Pathology Of Male Genital Tract

Front 1

what are the congenital anomalies of penis, urethra and scrotum? (3)

Back 1

hypospadia & epispadia;
congenital urethral valvular obstruction;
phimosis

Front 2

what is hypospadia and epispadia (2)

Back 2

1. urethral opening on ventral/dorsal side of penis
2. predispose to UTI in infancy & childhood, and interfere with normal ejaculation

Front 3

what is congenital urethral valvular obstruction?

Back 3

membranous flap in prostatic urethra, causing urinary obstruction

Front 4

what is phimosis?

Back 4

orifice of prepuce too small for normal retraction,
may also be produced after inflammatory scarring

Front 5

what can inflammation of urethra/scrotum be caused by?

Back 5

1. nonspecific (UTI, candida albicans, mumps, TB)

2. sexually transmitted disease

Front 6

complication of gonorrhoea in male patients

Back 6

1. Spread of infection
urethra (fistula, stricture) → prostate → vas deferens → epididymus → testis (atrophy, scarring)

2. Chronic persistent inflammation

3. Systemic involvement: endocarditis, arthritis

Front 7

give 5 causes of inflammation that are transmitted mainly by sexual contact

Back 7

syphilis, gonorrhea, chlamydial infections, lymphogranuloma venereum, granuloma inguinale, genital herpes, chancroid, trichomonas vaginalis, condyloma accuminata, AIDS

Front 8

what are tumour and tumour-like lesions of the penis/urethra? (3)

Back 8

1. condyloma acuminatum
2. carcinoma in situ
3. SCC

Front 9

1. what is condyloma acuminatum
2. gross (2)
3. histology (3)

Back 9

1. benign, sexually transmitted tumor (HPV)

2. flat & warty papillary growth on coronal sulcus + inner surface of prepuce.
~may spread locally to involve wide areas in anogenital region. found on moist mucocutaenous surface

3. fibroblastic branching stalk covered by acanthotic squamous epithelium
~koilocytes: perinuclear halo, smudged nuclei
~differentated from squamous carcinoma by mature epithelium

Front 10

describe SCC of male GT
1. epidemiology
2. etiology (3)
3. gross (3)
4. histology
5. course

Back 10

1. most common malignant tumour of penis, age 50-70 years

2. Carcinogens: smegma, smoking, no circumcision
HPV infection: usually 16 or 18

3. exophytic ulcerated growth or nodular plaques
a) papillary: like condyloma (椰菜花, fungating)
b) flat; epithelial thickening, gray+fissuring of mucosal surface.

4. SCC !_!
5. regional LN met

Front 11

describe CIS of male genital tract

Back 11

smooth, soft red plaques or elevated, scaly reddish papules on glands & penis

~may develop into invasive SCC if untreated

Front 12

2 lesions that display histologic features of CIS
1. (3)
2. (3)

Back 12

1. Bowen disease
~solitary, thickened gray-white opaque plaque on glands + prepuce as single/multiple shiny red plaques
~cells dysplastic, large hyperchromatic nuclei, lack of orderly maturation
~dermal-epidermal border sharply delineated by intact BM

2. Bowenoid papulosis
~strong association with HPV (type 16)
~histology, same as Bowen disease
~multiple red-brown papular lesions; spontaneously regressing

Front 13

what types of prostatic inflammation are there?

Back 13

1. acute & chronic prostatitis
~extend form bladder or urethra
~nonspecific infection: coliform bacteria, GC, CT

2. granulomatous prostatitis
~may be specific infections: TB, syphilis
~nonspecific inflamm reaction to inspissated secretion/autoimmune causation

Front 14

BPH/BNH
1. gross
2. histology
3. clinical symptoms, signs, complications (3)

Back 14

1. distinct, circumscribed grey white nodules in periurethral zone

2. proliferation of glandular & fibromuscular stromal elements +/- infarct, infection, squamous metaplasia

3. either asymptomatic or
~compress urethra: retention, frequency, dribbling
~superimposed infections: prostatitis/cystitis

Front 15

3 consequences of urine retention

Back 15

~bladder distended and hypertrophic,
~hydroureter & hydronephrosis,
~post-renal CRF

Front 16

incidence of prostatic carcinoma

Back 16

common in American males, more prevalent in blacks
uncommon in orientals

Front 17

etiology of prostatic carcinoma

Back 17

Androgen plays role in growth of tumour

Front 18

clin presentations of prostatic carcinoma (4)

Back 18

may be latent, occult or overt
1. prostatism present: hard mass in PR
2. incidental finding in microscopic exam when prostatic tissue removed
3. S/S of metastasis: back pain (vertebral met)
4. autopsy (no clinical evidence of ca prostate)

Front 19

1. tumour markers of prostatic carcinoma
2. significance (3)

Back 19

1. prostatic specific antigen (product of prostatic epithelium, secreted in semen)

2. detect recurrence, exclude distant metastasis, identify primary tumour in case of met of unknown origin

Front 20

appearance of prostatic carcinoma
1. gross
2. histology (2)

Back 20

1. yellowish, hard, gritty tissue
2.
~adenocarcinoma, usually microacini (absent basal cell layer typical of benign glands)
~perineural invasion

Front 21

spread of prostatic carcinoma (3)

Back 21

1. Local
~prostatic urethra obstruction, infiltrating into periphery adjacent tissue

2. lymphatics
~presacral in pelvis, iliac and paraaortic LN

3. blood
~vertebra, osteoblastic, widespread met
~esp. axial skeleton (lumbar spine, proximal femur, pelvis, thoracic spine)

Front 22

DDx for scrotal mass (6)

Back 22

1. testiculuar tumour
2. tumour-like conditions: hydrocele, haematocele
3. hernia
4. orchitis
5. torsion
6. tumour, tumour-like conditions of spermatic cord & testicular appendages

Front 23

congenital anomalies of testes and epididymis

Back 23

cryptorchidism :
~complete/incomplete failure of intraabd. testes to descend into scrotal sac (usually unilateral)
~0.25% adult males
~significance: inguinal hernia, trauma, testicular atrophy at/after puberty, ↑ incidence testicular tumour

Front 24

describe inflammation of testes and epididymis (4)

Back 24

- GC and TB arise in epididymis (almost invariably)
- syphilis affects testes first
- orchitis complicates 25-30% mumps (postpubertal)
- granulomatous orchitis: reaction to extravasated sperms, in middle aged men or clinically simulate tuberculous orchitis or testicular tumour

Front 25

what is torsion? (3)

Back 25

twisting of spermatic cord,
interferes w. venous drainage.
cause engorgement & hemorrhagic infarct of testis

Front 26

what are testicular tumours
i) frequency
ii) origin

Back 26

i) <1% cancers in male. infrequent, nearly always malignant
ii)
>90% primary testicular tumours considered to be of germ cell origin.
5% gonadal stroma
(rest from other components of testis)

Front 27

aetiology of germ cell tumours
1. (4)
2.

Back 27

1. cryptorchidism
~abd testis higher rate than inguinal ones
~contralateral normal testis may be involved, BUT cryptorchid testis 30-50x more likely
~frequency of malignancy doesn't decrease in orchiopexy after 6y/o
~seminoma most common type

2. genetic (?higher incidence in siblings)

Front 28

pathology of undescended testis (5)

Back 28

1. ↑ interstitial fibrosis
2. disappearance of specialized spermatogenic cells
3. shrinkage of organ
4. progressive degenerative changes
5. depend on age of patient

Front 29

complications of undescended testes (4)

Back 29

1. infertility if bilateral
2. occurence of associated hernia
3. develop testicular tumour
4. liability of truma

Front 30

presentation of ca testes

Back 30

testicular enlargement or pain,
distant metastasis

Front 31

What types of testicular tumours are there (6),
and describe their histogenesis (5)?

Back 31

1. seminoma, embryonal carcinoma, choriocarcinoma, yolk sac tumour (endodermal sinus tumour), teratoma (combinations) and mixed type.

2. (extra-embryonic tissue: EET)
~Germ cell: seminoma
~Tumour of totipotent cell: embryonal carcinoma
~trophoblast of EET: choriocarcinoma
~yolk sac of EET: yolk sac tumour
~embryonic tissue (ecto/meso/endo): teratoma

Front 32

age and incidence of germ cell tumours for males (6)

Back 32

1. yolk sac (0-5)
2. teratoma (0-5)
3. choriocarcinoma (5-30)
4. embryonal Ca (18-50)
5. seminoma (30)
6. spermatocytic seminoma (60s)

children: 最多yolk sac tumour, then teratoma
adults最多seminoma, then embryonal carcinoma

Front 33

pattern of spread: mode of spread (3)

Back 33

1. Lymphatic~ seminoma
2. Blood and lymphatic: embryonal Ca, teratoma
3. Blood~choriocarcinoma

Front 34

histology of seminoma
(3)

Back 34

1. well-demarcated, tan-white homogeneous mass composed of uniform cells in lobules separated by a fine stroma

2. tumour cells large & round w. large central hyperchromatic nucleus, prominent nucleoli, sharp cell border. cells contain glycogen

3. classically: radiosensitive, favourable prognosis after orchidectomy & postsurgical irradiation

Front 35

histology of embryonal Ca (tumour of totipotent cell) (2)

Back 35

1. highly malignant, variable pattern. anaplastic epithelial cells

2. lymphatic spread, frequently with haematogenous dissemination. prognosis is poor

Front 36

histology of choriocarcinoma (3)

Back 36

1. highly malignant tumour composed of cytotrophoblastic & syncytiotrophoblastic cells

2. serum and urinary HCG is elevated

3. distinct propensity to haematogenous dissemination

Front 37

histology of yolk sac tumour (3)

Back 37

1. distinctive perivascular structures & hyaline globules

2. demonstrable alpha-fetoprotein

3. lymphatic & blood spread

Front 38

histology of teratoma (2)

Back 38

1. tissue derived from more than the germ layers (ecto, meso, endo)

2. subdivided into mature and immature teratomas. teratomas in adults capable of metastasis, even if appear entirely mature. differentiated mature teratomas of testis in infants/small children usually benign

Front 39

Tumour markers (2)

Back 39

1. HCG

2. AFP

Front 40

HCG elevation signifies?
seen in? (4)

Back 40

~ syncytiotrophoblastic cells in placenta
~ choriocarcinomas, embryonal carcinomas, seminoma with syncytiotrophoblast, occasionally epithelial malignancy

Front 41

AFP
a) site
b) raised in?

Back 41

a) fetal yolk sac, GIT, liver
b) HCC, yolk sac tumour, embryonic carcinoma

Front 42

what is the significance of tumour markers? (3)

Back 42

1. detect non-seminomatous elements
2. detect recurrence
3. detect metastasis.

Front 43

what are gonadal stromal tumours

Back 43

from sex cord
1. sertoli cells
2. granulosa cells

from stroma
1. Leydig cells
2. Theca cells

~5% testicular tumours, majority largely Leydig cell tumours

Front 44

lymphoma and leukaemia in testicular malignancies?

Back 44

around 2-5%, mostly secondary
testicular lymphoma most common tumour in men >60 y/o