Male Path 2 Flashcards
Hypospadias
urethra opening on the ventral surface (1 in 300)
Epispadias
urethral opening on the dorsal surface
Phimosis
prepuce can not be retracted
poor hygiene–infection–phimosis–infection–?carcinoma
Paraphimosis
phimotic prepuce is forcibly retracted
-constriction and swelling–pain–acute urinary retention
What are complications of gonorrhea?
urethritis-urethral strictures-sterility- and ectopic pregnancies
Who is more likely to get chlamydia non gonorrheal urethritis male or female?
male
chlamydia lymphogranuloma venereum
small epidermal vesicle–ulcer—inguinal and rectal lymphadenopathy
chlamydia trachomatis
chronic keratoconjuntivitis
reiter syndrome
can pee cant see cant climb a tree
-conjunctivitis, polyarthritis and genital infection
What is 1,2,3 syphilis?
1 (3 weeks)- chancre
2 (2-10 weeks)-palmar, solar rash, lymphadenopathy, arthritis, headache, fever, condyloma latum
3 (years)- neurosyphilis, aortitis, gummas
Condyloma Acuminatum
HPV 6,11
Gross: single or multiple sessile or pedunculated, red papillary excrescencies, one-several mm
Micro: papillary proliferation of squamous cells. koilocytosis- clear vacuolization of cytoplasm
Squamous cell carcinoma of the penis Risk factors HPV type Gross Micro
poor hygiene and phimosis-accumulation of smegma, and history of genital warts
-circumcision confers protection
HPV types 16 and 18
Cryptorchisidism
Undescended testis
- majority idiopathic, trisomy 13
- unilateral, 25%-bilateral
- complications-infertility and germ cell neoplasia
Gross: small, firm testicles
Micro: tubular atrophy
Testicular Torsion
twisting of the cord–thick walled arteries patent–vascular engorgement–infarction
- sudden severe pain
- congestion, edema, hemorrhage—hemorrhagic infarct–fibrosis
- surgery within 8 hrs–80% slalvage
- after 10 hours–20 % salvage
UROLOGIC EMERGENCY
What is the epidemiology of testicular tumors?
15-34 most common tumor in men bimodal young and old young-germ cell old-lymphoma white: african american 5:1
Germ cell tumors can be split up into seminomas and nonseminomatous germ cell tumors, what is the difference?
Seminoma
- localized to testis for long time
- 70% stage 1 (at presentation)
- metastasis to lymph nodes
- RADIOSENSITIVE
- 95% cured
NSGCT
- more aggressive
- 60% stage 2 and 3
- hematogenous spread (lungs and liver)
- radioresistant
- 90% complete remission and cure with aggressive chemotherapy
What are risk factors for testicular tumors?
- Cryptorchidism-higher the testis location, higher the risk of cancer (R>L)
- gonadal dysgenesis with Y chromosome
- testicular feminization
- presence of ITGCN
- HIV infection
- **Trauma is not a risk factor
What is a molecular risk factor for invasive testicular tumors regardless of the histological type?
isochromosome of the short arm of chromosome 12
90% of invasive tumors
What are the clinical features of germ cell tumors?
- Painless enlargement of testis
- Lymphatic spread-retroperitoneal, para aortic, mediastinal, supraclavicular LN
- Hematogenous spread-lungs, liver, brain
AFP-yolk sac tumor
HCG-chroiocarcinoma
ITGCN
Intratubular germ cell neoplasia
seen often associated with malignant germ cell tumors
Intratubular proliferation of malignant gem cells
Large atypical cells, abundant clear cytoplasm, central nucleus, prominent nucleoli “fried egg appearance”
Seminoma
most common germ cell tumor
peak 30-40 years old
gross: homogenous gray-white cut surface
micro:
-sheets of uniform large cells with distinct cell membrane clear cytoplasm, large central nucleolus
-fibrous septae infiltrated with lymphocytes
-serum bHCG could be high in 10% of cases, AFP is normal
Embryonal carcinoma
peak 20-30 old
gross-variegated poorly demarcated, foci of necrosis and hemorrhage
micro-large anaplastic cells with prominent nucleoli with indistinct borders arranged in solid, glandular, tubular, papillary patterns
yolk sac tumor
two peaks: 1 infants(good prognosis) and young adults (mixed tumors)
most common testicular tomor in infants up to 3 Y**
micro: reticular network of cuboidal cells, papillary and solid patterns (Schiller-Duval or glomeruloid bodies) and hyaline-like globules (AFP and alpha 1 antitrypsin)
choriocarcinoma
Metastasis at presentation, highly aggressive
-Pure form
teratoma
Random admixture of tissue derived from ectoderm, endoderm and mesoderm
- From infancy (pure) to adulthood (mixed germ cell tumors)
- Mature, immature, with malignant transformations
- NO BENIGN TERATOMAS IN POST PUBERTAL MALES **
Leydig cell tumor
common sex cord-stromal tumor
- any age 20-60s
- usually unilateral
- testicular enlargement, endocrine manifestations
Gross: well circumscribed ~3-4 cm nodule with homogenous, golden-brown cut surface
Micro: solid growth of large, polygonal cells with abundant granular cytoplasm and singe, round, centrally located nuclei with prominent nucleoli
CRYSTALLOIDS of REINKE***
lymphoma
Usually secondary
Most common- large b cell lymphoma
> 60 MOST COMMON testicular neoplasm (the second-metastasis to testes)
-prognosis-poor
Gross-fleshy, white gray to pink, usually replace testicular parenchyma
Most common testicular tumor in adults
seminoma
most common bilateral primary testicular tumor
seminoma
most common bilateral testicular tumor
lymphoma
Most common testicular cancer in infants and children?
yolk sac tumor
Most common non germ cell tumor of the testes?
leydig cell tumor
Which are more common in the testis-mixed or pure histological tumor types?
mixed
