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rgu 3 > Pathology of Penis and Testes > Flashcards

Pathology of Penis and Testes Flashcards

1
Q

What is HYPOspadias?

A
  • opening of urethra on inferior surface of penis due to failure of the urethral folds to close.
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2
Q

What is EPIspadias?

A
  • opening of urethra on superior surface of penis due to abnormal positioning of the genital tubercle.
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3
Q

With what is EPIspadias associated?

A
  • bladder EXSTROPHY
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4
Q

What is condyloma acuminatum?

A
  • benign warty growth on genital skin due to HPV types 6 or 11.
  • characterized by KOILOCYTIC change (“raisin-like nuclei”)
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5
Q

What is lymphogranuloma venereum?

A
  • 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.
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6
Q

What is squamous cell carcinoma of the penis?

A
  • malignant proliferation of squamous cells of penile skin.
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7
Q

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

A
  • high risk HPV (16, 18, 31, 33)

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

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8
Q

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

A
  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.
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9
Q

What is Cryptoorchidism?

A
  • 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).
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10
Q

Do most cases of cryptoorchidism resolve spontaneously?

A
  • YES, otherwise orchiopexy is performed before 2 years of age.
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11
Q

What is orchitis?

A
  • 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.
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12
Q

What is testicular torsion?

A
  • 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).
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13
Q

How does testicular torsion present?

A
  • in adolescents with sudden testicular pain and absent cremasteric reflex.
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14
Q

What is a varicocele?

A
  • dilation of the spermatic vein due to impaired drainage.

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

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15
Q

How does a varicocele present?

A
  • scrotal swelling with a “bag of worms” appearance.
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16
Q

With what is varicocele associated?

A
  • infertile males

- left-sided renal cell carcinoma.

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17
Q

What is a hydrocele?

A
  • 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).
18
Q

How does a hydrocele present?

A
  • scrotal swelling that can be transilluminated.
19
Q

** How do testicular tumors arise?

A
  • from GERM CELLS or SEX CORD-STROMA.
20
Q

How do testicular tumors present?

A
  • firm, painLESS testicular mass that cannot be transilluminated.
21
Q

Should you ever biopsy a testicular tumor?

A
  • NO due to risk of seeding the scrotum.

* instead they are removed via radical orchiectomy.

22
Q

*** What are GERM CELL tumors?

A
  • 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%).
23
Q

What are the risk factors for GERM CELL tumors?

A
  • cryptorchidism (undescended testicle) and Klinefelter syndrome.
24
Q

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

A
  • 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.
25
Q

Are SEMINOMAS (germ cell type) responsive to radiotherapy?

A
  • YES very!

* usually metastasize late and have an excellent prognosis :)

26
Q

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

A
  • B-hCG
27
Q

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

A
  • MALIGNANT tumor comprised of immature, primitive cells (think embryo, so early/primitive) that MAY produce GLANDS.
  • HEMORRHAGE MASS with NECROSIS
28
Q

Are EMBRYONAL carcinomas (germ cell type) aggressive?

A
  • YES with early hematogenous spread :(

* chemo may result in differentiation into another type of germ cell tumor (e.g. teratoma).

29
Q

What can EMBRYONAL carcinomas (germ cell type) secrete?

A
  • AFP

- B-hCG

30
Q

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

A
  • MALIGNANT tumor that resembles yolk sac elements.
  • MOST COMMON testicular tumor in CHILDREN.
  • SCHILLER-DUVAL bodies (glomerulus-like structures) are seen on histology.
31
Q

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

A
  • AFP
32
Q

** What is CHORIOCARCINOMA (germ cell type)?

A
  • MALIGNANT tumor of synctiotrophoblasts and cytotrophoblasts (placenta-like tissue, but villi are absent).
  • spreads early via BLOOD :(
33
Q

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

A
  • B-hCG (from SYNCTIOtrophoblasts)

* may lead to hyperthyroidism or gynecomastia (bc alpha subunit is similar to LH, FSH, or TSH).

34
Q

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

A
  • MALIGNANT tumor in males (as opposed to females) derived from 2 or 3 embryonic layers.
35
Q

What can TERATOMAS (germ cell tumor) produce?

A
  • AFP

- B-hCG

36
Q

** Are most germ cell tumors usually mixed?

A

YES

*prognosis based on the worst component.

37
Q

** What are SEX CORD-STROMAL tumors?

A
  • tumors that resemble sex cord-stromal tissues of the testicle
  • usually BENIGN
38
Q

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

A
  1. LEYDIG CELL tumor= cells between the seminiferous tubules.
  2. SERTOLI CELL tumor= cells that line the inside of the seminferous tubules.
39
Q

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

A
  • produces ANDROGEN, causing PRECOCIOUS PUBERTY in children or GYNECOMASTIA in adults.
  • will see REINKE CRYSTALS on histology.
40
Q

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

A
  • usually clinically silent
41
Q

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

A
  • LYMPHOMA (often bilateral)

* usually diffuse large B-cell type

rgu 3 (19 decks)

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