Repro - 1-13 Male Pathology (Penis, Scortum, Benign Diseases Of Testis)

Front 1

Penis congenital issues

Back 1

Hypospadius (ventral malformation of urethral groove)

Epispadias - dorsal

Front 2

Epispadius

Back 2

Dorsal malformation of urethral groove

Associated with poor testicular descent, urinary tract malformations, opening constricted (inc risk of infection), and chordee (ventral bending of penis that can also be associated with hypospadius)

Front 3

Phimosis

Back 3

Orifice of prepuce (foreskin) is too small to normally be retracted behind glans penis.


Can be congenital or acquired (inflammation - balanoposthitis or balantis - often interferes with hygiene and predisposes to infection or CA)

Front 4

Balanoposthitis

Back 4

Inflammation of glans and prepuce (foreskin) to cause phimosis

Front 5

Balantis

Back 5

Inflamm of glans to cause phimosis

Front 6

Glans

Back 6

the head of the penis

Front 7

Tx of phimosis

Back 7

Circumcision.

Front 8

Paraphimosis

Back 8

When phimotic prepuce is forcefully retratacted over glans and it can't be replaced and it swells.

Can cause urethral constrictio and acute urinary retention.

Front 9

Syphilis

Back 9

From treponema pallidum

Primary (chancre), secondary (palmar rash, lymphadenopathy, condyloma latum) and tertiary (neurosyph, aortitis, gummas) phases

Can also be congenital (late abortion, infantile or childhood)

Front 10

Primary stage of syphilis

Back 10

Chancre - raised non-tender lesions at site of treponemal invasion in penis/cervix/vag wall/anus.

Heals in 3-6 weeks with or w/out therapy

Spirochetes abundant in chancre

Front 11

Micro presentation of syphilis

Back 11

Infiltration of plasma cells with macros, lymphocytes and endarteritis - seen in all stages of syph

Starts with endothelial cell activation
Progresses to intimal fibrosis
Lymphnodes are enlarged

Front 12

Secondary syphilis

Back 12

1-20 weeks after chancre in 3/4 untreated pts.

Mucocutaneous lesions involving oral cavity, palms, soles
SKin rash

Rich in microorganisms.

Condyloma lata - broad elevated plaques in moist areas of skin

Front 13

Tertiary syph

Back 13

Aortitis - endarteritis of vasavasorum of prox aorta leading to scarring and dilation of aortic root and arch leading to aneurysm of proximal aorta (aortic insufficiency leading to infarcts)

Narrowing of coronary ostia leading to infarcts

Neurosyph - meningovascular syphilis, tabes dorsalis and paresis (impaired sensatio fo pain, position, ataxia..)
Can also get delusions of grandeur

Gummas - Focal point of central necrosis surrounded my macrophages. Common in skin, subcut tissue, bones, joints.

Front 14

How to ID spirochetes (syphilis)

Back 14

They are delicate, slender, use silver stain.

Front 15

Gonorrhea

Back 15

Neisseria gonorrhoeae (gram neg diplococci)

urethritis with discharge
Can ascend to epididymitis, orchitis (inflamm of testis) and infertility

Front 16

Which pop has resurgence of syphilis?

Back 16

HIV +

Front 17

Chancroid

Back 17

Haemophilis ducreyi

Acute, tender, erythematous ulcers, lymphadenopathy with buboes

Painfil acute ulcers

Front 18

Granuloma inguinale

Back 18

Klebsiella granuomatosis (calymmatobacterium donovani)

Leads to elephantiases of ext genirals because of lymph obstruction and scarring

Front 19

Microscopic view of granuloma inguinale

Back 19

Pseudoepitheliomatous hyperplasia

Donovan bodies - Use Giamsa stain. Minute encapsulated organisms in macrophages

Front 20

Lymphogranuloma venereum

Back 20

Chlamydia trachomatis
Most common STI (bacterial) in the world

Starts as ulcer, can get chronic lymphatic obstruction.

Stellate (star) shaped abscesses with granulomatous appearance surrounded by neutrophils.

Front 21

Genital herpes

Back 21

Herpes simplex virus type 2

Vesicles on mucous membranes and external genitalia - has clear fluid in it.

Can become rapidly superficially ulcerated.

Front 22

Microscopy of herpes

Back 22

Looking for mulinucleation and modulation of chromatin

Dx made by scraping lesions and obtaining Tzank smear.

Front 23

Lichen sclerosus

Back 23

Balantis xerotica obliterans

Usually in older men and is asymptomatic

Autoimmune

Appears as white patch

A dermatosis

Can lead to phimosis or carcinoma.

Front 24

Micro of lichen sclerosus

Back 24

Homogenized collagen band

Front 25

Peyronie's disease

Back 25

Caused by dense fibrous band or plaque involving tunica albuginea along shaft resembling fibromatosis.

Presents with bending of penis on erection

Associated with Dupuytren's contractures, coiral trauma, urethral instrumentation, beta blockers, HTN, diabetes...

Front 26

Penile cysts

Back 26

Epidermal cysts - most common - often on shaft

Mucoid cysts - lined with column epithelium fille with mucous. usually on prepuce or glans

Median raphe cysts - secondary to incomplete closure of genital fold.

Front 27

Condyloma acuminatum

Back 27

Benign tumor.

Caused by HPV (usually benign ones - types 6 and 11)

Flat, warty, papillary

Front 28

Hallmark micro appearance of condyloma acuminatum

Back 28

Koilocyte - epithelial cell with hyperchromatic/shriveled nucleus surrounded by large halo.

Front 29

Carcinoma-in-situ

Back 29

Precancerous lesion in epithelium

3 lesions with similar histo (but not gross) features
Bowen's disease - Crusty lesion. older males can dev to CA
Erythroplasia of Queyrat - Shiny and elevated. Older males. Can prog to CA.
Bowenoid papulosis - Young men, usually doesn't prog to CA.

Front 30

Bowenoid papulosis is...

Back 30

indolent

Front 31

Malignant carcinomas

Back 31

squamous cell carcinoma and verrucous carcinoma

Front 32

Squamous cell CA

Back 32

Most common CA of the penis.
Often due to HPV 16 and 18 (high risk viruses)
Ulcerated mass.
Micro - keratinization and keratin pearl formation
Extensive local spread and infiltrative lymph spread

Front 33

Verrucous carcinoma

Back 33

Large, broad throngs from epithelium and invades in a pushing manner.

Grows locally and does not metastasize. Very well-differentiated.

Some may be associated with HPV types 6 and 11.

Front 34

Fournier's gangrene

Back 34

Of the scrotum

idiopathic necrotizing fasciitis
Medical emergency often in immunesupp and diabetics.

Front 35

Tumors of scrotum

Back 35

Benign - Cysts
Malignant - Squamous cell CA (linked to chimney sweeps). Hygeine is key.
Polycyclic hydrocarbons found to be potent carcinogens.

Front 36

Testis and epididyms congenital issues

Back 36

Cryptorchidism (undescended testis)
Usually swollen inguinal region, but can be be abdomen.
Often due to anatomic anomalies, hormone issues (HPA axis), dysgenesis...
1/4 are bilateral
Can result in atrophy, trauma infertility, cancer (even in the descended testis).

CA risk increases with distance from scortum and orchiopexy can decrease the risk (moving the testis into the scrotum)

Front 37

Micro view of cryptorchidism

Back 37

Sertoli cells and spermatogonia predominate (seminiferous tubules).
Germ cells arrested in development.
Marked hyalinization and thickening of the basement membrane of the spermatic tubules.

Testes are small and fibrotic

Front 38

Infertility and cryptorchidism

Back 38

If bilateral, more like to be infertile.

Age of orchioplexy may influence fertility. (before age 4 is important)

Front 39

Torsion

Back 39

A MEDICAL EMERGENCY

Twisting of spermatic cord with interruption of blood flow.

Incidence is high in neonates and young adoscents.

Severe pain in lower abdomen and groin with radiation to scrotum.
Testis itself if bright red, hard (induration), and tender

Front 40

Pathology of torsion

Back 40

intense engorgement and hemorrhagic infarction.

Front 41

DDx of torsion

Back 41

incarcerated hernia, renal colic, acute abdomen, appendicitis, acute epididymitis, torsion of appendix testis.

Front 42

Which is more frequent - epididymitis or orchitis?

Back 42

epedidymitis

Front 43

Testis/epididymis non-spec infections

Back 43

Childhood - gram - rods associated with genitourinary abnormalities

Young adult - sexually transmitted (chlamydia or gonorrheoeae)

OLder adults - EColi or pseudomonas

Front 44

Testis and epididymis specific infections

Back 44

Gonorrhea - urethra to prostate to seminal vesicles to epididymis

Mumps - Orchitis is rare in children. Unilateral most commonly. With bilateral, more common to have infertilit (infarcts)

TB - After infections higher in GU tract (from epididymis to testis)

Syphilis - from testis to epididymis. Inflamm and endarteritis or gumma.

Front 45

Granulomatous inflamm in testis and epididymis

Back 45

Idiopathic, autoimmune.

Sperm granulomas are pots-inflammatory and post-obstructure (e.g. vasctomy)

"ANYTHING CAUSING SPERM TO COME OUT OF SEMINIFEROUS TUBULES CAN INCITE GRANULOMATOUS RESPONSE"

Front 46

Hydrocele

Back 46

Fluid around testis in potential space.

Most common cause of scrotal swelling.

Congenital if associated with patent processus vaginalis. very rare
Acquired if associated with inflammation

Can mask tumors

Dx - non-tender and transilluminates (unless infected)

Tx - surgical removal.

Front 47

Important to differentiate hydrocele from....

Back 47

spermatocele.