Pathology 3 Flashcards
normal structure of penis?
corpus cavernosum - erectile tissue (network of vessels) corpus spongiosum (contains urethra, does not expand during an erection)
tumour in what part of the penis is more likely to metastasise?
cavernosum (access to blood vessels)
how are skin and penis related?
virtually all skin pathology can be seen on the penis
what is balanitis xerotic obliterans/lichen sclerosus?
usually in young people (primary schools kids)
presents with phimosis/paraphimosis
- can cause pain, problems voiding urine
- phimosis = cant retract foreskin
- paraphimosis = can retract foreskin but cant pull it back down
similar to lichen planus on the skin (chronic inflammation with band of pink hyaline tissue underneath, can lead to scarring and fibrosis etc)
which HPV causes genital warts/papilloma?
HPV 6 and 11
high risk HPV types?
16 and 18
pre-malignant penile cancer?
PEiN (penile intraepithelial neoplasia)
same as CIN but not split into 3 categories, just PEiN
what are the 2 types of PEiN?
differentiated - non HPV
dedifferentiated - HPV related
what can cause penile cancer?
chronic inflammation
HPV
how is serious penile cancer managed?
removal of penis
testicular pathology?
lumps and bumps paratesticular swellings testicular swellings orchitis torsion
normal testicle?
functional unit = seminiferous tubules (site of sperm generation) - edge of tubule = germ cells (produce immature sperm) and sertoli cells (stimulated by FSH to trigger spermatogenesis and control environment within tubules) leidig cells (pink and fluffy)
what does it indicate if only sertoli cells are present?
infertility, cant produce sperm
what is contained in seminiferous tubules?
germ cells
sertoli cells
maturing sperm
what cells are found in interstitium and what do they do?
leydig cells
under control of LH
produce dehydrorepiandrosterone (DHEA) converted to testosterone
common causes of lumps and bumps in testes?
hernia
cystocele
hydrocele
spermatocoele
rarer causes of testicular lumps?
adenomatoid tumour
mesothelioma
liposarcoma
what is hydrocele?
most common testicular lump
accumulation of fluid around testes between layers of tunica vaginalis (mesothelial lining)
unicystic, smooth, fluid filled
what is spermatocele?
cystic change within the vas of the epididymis
usually asymptomatic, just feel a lump and present after self examination
may feel a fullness
what is variocele?
varicosities of venous plexus that drains the testis
usually asymptomatic and people present after feeling a lump
looks like a bag of worms
examination of testes lump?
is it in testes or separate? epididymal or other? can you get above it? (hernia if you cant) solid or cystic? painful?
what is torsion?
testis and cord rotate around the arterial blood supply
causes severe pain
testicle dies within 4-6 hrs if not surgically fixed (irreversible)
what causes torsion?
bell clapper deformity
testis swings too freely in the scrotum
the insertion of the tunica vaginalis is too high meaning the testicle can rotate and can sit laterally in the sac
how does torsion present?
extreme pain
no particular precipitating factors (just as likely while in bed as while playing sports etc)
common in neonates and adolescents
how does a testicular neoplasia present?
lump inside the testis, not separate
commoner in younger age groups
testicular neoplasia prognosis?
good
2 groups of testicular tumour?
seminomatous
non seminomatous
(both are germ cell tumours)
describe seminoma
potato tumour (looks like a potato when cut open - white, homogenous) most common slightly older age range (around 40) risk = undescended testes equal risk in other testicle
how is seminoma managed?
95% cure rate
extremely responsive to radiotherapy
describe non-seminoma
less common
rarely exist as a “Pure” tumour
often have lots of different types within the one tumour
usually occurs around age 30
far more aggressive and very fast to metastatic
how is non-seminoma managed?
very responsible to chemotherapy but have to treat early (within days)
4 sub-types of non-seminmatous cancer?
yolk sac - can produce alpha feto protein
embryonal - aggressive form, looks high grade and is associated with mets
trophoblast - wacky looking cells, positive for HCG (causes a positive pregnancy test) - “choriocarcinoma”
teratoma
