethra
MORPHOLOGY:
- tissue destruction
- fibroblast proliferation
- inflammatory cells
CLINICAL FEATURES:
- urinary or sexual dysfunction
- lower back pain, dysuria, perineal discomfort
```
27
91. Prostatitis, nodular hyperplasia of prostate:
| CHRONIC NON-BACTERIAL PROSTATITIS/ CHRONIC PELVIC PAIN SYNDROME
- no uropathogen
| - symptoms and increased amount of leukocytes in prostatic secretion
28
91. Prostatitis, nodular hyperplasia of prostate:
| ASYMPTOMATIC INFLAMMATORY PROSTATITIS
increased leukocytes in prostatic secretion
29
91. Prostatitis, nodular hyperplasia of prostate:
| BENIGN PROSTATIC HYPERPLASIA etiology
- glandular and stromal hyperplasia
- men age 40
- excessive androgen stimulation ⇒ DHT binds nuclear androgen receptor ⇒ synthesis of DNA, RNA, growth factors ⇒ hyperplasia
30
91. Prostatitis, nodular hyperplasia of prostate:
| BENIGN PROSTATIC HYPERPLASIA morphology
- inner transitional zone
- forms well-circumscribed nodules, solid with cystic spaces
- histo: proliferation of streams and epithelial cells ⇒ enlargement + corpora amylacea
31
91. Prostatitis, nodular hyperplasia of prostate:
| BENIGN PROSTATIC HYPERPLASIA clinical features
- lower urinary tract obstruction ⇒ hesitancy or intermittent interruption
- complete obstruction ⇒ painful distension ⇒ hydronephrosis
- symptoms: urinary urgency, frequency, nocturia
- enlarged, firm, rubbery prostate gland
32
91. Prostatitis, nodular hyperplasia of prostate:
| BENIGN PROSTATIC HYPERPLASIA treatment
- DHT formation blockers
- drugs relaxing smooth muscle by blocking alpha-adrenergic blocks
- transurethral resection
33
92. Tumors of prostate:
| PROSTATE ADENOCARCINOMA etiology
- men over 50 years old
1. Hormonal influcence
2. Hereditary influences
3. Environmental influence
* industrial settings
* geographic differences
4. Genetic influences
* fusion gene: TMPRSS2 and ETS
* activation of P13K/AKT signaling pathway
34
92. Tumors of prostate:
| PROSTATE ADENOCARCINOMA morpholgy
- firm, grey-white with ill-defined margins that infiltrate adjacent glands
HISTO:
- well-defined glands
- atypical epithelium
- fibrous stroma (scirrhous form)
- precursor lesion: high-grade prostatic intraepithelial neoplasia
35
92. Tumors of prostate:
| PROSTATE ADENOCARCINOMA clinical features
- clinically silent ⇒ accidental finding
- arise in peripheral region
- hard, irregular nodules and fixed prostate
- local discomfort, urethral complications
- metastasis:
* bone ⇒ osteolytic or osteoblastic
* LN + viscera
36
92. Tumors of prostate:
| GRADING AND STAGING
GRADING:
- Gleason system ⇒ 5 grades based on glandular pattern of differentiation
```
STAGING:
T1⇒ clinically inapparent lesion
T2⇒ palpable, visible carcinoma
T3⇒ local extraprostatic extension
T4⇒ invasion of contiguous organs/supporting structures
```
37
92. Tumors of prostate:
| PSA
- prostate-specific antigen
- serine proatease ⇒ cleave + liquefy seminal coagulum
- is organ specific but not not cancer specific ⇒ BPH, prostatitis, prostatic infarcts, ejaculation increase PSA
38
93. Inflammatory lesions of testis and epididymis, cryptorchidism, infertility:
NON-SPECIFIC EPIDIDYMITIS
- inflammation of epididymis
ETIOLOGY:
- primary UTI which ascends through vas deference ⇒ testes
- related to gonorrhea, syphilis, TB
SYMPTOMS:
- testicular pain
- scrotum: red, warm, swollen, tender + neutrophilic inflammatory infiltrate
39
93. Inflammatory lesions of testis and epididymis, cryptorchidism, infertility:
NON-SPECIFIC ORCHITIS
```
- inflammation of testes
ETIOLOGY:
- UTI ⇒ ascends
- STDs: chamydia, gonorrhea
- E.coli
- pyogenic bacteria ⇒ abscess of testes
SYMPTOMS:
- ejaculation of blood
- hematuria
- severe pain
- swelling of testes + inguinal LN
```
40
93. Inflammatory lesions of testis and epididymis, cryptorchidism, infertility:
MUMPS ORCHITIS
ETIOLOGY:
- mumps virus - Rubulavirus
- occurs in adult men
SYMPTOMS:
- testis is edematous, congested, painful
- lymphoplasmacytic inflammatory infiltrate
- severe cases: loss of seminiferous epithelium ⇒ tubular necrosis, atrophy, fibrosis and sterility
41
93. Inflammatory lesions of testis and epididymis, cryptorchidism, infertility:
MUMPS ORCHITIS
ETIOLOGY:
- mumps virus - Rubulavirus
- occurs in adult men
SYMPTOMS:
- testis is edematous, congested, painful
- lymphoplasmacytic inflammatory infiltrate
- severe cases: loss of seminiferous epithelium ⇒ tubular necrosis, atrophy, fibrosis and sterility
42
93. Inflammatory lesions of testis and epididymis, cryptorchidism, infertility:
CRYPTORCHIDISM etiology
```
= testes fail to descend into scrotum
⇒ hormonal abnormality
⇒ intrinsic testicular abnormality
⇒ mechanical problems
- congenital syndromes (Prader-Willi)
```
43
93. Inflammatory lesions of testis and epididymis, cryptorchidism, infertility:
CRYPTORCHIDISM morphology
```
- small, firm brown testis
HISTO:
- hyalinization and thickening of tubular basement membrane
- prominent Leydig cells
- hyperplastic Sertoli cells
- atrophy of other cells
```
44
93. Inflammatory lesions of testis and epididymis, cryptorchidism, infertility:
CRYPTORCHIDISM complications
- bilateral: sterility
- unilateral: atrophy of contralateral descended gonad ⇒ sterility
- trauma, torsion, inguinal hernia
- testicular malignancy
TREATMENT:
- orchioplexy
45
93. Inflammatory lesions of testis and epididymis, cryptorchidism, infertility:
CRYPTORCHIDISM complications
- bilateral: sterility
- unilateral: atrophy of contralateral descended gonad ⇒ sterility
- trauma, torsion, inguinal hernia
- testicular malignancy
TREATMENT:
- orchioplexy
46
93. Inflammatory lesions of testis and epididymis, cryptorchidism, infertility:
INFERTILITY pre-testicular causes
Conditions that impede adequate support of testes
- hypogonadism
- drugs, alcohol, smoking
- strenuous riding
- medications
- failure of pituitary to produce gonadotropins
47
93. Inflammatory lesions of testis and epididymis, cryptorchidism, infertility:
INFERTILITY testicular causes
Conditions where testes produce semen of low quantity and/or poor quality despite adequate hormonal support
- age
- genetic defect in Y chromosome
- cryptorchidism
- trauma
- hydrocele
- mumps
- testicular cancer
- idiopathic oligospermia
48
93. Inflammatory lesions of testis and epididymis, cryptorchidism, infertility:
INFERTILITY post-testicular causes
Conditions that affect male genital system after sperm production, include defects in genital tract and problems in ejaculation
- vas deferens obstruction
- lack of vas deference
- infection
- retrograde ejaculation
- ejaculatory duct obstruction
- hypospadias
- impotence
49
93. Inflammatory lesions of testis and epididymis, cryptorchidism, infertility:
INFERTILITY treatment
- pre-testicular: medical means and interventions
- testicular: sperm for intrauterine insemination, IVF
- post-testicular: surgery
- medication
50
94. Tumors of testis and epididymis:
| ETIOLOGY
- 6/100 000
- incidence: 15-34 years
- Types: germ cell tumors, stromal tumors
- arise in situ
- intersex syndromes
- wide range of abnormalities⇒ most common isochomosome of short arm of chromosome 12
51
94. Tumors of testis and epididymis:
| SEMINOMA
```
- 40-50 years old
MORPHOLOGY:
- soft, grey-white/yellow, well-circumscribed
- bulges from surface of testis
- no capsule
- Histo: cluster of uniform polygonal cells with clear cytoplasm, lymphocytes in stroma
- tumor marker: hCG
- radiosensitive ⇒ curable
```
52
94. Tumors of testis and epididymis:
| EMBRYONAL CARCINOMA
```
- 20-30 years old
HISTO:
- poorly differentiated, pleiomorphic cells in cords, tubular formation
- contain yolk sac + choriocarcinoma cells
MORPHOLOGY:
- foci of hemorrhage and necrosis
- radioresistant
- tumor markers: hCG, AFP
```
53
94. Tumors of testis and epididymis:
| YOLK SAC TUMOR
```
- 3 years old
HISTOLOGY:
- poorly differentiated endothelium-like, cuboidal or columnar cells
- large, well-demarcated
- Schiller-Duval bodies
- tumor markers: AFP
```
54
94. Tumors of testis and epididymis:
| CHORIOCARCINOMA
- 20-30 years old
- very malignant
HISTOLOGY:
- atypical cytotrophoblast, syncytiotrophoblast cells
MORPHOLOGY:
- cystic hemorrhagic central parts, surrounded by solid parts
TUMOR MARKER: hCG
55
94. Tumors of testis and epididymis:
| TERATOMA
- all ages
HISTOLOGY:
- tissue from all 3 germ layers
- malignant in adult ages
56
94. Tumors of testis and epididymis:
| MIXED GERM CELL TUMOR
- 15-30 years old
MORPHOLOGY:
- teratoma + embryonal carcinoma
TUMOR MARKER: hCG, AFP
57
94. Tumors of testis and epididymis:
| CLINICAL FEATURES
- painless enlargement of testis
METASTASIS:
⇒ iliac and para-aortic LN
⇒ hematogenous to liver and lungs, brain, bones
58
94. Tumors of testis and epididymis:
| TUMOR MARKERS
1. hCG ⇒ produced by neoplastic syncythiotrophoblastic cells
* choriocarcinoma
* seminoma
2. AFP ⇒ produced by yolk sac
3. LDH ⇒ assess tumor burden
59
94. Tumors of testis and epididymis:
| TREATMENT
chemotherapy
60
94. Tumors of testis and epididymis:
| ADENOMATOID TUMOR
- tumor of epididymis
- age: 20-40 years
- painful
- benign
MORPHOLOGY:
- circumscribed, firm, white-grey, cystic
HISTOLOGY:
- mesothelial origin
- uncapsulated, cubital-flat cells form cords, cytoplasmic vacuoles
61
94. Tumors of testis and epididymis:
| ADENOMATOID TUMOR
- tumor of epididymis
- age: 20-40 years
- painful
- benign
MORPHOLOGY:
- circumscribed, firm, white-grey, cystic
HISTOLOGY:
- mesothelial origin
- uncapsulated, cubital-flat cells form cords, cytoplasmic vacuoles
TREATMENT: resection
