pathoma male repro pathology Flashcards
hypospadias
opening of urethra on inferior surface of penis; due to failure of the urethral folds to close
epispadias
opening of the urethra on superior surface of the penis; due to abnormal positioning of the genital tubercle
–associated with bladder exstrophy
condyloma acuminatum
benign warty growth on genital skin; due to hpv 6 or 11; characterized by koilocytic change
lymphogranuloma venerum
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
squamous cell carcinoma of penis
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)
precursor lesions of penis squamous cell carcinoma
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
cryptorchidism
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
orchitis
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
testicular torsion
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
varicocele
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
hydrocele
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
two types of testicular germ cell tumors
seminoma = responsive to radiotherapy, metastasize late, excellent prognosis
nonseminoma = variable response to radiotherapy, metastasize early
risk factors for testicular germ cell tumors?
- cryptorchidism
- klinefelter syndrome
seminoma
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
embryonal carcinoma
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
yolk sac (endodermal sinus) tumor
malignant tumor that resembles yolk sac; most common testicular tumor in kids
-schiller-duval bodies present; AFP elevated
choriocarcinoma
malignant tumor of syncytiotrophoblasts and cytotrophoblasts (placenta like tissue without villi)
- early hematogenous spread
- elevated B-hCG
- can cause hyperthyroidism or gynecomastia
teratoma
tumor of mature fetal tissue derived from 2-3 embryonic layers
malignant in males; benign in females
-AFP or B-hCG may be elevated
prognosis of mixed germ cell tumors
prognosis is based on the worst component
sex cord-stromal tumors (non germ cell)
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
reinke crystals
sex-cord stromal tumor –> leydig cell tumors
lymphoma
most common cause of a testicular mass in males >60 yo; often bilateral
-usually of diffuse large B-cell type; not primary, it metastasizes
acute prostatitis
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
chronic prostatitis
chronic prostate inflammation
presents as dysuria with pelvic or low back pain
-secretions show WBCs but culture does NOT show bacteria
BPH (benign prostatic hyperplasia)
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)
treatment of BPH
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
prostate adenocarcinoma
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)
risk factors for prostate adenocarcinoma
age
race (African americans>Caucasians>Asians)
diet high in saturated fats
priapism
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)
spermatocele
dilated epididymal duct; testicular mass that can be transilluminated
