Male Reproductive Pathology Flashcards
where do most cases of BPH occur?
Transitional Zone!!!
where do most cases of carcinomas occur? and why?
Peripheral zone! 70% of gland mass
what types of bacteria cause acute prostatitis?
mostly Gram-negative rods (same organisms as UTIs: Proteus and E.coli)
what digital rectal exam finding do you find in acute bacterial prostatitis? what clinical symptoms are present?
extremely tender and boggy. fever, chills, dysuria, very painful
what is the clinical presentation for chronic bacterial prostatitis?
non-specific: low back pain, dysuria, perineal pain.
what is the most common form of prostatitis today? what does it consist of?
chronic Abacterial. STD organisms have been implicated (Chlamydia, mycoplasma, ureaplasma)
when should you really use PSA testing?
male w/ strong family history
is BPH pre-malignant?
NO. nodular proliferation of both glands and stroma.
clinical features of BPH?
nocturia**
BPH treatment?
5-alpha reductase inhibitory (finasteride) testoterone>DHT. multiply PSAx2.3 if taking 1mg/d >4yrs
why is vericocele great on the left?
because drainage has to go through renal vein first before IVC on the LEFT.
where does testicular cancer metastize?
nodes
what is phase 1 (transabdominal) of testicular descent controlled by?
mullerian-inhibiting substance
what is phase 2 (inguinoscrotal: descends through inguinal canal into scrotum) of testicular descent controlled by?
androgen dependent.
Cryptorchid testis cases are 75% ____ (unilateral or bilateral)
unilateral.
what happens if cryptorchid testis is bilateral and left uncorrected?
sterility!
what type of tumors are you at an increased risk for with Cryptorchid testis?
5-10x increase in germ cell tumors! WHILE, 5-10% of testicular germ cell tumors occur in cryptorchid testes
what is the treatment for cryptorchid testis?
orchiopexy (stitch down to prevent movement). before 2yrs old for fertility, 10 yrs for neoplasm. deficient spermatogenesis still in 10-60% even WHEN corrected & still SOME increased risk of cancer REMAINS
what are examples of chromosomal abnormalities leading to testicular infertility?
Klinefelter’s syndrome (47 XXY- sterility is the defining feature). Down’s syndrome (trisomy 21).
what are the causes of bacterial Epididymo-orchitis in patients under 35 yrs old?
most are sexually transmitted: N. gonorrheae, Chlamydia, Mycoplasma, Treponema Pallidum (primary syphillis)
a male patient noticed his left testicle looking like a ‘bag of worms’. name that disorder! what is it a cause of? is this painless or painful?
Varicocele. Infertility (relative HYPERthermia). painLESS.
what are the two main types of testicular neoplasms? what are their subcategories?
Germ cell tumors & Sex cord stromal tumors.
Germ cell: Seminoma, nonseminoma (Embryonal carcinoma, yolk sac tumor, choriocarcinoma).
Sex cord stromal: Sertoli cell, Leydig cell tumor, ganulosa cell tumor, mixed.
Are Nonseminoma Germ Cell Tumors benign or metastatic? what about sex cord stromal tumors??
Nonseminoma: metastatic.
Sex cord stromal: rare, benign, small.
What is the most common type of testicular tumor (solid)? PATHOMA
Germ Cell Tumors (95% of cases)
_____ (of the Germ Cell Tumors) are highly responsive to radiotherapy, metastasize late and have an excellent prognosis? PATHOMA
seminomas
___ (of Germ Cell Tumors) often metastasize early? PATHOMA
NONseminomas
what is the most common testicular tumor in children? what is characteristically elevated? PATHOMA
Yolk Sac (endodermal sinus) tumor is a malignant tumor. Schiller-Duval bodies seen on histology. AFP is characteristically elevated
what is the most common cause of a testicular mass in males > 60 yrs, often bilateral? PATHOMA
Lymphoma (usually diffuse large B-cell type)
what is referred to as the ‘fish flesh tumor’? large, fleshy, homogenous that encompasses entire testicle and has NO hemorrhage or necrosis.
Seminoma. non-caseating granuloma
what type of tumor is a malignant tumor comprised of immature, primitive cells that may produce glands; forms HEMORRHAGIC mass with necrosis? what is the usual age group? PATHOMA
Embryonal carcinoma. 20-30 yrs. more aggressive than Seminoma.
what is a malignant tumor of syncytiotrophoblasts and cytotrophoblasts? what is characteristically elevated?
Choriocarcinoma. beta-hCG
_____ is a tumor composed of mature fetal tissue derived from two or more embryonic layers?
teratoma
teratoma: is it malignant or benign in males? females?
malignant in males, benign in females.
where does hematogenous spread lead to?
lung, brain, liver
T or F: Seminomatous component of mixed tumors usually does not metastasize?
He said TRUE. however, that’s confusing since PATHOMA says seminomatous tumor is malignant but metastasizes LATE
A patient gets diagnosed with a testicular cancer and it is confined to the testis. What stage is it?
Ia. Ib: spread to adnexa. Ic: spread to scrotum (rare bc tunixa holds tumor in)
what stage involves the retroperitoneal lymphatics in testicular cancer?
Stage II.
T or F: Seminoma will often remain localized?
True. 70% stage I.
what is the least favorable non-seminomatous element?
choriocarcinoma
are you more likely to have mortality in a seminoma or non-seminoma category?
non-seminoma (more aggressive and spreads faster and is hemorrhagic and necrotic). seminoma- does spread, but very LATE and is nonhemorrhagic and does not show necrosis.
what elevation are you looking for in choriocarcinoma or syncitiotrophoblast?
hCG
____ are exquisitely radiosensitive?
Seminomas
_____ tumor is comprised of tubules and is usually clinically silent. what is it associated with?
Sertoli cell tumor. Gynecomastia
what do Leydig cell tumors cause ((1) in children (2) in adults) due to elaborate production of androgens and/or estrogens?
causing precocious puberty in children or gynecomastia in adults.
what are the most common primary sites of metastatic tumors in older males ?
lung and prostate
what is a hydrocele due to?
failure to obliterate the inguinal canal. filling of fluid in tunica vaginalis. associated with incomplete closure of processus vaginalis
