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USMLE > Reproductive - Male Pathology > Flashcards

Reproductive - Male Pathology Flashcards

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USMLE® Step 1 flashcards
1
Q

Hypospadias: Mechanism and Presentation

A

Failure of urethral folds to close leading to opening of urethra on inferior surface of penis

May be associated with androgen dysfunction

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2
Q

What is the most common malformation of urethral grove?

A

Hypospadias

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3
Q

Why treat hypospadias?

A

Prevent UTI

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4
Q

Epispadias: Mechanism and Presentation

A

Opening of urethra on superior surface of penis

Due to faulty positioning of genital tubercle

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5
Q

What is episapdias associated with?

A

Extrophy of bladder

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6
Q

Condyloma acuminatum: Mechanism and Cause

A

Benign warty growth on genital skin

Due to HPV type 6, 11; koilocytic changes

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7
Q

Lymphogranuloma venereum: Presentation

A

Necrotizing granulomatous inflammation of inguinal lymphatics and lymph nodes (Chlamydia L1-L3)

Heals with fibrosis; perianal involvement may result in rectal stricture

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8
Q

Squamous Cell Carcinoma of Penis: Risk factors

A

high risk HPV, lack of circumcision

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9
Q

Squamous Cell Carcinoma of Penis: Epidemiology

A

More common in Asia, Africa, South American

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10
Q

What are the precursor lesions of Squamous Cell Carcinoma of Penis?

A

Bowen disease
Erythroplasia of Queryrat
Bowenoid papulosis (not precursor)

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11
Q

Bowen disease

A

In situ carcinoma of penile shaft or scrotum with leukoplakia

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12
Q

Erythroplasia of Queyrat

A

In situa carcinoma on glans that presents as erythroplakia

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13
Q

Bowenoid papulosis

A

In situa carcinoma with multiple reddish papules in younger patients (40s)

Does not progress to invasive carcinoma

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14
Q

Peyronie’s disease

A

Bent penis due to acquired fibrous tissue formation

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15
Q

Priapism

A

Painful sustained erection not associated with sexual stimulation or desire

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16
Q

Priapism: Causes

A

trauma

sickle-cell disease (sickled RBCs trapped in vascular channels)

medications (anticoagulants, PDE5 inhibitors, antidepressants, alpha-blockers, cocaine)

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17
Q

Cryptorchidism

A

Failure to testicle to descend into scrotal sac

If not resolve spontaneously, orchipexy before age 2

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18
Q

Cryptorchidism: Complications

A

testicular atrophy with infertility (impaired spermatogenesis); increased risk of seminoma

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19
Q

Cryptorchidism: Levels of sex hormones

A

Normal testosterone level (Leydig cells unaffected by temperature)

High FSH, LH, low inhibin
Low testosterone if bilateral

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20
Q

Cryptorchidism: Risk factor

A

Prematurity

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21
Q

What is the most common congenital male reproductive abnormality? (1%)

A

Cryptorchidism

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22
Q

Orchitis

A

Inflammation of testicle

increased risk of sterility but libido unaffected

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23
Q

Orchitis: Causes

A

Young adults: chlamydia trachomatis (DK) or Neisseria gonorrhoeae

Older adults: E. coli and pseudomonas (UTI pathogens)

Mumps virus (teenage): infertility - not seen in < 10 yo

Autoimmune orchitis: granulomas involving seminiferous tubules

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24
Q

Testicular torsion: Presentation and Mechanism

A

Adolescent with sudden testicular pain and absent cremasteric reflex
(Congenital failure of testes to attach to inner lining of scrotum)

Twisting of spermatic cord; thin-walled veins obstructed -> congestion and hemorrhagic infarction

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25
Q

Varicocele: Presentation

A

Left-sided scrotal swelling with “bag of worms” appearance”

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26
Q

Varicocele: Mechanism

A

Dilation of veins in pampiniform plexus due to impaired drainage (increased venous pressure)
Left side affected - drains into left renal vein

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27
Q

What is left-sided varicocele associated with?

A

Left sided renal cell carcinoma (RCC invades renal vein)

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28
Q

Varicocele: Complications

A

Infertility (increased temperature)

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29
Q

Varicocele: Diagnosis and Treatment

A

Diagnosis: ultrasound
Treatment: Varicocelectomy, ebolization

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30
Q

Hydrocele: Presentation and Mechansim

A

Scrotal swelling that can be transilluminated

Fluid collection within tunica vaginalis (serous membrane that covers testicles and internal surface of scrotum)

31
Q

What is hydrocele associated with in children? In adults?

A

Children: incomplete closure of processus vaginalis leading to communications with peritoneal cavity

Adults: blockage of lymphatic drainage

32
Q

Testicular tumors: Presentations

A

Firm, painless testicular mass; not transilluminated

Germ cells or sex cord-stroma

33
Q

Testicular tumors: Diagnosis

A

Usually not biopsied

  • risk of seeding to scrotum
  • most are malignant germ cell tumors
34
Q

What are the two types of testicular tumors?

A

Divided to seminoma (responsive to radiotherapy), and nonseminoma (early metastasis)

35
Q

Testicular tumors: risk factors

A

cryptochidism, kleinfelter syndrome

36
Q

Seminoma: Histology

A

Homogeneous mass with no hemorrhage or necrosis

Malignant tumor of large cells with clear cytoplasm and central nuclei (resembles ovarian dysgerminoma)

37
Q

Seminoma: Lab

A

beta-hCG

38
Q

Seminoma: Metastasis and Prognosis

A

Good prognosis, late metastasis; respond to radiotherapy

39
Q

Seminoma: Age group

A

Males 15-35 yo

40
Q

Embryonal carcinoma (Male): Histology

A

Painful, hemorrhagic mass with necrosis

Immature, primitive cells that may produce glands/papillary; most are mixed

41
Q

Embryonal carcinoma (Male): Metastasis and Prognosis

A

Aggressive with early hematogenous spread

Chemotherapy may result in differentiation into another type of germ cell tumor

42
Q

Embryonal carcinoma (Male): Lab

A

Increased AFP (mixed)/beta-hCG

43
Q

Endodermal sinus tumor (Male): Presentation and Histology

A

Yolk sac, yellow mucinous tumor in children

Schiller-duval bodies (glomerulus-like structures)

44
Q

Endodermal sinus tumor (Male): Lab

A

Elevated AFP

45
Q

Choriocarcinoma (Male): Histology

A

Malignant tumor of synctiotrophoblasts (high beta HCG) and cytotrophoblasts (placental-like tissue without villi)

46
Q

Choriocarcinoma (Male): Lab

A

High beta-HCG can lead to hyperthyroidism or gynecomastic (alpha subunit similar to FSH/LH/TSH)

47
Q

Choriocarcinoma (Male): Metastasis

A

Hematogenous metastasis to lungs

48
Q

Teratoma (Male): Histology

A

Mature fetal tissue tumors with 2-3 embryonic layers

49
Q

Teratoma (Male): Prognosis

A

Malignant in males (benign in females, children)

50
Q

Teratoma (Male): Lab

A

Increased hCG and/or AFP in 50% of cases

51
Q

Mixed germ cell tumors (Male)

A

Most germ cell tumors are mixed

prognosis based on worst component

52
Q

Leydig cell tumor (Male): Histology

A

Golden brown color; Reinke crystals

53
Q

Leydig cell tumor (Male): Presentation

A

Produces androgen (precocious puberty in children; gynecomastia in adults)

54
Q

Sertoli cell tumor

A

Sex cord-stromal tumor with tubules

usually clinically silent

55
Q

Lymphoma (testicular tumor)

A

Testicular mass in males > 60 yo

Often bilateral and aggressive; diffuse large B-cell type

56
Q

Prostate: histology

A

Glands and stroma
Glands: inner layer of luminal cells and outer layers of basal cells (make alkaline, milky fluid added to sperm and seminal vesical fluid to make semen)

Glands and stroma are maintained by androgens

57
Q

Acute prostatitis: Presentation and Mechanism

A

Acute inflammation
Dysuria with fever, chills
Prostate tender and boggy on digital rectal exam

58
Q

Acute prostatitis: Causes

A

Young adults - chlamydia, neisseria

Old adults - E. coli, pseudomonas

59
Q

Acute prostatitis: Diagnosis

A

Prostatic secretions show WBCs; culture reveals bacteria

60
Q

Chronic prostatitis: Presentation and Diagnosis

A

Chronic inflammation
Dysuria with pelvic or low back pain

WBCs but no culture

61
Q

Benign prostatic hyperplasia (BPH): Presentations (6)

A
  1. Impaired bladder emptying (increased risk of infection/hydronephrosis)
  2. Dribbling
  3. Problem with urine stream
  4. hypertrophy of bladder wall smooth muscle (bladder diverticula)
  5. microscopic hematuria
  6. Slightly elevated PSA (increased number of glands)
62
Q

Benign prostatic hyperplasia (BPH): Presentation

A

Hyperplasia of prostatic stroma and glands

In central periurethral zone of prostate (lateral and middle lobes)

63
Q

Benign prostatic hyperplasia (BPH): Risk and Associations

A

Associated with DHT (from testosterone by 5alpha-reductase in stromal cells)

Increased with age; no increased risk of cancer

64
Q

Benign prostatic hyperplasia (BPH): Treatment

A
  1. alpha-1 antagonist (terazosin) to relax smooth muscle
    (also for blood pressure)

Tamsulosin (alpha-1A antagonist) - no effect of alpha-1B on blood vessels

  1. 5 alpha reductase inhibitor (block conversion to DHT)
    Tox: gynecomastia, sexual dysfunction
65
Q

Prostate adenocarcinoma: Epidemiology

A

Malignant proliferation of prostatic gland
Risk factors: African Americans > Caucasians > Asians; saturated fat diet

Most common cancer in men; 2nd most common cause of cancer death

66
Q

Prostate adenocarcinoma: Presentation

A

Most often clinically silent

Arise in peripheral, posterior region - not produce urinary symptoms early on

67
Q

Prostate adenocarcinoma: Screening Protocol

A

Screening 50 yo with DRE and PSA (decreased %free-PSA worrisome for cancer)

68
Q

Prostate adeocarcinoma: Histology

A

Biopsy required for confirmation

Invasive glands with prominent nucleoli

69
Q

Prostate adeocarcinoma: Grading system

A

Gleason grading system - architecture alone

70
Q

Prostate adeocarcinoma: Metastasis

A

Can spread to lumbar spine/pelvis (osteoblastic - elevated alkaline phosphatase, PSA, prostatic acid phosphatase PAP)

71
Q

Prostate adeocarcinoma: Treatment

A

Prostatectomy for localized disease

Advance: hormone suppression (leuprolide; flutamide)

72
Q

Tunica vaginalis lesions

A

Lesions in serous covering of testis as masses that can be transilluminated
Hydrocele and Spermatocele

73
Q

Spermatocele

A

Dilated epididymal duct

USMLE (13 decks)

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