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Repro II > male pathology > Flashcards

male pathology Flashcards

1
Q

hypospadias

A

ventral/inferior opening of urethra
common
associated with constriction UTIs

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2
Q

epispadias

A

dorsal/superior opening of urethra
less common
almost always associated with extrophy of bladder
associated with constriction UTIs

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3
Q

phimosis

A

excessive retraction of foreskin
congenital or acquires s/d recurrent infection in uncircumcised adults
may lead to paraphimosis (strangulation of venous flow)

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4
Q

vesicoureteral reflux

A

short intramural ureter gives poor flap-valve fnx -> reflux of urine into bladder
recurrent UTIs

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5
Q

extrophy of bladder

A

failure of cloacal membrane development occurs at same time as lower abdominal wall formation so bladder at surface
associated with epispadias of penis
surgical repair

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6
Q

testicular descent

A
  • testes appear on urogenital ridge in month 2
  • coelomic cavity envaginates into scrotal swelling forming processes vaginalis in month 3
  • testes begin descent into scrotum guided by gubernaculum in month 7
  • processes vaginalis obliterates after birth
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7
Q

communicating hydrocele

A

patent inguinal canal allows for peritoneal fluid to drain into scrotum more common on R

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8
Q

non-communicating hydrocele

A

usually older children and adults

may be idiopathic or secondary to epididymitis, orchitis, testicular torsion, trauma, or tumor

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9
Q

varicocele

A

dilated and tortuous vv of papiniform plexus more common on L
only 10-15% of fertility issues

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10
Q

spermatocele

A

aka epididymal cyst

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11
Q

Tumor on PE

A

Firm
does not transilluminates
does not increase with valsalva maneuver

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12
Q

varicocele on PE

A

bag of worms
does not transilluminate
does increase with valsalva maneuver

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13
Q

noncommunicating hydrocele

A

fluid filled
does transilluminate
does not increase with valsalva maneuver

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14
Q

communicating hydrocele

A

fluid filled
does transilluminate
does increase with valsalva maneuver

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15
Q

spermatocele

A

small soft and localized cyst
does transilluminate
does not increase with valsalva maneuver

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16
Q

balanoposthitis

A

inflammation of foreskin and glands d/t poor hygiene
caused by multiple organisms
smegma
may cause phimosis

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17
Q

circinate balanitis

A

assocaited with Chlamydia, reactive arthritis (Reiter syndrome)
painless ulcers resolve in months

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18
Q

LS&A

A

same as in women
autoimmune
can cause painful erections and narrowing of urethra

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19
Q

condyloma accuminata

A

HPV

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20
Q

CIS

A

bowen disease, bowenoid papulosis, erythroplasia of querat

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21
Q

bowen disease

A

red or gray plaque on shaft

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22
Q

erythroplaisa of querat

A

shiny soft red plauqes on glans and foreskin

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23
Q

bowenoid papulosis

A

multiple reddish-tan papules in young adults

DO NOT invade

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24
Q

high risk HPV

A

incorporate into host DNA where viral E6 gene oncoprotein inactivated host p53 gene and E7 inactivated pRB

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25
Q

invasive squamous cell carcinoma

A

rare
slow growing painless tumor
prognosis depends on spread to lymph nodes

26
Q

risk factors for invasive squamous cell carcinoma

A 
lack of circumcision 
association with HPV 16&18
40-70
association with smoking
inflammatory conditions LS&A
27
Q

pearly penile papules

A

normal variant
appears in 2nd-3rd decade
usually goes away
2 rows of papules

28
Q

cryptorchidism

A

failure of testes to descend
associated with kleinefelters, prematures birth, and FHx
at risk for testicular CA, trauma, torsion, and infertility
must be surgically corrected

29
Q

2 embryological phases of testical development

A
  • transabdominal: at 6 wks sertolid cells -> MIS/AMH -> regression of female organs then at 9 wks leydig cells produce T -> wollifian duct develops into male genitalia -> testis up in lower abdomen
  • inguinal-scrotal: androgen driven craniosuspensory ligament dissolves gubernaculum guides testis into scrotum
30
Q

cryptorchid histo

A

hyperplasia of leydig cells
peritubulor fiborisis
few sertoli cells

31
Q

prune belly syndrome

A

aka eagle-barrett syndrome
abdominal mm deficiency
severe uriary tract abnormalites
b/l cryptorchidism

32
Q

epdidymitis

A

bacteria: gonorrhea, chlamydia, may get abscesses, in older men may see E. coli from UTI
TB- palpable enlargement

33
Q

benign testicular tumors

A

sertoli cell tumors
sex cord stromal tumors (usually benign)
leydig cell tumors

34
Q

malignant testicular tumors

A

germ cell tumors (90% of tumors)

rare germ cell tumors

35
Q

common germ cell tumors

A

seminoma
embryonal-NSGCT
mixed (seminoma +NSGCT)

36
Q

rare germ cell tumors

A 
yolk sac tumor
teratoma
spermatocytic seminoma
embyronal carcinoma
choriocarcinoma 
all respond well to chemo with good prognosis
37
Q

genetic marker of germ cell tumors

A

i(12p)

38
Q

risk factors for germ cell tumor

A 
cryptorchisdim
prior GCT
FHx- KIT & BAK
whites>blacks 5:1
borthers 8-10x increased risk
39
Q

pathogenesis of GCT

A

precursor malignant cell develops in fetus and is activated and puberty called intratubular germ cell neoplasia (ITGCN=CIS) -> progression
mets to periaortic abdominal nodes

40
Q

serum markers of GCT

A

seen in 60%
HCG
LDH
alpha fetal protein

41
Q

seminoma

A

most common 50%

slow growing late spread 75% stage I at Dx

42
Q

serum markers of serminoma

A

LDH- nonspecific marker of tumor
HCG- presence of synctiotrophoblasts
AFP- never seen in pure seminoma, must be mixed or NSGCT

43
Q

Tx of seminoma

A

sperm preserved
stage
radical orchiectomy with lymph node dissection
if no mets (low risk) - radiation
if mets (intermediate risk) - platinum based chemo

44
Q

seminoma histo

A

fried eggs nested in fibrotic tissue admixed with lymphocytes

45
Q

spermatocytic seminoma

A 
rare tumor 
>65
slow growing
no mets
\
46
Q

non-seminomatous germ cell tumors (NSGCT)

A

50-60% mixed
more aggressive then seminoma with worse prognosis
may have hematogenous spread before lymph spread

47
Q

leydig cell tumors

A

present as testicular masses in young adults
produce sex hormones
usually androgens and may produce estrogens
90%benign

48
Q

sertoli cell tumor

A

present as scrotal masses in young adults
1/3 have gynecomastia
benign

49
Q

acute prostatitis

A 
not very common
same bacteria as acute ITIs
throught to arise from reflux of urine or iatrogenic implant
presents as fever and chills dysuria
abx
50
Q

chronic bacterial prostatitis

A

pts often have Hx of recurrent UTIs, dysuria, localized pain

Dx with PMNs in urine + culture

51
Q

granulomatous prostatitis

A

most are secondary to ruptures acini

most common cause in BCG for TCC

52
Q

BPH

A

enlargement of prostate in transition zone

stromal cells make 5hydroxy-reductase with converts T -> DHT -> increased GFs

53
Q

Tx of BPH

A

alpha-blockers to decrease smooth mm tone
5-alpha reductase inhibitors
tissue destruction

54
Q

complications of BPH

A

obstruction of bladder (cystitis, peylonephritis, obstructive nephropathy)
infection of internal genitalia
urosepsis

55
Q

adenocarcinoma of prostate

A

most common Dx non-cutaneous CA in men

2nd leading cause of CA death

56
Q

risk factors for adenocarcinoma of prostate

A

> 50
african american
FHx

57
Q

pathogenesis of adenocarcinoma of prostate

A

androgen dependent
multiplicity of genetic mutations
prostatic intraepithlial neoplasm precursor lesion

58
Q

screening for adenocarcinoma of prostate

A

DRE 70% of nodules are in post lobe

PSA

59
Q

interpreting PSA values

A

PSA density- PSA increases with size of prostate
PSA velocity- if changed significantly in 18 months more likely CA
Free PSA- CA PSA usually binds proteins, therefore if most of PSA is free more likely benign

60
Q

gleason grading system

A

tumor classified 1-5 with 5 worst

61
Q

staging TMN system

A

T score- most important in extracapsular extension
T2 confined 90% 5 yr
T3 extracapsular
T4 adjacent organs 10% 5 yr

Repro II (20 decks)

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