Testes, Penile, and Prostate Disorders

Question 1

Cryptochidism

Answer 1

10-40x increase cancer risk in both
can cause infertility
Atrophy as early as 2 yrs

Question 2

Mumps orchiditis

Answer 2

Pubertal/adults. 30% of mumps. Usually after parotid. 70% unilateral.
Mononuclear inflammatory infiltrate with interstitial edema +/- neutrophils

Question 3

Tuberculus orchiditis

Answer 3

Almost always begins in epididymis and spreads to testes; usually part of systemic disease
 Caseating granulomas

Question 4

Syphilis

Answer 4

usually testes first
Diffuse mononuclear interstitial inflammation rich in plasma cells
Obliterative endarteritis +/- gummas

Question 5

Varicocele

Answer 5

Abnormal dilatation & tortuosity of veins in pampiniform plexus
Left side 90%

Question 6

Nonspecific Epididymitis

Answer 6

Usually due to direct extension from urinary tract and tends to affect epididymis first with subsequent orchitis
kids, usually from urinary tract malformations (gram negative rods)
sexually active adults, usually Chlamydia or Gonorrhea
elderly, usually due to enterobacteria
May develop abscesses with acute inflammation

Question 7

Seminoma

Answer 7

Most primitive; most common germ cell tumor. 40s.
“Fish-flesh” tumor
Large polygonal cells with clear
cytoplasm and large central
nucleus
Biphasic look
Good prog

Question 8

Embryonal Carcinoma

Answer 8

Most common mixed GCTs
Large hyperchromatic, pleomorphic nuclei and indistinct cytoplasm
Mitoses are frequent
PLAP pos

Question 9

Teratoma

Answer 9

Mature: heterogenous differentiated elements i.e neural tissue, muscle, cartilage, etc
Immature: incompletely differentiated
Chemo resistant

Question 10

Choriocarcinoma

Answer 10

Rare pure, but mixed.
Placental differentiation (syncytiotrophoblast and cytotrophoblast)
Produce hCG
Aggressive

Question 11

Yolk Sac Tumor

Answer 11

Most common testicular tumor of infants and children
Loose cell on thin fibrovascular cords or microcystic/myxomatous
Cells accumulate and secrete alpha-fetoprotein

Question 12

Condyloma Acuminatum

Answer 12

NOT cancer, but can be cancer precursor
“Genital wart” composed of papillary projections
Koilocytes: epithelial cells with atypical crinkled nuclei and large perinucelar halocharacteristic of HPV 6 and 11

Question 13

Bowen’s disease

Answer 13

Squamous CIS involving skin of genital region

5-10% will progress to invasive squamous carcinoma o associated with visceral cancers

Question 14

Erythroplasia Queyrat

Answer 14

Squamous CIS involving mucosal surfaces of glans penis in non-circumsized men
Also can progess to invasive carcinoma

Question 15

Squamous Carcinoma

Answer 15

Significant health problem in areas of the world where not good genital hygiene
HPV types 16 and 18 implicated
Elderly. african american

Question 16

Acute Prostatitis

Answer 16

Usually e.coli or enterobacteria or s. aureua
Infections from bladder
Obstructive urinary symptoms

Question 17

Malakoplakia

Answer 17

Believed to be due to aberrant phagocytic process which leads to retention of bacterial wall fragments that subsequently calcify
Nodular histiocyte aggregates containing intracytoplasmic calcified inclusions (Michaelis-Gutmann Bodies)

Question 18

BPH

Answer 18

thought to involve androgen/estrogen balance
BPH nodules in the transition zone
Difficulty in starting and stopping urination
Frequency and nocturia
Tx = androgen & alpha antags

Question 19

Prostate Cancer

Answer 19

>

50. AA> caucasions > asians.
    Most common metastases are to axial skeleton (osteoblastic) or lymphatic to obturator lymph nodes
    Most common in peripheral zone
    atypical glands lined by single layer of malignant cuboidal to columnar cells, lack basal cell layer that is normally present in prostate glands
    Tx = surgery, androgen ablation