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FA - Reproductive > Repro - Pathology (Male Reproductive pathology) > Flashcards

Repro - Pathology (Male Reproductive pathology) Flashcards

Pg. 586-588 in First Aid 2014 Sections include: -Prostate pathology -Benign prostatic hyperplasia -Prostatic adenocarcinoma -Cryptorchidism -Varicocele -Testicular germ cell tumors -Testicular non-germ cell tumors -Tunica vaginalis lesions -Penile pathology

1
Q

What are 4 symptoms of prostatitis?

A

Prostatitis - (1) Dysuria (2) Frequency (3) Urgency (4) Low back pain

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2
Q

What is (are) the causes of acute versus chronic prostatitis? Which is most common?

A

ACUTE: bacterial (e.g., E. coli); CHRONIC: bacterial or abacterial (most common)

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3
Q

In what patient population is benign prostatic hyperplasia common?

A

Common in men > 50 years old.

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4
Q

Define the physiological change benign prostatic hyperplasia.

A

Hyperplasia (not hypertrophy) of the prostate gland

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5
Q

What physical findings characterize benign prostatic hyperplasia? Is it a premalignancy?

A

Characterized by a smooth, elastic, firm nodular enlargement of the periurethral (lateral and middle) lobes, which compress the urethra into a vertical slit. Not considered a premalignant lesion.

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6
Q

What are 4 signs/symptoms with which benign prostatic hyperplasia often presents?

A

Often presents with (1) increased frequency of urination, (2) nocturia, (3) difficulty starting and stopping the stream of urine, and (4) dysuria.

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7
Q

What are 3 conditions/complications that may result from benign prostatic hyperplasia?

A

May lead to (1) distention and hypertrophy of the bladder, (2) hydronephrosis, and (3) UTIs.

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8
Q

What key lab finding is associated with benign prostatic hyperplasia?

A

Increased free prostate specific antigen (PSA)

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9
Q

What are the treatment options for benign prostatic hyperplasia? What is the mechanism behind these treatments?

A

Treatment: alpha-1 antagonists (terazosin, tamsulosin), which cause relaxation of smooth muscle; Finasteride (5alpha-reductase inhibitor)

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10
Q

Draw a visual of the prostate, including and labeling the following: (1) Anterior lobe (2) Benign prostatic hyperplasia (boundaries) (3) Lateral lobe (4) Middle lobe (5) Posterior lobe (6) Prostate cancer (7) Urethra.

A

See p. 586 in First Aid 2014 for visual at bottom right of page

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11
Q

In what patient population is prostatic adenocarcinoma common? What other reproductive pathology is also notable for being common in this patient population?

A

Common in men > 50 years old; Benign prostatic hyperplasia

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12
Q

From where in the prostate gland does prostatic adenocarcinoma most often arise? How is it most frequently diagnosed?

A

Arises most often from the posterior lobe (peripheral zone) of the prostate gland and is most frequently diagnosed by increased PSA and subsequent needle core biopsies.

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13
Q

What are 2 useful tumor markers for prostatic adenocarcinoma?

A

Prostatic acid phosphatase (PAP) and PSA are useful tumor markers (increase total PSA, with decreased fraction of free PSA).

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14
Q

What complication may develop in late stages of prostatic adenocarcinoma? What 3 symptoms/signs indicate this?

A

Osteoblastic metastases in bone may develop in late stages, as indicated by lower back pain and an increase in serum ALP and PSA.

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15
Q

What histological finding(s) characterize(s) Prostatic adenocarcinoma?

A

Note the small neoplastic glands with prominent nucleoli amid normal prostate stroma

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16
Q

What is cryptorchidism?

A

Undescended testis (one or both)

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17
Q

What effect does cryptorchidism have on spermatogenesis and testosterone levels, and why?

A

Impaired spermatogenesis (since sperm develop best at temperatures < 37 C); can have normal testosterone levels (Leydig cells are unaffected by temperature)

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18
Q

Of what other pathology does cryptorchidism increase the risk?

A

Associated with increased risk of germ cell tumors

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19
Q

What increases the risk of cryptorchidism?

A

Prematurity increased the risk of cryptorchidism

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20
Q

What are the key hormonal changes in cryptorchidism? Which hormone level varies, and according to what?

A

Decreased inhibin, Increased FSH, and Increased LH; Testosterone decreases in bilateral cryptorchidism, normal in unilateral

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21
Q

What is Varicocele, and what causes it?

A

Dilated veins in pampiniform plexus as a result of increased venous pressure

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22
Q

What is the most common cause of scrotal enlargement in adult males?

A

Varicocele

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23
Q

On what side does varicocele most often occur, and why?

A

Most often on the left side because of increased resistance to flow from left gonadal vein drainage into the left renal vein

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24
Q

What effect can varicocele have on fertility, and why?

A

Can cause infertility because of increased temperature

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25
Q

How does varicocele appear?

A

“Bag of worms” appearance

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26
Q

How is varicocele diagnosed?

A

Diagnosed by ultrasound with Doppler

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27
Q

What are the treatment options for Varicocele?

A

Treatment: Varicocelectomy, Embolization by interventional radiologist

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28
Q

What percentage of testicular tumors are germ cell versus non-germ cell tumors?

A

Germ cell: ~95% of all testicular tumors; Non-germ cell: ~5% of all testicular tumors.

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29
Q

In what patient population do testicular germ cell tumors most often occur?

A

Most often occur in young men

30
Q

What are 2 risk factors for testicular germ cell tumors?

A

Risk factors: (1) Cryptorchidism (2) Klinefelter syndrome

31
Q

As what kind of tumor can testicular germ cell tumors present?

A

Can present as a mixed germ cell tumor

32
Q

What is the differential diagnosis for testicular mass that does not transilluminate?

A

Differential diagnosis for testicular mass that does not transilluminate: cancer.

33
Q

Are testicular non-germ cell tumors mostly benign or malignant?

A

Mostly benign

34
Q

What are 5 types of testicular germ cell tumors?

A

(1) Seminoma (2) Yolk sac (endodermal sinus) tumor (3) Choriocarcinoma (4) Teratoma (5) Embryonal carcinoma

35
Q

Is seminoma benign or malignant?

A

Malignant

36
Q

What is the presentation of seminoma?

A

Painless, homogenous testicular enlargement

37
Q

What is the most common testicular tumor?

A

Seminoma

38
Q

When does seminoma most commonly present? When does it never present?

A

Most common in 3rd decade, Never in infancy

39
Q

What characterizes seminoma on histology?

A

Large cells in lobules with watery cytoplasm and a “fried egg” appearance.

40
Q

What lab finding is significant for a seminoma?

A

Increase placental ALP

41
Q

Is seminoma sensitive or resistant to radiation?

A

Radiosensitive

42
Q

When in the course of seminoma does metastasis occur? What is the prognosis of seminoma?

A

Late metastasis, Excellent prognosis

43
Q

What is another name for yolk sac tumor? What physical traits characterize it?

A

Yolk sac (endodermal sinus) tumor; Yellow, mucinous

44
Q

What part of the body is affected by a yolk sac tumor in males? Is it aggressive and/or malignant? To what tumor in females is it analogous?

A

Aggressive malignancy of testes, analogous to ovarian yolk sac tumor.

45
Q

What is the name of the bodies associated with Yolk sac (endodermal sinus) tumor? What do they resemble?

A

Schiller-Duval bodies resemble primitive glomeruli

46
Q

What is the most common testicular tumor in boys < 3 years old?

A

Yolk sac (endodermal sinus) tumor

47
Q

Is choriocarcinoma benign or malignant? With what hormone level change is it associated?

A

Malignant, Increase hCG.

48
Q

What mechanism/underlying change causes choriocarcinoma?

A

Disordered synctiotrophoblastic and cytotrophoblastic elements

49
Q

How does choriocarcinoma metastasize, and to where? What complications may result from such metastases, and why?

A

Hematogenous metastases to lung and brain (may present with “hemorrhagic stroke” due to bleeding into the metastasis.

50
Q

With what symptoms may choriocarcinoma present, and why?

A

May produce gynecomastia or symptoms of hyperthyroidism (hCG is an LH and TSH analog)

51
Q

Are teratomas in (adult) males benign or malignant? How does this compare/contrast to teratomas in females? Are teratomas in benign or malignant in children?

A

Unlike in females, mature teratoma in adult males may be malignant; Benign in children

52
Q

What are 2 hormone/factor changes that may occur in male teratomas, and in what percentage of cases does this occur?

A

Increased hCG and/or AFP in 50% of cases.

53
Q

Is embryonal carcinoma benign or malignant? Describe the mass that presents. Compare/Contrast its prognosis to that of seminoma.

A

Malignant, hemorrhagic mass with necrosis; painful; worse prognosis than seminoma.

54
Q

What kind of morphology does embryonal carcinoma often have?

A

Often glandular/papillary morphology

55
Q

Briefly describe how embryonal carcinoma most commonly presents in terms of type(s) of cancer.

A

“Pure” embryonal carcinoma is rare; most commonly mixed with other tumor types

56
Q

With what hormone/factor levels may embryonal carcinoma be associated? According to what can this vary, and how so?

A

May be associated with increased hCG and normal AFP levels when pure (increase AFP when mixed)

57
Q

What are 3 types of testicular non-germ cell tumors?

A

(1) Leydig cell (2) Sertoli cell (3) Testicular lymphoma

58
Q

What histological finding characterizes Leydig cell tumors? What color is the tumor?

A

Contains Reinke crystals; Golden brown color

59
Q

What do Leydig cell tumors usually produce? How do they present in men versus boys?

A

Usually androgen producing, gynecomastia in men, precocious puberty in boys

60
Q

What is a Sertoli cell tumor, and from where does it arise?

A

Androblastoma from sex cord stroma

61
Q

What is the most common testicular cancer in older men? What is important to note about its progression?

A

Testicular lymphoma; Aggressive

62
Q

Is testicular lymphoma due to a primary cancer or metastases?

A

Not a primary cancer, arises from lymphoma metastases to testes

63
Q

What are tunica vaginalis lesions? How are they distinguished from testicular tumors?

A

Lesions in the serous covering of testis present as testicular masses that can be transilluminated (vs. testicular tumors)

64
Q

What are 2 types of tunica vaginalis lesions?

A

(1) Hydrocele (2) Spermatocele

65
Q

What causes hydrocele?

A

Hydrocele - increased fluid secondary to incomplete obliteration of processus vaginalis

66
Q

What defines/causes spermatocele?

A

Spermatocele - dilated epididymal duct

67
Q

On what 3 continents is squamous cell carcinoma of the penis more common?

A

More common in Asia, Africa, and South America

68
Q

What are 3 precursor in situ lesions for penile squamous cell carcinoma? How does each present?

A

Precursor in situ lesions: (1) Bowen disease (in penile shaft, presents as leukoplakia) (2) Erythroplasia of Queyrat (cancer of glans, presents as erythroplakia) (3) Bowenoid papulosis (presents as reddish papules)

69
Q

With what 2 factors/conditions is squamous cell carcinoma associated?

A

Associated with HPV, lack of circumcision

70
Q

What is priapism?

A

Painful sustained erection not associated with sexual stimulation or desire

71
Q

What are 3 factors/conditions associated with priapism?

A

Associated with (1) trauma, (2) sickle cell disease (sickled RBCs get trapped in vascular channels), (3) medications (anticoagulants, PDE-5 inhibitors, antidepressants, alpha-blockers, cocaine).

72
Q

What are 5 examples of medications associated with priapism?

A

Medications (anticoagulants, PDE-5 inhibitors, antidepressants, alpha-blockers, cocaine)

FA - Reproductive (18 decks)

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