Male Pathology Flashcards
Cryptorchidism is _
Cryptorchidism is failure of the testicles to descend into the scrotum
The testes begin in the _ and descend through the inguinal canal and into the scrotum by month _ of life
The testes begin in the retroperitoneum and descend through the inguinal canal and into the scrotum by month 3-6 of life
Complications of cryptorchidism include _ and _
Complications of cryptorchidism include infertility and cancer risk (seminomas)
How does cryptorchidism lead to impaired testicular function/infertility?
Increased temperature damages cells in the testis
(Sertoli/Leydig) cells are more temperature sensitive and at risk of damage from cryptochidism
Sertoli cells are more temperature sensitive and at risk of damage from cryptochidism
* Leydig cells are largely unaffected
_ and _ are risk factors that increase the risk of cryptorchidism
Prematurity and Low birth weight are risk factors that increase the risk of cryptorchidism
Cryptorchidism presents as _
Cryptorchidism presents as absence of one or both testes in the scrotum
Cryptochidism will present with the following labs:
Sperm count
Inhibin
FSH
LH
Testosterone
Cryptochidism will present with the following labs:
Low Sperm count
Low Inhibin
High FSH
High LH
Low or normal Testosterone
Bilateral cryptorchidism will cause _ testosterone levels
Bilateral cryptorchidism will cause low testosterone levels
* Unilateral will result in normal testosterone levels
Cryptorchidism often resolves spontaneously but if persistent, _ should be performed between 6 months- 2 years of age
Cryptorchidism often resolves spontaneously but if persistent, orchiopexy should be performed between 6 months- 2 years of age
The _ is an outpouching of pertitoneum that guides the testes down through the inguinal canal
The processus vaginalis is an outpouching of pertitoneum that guides the testes down through the inguinal canal
Testicular torsion is an error of the _
Testicular torsion is an error of the processus vaginalis
* Failure of the testes to attach to the inner lining of the scrotum
Testicular torsion is _
Testicular torsion is rotation of testicle around the spermatic cord
* Causes risk of testicular necrosis
Testicular torsion is most common in _ population
Testicular torsion is most common in males 12-18 yo +/ groin trauma
* Population is very active (sports, etc)
* Horizontally aligned testicles is a risk factor
Testicular torsion presents with acute and severe testicular pain with “high riding testicle” and absent _ relex
Testicular torsion presents with acute and severe testicular pain with “high riding testicle” and absent cremasteric reflex
* May also present with nausea, vomiting, abdominal pain
In neonates, we might expect to see _ in testicular torsion
In neonates, we might expect to see blue unilateral scrotal mass in testicular torsion
Testicular torsion pain is not relieved by manual elevation of the testicle; this is a negative _ sign
Testicular torsion pain is not relieved by manual elevation of the testicle; this is a negative Prehn sign
We can diagnose testicular torsion via _
We can diagnose testicular torsion via ultrasound with doppler showing absence of testicular blood flow
We manage testicular torsion with _
We manage testicular torsion with orchiopexy within 6 hours
* Manual detorsion if surgical intervention is not available
Spermatocele is an accumulation of _
Spermatocele is an accumulation of sperm
Spermatocele is caused by _
Spermatocele is caused by dilation of rete testis or epididymal ducts
* Sperm collects in these locations –> cyst formation
A spermatocele presents as a fluctuant (tender/non-tender) paratesticular nodule
A spermatocele presents as a fluctuant non-tender paratesticular nodule
A spermatocele will have a (positive/ negative) transillumination test
A spermatocele will have a positive transillumination test
Congenital hydrocele is an incomplete obliteration of the _
Congenital hydrocele is an incomplete obliteration of the processus vaginalis
Congenital hydrocele is a scrotal accumulation of _
Congenital hydrocele is a scrotal accumulation of peritoneal fluid
The most common cause of scrotal swelling in infants is _
The most common cause of scrotal swelling in infants is congenital hydrocele
Congenital hydrocele will have a (positive/negative) transillumination test
Congenital hydrocele will have a positive transillumination test
How is congenital hydrocele managed?
Congenital hydrocele will spontaneously resolve by age 1
Acquired hydrocele is a fluid accumulation in the scrotum often caused by _
Acquired hydrocele is a fluid accumulation in the scrotum often caused by infection, trauma, neoplastic activity
Varicocele is _
Varicocele is venous accumulation in the pampiniform plexus
Varicocele results from a distal blockage of the _
Varicocele results from a distal blockage of the testicular vein
The most common cause of scrotal enlargement in adult males is _
The most common cause of scrotal enlargement in adult males is varicocele
(Left/Right) sided varicocele is more common
Left-sided varicocele is more common; due to the left renal vein architecture
The pampiniform dilation seen in varicocele is often called _
The pampiniform dilation seen in varicocele is often called “bag of worms”
* It is larger with standing/valsalva
Varicocele will have (positive/negative) transillumination test
Varicocele will have negative transillumination test
We can diagnose varicocele via _ and manage it with _
We can diagnose varicocele via ultrasound showing pampiniform dilation and manage it with surgical ligation/embolization
Distortion of the penile architecture due to fibrous scar tissue following trauma is called _
Distortion of the penile architecture due to fibrous scar tissue following trauma is called peyronie’s disease
Peyronie’s disease involves fibrous scar tissue deposition in the _
Peyronie’s disease involves fibrous scar tissue deposition in the tunica albuginea
Peyronie’s disease is most often induced by _ (etiology)
Peyronie’s disease is most often induced by repeated trauma during intercourse
Peyronie’s disease often presents with _
Peyronie’s disease often presents with curved penis + erectile dysfunction (may or may not have pain)
Peyronie’s disease can be managed with _
Peyronie’s disease can be managed with collagenase injections or surgical repair
Prolonged erection resulting in penile ischemia is called _
Prolonged erection resulting in penile ischemia is called ischemic priapism
Explain the pathophysiology of ischemic priapism
- Continuous erection > 4 hours
- Mechanical obstruction of blood flow
- Penile ischemia
_ disease can be a cause of ischemic priapism
Sickle cell disease can be a cause of ischemic priapism
* Sickled RBCs block venous drainage
Medications that can cause ischemic priapism disease include _
Medications that can cause ischemic priapism include sildenafil, trazodone
Ischemic priapism presents as _
Ischemic priapism presents as erection > 4 hours + pain
How do we manage ischemic priapism?
- Corporal aspiration
- Intracavernosal phenylephrine
- Surgical decompression
Bowen disease is an in situ squamous cell carcinoma that involves _ precursor lesion
Bowen disease is an in situ squamous cell carcinoma that involves leukoplakia (white plaques) of penile shaft
Erythroplasia of Queyrat is an in situ squamous cell carcinoma that involves _ precursor lesion
Erythroplasia of Queyrat is an in situ squamous cell carcinoma that involves erythroplakia (red plaque) of the penile glans/ foreskin
Bowenoid papulosis is an in situ squamous cell carcinoma that involves _ precursor lesion
Bowenoid papulosis is an in situ squamous cell carcinoma that involves reddish papules throughout entire penis
Risk factors of squamous cell carcinoma of the penis include _ and _
Risk factors of squamous cell carcinoma of the penis include HPV infection and uncircumcised males
Benign prostatic hyperplasia is a hyperplasia of the _ and _ of the _ and _ lobes of the prostate
Benign prostatic hyperplasia is a hyperplasia of the stromal and epithelial cells of the middle and lateral lobes of the prostate
BPH is caused by high levels of _ (hormone)
BPH is caused by high levels of DHT
How does BPH present?
- Urinary frequency
- Dysuria
- Difficulty with initation and termination of urination
- Bladder distension, UTIs
Complications of BPH include:
Complications of BPH include:
* Hydronephrosis
* Bladder distension/hypertrophy
* UTIs
* Post-renal AKI
Hypospadias is an abnormal (ventral/dorsal) opening of the meatus
Hypospadias is an abnormal ventral opening of the meatus
* Meatus will more commonly be distal on the shaft/tip
Epispadias is an abnormal (ventral/dorsal) opening of the meatus
Epispadias is an abnormal dorsal opening of the meatus
Hypospadias is caused by failure of _
Hypospadias is caused by failure of the urethral folds to fuse
Hypospadias can be associated with _ testicular pathology
Hypospadias can be associated with undecended testis
Epispadias is caused by failure of _
Epispadias is caused by failure of genital tubercle to attain correct position
(Epispadias/ Hypospadias) is associated with bladder exstrophy (urologic malformation where the bladder is open on lower abdomen)
Epispadias is associated with bladder exstrophy (urologic malformation where the bladder is open on lower abdomen)
Peyronie’s disease involves fibrous plaque deposition in the _
Peyronie’s disease involves fibrous plaque deposition in the tunica albuginea
* Presents at the dorsal midline
* Often palpable mass
Peyronie’s disease is associated with _ , abnormal thickening in the hand tissues resulting in contractures
Peyronie’s disease is associated with Dupuytren’s contracture , abnormal thickening in the hand tissues resulting in contractures
Risk factors of peyronie’s disease includes _
Risk factors of peyronie’s disease includes:
* Penile trauma
* Diabetes
* Smoking
Anterior urethral injuries involve the _ urethra to the _ urethra
Anterior urethral injuries involve the penile urethra to the bulbar urethra
Perineal straddle injuries, MVCs, penetrating trauma, penile fractures are more commonly associated with (anterior/posterior) urethral injuries
Perineal straddle injuries, MVCs, penetrating trauma, penile fractures are more commonly associated with anterior injuries
Pelvic fractures are more commonly associated with (anterior/posterior) urethral fractures
Pelvic fractures are more commonly associated with posterior urethral injuries
The posterior urethra involves the _ urethra to the _ urethra
The posterior urethra involves the membranous urethra to the prostatic urethra
Penile warts are also called _ and are most commonly caused by HPV
Penile warts are also called penile condyloma ; penile condyloma acuminatum are most commonly caused by HPV (mainly 6 and 11)
Epithelial cells that are transformed by HPV are called _ on histology
Epithelial cells that are transformed by HPV are called koilocytes on histology
“Large, dark, wrinkled, rasinoid nuclei”
“Large, dark, wrinkled, rasinoid nuclei” –> Koilocytes
The most common cancer of the penis is _
The most common cancer of the penis is squamous cell carcinoma
* About 60% is HPV-dependent
* HPV 16, 18, 31, 33
70% of males over age 60 have prostatic enlargement due to rapid replication of prostate cells, known as _
70% of males over age 60 have prostatic enlargement due to rapid replication of prostate cells, known as benign prostatic hyperplasia (BPH)
BPH is most common in _ and _ zones
BPH is most common in transition zone and periurethral zone
The prostatic growth in BPH is stimulated by _ hormone
The prostatic growth in BPH is stimulated by DHT
Weak stream, intermittency, sense of incomplete emptying, straining are signs of (obstructive/irritative) issues of the bladder
Weak stream, intermittency, sense of incomplete emptying, straining are signs of obstructive issues of the bladder
Frequency, urgency, urgency incontinence, and nocturia are signs of (obstructive/irritative) issues of the bladder
Frequency, urgency, urgency incontinence, and nocturia are signs of irritative issues of the bladder
Complications of BPH:
Complications of BPH:
* Urinary retention
* Gross hematuria
* UTI
* AKI
* Bladder stones
A normal prostate is _ grams, an enlarged prostate is _ grams or larger
A normal prostate is 20-25 grams, an enlarged prostate is 30 grams or larger
What is PSA?
PSA stands for prostate-specific antigen which is a protein secreted by prostatic epithelial cells
Terazosin, tamsulosin, and silodosin are _ drugs
Terazosin, tamsulosin, and silodosin are alpha1 blockers
* Can be used for BPH
* They relax smooth muscle at the prostate to relieve obstruction
Finasteride and dutasteride are _ drugs
Finasteride and dutasteride are 5alpha-reductase inhibitors
* Inhibit enzyme that converts testosterone to DHT to reduce hyperplasia in the setting of BPH
* Can take 6-9 months to notice effect
Side effects of “-osins”
Side effects of “-osins”
* Orthostatic hypotension
* Dizziness
* Headache
* Nasal congestion
* Ejaculatory dysfunction
Side effects of “-erides” like finasteride
Side effects of “-erides” like finasteride
* Sexual dysfunction (reduced libido)
* Gynecomastia
* Depression
One surgical approach to treating BPH is TURP which is _
One surgical approach to treating BPH is TURP which is transurethral resection of the prostate
Prostatitis is _
Prostatitis is inflammation of the prostate gland, usually due to infection
Prostate feels tender and “boggy” on digital rectal exam
Prostate feels tender and “boggy” on digital rectal exam: prostatitis
Acute bacterial prostatitis is often caused by microbial infection by pathogens such as _
Acute bacterial prostatitis is often caused by microbial infection by pathogens such as E.coli, proteus, klebsiella
* Can result from prostate biopsy, catheterization
Symptoms and complications of acute bacterial prostatitis:
Symptoms and complications of acute bacterial prostatitis:
* Fever, chills
* Dysuria, frequency, urgency
* Pelvic, rectal, perineal pain/tenderness
* Complications: urinary retention, prostatic abscess
Diagnosis of acute bacterial prostatitis requires _ ; treatment involves _
Diagnosis of acute bacterial prostatitis requires urinalysis, urine culture; treatment involves fluoroquinolones or TMP-SMX
* Prostatic secretions show WBCs
* Culture reveals bacteria
Chronic colonization of the prostate gland (ie E.coli) can lead to _
Chronic colonization of the prostate gland (ie E.coli) can lead to chronic bacterial prostatitis
* Presents as dysuria with pelvic or low back pain
Risk factors for chronic bacterial prostatitis
Risk factors for chronic bacterial prostatitis:
* Cystitis
* Epididymitis
* Catheter placement
* Anal intercourse
Prostate cancer is the most common cancer in males in the US and the _ most common cause of cancer death
Prostate cancer is the most common cancer in males in the US and the second mcc of cancer death
The most common type of prostate cancer is _
The most common type of prostate cancer is prostatic adenocarcinoma
Risk factors for prostate cancer
Risk factors for prostate cancer:
* Age
* African American
* Family history
* Genetic factors (BRCA2)
Prostate cancer most often originates from the _ zone
Prostate cancer most often originates from the posterior peripheral zone, around the apex of the prostate
How does prostate cancer usually present?
Prostate cancer:
* Often asymptomatic
* Irregular nodularity on DRE
* Elevated PSA
Prostate cancer can be characterized by loss of _ on histology
Prostate cancer can be characterized by loss of basal cell layer on histology
Lymphogranuloma venereum is _
Lymphogranuloma venereum is necrotizing granulomatous inflammation of the inguinal lymphatics and lymph nodes
* Heals with fibrosis –> rectal strictures
Lymphogranuloma venereum is a sexually transmitted disease caused by _
Lymphogranuloma venereum is a sexually transmitted disease caused by Chlamydia trachomatis
* Caused by serotypes L1-L3
Orchitis is _
Orchitis is inflammation of the testicle
Name (4) common causes of orchitis
Name (4) common causes of orchitis:
1. Chlamydia trachomatis (young adults)
2. E.coli and Pseudomonas (UTI that travels)
3. Mumps (teenagers)
4. Autoimmune (granulomas in seminiferous tubules)
Left sided renal cell carcinoma invading the renal vein puts a male at risk of _
Left sided renal cell carcinoma invading the renal vein puts a male at risk of varicocele
Two categories of testicular tumors include _ and _
Two categories of testicular tumors include germ cells and sex cord-stroma
Testicular tumors will be (positive/negative) on transillumination test
Testicular tumors will be negative on transillumination test
(True/False) testicular tumors must be biopsied for diagnosis
False; we do not biopsy testicular tumors for risk of seeding the scrotum
* We just remove the testis with radical orchiectomy
* Most testicular tumors are malignant germ cell tumors
95% of testicular tumors are _ tumors
95% of testicular tumors are germ cell tumors
* Usually occur between 15-40
(Seminomas/ Nonseminomas) respond better to radiotherapy, metastasize later, and have a better prognosis
Seminomas respond better to radiotherapy, metastasize later, and have a better prognosis
* About 55% are seminomas, 45% are nonseminomas
Seminomas resemble ovarian dysgerminomas, the tumor is comprised of cells with _
Seminomas resemble ovarian dysgerminomas, the tumor is comprised of large cells with clear cytoplasm + central nuclei
* Resemble spermatogonia
(Seminomas/nonseminomas) form homogenous masses with no hemorrhage or necrosis
Seminomas form homogenous masses with no hemorrhage or necrosis
_ is a malignant tumor of the testis comprised of immature, primitive cells that may produce glands; forming hemorrhagic mass with necrosis
Embryonal carcinoma is a malignant tumor of the testis comprised of immature, primitive cells that may produce glands; forming hemorrhagic mass with necrosis
If embryonal carcinoma is treated with chemotherapy there may be _
If embryonal carcinoma is treated with chemotherapy there may be differentiation into another type of germ cell tumor (teratoma)
The most common testicular tumor in children is the _ tumor
The most common testicular tumor in children (< 3) is the yolk sac tumor
Teratomas are (malignant/benign) in males
Teratomas are malignant in males (as opposed to females)
Types of nonseminomous tumors:
Types of nonseminomous tumors:
* Embryonal carcinoma
* Yolk sac
* Choriocarcinoma
* Teratoma
* Mixed germ cell
Leydig cell tumors cause _ in male children and _ in male adults
Leydig cell tumors cause precocious puberty in male children and gynecomastia in male adults
* Leydig cells produce excess androgen
Sertoli cell tumor is comprised of _ and usually has _ effect on males
Sertoli cell tumor is comprised of tubules and usually clinically silent in males
The most common cause of testicular mass in males > 60 years old is _
The most common cause of testicular mass in males > 60 years old is lymphoma
* Typically diffuse large B-cell
* Often bilateral
PSA > _ is worrisome at any age
PSA > 10 is worrisome at any age
Decreased percent of free-PSA is indicative of _
Decreased percent of free-PSA is indicative of cancer
* Cancer makes bound PSA
Prostate cancer commonly spreads to the _ or _
Prostate cancer commonly spreads to the lumbar spine or pelvis
* Can present with low back pain
We expect _ bacteria on UA and culture for chronic prostatitis cases
We expect no bacteria on UA and culture for chronic prostatitis cases
* We have inflammation of the prostate without infection
* Due to normal flora, trauma, or autoimmune conditions
Three main types of urinary incontinence:
Three main types of urinary incontinence:
Overflow incontinence is a neurologic dysfunction of _
Overflow incontinence is a neurologic dysfunction of detrusor underactivity
Overflow incontinence is often caused by _
Overflow incontinence is often caused by obstruction, stricture
* Can be diagnosed ivia bladder US or bladder scan
Sress incontinence is due to _
Sress incontinence is due to weak outlet
* Common in individuals with a weak pelvic floor (vaginal deliveries, prostate surgery)
Leakage with increased abdominal pressure describes _ incontinence
Leakage with increased abdominal pressure describes stress incontinence
* Coughing, laughing, standing up
Urge incontinence is an issue of _
Urge incontinence is an issue of bladder overactivity
* The leakage is preceded by sense of urgency
The most common type of cancer arising in the bladder is _
The most common type of cancer arising in the bladder is urothelial carcinoma
* Can also have squamous cell carcinoma and adenocarcinoma of the bladder
The classic presentation of urothelial carcinoma is _
The classic presentation of urothelial carcinoma is painless hematuria
Urothelial carcinoma arises via two distinct pathways _ or _
Urothelial carcinoma arises via two distinct pathways flat or papillary
(Flat/papillary) urothelial carcinomas will develop as high-grade tumors that invade
Flat urothelial carcinomas will develop as high-grade tumors that invade
Flat urothelial carcinoma is aggressive and associated with early _ mutations
Flat urothelial carcinoma is aggressive and associated with early p53 mutations
Urothelial carcinoma is strongly associated with environmental carcinogen exposure such as:
Urothelial carcinoma is strongly associated with environmental carcinogen exposure such as:
* Smoking
* Aromatic amines (dyes)
* Cyclophosphamide
Bladder cancer diagnosis (or work up for hematuria) includes _ imaging
Bladder cancer diagnosis (or work up for hematuria) includes cytoscopy
Invasive urothelial carcinoma invades into the _ into deeper layers like _
Invasive urothelial carcinoma invades into the basement membrane into deeper layers like submucosa, muscularis propria
Most papillary urothelial carcinomas are _
Most papillary urothelial carcinomas are indolent (low grade)
_ and _ are two risk factors for testicular cancer
Cryptorchidism and Klinefelter are two risk factors for testicular cancer
Seminoma:
* Sheets of malignant germ cells with clear cytoplasm giving “fried egg” appearance
_ is a germ cell tumor in males that is associated with high placental alkaline phosphatase (ALP) levels
Seminoma is a germ cell tumor in males that is associated with high placental alkaline phosphatase (ALP) levels
_ contain disordered syncytiotrophoblasts and cytotrophoblastic elements and metastasis to the _ and _
Choriocarcinomas contain disordered syncytiotrophoblasts and cytotrophoblastic elements and metastasis to the lungs and brain
_ is associated with an increased fraction of free PSA
BPH is associated with an increased fraction of free PSA
* Prostate adenocarcinoma will have low fraction free PSA
BPH/ prostate adenocarcinoma may cause a post-renal AKI with labs:
BPH/ prostate adenocarcinoma may cause a post-renal AKI with labs:
High BUN
High Cr
BUN/Cr < 20
Embryonal carcinoma ‘cell markers’
AFP and hCG
