A-Male Genital Tract I And Ii

Front 1

What are the two layers of the urothelium? (male gu)

Back 1

1. lamina propria = loose connective tissue, and bundles of smooth muscle fibers on tip of muscularis propria

2. Muscularis propria: deep muscle, detrusor muscle, arranged in several layers

Front 2

What is the function of the urothelium?

Back 2

To form a tight barrier bwtween urine and blood (umbrella cells form the tight barrier)

Front 3

VIP
What is the most common cause of hydronephritis is children?

Back 3

A uretropelvic junction obstruction.

Front 4

What is cystitis?

Back 4

Bacterial induced increase in frequency of urination, pain, and dysuria.

Front 5

Who is more likely to have cystitis?

Back 5

Women, because of short urethra

Front 6

What is interstitial cystitis? (aka Hunner's Ulcer"

Back 6

It is a non-bacterial form of cystitis (90% female) associated with allergies and autoimmune diseases (SLE, RA, thyroiditis)

Causes UTI symptoms

Front 7

What are the microscopic findings of a Hunner's ulcer:

Back 7

Fissures and punctate hemorrhages (causing the UTI-like symp and causing diminished bladder capacity)

Front 8

VIP

What are two unusual causes of bladder CA?

Back 8

1. Schistosomiasis (parasite endemic in Egypt that causes squamous cell CA of bladder)

2. Chronic irritation of bladder (ie stones)

Front 9

VIP

What are the two molecular pathways in development of bladder CA?

Back 9

1. 9p deletion (first event)

2. As deletion progresses others occur: 17p, 5q, 13q, 11p

Front 10

Compare papillary urothelial carcinoma - low grade to high grade:

Back 10

Low: orderly appearance (VIP: minimal nuclear atypia), only 10% progression. Can see thin projectins and capillaries inside. Can test patient's chromosomes.

High grade: dyscohesive, large hyperchromatic nuclei, loss of polarity, mitotic figures (80% invasion - VIP)

Front 11

BLADDER CA
Treatment for:
1. Papillary low grade
2. CIS, papillary high grade
3. T2
4. T4

Back 11

1. Low grade = resection, follow up
2. Pap high grade = intravesical immunotherapy
3. T2 = cystectomy
4. T4 = chemotherapy

Front 12

What kind of bladder CA is caused by Mycobacterium TB?
What is the unique treatment?

Back 12

Bacillius Calmate-Guerin

treatment: intravesical BCG immunotherapy that elicits a local cell-mediated immune reaction that destroys tumor cells.

Front 13

Describe the normal prostate:

Back 13

Has a fibrous stroma with lots of acini and ducts, also has secretory and basal cells.

It is chest-nut shaped.

Front 14

What is the age range effected for benign prostatic hyperplasia?

Back 14

ages > 50yo

Front 15

Describe the effects of benign prostatic hyperplasia:

Back 15

It causes a nodular enlargement of the periurethral (lateral and middle) lobes of the prostate gland.

This compresses the urethra into a vertical slit. So the patient often presents with problems with urination.

Front 16

In benign prostatic hyperplasia, what tissue is hyperplastic?

Back 16

Both the prostatic glands and the stroma's muscular component!

Front 17

What percentage of men with has benign prostatic hyperplasia by the age of 70?

Back 17

90%

Front 18

What is the main cause of benign prostatic hyperplasia?

Back 18

BPH is directly related to the action of DHT, a testosterone metabolite. DHT is synthesized from testosterone by the action of 5-alpha-reductase (reduce in treatment). With the production of DHT = growth-promoting effects.

Front 19

How does benign prostatic hyperplasia increase the chance of a diverticuli of the bladder?

Back 19

From the compression of the urethra induced by benign prostatic hyperplasia their is stasis of the bladder --> bladder trys to push it out --> hypertrophy of the wall (increase chance of diverticuli)

Front 20

What is the most common CA in men and second cause of death?

Back 20

Adenocarcinoma of the prostate(bladder CA is very common but it doesn't kill)

Front 21

What are two predisposing factors to adenocarcinoma of the prostate?

Back 21

1. age, 80% at 80 yo
2. AA > European

Front 22

VIP
What is PSA?

Back 22

A serine protease composed of a single-chain glycoprotein that is secreted into the seminal fluid.
It is produced by epithelial cells of normal, hyperplastic, AND cancerous prostate tissue.

Front 23

VIP

Does high grade adenocarcinoma of the prostate always show a very high PSA?

Back 23

No, very advanced CA's can stop making PSA!

Front 24

Do PSA levels increase with age?

Back 24

Yes

Front 25

What is an abnormal PSA?

What is the gray area?

Back 25

Abnormal > 4nm/mL

Gray zone: 4-10nm/mL (not necessarily CA)

Front 26

How is the ratio of free tobound PSA different in adenocarcinoma of the prostate than it is for BPH?

Back 26

Free:Bound PSA is lower in adenocarcinoma of the prostate than it is in BPH

CA < BPH (BPH has more free)

Front 27

VIP
What are the three characterisitic microscopic features of adenocarcinoma of the prostate?

Back 27

1. prominent nucleoli
2. single cell layer (no more basal cell layer)
3. perineural invasion

Front 28

VIP
What are Gleason scores and what are they used for?

Back 28

To predict prognosis of prostate CA.

They look a combination of archetecture of the cells (size, glandular component) and the amount of differentiation (well diff = good). Each are graded on a scale of 1-5 and added together to determine management.

Front 29

What is a prostatic intraepithelial neoplasm?

Back 29

A precancerous lesion that affects only the large ducts. However, since they are so closely correlated with prostate CA (33-100% for highgrade PIN), once we see these --> think, "Did I miss a CA?"

Front 30

What does an increased total PSA and a decreased fraction of free PSA indicate?

Back 30

Malignancy

Front 31

What does an increased total PSA and an increased fraction of free PSA indicate?

Back 31

Benign prostatic hyperplasia

Front 32

VIP
What is hypospadias?

Back 32

Urethral opening on the ventral surface of the penis.

Front 33

VIP
What is epispedias?

Back 33

Urethral opening on the dorsal side of the penis.

Front 34

VIP

Phimosis?

Back 34

Prepuce can not be retracted, caused by poor hygiene. Can cause infections and cancer

Front 35

VIP

Paraphimosis?

Back 35

Prepuce becomes trapped behind the glans penis and can't be pulled back --> medical emergency

Front 36

What effects can Gonorrhea have on the penis?

Back 36

Can cause urethritis that can lead to urethral strictures causing sterility (in females = ectopic pregnancies)

Front 37

What effects can Chlamydia trachomatis have on the penis?

Back 37

C. trachomatis = nongonoreal urethritis
It causes lymphogranulmoa venerum which is when small epidermal vesicles --> ulcer --> inguinal and rectal lyphadenopathy (penile inflammation)

Front 38

What effect can Tremonena pallidum have on the penus? Describe its progression.

Back 38

T. Pallidum (syph) has a primary infection of a chancre formation (3 wks), can progress to a palmar/solar rash, lymphadenopathy, headache, fever, and Condyloma latum (2-10wks). If untreated can again progress to neurosyphilis, aortitis, and gummas.

Front 39

What is a condyloma acuminatum? What causes it?

Back 39

Veneral wart (red papillary), caused by HPV types 6 and 11.

Front 40

What characteristic does condyloma acuminatum have microscopically?

Back 40

Proliferation of squamous cells with KOILOCYTOSIS (clear vacuolization of the cytoplasm)

Front 41

What causes penile squamous cell carcinoma?

Back 41

HPV 16 and 18

Front 42

What are the characteristics of penile squamous cell carcinoma? (3)

Back 42

1. ulcerative
2. plaque-like
3. keratin pearls

Front 43

What is cryptorchism?

Back 43

Undescended testis (one or both). There is often a lack of spermatogenesis due to high body temperature (infertility) and it is associated with an increase in germ cell tumors.

Front 44

Microscopically what will you see in cryptorchism?

Back 44

Tubular atrophy from a small testicle

Front 45

Even if cryptorchism is corrected, is there still a high risk of developing germ cell neoplasia?

Back 45

Yes

Front 46

What is the tunical vaginalis?

Back 46

Serous covering of testis

Front 47

VIP

Hydrocele testes?

Back 47

Clear fluid accumulation around testis

Front 48

VIP

Hematocele testes? Causes (2)

Back 48

Blood accumulation around testes (trauma, torsion)

Front 49

VIP

Chylocele testes?

Back 49

Lymphatic accumlation around testes (elephantitis)

Front 50

VIP

Spermatocele?

Back 50

A retention cyst around the testicles that contains semen

Front 51

VIP

Varicocele?

Back 51

Dilated vein in the spermatic cord.

Front 52

VIP

Describe the progression of how the male genitalia is effected (spread) in a:
1. Gonorrhea (or TB) infection
2. Syphilis infection

Back 52

1. Gonorrhea -- starts in the epididymis and spreads to the testis

2. Syphilis --> starts in the testes and spreads to the epididymis

Front 53

What infection can both mumps and Coxackie B cause?

Back 53

Epididymo-orchitis

Front 54

Male presents to the ER with sudden severe pain of his testicles. Surgeon says he must have surgery on it within 8hrs. What is wrong with the man?

Back 54

He has torsion of the spermatic cord which supplies blood to the testicle. This can cause the infarction of the testicle (and then fibrosis). Must be corrected within 8 hrs (80% salvage; within 10hrs = 20%)

Front 55

What are the most common tumors in men aged 15-34?

Back 55

Testicular tumors

Front 56

VIP VIP VIP

Three things that predispose the pathogenesis of germ cell testicular tumors?

Back 56

1. Cryptorchism (even if corrected)
2. Testicular dysgenesis (disorder of testicular development seen in Klinefelters XXY and others)
3. ISOCHROMOSOME of SHORT ARM of CHR 12, i(12p) = 90%!!! VIP

Front 57

What is the first thing you must know about a testicular germ cell tumor once you've identified it? Why?

Back 57

Is it semiomatous or nonseminomatous (NSGCT = resistant to radiation therapy)

Front 58

VIP
What is the most common testicular tumor in elderly men?

Back 58

Spermatocytic seminoma
(most common primary tumor in elderly men)

Front 59

Describe the five differences between seminomas and nonseminomatous germ cell tumors?

Back 59

Seminoma:
1. a "benign" malignancy
2. 70% in stage 1
3. met to LN
4. radiosensitive
5. 95% cured

NSGCT
1. more aggressive
2. 60% in stage II and III
3. hematogenous spread (lungs/liver)
4. radioresistant
5. 90% remission with aggressive chemo

Front 60

VIP
Describe the microscopic findings of a seminoma:

Back 60

1. Gray-white cut surface
2. Sheets of large cells
3. Has a FIBROUS SEPTA infiltrated with LYMPHOCYTES

Front 61

VIP

Explain why Embryonal CA is considered "so different" from a seminoma:

Back 61

Embryonal:
1. Onset 20-30y (S: 30-40)
2. Gross: poorly demarcated with necrosis and hemorrhage (S: solid gray white surface)
3. Micro: glandular, tubular papillary patterns of large cells (S: large cells with fibrous septa filled with lymphocytes)

Front 62

Yolk sac tumors have two peaks of age ranges effected - which is better to get?

Back 62

1. infantile (good prognosis)
2. young adults (mixed tumors)

Front 63

Describe the microscopic appearance of yolk sac tumors?

Back 63

Network of cuboidal cellsin a papillary pattern (Schiller-Duval) and hylin-like globules

Front 64

Is a choriocarcinoma often slow growing or fast?

Age most commonly effected?

Back 64

Very aggressive - often mets at presentation

(20-30yo)

Front 65

Are there any benign teratomas in post-pubertal males?

Back 65

NO!!! (in infancy they are pure but in adulthood they are mixed germ cell tumors)

Front 66

Is patient at risk for developing metatasis with a teratoma?

Back 66

Yes

Front 67

How can we tell if a Leydig tumor is cancer?

Back 67

The only way is to see if it metastasized.

Front 68

VIP

Describe the gross and micro appearance of a Leydig tumor:

Back 68

Gross: homogenous nodule with golden brown cut surface

Micro: large cell with alot of granular cytoplasm around a centrally located nuclei with prominent nucleoli.

Front 69

VIP!! MOST IMPORTANT

What is a lymphoma of testicles?

Back 69

The most common testicular neoplasm > 60yo! (first think lymphoma, 2nd-met, 3rd spermatolytic seminoma)

It is usually secondary and its most common form is B-cell lymphoma.

Front 70

VIP
What are the characteristics of a lymphoma from the testicles?

Back 70

Gross: fleshy, white to pink, and they usually replace testicular parenchyma!!