Male GU

Question 1

urethritis

Answer 1

Gonococcal or non-gonococcal accompanied by cystitis or prostatitis
- adults are e coli

Question 2

Caruncles

Answer 2

painful, small, red, inflammatory lesions

- polyps of external urethral meatus in women

Question 3

peyronie disease

Answer 3

fibrosis of penile corpus cavernosum, curvature and pain during intercourse

Question 4

urethral carcinoma

Answer 4

uncommon, proximal urethra which are analagous to bladder urothelial malignancy
- distal urethra they are sq cell carcinomas

Question 5

hypospadias and epispadias

Answer 5

malformations of the urethral canal can produce aberrant openings on ventral aspect of penis (hypo) or dorsal surface (epi)

• can be associated with undescended testes
• predispose to UTI or severity

Question 6

phimosis

Answer 6

designation for a prepuce (foreskin) orifice too small to permit normal retraction

• secondary to inflammation
• secondary infections and CA

Question 7

condyloma acuminatum

Answer 7

benign sexually transmitted epithelial proliferation caused by HPV 6 and 11
Morph: single or multiple sessile or pedunculated red papillary excrescences
- micro - branching papillae covered by hyperplastic stratified squamous epithelium with hyperkeratosis

Question 8

Bowen disease

Answer 8

CIS
involve male or female older than 35
- gray white or shiny plaques along penile shaft
Morph: epithelial atypia with no invasion
- epithelial thickening on inner surface progressing to ulceroinfiltrative or exophytic growth
Sx: slow growth

Question 9

Bowenoid papulosis

Answer 9

CIS
multiple, pigmented papular lesions on external genitalia in younger, sexually active patients
Morph: epithelial thickening on inner surface progressing to ulceroinfiltrative or exophytic growth
Sx: slow growth

Question 10

Invasive carcinoma

Answer 10

penile squamous cell carcinoma less than 1 percent, higher without circumcision
Morph: epithelial thickening on inner surface progressing to ulceroinfiltrative or exophytic growth
Sx: slow growth

Question 11

cryptorchidism

Answer 11

failure of testicular descent, usually unilateral
Morph: decreased germ cell development thickening and hyalinization of seminiferous tubule basement membrane and interstitial fibrosis
- spares leydig cells
Sx: sterility, inguinal hernias
- increased incidence of testicular malignancy

Question 12

Testicular torsion

Answer 12

twisting of spermatic cord cuts of venous drainage

- needs to be fixed to scrotum

Question 13

Germ cell tumor - seminoma

Answer 13

Age: 30-40
Morph: gross - homogeneous lobulated gray white masses, devoid of hemorrhage or necrosis
micro - single histologic pattern
- clear cytoplasm, large nuclei, prominent nucleoli
- irregular lobules lymphocytic
- cKIT, OCT4, PLAP, hCG

Question 14

Germ cell tumor - spermatocytic seminoma

Answer 14

Uncommon neoplasm
Age: older patients
Course: no metastases
Morph: gross - soft gray cut surfaces with mucoid cysts
micro - mixture of three cell populations, small cells

Question 15

Germ cell tumor - embryonal carcinoma

Answer 15

Age: 20-30
Course: more aggressive than seminomas
Morph: gross - small, gray-white masses with hemorrhage or necrosis
micro - lesions have primitive epithelial cells with indistinct borders with irregular sheets, tubules, alveoli, papillary structures

Question 16

Yolk sac tumor (endodermal sinus tumor)

Answer 16

Common testicular neoplasm in patients under 3 years
- good prognosis
Morph: Grossly - typically infiltrative, homogeneous, yellow-white mucinous tumor
Micro - cuboidal neoplastic cells in lacelike network
- schiller duval bodies seen in half

Question 17

Choriocarcinoma

Answer 17

Malignant neoplasm with cytotrophoblastic and syncytiotrophoblastic elements
Morph: grossly - neoplasm small with widespread systemic metastases
micro - polygonal comparatively uniform cytotrophoblastic cells in sheets and cords

Question 18

Teratoma

Answer 18

neoplasm with differentiation along endodermal, mesodermal, ectodermal cell lines
- men they are malignant

Morph: tumors are large, heterogenous can have hemorrahge
- haphazard array of differentiated mesodermal, ectodermal, endodermal elements

Question 19

Leydig cell tumor

Answer 19

Age: 20-60
Tumor production: androgens, estrogens, corticosteroids
- most are benign
Morph: grossly - circumscribed nodules with homogenous golden brown cut surface
micro - polygonal cells with abundant granular, eosinophilic cytoplasm and indistinct cell borders

Question 20

Sertoli cell tumors

Answer 20

10% malignant, otherwise testicular mass hormonally silent
Morph: tumors are gray-white to yellow mass
micro - tall columnar cells in trabeculae

Question 21

Testicular lymphoma

Answer 21

Age: older than 60
Most common tumor in that age group
- usually large b cell non hodkin lymphoma with CNS involvement

Question 22

hydrocele

Answer 22

accumulation of serous fluid within mesothelial lined tunica vaginalis from generalized edema

Question 23

hematocele

Answer 23

accumulation of blood secondary to trauma, torsion, or generalized bleeding diathesis

Question 24

chylocele

Answer 24

accumulation of lymphatic fluid secondary to lymphatic obstruction (elephantiasis)

Question 25

Spermatocele

Answer 25

local cystic accumulation of semen in dilated ductuli efferentes or rete testis

Question 26

Varicocele

Answer 26

dilated vein in spermatic cord may be asymptomatic or contribute to infertility

Question 27

Acute bacterial prostatitis

Answer 27

Cause: organisms assoc with UTI - urinary reflux or lympho seeding, cath, surgical Sx: fever, chills, dysuria, boggy tender prostate

Question 28

Chronic bacterial prostatitis

Answer 28

insidious disorder Sx: asymptomatic or low back pain, suprapubic and perineal discomfort, dysuria - history of recurrent UTIs

Question 29

Chronic abacterial prostatitis

Answer 29

most common, without recurrent UTI | - 10 leukocytes on high powered field

Question 30

Granulomatous prostatitis

Answer 30

installation of BCG to treat bladder cancer most common cause

Question 31

Benign prostatic hyperplasia

Answer 31

Common disorder by periurethral epithelial and stromal hyperplasia that compresses urethra Path: DHT causes sx through FGF7 and FGF1 Morph: grossly - nodules in transitional and periurethral zones micro - nodules composed of proliferating glands and fibromuscular stroma - sq metaplasia and infarcts Sx: restriction of flow, urinary retention, urinary frequency, nocturia, urinary stasis with resultant bacterial overgrowth and UTI - urinary bladder diverticula and hydronephrosis Tx: alpha 1 blocker and 5 alpha reductase blocker

Question 32

Adenocarcinoma

Answer 32

Most common form of CA in men, 1/6 lifetime risk Age: older than 50 Path: requires androgens for survival - treat with castration and anti-andorgen therapies Germline genes - BRCA2 mutations Diet - risk associated with increased fat consumption; dietary products that prevent prostate cancer Morph: gritty, firm, yellow, poorly demarcated - can infiltrate seminal vesicles and urinary bladder Micro - small crowded glands by single layer of epi, nuclei are large with nucleoli Metastases - obturator nodes to bones through hematogenous dissemination PSA is organ specific yet not cancer specific - normally secreted in semen, elevated in CA - PSA velocity better diagnostic measurement