Male repro system Gianani Flashcards
Malformation of the urethral groove and urethral canal
Hypospadias: abnormal urethral opening on the ventral surface of the penis.
Epispadias: abnormal urethral opening on the dorsal surface of the penis.
Ascending congenital infection and sterility
Phimosis:
The orifice of prepuce is too small for normal retraction of the foreskin.
Paraphimosis:
The foreskin is trapped behing the glans penis.
balanitis:
Phimosis can be complicated by Acute and Chronic balanitis: Accumulation of smegma, acute and chronic inflammatory changes of the glans penis.
Peyronie disease
benign proliferations of fibroblasts on the penis
characteristic appearance of molluscum contagiosum
dome-shaped papule with dimpled center
condyloma acuminatum of the penis
benign sexually transmitted wart caused by HPV. Related to the common wart, may occur on any moist mucocutaneous surface of the external genitals in either sex. HPV type 6 and less frequently type 11- most frequent agents.
can be single or multiple sessile or pedunculated, red papillary excrescences
2 distinct lesions of carcinoma in situ
bowen disease
bowenoid papulosis
invasive squamous cell carcinoma of the penis - important facts
tends to metastasize to inguinal lymph nodes
more common in Asia, Africa, South America
circumcision cnfers protection
Testis and Epydidimis congenital anomalies
except for cryptorchidism, congenital anomalies are extremely rare and include absence of one or both testes and fusion of testes (synorchism)
cryptorchidism
unilateral in most cases
histologic changes in the malpositioned testis begin as early as 2 y/o:
- arrested germ cell development
- marked hyalinization and thickening of the basement membrane
tubules –> appear as dense cords of hyaline connective tissue outlined by prominent basement membranes.
Leydig cells spared- appear to be prominent.
cryptorchid testis- small in size, firm in consistency (fibrotic changes)
inflammation of the epididymis/ testis
more common in the epididymis
gonorrhea and tuberculosis- epididymis
syphilis- affects testis first
nonspecific epididymitis and orchitis
related to infections in the urinary tract (–> via vas deferens or lymphatics of the spermatic cord to epididymis)
in childhood usually associated with a congenital genitourinary abnormality and infection with gram-negative rods.
C trachomatis and N. gonorrhoeae are most frequent culprits in under 35 y/o sexually active
over 35- E. coli and pseudomonas (urinary tract pathogens)
VARICOCELE
Abnormal dilation and tortuosity of veins in pampiniform plexus of spermatic cord, probably due to insufficiency of venous valves
More common on the left
Rule out mesothelioma
HYDROCELE
Accumulation of clear serous fluid between visceral and parietal layers of tunica vaginalis; associated with trauma and epididymitis
make sure you are not missing an underlying tumor.
Testicular Tumors
in 15-34-year old group, testicular germ cell tumors constitute the most common tumor of men and cause approximately 10% of all cancer deaths.
Environmental factors
Genetic factors
Most testicular germ cell tumors originate from a precursor lesion called intratubular germ cell neoplasia (ITGCN)
Testicular Torsion
Twisting of the spermatic cord with impairment of the testicular venous drainage can lead to testicular infarction
Seminoma
most common type of germ cell tumor, about 50% of them.
germ cell tumors can also occur in the brain and mediastinum
germ cell tumors can be pure or mixed
if an elderly person has seminoma what kind is it likely?
spermatocytic
rare, slow-growing
most common testicular tumor in elderly patients
lymphoma
immunohistochemical positivity for CD20
Choriocarcinoma
Choriocarcinoma is a highly malignant form of testicular tumor. In its “pure” form, choriocarcinoma is rare, constituting less than 1% of all germ cell tumors.
- often cause no testicular enlargement; detected only as a small palpable nodule
- 2 cell types: syncytiotrophoblasts and cytotrophoblasts
the prognosis of a mixed tumor is
the prognosis of its worst component
a teratoma will have
elements from various cellular or organoid components
robbins summary of testicular tumors
- most common cause of painless enlargement
- go with undescended testis and testicular dysgenesis
- germ cells source of 95%; most from sertoli or leydig
- most pure ones are seminoma, embryonal carcinoma, yolk sac tumors, choriocarcinoma, and teratoma. Mixed: more than one element.
- 2 clinical groups: seminomas and nonseminomas.
- seminomas remain in testis a long time and go to paraaortic nodes, distant spread rare.
- nonseminomas spread earlier
- HCG is produced by syncytiotrophoblasts, always elevated in pts with choriocarcinomas
- AFP elevated in yolk sac tumor
- non germ cell tumors: sex cord-gonadal stroma and non-hodgkin lymphoma (most common test. tumor in older men)
Prostate regions
central
periperal
transitional
peri-urethral
most carcinomas arise from peripheral zone
nodular hyperplasia arises from the more centrally situated transitional zone and often produces urinary obstruction
seminoma with syncytiotrophoblasts and cytotrophoblasts =
seminoma plus choriocarcinoma
according to Gianani
BPH
most common benign prostatic disease in men over 50
results from nodular hyperplasia of prostatic stromal and epithelial cells and often leads to urinary obstruction
- formation of nodules in periurethral region of prsotate. Can compress and narrow the urethral canal
nodular hyperplasia is not considered to be a premalignant lesion.
adenocarcinoma of the prostate
most common cancer in men
can be very aggressive or clinically insignificant
buzz word for prostate metastasis to the bone
osteoblastic metastasis
prostate cancer grading and staging
are both important.
Gleason system is used for grading, from grade 1 to 5 the histology gets worse. Gleason : add up the two most common components of the tumor grades.
