PATH - Penis Problems Flashcards
Peyronie disease
Abnormal curvature of penis due to *fibrous plaque within *tunica albuginea.
Associated with erectile dysfunction
Can cause pain, anxiety
Consider surgical repair once curvature stabilizes.
Ischemic priapism
Painful sustained erection lasting > 4 hours
Associated with sickle cell disease (sickled RBCs
get trapped in vascular channels), medications (sildenafil, trazodone)
Treat immediately
with corporal aspiration, intracavernosal phenylephrine, or surgical decompression to prevent
ischemia.
Squamous cell carcinoma of penis
Precursor in situ lesions: Bowen disease (in
penile shaft, presents as leukoplakia), erythroplasia of Queyrat (cancer of glans, presents as erythroplakia), Bowenoid papulosis (carcinoma in situ of unclear malignant potential, presenting as reddish papule)
Associated with *HPV and *lack of circumcision
More common in Asia, Africa, South America
Cryptorchidism
Undescended testis (one or both)
impaired spermatogenesis (since sperm develop best at temperatures
Varicocele
Dilated veins in *pampiniform plexus due to INC venous pressure
most common cause of scrotal enlargement in adult males
most often on left side because of INC resistance to flow from left gonadal vein drainage into left renal vein
can cause infertility because of INC temperature
diagnosed by standing clinical exam (distension on inspection and *“bag of worms” on palpation)
or ultrasound with Doppler; *does not transilluminate
TX: varicocelectomy, embolization
Scrotal masses
Benign scrotal lesions present as testicular masses that *can be transilluminated
Congenital hydrocele
Common cause of scrotal swelling in infants, due to incomplete obliteration of *processus vaginalis
Acquired hydrocele
Scrotal fluid collection usually 2° to infection, trauma, tumor
If bloody–>hematocele.
Spermatocele
Cyst due to dilated *epididymal duct or *rete
testis
*Paratesticular fluctuant nodule
Testicular germ cell tumors
95% of all testicular tumors.
Most often occur in young men
Risk factors: cryptorchidism,
Klinefelter syndrome
Can present as a mixed germ cell tumor
Testicular mass that *does not
transilluminate
Seminoma
Testicular germ cell tumors
Malignant
painless, homogenous testicular enlargement
most common testicular tumor
Does not occur in infancy.
Large cells in lobules with *watery cytoplasm and *“fried egg” appearance
INC placental ALP
Radiosensitive
Late metastasis, excellent prognosis.
Yolk sac (endodermal sinus) tumor
Testicular germ cell tumors
Yellow, mucinous
aggressive malignancy of testes, analogous to *ovarian yolk sac tumor
*Schiller-Duval bodies resemble primitive glomeruli.
INC AFP is highly characteristic
Most common testicular tumor in boys
Choriocarcinoma
Testicular germ cell tumors
Malignant
INC hCG
Disordered syncytiotrophoblastic and cytotrophoblastic elements.
Hematogenous metastases to *lungs and *brain.
May produce gynecomastia, symptoms of hyperthyroidism (hCG is structurally similar to LH, FSH, TSH).
Teratoma
Testicular germ cell tumors
Unlike in females, mature teratoma in *adult males may be *malignant
Benign in children.
Embryonal carcinoma
Testicular germ cell tumors
Malignant, hemorrhagic mass with necrosis
painful
worse prognosis than seminoma
Often glandular/papillary morphology.
“Pure” embryonal carcinoma is rare
most commonly mixed
with other tumor types.
May be associated with INC hCG and normal AFP levels when pure (INC AFP
when mixed).
