Male Pathology Flashcards
Review: layers of the spermatic cord
Some: Skin, SubQ
Damn: Dartos muscle (very fine, thin muscle layer)
Englishman: External spermatic fascia
Called: Cremaster muscle
It the: Internal spermatic fascia
Testis: Testes (V,A,N, lymph tissue, vas deferens) OR Testis Vaginalis
_____ is the twisting of the spermatic cord, causing compression of its blood supply
Testicular torision
What is the most common cause of testicular torsion?
Bellclapper’s deformity
No one is clapping for this deformity
How can an in-utero torsion manifest in a child once they are born?
They only have 1 testis
What are common sx of torsion?
Significant and acute pain
PE signs of testicular torsion…
Cremasteric reflex = typically absent
Testis = swollen, tender, high in scrotum, transverse lie
What are dx terms for testicular inflammation and what is it usually caused by?
(Orchitis) (Orchitis-Epididymitis)
INFECTION, often in combo w/ epididymal inflammation
What are the 2 possible paths for infxn that causes orchitis?
From the bloodstream
From the vas deferens to the epididymis to the testis (Retrograde)
What are the 3 types of pathogens that can cause orchitis? (provide examples)
Bacterial and non-sexually transmitted: Staph, Strep, E. Coli
Sexually transmitted: Gonorrhea, Chlamydia, Syphilis
Viral: Usually mumps, also coxsackie or parvovirus
What are s/s of orchitis? (Local and Systemic)
Rapid onset of pain, heaviness, pain w/ urination and pain w/ bowel movement
Blood in urethral discharge
(Discharge is a disturbing word)
Testes/Scrotum appear red, swollen
(You can paint them like a jacko lantern)
Systemic sx: Fever, N/V, Malaise
Tx for orchitis?
Abx
What kind of counseling may a pt w/ orchitis need?
STD counseling (Please don’t have babies wild thang)
Fertilization counseling (both testes are affected, fertility can be affected)
- Damage to Leydig cells– testosterone
- Damage to seminiferous tubules
- Especially concerning with mumps orchitis
What are the 2 cells testicular tumors can arise from?
What kind of markers do each provide?
Germ cells (seminoma) –> make tumor markers
Non-germ cells (sertoli, leydig) –> may release testosterone
T/F Testicular CA is a dz of old people
F, it is a dz of young people
50% dx 20-34 y/o
What is the most common testicular tumor?
Seminoma
What is the cure rate and 5 year survival for testicular CA
90% survival at 5 yrs
Where is testicular CA likely to spread?
Along the abdominal aorta and IVC
*think lymph nodes *
__% of people w/ testicular CA have an extra copy of a portion of chromosome 12
80%
**Most CA cells are triploid or tetraploid, so the genetic defect seems to affect proofreading of chromosomes at the pre-mitotic checkpoint
If the CA arises from germ cells, what can testicular CA secrete?
Embryonic proteins, like β-HCG, AFP, or LDH
**Markers can be followed to monitor tx
A varicocele is the dilation of veins in the ____
Pampiniform plexus
Which testicle is more likely to have varices?
Left
sharp turn the vein has to take at the renal vein to the IVC on the L side
What is the most common cause of a varicocele?
Poor blood return from pampiniform plexus → testicular vein → central circulation
How do you tx a varicocele?
Embolize the veins
___ is a fluid collection w/in the scrotum that can occur in adults or infants.
All are caused by fluid accumulation w/in the _____.
Hydrocele
Tunica vaginalis
What are they two type of Hydroceles?
Communicating
Non-communicating
Describe how a communicating hydrocele occurs?
Tunica vaginalis remains open to the peritoneal cavity (normally it closes by 3 weeks postpartum) –> called a funicular process
A patent funicular process may increase the risk of developing a(n) ____ in men
Indirect hernia
What intra-abdominal dz processes could cause a person with a patent funicular process to have scrotal swelling?
Intraperitoneal bleeding
Ascites
Abd CA
How does a non-communicating occur?
Processus vaginalis has closed and is now a tunica vaginalis. Fluid accumulates in the tunica vaginalis before birth, and does not get reabsorbed
What can cause a non-communicating hydrocele?
A process inside the scrotum (infxn, CA, or fluid production by the tunica itself) causes fluid to build up there.
___ is an ↑ number, not size, of cells of the prostate.
Which cells are increasing in numbers?
BPH
Gland (secretory) and muscle cells
The key to urinary sx that correlate with the increasing size of the prostate is due to the ____, which seems to contain the prostate laterally, transmitting pressure of the increased growth medially.
Prostate capsule
T/F Prostate enlargement can compress the plexus branches to the bladder, or cause retrograde dysfunction of those nerves
T
What is the main cause of prostate growth?
DHT (metabolite of testosterone)
**Testosterone and DHT are responsible for the growth of prostate cells, but T decreases as men age so DTH is left
***DHT is produced even when testosterone levels go ↓
Prostate CA is most common in the what zone of the prostate?
The peripheral zone
What are risk factors for prostate CA?
What prostate related dz is NOT a risk factor?
Multiple sex partners
HSV/HPV, especially HPV 16 and 18
BPH is NOT a risk factor
Many prostate cancers ↑ production of transcription factors that eliminate ___ and ↑ odds of cellular _____.
Apoptosis
Immortality
Prostate CA is also assoc. w/ ____ that ↑ cell turnover (↑ mitotic events)
Androgens
What are histological signs of prostate CA?
↑ metastases
↓ organization
obliterated secretory spaces
____ is an inability to completely retract foreskin that covers the head of the penis
Phimosis
Like a dog with his head stuck in a sweater sleeve
What are the 3 types of phimosis?
Physiologic Phimosis
Pathologic Phimosis
Paraphimosis
In physiologic phimosis….
At birth, glans is exposable in < __% of boys
At 3 y/o, __% of boys still do not have a retractable foreskin
Typically resolved by age __
4%
10%
7 y/o
___ is a secondary phimotic condition where the glans either cannot be exposed at all or can only be exposed partially because adhesions and scar tissue prevent full exposure
What are common causes of this?
Pathologic Phimosis
Recurrent balanitis (infxn below the foreskin) improper hygiene
____ is foreskin is partially retracted but “stuck” at that position and cannot return to covering the glans
Paraphimosis
What makes Paraphimosis an emergency
Skin is so tight that venous congestion occurs distal to the ring of foreskin
Congestion causes compression of underlying penile tissue and hinders blood flow – uh oh!
What is the tx for Phimosis?
Good hygiene
Gental manipulation
Circumcision for emergencies
What are the types of penile tumors?
Papillomas (HPV: 16, 18 cause unregulated epithelial growth)
Squamous carcinoma
What are the stages of penile CA?
in situ invasive ulcerative Regional lymph nodes Metastasizes widely
____ is an acquired inflammatory condition of the penis
Peyronie’s Dz
Elbow macaroni dong
The principal manifestation of Peyronie’s dz is formation of a ___(a segment of flat scar tissue) w/in the connective tissue (tunica albugenia) of the penis
This can be felt through the penile skin and may lead to serious problems such as curved and/or painful erections.
plaque
Plaques reduce the elasticity of the penile connective tissue, which causes it to……..
(Brush your penis with crest 2x a day to reduce plaque)
bend towards the plaque region during erection
**Some men have more than one plaque, which may cause complex curvatures
(Lightning bolt penis)
Where are Peyronie’s plaques most commonly located?
Top of the penis, but they may also occur on the bottom (ventral) or side (lateral) of penis
Occasionally an extensive circumferential plaque develops→ these typically do not cause curvature but may cause a ___ deformity of the penile shaft
“wasting” or “bottleneck”
“Sir your penis looks like a bottle neck dolphin”
In severe cases, the plaque may accumulate __ and become very hard, almost like a bone.
In addition to penile curvature, many patients also report ___ or ____ of their penis.
Ca++
shrinkage or shortening (nooooo!!!!!!)
What is the cause of Peyronie’s plaques?
Unknown
Perhaps due to secondary to mild penile trauma
- Vigorous sexual activity?
- Injuries from sports or accidents?
Risk factors for Peyronie’s plaques…
DM Tobacco use Hx of pelvic trauma Poor wound healing More traumatized tissue than normal
How do you dx Peyronie’s plaques?
Sx = Pain w/ erection, abnormal appearing erection
PE: Hard plaques palpated
US or XR examination of the penis is used to characterize the plaque and check for the presence of calcification
____ is painful erection lasting >4 hours
Uncommon, usually (not due to/due to) sexual stimulation
What are the two pathophysiological causes of this condition?
Priapism
Not due to
Has to do w/ increased flow into penis vs. decreased flow out
What are the 2 types of priapism?
High-flow (non-ischemic): Result of overabundance of arterial flow
Low Flow (ischemic): Result of decreased venous drainage, usually due to vaso-occlusion
Metabolic demands w/in the penile tissue are low, where the average temperature is _____ (lower/higher) than the body.
4 degrees lower
Probably why erection can be tolerated for up to 4 hours
Metabolic needs cannot be met in (low/high) flow priapism bc of Elevated pCO2, low pO2, Acidic pH
low-flow priapism
What populations are at risk for priapism?
Viscous or occlusive blood disorders: Sickle cell, Leukemia, Polycythemia
Those on certain Rx meds
Viagra, cialis, Zyprexa, wellbutrin, coumadin
Penile/ genital injury
Spinal cord injury, blood clots, spider venoms
What is the tx for priapism?
Inhibitors of parasympathetic muscle relaxation
Intracavernous injections of vasoconstrictors
Shunting of venous blood
