Male Genital System- PENIS CONGENITAL ANOMaLIES/ Inflammation/ TUmors

Question 1

Penis
The penis can be affected by congenital anomalies, inflammations, and tumors, ______________ being the most important. The venereal infections (e.g., syphilis and gonorrhea)
usually begin with penile lesions. Carcinoma of the penis is an uncommon neoplasm in North America

Answer 1

inflammations
and tumors

Question 2

CONGENITAL ANOMALIES

The penis is the site of many forms of congenital anomalies, only some of which have clinical
significance.

Answer 2

1. Hypospadias and Epispadias
2. Phimosis

Question 3

Malformation of the urethral groove and urethral canal may create abnormal openings either on
the ______________ or on the __________[58]

Answer 3

• ventral surface of the penis (hypospadias)
• dorsal surface (epispadias).

Question 4

Though more frequent with epispadias, either of these two anomalies may be associated with
__________________________

Answer 4

failure of normal descent of the testes and with malformations of the urinary tract

Question 5

___________________
the more common of the two, occurs in approximately 1 in 300 live male births. [59]

Even when
isolated, these urethral defects may have clinical significance, because the abnormal opening is
often constricted, resulting inurinary tract obstructionand anincreased risk of ascending
urinary tract infections. \

When the orifices are situated near the base of the penis, normal
ejaculation and insemination are hampered or totally blocked. These lesions therefore are
possible causes of sterility in men.

Answer 5

. Hypospadias,

Question 6

When the orifice of the prepuce is too small to permit its normal retraction, the condition is
designated ____________

Answer 6

phimosis.

Question 7

Phimosis Such an abnormally small orifice may result from ________________

Answer 7

anomalous development
but is more frequently the result of repeated attacks of infection that cause scarring of the
preputial ring.

Question 8

Phimosis is important because _________________

Answer 8

• it interferes with cleanliness
• and permits the accumulation of secretions and detritus under the prepuce, favoring the development of secondary infections and possibly carcinoma.

Question 9

Inflammations of the penis almost invariably involve the _________________ and include a wide
variety of specific and nonspecific infections.

Answer 9

glans and prepuce

Question 10

Inflammation of the penis

The specific infections—_______________________

—are sexually
transmitted and are discussed in Chapter 8 .

Answer 10

• syphilis,
• gonorrhea,
• chancroid,
• granuloma inguinale,
• lymphopathia venerea,
• genital herpes

Question 11

_______________refers to infection of the glans and prepuce caused by a wide variety of
organisms

Answer 11

Balanoposthitis

Question 12

What are the most common agents in Balanoposthitis?

Answer 12

. Among the more common agents are :

1. Candida albicans,
2. anaerobic bacteria,
3. Gardnerella,
4. and pyogenic bacteria. [61]

Question 13

Most cases of Balanoposthitis occur as a consequence________________, with accumulation of desquamated epithelial cells, sweat, and
debris, termed smegma, acting as local irritant. Persistence of such infections leads to inflammatory scarring and, as mentioned earlier, is a common cause of phimosis.

Answer 13

of poor local hygiene in uncircumcised males

Question 14

Tumors of the penis are, on the whole, uncommon.

The most frequent neoplasms are
________________ and __________.

Answer 14

• carcinomas
• and a benign epithelial tumor,
• condyloma acuminatum.

Question 15

Condyloma acuminatum is a benign sexually transmitted tumor caused by _______________________

It is related to the common wart and may occur on any moist mucocutaneous surface of
the external genitals in either sex.

Answer 15

human papillomavirus
(HPV).

Question 16

HPV____________, and less frequently type 11, are the most
frequent agents that cause condylomata acuminata.

Answer 16

** type 6**

Question 17

Condylomata acuminata may occur on the____________ and ___________

Answer 17

external genitalia or perineal areas.

Question 18

In the Condyloma acuminatum on the penis these lesions occur most often about the_________________

.

Answer 18

coronal sulcus and inner surface of
the prepuce

Question 19

In condyloma acuminatum located in the coronal sulcus and inner surface of the prepuce they consist of_________________ ( Fig. 21-15 ).

Answer 19

single or multiple sessile or pedunculated, red papillary
excrescences that vary from 1 mm to several millimeters in diameter

Question 20

WHat is the histological appearance of Condylomata acuminatum?

Answer 20

Histologically a branching, villous, papillary connective tissue stroma is covered by epithelium
that may have considerable superficial hyperkeratosis and thickening of the underlying
epidermis (acanthosis) ( Fig. 21-16 ).

The normal orderly maturation of the epithelial cells is
preserved.

Question 21

______________________characteristic of
HPV infection, is noted in these lesions ( Fig. 21-17 )

. Cells may have degenerative (viral)
atypia but true dysplasia is rare.

Condylomata acuminata tend to recur but only rarely
progress into in situ or invasive cancers.

Answer 21

Cytoplasmic vacuolization of the squamous cells (koilocytosis),

Question 22

Carcinoma in Situ (CIS)
In the external male genitalia, two distinct lesions display histologic features of CIS: _____________ and __________

Answer 22

1. Bowen
   disease
2. and bowenoid papulosis.

Question 23

CIS lesions have a strong association with infection by
_____________________

Answer 23

HPV, most commonly type 16.

Question 24

_______________ occurs in the genital region of both men and women, usually in those over the
age of 35 years.

In men it tends to involve the skin of the shaft of the penis and the scrotum.

Answer 24

Bowen disease

Question 25

What is the appearance of Bowen disease grossly?

Answer 25

Grossly it appears as a:

• solitary,
• thickened,
• gray-white,
• opaque plaque.

It can also manifest on the glans and prepuce:

• as single or multiple shiny red,
• sometimes velvety plaques.

Question 26

What is the appearance of Bowens disease histologically?

Answer 26

• the epidermis shows proliferation with **numerous mitoses, some atypical. **
• The cells are** markedly dysplastic with large hyperchromatic nuclei**
• and lack of orderly maturation ( Fig. 21-18 ).
• Nevertheless, the** dermal-epidermal border is sharply delineated by an intact basement membrane. **

Question 27

_______________ occurs in sexually active adults.

Answer 27

Bowenoid papulosis

Question 28

What is the clinically difference of Bowenoid papuloisis from Bowens disease?

Answer 28

it differs from Bowen disease by
the younger age of patients and the presence of multiple (rather than solitary) reddish brown
papular lesions.

” MAS MADAMI AT MAS BATA”

Question 29

Histologically, bowenoid papulosis is indistinguishable from Bowen disease and
is also related to HPV type 16.

However, in contrast to Bowen disease, bowenoid papulosis
virtually never develops into an_________________

Answer 29

• • invasive carcinoma and in many cases spontaneously
    regresses. **

**” **So tandaan.. Bowenoid papulosis doesnt result to invasive CA and usually it REGRESS!”

Question 30

_____________of the penis is an uncommon malignancy in the United States,
accounting for fewer than 1% of cancers in males

. By contrast, in some parts of Asia, Africa,
and South America the incidence of squamous cell carcinoma of the penis ranges from 10% to
20% of male malignancies.

Answer 30

Squamous cell carcinoma

Question 31

What is the explanation why SCCA in penis ranges from 10 to 20 percent in other parts of the world like in Asia and Africa in contrast to the USA.

Answer 31

Circumcision confers protection, and hence this cancer is extremely
rare among Jews and Moslemsand is correspondinglymore common in populations in which
circumcision is not routinely practiced.

It is postulated that circumcision is associated with better
genital hygiene,which, in turn,reduces exposure to carcinogensthatmay be concentrated in
smegmaanddecreases the likelihood of infection with potentially oncogenic types of HPV.

HPV DNA can be detected in **penile squamous cancer in approximately 50% of patients. [62] HPV
type 16is themost frequent culprit**, but HPV 18 is also implicated.

Cigarette smoking elevates
the risk of developing cancer of the penis. [63] Carcinomas are usually found in patients
between the ages of 40 and 70.

Question 32

What are the Clinical Features of SCCA in Penis?

Answer 32

Invasive squamous cell carcinoma of the penis is a:

• slowly growing, locally invasive lesion that
• often has been present for a year or more before it is brought to medical attention. [66]

The lesions are nonpainful until they undergo secondary ulceration and infection.

Question 33

Metastases to inguinal lymph nodes characterize the early stage, but widespread dissemination is extremely
uncommon until the lesion is far advanced.

Clinical assessment of regional lymph node
involvement is notoriously inaccurate; **50% of men with penile squamous cell carcinoma and
clinically enlarged inguinal nodes have only reactive lymphoid **hyperplasia when examined
histologically.

The prognosis is related to the stage of the tumor.

In persons with limited lesions
without invasion of the inguinal lymph nodes, there is a 66% 5-year survival rate, whereas
metastasis to the lymph nodes carries a grim 27% 5-year survival.