Male genital tract Flashcards
What is erythroplasia of Queyrat? How would you describe this histologically?
Squamous cell carcinoma in situ (bowen’s) of the glans of the penis
Full thickness dysplasia of epidermis
Is invasive malignancy of the penis common?
No
Where is incidence of squamous cell carcinoma of the penis high?
South America
Africa
East Asia
How circumcised or uncircumcised men get squamous cell carcinoma of the penis?
Uncircumcised
Name two associations of squamous cell carcinoma of the penis
Poor hygiene
HPV infection
Which sites on the penis are most commonly affected by squamous cell carcinoma?
Glans
Prepuce (foreskin)
What are the two different morphologies of squamous cell carcinoma of the penis
Indurated erythematous plaque
Exophytic mass
Is squamous cell carcinoma of the scrotum associated with carcinogen exposure?
Yes (chimney sweeps)
Is benign prostatic hyperplasia common? Are symptoms common?
Yes, most men over 70 affected
No
What is benign prostatic hyperplasia?
Irregular proliferation of stromal and glandular prostate tissue
What causes benign prostatic hyperplasia?
Androgen/oestrogen ratio imbalance causing proliferation of central prostate
What problems can benign prostatic hyperplasia cause?
Physical obstruction of urethra
Physiological interference with peri-urethral glands
What is prostatism?
Hesitancy
Overflow incontinence
Slow stream
What type of retention can benign prostatic hyperplasia cause?
Acute
Chronic
Benign prostatic hyperplasia is occasionally pre malignant. T/F
False - not pre malignant ever
What complications can arise from benign prostatic hyperplasia?
Hydroureter
Hydronephrosis
Infection
Bladder hypertrophy –> diverticulum
How is benign prostatic hyperplasia treated?
Surgery (transurethral resection)
Pharmacological (alpha blockers, 5 alpha reductase inhibitors)
How common is prostatic cancer?
Common (second leading cause of cancer deaths in males)
Which age group is affected by prostatic cancer?
> 50 (60-80)
There is decreased risk of prostatic cancer but increased risk of benign prostatic hyperplasia if a 1st degree relative is affected with prostatic cancer at a young age. T/F
False - inc risk of cancer and no correlation to BPH
Where in the prostate does prostatic cancer most commonly present?
Peripheral (particularly posterior lobe)
Nb - central gland only affected in late stage cancer
What is latent prostate cancer?
Cancer found incidentally which has not began to cause clinical problems
How does prostate cancer spread?
Local - seminal vesicles, bladder, rectum, capsular penetration & urethral obstruction
Lymph - sacral, iliac, para-aortic nodes
Blood - bone (osteosclerotic) in lumbosacral region, lungs, liver
How common is metastatic spread/locally advanced prostatic disease at presentation?
Very common
How is carcinoma of the prostate diagnosed?
Rectal exam
USS, skeletal x-ray, bone scan
Prostate specific antigen (not always present)
TUR (transurethral resection)
Multiple, needle core biopsies guided by ultrasound
How is carcinoma of the prostate managed?
Hormone therapy (anti-androgen, oestrogen, cyproterone)
Radiotherapy for bone mets
Surgery (radical protatectomy)
How common are testicular tumours?
Uncommon (commonest solid organ malignancy in young males)
What is a huge risk factor for testicular tumours?
Testicular maldescent
How do testicular tumours present?
Painless testicular enlargement +/-
- hydrocele
- gynecomastia
- systemic symptoms
List the different types of testicular tumours
Germ cell (seminoma, teratoma)
Lymphoma
Stromal tumour
Metastases
List the different types of paratesticular tumours
adenomatoid
sarcoma
What is the commonest type of testicular tumour?
Seminoma “potato tumour”
Who gets seminomas?
30-50 y/o (rare before puberty)
What are the two types of seminoma?
Spermatocytic
Anaplastic
How does seminoma spread?
Lymph - para-aortic
Blood - liver & lungs
How is seminoma treated? What are the cure rates?
Radiotherapy.
High
Who gets teratoma?
20-30 y/o (can occur in childhood)
List the different types of teratoma
Differentiated
Malignant intermediate
Malignant undifferentiated
Malignant trophoblastic
What is a mixed serinoma/teratoma?
Exactly what it sounds like
What tumour markers can be used for testicular tumours?
bHCG - trophoblastic
AFP - yolk sac
PLAP - seminoma
