Prostatic Neoplasia - Fremont-Smith Flashcards
condyloma accuminata
benign
-STD - HPV type 6 and 11
most often - coronal sulcus and inner prepuce - under foreskin
bowen disease
CIS
-variant high risk HPV - 16
red or gray plaque on shaft
bowenoid papulosis
CIS
-variant high risk HPV - 16
multple red-tan papules in young adults
-doesnt go to SCC**
erythroplasia of querat
CIS
-variant high risk HPV - 16
shiny red soft red plaque on glans and foreskin
high risk HPV
incorporates into host DIA
viral E6 oncoprotein inactivates p53 and E7 inactivates pRB (retinoblastoma)
male HPV infection
often don’t see anything
acetowhite - look for tiny lesions
remove a lesion
not removing a virus**
still HPV on skin surface
-is the immune system that removes virus
condyloma
koilocytic change
does not invade to SCC
bowenoid papulosis
perakeratosis
nuclei in keratin layer - indicate rapid turnover
whiteness and red lesions
CIS
need excised
but not bowenoid papulosis - bc does not invade
invasive SCC of penis
rare
risk fx - lack of circumcision, HPV 16/18, age 40-70yo, smoking
slow growing painless tumor
prognosis of penile SCC
depends on spread to nodes
no inguinal - 66% 5 year
yes inguinal - 27% 5 years
keratin pearl
SCC
pearly penile papules
variant of normal**
papillary growth around corona of glans
not sex transmission
will go away after time
appendix testes
on a stalk
stalk can become torsioned - ischemic/pain
common issue young boys
see dusky blue through scrotal sac
“the blue dot”
tunica albuginea
covers seminiferous tubules
pyocele, hydrocele, hematocele
around testicle
early testicular descent
mullerian inhibiting substance
late testicular descent
androgen dependent
cryptorchidism
improper testicle descent
testicle descent
two phases:
1 - transabdominal 6 weeks - due to MIS - from sertoli cells
2 - inguinal scrotal - androgen driven - gubernaculum guides testes
risk with cryptorchidism
testicular ca
trauma
torsion
infertility
orchiopexy
surgical correction of cryptorchidism
B/L cryptorchidism
25%
klinefelters
premature birth
fam hx
leydig cells
in stroma
sertoli cells
mixed in with germ cells
required for spermatogenesis
-source of MIS - for initial descent phase of testicle
intraabdominal testicle
needs to be corrected
-remove or bring down to scrotum
cryptorchid testis histo
leydig hyperplasia
peritubular fibrosis
only sertoli in tubules
prune belly syndrome
bilateral cryptorchidism
aka eagle-barret syndrome
absence of abdominal muscles**
torsion
twisting of spermatic cord
2/3 medially**
1/3 laterally
due to dissociation of tunica vaginalis - this keeps it from torsioning
12 hours to save testicle
tunica vaginalis
hydrocele space
partial envelopes testicle
involved in torsion
attachment to tunica vaginalis
stops torsion
not completely developed until 1-2 yrs old
in utero torsion
testicle present in scrotum
- no pain
- hard, discoloration of scrotum
- may be absent
see fibrosis and hemosiderin
torsion after birth
acute pain
-swelling and color changes to scrotum
bell clapper deformity
testicle lateral
not up and down orientation
testicular torsion diagnosis
color doppler blood flow
also nuclear scan - looking for blood flow
epididymis
bacteria - gonorrhea, chlamydia
old men - e. coli from UTI - reflux of bacteria up vas
need to culture urine**
also TB
syphilis
testis affected first and may spare epididymis
mumps
pressure atrophy due to tunica albuginea
-unusual in kids
granulomatous orchitis
man has vasectomy
- sperm to surrounding tissue
- form granuloma
most common - secondary to BCG for transitional cell carcinoma of bladder
-introduce BCG to bladder - granulomatous change - can get into urine to testicle**
