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Male Genitalia Flashcards

1
Q

What are the 3 kinds of penile pathology?

A

Congenital disorders
Inflammatory lesions
Penile tumors

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2
Q

What are the 2 types of congenital disorders of the penis?

A

Hypospasias and Epispadias

Phimoses & Paraphimosis

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3
Q

What congenital disorder of the penis has a malformation of the urethral groove & urethral canal that results in an abnormal urethral opening anywhere along the shaft of the penis?

A

Hypospadias & Epispadias

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4
Q

What is the difference between Hypospadias & Epispadias?

A

Hypoaspadias - opening is found in the ventral surface of the penis ; more comomon

Epispadias - opening is found in the dorsal surface of the penis

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5
Q

What congenital disorder of the penis that has abnormal small opening of prepuce (foreskin) which prevents its normal refraction?

A

Phimosis

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6
Q

What is the appearance of severe phimosis?

A

causes pain during urination, urinary retention, UTI

foreskin is too tight or narrow, unable to be pulled back to expose the head of the penis

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7
Q

What congenital disorder of the penis is a condition wherein the phimotic prepuce is forcible retracted over the glans penis but cannot be rolled back?

A

Paraphimosis

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8
Q

What is the usual site of inflammatory lesion in the penis?

A

Glans penis & Prepuce

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9
Q

What are non-specific inflammatory lesions based on their anatomic location?

A

Balanitis - glans penis
Posthitis - prepuce
Balanoposthitis - both prepuce and glans

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10
Q

What is the cause of non-infectious inflammation of the penis? What is the clin manifestation of this?

A

Poor hygiene

Red, swollen and tender distal penis

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11
Q

What is a complication of non-infectious inflammation of the penis?

A

Inflammatory scarring and narrowing of preputial opening (phimosis)

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12
Q

What part of the penis are affected in infectious inflammation of the penis?

A

Glans & prepuce

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13
Q

What are the diff benign, premalignant, malignant penile tumors?

A

Benign - Condyloma cuminata
Premalignant - Premalignant penile intraepithlial neoplasia, Bowen’s disease, Bowenoid Papulosis

Malignant - squamous cell carcinoma

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14
Q

What is the causative agent of Condyloma Acuminatum?

A

HPV strains ^&11

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15
Q

What is a significant gross and histologic feature of Condyloma Acuminatum?

A

Gross: cauliflower appearance
Histo: Superficial keratosis, Koilocytes

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16
Q

What is the causative agent of Penile Intraepithelial neoplasia?

A

HPV 16 & 18

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17
Q

What condition has an ulcerated infiltrative lesion in the shaft of the penis at the distal area?

A

Penile Squamous Cell Carcinoma (Malignant)

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18
Q

What are the 2 macroscopic lesions seen in Penile SCC?

A

Papillary lesion - simulates condylomata acuminata and may produce a CAULIFLOWER-like appearance

Flat lesion - epithelial thickening accompanied by graying and fissuring of the mucosal surface

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19
Q

What are predisposing factors of Penile SCC?

A

poor genital hygiene and lack of circumcision
HPV 16&18
Smoking
Chronic inflammatory conditions
INC sexual partners

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20
Q

what are the 4 categories of lesions of the testes

A

COngeniital (Cryptorchidism)
Regressive changes

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21
Q

what are the 4 categories of lesions of the testes

A

Congenital (Cryptorchidism)
Regressive changes (Atrophy)
Inflammatory (Mumps, Gonococcal, Chlamydial, E. coli, Pseudomonas, and Tuberculosis)
Tumors (Benign or Malignant)

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22
Q

What is the most common congenital anomaly of the male genital tract that has a complete or partial failure of the intra-abdominal testes to descend into the scrtoal sac?

A

Cryptorchidism

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23
Q

What is the complication of Cryptorchidism that develops if a child under 2 y/o does not correct this?

A

Testicular atrophy

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24
Q

what are the diff causes of testicular atrophy?

A

cryptorchidism
atherosclerotic narrowing of the blood supply in old age
end stage of an inflammatory orchitis
generalized malnutrition or cachexia
irradiation
hypopituitarism
prolonged tx with female sex hormones

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25
Q

What is the histologic feature of testicular atrophy?

A

focal atrophy of tubules with a patchy pattern

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26
Q

what are the sources of infections that develop into inflammaotry lesions?

A

ascending route from urethra & ductus deferens
Hematogenous spread from a distant source

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27
Q

what are the 4 inflammatory lesions of the testes?

A

epididymitis
mumps orchitis
tuberculous orchitis
autoimmune granulomatous orchitis

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28
Q

what condition has an inflammation in the testicle which involves the epididymis and related to mumps, TB, chlamydia and torsion?

A

Epididymis

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29
Q

what is the histologic feature of epididiymis?

A

predominance of neutrophils, congestion, edema, mixed inflammatory infiltrates

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30
Q

what is the histologic feature of mumps orchitis?

A

chronic inflammatory infiltrate may cause focal atrophy

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31
Q

what is the histologic feature of tuberculous orchitis?

A

Granulomatous inflammation and caseous necrosis

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32
Q

what cells are found in tuberculous orchitis?

A

Langhans GIant cells

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33
Q

What is an idiopathic granulomatous orchitiis that presents in middle age as moderate tender testicular mass of sudden onset?

A

Autoimmune granulomatous orchitis

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34
Q

What is the histologic feature of autoimmune granulomatous orchitis?

A

Non-caseating granulomatous inflammation

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35
Q

what is the most common testicular neoplasm in men >50yo that is a diffuse large cell lymphoma?

A

testicular tumors

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36
Q

What is a premalignant lesion of testicular tumors?

A

Intratubular germ cell neoplasia

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37
Q

what type of testicular tumor is malignant, painless enlargement of testes?

A

testicular germ cell tumor

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38
Q

What are the 2 major histological types of testicular germ cell tumor?

A

Seminomas - better prognosis
Non-seminomas - embryonal carcinoma, teratoma, yolk sac tumor, choriocarcinoma

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39
Q

What are the 2 kinds of differentiation germ cell tumors go through?

A

Gonadal differentiation - give rise to seminoma
Totipotential (non-seminoma) differentiation

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40
Q

What kinds of differentiation does Totipotential differentiation go through?

A

Trophoblastic differentiation –> choriocarcinomas
Yolk sac differentiation –> yolk sac tumors
Somatic differentiation –> teratomas

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41
Q

What are serum tumor markers of testicular cancer?

A

HcG, AFP (alpha-fetoprotein)

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42
Q

what are the 7 different testicular germ cell tumors?

A

Intratubular germ cell neoplasia
Seminoma
Embryonal carcinoma
Choriocarcinoma
Yolk Sac tumor
Teratoma
Mixed germ cell tumor

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43
Q

What is a precursor lesion of testicular germ cell tumor that is equivalent of carcinoma in situ in epithelial malignancies

A

intratubular germ cell neoplasia

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44
Q

Where is the alteration of intratubular germ cell neoplasia?

A

short arm of chromosome 12 in the form of isochorome i (12p)

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45
Q

What is the histologic feature of intratubular germ cell neoplasia?

A

Atypical primordial germ cells with large nuclei and clear cytoplasm that is 2x the normal size

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46
Q

What is the most common type of germ cell tumor that peaks incidence at the 4th decade of life?

A

Seminoma - excellen prognosis

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47
Q

What is the gross feature of seminoma?

A

bulky, well-circumscribed, pale, fleshy, homogenous, gray white lobulated mass without hemorrhage or necrosis

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48
Q

What is the histological feature of seminoma?

A

nests, solid sheets of uniform cells divided into poorly demarcated lobules by delicate fibrous septa containing a lymphocytic infilrtate

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49
Q

what is the 2nd most common germ cell tumor that presents with testicular mass accopanied by gynecomastia?

A

Embryonal carcinoma - poor prognosis

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50
Q

What is the gross morphology of embryonal carcinoma?

A

Variegated and with necrosis and hemorrhage

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51
Q

what is the histologic morphology of embryonal carcinoma?

A

highly pleomorphic tumor cells
Alveolar or tubular pattern

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52
Q

what kind of tumor germ cell tumor has synctiotrophoblast & cytotrophoblast and is the most aggressive of all GCT?

A

Choriocarcinoma

53
Q

What is the gross morphology of Choriocarcinoma?

A

Hemorrhages and necrosis, no testicular enlargement, tumors are rarely >5cm

54
Q

what is the histologic morphology of Choriocarcinoma?

A

Synctiotrophoblasts - abundant eosinophilic vacuolted cytoplasm containing hCG

Cytotrophoblasts - regular and tend to be polyglonal, cords or sheets, single, fairly uniform nucleus

55
Q

What testicular germ cell tumor is aka Endodermal sinus tumor and is the most common testicular tumor in iNFANTS & YOUNG children?

A

Yolk sac tumor

56
Q

what are the 2 age peaks of yolk sac tumor?

A

16-18 mons = pure YST –> good prognosis
25-35 yrs old = YST in mixed germ cell tumor

57
Q

What is the marker for yolk sac tumor?

A

INC serum AFP

58
Q

What is the gross appearance of yolk sac tumor?

A

Gray-white tumors w/ myxoid or gelatinous cut surface

Nonencapsulated with a homogenous yellow-white appearance

59
Q

What is the histologic feature of yolk sac tumor?

A

Lacelike (reticular) network of medium-sized cuboidal or flattened cells

Schiller-Duval bodies (Glomeruloid bodies)

Eosinophilic, hyaline-like globules containing AFP & Alpha 1-antitrypsin

60
Q

What is the 2nd most common tumor in pediatric patients occurring in a pure form?

61
Q

What are the 2 age peaks of Teratoma occurence?

A

<4 yo = benign case
20-40yo = Post-pubertal, malignant case

62
Q

What is the gross appearance of Teratoma?

A

Well-circumscribed, heterogenous, with solid & cystic features reflecting presence of multiple tissue types

63
Q

What is the histologic appearance of Teratoma?

A

1 mature or immature somatic tissue derived from different germinal layers

64
Q

What is a mature teratoma?

A

Ectoderm: Epidermis, Neuronal tissue
Endderm: GI/Respiratory mucosa & glands
Mesoderm: Cartilage, bone or msucles

65
Q

What is an immature teratoma?

A

Undifferentiated spindle cells, primitive neuroectodermal tissue or blasternal tissue

66
Q

what type of teratoma is chemoresistant to therapy?

A

Teratoma with somatic type malignancy

67
Q

What is the second most comon germ cell tumor after seminoma?

A

Mixed germ cell tumor

68
Q

Is the prognosis better if mixed germ cell tumor has predominant mature teratoma?

69
Q

What is the gross appearance of mixed germ cell tumor?

A

Heterogenous or variegated tumor
Necrosis & Hemorrhage

70
Q

What are the 2 non-germ cell tumors?

A

Leydig cell tumor
Testicular lymphoma

71
Q

What is the common clin presentation of non-germ cell tumors?

A

painless mass or hormone-related symptoms
metastasis - only reliable criterion for malignancy

72
Q

What is the most common type of SCST and most of it is benign?

A

Leydig cell tumor

73
Q

What are the 2 age peaks of Leydig cell tumor and what distinct features does it present?

A

5-10 y/o -> Precocious puberty (INC androgen)
30-35 yo -> Gynecomastia (INC estrogen)

74
Q

What is the gross appearance of Leydig cell tumor?

A

Circumscribed golden brown nodules, usually <5cm in diameter

75
Q

What is the histologic appearance of Leydig cell tumor?

A

Resembles normal Leydig cells
Crystalloids of Reinke (pathognomonic)

76
Q

What is the most common non-germ cell tumor in men >60yo?

A

Testicular lymphoma

77
Q

What is the clin presentation of testicular lymphoma?

A

Bilateral & involves the spermatic cord

78
Q

what is the histologic appearance of testicular lymphoma?

A

Diffuse large B cell lymphoma

79
Q

where do testicular tumors metastasize?

A

Peraortic nodes

80
Q

What are the 3 stages of testicular tumors & its location?

A

Stage I - confined to testis, epididymis or spermatic cord
Stage II - Distant spread to retroperitoneal nodes below the diaphragm
Stage III - Metastases outside the retroperitoneal nodes or above the diaphragm

81
Q

What are the roles of tumor markers?

A

Aid in initial screening and diagnosis
Assessing response tx
Monitoring recurrence or metastatic spread
Assess tumor burden
In staging of tumors

82
Q

What are the serum biomarkers in germ cell tumor?

A

LDH
serum AFP or hCG levels

83
Q

What serum biomarkers are positive for Seminoma, YST, Choriocarcinoma, Embryonal Carcinoma, & Teratoma?

A

Seminoma = (+) B-hCG; (++) LDH
YST = (+++) AFP; (+) B-hCG; (+) LDH
Choriocarcinoma = (+++) B-hCG; (+) LDH
Teratoma = none positive

84
Q

What are the 3 prostate gland diseases?

A

Prostatitis
Benign Prostatic Hyperplasia
Prostatic Carcinoma

85
Q

What is the inflammation of the prostate and 3rd most common urinary tract disease in men?

A

Prostatitis

86
Q

What are the different conditions of Prostatitis?

A

Acute Bacterial Prostatitis
Chronic bacterial prostatitis
Chronic Abacterial prostatitis/Chronic pelvic pain syndrome
Granulomatous prostatitis

87
Q

What is the histologic appearance of acute bacterial prostatitis?

A

Neutrophilic infiltration and some glands are destroyed
Purulent exudates in the lumen

88
Q

What is the clin manifestation of chronic bacterial prostatitis?

A

Low back pain, dysuria, and perineal and suprapubic discomfort

89
Q

What is the histologic appearance of chronic bacterial prostatitis?

A

predominance of lymphocytes in the stroma

demonsratation of leykocytosis

90
Q

what is the most common form of Prostatitis and is inditinguishable from chronic bacterial prostatitis & is non-responsive to antibiotics?

A

chronic abacterial prostatitis/chronic pelvic pain syndrome

91
Q

What is the cause of Granulomatous prostatitis?

A

Specific infectious agent of TB where there is a reflux of contaminated urine

spreads to the lymph and blood

92
Q

What is the histological apperance of granulomatous prostatitis?

A

Aggregates of histiocytes

93
Q

What is the clin presentation of Granulomatous prostatitis?

A

TB symptoms; seen in immunocompromised hosts

94
Q

What condition of the prostate has non-neoplastic enlargement of the prostate & peri-urethral regions that are common in men >50 yo?

A

Benign prostatic hyperplasia

95
Q

What is the gross appearance of Benign Prostatic Hyperplasia?

A

Normal prostate gland is about 3-4cm in diameter, smooth, no nodules, not enlarged

96
Q

Where is the location of benign prostatic hyperplasia? WHat does it feel like during DRE?

A

Transition zone

Rubbery to firm prostate upon palpation

97
Q

What are active androgen metabolites derived from testosterone that are major stimulus for proliferation?

A

5-a-dihydrotestosterone or dihydroxy-testosterone

98
Q

What is the gross morphology of Benign Prostatic Hyperplasia?

A

Nodules vary in size, color, and consistency
Soft, yellow-pink to firm grey-white

99
Q

What is an eosiphilic secretion secreted in both glands and stroma of Benign Prostatic hyperplasia?

A

Corpora Amylacea

100
Q

What are the signs&symtoms of benign prostatic hyeprplasia?

A

INC resistance to urinary outflow –> bladder hypertrophy & distention + reservoir of residual urine that is a common source of infction

101
Q

What is the tx of Benign prostatic hyperplasia?

A

a-adrenergic blockers
5-a-reductase inhibitors

102
Q

What are the complications that can arise from BPH?

A

obstruction of urinary outflow leads to:
- bladder distention, accompanied by urine stasis
- residual urine causes irritative symptoms and increases the risk of urinary infection

103
Q

What are the diff BPH complciaitons?

A

obstructive uropathy
bladder hypertrophy
trabeculation
diverticular formation
hydroureter-bilateral
Hydronephrosis
Lithiasis/stone
Secondary infection

104
Q

What is the most common cancer in men in the US and 2nd most common cause of death in men?

A

Prostatic crcinoma

105
Q

What are the predisposing factors of Prostatic carcnoma?

A

Advancing age
Race -> africa american
Hormonal: Androgen excess
Genetic factors
Environmental factors

106
Q

What is the most common genetic alteration in prostatic carcinoma?

A

ETV1-TMPRSS2

107
Q

What is used as a screenign test for Prostatic carcinoma?

A

Prostate specific antigen

108
Q

Where is the location of Prostatic carcinoma?

A

A hard rock prostate

109
Q

What are the risk zones in the prostate gland?

A

Peripheral zone - most
Central zone
Transitional zone - most comon for benign prostatic hyeprplasia

110
Q

What is the gross morphology of Prostatic carcinoma?

A

Solid yellow or gray-white areas

111
Q

What is the microscopic morphology of a benign gland?

A

2 layers lining the organ
-> 1 layer = inner columnar secretory cells
-> 1 layer - outer cuboidal to flattened basal cell layers
Lumens with papillary infoldings

112
Q

What is the microscopic morphology of a malignant gland?

A

Small back to back glands
Single layer with absent outer basal cells

113
Q

What is the cytologic Major criteria for diagnosis of Prostatic carcinoma?

A

Basal cells lost
Prominent nucleoli
Infiltrative growth pattern

114
Q

What is the cytologic minor criteria for diagnosis of Prostatic carcinoma?

A

wispy blue mucin
nuclear hyperchromasia
and many more –> ito lang important to remember

115
Q

What are other histologic features of prostatic carcinoma that is very important?

A

back to back small glands with little intervening stroma; glands with simplified round or oval lumens

116
Q

What is a probable precursor lesion for prostate carcinoma?

A

high grade prostatitc intraepithelial neoplasia

117
Q

What are the 4 major architectural patterns of high grade prostatic intraepithelial neoplasia?

A

Micropapilary, Cribriform, Tufted or Flat

118
Q

What is the acquired genetic alterations in Prostatic carcinoma that is due to the fusion w/ androgen regulate TMPRSS2 promoted, the most common genetic alteration?

A

Andrgen-dependent over expression of ETS gene

119
Q

Are most Prostatic carcinomas, adenocarcinomas?

120
Q

What is a pathognomonic diagnostic feature of Prostatic carcinomas?

A

Circumferential perineural or intraneural invasion

121
Q

What is the Grading system for prostate cancer?

A

Grade 1, 2 –> well-differentiated, looks like healthy tissue
Grade 3,4 –> moderately differentiated
Grade 5 –> Poorly differentiated, looks like abnormal tissue

122
Q

What does it indicate if the Gleason score for prostate cancer is 6-10?

A

Score <6 = Tumor looks similar to normal cells –> cancer is slowly growing

Score >7 = Intermediate risk for aggresive cancer

Score >8 = likely to spread more rapidly, poorly differentiated/ high grade

123
Q

What are the clinical signs and symptoms of prostatic cancer in the early & late stage?

A

Early stage - usually no symptoms, may present with LUTS, hematuria

Late stage = bone pain with lumbar bone metastasis

Bone pain may present also with metastatic disases

124
Q

What is the basis of staging of Prostatic tumors?

A

Extend and spread of the cancer

125
Q

How does protastatic cancer spread?

A

1st = spreads to lymphatics –> obturator nodes then para-aortic nodes
2nd = signs of spinal cord compression
Hematogenous spread to the bones

126
Q

What are the stages of prostatic cancer & its extent?

A

Stage I (T1) = Microscopic only
Stage II (T2) = Macroscopic (palpable)
Stage III (T3, T4) = Extracapsular spread
Stage IV (N1, N2, N3, M1) = Distant metastasis

127
Q

What can indicate immediately that it is definitely protastitic cancer?

A

Multiple bones metastases in males

128
Q

What can help confirm prostatic origin?

A

PSA immunostain

Pathology (8 decks)

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