P- Male GU System Flashcards
What are the 2 congenital anomalies associated with the penis?
- hypospadias - urethra opens ventrally
2. epispadias- urethra opens dorsally
What is phimosis?
What is the etiology?
What are the sequelae?
It is when the orifice of the prepuce [foreskin] is too small to retract over the glans.
It occurs because of inflammatory scarring or anomalous development.
Sequelae:
- interfere with hygiene
- accumulation of smegma [sebaceous secretion]
- infections
- carcinoma [not likely]
What is condyloma accuminatum?
What is the likely cause?
It is a genital wart most likely caused by HPV 6, 11
What is the likely etiological agent of carcinoma in situ in the penis?
What are the 3 clinical variants of penile CIS?
Penile CIS is likely caused by HPV 16
Clinical variants:
- Bowen disease
- erythroplasia of Queyrat
- Bowenoid papulosis
A 60 year old man presents with a scaly erythematous plaque on the penile shaft and scrotum. On histology you note features of squamous cell carcinoma but without invasion. What is the likely diagnosis?
Bowen disease
A man presents with a growing red plaque on the glans of his penis. Histology shows what looks like squamous cell carcinoma in situ. What is the likely diagnosis?
Erythroplasia of Queyrat
A 30 year old presents with multiple papular lesions on the body of the penis. Histology shows squamous cell CIS. What is the likely diagnosis?
Bowenoid papulosis
What is the etiology of penile invasive carcinoma?
What confers protection from getting it?
Who is most likely to get penile carcinoma?
Does it metastasize? If so, where?
What is the prognosis?
Penile invasive carcinoma is a squamous cell carcinoma caused by HPV 16, 18.
Circumcision confers protection so the most frequent patient is a 40-70 yr old uncircumcised man.
It metastasizes to the inguinal and iliac lymph nodes
66% 5YSR if confined to penis, 27% if mets
What is testicular torsion?
What is the cause?
What is the treatment?
How does it look grossly and histologically?
It is when the spermatic cords twists and leads to hemorrhagic infarction of the testes.
It is caused by trauma and the predisposing factor of increased mobility due to the absence of gubernaculum or atrophy.
Treatment: untwist the cord w/in 6 hours or give orchiectomy
Gross: red, hemorrhagic
Microscopic: coagulative necrosis
What is cryptochidism?
What are the two most important sequelae?
What is treatment?
It is when the testes fail to descend into the scrotum.
Sequelae:
- atrophy and sterility
- 10x increased risk of germ cell tumor development [risk is bilateral even if only one teste is not descended]
Treatment: orchiplexy [drop the balls down and fix them into the scrotum] by 2-3 months to preserve fertility
What type of tumor compose 95% of all testicular tumors? How does this compare to ovarian tumors?
Majority of testicular tumors are germ cell tumors.
The majority of ovarian tumors are from surface epithelial cell origin
95% of testicular tumors are germ cell tumors. The other 5% are what?
- Sex chord tumors - stromal tumors of leydig and sertoli cells
- surface epithelium tumors [so rare they basically don’t occur]
What is the most important distinction to make when classifying germ cell tumors of the testes?
- classic seminoma
2. non-seminomatous germ cell tumors
For a classic seminoma
- age of presentation
- histology
- Rx
- serum markers
- spread?
- stage at presentation
- prognosis
- 30s
- pure [not a mixed germ cell tumor] sheets of polygonal cells
- orchiectomy or radiotherapy
- none
- to the lymphatics
- low, 70% are in stage 1
- 95% cure with stage 1 or 2
What are the 4 types of non-seminomatous germ cell tumors of the testes?
- embryonal carcinoma
- yolk sac tumor [endodermal sinus tumor]
- teratoma
- choriocarcinoma
For non-seminomatous carcinoma of the testes:
- age
- histology
- treatment
- serum markers
- spread?
- stage at presentation
- prognosis
- infant to 30
- mixed
- ochiectomy and chemotherapy
- choriocarcinoma =hCG, yolk sac = AFP
- lymphatics and hematogenous
- late, 40% stage 1
- 90% with chemo
You do histology of a germ cell tumor and note:
- sheets of polygonal cells
- clear cytoplasm with prominent nucleoli
- fibrous bands infiltrated with lymphocytes
There are no glands, keratin pearls, or cartilage. What type of tumor is this suggestive of?
Classic Seminona
You do histology of a testicular germ cell tumor and note:
- pleomorphic epithelioid malignant cells
- formation of gland-like structures
What is the likely tumor type?
Embryonal carcinoma
You do histology of a testicular germ cell tumor and note:
perivascular rosettes of cells [Schiller-Duval bodies]
What is the likely tumor and what is the serum marker?
Endodermal sinus tumor [yolk sac] and the serum marker is AFP
You do a biopsy of a testicular germ cell tumor and note syncytiotrophoblast surrounding cytotrophoblasts. What serum marker is bound to be elevated and what is the suspected tumor?
HCG will be high because this histology is associated with choriocarcinoma
What is the likely cause of:
- acute bacterial prostatitis
- chronic bacterial prostatitis
- chronic abacterial prostatitis
Which of the 3 is most common?
- E. coli
- E. coli
- culture neg and etiology unknown [possibly chlamydia, ureaplasma]
chronic abacterial prostatitis is the most common
How does the pathology of BPH compare to prostate carcinoma?
How does the feeling differ for DRE?
BPH is periurethral and symmetrical nodules of hyperplastic glands and/or stroma.
On DRE, you would feel large rubbery symmetrical masses
Carcinoma is peripheral and would feel rock hard on DRE palpation
What is the incidence of prostatic nodular hyperplasia [BPH]?
What is the etiology?
What is the chance it progresses to carcinoma?
90% of men will have BPH by the age of 70.
It is caused by DHT and estogens
It does NOT progress to carcinoma
A patient presents with urinary frequency, nocturia, hesitancy, dribbling and history of UTIs. What is the likely cause and what are possible treatments?
BPH
Treatments:
- TURP - [transurethral resection of the prostate-scrape a bigger urethra opening]
- 5a-reductase inhibitor so testosteroneue can’t go to DHT [finasteride]
- a1 adrenergic inhibitor to relax the urethra to open more [doxazosin]
