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Pathology Term 5 > Week 3 - MGS > Flashcards

Week 3 - MGS Flashcards

STDs, Orchitis, Tumours, Penis

1
Q

What bacteria causes syphilis? and how is it transmitted?

A

Treponema pallidum

  • body fluids –> skin/mucosa
  • vertical transmission (placenta to newborn)
  • bacteria CANNOT survive outside the body (i.e. direct contact required)
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2
Q

What is the characteristic lesions present in syphilis?

A

proliferative endarteritis

  • vascular damage
  • chronic inflamm - plasma cells**
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3
Q

What is chancre?

A
  • primary phase of syphilis (3wks)
  • ulcerated papule
  • resolve spontaneously*
  • highly infectious!
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4
Q

What are the 3 stages of syphilis?

A
  1. primary (3wks)
    - chancre –> ulcerated papule; resolves spontaneously, highly infectious*
  2. secondary (months)
    - following healing of primary chancre
    - recurrent lymphadenopathy
    - palmar rash
    - condyloma lata (painless, moist plaques)
    - highly infectious*
    - resolves without Tx usually
  3. tertiary (years)
    - 5-20yrs
    - gumma - necrotising granuloma
    - CVS* + CNS involvement –> aortitis (AR); neurosyphilis
    - tabes dorsalis
    - general paresis
    - aortic aneurysms* (80%)
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5
Q

What are 2 forms of neurosyphilis and what stage are they seen?

A
  1. tabes dorsalis –> demyelination of posterior cord tracts (proprioception, vibration, discriminative touch)
  2. general paresis –> chronic inflammation of the brain and meninges and is characterized by memory loss, muscle weakness, personality changes, progressive dementia, seizures, and generalized paralysis
    * seen in tertiary syphilis
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6
Q

What is condyloma lata?

A

-moist painless plaques which occur as a manifestation of secondary syphilis

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7
Q

What are the possible outcomes for congenital syphilis?

A

intrauterine –> rash, liver + lung fibrosis, 8th nerve deafness, interstitial keratitis, hutchinson teeth

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8
Q

What are hutchinson teeth?

A

-sign of congenital syphilis. –babies with this have teeth that are smaller and more widely spaced than normal and which have notches on their incisors

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9
Q

What are non-treponemal antibodies directed against?

A

cardiolipin

  • present in bacteria AND in our bodies
  • usually only in early phase (not in tertiary phase)
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10
Q

What are the 2 tests for non-treponemal antibodies?

A
  1. VDRL (venereal disease research lab)
  2. RPR (rapid plasma reagin)
    * non-specific; false positive; only early phase
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11
Q

What are the treponemal antibody tests?

A
  • FTA-ABS (fluorescent treponema antibody)
  • TP-PA (TP particle agglutination)
  • MHA-TP (microhemagglutinin assay)
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12
Q

What is the purpose of non-treponemal Ab tests?

A
  • non-specific to bacteria
  • used for SCREENING purposes only
  • diagnostic confirmation achieved by treponemal Ab specific testing (FTA-ABS, TP-PA, MHA-TP)
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13
Q

How is syphilis diagnosed via direct detection?

A
  • darkfield microscopy
  • PCR*
  • culture
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14
Q

What is the most common and second most common STI?

A 
1 = chlamydia
2 = gonorrhoea
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15
Q

How is gonorrhoea transmitted?

A
  • only in humans
  • person to person
  • vertical transmission on birth (passage)
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16
Q

What are the Sx. of gonorrhoea?

A
  • stick to epithelia, incubation 1-14days –> then penetrate and cause Sx:
  • fever, pain, inflammation, dysuria, discharge (white pus)
  • urethritis, conjunctivitis, cervicitis, proctitis, pharyngitis, iritis –> “ITIS”
  • dysuria, mucopurelent discharge –> PID
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17
Q

What bacteria causes gonorrhoea?

A

Neisseria gonorrhoeae

-gram negative diplococci (intracellular - within neutrophils)

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18
Q

What are the complications of gonorrhoea?

A
  • stricture –> urethritis, proctitis (dysuria) –> PID

- fibrosis of pelvic region –> “frozen pelvis”

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19
Q

What is nongonococcal urethritis commonly caused by?

A
  • chlamydia** (commonest)
  • trichomonas vaginalis
  • ureaplasma
  • mycoplasma genitalium
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20
Q

Which STI is more suppurative - gonnorhoea or chlamydia?

A

gonorrhoea

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21
Q

What type of bacteria is Chlamydia trachomatis?

A

gram negative

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22
Q

What are the 2 forms of chlamydia trachomatis?

A
  1. elementary body (outside cell)

2. reticulate body (inside cell)

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23
Q

What can NGU lead to in patients with HLAB27?

A

Reiter’s syndrome

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24
Q

What does chlamydia trachomatis cause in men?

A
  • urethritis
  • epididymo-orchitis
  • prostatitis
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25
Q

What is the commonest Sx. of chlamydia?

A
  • 50% asymptomatic**
  • 40% PID
  • 20% infertility
  • 9% ectopic pregnancy
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26
Q

What does chlamydia trachomatis cause in children?

A
  • seasonal purulent conjunctivitis

- repeated, untreated –> scarring of cornea/eyelids –> visual impairment/blindness

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27
Q

How is NGU diagnosed?

A

Nucleic acid amplification test (NAAT)

  • sensitive
  • in combination with tests for Neisseria gonorrheae and HIV (sexually transmitted)
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28
Q

What are 2 differences between GU and NGU?

A

GU:

  • intracellular diplococci
  • less pus

NGU:

  • no organisms; polymorphonuclear leukocytes
  • more pus
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29
Q

What is lymphogranuloma venereum?

A
  • LGV (L1-L3 serotypes)
  • caused by chlamydia trachomatis
  • chronic ulcerative (ulcers form after initial inguinal lymphadenitis)
  • lymphedema; procto-colitis
  • genital painless papule 2-5days
  • suppurative granuloma (neutrophil abscess) + chlamydial inclusions in microscopy
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30
Q

What are the complications of LGV?

A
  • rectal strictures
  • PID
  • frozen pelvis - extensive fibrosis
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31
Q

What is chancroid (soft chancre) AKA?

A

third venereal disease (syphilis, gonorrhoea)

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32
Q

What causes LGV?

A

chlamydia trachomatis

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33
Q

What causes chancroid?

A

Haemophilus ducreyi

-gram negative coccobacillus

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34
Q

Which disease is prostitution a risk factor for?

A

chancroid (soft chancre)/third venereal disease

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35
Q

What are the characteristic features of chancroid?

A
  • erythematous papule –> painful ulcer with yellow pus

- marked inguinal lymphadenopathy –> buboes –> pus draining ulcers

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36
Q

What does Klebsiella granulomatis cause?

A

granuloma inguinale

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37
Q

What are the features of granuloma inguinale?

A
  • initial papules on genitalia –> ulcers –> urethral, vulvar or anal strictures
  • granulation tissue and intense epithelial hyperplasia that can mimic SCC
  • donovan bodies
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38
Q

What are donovan bodies?

A

-intracellular coccobacilli (Klebsiella granulomatis) within vacuolated macrophages –> seen in granuloma inguinale

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39
Q

Which HSV is most common in genital herpes?

A

HSV2

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40
Q

What % of HIV+ are also positive for HSV?

A

95%

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41
Q

True or false?

HSV can be transmitted via fomites

A

FALSE

-direct contact only

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42
Q

What are the features of genital herpes?

A
  • itchy, painful, CLOSELY grouped vesicles surrounded by erythema
  • vesicles burst –> PAINFUL ulcers
  • multinucleate giant cells with viral inclusion
  • painful inguinal lymphadenopathy
  • self limited/mild in normal pts., severe infection in immunocomprimised
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43
Q

What are Cowdry type A bodies?

A
  • viral inclusions seen in multinucleated giant cells in herpes simplex virus
  • characteristic; positive by anti herpes virus Ab
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44
Q

Which LNs correspond to testes and which correspond to penis/scrotum?

A

Testes
-para-aortic LNs (testes develop in the abdomen)

Penis/Scrotum
-inguinal LNs

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45
Q

Outline development of sperm

A

spermatogonium –> primary spermatocyte –> secondary spermatocyte –> spermatids –> sperm cells (haploid)

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46
Q

What is the commonest etiology of epididymo-orchitis?

A
  1. non-gonococcal (chlamydia*, mycoplasma)

2. gonococcal (N. gonorrhoeae)

47
Q

What are the Sx. of epididymo-orchitis?

A
  • testicular pain (unilateral)
  • erythema/oedema of scrotum
  • urethritis, dysuria, urethral discharge
48
Q

What are the gross and microscopic features of epididymo-orchitis?

A

Gross:

  • swollen
  • hot
  • acute inflammation
  • oedema

Micro:

  • neutrophils
  • oedema
  • necrosis
49
Q

What Ix are used to diagnose epididymo-orchitis?

A
  • exclude torsion/trauma in <30yrs

- serology, microbiology: C/S, PCR

50
Q

True or False?

Mumps can cause orchitis?

A

TRUE

  • patchy inflammation
  • can lead to infertility if severe due to patchy atrophy
51
Q

What is cryptorchidism AKA?

A

“undescended testes”

52
Q

What is the normal descent timeline for testes?

A
  • reaches pelvis at 3months
  • reaches scrotum by birth (9months)

*non-descent –> 5% at birth; 1% at 1yr

53
Q

What are the causes of cryptorchidism?

A
  • hormonal
  • intrinsic
  • mechanical

*common in Patau syndrome, Praer willi syndrome, etc

54
Q

What is the complication of cryptorchidism?

A

ATROPHY*

  • due to increased temperature –> spermatogonia undergo atrophy
  • sertoli + leydig cell hyperplasia**
  • 3-5 fold increase in germ cell malignancy - even in other testes
55
Q

What is orchiopexy?

A
  • surgical fixing of undescended testes

- reduces risk of sterility + cancer

56
Q

What is torsion of testes and what is it precipitated by?

A
  • twisting of spermatic cord on its axis
  • 1yr or 13-16yr
  • swollen, hard, painful*

*precipitated by exertion/contraction of cremaster muscle

57
Q

What are the risk factors for torsion of testes?

A
  • maldescent of testes

- long spermatic cord/mesorchium

58
Q

What are the 2 types/levels of torsion of testes?

A
  1. within tunica vaginalis
    - commonest*
    - testis and epididymis involvement ONLY
  2. above tunica
    - all structures in that side of the scrotum (includes tunica vaginalis)
59
Q

What is the pathogenesis of torsion of testes?

A
  • due to twisting there is obstruction to venous outflow –> venous infarction
  • arterial supply still intact
60
Q

What is Tx of torsion of testes?

A 
surgical emergency (within few hrs)
-correction/orchidectomy
61
Q

What are the 4 inflammatory accumulations in the testes?

A
  1. hydrocele
  2. varicocele
  3. spermatocele
  4. hematocele
62
Q

What is hydrocele?

A
  • common
  • accumulation of clear fluid in tunica vaginalis
  • congenital or acquired (inflammation)
63
Q

What is varicocele?

A
  • engorged spermatic cord veins (pampiniform plexus)
  • common cause of infertility/oligospermia
  • primary/secondary
64
Q

What is spermatocele?

A
  • trauma/infection of tubules of epididymis causing dilatation forming a cyst containing semen
  • multilocular
65
Q

What is hematocele?

A
  • blood in tunica in vaginalis
  • caused by trauma or tumours
  • accumulation of blood leads to atrophy of testes due to compression and increased temperature
66
Q

Why is hydrocele transilluminating?

A

-clear fluid, no inflammation

67
Q

What are the 3 types of hydrocele?

A
  1. non-communicating (confined to TV)
  2. communicating
    - communicates with abdominal cavity
  3. hydrocele of the cord
    - clear fluid in spermatic cord
68
Q

What is required for an individual to become male sex?

A
  • by default we are ALL female*

- unless we have the SRY gene (sex-determining region Y/TDF) on short arm of Y chromosome –> androgens –> MALE SEX

69
Q

What is the most common cause of transgender sex?

A

congenital adrenal hyperplasia (CAH)

-female pseudohermaphrodite** –> XX male (46, XX DSD - disorder of sexual development)

70
Q

What causes male pseudohermaphroditism?

A

XY female - 46, XY DSD

gonadal dysgenesis

71
Q

What is true hermaphroditism?

A

ovotesticular DSD

-both gonads in single person (ovaries + testes)

72
Q

What is 45 XO?

A

Turner’s syndrome

73
Q

What is 47 XXY?

A

Klinefelter’s syndrome

74
Q

What is the commonest tumour of young males?

A
  • testes tumours

- PAINLESS swellings

75
Q

What is the etiology of testes tumours?

A
  • *idiopathic = most common

- undescended testes (10%; 10x more likely to develop tumours)

76
Q

What is the classification of testes tumours and specify which is the commonest type?

A
  1. Germ cell tumours** (95% - commonest)
    - seminoma (45%) –> good prognosis
    - non-seminoma (NSGT - 45%) –> poor prognosis; embryonal ca, teratoma, chriocarcinoma
    - mixed –> common
  2. Sertoli/leydig cell tumours (5%)
77
Q

What is the commonest testes tumour?

A

seminoma* –> adults (20-40yrs)

N.B. children <10yrs –> NSGT (yolksac tumour*)

78
Q

What are the clinical features of testes tumours?

A
  • painless
  • ‘dragging’ sensation
  • unilateral, solid swelling
  • metastases to para-aortic LBs (embryologic origin)
79
Q

What are the gross and microscopic features of seminoma?

A

Gross:

  • firm, grey, smooth, painless swelling
  • benign appearance
  • well demarcated
  • minimal haemorrhage

Micro:
-uniform clear cells + lymphocytes

80
Q

What tumour is seminoma mixed with to produce beta-hCG?

A

choriocarcinoma –> beta-hCG 10%

-otherwise seminomas do not produce hormones

81
Q

What are the clinical features of non-seminomatous germ cell tumours (NSGT): embryonal carcinoma?

A
  • painless swelling
  • haemorrhagic ** (c.f. seminoma)
  • malignant
  • poor prognosis :(
  • metastases rapidly
82
Q

What are the gross and microscopic features of NSGT: embryonal carcinoma?

A

Gross:
-haemorrhagic, necrotic tumour

Micro:

  • pleomorphic cells forming embryoid structures/bodies
  • pink AFP (alpha feto protein) globules in cells
83
Q

What is NSGT referred to as in adults vs. children?

A

adults –> embryonal carcinoma

children –> yolksac tumour

84
Q

What tumour marker is present in NSGT: embryonal ca?

A

alpha feto protein (AFP)

85
Q

What is the commonest NSGT?

A

embryonal carcinoma

86
Q

True or False?

all teratomas are malignant

A

False

  • normal looking, mature cells –> mature/benign teratoma
  • malignant cells –> immature/malignant teratoma
87
Q

What is teratocarcinoma?

A

teratoma + other germ cell tumour (i.e. embryonal carcinoma)

88
Q

What does it suggest if beta-hCG and AFP are btoh positive in a teratoma?

A

-that it is MIXED type with embryonal carcinoma

89
Q

Which tumour is strongly positive for AFP?

A

yolk sac tumour (<3yrs) - 90%

90
Q

Which tumour is 100% positive for beta-hCG?

A

choriocarcinoma

91
Q

What are the erectile tissues of the penis?

A

3 cylindrical bodies

  • corpus cavernosum (2 bodies)
  • corpus spongiosum (base)
  • urethra in the middle of corpus spongiosum
92
Q

What is the lymphatic drainage of the penis?

A

skin –> superior inguinal LNs

deeper tissues –> interior iliac LNs

93
Q

What is phimosis?

A
  • congenital malformation; can be acquired due to infections

- narrow opening of prepuce (foreskin) –> cannot be pulled back over glans

94
Q

What is paraphimosis?

A
  • congenital malformation
  • urologic emergency
  • retracted foreskin cannoth be returned to its normal anatomic position
  • foreskin/prepuce strangulates penis
95
Q

What is hypospadias?

A
  • congenital malformation

- urethra opens on the ventral surface

96
Q

What is epispadias?

A
  • congenital malformation

- urethra opens on the dorsal surface

97
Q

What is inflammation of the glans and prepuce reffered to as?

A

balanitis –> inflammation of glans

posthitis –> inflammation of the inner surface of prepuce

balanoposthitis –> inflammation of BOTH glans + prepuce

98
Q

What is balanitis/posthitis/balanoposthitis often associated with/what does it lead to?

A

-often associated with phimosis or leads to phimosis

99
Q

What is the etiology of inflammation of the penis (balanitis, posthitis, balanoposthitis)?

A
  • poor hygiene, accumulation of smegma
  • non-STI –> candida**, staph/strep, gardnerella
  • STI –> syphillis, gonorrhoea, herpes, etc

*common cause of balanoposthitis = candida infection (non-STI cause)

100
Q

What is balanitis xerotica obliterans?

A
  • similar to lichen sclerosus of vulva or elsewhere
  • not common, adults, >30yrs
  • white plaques, fissures –> glans/prepuce
  • epidermal atrophy, hyperkaratosis with basal layer degeneration, dermal hyalinisation
101
Q

What is peyronie’s disease?

A
  • penile fibromamtosis –> fibrous plaques
  • focal, fibrosis with deformity
  • unknown cause
102
Q

What is peyronie’s disease associated with?

A

dupuytren’s contracture

  • palmar fibromatosis
  • 25% cases
103
Q

What causes condyloma accuminatum?

A

human papilloma virus (HPV)

  • HPV serotypes 6 + 11 (benign wart)
  • papillary epithelial benign growth
104
Q

What is the difference in appearance of warts in HPV causing condylmoa accuminatum on the glans v skin?

A

glans –> fleshy appearance

skin –> warty, hard growths

105
Q

What are koilocytes?

A
  • clear cells loaded with HPV virus
  • seen on microscopy of condyloma accuminatum
  • acanthosis is also seen on microscopy*
106
Q

What is epithelial hyperplasia and DYSPLASIA conditions known as on the glans vs the shaft?

A

on glans –> erythroplasia of Queyrat

on shaft –> bowen’s disease

107
Q

What is the microscopy of bowen’s disease/erythroplasia of Queyrat?

A
  • pleomorphic cells with intact basal layer
  • DYSPLASIA
  • pre-malignant –> sq. cell ca.
108
Q

What is the commonest carcinoma of the penis?

A

squamous cell carcinoma

109
Q

What are the risk factors for penis carcinoma (sq. cell ca)?

A
  • smoking

- HPV 16 + 18 (malignant strains)

110
Q

What is known to prevent carcinoma of the penis?

A

circumcision

-supports the fact that it is due to infection (hygiene, smegma irritation?)

111
Q

What is the pathogenesis of penis carcinoma?

A

-risk factors (smoking, HPV 16/18, uncircumcised penis) –> erythroplakia/leukoplakia: dysplasia/ca-in-situ –> well-differentiated squamous cell carcinoma (epithelial pearls) –> slow growth, good prognosis (70% 5yr survival rate)

112
Q

True or False?

There is no pleomorphism on microscopy of verrucous carcinoma nor metastasis?

A

TRUE

  • looks benign (large, irregular, papillary/warty “cauliflower”)
  • variant of sq. cell ca
  • locally invasive (no mets)
113
Q

What is the micrscopy of mumps orchitis?

A

PATCHY INFLAMMATION

114
Q

Bilateral orchitis is typical of?

A

Mumps

Pathology Term 5 (6 decks)

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