Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Pathology > Male genitalia path > Flashcards

Male genitalia path Flashcards

1
Q

Penis: MalformationsHypospadias and epispadias

A

Urethral opening
-below tip of penis (ventral) = hypospadias
-above tip of penis (dorsal) = epispadias
may be associated with other genital abnormalities
the urethral orifice may be constricted, causing complications from urinary tract obstruction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Penis: InflammationsBalanitis

A

local inflammation of the glans penis
+ overlying prepuce = balanoposthitis
usually due to smegma accumulation, typically under the foreskin of uncircumcised males
-smegma = sweat, debris, desquamated epithelial cells
distal penis is red, swollen, and tender; may have purulent discharge

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Penis: InflammationsPhimosis

A

Inability to retract the foreskin of uncircumcised penis because of scarring or adhesions, usually secondary to balanoposthitis
Interferes with cleanliness; smegma accumulation favors the development of secondary infections and possibly carcinoma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Penis: InflammationsParaphimosis

A

Forcible retraction of foreskin with phimosis leads to painful swelling that can obstruct the urethra
-severe cases may cause urinary retention

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Penis:Neoplasms

A

uncommon; most originate from squamous epithelium (squamous cell carcinomas)
most cases occur in uncircumcised patients >40 yoa
risk factors:
-phimosis
-poor hygiene
-infection with HPV types 16 and 18

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Penis:Squamous Cell Carcinoma

A

usually preceded by 1 of 3 variants of carcinoma in situ

  • Bowen disease
  • erythroplasia of Queryat
  • bowenoid papulosis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Bowen disease

A

Appears as a solitary, plaque-like lesion on the shaft of the penis
most common >30 yoa
~1/3 of patients develop visceral cancers

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Erythroplasia of Queyrat

A

variant of Bowen disease

erythematous patch on the glans penis and other mucosal surfaces

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Bowenoid papulosis

A

venereally transmitted viral (HPV 16) lesion of the penile shaft
Patients typically younger than seen in Bowen disease
Presents with multiple reddish-brown pigmented papules (may be verrucoid)
Histologically indistinguishable from Bowen disease
virtually never develops into invasive carcinoma and may spontaneously regress

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Penis:Squamous cell carcinoma

A

SCC of the penis is uncommon in the U.S. (<1% of male cancers)
-In some parts of Asia, South America, and Africa it comprises 10-20% of male malignancies
Usually found in patients between 40-70 yo
Is extremely rare in populations that practice circumcision
-better genital hygiene?
-decreases likelihood of HPV infection?

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

SSC clinical course

A

SCC is slowly growing, locally invasive, and probably present for a year or more before brought to medical attention
-In early stage metastasize to inguinal and iliac lymph nodes
-Widespread dissemination is uncommon, but occurs late in disease
Not painful until they undergo ulceration (may bleed) and infection
Prognosis is related to tumor stage
-In limited lesions without inguinal node involvement, there is a 66% 5-year survival rate
-Metastasis to a lymph node results in only a 27% 5-year survival rate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Cryptorchidism

A

Represents a complete or incomplete failure of testicular descent into the scrotal sac
-involves right testis more commonly than the left, but bilateral in 25%
-usually results in testicular atrophy and hyalinization by puberty
*4x increased risk of malignancy (less risk in the normally-descended testis)
*may result in sterility
usually occurs as an isolated anomaly, but may be associated with other malformations such as hypospadias or other congenital syndromes (e.g., Prader-Willi syndrome)
diagnosis is uncertain before 1 year of age (complete descent isn’t universally present at birth)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Epididymitis and orchitis

A

Commonly related to infections of the urinary tract (cystitis, urethritis, genitoprostatitis) that spread to the testis via the vas deferens and spermatic cord lymphatics
Cause varies with age
-In childhood associated with congenital abnormality and Gram Negative Bacteria
-In sexually active men 35 yo, common UT pathogens: Escherichia coli and Pseudomonas sp.
May lead to sterility if testis involved and inflammation not resolved in a timely fashion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Gonorrhea

A

neglected infection extends from posterior urethra to the prostate → seminal vesicles → epididymis
-results in abscesses that may destroy the epididymis
may spread to testis and produce a suppurative orchitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Mumps

A

testicular involvement uncommon in school-age children, but produces orchitis in 20-30% of postpubertal males
-usually develops ~1 wk after swelling of parotid glands

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Tuberculosis

A

believed epididymitis results from spread via prostate and seminal vesicles
caseating granulomas

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Testicular Atrophy causes

A

Progressive atherosclerotic narrowing of the blood supply (old age)
End stage of inflammatory orchitis (by any cause)
Cryptorchidism
Hypopituitarism
Generalized malnutrition or cachexia
Irradiation
Prolonged exposure to female sex hormones

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Testicular Torsion

A

Twisting of the spermatic cord may cut off venous drainage and arterial supply to testis
-Infarction may follow

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Testicular Torsion clinical course

A

presents as sudden pain
intense congestion and widespread extravasation of blood into interstitial tissues
one of the few urologic emergencies
-need to be surgically resolved in <6 hours to retain testicular viability

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Testicular torsion

A 
sudden onset
extreme pain
elevated testicle
absent cremasteric reflex
age <20
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Epididymitis

A

Hx urethritis
pyuria
tenderness, swelling
age <35

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Varicocele

A

dilated vein within the spermatic cord
cause of infertility
-left testicle more commonly involved
-A rapidly developing variocele is suspicious for renal cell carcinoma

23
Q

Hydrocele

A

accumulation of clear serous fluid in the tunica vaginalis causing enlargement of the scrotal sac
-may be mistaken for testicular enlargement
often occur spontaneously without any apparent cause
Diagnostic technique to detect a hydrocele = transillumination

24
Q

Testicular neoplasms

A

neoplasms of the scrotal sac are unusual, but don’t forget the association of scrotal squamous cell carcinoma with chimney sweeps
We’ll focus here on testicular neoplasms, which are derived from -germ cells (95% of cases)
Some trends you should notice:
germ cell tumors are usually very aggressive cancers
-sex cord or stromal tumors are usually benign, but can elaborate steroids that cause interesting endocrinologic syndromes
most commonly present with painless enlargement of the testis

25
Q

Biopsy of testicular neoplasm?

A

Biopsy of a testicular neoplasm is associated with a risk of tumor spillage which would necessitate excision of the scrotal skin in addition to orchiectomy
Standard management of a solid testicular mass is radical orchiectomy based on the presumption of malignancy!

26
Q

Testicular Cancer Risk Factors

A

Cryptorchidism (3x-5x fold increase)
Family history (brothers 8x-10x fold increase)
Testicular dysgenesis
-feminization
-Klinefelter syndrome
Age range: 20-54, peak at 15-34
Caucasian
NO ASSOCIATION with lifestyle (smoking, obesity, etc.)
Development of cancer in one testis is associated with a markedly increase risk in contralateral testis

27
Q

Testicular cancers

A 
Seminoma
Spermatocytic Seminoma
Embryonal Carcinoma
Yolk Sac Tumor
Choriocarcinoma
Teratoma
Mixed Germ Cell Tumors
28
Q

Seminoma

A

50% of germ-cell tumors
40-50 yoa
Large, soft, well-demarcated tumors
may have coagulation necrosis, but no hemorrhage
identical to ovarian dysgerminomas
large cells with clear, glycogen-rich cytoplasm; conspicuous nucleoli
Tumor marker:
10 % of patients have elevated hCG
7-24% have syncytiotrophoblast-like giant cells

29
Q

seminoma prognosis

A

late metastases
very radiosensitive
chemosensitive
excellent prognosis

30
Q

Spermatocytic Seminoma

A 
larger than classic seminoma but uncommon
pale gray, soft, mucoid cysts 
affects elderly (> 65 years )
best prognosis
mixture of large & small tumor cells
rarely metastasize
31
Q

Embryonal Carcinoma

A

smaller than seminomas, but poorly demarcated
contains foci of hemorrhage or necrosis
poorly differentiated, pleomorphic cells in sheets or cords
cellular pleomorphism and nuclear atypia present in the tumor cells

32
Q

Embryonal Carcinoma prognosis

A

more aggressive than seminomas
not radiosensitive
chemosensitive
early metastases

33
Q

Yolk Sac Tumor

A

nonencapsulated, yellow-white, mucinous tumor
most common testicular tumor <3 (good prognosis)
Adult yolk sac tumors are often seen admixed with embryonal carcinoma

34
Q

Yolk Sac Tumor cells

A

reticular network of poorly differentiated cuboidal or columnar cells
50% contain Schiller-Duval bodies

35
Q

Choriocarcinoma

A

do not cause testicular enlargement, but metastasize rapidly
hemorrhage and necrosis common
rarest type (~1%)
20-30 yoa
100% have elevated BhCG
-The detection of βhCG after orchiectomy is an indicator of metastatic disease.
Primary tumors are small, nonpalpable lesions

36
Q

Choriocarcinoma prognosis

A

very early and rapid metastases
not radiosensitive or chemosensitive
poor prognosis

37
Q

Teratoma

A

large, with solid, sometimes cartilaginous, and cystic areas
in child, benign
in adult, always regarded as malignant
local resection for cure

38
Q

Mixed Germ Cell Tumors

A

Mixed germ-cell tumors account for ~60% of testicular germ-cell neoplasms
most common is a combination of teratoma, embryonal carcinoma, and yolk sac tumors

nonseminomatous mixed germ cell tumor with various textures and colors is displayed

39
Q

Tumors of Sex Cord or Stroma

A

Leydig Cell Tumors
Sertoli Cell Tumors
Testicular Lymphoma

40
Q

Leydig Cell Tumors

A

may elaborate androgens, estrogens, even corticosteroids
most common 20-60 yoa
adults → gynecomastia; children → sexual precocity
excellent prognosis
~90% are benign

41
Q

Steroli Cell Tumors

A

insufficient quantities of estrogens or androgens to cause masculinization or feminization, but sometimes gynecomastia
excellent prognosis
~90% are benign

42
Q

Testicular Lymphoma

A

not a primary tumor, but discussed here because they account for ~5% of testicular neoplasms
most common form of testicular neoplasm in men >60 yoa
most common type = diffuse large-cell type Non-Hodgkin Lymphoma

43
Q

Prostate

A

Nodular Hyperplasia

Adenocarcinoma

44
Q

Nodular Hyperplasia

A

aka, benign prostatic hypertrophy (BPH) but misnomer
Extremely common disorder in men > 50 yo
Characterized by hyperplasia of stromal and epithelial cells resulting in the formation of large, discrete nodules in the periurethral (central) region of the prostate- postvoid dripping
When sufficiently large, can obstruct the urethra
Well-circumscribed, white-tan, rubbery hyperplastic nodules symmetrically on either side of the compressed urethra

45
Q

Adenocarcinoma

A

Most common form of cancer in men and second leading cause of cancer death
Typically a disease of men > 60 yoa
Uncommon in Asians; higher incidence in African-Americans
In contrast to nodular hyperplasia, arises from the peripheral glands
no postvoid dripping

46
Q

AdenocarcinomaRisk factors

A

Age, race, family history, hormone levels, and environmental influences
Incidence rises as people from areas of low risk move to areas of higher risk (change of diet, environmental carcinogens, etc.)
Androgens and estrogens believed to play a role (inhibition of these tumors occurs with orchiectomy)
In ~10% of white American men, prostate cancer has been linked to germ-line inheritance
-Men with one first-degree relative have a 2X higher risk of developing prostate cancer, and those with 2 first-degree relatives have a 5X higher risk

47
Q

Adenocarcinoma diagnostic approach

A

Digital rectal exam suffers from low sensitivity and low specificity
-Imaging studies (transurethral unltrasonography [TRUS], etc.) are also of poor specificity and sensitivity
-Transperitoneal or transrectal biopsy is required for confirmation
Prostate specific antigen (PSA)

48
Q

Prostate specific antigen (PSA)

A

Elevated blood levels occur in association with localized as well as advanced cancer
-In most labs, 4 ng/mL is the upper limit of normal
Caveats:
-PSA is organ specific but NOT cancer specific
-Nodular hyperplasia, prostatitis, infarct, instrumentation, and ejaculation increase serum PSA
-only ~2/3rds of men with localized prostate cancer have increased PSA (compared to 95% of metastatic)

49
Q

Refinements in the interpretation of PSA values

A

The recommended age-specific upper reference ranges for serum PSA are
2.5 ng/mL for men 40-49 yoa
3.5 ng/mL for men 50-59 yoa
4.5 ng/mL for men 60 -69 yoa
6.5 ng.mL for men 70-79 yoa
Men with prostate cancer demonstrate an increased rate of rise in PSA compared to men without prostate cancer
-suspicious for prostate cancer if >0.75 ng/mL/y
measure 3x over 1.5 years

50
Q

PSA controversy

A

serum PSA by itself cannot be used for early detection of prostate cancer
considerable controversy about continuing to promote PSA testing as a cancer screening tool:
recent studies show that it does NOT reduce prostate cancer mortality (evidence that screened men actually have higher morbidity and mortality, likely due to treatment side effects)
despite this evidence, the American Urological Association (April 2009) changed their recommendation to start PSA testing earlier (now at 40 yoa instead of 50 yoa)
in October 2011, the USPSTF released its draft recommendation that PSA screening be discouraged

51
Q

Adenocarcinoma clinical course

A

Microscopic cancers found incidentally at autopsy or biopsies for nodular hyperplasia are asymptomatic
-Their long term significance is not clear
*autopsy studies have shown that 30% of men >50 yoa and 70% of men >70 yoa have occult prostate cancer
Prostate cancer that is local/regional has excellent prognosis!

52
Q

Adenocarcinoma clinical course

A

Patients with clinically localized disease do not have urinary symptoms
-The lesion is discovered by digital rectal exam and/or PSA testing
Patients with clinically advanced disease have symptoms
-Some patients come to medical attention because of back pain
-The finding of osteoblastic bone disease is virtually diagnostic for this form of cancer in men
can have osteoblastic metastases from prostatic adenocarcinoma
-Osteoblastic bone disease is virtually diagnostic for prostate cancer!

53
Q

hyperplasia vs adenocarcinoma location

A

Nodular hyperplasia typically occurs periurethrally, while adenocarcinoma tends to occur peripherally.

Pathology (16 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions