Path: Male Genital

Question 1

What are the congenital anomalies of the penis?

Answer 1

hypospadias - urethra opens ventrally

epispadias - urethra opens dorsally

Question 2

What is phimosis?

Answer 2

inflammatory disorder of penis - orifice of prepuce too small to retract over glans
due to scarring or dev anomaly
can lead to hygiene problems, accumulation of smegma –> inf, maybe carcinoma

Question 3

What are the 3 tumors of the penis and their associations?

Answer 3

condyloma acuminatum - HPV 6 and 11
carcinoma in situ - HPV 16
invasive carcinoma (squamous cell) - HPV 16 and 18

Question 4

What are the clinical variants of penile carcinoma in situ?

Answer 4

bowen dz: scaly, shaft and scrotum, 10% progress to invasive
erythroplasia of queyrat: red plaques, glans, 10%
bowenoid papulosis: younger, rare progression, can spontaneously regress

Question 5

What are the clinical features of penile invasive carcinoma?

Answer 5

circumcision confers protection
typically 40-70
metastasizes to inguinal and iliac nodes
squamous –> keratin pearls!

Question 6

What are predisposing factors for testicular torsion?

Answer 6

increased mobility to to absence of gubernaculum or atrophy

Question 7

What is seen w testicular torsion?

Answer 7

red and hemorrhagic parenchyma

coagulative necrosis

Question 8

What are sequelae of cryptorchidism?

Answer 8

atrophy and sterility

10X increase of germ cell tumors - bilateral risk even if unilateral cryptorchidism

Question 9

What are the different types of testicular tumors?

Answer 9

most are germ cell tumors

seminoma or non-seminomatous (embryonal carcinoma, yolk sac tumor, teratoma, chorciocarcinoma)

Question 10

Compare and contrast seminomas vs. non-seminomatous tumors of the testicles.

Answer 10

pure vs. mixed histology
orchiectomy and RADIOtherapy vs. orchiectomy and CHEMOtherapy
no serum markers (LDH nonspecific) vs. HCG & AFP
lymphatic spread vs. lymphatic & hematogenous
low stage presentation vs. high stage

Question 11

What are the morphologic highpoints of classic seminoma?

Answer 11

sheets polygonal cells, clear cytoplasm, prominent cherry red nucleoli separated by fibrous bands w lymphocytes

Question 12

What are the morphologic highpoints of embryonal carcinoma?

Answer 12

pleomorphic epithelioid malignant cells forming gland-like structures, mitotic features

Question 13

What are the morphological high points of yolk sac tumor?

Answer 13

perivascular rosettes = schiller-duval bodies

AFP!

Question 14

What are the morphological high points of choriocarcinoma of the testes?

Answer 14

admixture of syncytio- and cytotrophoblasts - need both

hCG!

Question 15

What are inflammatory conditions of the prostate?

Answer 15

acute and chronic bacterial prostatitis: e. coli

chronic abacterial prostatitis: most common, maybe chlamydia, ureaplasma

Question 16

What are the features of BPH?

Answer 16

does not predispose to cancer, DHT and estrogen accumulation

Question 17

What is the role of 5alpha-reductase in the pathogenesis of BPH?

Answer 17

converts testosterone into DHT

Question 18

What can help diagnose prostate cancer?

Answer 18

hypoechoic areas on ultrasound
PSA >10 - but more specific ways:
PSA density, velocity, or percent free PSA (lower w cancer)
PSA can help monitor response to therapy

Question 19

What are etiological factors in the dev of prostate cancer?

Answer 19

common in African Americans, rare in Asians

1st degree relatives at increased risk, fatty diet?

Question 20

What is the pathology of prostate cancer?

Answer 20

mostly adenocarcinomas
spread by lymphatic and hematogenous: lots to bone - osteoblastic!
peripheral nodules (BPH more central)

Question 21

What is seen microscopically w prostate cancer?

Answer 21

back to back gland proliferation
large nucleus w cherry red nucleoli
pink amorphous secretion
perineural invasion

Question 22

What is prostatic intraepithelial neoplasia (PIN)?

Answer 22

premalignant lesion of prostate - graded as low or high grade, but only high grade usually found