Male Pathologies Flashcards
1
Q
What is erectile dysfunction?
A
Inability to attain or maintain a penile erection sufficient for satisfactory sexual performance.
2
Q
What characterizes priapism?
A
A persistent erection for greater than 4 hours unrelated to sexual stimulation.
3
Q
What percentage of men aged 40-70 years old report erectile dysfunction?
A
> 50%
4
Q
What percentage of men over 65 report being sexually active but unsatisfied?
A
70%
5
Q
What are the two types of erections classified in erectile dysfunction?
A
- Reflexogenic (genital stimulated) * Psychogenic (central stimulated)
6
Q
What are some neurogenic disorders that can cause erectile dysfunction?
A
- Dementia * Parkinson’s disease * CVA * Tumors * Head trauma
7
Q
What role does testosterone play in erectile dysfunction?
A
Related to libido but not directly related to ED.
8
Q
What is the relationship between erectile dysfunction and coronary artery disease (CAD)?
A
Onset of ED often precedes CAD-related events by 12-36 months.
9
Q
List medications that can induce erectile dysfunction.
A
- Antidepressants (SSRIs) * Antipsychotics * Beta-adrenergic blockers * Thiazide diuretics * Spironolactone
10
Q
True or False: Smoking increases the rate of erectile dysfunction in patients with CAD.
A
True
11
Q
What are the treatment options for erectile dysfunction?
A
- Oral medication * Transurethral therapy * Vacuum constriction device * Intracavernous injection therapy * Penile prosthesis * Venous surgery
12
Q
What is the mechanism of action for phosphodiesterase inhibitors?
A
Amplify the NO-cyclic cGMP pathway through competitive inhibition of cGMP degradation by type 5 phosphodiesterase.
13
Q
What are the potential adverse effects of phosphodiesterase inhibitors?
A
- Flushing * Visual issues * Low BP * GI side effects* Nitrates
14
Q
What is a risk associated with intracavernous injection therapy?
A
Priapism and vessel fibrosis
15
Q
What is the most common type of priapism?
A
Low flow/ischemic
16
Q
What are possible complications of untreated priapism?
A
- Hypoxia * Acidosis * Fibrosis * Impotence * Necrosis
17
Q
What is the recommended treatment for priapism?
A
- Rapid detumescence * Oral pseudoephedrine * Aspiration and irrigation with large gauge needle
18
Q
What is a varicocele?
A
A condition characterized by enlarged veins within the scrotum.
19
Q
What percentage of pregnancies result from watchful waiting for varicocele?
A
16%
20
Q
List the treatment options for varicocele.
A
- Ligation of spermatic vein * Incisional surgery * Laparoscopic surgery * Radiologic intervention
21
Q
What is the pregnancy rate for varicocele treatment through laparoscopic surgery?
A
12-32%
22
Q
What are the outcome parameters for varicocele treatments?
A
- Semen improvement * Pregnancy rate * Recurrence * Technical failure
23
Q
Fill in the blank: The International Index of Erectile Function consists of ______ questions.
A
15
24
Q
what are common peripheral neuropathies assoc. w/ neurogenic ED?
A
DM
chronic alcoholism
Vit. deficiencies
cavernous and pudendal nerve injuries
25
T or F: low testosterone levels are directly related to ED.
false
26
what hormone/s is/are related to ED.
cortisol
hyperprolactin
27
ED can be mitigated w/ what pharmacologic agents?
alpha-1 blockers
ARBs
28
T or F: alcohol in moderation can mitigate ED if anxiety is the underlying etiology.
true
29
What anti-ED agent is admin. transurethral?
alprostadil
synthetic PGE1
30
what anti-ED agents are used for intracavernous injections?
alprostadil
papaverine
phentolamine
31
how is priapism clinically defined?
persistent erection > 4 hrs.
32
what are risk factors for ischemic priapism?
sickle cell anemia
cancer
cocaine abuse
33
before attempting a aspiration and irrigation w/ large gauge needle (18G) in a sickle cell pt, what should be done?
adequately hydrate and admin. O2
34
what is the benefit of ligation of spermatic veins?
preserves fertility b/c ligation of these veins will prevent retrograde semin flow
35
What are the congenital pathologies of the penis?
Hypospadias and epispadias
## Footnote
Hypospadias involves an abnormal opening on the ventral surface, while epispadias involves an opening on the dorsal surface.
36
What is hypospadias?
An opening of the external urethral orifice on the ventral surface of the penis
## Footnote
Occurs in approximately 1 in 300 live male births and is associated with undescended testes and chordee.
37
What is epispadias?
An opening of the external urethral orifice on the dorsal surface of the penis
## Footnote
Often associated with bladder exstrophy and undescended testes.
38
What are the inflammatory diseases of the penis?
Phimosis, paraphimosis, balanoposthitis, condyloma acuminatum
## Footnote
These conditions can lead to significant discomfort and complications if untreated.
39
Define phimosis.
Condition where the orifice of the prepuce is too small to retract over the head of the penis
assoc. w/ repeated infections
## Footnote
Can be due to anomalous development or repeated infections leading to scarring.
40
What is paraphimosis?
Swelling and constriction of retracted prepuce that prevents its replacement
## Footnote
Can lead to tissue ischemia and gangrene if not addressed.
41
What causes balanoposthitis?
Infection of the glans and prepuce, commonly seen in uncircumcised males with poor hygiene
## Footnote
Associated with organisms like Candida albicans and pyogenic bacteria.
42
What is condyloma acuminatum?
Benign sexually transmitted infection caused by human papillomavirus (HPV) - 6 or 11
## Footnote
Commonly associated with HPV types 6 and 11.
43
What types of tumors are associated with the penis?
Carcinoma-in-situ (Bowen’s disease, Bowenoid papulosis) and invasive squamous cell carcinoma
## Footnote
Both types can be associated with HPV infections.
44
What is Bowen's disease?
A form of squamous carcinoma in situ that typically presents as a solitary thickened gray-white plaque
## Footnote
Associated with HPV type 16 and can progress to invasive carcinoma.
45
What is the difference between undifferentiated and differentiated PeIN?
Undifferentiated PeIN has more overtly malignant cells, while differentiated PeIN retains some squamous maturation
## Footnote
Both are forms of penile intraepithelial neoplasia.
46
What characterizes squamous cell carcinoma of the penis?
It typically affects middle-aged and older patients and is associated with high-risk HPV infections
## Footnote
Less than 1% of male cancers in the US but has significant risk factors like poor hygiene.
47
What are the histological subtypes of squamous cell carcinoma of the penis?
Includes usual squamous cell carcinoma, pseudohyperplastic carcinoma, verrucous carcinoma, and basaloid carcinoma
## Footnote
Each subtype has distinct characteristics and implications for treatment.
48
What is Peyronie’s Disease?
A fibrosing disorder of the penis characterized by penile curvature
## Footnote
Likely due to microvascular trauma and treated with surgery or collagenase.
49
What is priapism?
Prolonged and painful erection unrelated to sexual interest or stimulation
## Footnote
Can result from various causes including medications and conditions like sickle cell disease.
50
What are the major benign pathologies of the testes?
Cryptorchidism, atrophy, testicular torsion, varicocele, hydrocele, spermatocele
## Footnote
These conditions can lead to complications if not diagnosed and treated appropriately.
51
What is cryptorchidism?
Failure of one or both testes to descend into the scrotum
## Footnote
Associated with increased risk of infertility and testicular cancer.
52
What is varicocele?
Enlargement of the veins within the scrotum
## Footnote
Can lead to reduced fertility and is often asymptomatic.
53
What is hydrocele?
Accumulation of fluid in the tunica vaginalis surrounding the testes
## Footnote
Often painless and may resolve spontaneously.
54
What is spermatocele?
Cystic accumulation of fluid in the epididymis
## Footnote
Typically asymptomatic and may not require treatment.
55
What are the risk factors for penile squamous cell carcinoma?
High-risk HPV infections, poor genital hygiene, chronic inflammation, smoking
## Footnote
Circumcision may reduce risk by decreasing exposure to carcinogens.
56
What is the pathogenesis of HPV-related squamous cell carcinoma?
High-risk HPV encodes E6 and E7 proteins that inactivate tumor suppressor proteins p53 and RB
## Footnote
This leads to genomic instability and increased cellular proliferation.
57
What is the prognosis for penile cancer?
Strongly correlated with tumor stage at diagnosis
## Footnote
Early detection improves treatment outcomes and survival rates.
58
What do Sertoli cells secrete to inhibit FSH?
Inhibin
## Footnote
Sertoli cells are non-germ cells that play a crucial role in sperm synthesis.
59
What protein do Sertoli cells secrete to maintain testosterone levels?
Androgen-binding protein (ABP)
## Footnote
ABP binds to testosterone to enhance its effects within the seminiferous tubules.
60
What structure do tight junctions between Sertoli cells form?
Blood-testes barrier
## Footnote
This barrier isolates gametes from autoimmune attack.
61
What is the primary role of Sertoli cells?
Support sperm synthesis
## Footnote
They provide structural organization to the seminiferous tubules.
62
What do Leydig cells secrete?
Testosterone
## Footnote
Leydig cells are located in the interstitium between seminiferous tubules.
63
What initiates spermatogenesis?
Puberty with spermatogonia
## Footnote
Spermatogenesis begins with spermatogonia and fully develops in seminiferous tubules.
64
How long does full development of sperm take?
2 months
## Footnote
This process results in the formation of mature motile spermatozoa.
65
What is the shape of mature spermatozoa?
Needle-like shape
## Footnote
They undergo significant morphological changes during spermiogenesis.
66
What is cryptorchidism?
Complete or partial failure of testicular descent
## Footnote
It may result in the testes being located anywhere along the descent pathway.
67
What are the two phases of testicular descent?
1. Transabdominal phase
2. Inguinoscrotal phase
## Footnote
The first phase is controlled by Müllerian-inhibiting substance hormone, and the second is androgen-dependent.
68
What is the most common site for undescended testes?
Inguinal canal
## Footnote
Surgical correction is often required if the testes remain undescended.
69
What percentage of inguinal cryptorchid testes descend spontaneously by the first year of life?
80%
## Footnote
Most of these descend within the first three months.
70
What is the incidence of true cryptorchidism?
~1%
## Footnote
The condition is usually isolated but may be associated with other genitourinary malformations.
71
What complications are associated with cryptorchidism?
* Testicular atrophy
* Infertility
* Increased risk of testicular cancer
* Inguinal hernia
* Testicular torsion
## Footnote
Undescended testes have a 3-5 times higher risk of cancer compared to normally descended testes.
72
What histological changes occur in cryptorchidism?
* Thickening of basement membrane
* Germ cell development arrest
* Loss of spermatogonia - leave tubules w/ only sertoli cells
* Scarred tubules-hyaline CT
leydig cells spared
## Footnote
Leydig cells are typically spared and remain prominent.
73
What causes retractile testis?
Overactive cremaster muscle
assoc. w/ increased risk for cryptorchidism
## Footnote
This condition allows a testicle to be pulled back into the groin but is not associated with complications.
74
What are common causes of testicular atrophy?
* Atherosclerosis
* End-stage inflammatory orchitis
* Cryptorchidism
* Cirrhosis
* Generalized malnutrition
* Hypopituitarism
* Exhaustion atrophy
* Prolonged antiandrogens
* Irradiation
* Genetic origins (e.g., Klinefelter syndrome)
## Footnote
Testicular atrophy can lead to similar changes as seen in cryptorchidism.
75
What is the most common age group for testicular torsion?
Ages 12-18
## Footnote
Testicular torsion is a surgical emergency and requires prompt intervention.
76
What is the hallmark symptom of epididymitis?
Scrotal pain radiating into the spermatic cord
## Footnote
Other symptoms may include epididymal swelling and tenderness.
77
What is a common infectious cause of epididymitis in sexually active men under 35?
C. trachomatis and Neisseria gonorrhoeae
## Footnote
In men over 35, urinary tract pathogens are more common.
78
What is the histological hallmark of syphilis in the testis?
Obliterative endarteritis with perivascular cuffs of lymphocytes and plasma cells; granulomatous inflammation
## Footnote
Granulomatous inflammation is also associated with syphilis.
79
What is a common complication of neglected gonococcal infection?
Epididymal abscesses
## Footnote
These may lead to destruction and scarring of the epididymis and testis.
80
What is the typical presentation of granulomatous orchitis?
Moderately tender testicular mass of sudden onset
## Footnote
It may mimic a testicular tumor and is suspected to be autoimmune in nature.
81
What is the treatment for acute epididymitis?
Antibiotics
## Footnote
It is essential to rule out testicular torsion and cancer.
82
What is a varicocele?
Dilation of pampiniform venous plexus due to testicular vein valve dysfunction
## Footnote
It often presents as a 'bag of worms' feeling in the scrotum.
83
What is the most common cause of hydrocele?
Congenital abnormality with failure of processus vaginalis to close
## Footnote
Hydroceles are usually painless masses that can occur at any age.
84
What is a spermatocele?
Cyst-like mass that forms in the epididymis filled with fluid and dead sperm cells
## Footnote
It is usually painless and mobile, more common in older males.
85
failure of urethral folds to fuse completely on the ventral side during fetal development can increase the risk for what long-term consequences?
undescended testes
chordee (congenital curved penis)
86
failure of urethral folds to fuse completely on the dorsal side during fetal development can increase the risk for what long-term consequences?
exstrophy-everted hyperuremic bladder
tied umbilical cord
87
what clinical complications can arise w/ untreated paraphimosis
Cut-off from vessel supplies leads to edema and subsequent tissue ischemia
eventually gangrene develops and the penis undergoes auto amputation
88
balanoposthitis increases risk for what pathogenic infections?
candida albicans
gardnerella
pyogenic bacteria
anaerobes
89
what is the most common cause of acquired phimosis?
balanoposthitis
90
describe the gross characteristics of condyloma acuminatum?
tan-brown-red pedunculated papillary excrescences
91
describe the histologic features of condyloma acuminatum?
papillary CT stroma
superficial hyperkeratosis of epithelium
thickened epidermis-acanthosis
Koilocytosis- HPV feature
92
what penis tumors are assoc. w/ malignant HPV?
Bowen disease
bowenoid papulosis
usually HPV 16 serotype
93
differentiated PeIN is asso. w/ what?
balanitis exerotica obliterans
AKA: penile lichen sclerosus-progressive sclerosing inflammatory dermatosis of glans penis and foreskin of older pts.
94
T or F: bowen disease is commonly seen in older men.
true
95
describe the gross features of bowen disease
solitary
gray-white
opaque plaque
velvety red appearance
96
bowen disease is most commonly found on what regions of the penis?
penile shaft
scrotum
less often glans
97
If you had to sum up the histologic features of bowen disease into one word, what would that word be?
dysplasia
98
Bowen disease can be a precursor for what manignancy?
invasive squamous cell carcinoma
assoc. w/ HPV 16
99
compare and contrast the differences b/t bowen disease & bowenoid papulosis.
BOTH ARE ASSOC. W/ HPV 16
bowen:
older men
solitary papules
progression to invasive carcinoma common
bowenoid:
younger men
multiple papules
progression to invasive carcinoma rare
100
T or F: circumcision has shown to be a protective factor against oncogenic HPV.
true
101
describe the gross characteristics of SCC of the penis.
irregular, fungating cauliflower-like mass
large verruciform
ulcerated
originating from glans or inner prepuce near coronal sulcus
102
T or F: Penis SCC is usually symptomatic
false
it is a slow-growing tumor
103
verrucous and papillary carcinoma are graded as what?
grade 1 tumors due to good differentiation
not assoc. w/ HPV
104
what Penis carcinomas are poorly differentiated and considered grade 3 tumors?
sarcomatoid
basaloid
assoc. w/ HPV
105
what is the pathogenesis of peyronie's disease?
reactive process (so not neoplastic) due to microvascular trauma and organizing sclerosing chronic inflammation
106
describe the histologic features of peyronie's disease?
deposition of a collagen plaque in CT b/t the corpora cavernosa and tunica albuginea
107
leydig cells stain eosinophilia due to what
elaborate SER
108
what hormone/s regulate/s the descent of the testis during fetal development?
mullerian-inhibiting substance hormone in lower-transabdominal phase
androgen-inguinoscrotal phase
109
what surgery is recommended for cryptochidism?
orchiopexy
110
what kind of testicular cancer are pts. w/ h/o cryptorchidism at increased risk for?
seminoma
111
what pathogens become common in UTIs for men > 35 yrs. old?
pseudomonas
E. coli
112
T or F: leydig cells are usually not destroyed in epididymitis and orchitis.
true
androgen production relatively unaffected
113
what is epididymitis in ped pts. most commonly assoc. w/?
congenital genitourinary abnormality
& UTIs
114
what is the most common cause of epididymitis and orchitis?
UTIs that spread through the vas deferns and spermatic cord
115
what pathogens are more commonly assoc. w/ epididymis?
tuberculosis and gonorrhea
invade epididymis and then the testis
116
what UTI pathogen travels to the testis first before reaching the epididymis?
syphilis
117
for tuberculosis you would expect to see what?
caseating granulomas
118
what are the most common clinical presentations of mumps?
affects school-aged children
testicular involvement is rare
causes acute interstitial orchitis in adult males w/ parotid gland edema prodrome
119
what is the pathogenesis of granulomatous orchitis?
autoimmune
120
Unlike tuberculosis, granulomatous orchitis is confined to what structures?
spermatic tubules
121
how is testicular torsion managed medically?
SURGICAL EMERGENCY-must be performed within 6 hrs. of pain onset
CL orchiopexy is also performed to prevent recurrence in the unaffected testis
122
which testicular vein is more susceptible to varicocele? Explain your reasoning.
the left testicular vein b/t the path it travels is much longer than the right testicular vein
123
what are the typical clinical signs of varicocele?
aching pain when standing
lying down relieves the pain
124
hydrocele is always assoc. w/ what?
inguinal hernias
125
what are the most common causes of hydrocele in adult males?
infection
tumor
trauma
126
T or F: spermatocele is often painful
false
usually painless and mobile
127
what are the most common causes of spermatocele?
trauma
infection
blockage of epididymis
128
What are the two main categories of testicular tumors?
Germ cell tumors and non-germ cell tumors
129
What percentage of testicular tumors are germ cell derived?
95%
130
What is the standard management for a solid testicular mass?
Radical orchiectomy
131
True or False: Biopsy is recommended for solid testicular masses.
False
risk of tumor spillage (seeding scrotum)
132
What are the common clinical presentations of testicular neoplasms?
Painless enlargement of the testis, cannot be transilluminated
133
Where do lymphatic metastases from testicular tumors typically spread first?
Retroperitoneal and para-aortic nodes
134
What is the common hematogenous spread site for testicular tumors later in the disease?
Lungs
135
What are serum biomarkers used for in germ cell tumors?
Initial evaluation, staging, assessing tumor burden, monitoring therapy response
136
Which biomarker correlates with the mass of tumor cells in germ cell tumors?
Lactate dehydrogenase
137
Which tumor marker is elevated in over 80% of nonseminomatous germ cell tumors?
AFP or hCG
138
What is the peak incidence age for classic seminoma?
Thirties
139
What is the histological pattern primarily seen in germ cell tumors?
Single histological pattern, primarily seminoma
140
What is intratubular germ cell neoplasia (ITGCN)?
Similar to carcinoma-in-situ in other organs, found in ~90% of testes with GCTs
141
What transcription factors are important in maintaining pluripotent stem cells in GCTs?
OCT3/4 and NANOG
142
What is the gross appearance of a classic seminoma?
Bulky solid mass, grey-white, lobulated, homogeneous cut surface w/ not apparent hemorrhage or necrosis
tunica albuginea intact
143
What type of tumor is a spermatocytic tumor?
Rare testicular tumor, 1-2% of all testicular tumors
144
What is the typical age of presentation for embryonal carcinoma?
20-30 years old
145
What is a common feature of yolk sac tumors in infants/children?
Good prognosis
146
What type of tumor is known as the most common testicular tumor in infants/children?
Yolk sac tumor
147
What is the histopathological pattern of yolk sac tumors?
Lace-like reticular network of medium-sized cuboidal, flattened, or spindled cells
148
Fill in the blank: Classic seminoma is identified by positive staining for _______.
placental alkaline phosphatase (PLAP)
149
What is the significance of the Gleason grade/scoring in prostatic carcinoma?
It helps in assessing the prognosis of the cancer
150
What is benign prostatic hyperplasia (BPH) associated with?
DHT and hormonal influences
151
What is the risk factor associated with testicular dysgenesis syndrome?
Cryptorchidism
152
What is the genetic change associated with most germ cell tumors?
Isochromosome 12p (i12p)
153
What is the gross appearance of a yolk sac tumor?
Homogenous, yellow-white, soft, solid, myxoid or gelatinous.
154
What histopathological feature is characteristic of yolk sac tumors?
Lace-like (reticular) network of medium-sized cuboidal, flattened, or spindled cells.
155
What are Schiller-Duval bodies?
Structures resembling endodermal sinuses seen in yolk sac tumors.
156
What is the significance of eosinophilic hyaline globules in yolk sac tumors?
They are positive for AFP and alpha1-antitrypsin.
157
What is the prevalence of choriocarcinoma among germ cell tumors?
<1% of germ cell tumors.
158
What is a common histological feature of choriocarcinoma?
Classic biphasic appearance with syncytiotrophoblastic and cytotrophoblastic cells.
159
What is the prognosis for pure choriocarcinoma?
Poor prognosis due to its highly malignant nature.
160
What are the two types of cells found in choriocarcinoma?
* Cytotrophoblastic cells (mononucleated w/ clear cytoplasm)
* Syncytiotrophoblastic cells. (multinucleated w/ eosinophilic cytoplasm)
161
What is the origin of teratomas?
Derived from more than one germ cell layer (ectoderm, mesoderm, endoderm).
162
What is the typical behavior of prepubertal teratomas?
Usually benign and less likely to metastasize or recur.
163
What is the significance of immature tissue types in teratomas?
A high degree of immaturity in the primary tumor is a sign of poor prognosis.
164
What types of tissue can be found in teratomas?
* Neural tissue
* Muscle
* Cartilage
* Squamous epithelium
* Intestinal wall
* Thyroid tissue
* Bronchial epithelium.
165
What is the typical size range of teratomas?
Large, 5-10 cm in diameter.
166
What percentage of patients with stage I and II non-seminomatous germ cell tumors can achieve remission?
~90% can achieve remission with aggressive chemotherapy.
167
What is the most common site for metastasis of seminomas?
Lymph nodes.
168
What is the typical age range for seminoma occurrence?
30-35 years.
169
What tumor markers are associated with yolk sac tumors?
Increase in AFP in all cases.
170
What is the histological appearance of Leydig cell tumors?
Usually well-circumscribed nodule, <5 cm with uniform polygonal cells.
171
What is the most common type of primary testicular lymphoma?
Diffuse large cell lymphoma.
172
What is the typical presentation of chronic prostatitis?
May be asymptomatic but may have low back pain, perineal and suprapubic discomfort.
173
What factors contribute to acute bacterial prostatitis?
Urine reflux and surgical manipulation.
174
What is the typical age range for chronic prostatitis?
40–70 years old.
175
What is the typical histological feature of the prostate?
Glands have two layers of cells: basal layer of low cuboidal basal epithelium and a layer of columnar secretory cells.
176
What treatment is required for acute bacterial prostatitis?
Requires treatment with antibiotics; do not biopsy.
177
What is the main risk associated with not performing a biopsy in prostate inflammation?
May lead to sepsis
178
What is the most common type of chronic prostatitis?
Chronic abacterial prostatitis aka chronic pelvic pain syndrome
179
What age group is primarily affected by chronic bacterial prostatitis?
40–70 y.o males
180
What are common symptoms of chronic prostatitis?
* Asymptomatic
* Low back pain
* Perineal discomfort
* Suprapubic discomfort
181
What is the etiology of chronic bacterial prostatitis?
Same organisms that cause acute prostatitis
182
What is the significance of leukocytosis in expressed prostate secretions?
Indicates chronic prostatitis
183
What is the most common cause of granulomatous prostatitis in the US?
Instillation of BCG for treatment of bladder cancer
184
What is the histologic hallmark of benign prostatic hyperplasia (BPH)?
Hyperplasia of stroma and glands
185
What is the typical age of onset for benign prostatic hyperplasia (BPH)?
Men > 50 years old
186
Is benign prostatic hyperplasia (BPH) considered a premalignant lesion?
No risk for prostate cancer
187
What is the main androgen involved in the pathogenesis of BPH?
Dihydrotestosterone (DHT)
188
What enzyme converts testosterone to DHT in the prostate?
Type 2 5α-reductase
189
What role do estrogens play in BPH?
Contribute to BPH by tipping balance towards proliferation
190
What are common symptoms of BPH?
* Nocturia
* Dysuria
* Increased urinary frequency
* Difficulty starting/stopping urine stream
191
What is the first-line treatment for BPH?
Alpha-adrenergic blockers
192
What does TURP stand for?
Transurethral resection of the prostate
193
What is the most common cancer in men?
Prostate cancer - adenocarcinoma
194
What is the predominant genetic alteration in prostate cancer?
Chromosomal rearrangement juxtaposing ETS transcription factor gene next to androgen-regulated TMPRSS2 promoter - upregulates MMPs and epithelial growth
195
What is the Gleason score range for prostate cancer?
2-10
196
What is a distinguishing feature of malignant prostate glands compared to benign glands?
Absence of basal cells for malignant glands
197
What is the common histological pattern of prostate cancer?
Glands lined by a single uniform layer of cuboidal or low columnar epithelium
198
What is the common consequence of bladder hypertrophy and distention due to BPH?
Increased urinary outflow resistance with residual urine retention
199
What percentage of men will have histologic evidence of BPH by age 80?
Up to 90%
200
Fill in the blank: The prostate normally weighs about ______ grams.
20
201
What is the common laboratory finding in chronic bacterial prostatitis?
Positive bacterial cultures
202
What is the significance of Gleason scores of 8-10?
Tend to be advanced cancers, less likely to be cured
203
What is a common treatment option that shrinks prostate size in BPH?
5α-reductase inhibitors
204
What Gleason score indicates advanced cancers that are less likely to be cured?
Scores of 8-10
## Footnote
Gleason scores are used to assess the aggressiveness of prostate cancer.
205
What is the Gleason grade range?
1-5
## Footnote
Grade 1 indicates well-differentiated neoplastic glands, while Grade 5 indicates no gland formation.
206
What characterizes Gleason Grade 1?
Well-differentiated neoplastic glands, uniform and round, packed into well-circumscribed nodules
207
What characterizes Gleason Grade 5?
No glands, tumor cells infiltrating stroma in cords, sheets, and solid nests
208
What is the prognosis for Gleason grade group 1?
Excellent prognosis, no metastases
score < 6
209
What is the Gleason score for Grade group 2?
3 + 4 = 7
210
What is the prognosis for Gleason grade group 2?
Very good prognosis, rare metastases
211
What distinguishes Gleason grade group 3 from group 2?
Predominantly poorly-formed/fused, cribriform glands with a lesser component of well-formed glands compared to grade 2
212
What is the Gleason score for Grade group 4?
8 (4 + 4/3 + 5/5 + 3)
213
What characterizes Gleason grade group 4?
Only poorly formed/fused/cribriform glands OR predominantly mix of well-formed glands and lack of glands
214
What is the Gleason score range for Grade group 5?
9 – 10 (4 + 5/5 + 4/5 + 5)
215
What characterizes Gleason grade group 5?
Lack gland formation (or with necrosis) with or without poorly formed/fused/cribriform glands
216
What is the pTNM designation used for in prostate cancer?
Staging based on tumor extent and presence of nodal or distant metastasis
217
What does pT2 indicate?
Organ confined
218
What does pT3b indicate?
Tumor invades seminal vesicles
219
What does Nx signify in regional lymph node classification?
Regional nodes not accessed
220
What does M1b indicate in distant metastasis classification?
Bone metastases
221
What is a common method for confirming a prostate cancer diagnosis?
Transrectal needle biopsy
222
What is the role of serum PSA in prostate cancer?
Assist diagnosis and management, but controversial as a screening test- lacks sensitivity and specificity
223
What is the normal range of serum PSA for a 40-year-old?
<2.5 ng/ml
224
What is PSA density?
Ratio of serum PSA and volume of prostate gland
225
What does a lower percentage of free PSA indicate?
Higher risk of cancer
226
What can cause serum PSA levels to rise?
* Cancer
* BPH
* Prostatitis
* Infarct
* Instrumentation
* Ejaculation
227
What type of prostate cancer has a relatively poor prognosis?
Ductal adenocarcinoma
228
What is the most aggressive variant of prostate cancer?
Small-cell carcinoma (neuroendocrine carcinoma)- rapidly fatal
229
What is the most common tumor to secondarily involve the prostate?
Urothelial cancer
230
non-germ cell tumors are usually derived from what?
sex cord or stroma
231
ITGCNs are thought to arise how?
in utero and stays dormant until puberty and assoc. w/ germline variants in KIT which provides the precursor lesion of GCT (ITGCN)
232
describe the histologic structures of classic seminoma.
demarcated lobules divided by a fibrous septa
septa infiltrated w/ lymphocytes
granulomas may also be present
233
describe the morphologic features of class seminoma.
polyhedral large cells w/ clear cytoplasm, pale nucleus and 2 prominent nucleoli
234
how does the genetic profile for spermatocytic tumors differ from the classic seminoma tumors.
spermatocytic lacks i12p and is instead assoc. w/ ch. 9q
does not arise from ITGCN
235
What types of cells are seen in spermatocytic tumors>
inflammatory infiltrates and syncytiotrophoblasts
236
T or F: unlike seminoma, embryonal carcinoma will grossly exhibit hemorrhagic and necrotic tissues.
true
237
how does embryonal carcinoma spread?
through the tunica albuginea and into the epididymis and spermatic cord
238
describe the histologic features of embryonal carcinoma.
lare, anaplastic cells of different sizes
vascular-lymphatic invasion
239
T or F: seminoma stains + for cytokeratin.
false
embryonal carcinoma stains + for cytokeratin
240
what tumor is reminiscent of primitive glomeruli?
yolk sac tumor
these are referred to as schiller-duval bodies
241
postpubertal teratomas are commonly assoc. w/ what?
germ cell neoplasia in situ or i12p unlike prepubertal teratomas
242
although rare, postpubertal teratomas can transform into somatic (non-germ cell) tumors. What malignancy is the most common transformation?
sarcoma
243
what conditions are assoc. w/ sertoli cell tumors?
PJ syndrome, familial adenomatosis polyposis syndrome
244
Leydig cell tumors are assoc. w/ what conditions?
klinefelter, cryptorchidism, renal cell carcinoma syndrome
245
sertoli cell tumors are derived from what?
the sex cord
246
leydig cell tumors are derived from what?
stroma
247
unlike sertoli cell tumors which remain hormonally silent, leydig cell tumors can cause what?
precocious sexual development and gynecomastia
248
primary testicular lymphoma is the most common testicular neoplasm in what group of male pts.?
men aged > 60 yrs.
249
prostatic hyperplasia commonly arise in which zone?
transition zone
250
T or F: the gold standard for identifying the pathogen in acute bacterial prostatitis is a biopsy.
FALSE!!!!!
this can cause sepsis and is an absolute CI
251
If a pt. presents w/ all the symptoms of chronic prostatitis but bacteria Cxs come back negative, what is your DDx?
chronic pelvic pain syndrome
252
what can cause granulomatous prostatitis?
fungal infections of the prostate
ruptured prostatic ducts and acini
instillation of BCG for treatment of bladder cancer (most common)
253
what extra prostatic organs secrete testosterone via Type 1 5alpha-reductase?
liver and skin
254
T or F: estrogens contribute to BPH by tipping balance towards proliferation.
true
255
compare and contrast the gross differences b/t prostatic stromal and glandular hyperplasia.
stromal:
pale-grey
very firm
no exudates
glandular:
yellow-pink
soft
milky white exudates
256
what are corpora amylacea?
small, carbohydrate-rich structures found in various tissues throughout the body
assoc. w/ prostatic glandular hyperplasia
usually benign
257
describe the MOA of 5alpha-reductase inhibitors in the management of BPH.
shrink prostate size by inhibiting DHT synthesis
258
what are risk factors for prostatic adenocarcinoma?
western diet (rich in polycyclic aromatic hydrocarbons)
estrogens
259
unlike benign prostate neoplasms, malignant prostatic neoplasm stain positive for what?
AMACR - DNA methylator upregulated in prostate cancer
260
what is the worst gleason score?
10
261
what gleason scores are potentially treatable w/ needle biopsy?
6 or 7
