Male Reproductive System-Fung Flashcards
What are the congenital anomalies of the urinary bladder?
Extrophy
Diverticula
Vesicouretal reflux
What are the metaplastic lesions of the urinary system?
- cystitis cystica et glandularis
- squamos metaplasia
- intestinal metaplasia
- nephrogenic adenoma
What is the grading of urothelial tuors?
- urotheilal papilloma
- urothelial neoplasma of low malignant potential
- papillary urothelial carcinoma, low grade
- papillary urothelial carcinoma, high grade
- urothelial carcinoma in-situ
How do you make spermatozoa?
spermatogonia type A-> mitosis-> spermatogonia type B-> mitosis-> primary spermatocytes-> migrate to adluminal compartment-> 1st meiotic division-> secondary spermatocytes-> 2nd meiotic division-> spermatids-> spermatozoa
What is the opening of the urethra on inferior surface of penis due to failure of the urethral folds to close?
Hypospadias
What is this:
opening of urethra on superior surface of penis, due to abnormal positioning of the genital tubercle
what is it associated with?
Epispadias
bladder exstrophy
What is this:
benign warty growth on genital skin
What is it due to?
Condyloma acuminatum
HPV 6 or 11; characterized by koilocytic change
What is this:
necrotizing granulomatous inflammation of the inguinal lymphatcs and lymph nodes
What is it caused by?
lymphogranuloma venerum
sexually transmitted disease caused by Chlamydia trachomatis
How does lymphogranuloma venerum heal and what may it involve?
fibrosis
perianal involvement may result in rectal stricture
What is this:
malignant proliferative of squamos cells of penile skin
Squamos cell carcinoma
What are the risk factors of squamos cell carcinoma?
- high risk HPV (2/3 cases)
- lack of circumcision (foreskin acts as a nidus for inflammation and irritation if not properly maintained)
What are the precursor in situ lesion in squamos cell carcinoma?
Bowen Disease
Erythroplasia of Queyrat
Bowenoid papulosis
What is this:
in situ carcinoma of penile shaft or scrotum that presents as leukoplakia
Bowen disease
What is this:
in situ carcinoma on the glans that prsents as erythoplakia
Erythroplasia of Queyrat
What is this:
In situ carcinoma that presents as multiple reddish papules
-seen in youner patients (40s) relative to Bowen disease and erythroplasia of Queyrat
DOES NOT PROGRESS TO INVASIVE CARCINOMA
Bowenoid papulosis
what is this:
failure of testicle to descend into the scrotal sac
Cryptorchidism
What is the most common congenital male reproductive abrnomality; seen in 1% of male infants. Most cases resolved spontaneously, otherwise orchiopexy is performed before 2 years of ae.
Cryptorchidism
What are complications of cryptorchidism?
testicular atrophy with infertility and increased risk fo seminoma
What is inflammation of testicles?
What causes this?
Orchitis
-Chlamydia trachomatis (D-k) or Neisseria gonorrhoeae, E. coli and pseudomonas, mumps and autoimmune orchitis
What causes orchitis in young adults?
What will this cause?
Chlamydia trachomatis or Neisseria gonorrhoeae
-increased risk of sterility, but libido is not affected because Leydig cells are spared
What will cause orchitis in older adults and what will this cause?
E. Coli and Pseudomonas
-UTI pathogens spread into the reproductive tract
What will cause orchitis in teenage males? What will this cause?
mumps virus
-increased risk for infertility; testicular
What kind of orchitis is this:
-characterized by granulomas involving the seminiferous tubules
autoimmune orchitis
What is this:
twisting of the psermatic cord; thin-walled veins become obstructed leading to congestions and hemorrhagic infarction
What causes this?
Testicular torsion
-usually due to congenital failure of testes to attach to inner lining of the scrotum (via the processus vaginalis)
How does testicular torsion present?
in adolescents with sudden testicular pain and absent cremaster reflex
What is this:
dilation of the spermatic vein due to impaired drainage-> presents as scrotal swelling with a “bag of worms” appearance.
Variocele
What side does a variocele typically preset on?
What is it associated with?
Who do you see this in?
left side
left-sided renal cell carcinoa (RCC often invades renal vein)
infertile males
What is a hydrocele?
What is it associated with?
fluid collection within the tunica vaginalis
-incomplete closure of the processus vaginalis leading to communication with the peritoneal cavity (infants) or blockage of lymphatic drainage (adults)
How can you tell the difference between a variococele and hydrocele?
hydrocele presents as scrotal swelling that can be transilluminated
What causes acute and chronic cystitis?
E.coli
Proteus
Klebsiella
Enterbacter
What are all the kinds of cystits?
Acute and chronic cystitis
Interstitial cystitis
Malacoplakia
Polypoid cystitis
Where do testicular tumors arise from?
How do they present?
Should you biopsy them?
How do you remove them?
arises from germ cells or sex-cord stroma
- presents as a firm, painless testicular mass that cannot be transilluminated
- usually not biopsied due to risk of seeding the scrtoum,
- removed via radial orchiectomy- most testicular tumors are malignant germ cell tumors
What is the most common type of testicular tumor?
What ages does this occur in?
Germ cell tumor (>95% of cases)
15-40 years of age
What are the risk factors for germ cell testicular tumors?
-Cryptorchidism and Klinefelter syndrome
Germ cell tumors are divided into what 2 categories?
Which has a better prognosis?
seminomas and nonseminomas
seminomas
(blank) make up 55% of cases and are highly responsive to radiotherapy, metastasize late, and have an excellent prognosis
seminomas
(blank) make up 45% of cases and show variable response to tx and often metastasize early
nonseminomas
What does a seminoma look like?
a malignant tumor comprised of large cells with clear cytopasma and central nuclei (resemble spermatogonia) forms a homogenous mass with no hemorrhage or necrosis.
What is the most common testicular tumor, rare cases may produce B-hCG?
What is it called in the ovary?
Seminoma (good prognosis responds to radiotherapy)
Dysgerminoma in the ovary
(blank) is a malignant tumor comprised of immature, primitive cells that may produce glands. It is aggressie with early (blank). (bank) may result in differentiation into another type of germ cell tumor (e.g teratoma). Increased (blank or blank) may be present
Embryonal carcinoma
Hematogenous spread
Chemotherapy
AFP or B-hCG
What is the most common testicular tumor in children? Is it malignant?
What will you see on histology?
DO you have elevated AFP?
Yolk sac (endodermial sinus) tumor
Yes
Schiler-Duval bodies (glomerulus like structures)
-yes
What is a choriocarcinoma?
-malignant tumor of synctiotrophoblasts and cytotrophoblasts (placenta-like tissue, but villi are absent)
How does a choriocarcinoa spread? What is typically elevated in choriocarcinoma? What can choriocarcinoma lead to?
early via blood
beta-hCG eleavted-> may lead to hyperthyroidism or gynecomastia (a-subunit of hCG is similar to that of FSH, LH, and TSH
(blank) is a tumor composed of mature fetal tissue derived from two or three embryonic layers. Is it malignant?
What may be increased
Teratoma
in males, not females
AFP or B-hCG
Germ cell tumors are usually (blank). Prognosis is based on the (blank)
mixed
worst component
What is this:
resembles sex cord-stromal tissues of the testicle; usually benign
Sex cord-stromal tumors
What will a leydig cell tumor cause?
increased androgen causing precocious puberty in children or gynecomastia in adults
What will you see on histology of leydig cell tumors?
Reinke crystals
(blank) tumor is comprised of tubules and is usually clinically silent
Sertoli cell
What are the seminomatous tumors?
seminoma and spermatocytic seminomas
What are the non-seminomatous tumors?
- Embryonal carcinoma
- Yolk sac (endodermal sinus) tumor
- Choriocarcinoma
- Teratoma
What are the sex-cord stromal tumors?
leydic cell tumor
sertoli cell tumors
What causes neoplasms of the testis?
environment
genetics
Testicular dysgenesis syndrome (Cryptorchidism, hypospadias, klinefelters syndrome)
What is the most common cause of a testicular mass in males > 60 years old; often bilateral. Usually of diffuse large B-cell type?
Lymphoma
What does the prostate consist of?
glands and stroma
-glands are composed of an inner layer of luminal cells and an outer layer of basal cells
What do the glands of the prostate do? What maintains the glands and stroma?
- secrete alkaline, milky fluid that is added to sperm and seminal vesicle fluid to make semen
- androgens
What causes the acute inflammation of the prostate?
bacteria:
Young adults-Chalmydia trachomatis and Neisseria gonorrhoeae
Older adults-E. coli and pseudomonas
What is this:
presents as dysuria and chills
boggy and tender prostate
prostatic secretions show WBCs but cultures are negative
Acute prostatitis
What is this:
chronic inflammation of prostate
presents as dysuria with pelvic or low back pain
prostatic secretions show WBCs, but cultures are negative
Chronic prostatitis
What is this:
hyperplasia of prostatic stroma and gland
no increased risk for cancer
age related change (present in most men by age 60)
Related to DHT
BPH
Why is BPH related to DHT?
-testoterone is converted to DHT by 5a-reductase in stromal cells. DHT acts on the androgen receptor of stromal and epithelial cells resulting in hyperplastic nodules
What are the clinical features of BPH?
impaired bladder emptying with increased risk for infection and hydronephrosis, problems starting and stopping urine stream, dribbling, hypertrophy of the bladd wall smooth muscle increase risk for bladder diverticula, microscopic hematuria
How do you treat BPH?
a1 antagonist to relax SM (terazosin)
5a reductase inhibitor- blocks conversion of testosterone to DHT (can be used for male patterned baldness too, SE are gynecomastia and sexual dysfunction)
What is this:
malignant proliferation of prostatic gland. Most COMMON cancer in men. 2nd most common cause of cancer related death
Prostate adenocarcinoma
What are the risk factors of prostate adenocarcinoma?
age, race (AA>caucasions>asians), and diet high in saturated fat
Prostatic carcinoma is usually clincally (blank). Why?
silent
-usually arises in the peripheral , posterior region of the prostate and hence does not produce urinary symptoms early on
When do you begin screening for prostate adenocarcinoma?
What will the screening tell you?
What is required to confirm the presence of carcinoma and what will you find?
begins at age 50 with DRE and PSA
PSA >10 ng/mL is highly worrisome
decreased % free PSA is suggestive of cancer
-prostatic biopsy, shows small, invasive glands with prominent nucleoli
What is the gleason grading system and what is it for?
- Gleason grading system is based on architecture alone (and not nuclear atypia)
1. multiple regions of the tumor are assessed because architecture varies from area to area
2. a score (1-5) is assigned for 2 distinct areas and then added to produce a final score (2-10)
3. higher score suggests worse prognosis
Where does a prostate adenocarcinoma spread to?
lumbar spine or pelvis
What are the clinical findings of prostate adenocarcinoma?
osteoblastic metastases
Increased Alkaline phosphatase
PSA
PAP
How do you treat localized prostate adenocarcinoma?
How do you treat advanced disease?
prostatectomy
hormone suppression to reduce testosterone and DHT
How do you hormonally suppress testosterone and DHT to treat adenocarcinoma?
- continuous GnRH analogs (leuprolife) shuts down the anterior pituitary gonadotrophs (LH and FSH are reduced)
- Flutamide acts as a competitive inhibitor at the androgen receptor
What cells prevent urothelium from losing water into the hypertonic urine?
Umbrella cells
What is this:
non specific inflammation on histology, negative leukocyte esterase and nitrates b/c this is not due to a uropathogen (i.e. symptoms but no infection)
Interstitial cystitis
What cause malakoplakia?
macrophage defect, infectious process
Most neoplasma of the bladder are (Blank)
papillary
What is this:
nests of von brune
invaginations of the urothelium into the LP
cells do not have any atypia
Cystitis cystica
What is this:
forms from nests of von brune
forms due to bladder irritation
Cystitis cystic et glandularis
What is this:
shedding of renal tubular cells that implant in the bladder
nephrogenic adenoma (benign)
What are the 2 types of bladder injuries?
flat and papillary
What is the most common location of the congenital anomalie of an abnormal urethral opening?
hypospadias -> associated with cryptochidism
What is this;
a congenital narrowing of the opening of the foreskin so that it cannot be retracted.
phimosis (caused by inflammation)
What is this: is an inflammation of the glans (the rounded head) of the penis. What can cause this? What is this associated with?
Balanitis
Candida, anaerobic bacteria, gardnerella, pyogenic bacteria
Smegma
What is this:
flat lesions with atypia is…?
urothelial adenoma in situ or urothelial carcinoma ( for flat lesions, carcinomas can be non-invasive or invasive)
What is this:
low malignant potential; little bit of atypia, thickened layers
Urothelial neoplasms
