Test 3 Flashcards
refers to a congenital absence of the
breast.
Amastia
denotes conditions in which
more than two breasts have developed.
Polymastia
The most common inflammatory disease of
the breast, usually affecting women who are
lactating and is caused by purulent bacteria,
such as Staph or Strept.
Acute Mastitis
• A rare disease of unknown cause.
• Because it produces small lumps in the breast, it
may mimic cancer, therefore a biopsy may be
indicated.
Chronic Mastitis
A change sometimes mistaken for carcinoma of the breast.
When extensive necrosis occurs from acute
mastitis, the destroyed breast tissue may be
replaced by a fibrous scar, sometimes
accompanied by nipple retraction
Tends to occur as a solitary, sharply localized
process in one breast, and almost all patients
give a history of previous trauma, prior surgical
intervention, or radiation therapy.
Fat Necrosis of the Breast
A term used to describe fibrosis and cysts with
reactive and degenerative changes that occur in
the breast of older women.
Fibrocystic Change of the Breast
Produces palpable lumps in the breast substance,
and histologic signs are found in approx. 50% of
all women whose breasts are examined at biopsy
or autopsy. Does not occur before puberty, and
is unusual to diagnosis the onset clinically in
postmenopausal women.
Fibrocystic Change of the Breast
Fibrocystic Change of the Breast
is related to…
The pathogenesis is related to sex hormones,
estrogen and progesterone which stimulate the
proliferation of cells in the excretory ducts of
the breast and the intralobular stroma.
When it comes to Fibrocystic Change of the Breast It is estimated that only ____% of women between___ and____ years of age have symptoms pertaining to fibrocystic change.
10-15%
20-50
The most constant feature of fibrocystic
change is fibrosis….
These changes may include dense fibrosis,
cystic dilation of ducts, and various ductal
proliferative changes.
Are the most common types of alterations in Fibrocystic Change of the Breast…
Blue Domed Cysts
The only change related to the development of carcinoma when it comes to Fibrocystic Change of the Breast
When the epithelial hyperplasia becomes
multilayered, with atypical nuclear change, this
is referred to as Atypical Epithelial Hyperplasia,
which is the only change related to the
development of carcinoma.
Fibrocystic Changes of the Breast Mammography may reveal…
condensed areas, cysts, and even areas of calcification. Because these calcified areas are indistinguishable from those seen in cancer, biopsy examination is the only safe way to establish a definitive diagnosis.
Typical fibrocystic change does not require
treatment, but it does when…
Atypical epithelial hyperplasia are found,
additional surgical resection is recommended.
most common of the benign tumors.
Fibroadenomas
Describe Fibroadenomas
Typically, they measure 2-5 cm in diameter and
are well-encapsulated spherical nodules, usually
well-circumscribed from the breast parenchyma
and are freely moveable from the surrounding
breast substance.
The two things Fibroadenomas are composed of…
the tumor is composed of
two components: fibrous stroma and glandular
epithelium.
• Tumors of young women that occurs most
commonly in the upper outer quadrant of the breast.
• Well-encapsulated, gray-white tumors that are
easily removed without consequences.
• They do not recur and do not undergo malignant
change; they have an excellent prognosis.
Fibroadenoma
• A neoplastic papillary growth within a milk duct.
• Most are solitary and are found within the principle
lactiferous ducts or sinuses. Presents clinically as a
serous or bloody discharge from the nipple, a small
sub-areolar mass and rarely nipple retraction.
Intraductal Papilloma
Multiple papillomas are associated with an…
Increased risk of papillary carcinomas.Solitary ones are benign. 2-5 together indicate.
is male breast enlargement associated
with hormonal changes in puberty. The enlargement is
secondary to an inordinate proliferation of the excretory
ducts and the surrounding connective tissue. This may
also occur in adulthood owing to an excess of
estrogens, as from cirrhosis or tumors
Gynecomastia
The second most common cancer in women,
behind lung cancer.
Carcinoma of the Breast
It is estimated that __ in __women will develop breast cancer during her life.
1/14
____ new cases of breast cancer
are diagnosed each year and the numbers are
increasing steadily.
180,000
________ women die of breast cancer
every year
46,000
When it comes to Carcinoma of the Breast The most important risk factor points to…
Hormonal and genetic etiologies which may
act concomitantly, and they may also be
paired with some additional unidentified
carcinogenic substances in the environment,
or with some carcinogenic viruses.
Cancer of the Breast-Risk Factors incidence slowly rises after the age of___ years and peaks in postmenopausal women who are about_____ years of age.
35
60
Cancer of the Breast-Risk is Uncommon in______, and______, and is most common in________, espec._______.
Uncommon in Japanese and Chinese
most common in Caucasians especially jews.
Hormonal Factors contributing to Cancer of the Breast
Women who are exposed to estrogens for prolonged periods tend to develop breast cancer more frequently than those who are not.
What is a Nulliparous women?
A women who has not born offspring…
…are at a greater risk for breast cancer than those
who have multiple children, probably because
pregnancy interrupts the cyclic secretion of
ovarian estrogens.
Nulliparous women
The incidence of breast cancers is increased in women who have…
cancer in the other breast, as well as
those who have ovarian or endometrial cancer, maybe because these tumors are hormonally
induced, occurring in women in whom there is hyperestrinism.
A breast cancer risk factor that includes atypical epithelial hyperplasia.
Premalignant Fibrocystic Changes and Multiple Intraductal Papillomatosis
Most malignant breast tumors are of________
origin and are therefore_________.
epithelial
Carcinomas
Most breast carcinomas (____%) occur in the
________ quadrant and approx.____% of breast
cancers are______, underneath the areola.
45%
upper outer
25%
central
20-30% of carcinomas and defined as a malig-
nant population of cells that lack the capacity to
invade through the basement membrane and
therefore no distant spread.
Non-Invasive Intraductal Carcinoma
Non-Invasive Intraductal Carcinoma cells spread through a ductal system and still produce extensive lesions involving a large area of the breast. It is thought to be
It is thought to be a precursor of invasive carcinoma.
Non-Invasive Intraductal Carcinoma AKA
AKA Comedocarcinoma
Seen in breasts removed for fibrocystic
change and is also seen in the vicinity of
invasive carcinoma or can be admixed with
foci of intraductal carcinoma.
Lobular Carcinoma In-Situ
Lobular Carcinoma In-Situ is Frequently a marker for…
invasive ductal or lobular carcinoma.
More than 2/3 of invasive carcinomas
Invasive Ductal Carcinoma
Invasive Ductal Carcinoma appearance.
The tumor appears firm and gritty on
sectioning
An adenocarcinoma that is accompanied by
a very strong “Desmoplastic” reaction
where the tumor cells infiltrating the tissue
are surrounded by dense connective tissue
that is produced by the host in response to
the tumor.
Invasive Ductal Carcinoma
The dense connective tissue pulls on the
adjacent tissue of and Invasive Ductal Carcinoma causes…
causing puckering of the skin
and retraction of the nipple which are typical
signs of a malignant breast lesion.
On palpation, Invasive Ductal Carcinoma these tumors are…
firm and do not
have sharp margins, as they infiltrate into the
surrounding tissues.
Histologically, Ductal Carcinoma are…
malignant duct lining cells in cords, solid nests,
and tubules invading the surrounding stroma.
- 5-10% of all breast cancers.
- Arise from terminal ductules of the acini.
- Tends to be bilateral far more frequently than invasive ductal cancers, and tends to be multicentric within the same breast.
- The tumors are rubbery and poorly circumscribed (no Desmoplasia).
Invasive Lobular Carcinoma
Invasive Lobular Carcinoma are Known for having…
solid nests and sheets arranged in concentric rings about normal ducts, called a Targetoid pattern of
arrangement.
A ductal carcinoma that forms in the nipple and
areolar area, with usually an underlying
carcinoma beneath. Affects the skin of the
nipple, causing ulcers, fissures, discharge
oozing, along with edema and inflammation
surrounding the nipple.
Paget’s Disease of the Breast
Describe Paget’s Disease of the Breast Histologically…
Involvement of the epidermis by malignant,
large clear-staining cells (Pagets cells), from the
underlying cancer present beneath the nipple that
is palpable in about 60% of cases.
Two common ways breast cancer spreads…
Metastasize via the lymphatics
Become adherent to the deep fascia of the chest wall and become fixed in position.
The breast tumors located here may spread into the internal mammary lymph nodes.
Medially or centrally located
common Distant metastases for breast carcinomas
are common in the lungs, liver, bones, brain, and adrenals.
In ___% of cases of breast carcinomas, the
mass lesion is detected by self-examination,
palpation in the clinician’s office, or by
Mammography.
In 80-90%
This technique delivers a biopsy specimen is relatively small and consists of cells that are smeared on a slide
for cytologic examination.
Fine needle aspiration
is the most conservative surgical procedure, as it is limited to resection of the tumor with surrounding fat tissue.
Lumpectomy
refers to removal of the entire breast, which is associated with axillary lymph node resection.
Mastectomy
The cancer consists of relatively small,
localized tumors (less than 2.5 cm in diameter)
without any distant metastases. Surgical
removal of the tumor is associated with an 80%
5 year survival rate.
Stage I Breast Cancer
Tumors measure more than 2.5 cm, but
less than 5 cm. in diameter. There may be
lymph node metastasis, but no evidence of
distant metastasis. 5 yr. survival rate is 65%.
Stage II Breast Cancer
tumors measure more than 5 cm,
with or without regional lymph node spread,
but without distant spread. The 5 year
survival rate is about 40%.
Stage III Breast Cancer
Tumors may be of any size and
may or may not be associated with local
lymph node metastasis, but are associated
with distant metastasis. The 5 year survival
rate is only 10%.
Stage IV Breast Cancer
most breast cancers are _________ and the more favorable variants are less common.
invasive ductal carcinomas
The overall 10 year survival of patients
operated on for breast cancer is in the range of…
50%
Although the sex is determined genetically at
the point of fertilization, the gonads do not acquire male or female characteristics until the_______ week of development.
seventh
Mesenchymal or stem cells (future sperm or eggs) that develop in the wall of the yolk sac near the allantois that migrate along the mesentery of the hindgut. This occurs at about the 3rd week of embryologic development.
primordial germ cells
What happens at the fifth week of development?
The primordial germ cells continue migration until they
reach the gonadal ridges and penetrate into the primitive gonad by the sixth week.
Under the influence of the SRY gene, the primitive sex cords continue to proliferate to form medullary cords which differentiate into the…
testicular seminiferous tubules, containing primitive germ cells which will contain immature sperm cells, the Spermatogonia.
In males What structures differentiate from the epithelium
and underlying mesenchyme of the genital ridge?
Tunica Albuginea
Sertoli (Sustenticular) Cells
Leydig (Interstitial) Cells
Mesenchymal cells between the Seminiferous tubules that secrete Testosterone by the eighth week of development
Leydig (Interstitial) Cells
for support and nutrition of the spermatozoa, located between the germ cells
Sertoli (Sustenticular) Cells
A dense layer of fibrous connective tissue separates the testes cords from the epithelium, called the
Tunica Albuginea
What are the three parts of the Urogenital Sinus?
- Urinary Bladder
- Pelvic Portion
- Phallic Portion
This structure belongs to the the upper and largest part of the Urogenital Sinus that is continuous with the allantois. Later the allantois degenerates to a fibrous cord called the urachus, which forms the Median Umbilical Ligament.
Bladder
This Portion of the urogenital sinus is a narrow canal which in the male forms the prostatic and membranous parts of the urethra.
Pelvic Portion
This part of the urogenital sinus forms the penile urethra in the male. It is flattened from side to side, and as the genital tubercle grows, (future penis) this part of the sinus will be pulled ventrally
Phallic Portion
The phallic (or definitive) urogenital sinus gives rise to the…
penile urethra
In females, the distal portion of the urethra gives rise to
urethral and paraurethral glands
What happens to the cloacal folds?
The cloacal folds differentiate into the anal and urethral folds
What are genital swellings and their locations?
Lateral to the urethral folds they are
elevations that form in both sexes. At this point, this indifferent stage is the same for both sexes with divergent courses with homologue tissues
Labioscrotal folds become what? in male and female
Male: scrotum
Female: Labia majora
Urogenital folds folds become what? in male and female
Male: Spongey Urethra
Female: Labia minora
Urogenital sinus homologous structures male:famale
Prostate : Skeens Glands
Cowper’s Glands : Bartholin’s glands
Bladder : Bladder
Urethra : Urethra, L vagina
Structures derived from the Wolffian Duct in a male
Rete testis
Epididymis
Vas Deferens
Seminal vesicles
Residual structure from Wolffian duct in a female
Rete ovarii
Residual structure from Mullerian duct in a male
Appendix testis
where the urethral meatus opens on the upper side (dorsal) of the penis
Epispadias
is usually associated with bladder exstrophy
(congenital absence of the anterior bladder wall
and anterior abdominal wall)
Epispadias
A congenital defect of the penis where the orifice
of the prepuce may be too narrow to allow
retraction over the glans penis
Phimosis
may lead to swelling and/or
enlargement of the scrotum
Cystic Scrotal Masses
a spontaneous accumulation
of clear serous fluid between the layers of the tunica
vaginalis and the testis or epididymis.
Hydrocele (Cystic Scrotal Mass)
refers to a small, cystic accumulation of semen in the dilated efferent ductules or ducts of the rete testis.
Spermatocele
an accumulation of blood between the layers of the tunica vaginalis, usually as a result of trauma.
Hematocele
most common cause of
scrotal swelling in infants and is often associated with an inguinal hernia.
Congenital Hydrocele
occurs in adults and is secondary to some other disease affecting the scrotum, such as an infection, tumor, or trauma. The cause of this fluid accumulation is unknown.
Acquired Hydrocele
Can also be seen after testicular torsion,
testicular tumors or rarely after infections of
the testis
Hematocele
• A congenital malpositioning of the testes outside of their normal scrotal location-it is the most important of the congenital abnormalities.
• The descent of the testes may be arrested at any point from the abdomen to the upper scrotum.
• Most commonly unilateral, one quarter it is
bilateral, and the cause for the maldescent is
unknown.
Crytorchidism
At term, about 4% of male newborns are
cryptorchid
During intrauterine life, the
testes slowly descend towards the inguinal
canal and through it, ultimately reaching the
scrotum by…
33 wks
When it comes to Cryptorchidism___% are located high in the scrotal sac,___% are located in the inguinal canal, and___% are located in the abdominal cavity.
60
25
15
Best defined as male hypogonadism (one of
the most common causes) and occurs when
there are two or more X chromosomes and
one or more Y chromosome.
Klinefelter Syndrome
With Crytorchidism The risk of developing germ cell tumors in untreated cryptorchidism , most commonly
Seminomas and Embryonal Carcinomas, is
increased 10-35 times.
the scrotum gives an environment
about__ degrees F. below body temperature.
3
The testes are covered by a dense layer of white
fibrous tissue, the ________ that extends
inward and divides each testis into a series of
internal compartments called_______.
Tunica Albuginea
Lobules
They account for only one percent of all
neoplasms in men (2 per 100,000).
Testicular Tumors
Clinically important because they occur at a relatively early age with a peak incidence at…
30- 40 years of age.
constitute more than 90% of testicular tumors
Tumors of germ cell origin
Originate from the neoplastic transformation of
germ cells and reflect their capacity to
differentiate along many histogenetic lines (cell phones)
Germ Cell Tumors
Three circumstances
have been demonstrated to be associated with an
increased risk of germ cell tumors:
prior diagnosis of a germ cell tumor in the
contralateral testis.
first degree family member diagnosis
Abnormal germ cells in gonadal dysgenesis,
(Klinefelter Syndrome and Cryptorchidism).
• Results from cytological atypia of germ cells
within the seminiferous tubules and was noted
to increase in severity with time.
• After a latent period, which can last 5-20 years,
the cancer can cross the basement membrane
and an invasive malignant disease develops.
Germ Cell Tumors-Histogenesis
Most Common Testicular Tumor
Seminoma
• An defect on the short arm of chromosome_____ is present in some 90% of testicular
germ cell tumors.
Chromosome 12
Seminomas are not found before puberty and most
patients are between the ages of ___ and ____.
25 and 55
90% of all seminomas are of the _____type,
with anaplastic and spermatocytic seminomas
presenting as much rare variants.
classic
Outwardly when the scrotum is directed out of the way, seminomas present themselves as….
a firm intratesticular poorly demarcated mass that bulges from the cut surface of the testis.
Histologically, they display solid nests of
proliferating tumor cells between scattered
fibrovascular trabeculae and lymphocytes. The
cells have well-defined borders with glycogen
rich clear cytoplasm and normal appearing
nuclei with coarse granular chromatin.
Seminomas
The entire testis is replaced by the Seminomas in over half the cases, which appears as…
yellow-white with rare focal areas of hemorrhage and necrosis
Seminomas are Exquisitely sensitive to_______, and in
localized tumors, this therapy has resulted
in 5 year survival rates of ___-___%.
Even in advanced cases, chemo is curative in
over__%.
radiation
85-95%
90%
• Second most common germ cell tumor,
accounting for 15-35% of these neoplasms.
• Also do not occur before puberty, and most are
found between the ages of 20 and 35.
• More aggressive and lethal than Seminomas
Embryonal Carcinomas
On sectioning, it is gray-white, poorly demarcated, and bulging, with varying degrees of hemorrhage and necrosis.
Embryonal Carcinomas
Grossly the tumor is small, and does replace the
entire testis.
Embryonal Carcinomas
The tunica albuginea and epididymis are invaded
in 20% of the cases.
Embryonal Carcinoma
Histologically, define the variable patterns of Embryonal Carcinomas.
have indistinct cell borders
dense nuclei with prominent nuceoli
marked pleomorphism and mitotic activity
Embryonal Carcinomas may be mixed with other tumors. What are these other tumors?
Choriocarcinoma’s and Yolk
Sac tumors
Embryonal Carcinomas Occasional cells may stain for…
Beta-HCG and AFP respectively
Embryonal Carcinomas Usually metastasize early to…
lymph nodes and distant organs (lungs and liver), and many patients already have mets at the time of diagnosis.
• Germ cell tumors characterized by tissue from
all three germ layers.
• Comprise almost half of the germ cell tumors in
infants and children but less than 5% of tumors
in adults.
Testicular Teratomas
• Much more common in adults and
demonstrates the same arrangement as a
mature teratoma, but the tissues are less
differentiated, and more primitive • The malignant teratoma has clearly malignant
squamous carcinoma or malignant
sarcomatous components, clearly defining a
true malignancy.
Immature and Malignant Teratoma
The most important predictor of the biological
behavior of a testicular teratoma is…
The age of the patient.
provide structural support for the gametes and also
produce secretions that are nutrients for the
spermatozoa.
Sertoli Cells
Between the semineferous tubules are clusters
of ______________, which secretes
Testosterone.
Interstitial Cells of Leydig
a network of ducts in the testes which possess cilia that push the sperm along.
Rete Testes
• Two comma-shaped organs, each lying along
the posterior border of the testis, consisting
mostly of tightly-coiled tubes.
• Lined by ciliated pseudostratified columnar
epithelium and their walls contain smooth
muscle.
• Functionally, it is the site of sperm maturation
and stores spermatozoa and propels them
toward the urethra during ejaculation.
Epididymis
Lined by pseudostratified epithelium with a
heavy coat of three muscle layers that propel the
sperm towards the urethra by peristalsis.
Ductus (Vas) Deferens
Posterior to the urinary bladder, each ductus
deferens joins it ejaculatory duct which
ejects spermatozoa into the prostatic
urethra.
• Also pseudostratified columnar epithelium .
Ejaculatory Duct
Histology of the Prostatic Portion, Membranous portion, and Spongy portions of the male urethra.
All portions are transitional epithelium.
Paired, convoluted pouch-like structures at the base of the urinary bladder. It secretes an alkaline viscous component of semen rich in the sugar fructose and pass it to the ejaculatory duct. It constitutes about 60% of the volume of semen.
Seminal Vesicles
• It is about the size of a chestnut, and secretes an
alkaline fluid and constitutes 13-33% of semen.
• contains about 30-50 individual compound tubuloalveolar glands, each gland having its own duct that delivers the secretory product to the prostatic urethra.
Prostate Gland
• Paired glands about the size of peas,
located beneath the prostate on either side of the membranous urethra.
• It secretes an alkaline fluid and
constitutes 7-10% of the semen.
Bulbourethral (Cowpers) Glands
The average volume of semen from each
ejaculation is…
2.5-6.0 ml.
The average range of spermatozoa
ejaculated is…
50-100 million sperm per ml.
when below 20 million/ml: sterility likely
are two dorsally located cylindrical masses of the Penis
The Corpora Cavernosa
a smaller ventral mass of the penis that contains the
spongy urethra.
The Corpora Spongiosum Penis
Represents the most common urinary tract neoplasm,
52,000 new cases are recorded each year in the U.S., and 10,000 deaths are attributed to this form of cancer.
Cancer of the Urinary Bladder
In Egypt, infection with _________________, a parasite, can also lead to cancer of the urinary bladder.
Schistosoma haematobium
Is most commonly caused by gram-negative
bacteria, especially E. coli., from a previous UTI due to reflux of infected urine into the prostate.
Acute Bacterial Prostatitis
A common, reactive, benign hyperplastic lesion
that may obstruct the flow of urine, related to male hormonal changes that occurs with aging.
Nodular Hyperplasia of Prostate (BPH)
What is the surgical treatments for BPH?
Can be treated surgically with a Transurethral Resection of the Prostate (TURP). Retrograde transurethral balloon dilation of the prostate can also be done with good results.
Recently, it became the most common
diagnosed cancer in men, overtaking lung cancer, and the 3rd most common cause of cancer related deaths in males.
Carcinoma of the Prostate
A tumor of older men, and of all patients with
disease, 75% are 60-80 years of age. Only 1% of cases are seen below the age of 50.
Carcinoma of the Prostate
What is the most common histologic type of
prostate cancer and what are the gross features?
98% of prostate cancers are Adenocarcinomas Grossly they are multicentric (or sometimes a
single nodule) lesions located in the peripheral
zones of the prostate. (posterior lobes)
A classification of prostate cancers based on
five histologic patterns of tumor gland formation and infiltration.
Gleason grading system?
(1-5)+(1-5)=score
Detectable levels of PSA after prostatectomy suggest…
persistent local or metastatic disease
• Obligate intracellular gram-negative organisms
which means they can survive only by
establishing residence inside animal cells. They
need their host’s ATP as an energy source for
their own cellular activity.
• Although they stain red with gram stain, it does
not have a peptidoglycan layer like the usual
gram-negative organisms.
Chlamydia
A triad of symptoms that include conjunctivitis,
polyarthritis, and genital inflammation.
Caused by C. trachomatis, serovar LGV 1,2 or 3,
that is a sexually-transmitted disease which
begins as a genital ulcer and progresses to a local
necrotizing lymphadenitis with scarring.
Reiter’s Syndrome
The organism is introduced through a break in the
skin, and after a 4-21 day incubation period, an
ulcer appears on the penis (or vagina), but the
lips, tongue and fingers may also be primary sites
Lymphogranuloma Venereum
Often called Gonococcus, causes the third most
common sexually transmitted disease (behind
venereal warts and Chlamydia).
Neisseria gonorrhoeae
• Tiny gram-negative organisms that look like
corkscrews and move with a unique spinning
fashion. Produces no toxins or tissue enzymes.
• Many of the disease manifestations are caused
by the host’s own immune responses, such as
inflammatory cell infiltrates, proliferative
vascular changes, and granuloma formation.
Treponema pallidum (Spirochetes)
• At the site of inoculation, the spirochetes
multiply and a local, non-tender ulcer called a
Chancre usually forms in 2-10 weeks.
-This is known as
Primary Syphilis
• Skin warts tend to occur in children and young
adults and tend to regress with age.
• The virus infects squamous epithelial cells and
produce cytoplasmic vacuoles within cells
called Koilocytes, the hallmark of infection.
Papillomavirus
• A malady of unknown etiology characterized
by focal, asymmetric, fibrous induration of the
shaft of the penis resulting in penile curvature
and pain during erection.
Peyronie Disease
Rare in the U.S., where it affects 1-2 men per
100,000 (0.5% of cancers). In other parts of the
world, where circumcision is not practiced and
poor hygiene is present, this cancer is much
more common (Africa and Asia >10% of male
cancers)
Carcinoma of the Penis
• Torsion of the spermatic cord, if complete,
produces severe pain and infarction of the
testicular germ cells within a few hours.
• Most commonly presents shortly after vigorous
physical exercise.
Torsion of the Testes
• A congenital anomaly of the penis in which the
urethra opens on the ventral (or under) surface.
• Results from incomplete closure of the urethral
folds of the urogenital sinus
• Occurs in about 1 in 350 male births, and most
cases are sporadic, although familial cases have
been reported
• In over 90% of cases, the urethral meatus is
located on the underside of the glans or the
corona. In 10% of cases, the opening is found
midshaft, or in the scrotum or perineum
Hypospadias
