Penis (Pathology)

Question 0

Phimosis?

Answer 0

abnormal narrow and long (foreskin)
- hygiene
smegma (material around glands) = carcinogenic (100% of cases)

Question 1

Congenital anomalies of penis?

Answer 1

Epispadias - open dorsal surface
Hypospadias - open ventral surface (MC)
- obstruction
- infertility
- infections

Question 2

Paraphimosis?

Answer 2

forcible retraction –> extremely painful, severe congestion of glans, obstruction

Question 3

Balanitis

Answer 3

inflamation of the glands

Question 4

Balanoposthisis

Answer 4

infection of glans, prepuce

• candida
• mycoplasma

Question 5

Gonorrhea in penis?

Answer 5

retrograde spread = epiditimal orchitis

cause strictures from fibrosis healing

Question 6

Syphilis course?

Answer 6

1. 6 wks, localized smptoms (chancre)
2. 6 mons, asymptomatic (rash, condyloma lata)
3. tree bark aorta, CNS, paralysis, spinal cord, granulomatous lesions

Question 7

Histology in syphilis

Answer 7

obliterative endarteritis –> loss lumen

plasma cells - cuff around the vessels

Question 8

Chanchroid

Answer 8

painful and soft lesion

Question 9

Lymphogranuloma venerum

Answer 9

Chlamydia trachomatis
rectum involved
stellate abscess

Question 10

Granuloma inguinale

Answer 10

calymmatobacterium donovani
donovan bodies

rare in US

Question 11

Condyloma accuminatum

Answer 11

genital warts
HPV 6,11 (no malignancy)
koilocytic change (perinuclear halo)
infect squamous cells

Question 12

Bowen’s disease

Answer 12

carcinoma in situ
- cancerous cells, BM intact
HPV 16
>30 yrs
solitary , gray white
\++ other malignancies visceral

Question 13

Erythroplasia of Queyat

Answer 13

more dysplasia
shiny red plaque
variant of carcinoma

Question 14

Bowenoid papulosis

Answer 14

looks like Bowen
HPV 16 
multiple, red brown
<30 yrs 
no malignancy

Question 15

Squamous Cell Cercinoma (penis)

Answer 15

60 yrs
non-circumcised 
HPV 16, 18
keratin pearls
prog: <50% no LN, 30% LN

early circumcision can prevent

Question 16

Cryptorchisim

Answer 16

Failure to descend through inguinal canal

Question 17

Testicular cancer with cryptorchidism?

Answer 17

abdomen - infertility, testicular cancer (seminoma)

inguinal - trauma, infertility, hernia

Question 18

Atrophic changes with cryptorchidism?

Answer 18

sparing leydig cells

hyalinization of seminiferous tubules/interstitial fibrosis

Question 19

Treatment for cryptorchidism?

Answer 19

if after 1 yrs pull it down
if before 1 yr it can still descend

MUST before 2 yrs
orchiopexy - pull down and ligating to the sack

Question 20

result of orchiopexy

Answer 20

infertility - 20-25% may regain
cancer risk - unchanged
if cancer - easier to palpate for cancers

Question 21

where do you see testicular atrophy?

Answer 21

1. Kleifelter syndrome
2. to many things (criptorchidism etc.)

lead to infertility

Question 22

Histology of testicular atrophy

Answer 22

sparing Leydig cells

hyalinization of seminiferous tubules

Question 23

Non-specific epididymitis/orchitis
children?
adults?
older adults?

Answer 23

children = gram - rods
adults = chlamydia, neisseria
older = e.coli, pseudomonas

Question 24

granulomatous orchitis

Answer 24

autoimmune orchitis
sudden onset with fever
granulomas (seminiferous tubules)

DD: Tb (everywhere)

Question 25

gonorrheal epidimymo-orchitis retrograde infection

Answer 25

spread to testes/prostate (untreated)

Question 26

mumps orchitis

Answer 26

adults
after parotitis
unilateral
with mumps pancreatitis

mononuclear cells infeltrate

Tx: steroids

Question 27

tuberculous epididymo-orchitis

Answer 27

primarily in epiditimis

caseating granulomas

Question 28

syphilitic orchitis

Answer 28

start in testes

rarely spreads

Question 29

torsion of testes

Answer 29

twisting of spermatic cord
arterial/venous obstruction

cause: crimtochitism, testicular atrophy, absence of oscrotal ligaments

Question 30

what must be done with testicular torsion?

Answer 30

orchiopexy of unaffected side as well

Question 31

where do you see torsion?

Answer 31

testes and ovaries

venous infarction

Question 32

MC cancer in testes?

Answer 32

seminoma

Question 33

germ cell tumors?

Answer 33

seminoma

nsgct

Question 34

seminomas types?

Answer 34

1. classic (MC)
2. anaplastic
3. spermatocytic

PAP marker
40s

Question 35

NSGCT classes?

Answer 35

1. embryonal ca. 30s,testicular shape lost
2. yolk sac tumor (M,F <3yrs, schiller-duval bodies, AFP)
3. choriocarcinoma (Beta-hCG) metastases
4. teratoma (children mature)
5. mixed tumors

Question 36

choriocarcinoma

Answer 36

1. gestational (abortion, pregnancy, mole)
2. gonadal (testes, ovaries)

absent of chorionic villi
produce Beta-hCG
bad treatment - single drug(methotrexate)

Question 37

non-GCT classes?

Answer 37

1. leydig cell (++testosterone)
2. sertoli cell (++estrogen)
3. lymphoma B-NHL (MC >60yrs, worst prog)

Question 38

clinical features of GCT?

Answer 38

1. painless mass enlargement of testes

2. spread through blood and lymph

Question 39

staging of GCT?

Answer 39

1-confirmed testes
2-spread below diapharam
3-above diaphram

Question 40

seminoma testicular shape?

Answer 40

maintained shape
intact tunica albuginea
no hemorrhage
no necrosis

Question 41

histology of seminoma?

Answer 41

seminoma cells with l ymphocytic infiltrates and granulomas

Question 42

NSGCT testicular shape?

Answer 42

lost testicular shape + local invasion

Question 43

treatment for seminoma?

Answer 43

RT effective - not aggressive

Question 44

NSGCT treatment?

Answer 44

not effective and can be aggressive

Question 45

teratoma classes?

Answer 45

3 germ layers

1. mature (children)
2. immature (adults)
3. mondermal malignancy (SCC, AdeC)

Question 46

histology in leydig cell tumor?

Answer 46

Reinke crystalloids (eosinophilic cytoplasm)
90% benign