Male repro system Gianani

Question 1

Malformation of the urethral groove and urethral canal

Answer 1

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

Question 2

Phimosis:

Answer 2

The orifice of prepuce is too small for normal retraction of the foreskin.

Question 3

Paraphimosis:

Answer 3

The foreskin is trapped behing the glans penis.

Question 4

balanitis:

Answer 4

Phimosis can be complicated by Acute and Chronic balanitis: Accumulation of smegma, acute and chronic inflammatory changes of the glans penis.

Question 5

Peyronie disease

Answer 5

benign proliferations of fibroblasts on the penis

Question 6

characteristic appearance of molluscum contagiosum

Answer 6

dome-shaped papule with dimpled center

Question 7

condyloma acuminatum of the penis

Answer 7

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

Question 8

2 distinct lesions of carcinoma in situ

Answer 8

bowen disease

bowenoid papulosis

Question 9

invasive squamous cell carcinoma of the penis - important facts

Answer 9

tends to metastasize to inguinal lymph nodes

more common in Asia, Africa, South America

circumcision cnfers protection

Question 10

Testis and Epydidimis congenital anomalies

Answer 10

except for cryptorchidism, congenital anomalies are extremely rare and include absence of one or both testes and fusion of testes (synorchism)

Question 11

cryptorchidism

Answer 11

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)

Question 12

inflammation of the epididymis/ testis

Answer 12

more common in the epididymis
gonorrhea and tuberculosis- epididymis
syphilis- affects testis first

Question 13

nonspecific epididymitis and orchitis

Answer 13

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)

Question 14

VARICOCELE

Answer 14

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

Question 15

HYDROCELE

Answer 15

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.

Question 16

Testicular Tumors

Answer 16

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)

Question 17

Testicular Torsion

Answer 17

Twisting of the spermatic cord with impairment of the testicular venous drainage can lead to testicular infarction

Question 18

Seminoma

Answer 18

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

Question 19

if an elderly person has seminoma what kind is it likely?

Answer 19

spermatocytic

rare, slow-growing

Question 20

most common testicular tumor in elderly patients

Answer 20

lymphoma

immunohistochemical positivity for CD20

Question 21

Choriocarcinoma

Answer 21

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

Question 22

the prognosis of a mixed tumor is

Answer 22

the prognosis of its worst component

Question 23

a teratoma will have

Answer 23

elements from various cellular or organoid components

Question 24

robbins summary of testicular tumors

Answer 24

• 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)

Question 25

Prostate regions

Answer 25

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

Question 26

seminoma with syncytiotrophoblasts and cytotrophoblasts =

Answer 26

seminoma plus choriocarcinoma

according to Gianani

Question 27

BPH

Answer 27

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.

Question 28

adenocarcinoma of the prostate

Answer 28

most common cancer in men

can be very aggressive or clinically insignificant

Question 29

buzz word for prostate metastasis to the bone

Answer 29

osteoblastic metastasis

Question 30

prostate cancer grading and staging

Answer 30

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.