testicular + penile + prostate pathology Flashcards
painful upon palpation of epididymis
+/- testicular swelling
IMPROVES with elevation of testicles
epididymitis
treatment for male
STD: gonorrhea/chlamydia ceftriaxone IM (1 dose), doxycycline x 10 days
treatment for male > 35 yo or hx of anal intercourse with epididymitis/prostatitis think of:
UTI:enterobacteriaceae (E. coli, klebsiella, serratia, enterobacter, proteus)
fluoroquinolones x 10-14 days (vs prostatis x 1 mo)
acute onset of pain in testes
high-riding teste on affected side
+/- testicular swelling
absent cremasteric reflex (tickle teste and no movement of teste)
testicular torsion: twisting of spermatic cord → ischemia/necrosis of testicle
(medical emergency)
diagnosis of testicular torsion requires
US - blood flow in testicle
treatment of testicular torsion
surgery within 6 hrs to prevent ischemia to testes: bilateral orchiopexy (suture teste to scrotum to prevent happening again)
failure of teste to descend into scrotum is called
cryptochordism
complications of cryptochordism
↑ temperature (only sertoli cells affected by temp): → impaired spermatogenesis
↑ risk malignant germ cell tumors
prematurity ↑ risk of cryptochoridism
treatment of cryptochordism
infant: early orchiopexy to suture testes down into scrotum (↓ cancer risk since can palpate tumors now)
post pubertal tx: orchiopexy or orchiectomy
differential diagnosis for cryptochordism
androgen insensitivity: 46 X,Y with testes but no scrotum (female genitalia - in labia majora), treatment is orchiectomy
bilateral undescended: 46 X,Y without testes
CAH: 46 X,X with male external genitalia
testicular mass that doesn’t transluminate think
testicular cancer
testicular mass that transluminates think
hydrocele
“fried egg” appearance
seminoma
also koilocytes in HPV, oligodendroglioma
most common testicular cancer
seminoma
PAINLESS testicular mass in 15-35yo
malignant, excellent prognosis (late mets)
seminoma
schiller-duval bodies (resemble primitive glomeruli, central capillary)
yolk sac tumor
most common testicular cancer
yolk sac tumor
yellow, mucinous testicular mass
malignant
↑AFP
yolk sac tumor
malignant
↑ HCG due to synctiotrophoblasts present (also has cytotrophoblasts)
choriocarcinoma
hemorrhagic stroke can be the presentation for this testicular cancer
choriocarcinoma
hematogenous mets to lungs + brain (bleed into mets in brain)
↑HCG and may have ↑AFP
malignant tumor in adult males (not malignant in females)
hair, teeth - multiple tissue types
teratoma
PAINFUL testicular mass
malignant
↑ HCG with normal AFP
bad prognosis
embryonal carcinoma
glandular/papillary morphology of testicular cancer
embryonal carcinoma
reinke crystals (rod-shaped, crystal like)
leydig cell
secrete testosterone→ peripheral conversion to estrogen → gynecomastia if adult (esp if obese) or precocious puberty in boy (due to ↑ exposure to T)
leydig cell
most common non-germ cell tumor
leydig cell
most common type of testicular tumor
germ cell tumor
germ cell tumor types (malignant)
seminoma yolk sac choriocarcinoma teratoma embryonal carcinoma
non-germ cell tumor (benign)
leydig cell
sertoli cell
testicular lymphoma
secrete estrogen → gynecomastia
associated with: Peutz-Jeghers syndrome, Carney syndrome
sertoli cell
testicular cancer in older man
testicular lymphoma:
lymphoma mets to testes
aggressive
dilated epididymal duct
spermatocele
incomplete fusion of processus vaginalis
hydrocele in infant
resolves on own
treatment of prostatitis
treat like UTI: give 4 wks
fluoroquinolones
levofloxacin
TMP-SMX
what can cause sexual dysfunction
drugs: antihypertensives, neuroleptics, SSRI (↓ libido), ethanol
disease: depression, diabetes, small vessel atherosclerosis
physiological: performance anxiety
hormones: low T, hyperprolactinemia
types of erectile dysfunction
can have any combo (no morning erections):
failure to initiate (psychogenic, endocrinologic, neuro)
failure to fill (atherosclerosis)
failure to store adequate blood volume in lacunar network
80% older men with ED have: diabetes (35-75% DM men), atherosclerosis, drug-related
types of bowen disease
bowen disease
erythroplasia of queyrat
bowenoid papulosis
gray, solitary,crusty plaque on PENILE SHAFT or SCROTUM (or female genitalia)
usually >50 yo
bowen disease
red, velvety plaque involving GLANS PENIS usually
erythroplasia of queyrat
multiple papular lesions (not invasive)
younger patients
bowenoid papulosis
benign genital warts (STD) caused by HPV types 6 + 11
condyloma acuminatum
male with dysuria, increase in frequency/urgency, and low back pain think
prostatitis
common cause of prostatitis by age
35 yo: UTI (E. coli, klebsiella, serratia, enterobacter, proteus)
chronic: can be bacterial or abacterial (chronic is hard to treat)
hyperplasia of prostate gland due to DHT
smooth, firm nodular enlargement of periurthetral (middle + lateral lobes) which compresses the urethra into a vertical slit
↑PSA (but not premalignant)
clinical diagnosis: ↑ frequency (2-3 times), difficulty starting or stropping a stream, dsyuria, sensation of incomplete voiding, weak stream
size of lesion does not correlate with degree of obstruction or symptom severity
benign prostatic hyperplasia
rectal exam will not highlight this pathology
BPH: occurs in middle + lateral lobes of prostate
rectal exam will highlight this pathology
prostatic adenocarcinoma: occurs in posterior lobe
treatment for BPH
α1 blocker (doxazosin, prazosin, terazosin)
α1ad blocker (tamulosin)
5αreductase (finasteride)
inflammation of glans penis
40% due to candida albicans
other causes: local trauma, STDs, virus
more common in diabetic or non-circumscribed
balanitis
associated with HPV and lack of circumcision
most common in Asia, Africa, South America
bowen disease can be a premalignant lesion of this
penile squamous cell carcinoma
painful sustained erection not associated with sexual stimulation or desire
associated with sickle cell disease or spinal cord injuries
can get ischemia + blood clots in penis
priapism
angulation of penis due to inflammatin + fibrous tissue formation in tunica albuginea
painful with erection
Peyronie disease
> 50 yo male same symptoms as BPH screening tool: ↑ PSA (high false positive) diagnosis: needle core bx prostate exam: asymemtric, hard nodule
prostatic adenocarcinoma
treatment for prostatic adenocarcinoma
flutamide: inhibit testosterone at the receptor level
osteoblastic bone lesions
low back pain
↑ alk phos
metastatic prostate cancer
complications of BPH
UTI
bladder distention
