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Repro > Male Pathophys > Flashcards

Male Pathophys Flashcards

1
Q

What are the most common penile congenital abnormalities?

A

epispadias, hypospadias

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2
Q

What are epispadias and hypospadias?

A

abnormal openings of the urethra on the dorsal/ventral penis from malformation of the urethral canal

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3
Q

How common are hypospadias?

A

1/300 births

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4
Q

What are the clinical implications of hypo/epispadias?

A

urethral obstruction or failure of normal ejaculatory function

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5
Q

Inflammation of the penis is most commonly due to ______.

A

phimosis (inability to easily retract the foreskin) or veneral disease

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6
Q

What is posthitis?

A

foreskin inflammation

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7
Q

What is balanitis?

A

glans inflammation

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8
Q

T or F Phimosis is prone to infection, commonly Candida. #

A

T

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9
Q

When is phimosis physiological?#

A

until 3 years of age

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10
Q

When do phimosis occur and what is the treatment?#

A

uncircumcised males that experience chronic infections and inflammation of the glans, sometimes due to poor hygiene. Broad-spectrum antibiotics/circumcision

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11
Q

What patient population is squamous cell carcinoma of the penis seen in?

A

uncircumcised, unhygienic males, linked with warts and high risk HPV

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12
Q

What does circumcision do to HIV transmission?

A

Decreased in 57% (not applicable for sex with men)

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13
Q

_____ are warty, cauliflower like growths which occur primarily in the anogenital region.

A

Condyloma acuminata

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14
Q

How is condyloma transmitted? What is the prognosis?

A

venereally transmitted, caused by HPV6 or 11, not pre-malignant but tend to recur despite vigorous therapy

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15
Q

Describe the appearance of condyloma histologically?

A 
exuberant exophytic growth pattern of the papillary lesion. Growth is orderly and there are very few mitoses and no necrosis
#Epidermal hyperplasia and koilocytosis (cytoplasmic vacuolization around pyknotic nuclei
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16
Q

Squamous carcinoma in situ on the penile skin is called _____.

A

Bowen disease

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17
Q

Squamous carcinoma in situ on the glans is called _____.

A

Erythroplasia of Queyrat

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18
Q

80% penile carcinoma in situ is due to what? What is the prognosis?

A

HPV type 16. 10% will progress to squamous carcinoma

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19
Q

Describe the appearance of Bowen’s and erythroplasia of queyrate

A

Painless, nonulcerated
#
Bowens: Intraepithelial, gray, solitarty, crusty plaque on penis or scrotum
EOQ: red, velvety plaques that typically involve the glans

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20
Q

Histological appearance of penile carcinoma in situ

A

anywhere…hyperkeratosis with disordered maturation and elongation of rete ridges and thickening of epidermis. Mitotic figures seen too high up.

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21
Q

Squamous cell carcinoma is related to _____ 50% of the time. What are other risk factors?

A

HPV- most commonly 16 and 18. poor hygiene and cigarette smoking

22
Q

Describe the presentation of cryptorchidism

A

1% of one year old boys. 75% are unilateral. There may be other abnormalities.

23
Q

What are the phases of normal testes descent? In which stage does failure occur?

A

Transabdominal phase: mediated by MIF, to brim of pelvis. Failure here in 5-10% of cases
Inguinoscrotal phase: mediated by hCG, androgen induced release of cacitonin-gene related peptide. Failure here in 90-95% of cases

24
Q

What are 3 complications with cryptorchidism

A

Inguinal testis is susceptible to trauma, sterility, neoplasms

25
Q

Describe complication of sterility with cryptorchidism

A

Decreased spermatogenesis in BOTH testes in unilateral cryptorchidism
Systemic mechanism, poorly understood (not just “overheated testis”)
Orchiopexy before age 2 improves (but does not guarantee) chances of normal spermatogenesis

26
Q

Describe complication of neoplasm with cryptorchidism

A

5-10 fold increase in risk of germ cell malignant neoplasm in cryptorchid testis
Some increased risk in contra lateral normally descended testis
Both risks are reduced but not totally eliminated by orchiopexy

27
Q

What is the genetic abnormality in Klinefelters?

A 
Abnormal number of X chromosomes (80% have XXY) and primary gonadal  insufficiency. 
#: each additional X correlates with an increasingly abnormal phenotype and with more severe mental retardation.
28
Q

Frequency of Klinefelters

A

1/1000-1400 live male births. 1/100 pt in mental institutions, 3.4/100 infertile men

29
Q

Clinical presentation of Klinefelters?

A 
Eunuchoid appearance with increased stature and small to normal sized well developed testes. Incomplete virilization, gynecomastia, mental retardation, speech difficulties, 
#: female hair distribution, elevated urinary gonadotropins, developmental delay
30
Q

Histology in Klinefelters?

A

small, hyalinized seminiferous tubules, pseudoadenomatous clusters of leydig cells. They only appear to be increased in number though because the decreased testicular volume.

31
Q

What clinical associations are seen with Klinefelters

A

increased incidence of extragonadal germ cell tumors (mediastinum>pineal gland, CNS, retroperitoneum) as well as hypopituitarism

32
Q

How does biopsy look for Klinefelters histologically?

A

small hyalinized seminiferous tubules and pseudo-adenomatous clusters of Leydig cells.

33
Q

What is the most infectious cause for focal atrophy of testicular tubules?

A

mumps orchitis

34
Q

Describe orchitis with mumps

A

Mumps infection post puberty may be complicated by orchitis in a fourth to a third of cases. In general, the orchitis is unilateral and patchy so that sterility following infection is uncommon.

35
Q

Describe epididymitis

A

epididymitis is a frequent cause for scrotal pain and swelling in adult males and is most likely to be the result of a sexually transmissible disease such as Chlamydia trachomatis or Neisseria gonorrheae in younger males or gram negative bacteria from urinary tract infection of older males. Disseminated tuberculosis may occasionally involve the epididymis

36
Q

Describe tertiary syphillis

A

Tertiary syphilis more often involves the testis first, then the epididymis; the micrograph shows a silver stain of testis with numerous spirochetes.

37
Q

Describe spread of gonorrhea

A

spreads retrograde from the urethra to the prostate, seminal vesicles, epididymis, and prostate.

38
Q

Describe spread of tuberculosis

A

tuberculosis spreads retrograde from the prostate to the epididymis, then to the testis.

39
Q

What is idiopathic granulomatous orchitis?

A

Idiopathic granulomatous orchitis is an uncommon inflammatory testicular lesion that follows a gram negative urinary tract infection in the majority of cases.

40
Q

When is idiopathic granulomatous orchitis most prevalent?

A

5th and 6th decade

41
Q

What part of the testes is involved with idiopathic granulomatous orchitis

A

Testicular involvement is usually diffuse but may also present as a localized nodular lesion and may simulate a testicular neoplasm. The epididymis and spermatic cord may also be involved.

42
Q

Describe idiopathic granulomatous orchitis histologically

A

The inflammatory process is predominantly intratubular with the cellular infiltrate containing a majority of histiocytes admixed with lymphocytes and plasma cells. Giant cells may also be present. The predominance of histiocytes imparts a granulomatous appearance but distinct granulomas are not formed. Non-specific chronic interstitial inflammation is also a feature of this condition.

43
Q

How can you tell the difference between granulomatous orchitis vs infectious orchitis and sarcoidosis?

A

intratubular localization of inflammation

44
Q

T or F Necrosis is a common feature of granulomatous orchitis

A

False. Not seen

45
Q

______ has rapid onset of testicular enlargement middle aged men which may be associated with febrile illness. What does histo show?

A

Autoimmune orchitis: granulomas without organisms

46
Q

Causes of testicular regression

A

V—Vascular conditions bring to mind varicoceles, which cause atrophy on the side of the dilated veins.
I—Inflammation recalls the atrophy following mumps orchitis and other causes of epidydimoorchitis.
N—Neoplasms suggest the atrophy that occurs in the estrogen treatment of prostatic carcinoma.
D—Degenerative suggests the atrophy resulting from aging.
I—Intoxication should remind one of the atrophy resulting from chronic alcoholism, Laennec cirrhosis, and hemochromatosis. X-ray exposure may also produce atrophy.
C—Congenital recalls undescended testes and torsion.
A—Autoimmune and allergic suggest nothing.
T—Trauma reminds one of the atrophy following vasectomy and accidental ligation of the blood supply during hernia repair.
E—Endocrine suggests the atrophy of hypopituitarism, Klinefelter syndrome, and other eunuchoidal states

47
Q

_____ is twisting of the spermatic cord, leading to ischemia and venous stasis.

A

torsion

48
Q

T or F. Torsion is a true urologic emergency, since surgery within 4-6 hours may save the testis; after that, hemorrhagic infarction with obliteration of the testis is inevitable if reduction of the torsion is too late.

A

T

49
Q

What predisposes to torsion?

A

anatomic abnormality which allows the testis excess mobility within the scrotum (“bell clapper phenomenon”); this abnormality may be bilateral, which is why there is a risk of contra lateral torsion in a patient who has torsion.

50
Q

What is the most common cause of testicular regression?

A

age

51
Q

T or F. The primary syphillis lesion is itchy and uncomfortable.

A

F: the primary syphillis lesion is painless.

52
Q

What is phimosis? What is paraphimosis?

A

Phi: inability to easily retract foreskin
Para: inability to reduce a retracted foreskin`

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