Male Gential Tract

Question 1

What can result if the urethral folds fail to close

Answer 1

1. Hypospadias - ventral side, most common congenital penile problem.
2. Epispadias - dorsal side, occurs if genital tubercle is located more posteriorly towards the anal opening

Question 2

What is the consequence of abnormal urethral canal?

Answer 2

1. obstruction - impaired ejaculation – infertility, wicket dribbling

Question 3

What else can be associated w/ congenital problems

Answer 3

undescended testes

Question 4

What is a common cause of inflammatory penile disease

Answer 4

1. Phismosis - inability to retract foreskin –> repeated bouts of inflammation –> scarring of preputial ring
2. Venereal dz - syphilis, gonorrhea, chancroid, granuloma, lymphopathia venereum, herpes

Question 5

What is balanoposthitis

Answer 5

inflammation of glans and foreskin from poor hygiene –> increased smegma, accumulation of debris, chronic inflammation – increased risk of carcinoma

Question 6

what is a condyloma acuminatum

Answer 6

a benign sexually transmitted tumor - common wart. caused by HPV 6 and 11. It is NOT premalignant

Question 7

What is the gross pathology of a condyloma

Answer 7

warty, cauliflower growth w/ sessile or pedunculated wart, papillary lesion, exophytic/fungating mass

Question 8

What is the microscopic pathology of a condyloma

Answer 8

hyperkeratosis, acanthosis, koilocytes

Question 9

What is carcinoma in situ?

Answer 9

neoplastic transformation of HPV 16; painless, nonulcerated

• Penile skin: Bowmen’s Dz
• Glans/Prepuce: Erythroplasia of Queyrat

Question 10

What is the microscopic pathology of carcioma in situ?

Answer 10

Hyperchromatic, increased mitosis, increased epitherlium w/ intact basement membrane, hyperkeratosis, elevation of rete pegs,

Question 11

What is invasive squamous cell carcinoma

Answer 11

malignant neoplasm of epithelial origin, HPV16/18

Question 12

What are risk factors for an invasive squamous cell carcinoma

Answer 12

• uncircumcised, cigarette smoking, poor hygiene

Question 13

What is cryptorchidism

Answer 13

undescended testes, MC is unilateral,

-found in neonates, associated w/ inguinal hernias

Question 14

what are the consequences of cryptochidism

Answer 14

1. trauma - inguinal canal testicle
2. Infertility : decreased spermatogenesis in both testicles
3. Cancer: 5-10 x increased risk of neoplasm even in normal controlateral side

Question 15

What are the 2 places the testes can get stuck

Answer 15

1. transabdominal phase: testis reaches the pelvic brim – mediated bt Mullerian Inhibiting Substance; only 5-15% failure
2. inguinoscrotal phase : testis reaches scrotum. mediated by calcitonin gene related peptide, failure here 95%
   - —> explains why most cases are found at pelvic brim or proximal to inguinal canal

Question 16

What is the gross pathology of cryptorchidism

Answer 16

small atrophied and firm fibrotic testicles on both sides

Question 17

What is the micro pathology of crytorchidism

Answer 17

no spermatogenesis, thickened basement membrane of spermatic tubules

Question 18

What is the treatment of crytorchidism

Answer 18

• orchiopexy –> before 2 y/o increased chance of spermatogenesis but does not guarantee fertility

Question 19

What are some causes of atrophy/regression of testes

Answer 19

1. Vascular - varioceles
2. Endocrine
3. Genetic/congential
4. others: inflammatory (mumps), irradiation, malnutrition/cachexia, seminal outflow obstruction, neoplasm, agin

Question 20

what is autoimmune granulomatous orchitis

Answer 20

rapid enlargement, unilateral testicular enlargement in middle aged men, granuloma w/out organisms present.

Question 21

what is granulomatous orchitis

Answer 21

inflammatory process, intratubular w/ cellular infiltrate, histiocytes w/ lymphocytes and plasma cells. NO necrosis

Question 22

What is mumps orchitis

Answer 22

mumps infection in post-pubertal males one wk post-parotid gland enlargement. causes focal atrophy of testicular tubules

Question 23

How do GC and TB inflame the testes and epididymis

Answer 23

retrograde; from posterior urethra infxn up the tract

Question 24

how does syphilis inflame the testes and epididymis

Answer 24

antegrade; testes first then epididymis

Question 25

What is vascular torsion

Answer 25

twisting of spermatic cord -- obstructed venous drainage --> venous stasis; increased risk of contralateral testicle

Question 26

What is the pathogenesis of vascular torsion

Answer 26

1. anatomical defect - bell clapper phenomenon: bilateral, testes have increased mobility - increased torsion 2. venous obstruction - leads to congestion and enlargement. Thick walled arteries remain open --> vascular engorgment --> hemorrhagic infarction

Question 27

why is vascular torsion a medical emergency

Answer 27

1. surgical correction in 4-6 hours may save the testicle | 2. hemorrhagic infarction post 4-6 hours + obliteration of testicle occurs otherwise

Question 28

what is the most common type of testicular tumor

Answer 28

95% are germ cell tumors - most common one is seminoma, 15-34 yr old, almost all malignant and treatable. White > AA

Question 29

what is the most common testicular tumor in infants

Answer 29

yolk sac tumor

Question 30

What testicular tumors produce hCG

Answer 30

choriocarcinoma > seminoma

Question 31

What do sex cord tumor cell produce

Answer 31

androgens, they are a minority of tumors and generally benign

Question 32

What is the pathology of a seminoma

Answer 32

Gross: Huge white homogenous mass, NO necrosis/hemorrhage Micro: uniform cells w/ clear cytoplasm and distinct cell membranes --> fried egg appearance

Question 33

What is the pathology of embryonal carcinoma

Answer 33

- More aggressive than seminoma - Gross: hemorrhagic mass - Micro: mixed tumor w/ sheets, tubules, alveoli, and papillary formations of ANAPLASTIC Cells

Question 34

what is the pathology of yolk sac tumor

Answer 34

- MC germ cell in infants; Schiller Duval bodies, AFP increased

Question 35

What is the pathology of a choriocarcinoma

Answer 35

-mixed tumor, mimics normal placenta - Increased vascularity -- bleeding Micro: mixed pattern of cyto and syncytiotrophblast --> Increased hCG

Question 36

what is the pathology of a teratoma

Answer 36

- Malignant in males - Pure form in kids, mature or immature - presents multiple germ layers - cysts are common, keratin pearls may be present

Question 37

what is the prostate composed of

Answer 37

glands and stroma

Question 38

what are the divisions of the prostate

Answer 38

central, peripheral, periurethral, transitional

Question 39

Where is BPH likely to occur

Answer 39

transitional and periurethral zone (median lobe) -- lots of pee b/c compresses urethra

Question 40

Where is prostate cancer likely to occur

Answer 40

peripheral zone (posterior lobe)--> palpable, urinary flow is not affected

Question 41

What is the micro anatomy of prostate

Answer 41

Luminal and basal epithelia - Luminal cells secrete seminal fluid and express PSA - Basal cells support/regulate growth of lumina cells and express P63

Question 42

What is PSA and what does it do

Answer 42

a serine protease, liquifies seminal fluid

Question 43

What causes acute bacterial prostatitis

Answer 43

UTI club -- E. Coli, enterococci, staph

Question 44

what causes chronic bacterial prostatitis

Answer 44

UTI club w/ history of chronic UTI by same organism

Question 45

what causes chronic abacterial prostatitis

Answer 45

presents like chronic bacterial w/out UTI history; bugs such as mycoplasma, ureaplasma, and CT

Question 46

What is BPH

Answer 46

- hyperplasia of glands and stroma driven by DHT | Bladder obstruction and urinary stasis -- infxn

Question 47

What is the pathogenesis of BPH

Answer 47

stromal cells contain 5alpha-reductase; stromal and epithelium cells contain DHT-receptors. **** DHT + DHT-R --> increase growth factors --> increase proliferation

Question 48

What is the most common cancer in men

Answer 48

prostate carcinoma, increased risk w/ increasing age

Question 49

What is thought to be the pathogenesis of adenocarcinoma of prostate

Answer 49

unknown interplay btw androgen, genetics, and environment

Question 50

what is the gross pathology of an adenocarcinoma of the prostate

Answer 50

- firm, yellow nodule (typical carcinoma)

Question 51

what is the micro pathology of an adenocarcinoma of the prostate

Answer 51

- range of barely malignant to completely anaplastic glands - capsular invasion --> lymphatic, hematogenous, perineural - loss of basal layer, luminal crystals, back-back glands

Question 52

How can one dx an adenocarcionoma of the prostate

Answer 52

- PSA is not cancer specific b/c it can increase w/ BPH and prostatitis - DRE - greatest screening benefit ages 55-69 No routine screening needed after age 70

Question 53

What is Klinefelter syndrome

Answer 53

abnormal number of X's, primary gondal insufficiency

Question 54

What is the clinical presentation of Klinefelter syndrome

Answer 54

- eunuchoid appearance w/ increased stature - small to normal well developed testes - incomplete virilization - gynecomastia - mental retardation, speech difficulties

Question 55

What is the histology of Klinefelter syndrome

Answer 55

- small hylanized seminiferous tubules; pseudoadenomatous clusters of leydig cells; increased incidence of extragonadal germ cell tumors