Pathology III Flashcards
What cells line the penis and glans?
Squamous cells
What composes the erectile tissue of the penis?
Corpus cavernosum and corpus spongiosum = lots of blood vessels and neural innervation
What cell types are present in the urethra?
Squamous at the distal end and then urothelial more proximally
What are some skin conditions that affect the penis?
Balantitis xerotic obliterans, papilloma, neoplasia
What are some features of balantitis xerotic obliterans?
Also called lichen sclerosis, very common but cause not known, usually young males, phimosis or paraphimosis
What are some features of papillomas?
Caused by HPV = common, genital warts caused by HPV 6 and 11, HPV 16 and 18 high risk for cancer
What is penile neoplasia classed as?
PEiN = penile intra-epithelial neoplasia Differentiated = non-HPV Dedifferentiated = HPV related
What are some features of penile cancer?
Linked with chronic inflammation and HPV = not uncommon
What is the function of the testis?
Makes sperm in the seminiferous tubules
Where does sperm arise from?
Germ cells = until they mature into spermatozoa
What is the function of the Sertoli cells in the testis?
Stimulated by FSH = control environment within the tubule, eventually absorb excess cytoplasm
What cells are contained within the seminiferous tubules?
Germ cells, Sertoli cells, maturing sperm
What is the function of Leydig cells of the testis interstitium?
Under control of LH = produce dehydroepialdosterone (DHEA) converted from testosterone
Can hernias occur in the testes?
Yes
What are hydrocoeles?
Accumulation of fluid around the testes = between the two layers the tunica vaginalis (mesothelial lining)
What is the appearance hydrocoeles?
Unicystic, smooth, fluid filled, softish and lucent on examination
What are spermatocoeles?
Cystic change in vas of epididymis = unknown cause and usually asymptomatic, may feel fullness, patients present after self examination
What are variocoeles?
Varicosities of venous plexus that drains the testis = usually asymptomatic, may present after feeling lump (bag of worms)
What are some important parts of the testis examination when there is a lump?
In testes or separate? Epididymal or other Can you get above it? = hernias Solid or cystic? Painful etc
Why is torsion an emergency?
Testis and cord rotate around arterial supply causing ischaemia then cell death = irretrievable after 6hrs
What is the bell clapper deformity?
Insertion of the tunica vaginalis is high = testis can rotate and even sit laterally
How does torsion present?
Excruciating pain with no precipitating cause
What age group is torsion common in?
Neonates and adolescents
What are some features of testicular neoplasia?
Lump in testes = not separate
Relatively common = younger age group
Generally good prognosis even when advanced
Often early stage but also responsive to chemo
What are the two types of neoplastic testicular tumours?
Seminomatous and non-seminomatous = both are types of germ cell tumour
What are some features of seminomatous testicular tumours?
Most common = look like potato
Patient age is around 40
Undescended testis is risk factor
What is the prognosis of seminomatous testicular tumours?
95% cure rate = extremely responsive to radiotherapy even if advanced
What are some features of non-seminomatous testicular tumours?
Less common than seminomas
Rarely exist as pure tumours = often mixed type
Patient age is about 30
Why does non-seminomatous neoplasm need to be treated early?
More aggressive and can metastasise
Very chemosensitive = reasonable outcomes even with metastases
What are the types of non-seminomatous tumours?
Mature teratoma = three germ layers, all malignant
Yolk sac = can produce alpha feto protein (aFP)
Embryonal = aggressive form
Trophoblast
What are some features on embryonal non-seminomatous tumours?
Look high grade and associated with frequent metastases
What are some features of trophoblast non-seminomatous tumours?
Cells are weird looking, positive for beta HCG, will give positive pregnancy test result
What does the prognosis of non-seminomatous neoplasm depend on?
Subtypes present and relative proportions
How are non-seminomatous neoplasms followed up and diagnosed?
LDH = most types aFP = yolk sac bHCG = choriocarcinoma
