male pathology Flashcards
hypospadias
ventral/inferior opening of urethra
common
associated with constriction UTIs
epispadias
dorsal/superior opening of urethra
less common
almost always associated with extrophy of bladder
associated with constriction UTIs
phimosis
excessive retraction of foreskin
congenital or acquires s/d recurrent infection in uncircumcised adults
may lead to paraphimosis (strangulation of venous flow)
vesicoureteral reflux
short intramural ureter gives poor flap-valve fnx -> reflux of urine into bladder
recurrent UTIs
extrophy of bladder
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
testicular descent
- 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
communicating hydrocele
patent inguinal canal allows for peritoneal fluid to drain into scrotum more common on R
non-communicating hydrocele
usually older children and adults
may be idiopathic or secondary to epididymitis, orchitis, testicular torsion, trauma, or tumor
varicocele
dilated and tortuous vv of papiniform plexus more common on L
only 10-15% of fertility issues
spermatocele
aka epididymal cyst
Tumor on PE
Firm
does not transilluminates
does not increase with valsalva maneuver
varicocele on PE
bag of worms
does not transilluminate
does increase with valsalva maneuver
noncommunicating hydrocele
fluid filled
does transilluminate
does not increase with valsalva maneuver
communicating hydrocele
fluid filled
does transilluminate
does increase with valsalva maneuver
spermatocele
small soft and localized cyst
does transilluminate
does not increase with valsalva maneuver
balanoposthitis
inflammation of foreskin and glands d/t poor hygiene
caused by multiple organisms
smegma
may cause phimosis
circinate balanitis
assocaited with Chlamydia, reactive arthritis (Reiter syndrome)
painless ulcers resolve in months
LS&A
same as in women
autoimmune
can cause painful erections and narrowing of urethra
condyloma accuminata
HPV
CIS
bowen disease, bowenoid papulosis, erythroplasia of querat
bowen disease
red or gray plaque on shaft
erythroplaisa of querat
shiny soft red plauqes on glans and foreskin
bowenoid papulosis
multiple reddish-tan papules in young adults
DO NOT invade
high risk HPV
incorporate into host DNA where viral E6 gene oncoprotein inactivated host p53 gene and E7 inactivated pRB
invasive squamous cell carcinoma
rare
slow growing painless tumor
prognosis depends on spread to lymph nodes
risk factors for invasive squamous cell carcinoma
lack of circumcision association with HPV 16&18 40-70 association with smoking inflammatory conditions LS&A
pearly penile papules
normal variant
appears in 2nd-3rd decade
usually goes away
2 rows of papules
cryptorchidism
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
2 embryological phases of testical development
- 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
cryptorchid histo
hyperplasia of leydig cells
peritubulor fiborisis
few sertoli cells
prune belly syndrome
aka eagle-barrett syndrome
abdominal mm deficiency
severe uriary tract abnormalites
b/l cryptorchidism
epdidymitis
bacteria: gonorrhea, chlamydia, may get abscesses, in older men may see E. coli from UTI
TB- palpable enlargement
benign testicular tumors
sertoli cell tumors
sex cord stromal tumors (usually benign)
leydig cell tumors
malignant testicular tumors
germ cell tumors (90% of tumors)
rare germ cell tumors
common germ cell tumors
seminoma
embryonal-NSGCT
mixed (seminoma +NSGCT)
rare germ cell tumors
yolk sac tumor teratoma spermatocytic seminoma embyronal carcinoma choriocarcinoma all respond well to chemo with good prognosis
genetic marker of germ cell tumors
i(12p)
risk factors for germ cell tumor
cryptorchisdim prior GCT FHx- KIT & BAK whites>blacks 5:1 borthers 8-10x increased risk
pathogenesis of GCT
precursor malignant cell develops in fetus and is activated and puberty called intratubular germ cell neoplasia (ITGCN=CIS) -> progression
mets to periaortic abdominal nodes
serum markers of GCT
seen in 60%
HCG
LDH
alpha fetal protein
seminoma
most common 50%
slow growing late spread 75% stage I at Dx
serum markers of serminoma
LDH- nonspecific marker of tumor
HCG- presence of synctiotrophoblasts
AFP- never seen in pure seminoma, must be mixed or NSGCT
Tx of seminoma
sperm preserved
stage
radical orchiectomy with lymph node dissection
if no mets (low risk) - radiation
if mets (intermediate risk) - platinum based chemo
seminoma histo
fried eggs nested in fibrotic tissue admixed with lymphocytes
spermatocytic seminoma
rare tumor >65 slow growing no mets \
non-seminomatous germ cell tumors (NSGCT)
50-60% mixed
more aggressive then seminoma with worse prognosis
may have hematogenous spread before lymph spread
leydig cell tumors
present as testicular masses in young adults
produce sex hormones
usually androgens and may produce estrogens
90%benign
sertoli cell tumor
present as scrotal masses in young adults
1/3 have gynecomastia
benign
acute prostatitis
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
chronic bacterial prostatitis
pts often have Hx of recurrent UTIs, dysuria, localized pain
Dx with PMNs in urine + culture
granulomatous prostatitis
most are secondary to ruptures acini
most common cause in BCG for TCC
BPH
enlargement of prostate in transition zone
stromal cells make 5hydroxy-reductase with converts T -> DHT -> increased GFs
Tx of BPH
alpha-blockers to decrease smooth mm tone
5-alpha reductase inhibitors
tissue destruction
complications of BPH
obstruction of bladder (cystitis, peylonephritis, obstructive nephropathy)
infection of internal genitalia
urosepsis
adenocarcinoma of prostate
most common Dx non-cutaneous CA in men
2nd leading cause of CA death
risk factors for adenocarcinoma of prostate
> 50
african american
FHx
pathogenesis of adenocarcinoma of prostate
androgen dependent
multiplicity of genetic mutations
prostatic intraepithlial neoplasm precursor lesion
screening for adenocarcinoma of prostate
DRE 70% of nodules are in post lobe
PSA
interpreting PSA values
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
gleason grading system
tumor classified 1-5 with 5 worst
staging TMN system
T score- most important in extracapsular extension
T2 confined 90% 5 yr
T3 extracapsular
T4 adjacent organs 10% 5 yr
