pathoma male repro pathology

Question 1

hypospadias

Answer 1

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

Question 2

epispadias

Answer 2

opening of the urethra on superior surface of the penis; due to abnormal positioning of the genital tubercle
–associated with bladder exstrophy

Question 3

condyloma acuminatum

Answer 3

benign warty growth on genital skin; due to hpv 6 or 11; characterized by koilocytic change

Question 4

lymphogranuloma venerum

Answer 4

necrotizing granulomatous inflammation of the inguinal lymphatics and lymph nodes

• this STD is caused by chlamydia trachomatis (serotypes L1-L3)
• -eventually heals with fibrosis; if perianal, can cause a rectal stricture

Question 5

squamous cell carcinoma of penis

Answer 5

malignant proliferation of squamous cells on penis
-risk factors: high risk HPV (16,18,31,33) or lack of circumcision (foreskin acts as a nidus for inflammation and irritation)

Question 6

precursor lesions of penis squamous cell carcinoma

Answer 6

1) bowen disease - in situ carcinoma of penile shaft, presents as leukoplakia
2) erythroplasia of queyrat - in situ carcinoma on glans; presents as erythroplakia
3) bowenoid papulosis - in situ carcinoma; presents as reddish papules; younger patients (40s); does NOT progress to invasive carcinoma

Question 7

cryptorchidism

Answer 7

failure of testicle to descend into the scrotal sac (testicles normally develop in the abdomen and then descend into the scrotal sac as fetus grows)

-either resolves spontaneously OR treat with orchiopexy before 2 yrs of age

Question 8

orchitis

Answer 8

inflammation of the testicle
causes:
--chlamydia or gonorrhea - young adults
--e coli or pseudomonas - older adults
--mumps virus - teenage males
--autoimmune - you see granulomas involving the seminiferous tubules

Question 9

testicular torsion

Answer 9

twisting of the spermatic cord; thin-walled veins become obstructed leading to congestion and hemorrhagic infarction

• due to congenital failure of testes to attach to the inner lining of the scrotum (via processus vaginalis)
• presents in adolescents with sudden testicular pain and absent cremasteric reflex

Question 10

varicocele

Answer 10

dilation of the spermatic vein due to impaired drainage; presents as scrotal swelling with a bag of worms appearance

• usually left sided; associated with left sided renal cell carcinoma
• seen in many infertile males

Question 11

hydrocele

Answer 11

fluid collection in tunica vaginalis(serous membrane that covers testicle and internal surface of scrotum)
-due to incomplete closure of the processus vaginalis leading to communication with the peritoneal cavity (infants) or blockage of lymphatic drainage (adults)

presents as scrotal swelling that can be transilluminated

Question 12

two types of testicular germ cell tumors

Answer 12

seminoma = responsive to radiotherapy, metastasize late, excellent prognosis

nonseminoma = variable response to radiotherapy, metastasize early

Question 13

risk factors for testicular germ cell tumors?

Answer 13

• cryptorchidism

- klinefelter syndrome

Question 14

seminoma

Answer 14

malignant tumor comprised of large cells with clear cytoplasm and central nuclei; forms homogenous mass with no hemorrhage or necrosis

good prognosis; responds to radiotherapy

Question 15

embryonal carcinoma

Answer 15

malignant tumor of immature, primitive cells that may produce glands; forms hemorrhagic mass with necrosis

• aggressive with early hematogenous spread; chemo could transform into a teratoma
• increased AFP or B-hCG

Question 16

yolk sac (endodermal sinus) tumor

Answer 16

malignant tumor that resembles yolk sac; most common testicular tumor in kids
-schiller-duval bodies present; AFP elevated

Question 17

choriocarcinoma

Answer 17

malignant tumor of syncytiotrophoblasts and cytotrophoblasts (placenta like tissue without villi)

• early hematogenous spread
• elevated B-hCG
• can cause hyperthyroidism or gynecomastia

Question 18

teratoma

Answer 18

tumor of mature fetal tissue derived from 2-3 embryonic layers
malignant in males; benign in females
-AFP or B-hCG may be elevated

Question 19

prognosis of mixed germ cell tumors

Answer 19

prognosis is based on the worst component

Question 20

sex cord-stromal tumors (non germ cell)

Answer 20

tumors that resemble sex cord-stromal tissues of the testicle; usually benign

• leydig cell tumor - usually produces androgen, causing precocious puberty in kids or gynecomastia in adults; displays reinke crystals
• sertoli cell tumor - comprised of tubules and is usually clinically silent

Question 21

reinke crystals

Answer 21

sex-cord stromal tumor –> leydig cell tumors

Question 22

lymphoma

Answer 22

most common cause of a testicular mass in males >60 yo; often bilateral
-usually of diffuse large B-cell type; not primary, it metastasizes

Question 23

acute prostatitis

Answer 23

acute inflammation of the prostate, usually due to bacteria
—young adults: chlamydia or ghonnorhea
–older adults: e coli or pseudomonas
presents as dysuria with fever and chills; prostate is tender and boggy on DRE; prostatic secretions show WBCS and culture shows bacteria

Question 24

chronic prostatitis

Answer 24

chronic prostate inflammation
presents as dysuria with pelvic or low back pain
-secretions show WBCs but culture does NOT show bacteria

Question 25

BPH (benign prostatic hyperplasia)

Answer 25

hyperplasia of prostatic stroma and glands in the central periurethral zone of prostate; age related change (usually present after 60) and not increased risk of cancer

related to DHT (dihydrotestosterone) –> DHT acts on the androgen receptor of stromal and epithelial cells resulting in hyperplastic nodules

presents with issue starting and stopping urine stream, impaired bladder emptying (risk for infection and hydronephrosis), dribbling, hypertrophy of bladder wall SM, hematuria, and elevated PSA (prostate specific antigen)

Question 26

treatment of BPH

Answer 26

alpha1 antagonist (terazosin) to relax smooth muscle 
----can pair with selective alpha1A antagonist (tamsulosin) to avoid 1B effects on blood vessels

or

5alpha reductase inhibitor - blocks conversion of testosterone to DHT; takes months for results
side effects: gynecomastia and sexual dysfunction

Question 27

prostate adenocarcinoma

Answer 27

malignant proliferation of prostatic glands
—-small invasive glands with prominent nucleoli
most often clinically silent – usually in the peripheral posterior region and so it doesn’t cause urinary symptoms until later – can metastasize to the lumbar spine or pelvis

screening begins at 50 with DRE and PSA

• -normal PSA increases with age due to BPH
• -PSA>10 is worrisome at any age
• -decreased % free-PSA suggests cancer (cancer makes BOUND PSA)

Question 28

risk factors for prostate adenocarcinoma

Answer 28

age
race (African americans>Caucasians>Asians)
diet high in saturated fats

Question 29

priapism

Answer 29

painful sustained erection not associated with sexual desire or stimulation

can be caused by: trauma, sickle cell disease (trapped in vascular channels), medications (anticoagulants, PDE5 inhibitors, alpha blockers)

Question 30

spermatocele

Answer 30

dilated epididymal duct; testicular mass that can be transilluminated