Pathology of Penis and Testes

Question 1

What is HYPOspadias?

Answer 1

• opening of urethra on inferior surface of penis due to failure of the urethral folds to close.

Question 2

What is EPIspadias?

Answer 2

• opening of urethra on superior surface of penis due to abnormal positioning of the genital tubercle.

Question 3

With what is EPIspadias associated?

Answer 3

• bladder EXSTROPHY

Question 4

What is condyloma acuminatum?

Answer 4

• benign warty growth on genital skin due to HPV types 6 or 11.
• characterized by KOILOCYTIC change (“raisin-like nuclei”)

Question 5

What is lymphogranuloma venereum?

Answer 5

• necrotizing granulomatous inflammation of the inguinal lymphatics and lymph nodes.
• sexually transmitted disease caused by Chlamydia trachomatis (serotypes L1-L3).
• eventually heals with fibrosis; perianal involvement may result in rectal stricture.

Question 6

What is squamous cell carcinoma of the penis?

Answer 6

• malignant proliferation of squamous cells of penile skin.

Question 7

What are the risk factors for squamous cell carcinoma of the penis?

Answer 7

• high risk HPV (16, 18, 31, 33)

- lack of circumcision (foreskin acts as a nidus for inflammation and irritation if not properly maintained).

Question 8

What are the 3 important precursor lesions for squamous cell carcinoma?

Answer 8

1. Bowen disease= in situ carcinoma of the penile SHAFT or scrotum that presents as LEUKOPLAKIA.
2. Erythroplasia of Queyrat= in situ carcinoma on the GLANS that presents as ERYTHROPLAKIA.
3. Bowenoid papulosis= in situ carcinoma that presents as multiple REDDISH PAPULES.

Question 9

What is Cryptoorchidism?

Answer 9

• failure of testicle to descend into the scrotal sac.
• MOST COMMON congenital male reproductive abnormality.
• complications include testicular atrophy with infertility and increased risk for seminoma (germ cell tumor).

Question 10

Do most cases of cryptoorchidism resolve spontaneously?

Answer 10

• YES, otherwise orchiopexy is performed before 2 years of age.

Question 11

What is orchitis?

Answer 11

• inflammation of the testicle classically seen with:
• Chlamydia trachomatis (D-K) or Neisseria gonorrhoeae= younger adults.
• E. coli and Pseudomonas= older adults.
• Mumps virus= inflammation NOT seen in children less than 10 years old.
• autoimmune orchitis= granulomas involving the seminiferous tubules.

Question 12

What is testicular torsion?

Answer 12

• twisting of the spermatic cord; thin-walled veins become obstructed leading to congestion and hemorrhagic infarction.
• usually due to congenital failure of testes to attach to the inner lining of the scrotum (via the processus vaginalis).

Question 13

How does testicular torsion present?

Answer 13

• in adolescents with sudden testicular pain and absent cremasteric reflex.

Question 14

What is a varicocele?

Answer 14

• dilation of the spermatic vein due to impaired drainage.

* usually LEFT-SIDED (due to drainage into left renal vein).

Question 15

How does a varicocele present?

Answer 15

• scrotal swelling with a “bag of worms” appearance.

Question 16

With what is varicocele associated?

Answer 16

• infertile males

- left-sided renal cell carcinoma.

Question 17

What is a hydrocele?

Answer 17

• fluid collection within the tunica vaginalis (serous membrane that covers the testicle as well as the internal surface of the scrotum), associated with incomplete closure of the processus vaginalis leading to communication with the peritoneal cavity (infants) or blockage of lymphatic drainage (adults).

Question 18

How does a hydrocele present?

Answer 18

• scrotal swelling that can be transilluminated.

Question 19

** How do testicular tumors arise?

Answer 19

• from GERM CELLS or SEX CORD-STROMA.

Question 20

How do testicular tumors present?

Answer 20

• firm, painLESS testicular mass that cannot be transilluminated.

Question 21

Should you ever biopsy a testicular tumor?

Answer 21

• NO due to risk of seeding the scrotum.

* instead they are removed via radical orchiectomy.

Question 22

*** What are GERM CELL tumors?

Answer 22

• MOST COMMON type of testicular tumor (95%), usually occurring between 15-40 years of age.
• divided into SEMINOMA (55%) and NONseminoma (embryonal, yolk sac, choriocarcinoma, or teratoma) (45%).

Question 23

What are the risk factors for GERM CELL tumors?

Answer 23

• cryptorchidism (undescended testicle) and Klinefelter syndrome.

Question 24

** What is a SEMINOMA (germ cell type)?

Answer 24

• MALIGNANT tumor comprised of large cells with clear cytoplasm and central nuclei (resemble spermatogonia; analogous to ovarian dysgerminoma).
• forms a HOMOGENOUS MASS with NO HEMORRHAGE or NECROSIS.

Question 25

Are SEMINOMAS (germ cell type) responsive to radiotherapy?

Answer 25

- YES very! | * usually metastasize late and have an excellent prognosis :)

Question 26

What can SEMINOMAS (germ cell type) produce in rare cases?

Answer 26

- B-hCG

Question 27

**** What is EMBRYONAL carcinoma (germ cell type)?

Answer 27

- MALIGNANT tumor comprised of immature, primitive cells (think embryo, so early/primitive) that MAY produce GLANDS. - HEMORRHAGE MASS with NECROSIS

Question 28

Are EMBRYONAL carcinomas (germ cell type) aggressive?

Answer 28

- YES with early hematogenous spread :( | * chemo may result in differentiation into another type of germ cell tumor (e.g. teratoma).

Question 29

What can EMBRYONAL carcinomas (germ cell type) secrete?

Answer 29

- AFP | - B-hCG

Question 30

**** What is a YOLK SAC tumor (germ cell type)?

Answer 30

- MALIGNANT tumor that resembles yolk sac elements. - MOST COMMON testicular tumor in CHILDREN. - SCHILLER-DUVAL bodies (glomerulus-like structures) are seen on histology.

Question 31

What is classically elevated in YOLK SAC tumors (germ cell type)?

Answer 31

- AFP

Question 32

**** What is CHORIOCARCINOMA (germ cell type)?

Answer 32

- MALIGNANT tumor of synctiotrophoblasts and cytotrophoblasts (placenta-like tissue, but villi are absent). - spreads early via BLOOD :(

Question 33

What is charcteristically elevated in CHORIOCARCINOMAS (germ cell type)?

Answer 33

- B-hCG (from SYNCTIOtrophoblasts) | * may lead to hyperthyroidism or gynecomastia (bc alpha subunit is similar to LH, FSH, or TSH).

Question 34

**** What is a TERATOMA (germ cell tumor)?

Answer 34

- MALIGNANT tumor in males (as opposed to females) derived from 2 or 3 embryonic layers.

Question 35

What can TERATOMAS (germ cell tumor) produce?

Answer 35

- AFP | - B-hCG

Question 36

**** Are most germ cell tumors usually mixed?

Answer 36

YES | *prognosis based on the worst component.

Question 37

**** What are SEX CORD-STROMAL tumors?

Answer 37

- tumors that resemble sex cord-stromal tissues of the testicle * usually BENIGN

Question 38

What are the 2 types of SEX CORD-STROMAL tumors?

Answer 38

1. LEYDIG CELL tumor= cells between the seminiferous tubules. 2. SERTOLI CELL tumor= cells that line the inside of the seminferous tubules.

Question 39

What is important to know about LEYDIG CELL tumors (sex cord-stromal type)?

Answer 39

- produces ANDROGEN, causing PRECOCIOUS PUBERTY in children or GYNECOMASTIA in adults. - will see REINKE CRYSTALS on histology.

Question 40

What is important to know about SERTOLI CELL tumors (sex cord-stromal type)?

Answer 40

- usually clinically silent

Question 41

*** What is the most common cause of a testicular mass in a male over the age of 60?

Answer 41

- LYMPHOMA (often bilateral) | * usually diffuse large B-cell type