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Endo/Repro: Week 5 > Tworney: Male Reproductive Pathology > Flashcards

Tworney: Male Reproductive Pathology Flashcards

1
Q

is there a true capsule around the prostate?

A

No just a fibromuscular area

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2
Q

most cases of BPH occur here

A

transitional zone

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3
Q

most carcinomas occur here

A

peripheral zone

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4
Q

5-10% of all carcinomas

A

central zone

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5
Q

gram negative rods (same orgs as UTIS)–older male
fever chills dysuria
VERY uncomfortable
extremly tender and boggy on exam

A

Prostatitis: Acute bacterial

dx: urine and clinical features

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6
Q

low back pain, dysuria, perineal pain or asymptomatic

A

chronic bacterial prostatitis

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7
Q

dx of chronic bacterial prostatis

A

+ prostatic massage > 10 leukocytes/HPF in prostatic field

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8
Q

MC form of prostatitis today

A

chronic abacterial

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9
Q

sexually active men w/ prostatitis sx, culture negative

A

chronic abacterial

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10
Q

chlamydia, mycoplasma, ureaplasma

A

chronic abacterial

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11
Q

how does prostatitis affect PSA

A

can increase or decrease it (30% have decreased)

don’t screen for prostate cancer when someone has prostatitis…but we don’t do that anymore anyway

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12
Q

what percent of men w/ BPH are symptomatic

A

50% (most ppl are 70 or older)

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13
Q

BPH cause

A

Androgens (dihydrotestosterone)>
increase in prostate stromal cells w/ aging>
stimulates growth

estrogen/Estradiol levels also increase in men w/ aging>
induce an increase in adrogen receptors in prostate

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14
Q

usual location of BPH

A

TZ and peri-ureth (nodular proliferation of both gland and stroma)

NOT pre-malignant

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15
Q 
hesitancy
urgency
frequency
decreased stream size
nocturia*** (2-3x w/ BPH)
terminal dribbling
A

BPH

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16
Q

complications of BPH

A

obstruction> bladder has to push harder to get passed enlarged prostatic urethra> hypertrophy of bladder
incomplete bladder emptying> increases frequency
infection
infarction> prostate outgrows blood supply

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17
Q

Finasteride

TAmsulosin

A

drugs used to tx BPH

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18
Q

inhibits conversion of testosterone to DHT

A

5 alpha reductase inhibitor

Finasteride

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19
Q

Finasteride affect on PSA

A

50% reduction

X2.3 if taking 1mg/d > 4 years

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20
Q

smooth muscle relaxant used to tx BPH

A

alpha 1 blocker

Tamsulosin

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21
Q

biggest SE of alpha 1 blocker

A

orthostatic hypoTN

*concern in elderly men, not the best choice

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22
Q

surgery for BPH

A

TURP- not great

first line:
cryotherapy
microwave
laser
US
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23
Q

which side are you more likely to see a varicocele

A

LEFT!

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24
Q

where do testes drain typically

A

para-aortic or illiac

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25
Q

penile tumor/scrotal skin infection

A

superficial groin nodes

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26
Q

controls testicular descent to lower abdomen/pelvic brim (phase I)

A

Mullerian inhibiting substance

transabdominal

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27
Q

Controls testicular descent through the inguinal canal and into scotum (phase 2)

A

androgen dependent

Inguinoscrotal

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28
Q

percent of premature infants w/ cryptochid testis

A

25%

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29
Q

cause of cryptorchid testis

A

not understood

asymptomatic–but don’t get normal maturation of sperms

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30
Q

MC site for cryptorchid testis

A
  1. high in scrotum
  2. inguinal canal
  3. intra-abdominal
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31
Q

histological findings seen w/ cryptorchid testis

A

germ cell arrest
basement membrane thickening/hyalinization
decreased germ cells in contralateral testis (looks normal, but germ cells aren’t normal)

**usually unilateral

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32
Q

sterility if bilateral or if unilateral
infertility
accompanying hernia
increased risk for crush injuries

A

Cryptorchid testis

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33
Q

oncogenic complication of cryptorchid testis

A

5-10 fold increase in GERM cell tumor

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34
Q

Tx for cryptorchid testis

A

orchiopexy (bring testis down and tack’em down)

BEFORE 2 years to increase chancer for fertility, before 10 for neoplasm

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35
Q

deficient spermatogenesis is seen in what percent of pt w/ cryptorchid testis

A

10-60%

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36
Q

stage where you go from 46 to 23

A

secondary spermatocyte

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37
Q

causes of testicular infertility

A

atherosclerosis
malnutrition/cachexia
irradiation
female sex hormones

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38
Q

working up a male, and everything is normal then….

A

reduced/absent sperm production

  • sertoli only syndrome (10-20%)
  • chromosomal abnormalities (klinefelter’s, DS)
39
Q

sertoli only syndrome

A

germ cell aplasia–no germ cells
ALL sertoli cells
small to nml size testes w/ azoosp

40
Q

infertility w/ oligospermia

A

20,0000,000

41
Q

MC site of obstruction leading to oligospermia

A

epidiymis
absence of vas
obstruction of vas/ejaculatory ducts

42
Q

what % of male infertility is idiopathic

A

40% can’t find the cause

43
Q

baterial causes of epididymo-orchitis

A
  1. related to UTIS> spread through vas or lymphatics (older men)
  2. under 35 y/o> sexually transmitted (G/C, mycoplasma, treponema pallidum)
  3. Older than 35 assoc. w/ recurrent UTI/BPH
44
Q

ganulomatous epididymo-orchitis

A

TB (caseating granulomas–fungal TB)

45
Q

virally caused epidiymo-orchitis

A

mumps

  • not usually involved pre-pubertal
  • usually unilateral
46
Q

violent motion/trauma, usually in setting of abnormal anatomy that leads to testicular torsion can lead to…

A

hemorrhagic infarction–> surgical repair required w/in 4 hrs to save fxn

venous> arterial

47
Q

dilation of veins in pampiniform plexus

A

varicocele (up to 25% of adults)

MC on left side

*can cause infertility

48
Q 
Seminoma
embryonal carcinoma
yolk sac tumor
teratoma 
choriocarcinoma
A

germ cell tumors (when ppl think of testicular cancer)

49
Q

sertoli cell tumor
leydig cell tumor
granulosa cell tumor
mixed

A

sex cord stromal tumors (benign, almost never see these)

50
Q

accounts for 30% of malignancies in 20-34

A

testicular

(leukemias, lymphomas are others)

  • higher risk for whites than balcks
  • non-familial, no major gene linkages
51
Q

precursor to testicular cancer

A

germ cell neoplasia (study in denmark)

52
Q

androgen insensitivity syndrome

A

second stage of testicular descent is dependent on androgens, without them the testicles don’t descend.

these men have vaginas instead of penises–phenotypically look female but are XY genetically and internally

53
Q

progressive painless testicular enlargement

A

testicular cancer

*lymphoma is the most likely cause in older men

54
Q

MC germ cell tumor that peaks in 30s (or beyond)

A

Seminoma

RARE in children

*typical seminoima MC

55
Q

fleshy tumor mass that encompasses the whole testicle, mostly homogenous

“fish flesh tumor”

A

seminoma

56
Q

water CLEAR cytoplasm, central round nuclei, fibrous tissue crosses through tumor

A

seminoma

*frequently also have non-caseating granulomas

57
Q

syncitiotrophoblast in seminoma

A

good news!

hCG in blood> you have a tumor marker! you can follow pt for recurrence

58
Q

2nd MC form of pure GCT

A

embryonal carcinoma

59
Q

cancer in 20-30 y/o–RARE after 50

more aggressive than seminoma

A

embryonal carcinoma

**smaller than seminoma

60
Q

tumor that doesn’t encompass entire testes, lots of bleeding, nerosis, variated

A

embryonal carcinoma

61
Q

MC testicular tumor in infants/under 3 years old

A

yolk sac tumor

62
Q

clear cells that recapitulate endodermal sinus

A

yolk sac tumor

63
Q

schiller duval bodies

A

yolk sac tumor

  • kinda looks like a glomerulus
  • may see collecitons of AFP
64
Q

marker for yolk sac tumor

A

aFP

65
Q

highly malignant tumor w/ trophoblastic elements

A

choriocarcinoma

66
Q

marker for choriocarcinoma

A

bHCG

67
Q

common presenting sx at dx of choriocarcinoma

A

distant metastases (brain tumor + testicular tumor)

68
Q

tumor that has all three germ cell layers (>1) seen in infancy to adulthood

A

teratoma

  • never benign in adult males
  • pure form in infancy, benign
69
Q

tumor w/ cystic spaces, brain, cartilage, bone

A

teratoma

70
Q

MC non seminoma tumor

A

mixed tumor (60%)

71
Q

MC mixed tumors

A

teratoma
embyronal
yolk sac
syncitiotrophoblast

*prognosis worsens w/ inclusion of more aggressive forms

72
Q

seminoma metasteses

A

lymphatic spread

  • ipsilateral para-aortic nodes
  • mediastinal and supraclavicular nodes (window to viscera)
73
Q

hematogenous metastesis

A

non seminomas

lung, brian, liver

74
Q

what component of mixed tumors usually doesn’t metastasize

A

seminomatous

75
Q

stage I

A

confined to the testis

76
Q

stage II

A

retroperitoneal lymphatics

77
Q

stage III

A

parenchymal metasteses (liver/lung)

78
Q

tumor that often remains localized (stage I)

A

seminoma

homogenous, better prog, >30s, encompass whole testes

79
Q

tumor that often presents in stage II and II

A

NSGCT

80
Q

prognosis for testicular cancer

A

greater than 90%

81
Q

major serum protein of early fetus, syntehsized in gut, liver yolk sac, produced by yolk sac tumors

also elevated in hepatocellular carcinoma

A

AFP

82
Q

biological marker in choriocarcinoma or syncitiotrophoblast

A

HCG

83
Q

Treatmentn for seminomas

A

radiosensitive

84
Q

Stage I seminoma tx

A

orchiectomy w/ WW

85
Q

stage II seminoma tx

A

orchiectomy and pelvic/paraortic LN, and single agent CISPLATIN

86
Q

NSGCT tx

A

chemo and possible RPLND

87
Q

tumors that present w/ gynecomastia

A

sertoli and leydig cell tumors

88
Q

tumor in adults > 60, w/ large cell histology and systemic disease

A

Testicular lymphoma

89
Q

Mestateses to testis usually comes form

A

lung/prostate

90
Q

failure to obliterate inguinal canal

A

mesentery can push down into scrotum> herina

91
Q

inguinal hernia

A

open communication to peritoneal cavity

92
Q

cystic space obliterated on each end

A

hydrocele

93
Q

cystic mass arising from efferent ducts, lumen filled w/ sperm

A

spermatocele

94
Q

testicular tumor vs hydrocele

A

US

Endo/Repro: Week 5 (6 decks)

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