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64 Cards in this Set

  • Front
  • Back
define hypospadias
- anomaly where the urethral meatus opens on the ventral surface of the penis
define epispadias
- anomaly where the uretral meatus opens on the dorsal surface of the penis
- less common than hypospadias
define phimosis
- abnormally tight foreskin that is difficult or impossible to retract over the glans
- can be congenital or result from inflammation or trauma
define Peyronie disease
- subcutaneous fibrosis of the dorsum of the penis
- older age group
- unknown etiology
define priapism
- intractable, often painful erection
- sometimes associated with venous thrombosis of the corpus cavernosa
list the inflammatory diseases of the penis
1. Balanitis
2. Syphilis
3. Gonorrhea
4. Chlamydia
define Balanitis
- inflammation of the glans penis
- associated with poor hygiene
- rare in circumcised men
define Syphilis
- caused by Treponema pallidum
- primary stage: chancre located on the glans penis or prepuce and heals in 2-6 wks
- without treatment, is followed by secondary or tertiary lues
define Chancre
- elevated, painless, superficially ulcerated, firm papule
- lasts 2-6 weeks
- caused by Nisseria gonorrhoeae (intracellular gram - diplococci)
- manifested by acute purulent urethritis
- can extend to the prostate and seminal vesicles
- can involve the epididymis
- rarely involves the testis
n. gonorrhoeae
- intracellular gram-neg diplococci
- common cause of nongonococcal urethritis
- can also cause epididymitis
- should be suspected when bacteria are not seen in the purulent erethral discharge
list the neoplams of the penis
1. Carcinoma in situ
- Bowen disease
- Erythroplasia of Queyrat
2. Bowenoid papulosis
Bowen disease
- Carcinoma in situ of the penis
- presents as a single erythematous plaque on the shaft or scrotum
- seen in uncircumsized men
- peak incidence: 50s
- evolves into invasive carcinoma in 10% of cases
- may also be associated with increased risk of visceral malignancy
Erythroplasia of Queyrat
- carcinoma in situ of the penis (like Bowen disease)
- single erythematous plaque seen on the glans or pepuce
- uncircumcized men in their 50s
- in 10% of cases, evolves inot invasive squamous cell carcinoma
- may be a variant of Bowen disease, but not associated with visceral malignancies
Beowenoid papulosis
- a neoplasm of the penis
- histologically resembles the carcinoma in situ diseases (Bowen & Ery. of Queyrat)
- presentation: multiple verrucoid lesions looking like condyloma acuminatum that contain HPV type 16 sequences
- affects younger men
- considered premalignant, but does not progress to invasive carcinoma
carcinoma of the penis
- penile cancer is most often squamous cell carcinoma
- disease is rare in circumcised men
- incidence is greatest in far east, africa, and central america
- associated with poor personal hygiene and veneral disease
- associated with HPV 16, 18, 31, 33
define cryptorchidism
- developmental failure of testes to descend
- assocaited with increased incidence of germ cell tumors, esp seminoma and embyronal carcinoma
- associated with testicular atrophy and sterility
define torsion of the spermatic cord
- compromises blood supply
- can result in testicular gangrene
define hydrocele
- serous fluid filling and distending the tunica vaginalis
- most often idiopathic (sometimes congenital)
- can be secondary to infection of lymphatic blockage by tumor
- can be differentiated from solid testicular tumors by transillumination
how do you get a congenital hydrocele?
- persistence of continuity of the tunica vaginalis with the peritoneal cavity
- blood distending the tunica vaginalis
- caused by trauma
- sometimes due to tumor
- varicose dilation of multiple veins of the spermatic cord
- sperm containing cyst
- often intratesticular
testicular atrophy
- etiology unknown
- can be associated with:
- orchitis, esp mumps orchitis
- trauma
- hormonal excess or deficiency
- cryptorchidism
- klinefelter syndrome
- chronic debilitating disease
- old age
which hormonal disorders can cause testicular atrophy?
- disorders of the hypothalamus or pit
- hormonal therapy (esp estrogens)
- cirrhosis of liver
list the two inflammatory diseases of the testes
- orchitis
- epididymitis
- when bacterial, associated with epididymitis (can be caused by syphilis)
- when viral, due to mumps virus
- when bilateral, can result in sterility from atrophy of the seminiferous tubules. [Testosterone] decreased, but FSH and LH are increased
- more common than orchitis
- caused by:
- n. gonorrhoeae
- chlamydia trachomatis
- E. coli
- M. tub
general description of testicular tumors
- most often malignant
- more than 90% are of germ cell origin
list the germ cell testicular tumors (of one histologic type)
1. Seminoma
2. Spermatocytic seminoma
3. Embryonal carcinoma
4. Yolk sac tumor
5. Polyembryoma
6. Choriocarcinoma
7. Teratoma
list the germ cell testicular tumors (of more than one histologic type)
1. embryonal carcinoma and teratoma
2. choriocarcinoma and any other type
3. other combinations
list the stromal sex-cord testicular tumors
1. Well differentiated:
- leydig cell
- sertoli cell
- granulosa cell
2. Mixed forms
3. incompletely differentiated forms
what percentage of testicular germ cell tumors are of one histologic type?
- more than 90% of tumors are of germ cell origin
- MALIGNANT germ cell tumor
- analogus to dysgerminoma of the ovary
- msot frequent germ cell tumor (40% of G-C tumors)
- peak incidence: 30s
- painless enlargement of testis
- somtimes associated with increased hCG
- VERY RADIOSENSITIVE - can be cured even when there are metastasis to abdominal lymph nodes
what is hCG associated with?
- seminoma
- choriocarcinoma
- other germ cell tumors
Embryonal carcinoma
- MALIGNANT germ cell tumor
- analogous to embryonal carinoma of the ovary
- second most common germ cell tumor (20-30%)
- pain or metastasis on presentation
- increased serum hCG
- prognosis is much worse than seminoma
Endodermal sinus (yolk sac) tumor
- MALIGNANT germ cell tumor
- analogous to endodermal sinus tumor of the ovary
- peak incidence in infancy and early childhood
- increased serum a-fetoprotein
what is a-fetoprotein associated with?
- endodermal sinus tumor
- hepatocellular carcinoma
Analogous tumors:
Embryonal carcinoma
Endodermal sinus
Analogous tumors:
Embryonal carcinoma
Endodermal sinus
what are the three types of teratomas seen in testicular cancers?
- mature: always malignant
- immature
- with malignant transformation (e.g. development of squamosu cell carcinoma within epidermoid compartment)
- germ cell tumor derived from two ro more embryonic layers
- most frequently malignant
- contains many tissue types
- differentiated into mature, immature, and that with malignant transformation
what are the tissue types seen in male teratomas?
- cartilage islands
- ciliated epithelium
- liver cells
- neuroglia
- embryonic gut
- striated muscle
mature teratoma
- almost always malignant
- corresponding ovarian tumor (dermoid cyst) is always benign
- MALIGNANT germ cell tumor
- can occur as an element of other germ cell tumors
- analogous to choriocarcinoma of the ovary
- incidence peaks in 2nd to 3rd decades
- histology: cells that look like syncytiotrophoblasts and cytotrophoblasts; also secretes hCG
multinucleated cells found in the placenta of human embryos.

They are the outer syncytial layer of the trophoblasts and actively invade the uterine wall.

They form the outermost fetal component of the placenta (also known as syntrophoblast) and massively increase the surface area available for nutrient exchange between the mother and the fetus.
what does the syncytiotrophoblast secrete?
is the inner layer of the trophoblast, interior to the syncytiotrophoblast.

Cytotrophoblasts are stem cells in the chorionic villous. During differentiation, mononuclear cytotrophoblast fuse together into the multinucleated syncytiotrophoblasts.
mixed germ cell tumors
- varying combinations of germ cell tumor types
- variable prognosis det by the least mature element
- can be teratocarcinoma: a combo of teratoma and embryonal carcinoma associated with poor prognosis
what are other combinations seen in mixed germ cell tumors?
- teratoma, embryonal carcinoma, seminoma
- embryonal arcinoma and seminoma
Leydig cell (interstitial) tumor
- non-germ cell tumor derved from testicular stroma
- most often benign
- see intracytoplasmic Reinke crystals
- androgen producing (sometimes also estrogen and corticosteriod producing as well)
- associated with precocious puberty (children) and gynectomastia (adults)
Sertoli cell tumor (androblastoma)
- non-germ cell tumor derived from sex cord-stroma
- similar to sertoli-leydic cell tumor of the ovary
- usually benign
- doesn't have endocrine manifestations
Reinke Crystals
Rectangular, crystal-like inclusions, composed of protein, with pointed or rounded ends in the interstitial cells of the testis (Leydig cells) and hilus cells in the ovary. They are not found in the Leydig cells of other mammals.
Anatomy of the prostate
chestnut sized organ
- four groupings of glands: periurethral, transitional, central, peripheral
periurethral, transitional, and central zones of the prostate
- equivalent to the anterior, middle, and lateral lobes
- site of BPH
peripheral zone of the prostate
- peripheral zone of glands is equivalent to the posterior lobe
- site of carcinoma
- no relation to prostate cancer, although the two can coexist
- directly related to the action of DHT - a testosterone metabolite
- can be caused by age-related increase in estrogens
- hyperplasia of both glandular and fibromuscular stroma elements of prostate
how is DHT synthesized?
- 5a-reductase on testosterone
- inhibiting enzyme can treat BPH
what happens to the uretha in BPH?
- compressed on sides -> vertical slit
what do you see with BPH?
- distention and muscualr hypertorphy of the bladder
- can see bands of enlarged bladder muscle that form a characteristic trabeculae
- hydroureter adn hydronephrosis
Adenocarcinoma of the prostate
- very common
- occurs in older men
- use Gleason system of grading tumor
- arises from peripheral glands of prostate
- diagnosed by rectal exam
- adenocarcinoma can progress to bony osteoblastic metastasis
what serum markers do you see with prostate cancer?
- PSA- reflect a complexed form (bound to a1-antichemotrypsin) that is elevated in prostate cancer; the unbound form is increased with BPH
- can see increased prostatic acid phophatase when tumor penetrates the capsule into surrouding tissue
what serum markers do you see when prostatic cancer progresses to bony osteoblastic metastasis?
- increase in serum alkaline phosphatase
- an indicator of osteoblastic lesions
- virtually ensures that the osteoblastic tumors came from the prostate
how do you treat disseminated prostate adenocarcinoma?
- endocrine therapy, b/c tumor growth is related to androgen activity