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116 Cards in this Set
- Front
- Back
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normal cell type of foreskin?
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stratified squamous epithelium
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what can happen to my wiener?
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Balantis xerotica obliterans
Condyloma Bowen Disease Squamous Cell Carcinoma Extramammary Paget's disease Melanoma |
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What on earth is Balantis xerotica obliterans?
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Dermal Fibrosis w/ Inflammation
Atrophy of the foreskin (dear God) |
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Who gets Balantis xerotica obliterans?
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Elderly males
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what is Balantis xerotica obliterans associated w/?
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Phimosis
Carcinoma |
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what parts of the wang are affected by Balantis xerotica obliterans?
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Glans
Prepuce Perimeatal region |
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Rx for Balantis xerotica obliterans?
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Steroids
Meatoplasty |
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who gets penile condylomas?
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Sexually active men
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Course for penile condylomas?
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benign
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what are penile condylomas associated w/?
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HPV 6, 11
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What areas are affected by penile condylomas?
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External Genitalia
Perianal region |
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Who are the Non-Invasive Squamous Penile Lesions?
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Erythroplasia of Queyrat (EQ)
Bowen Disease (BD) Bowenoid Papulosis (BP) |
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What's similar/different w/ the Non-Invasive Squamous Penile Lesions?
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Similar histological appearance
Differing clinical presentations |
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what is the histological appearance of Non-Invasive Squamous Penile Lesions?
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Full thickness atypia of the squamous mucosa/skin
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Risk factors for Erythroplasia of Queyrat?
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Old men
Uncircumcised Poor Hygiene Inflammatory Conditions |
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How does EQ present?
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Red lesion on glans and foreskin mucosa
Solitary or Multiple lesions |
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Rx for EQ?
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5-Flourouracil
Moh's Surgery |
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EQ risk of progression?
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10% progress to invasive SCC
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Cure rate?
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In situ lesion has 90% cure rate if treated
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what is Bowen Disease?
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Carcinoma In Situ
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who get's BD?
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old dudes
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Risk factors for BD?
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Uncircumcised
HPV 16, 18 |
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How does BD present?
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White scaly patch or plaque on skin of shaft or scrotum
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Progression of BD?
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5-10% progress to SCC
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Rx for BD?
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5-flourouracil
Moh's surgery |
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who gets BP?
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Young
Sexually Active Men |
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How does BP present?
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Multiple reddish brown papules on shaft, glans, or foreskin
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BP associations?
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HPV 16,18
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Progression of BP?
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Lesions can spontaneously regress (benign course)
Virtually never progresses to invasive carcinoma |
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Etiologic Factors of Penile Carcinoma?
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HPV (16 mostly)
Smoking Uncircumcised Phimosis Chronic Inflammation Conditions |
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avg age at Dx of penile carcinoma?
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60
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Location of most penile carcinomas?
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80% glans mucosa
15% foreskin mucosa 5% coronal sulcus |
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Histological types of penile carcinoma?
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Exophytic
Infiltrative (worse) |
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predictable course of penile carcinoma?
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Spreads to:
Superficial Inguinal (regional) LN's Deep groin and Pelvic LN's Retroperitoneal LN's |
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is penile carcinoma spread typicall unilateral or bilateral?
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Bilateral
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Where can penile carcinoma distantly metastasize to?
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Liver
Lung Bones |
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how do most penile carcinomas present in relation to stage? mortality?
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40% w/ superficial invasion (10% mortality)
30% w/ deep invasion, inguinal LN involvement, 67% metastasis 20% w/ minimal invasion, minimal metastasis |
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5 year survival of penile carcinoma?
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50%
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What was the first carcinoma linked to occupational exposure?
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SCC of scrotum
coal tar/soot in chimney sweeps 3'4'-benzpyrene |
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Third most common malignancy in men?
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prostate carcinoma
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what age do prostate carcinomas begin to become a problem
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40-50
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based on geography who gets prostate cancer?
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north america and europe >>>asia
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based on race, who gets prostate cancer?
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black>>>white>>>asian
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Established risk factors for prostate cancer?
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Age
FH Race Prostatic Intraepithelial neoplasia |
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Pathogenesis of Prostate Cancer?
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Hypermethylation of glutathione S-transferase (GST)
PTEN mutations Androgen Receptor Gene Mutations |
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Clinical Presentation of Prostate Cancer
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often asymptomatic
urinary hesitancy impotence weak urine flow blood in urine or semen back pain these sx's are more common w/ BPH |
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BPH vs Cancer
origin of issue? |
BPH: near urethra-->obstructive issues
Cancer: in periphery--> not obstructive issues until late |
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Autopsy incidence of prostate cancer?
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80% of men > 80 years old
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What has led to inc detection of prostate cancer?
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Prostate specific Ag testing
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what else can PSA be used for?
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monitoring therapy
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what else can cause elevated PSA?
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BPH
Infections |
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PSA levels are depenedent on?
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age
volume/size of prostate |
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what is more significant than PSA level?
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changes in PSA level
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difference in pre-PSA and post-PSA prostate cancer Dx?
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pre-PSA: 50% had metastasis at dx
post-PSA: 5% had metastasis at Dx |
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what is HGPIN?
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high grade prostatic intraepithelial neoplasia
pre-cancerous |
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histo of prostate cancer?
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prominent nucleoli
fused glands = higher grade than individual glands |
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histo marker for malignant prostate glands?
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basal cell marker negative
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what is Gleason Score?
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add together Predominant Pattern and Second/Minor Pattern
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what does prostate cancer have a proclivity to?
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invade nerves
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where does prostate cancer like to spread to?
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BONE
multiple bone lesions in a male = high suspicion of metastatic prostate cancer |
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Rx of Prostate Cancer
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Surgery
Radiation Hormonal Therapy Bilateral Orchiectomy (OUCH) |
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what can prostate surgery cause?
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impotence
incontinence death (blooooody) |
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what kind of hormonal therapy?
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anti-androgens can slow down the growth (can evolve into androgen independent)
this has the same purpose as nut removal |
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race and testicular cancer?
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White>>>black
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peak incidence of testicular cancer?
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20-30
except teratomas and yolk sac = infants and spermatocytic seminomas = 60 |
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Risk factors for testicular cancer?
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Cryptochidism (3-5 fold inc)
Testicular Dysgenesis (klinefelter's) Male infertility (weak ass) FH PMH of test. cancer |
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Usual origin of testicular cancer?
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Germ Cells (95%) that migrate to developing ridges of coleomic epithelium and underlying mesenchyme
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Other types of Testicular Cancer besides Germ Cell?
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Sex cord/gonadal stromal tumors (leydig or sertoli)
Collecting ducts and rete testis Paratesticular structures Spermatic Cord Lymphoma |
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What is IGCNU?
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Intratubular Germ Cell Neoplasia, unclassified
form of in-situ carcinoma in seminiferous tubules |
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Association of IGCNU w/ GCT of testis?
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80% of nut GCT's will have IGCNU
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progression of IGCNU to GCT?
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90% untreated will progress ti GCT in 7 yrs
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Histo of IGCNU?
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large, atypical cells
clear cytoplasm |
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When is IGCNU seen?
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undescended nuts
contralateral nut in pt w/ testicular cancer men w/ strong FH |
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Two types of testicular cancer based on histo?
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Mixed (60%) = non-seminomatous GCT
Pure (40%) seminomas |
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Clinical presentation of testicular cancer?
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Solid, painless mass (presumed malignant)
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testicular cancer staging?
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1: local: limited to nuts. no LN's. 72%
2: regional: LN in abd, 19% 3: distant: LN's and one or more organs (lung, liver, brain), 9% |
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Testicular Cancer Markers?
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In Non-Seminomas
AFP elevated in Yolk Sac tumors B-hCG elevated w/ any tumor w/ choriocarcinomatous elements LDH elevated in correlation w/ tumor volume |
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what % of all testicular cancers are classic seminomas?
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35-50%
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presentation of classic seminoma?
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40yrs old
Unilateral usually |
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markers for classic seminoma?
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hCG maybe elevated
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gross appearance of seminoma?
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homogenous, white tumor
no areas of hemorrhage or necrosis |
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Histo of classic seminoma?
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clusters of lymphocytes between uniform clear cytoplasm'd tumor cells
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Progression of Classic Seminomas?
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First to retroperitoneal LN's
Then widespread |
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seminoma Rx?
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Surgery
Radiation |
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Cure rate for classic seminoma?
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90% for tumors confined to nuts
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Who gets Spermatocytic Seminomas?
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Old > 60
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what are Spermatocytic Seminomas not associated w/?
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ITGCN's
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Rx and Px of Spermatocytic Seminomas?
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Rx is surgery
Px is excellent |
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what are NSGCT's?
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Non-seminomatous GCT's
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Gross characteristics of NSGCT's?
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Larger Tumors
Often have areas of Hemorrhage and Necrosis |
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Types of NSGCT's?
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Choriocarcinoma
Embryonal carcinoma Teratoma Yolk Sac Tumor Spermatocytic Seminoma |
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Seminoma vs NSGCT
presenting stage? |
Seminoma: 70% are stage I
NSGCT: 60% are advanced stage |
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Seminoma vs NSGCT
when do they metastasize? |
Seminoma: late in course
NSGCT: early in course |
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Seminoma vs NSGCT
Spread? |
Seminoma: LN initially
NSGCT: hematogenous |
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Seminoma vs NSGCT
Rx? |
Seminoma: radiosensitive
NSGCT: radioresistant treated w/ chemo |
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Seminoma vs NSGCT
Px? |
Seminoma: good
NSGCT: poor |
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How do Choriocarcinomas normally present?
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In a mixed GCT...not pure form
Sx's related to metastasis high hCG |
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Age for Choriocarcinoma?
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25-30
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What do Choriocarcinomas consist of?
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Cytotrophoblast
Syncytiotrophoblast |
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Px for Choriocarcinoma?
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POOR
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What is component of 80% of Mixed GCT's?
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Embryonal Carcinoma (EC)
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age for EC?
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30
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Presenting Sx's for EC?
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Possible pain b/c it grows so fast
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Histo kicker for EC?
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Poorly differentiated malignant cells
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Px for EC?
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stage dependent
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who gets a testicular teratoma?
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2/3rds in kids in first or second year of life
can be post-pubertal |
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Difference between pre and post pubertal teratomas?
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Pre: benign, no metastasis
Post: all are considered malignant w/ chance of metastasis (20-30%) |
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What is the most common testicular neoplasm in infants and young children?
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Yolk Sac Tumor
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Sx's for YST?
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Painless
Elevated AFP |
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What stage does YST normally present in?
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75% of kids' and 35% of adults' present in stage 1
10-20% have metastasis at presentation |
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Px for YST?
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favorable for younger kids
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Histo kicker for YST?
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Schiller-Duval Body
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Seminoma vs NSGCT
Rx aggressiveness? |
NSGCT treated more aggressively.
LN dissection Systemic chemo Measure markers after Rx |
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Age for testicular lymphoma?
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older men
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Kickers for Testicular Lymphoma?
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Often bilateral
Usually diffuse large B-cell lymphoma |
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Px for Testicular Lymphoma?
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when confined to testis, its favorable w/ cutting em out and radiation
for disseminated lymphoma its a poor process |
