penile and testicular pathology

Question 1

what is condyloma acuminatum, histo features

Answer 1

benign warty growth on genital skin due to HPV 6 and 11. see raisin-appearing nuclei: koilocytic change

Question 2

lymphogranuloma venereum: definition, background on causative agent, complications

Answer 2

necrotizing granulomatous inflammation of inguinal lymphatics and lymph nodes. STD caused by chlamydia trachomatis. remember, chlamydia is obligate intracellular because it doesn’t have ATP. it enters as elementary bodies (“enfectious”), then replicates as reticulate bodies. many serotypes of chlamydia: A-C= trichoma eye infections; D-K: urogenital infections and conjunctivitis, L1-L3 causes lymphogranuloma venerum.
eventually heals with fibrosis, though perianal involvement may lead to rectal strictures.

Question 3

What are risk factors for penile squamous cell carcinoma?

Answer 3

HPV (2/3 of cases), lack of circumcision.

Question 4

what are the precursors to squamous cell penile carcinoma?

Answer 4

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: reddish papules; in situ carcinoma. seen in younger pts relative to bowen disease and erythroplasia. does not progress to invasive carcinoma

Question 5

treatment, and complications of cryptorchidism

Answer 5

usually resolves spontaenously, but will be treated surgically if it doesn’t resolve by age 2. complications include testicular atrophy with infertility and incr. risk for seminoma.

Question 6

What are some risk factors for cryptorchidis? lab values?

Answer 6

prematurity increases the risk for cryptorchidism.
labs: decr. inhibin (secreted by sertoli cells to inhibit FSH), incr. FSH and LH. remember, sertoli cells are temperature sensitivie. testosterone is normal in unilateral cryptorchidism and lower in bilateral cryptorchidism.

Question 7

orchitis causes:

Answer 7

1. chlamydia trachomatis serotypes D-K or Neisseria gonorrhea. seen in young adults. there is an increased risk of sterility, but libido is not affected because leydig cells are spared.
2. E. coli and pseudomonas in older adults- UTI pathogens may spread to the reproductive tract.
3. mumps: (meningitis, orchitis, pancreatitis). seen in teen males with an incr. risk of infertility.
4. autoimmune orchitis: granulomas involving the seminiferous tubules (you might also think about TB).

Question 8

testicular torsion: process involved, risk factors.

Answer 8

twisting of the spermatic cord. thin walled veins become obstructed, but arteries are still clear. this casues congestion and hemorrhagic infarction (no blood flow across the organ).
usually due to congenital failure of testes to attach to the inner lining of the scrotum.
presents in teens with sudden testicular pain and absent cremasteric reflex (nerves for the reflex are also coming through the cord).

Question 9

varicocele: what is the process, how does it present, associations.

Answer 9

dilation of the spermatic veins/ panpiniform plexus. due to impaired drainage. presents as scrotal swelling with a bag of worms appearance. they are usually left sided. seen in a large percentage of infertile males. may also be seen in left sided renal cell carcinoma.

Question 10

varicocele treatment

Answer 10

varicocelectomy, embolization by radiologist.

Question 11

what is a hydrocele?

Answer 11

fluid collection within the tunical vaginals (serous membrane that covers the testicle as well as the internal surface of the scrotum).
in infants, it is associated with incomplete closure of the processus vaginalis, leading to communication with the peritoneal cavity. In adults, it is due to blockage of lymphatic drainage.
scrotal swelling that can be transilluminated.