Male Pathology Syndromes: Gupta

Question 1

Hypospadia and Epispadia

Answer 1

in the male it’s an abnormal development of the urethra:
hypospadia - opens to ventral aspect of penis
epispadia - opens to dorsal aspect of penis

Question 2

Balanitis and Balanoposthitis;

Causes

Answer 2

Balanitis = inflammation of the glans penis
Balanoposthitis = inflammation of the overlying prepuce (foreskin)
Causes include candida, anaerobes, gardnerella, pyogenic bacteria
*Most cases occur as a consequence of poor local hygiene in uncircumscised males

Question 3

Phimosis

Answer 3

a condition in which the prepuce cannot be retracted easily over the glans penis; can be normal but becomes pathologic when interfering with normal function

Question 4

Squamous cell carcinoma of the penis

Answer 4

• assoc’d with HPV infection and most cases occur in uncircumcised males
• ulceration on the glans or shaft of penis
• can spread to inguinal nodes and rarely to distant sites

Question 5

Cryptorchidism

Answer 5

• failure of testicular descent from the abdomen into the scrotum
• unknown cause
• assoc’d with 3-5 fold inc. risk of testicular cancer

Question 6

Testicular atrophy

Answer 6

testes diminish in size and may be accompanied by loss of function

Question 7

Inflammatory lesions of the testes

Answer 7

• more common in the epididymis
• can be caused by UTI spread through the vas deferens, mumps infection (20% adult males, rarely in kids), or TB
• UTI spread - NT infiltrate
• mumps - lymphoplasmacytic inflammatory infiltrate
• TB - granulomatous infiltration and caseous necrosis

Question 8

Testicular torsionw

Answer 8

• the obstruction of testicular venous drainage leaving the arteries patent; this is a urologic emergency because there’s about 6hrs to fix it or the testes may not remain viable
• neonatal = in utero or shortly after birth
• adult = sudden onset of pain where there’s an anatomic defect allowing for increased motility

Question 9

Seminoma

in testes

Answer 9

• a malignant germ cell tumor of the testicles; may or may not have syncytiotrophoblasts but that doesn’t affect prognosis
• 40-50yo’s
• will see sheets of polygonal cells with LCs in the stroma

Question 10

Embryonal carcinoma

in testes

Answer 10

• malignant tumor of undifferentiated cells and primitive gland-like structures
• nuclei are large and hyperchromatic
• primary can be small but metastatic and pure cases are rare, typically mixed cell types

Question 11

Yolk sac tumor

in testes

Answer 11

• tumors often have eosinophilic hyaline globules in which alpha-1-antitrypsin and AFP can be demonstrated
• contain Schiller-Duval bodies
• often children

Question 12

Choriocarcinoma

in testes

Answer 12

• tumor contains cytotrophoblastic (central nuclei) and syncytiotrophoblastic cells (multiple dark nuclei embedded in eosinophilic cytoplasm)
• hemorrhage and necrosis are prominent

Question 13

Teratoma

in testes

Answer 13

• germ cell tumor which can have mature or immature elements
• pure teratomas are second only in frequency to yolk sac tumors in kids
• can occur at any age but in pre-pubertal males - usually benign; if in post-pubertal males usually malignant

Question 14

3 Major conditions of the prostate

Answer 14

1. Prostatitis
2. BPH/Nodular Hyperplasia
3. Carcinoma

Question 15

Prostatitis

Answer 15

bacterial infection of the prostate, most common organism is E. coli or another Gram-neg rod; may be chronic or acute; will have NT infiltration of the prostate

Question 16

BPH (aka Nodular Hyperplasia)

Answer 16

• proliferation of benign stromal and glandular elements
• major stimulus for proliferation is DHT
• can form nodules which compress the urethra; sx include hesitancy, urgency, nocturia, and poor stream
• chronic obstruction predisposes to UTIs

Question 17

Carcinoma of the prostate

Answer 17

• cancerous tissue becomes more solid and white than the spongy normal prostate
• Grading is by the Gleason system; correlates with pathologic stage and prognosis
• IHC stains will show normal basal cells in normal glands and NO basal cells in malignant glands but inc. expression of racemase (red cytoplasmic stain)
• men over 50y; accounts for 25% of cancer in US (2009)
• androgens, heredity, environmental factors, and acquired somatic mutations have found to have a role in pathogenesis

Question 18

Double/Bifid ureter

Answer 18

congenital - multiple or split ureters; most are unilateral and no clinical significance

Question 19

Ureteropelvic junction (UPJ) obstruction

Answer 19

• anything obstruction the UPJ; it’s the MCC of hydronephrosis (cystic dilation and enlarged kideys) in infants/kids
• can be caused by: abnormal organization of smooth muscle bundles at the UPJ; deposition of collagen between smooth muscle bundles; or extrinsic compression of UPJ by renal vessels
• seen in males, bilateral (20%), assoc’d with other congenital abnormalities

Question 20

Diverticular of the ureter

Answer 20

(Diverticula = saccular outpouchings of the ureteral wall)

• these are uncommon; may be congenital or acquired
• typically asymptomatic but can cause urinary stasis and lead to recurrent infections

Question 21

Urothelial carcinomas

Answer 21

• primary malignant tumors of the ureter resemble those arising in the renal pelvis, calyces, and bladder
• occur most often in people in their 50s/60s and cause obstruction of the ureteral lumen
• can be multifocal and often occur concurrently with similar neoplasms in the bladder or renal pelvis

Question 22

Urinary obstruction:

• what can cause obstruction
• what does obstruction lead to

Answer 22

• Causes:
  Intrinsic = caliculi, strictures, tumors, blood clots, neurogenic
  Extrinsic = pregnancy, periureteral inflammation, endometriosis, tumors
• May lead to: hydroureter, hydronephrosis, pyelonephritis; kidney involvement is a major consequence

Question 23

Sclerosing Retroperitoneal Fibrosis

Answer 23

• sclerosis of the RP that can cause ureteral narrowing or obstruction
• uncommon, occurs in middle-late age males
• may be related to IgG4 diseases, with plasma cells that produce IgG4; assoc’d w/ Riedel’s thyroiditis?

Question 24

Vesicoureteral reflux

Answer 24

the backward flow of urine from the bladder into the kidneys; the most common and serious congenital anomaly as it contributes to renal infection and scarring

Question 25

Exstrophy of the bladder

Answer 25

developmental failure in the anterior wall of the abdomen and the bladder, so that the bladder directly communicates with the surface of the body, or lies as an opened sac

Question 26

Urachal anomalies

Answer 26

• the urachus (normally connects fetal bladder with the allantois) is normally obliterated at birth, but sometimes remains patent
• totally patent = fistulous urinary tract connects bladder with umbilicus
• partially patent = urachal cysts; cysts may give rise to carcinomas (if you have a pt with bladder tumor and cyst, it’s likely connected)

Question 27

Cystitis: Malakoplakia

Answer 27

• inflammatory condition that causes raised mucosal plaques (non-neoplastic); filled with foamy MPs and occasional MNGC and LCs
• the MPs have abundant granular cytoplasm 2/2 phagosomes stuffed with particulate and membranous debris of bacterial origin
• Michaelis-Gutmann bodies also present = mineralized concretions resulting from deposition of Ca

Question 28

Bladder Neoplasm

Answer 28

• causes include smoking, occupational carcinogens, and Schistosoma haematobium
• Schistosoma = flatworms infect the venous plexuses of the bladder and associated with development of SCC

Question 29

4 types of bladder neoplasms - and death rates

Answer 29

• Papilloma - none
• PUNLMP - none
• LGUC - 2-3%
• HGUC - 20%

Question 30

Syphilis

Answer 30

• an ulcerative genital disease/infection caused by spirochete Treponema pallidum (best seen on silver stain)
• micro: proliferative endarteritis with plasma cell inflammatory infiltrate
• primary = chancre (usually painless despite ulceration, and heal spontaneously)
• secondary = palmar rash, lymphadenopathy, chondyloma latum
• tertiary = neurosyphilis, aortitis, gummas (irregular firm mass of necrotic tissue surrounded resilient CT)
• congenital = late abortion/stillbirth, infantile (rash, osteochondritis, periostitis, lung/liver fibrosis), childhood (interstitial keratitis, teeth, CN8 deafness)

Question 31

Benign epithelial tumors of the urethra

Answer 31

• squamous papilloma
• urothelial papilloma
• inverted urothelial papilloma
• condylomas

Question 32

Urethral caruncle

Answer 32

• An inflammatory lesion that presents as a small, red, painful mass about the external urethral meatus, typically in older females.
• It consists of inflamed granulation tissue covered by an intact but extremely friable mucosa, which may ulcerate and bleed with the slightest trauma.
• Surgical excision affords prompt relief and cure.