Male Genital Tract Flashcards
What is the most common type of penis cancer
Squamous carcinoma in situ
What is the appearance of Bowen’s disease of the penis
Dry and crusty
Where does Erythroplasia of Queyrat of the penis arise
Normally the glans
It has a raised, red, velvety feature
Describe the histological appearance of both Bowen’s disease and Erythroplasia of Queyrat
Both full thickness dysplasia of the epidermis
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
What is the aetiology of squamous carcinoma of the penis
Poor hygiene and HPV infection
Describe the appearance of squamous carcinoma of the penis
Ulcerating, indurated tumour or exophytic mass of the glans/ prepuce
What occupation has an increased risk of SCC of the scrotum and why
Chimney sweeps - they have an occupational exposure to suit (carcinogen)
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
What tissues result in BNH
irregular proliferation of both glandular and stream prostatic tissue
What is the aetiology of BNH
hormonal imbalance
Alteration of androgen/ oestrogen ratio
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
What is prostatism
Difficulty in starting micturition, poor stream, overflow incontinence
When is urinary retention a urological emergency
When it is acute
What are some of the complications of BNH
Bladder hypertrophy
diverticulum formation
What happens if BNH is left untreated
Hydroureter
hydronephrosis
subsequent infection
What is the management for BNH
Surgery (transurethral resection)
Drugs (a-blockers, 5 alpha reductase inhibitors)
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
How common is carcinoma of the prostate
Pretty common- 11% of cancer deaths in males- second leading cause (lung is 1st)
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
