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ER Week 5 > Male Pathology > Flashcards

Male Pathology Flashcards

1
Q

How big is the prostate in a normal adult weight?

A

20 grams

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2
Q

Is the prostate retro or intraperitoneal?

A

retroperitoneal

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3
Q

What are the four anatomic zones?

A

peripheral
central
transitional
periurethral

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4
Q

Which zone has most of the caricnomas?

A

peripheral zone

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5
Q

Which zone has most of the BPH?

A

transitional

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6
Q

What ar ehte three general types of prostatitis?

A

acute bacterial
chronic bacterial
abacterial

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7
Q

Acute bacterial is usually from what kind of bugs?

A

gram negative rods - same as in UTIs

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8
Q

What is the exam like in acute bacterial prostatits?

A

fever, chills, dysuria, extremely tender/boggy prostate on exam

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9
Q

How do you make the diagnosis of acute bacterial rpsotatitis

A

urinalysis

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10
Q

How will a chronic bacterial prostatitis present?

A

not as severe - non-specific symptoms like low bak pain, dysuria, or perineal pain

may see recurrent UTIs

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11
Q

How do you make the diagnosis of chronic bacterial prostatitis?

A

do a prostatic massage and then take fluid to examine microscopically - you’d see increased leukocytes

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12
Q

What is the most common cause of prostatitis today?

A

chronic abacterial

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13
Q

Who usually gets the chronic abacterial prostatitis?

A

sexually active men

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14
Q

What are the typical bugs in chronic abaterial (it just means you can’t isolate is on culture)?

A

chlamydia
mycoplasma
ureaplasma

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15
Q

Prostatitis can increase the PSA. Should you care?

A

no - just treat with antibiotics and then recheck

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16
Q

What is the incidence of BPH?

A

20% of 40 yr olds
70% of 60 yr olds
90% of 70 yr olds

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17
Q

What percentage of those with BPH become symptomatic?

A

50%

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18
Q

What are the hormonal causes of BPH?

A

dihydrotestosterone production increases in prostate stromal cells with aging - stimulate growth

Estrogen levels increase in aging - induce an increase in androgen receptors in the prostate

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19
Q

Is it a hyperplasia or hypertrophy?

A

actually more of a hyperplasia - the name is wrong

you get nodular proliferation of both glands and stroma, but it’s not pre-malignant

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20
Q

What are the lcinical features of BPH?

A 
hesitancy
urgency
frequency
decreased stream size
nocturia
terminal dribbling
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21
Q

What’s the ONE question to ask males?

A

how many times a night do you get up to go to the bathroom?

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22
Q

What are the complications of BPH?

A

obstruction
incomplete bladder emptying
infection
infarction if it outgrows its blood supply (pain)

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23
Q

What happens to the bladder wall? What is a possible proximal sequelae of this?

A

trabeculated muscular hypertropy

might hypertrophy so much that the ureteral valves might close leading to reflux of urine back up into the kidneys! this is renal nephropathy.

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24
Q

What are the mediation treatments for BPH?

A
  1. 5-alpha reductase inhibitors like Finasteride (proscar) which inhibits conversion of testosterone to DHT
  2. Alpha-1 blocker Tamsulosin (Flomax) which is a smooth muscle relaxant
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25
Q

What is the consideration for PSA screening with finasteride?

A

finasteride inhbitis PSA production, so if they’re on it, you need to multiply the PSA by 2.3 to give you the equivalent.

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26
Q

What is the side effect issue with tamsulosin in the elderly?

A

orthostatic hypotension - increases fall risk

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27
Q

What are the surgical options for BPH?

A 
TURP
cryotherapy
microwave
laser
US
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28
Q

What are the two testicular descent phases?

A

phase 1: transabdominal where it desscends to lower abdomen/pelvic brim

phase 2: inguinoscrotal - descends through the inguinal canal into scrotum

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29
Q

What hormone controls phase i?

A

mullerian-inhibiting substance

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30
Q

What hormone controls phase 2?

A

androgens

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31
Q

What percentage of preemies will have a cryptorchid testis?

A

25%

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32
Q

4-6% of newborns have patent inuginal canals, which usually closes by when?

A

3 months of age

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33
Q

Where is the most common location for cryptorchid testis?

A

70% are high in the scrotum
20% are in the inguinal canal
10% inraabdominal

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34
Q

What causes cryptochidism?

A

we don’t know - rarely seen in hormonal disorders

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35
Q

What is the concern with cryptorchidism?

A

the testicle can’t mature appropriately, so you get infertility (sterility if bileratl), and increased cancer risk

also typical to have a hernia, higher risk for crush injuries

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36
Q

What percent of cyrptorchid testis are unilateral?

A

75%

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37
Q

What are the histologic changes seen as early as 2 years in cryptocrhid testis?

A

germ cell arrest

basement membrane thickening.hyalinization

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38
Q

What do you also seein the contralateral testis/

A

often see decreased germ cells there too!

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39
Q

What class of testicular tumors are more common in cryptorchid testis?

A

germ cell tumors

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40
Q

What is the treatment fr cryptorchid testis?

A

orchiopexy - free it up and bring it down to the sctorum and tack it to the scrotal wall (otherwise it will ascend back up)

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41
Q

WHen do you want to do the orchiepexy?

A

before 2 to save fertility

before 10 to avoid cancer

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42
Q

True or false: orchiepexy before age 10 completely resolves their cancer risk

A

false - still have increased risk, even in the contralateral testis

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43
Q

What are the three general classifications of male infertility?

A

hypothalamic-pituitary
testicular
posttesticular

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44
Q

What are 4 general things that can cause testicular atrophy and testicular infertility?

A

atherosclerosis
malnutrition
irradiation
female sex hormones

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45
Q

What is Sertoli only syndrome?

A

germ cell aplasia - seen in 10-20% of biopsies in infertile males

46
Q

What levels of sperm in a ml are considered oligospermia?

A

2-20,000,000

47
Q

What are some causes of post-testicular infertility?

A

usually obstruction

  • usually due to infection in the epididymi
  • absence of the vas (especially in cystic fibrosis)
    obstruction of the vas or ejaculatory ducts
48
Q

What percent of the time is male infertility considered idiopathic after workup?

A

40%

49
Q

Bacterial epididymo-orchitis is usuallyd ue to what bugs?

A

UTI bugs in older men and STDs in younger men - Neisseria, chlamydia, mycoplasma, trponema

50
Q

What makes treponema different than the others? -

A

trponema will go right to the testis, while the others do epididymis first

51
Q

What kind of orchitis will TB cause?

A

granulomatous

rare now

52
Q

What virus can cause orchitis in particular?

A

mumps

53
Q

WHy does orchitis lead to infertility?

A

because of that tight tunic, it’s quick to become ischemic in infection - especially with abscess formation

54
Q

In torsion, is the issue with arterial supply or venous drainage?

A

venous drainage - blood can’t get back out. tunica inhibits swelling, so you get infarction

55
Q

What is the indidence of varicocele?

A

up to 25% of adults!

56
Q

Which side more commonly gets a vericocele/

A

left side, but 10-15% are bilateral

this is due to the left testicle drainage into the left renal instead of the IVC

57
Q

Why is varicocele a cause of infertility?

A

because blood is warm

58
Q

What are the general categories of testicular neoplasia?

A

germ cell tumors

sex cord stromal tumors

59
Q

What tumors are included in the germ cell tumor group?

A 
seminoma
emryonial carcinoma
yolk sac tumor
teratoma
choriocarcinoma
60
Q

What are the 4 sex cord stromal tumors?

A

sertoli cell tumor
leydig cell tumor
granulosa cell tumor
mixed

61
Q

Which is more common - germ cell or sex cord?

A

germ cell by a long shot

62
Q

Testicular cancer makes up _% of malignancies in men age 20-34.

A

30%

rest are leuikemias and lymphomas

63
Q

What ethnic gruop is at higheer risk for testicular cancer?

A

us - white:black ratio is 5:1

64
Q

True or false: most cases are familial

A

false - most non-familial and no major gene linkage are apparent

there are some familial clusters, but only in a few african tribes

65
Q

True or false: testicular cancer has a very good survival rate

A

true

66
Q

What is the precursor lesion to germ cell tumor?

A

intratubular germ cell neoplasia (CIS) - seen in almost 1% of all males biopsied in denmark

67
Q

What percent has intratubular germ cell neoplasia in cryptorchidism?

A

10%

68
Q

How about in androgen insensitivity syndrome?

A

over 25% - related to the cryptorchidism

69
Q

90% of testicular cancers will have what chromosomal thing?

A

isochromosome 12p

70
Q

What is the typical presentation for testicular cancer?

A

progressive, painless testicular enlargement

71
Q

What percentage of testicular cancer will be bilateral?

A

1-3% (higher in cryptorchidism - and can have different phenotypic expression!)

72
Q

Wat is the most common of the germ cell tumors?

A

seminona - 50% of all germ cell tumors!

good news because they’re the most curable

73
Q

The seminomas peak at what age group?

A

30s

74
Q

What is the version of seminoma in the ovary?

A

dysgerminoma

75
Q

What does a seminoma look like grossly?

A

Seminomas are fleshy masses that usually encompass the entire testicle. Very homogeneous – almost like a filleted fish.

76
Q

What do they look like microscopically?

A

Microscopically they have water-clear cytoplasm with central round nuclei and bands of fibrous tissue that criss-cross through the tumor, infiltrated by T lymphocytes.

also frequently see noncaseating granulomas

and multinucleated syncitiotrophoblasts that secrete beta hCG (makes the urologists happy because you can use it as a marker)

77
Q

What is the second most frequent form or pure germ cell tumor?

A

embryonal carcinoma

78
Q

What age group do you get embryonal carcinoma?

A

20-30

79
Q

Which is more aggressive - seminoma or embryonal carcinoma?

A

embryonal

80
Q

What do the embryonal look like grossly?

A

They typically don’t encompass the whole testis. It’s really hemorrhagic and necrotic because they’re fast-growing. Multicolored.

81
Q

Microscopically?

A

More pleomorphic – less clear cytoplasm. Tend to be more eosinophilic. Form glands often. Nuclei vary more in size and shape.

82
Q

What’s the most common testicular cancer in infants?

A

yolk sac tumors - by far

83
Q

THe yok sac recapitulates what structure?

A

endodermal sinus

84
Q

What is the classic pathology sign for yolk sac tumor?

A

schiller-duval bodies

85
Q

What do the yolk sac tumors look like grossly?

A

yellow

86
Q

What are the schiller duval bodies?

A

structure that looks like a glomrulus, but isn’t

87
Q

Yolk sacs also have eosinophilic inclusions of what?

A

alphafetoprotein (the marker!)

88
Q

What germ cells tumor do you NOT want?

A

choriocarcinoma - they’re highly malignant

89
Q

What’s the marker for choriocarcinoma?

A

beta hCG again

90
Q

WHy is the prognosis so bad?

A

usually metastasized at diagnosis - usually the presenting symptom

91
Q

Which do choriocarcinoma have - cytotrophoblasts or syncitriotrophoglasts?

A

trick questions - need both for this diagnosis

92
Q

When are teratomas benign and when are they malignant?

A

benign in a child, always malignant in the adult male

93
Q

Which is more common - a pure germ cell tumor or a mixed germ cell tumor?

A

60% will be mixed

94
Q

Seminomas really like to go to lymph nodes. Which nodes would they go to?

A

para-aortic usually, but also can get up to the mediastinal/supraclavicular nodes

95
Q

The non-seminomas tend to be hematogneous. Where will they go?

A

lung, brain, liver

96
Q

True or false: in testicular germ cell tumors, the mets can have a different histology from the primary

A

true - very weird

97
Q

Staging of testicular cancer….What is Stage 1?

A

still in the testicle
1a - confined to testis
1b - spread to adnexa
1c - spread to scrotum

98
Q

WHat is stage II?

A

involvement of retroperitoenal lymphatics

99
Q

WHat is stage III?

A

parenchymal metastases or nodes beyond retroperitoneal

100
Q

Seminomas usually present in what stage?

A

70% in stage I

101
Q

Non-seminomatous germ cell tumors uuslaly present in what wtage/

A

60% will be in stage II or III

102
Q

How do you treat seminomas?

A

they’re super radiosensitive

stage I you can do orchiectomy alone
Stage II orchiectomy with radiation or chemo (usually cisplatin)

103
Q

How do you treat non-seminoma germ cell tumors?

A

chemotherapy and possibly radiation

104
Q

Are non-germ cell testicular tumors benign or malignant

A

basically always benigh

105
Q

What two types of non-germ cell tumors that can present with gynecopastia?

A

sertoli cell tumors

leydig cell tumors

106
Q

If a man comes in with testicular cancer in his 60s, what is the likely diagnosis?

A

lymphoma or metastatic tumors (maybe seminoma)

107
Q

If it’s met, where is it probably from?

A

lung or prostate

108
Q

WHat will cause a hernia in the scrotm?

A

failure to obliterate the inguinal canal

109
Q

If there is a cystic space in the testicle obliterated on each end, what is the diagnosis?

A

hydrocele

110
Q

If the fluid has sperm in it, what is it?

A

spermatocele - a cystic mass arising from the efferent ducts

ER Week 5 (6 decks)

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