Male Genital Tract Flashcards by Sasha Murdoch

What is the most common type of penis cancer

Squamous carcinoma in situ

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What is the appearance of Bowen’s disease of the penis

Dry and crusty

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Where does Erythroplasia of Queyrat of the penis arise

Normally the glans

It has a raised, red, velvety feature

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Describe the histological appearance of both Bowen’s disease and Erythroplasia of Queyrat

Both full thickness dysplasia of the epidermis

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What is the advantage of circumcision with regards to squamous carcinoma of the penis

It protects you

The younger the age of circumcision, the better the degree of protection

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What is the aetiology of squamous carcinoma of the penis

Poor hygiene and HPV infection

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Describe the appearance of squamous carcinoma of the penis

Ulcerating, indurated tumour or exophytic mass of the glans/ prepuce

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What occupation has an increased risk of SCC of the scrotum and why

Chimney sweeps - they have an occupational exposure to suit (carcinogen)

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How common is benign nodular hyperplasia of the prostate (BNH)

Common - at least 75% of men over 70 are affected but only about 5% have significant symptoms

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What tissues result in BNH

irregular proliferation of both glandular and stream prostatic tissue

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What is the aetiology of BNH

hormonal imbalance

Alteration of androgen/ oestrogen ratio

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What problems can BNH cause

Disturbance of the bladder sphincter mechanism by
1. physical obstruction
2. physiological interference - peri-urethral glands at internal urethral meatus
Acute and chronic urinary retention
Prostatism

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What is prostatism

Difficulty in starting micturition, poor stream, overflow incontinence

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When is urinary retention a urological emergency

When it is acute

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What are some of the complications of BNH

Bladder hypertrophy

diverticulum formation

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What happens if BNH is left untreated

Hydroureter
hydronephrosis
subsequent infection

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What is the management for BNH

Surgery (transurethral resection)

Drugs (a-blockers, 5 alpha reductase inhibitors)

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What are the chances of BNH becoming malignant

None - it does not increase the risk of developing carcinoma of the prostate. Both are common and so both can occur together

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How common is carcinoma of the prostate

Pretty common- 11% of cancer deaths in males- second leading cause (lung is 1st)

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When is the peak incidence of carcinoma of the prostate

60-80 years

What are some risk factors for carcinoma of the prostate

1st degree relative especially at a young age

Where in the prostate does carcinoma typically arise

Mainly in the peripheral ducts and glands, particularly the posterior lobe

What is meant by latent carcinom

Microscopic cancer foci found incidentally in surgical specimens or at autopsy. Some may progress to clinically significant disease

How can carcinoma of the prostate spread

Local - urethral obstruction, capsular penetration, seminal vesicles, bladder and scrotum
Lymphatic - sacral, iliac, para-aortic nodes
Blood - bone (lumbosacral area) - osteosclerotic metastases, lungs, and liver are common

What is unusual about the destruction of prostate cancer

It is osteosclerotic and causes bones to be denser than normal Most cancers cause bony destruction (lytic)

How is a diagnosis of carcinoma of the prostate made

Rectal examination Imaging - US skeletal XRay, bone scans Biochemistry - Prostate Specific Antigen (PSA) - increased levels in most but not all Biopsy is definitive, multiple needle core biopsies under ultrasound control

What are the 3 management options for prostate cancer

Hormonal therapy - anti-androgen treatment. Oestrogen and cyproterone Radiotherapy - bone metastases or pain associated Surgery - Radical prostatectomy - usually for organ confined disease

What is a major risk factor for a testicular tumour

Maldescended or undescended testicle

What is the most common presentation of testicular tumour

Painless, testicular enlargement

What is a symptoms for an infective process of the testicles

Pain or tenderness

What do testicular tumours secrete and what does this result in

Hormones | Gynaecomastia

What is the commonest type of testicular tumour

Germ cell - seminoma, teratoma or mixed

What are some other types of testicular tumours

Lymphoma leukaemia stromal tumour

Where do adenomatoid arise from

The mesothelial lining of the tunica-vaginalis

What is the peak age at which a summon arises

30-50 years | Very rare before puberty

Describe the appearance of a seminoma

Solid homogenous pale macroscopic appearance Potato tumour

Describe the prognosis of a seminoma with a large amount of lymphocytic infiltrate

The greater the lymphocytic infiltrate, the better the prognosis

Why does lymph from the testes drain to the periaortic area and not the groin

Lymph copies the arterial supply. The testes are supplied by the gonadal arteries which are branches of the abdominal aorta

What is the treatment and prognosis for summons

Radiotherapy or chemotherapy - most are cured as the tumour is so sensitive to these treatments even if there is metastatic spread

What age is the peak incidence of a teratoma

20-30 years although it can occur in childhood

Where does a teratoma arise from

all 3 cell lines - endoderm, mesoderm and ectoderm

What are the teratoma classification types

Differentiated Teratoma (TD) - benign or organoid differentiation of a variety of different tumour types Malignant Teratoma Undifferentiated (MTU) - undifferentiated, malignant tissue of teratoma, also referred to as embryonal carcinoma Malignant Teratoma Trophoblastic (MTT) - resembles human placenta - irrespective of other tissue types you have - most malignant Malignant teratoma intermediate (MTI) - mixture of differentiated and undifferentiated

On autopsy, what features suggest the presence of malignancy in a tumour

Necrosis and haemorrhage

What type of tissues can be found in a teratoma

Virtually anything | respiratory, pancreatic, cartilage, muscle

Describe the prognosis of a mixed seminoma/ Teratoma

Depends on most malignant tissue present

What tumours secrete bHCG

Trophoblastic tumours

AFP is secreted by what

Yolk sac tumours

A seminoma secretes what tumour marker

PLAP (Placental alkaline phosphatase)

Why do we measure the tumour markers

Levels of the markers are used to diagnose a tumour | Monitor response to therapy and detect early recurrence