Male Pathology - Penis and Scrotum

Question 1

Abnormal opening on the ventral surface of penis Due to faulty closure of urethral folds

Answer 1

Hypospadius (most common malformation)

Question 2

Abnormal opening on the dorsal surface of the penis Due to defect in the genital tubercle

Answer 2

Epispadias

Question 3

Orifice of prepuce is to small to retract over the head of the penis Due to prepuce scarring from prior infection

Answer 3

Phimosis

Question 4

Inflammation/infection of the glans

Answer 4

Balanitis

Question 5

Inflammation/infection of the glans and prepuce

Answer 5

Balanoposthitis Uncircumcised males with poor hygiene Accumulation of smegma leads to infection (Candida, pyogenic bacteria, and anaerobes) Inflammatory scarring may produce acquired phimosis

Question 6

Answer 6

Balanitis Xerotic Obliterans (Lichen sclerosis et atrophicus)

Question 7

A type of fibromatosis

Painful contractures of the penis

May cause infertility

Answer 7

Peyronie’s Disease

Question 8

Types of squamous cell carcinoma in situ

Answer 8

Bowen’s Disease

Erythroplasia of Queyrat

Bowenoid papulosis

Question 9

Involves the shaft of the penis and scrotum

Usually >35 yo

Associated with HPV type 16 and 18

Precursor for invasive squamous cell carcinoma (~10%)

Associated with other types of visceral cancer

Answer 9

Bowen’s Disease (Leukoplakia)

Question 10

Redness located on the mucosal surface of the glans and prefuce

HPV type 16 association

Precursor for invasive squamous cell carcinoma

Answer 10

Erythroplasia of Queyrat

Question 11

Multiple pigmented reddish brown papules on the external genitalia

Associated with HPV type 16

Does NOT develop into invasive squamous cell carcinoma

Is only CIS with no predisposition for invasion

Answer 11

Bowenoid Papulosis

Question 12

Answer 12

Normal squamous epithelium of penile skin

Question 13

Answer 13

HPV effect on penile skin

Question 14

Answer 14

Squamous cell carcinoma in situ of penile skin - No invasion

Question 15

Answer 15

Squamous cell carcinoma in situ of penile skin – No invasion

Question 16

Invasive Squamous Cell Carcinoma

Answer 16

Most common cancer of the penis

Men 40-70 yo

Common sites = glans or mucosal surface of prepuce

HPV type 16, 18 association in 2/3 of cases

Metastasizes to inguinal and iliac nodes

Question 17

What are some risk factors for Invasive Squamous Cell carcinoma?

Answer 17

Lack of circumcision

Bowen’s disease

Erythroplasia of Queyrat

Question 18

Answer 18

Squamous cell carcinoma

Question 19

Answer 19

Squamous Cell Carcinoma

Fills subepithelial tissue but does not invade corpus cavernosum (cc)

Question 20

Abnormal enlargement of the vein that is in the scrotum draining the testicles

Answer 20

Varicocele

“bag of worms”

Common cause of infertility –> heat decreases spermatogenesis

Question 21

Where do the right and left spermatic veins drain into?

Answer 21

Left spermatic vein drains into the left renal vein – blockage of L renal vein can produce a varicocele (renal cell carcinoma invading renal vein)

Right spermatic vein drains into the vena cava – blockage of R spermatic vein produces right sided varicocele (retroperitoneal fibrosis)

Question 22

Accumulation of fluid around the testis, due to fluid secreted into a potential space called the tunica vaginalis (TV)

Most common cause of scrotal enlargement (bike riders)

Answer 22

Hydrocele