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100 Cards in this Set

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What is this congenital disease?

- abnormal opening on ventral surface of urethral groove
- associated with failure of descent of testes
- urinary tract obstruction, infections, sterility
Hypospadias
What is this congenital disease?

- abnormal opening on dorsal surface of urethral groove
- associated with failure of descent of testes
- urinary tract obstruction, infections, sterility
Epispadias
What is this disease?

- orifice of the prepuce is too small to permit normal retraction
Phimosis
- congenital
- acquired: repeated infections with secondary fibrosis
What are some complications of phimosis?
- secondary infections
- carcinoma of penis
- paraphimosis: constriction of prepuce around penis with swelling and edema, preventing its replacement over the glans
What is paraphimosis? what might cause this?
Paraphimosis: constriction of prepuce around penis with swelling and edema, preventing its replacement over the glans
- it is a complication of phimosis (orifice of the prepuce is too small to permit its normal retraction)
Inflammation of the glans and prepuce is called ____.
balanoposthitis
- simple
- erosive
- gangrenous
- atrophic leukoplakic
- herpes simplex
Predisposing factors of balanosphthitis.
- lack of circumcision
- poor hygiene
- phimosis
What is this disease?

- lymphocytes and plasma cells infiltrating the dermis
- reactive epidermal hyperplasia
balanoposthitis
- lack of circumcision
- poor hygiene
- phimosis
What is this lesion?

- hyperplastic epithelium with hyperkeratosis and acanthosis
- branching connective tissue stroma
- koilocytotic changes in squamous cell nuclei (perinuclear vacuoles and raisinoid)
condyloma acuminatum
- HPV 6 often
- located on moist mucocutaneous surfaces of external genitalia
What are these abnormal cells called? what disease is it associated with?
koilocytes
- condyloma acuminatum (HPV6)
What are thest abnormal cell called? what disease is it associated with?
koilocyte (raisinoid): enlarged hyperchromatic nuclei with irregular membranes
- associated with condyloma accuminatum (HPV6)
What skin disease does each of the following cause?

- HPV6
- HPV16
- HPV6: condyloma acuminatum
- HPV16: squamous cell carcinoma in situ
What do the following share in common?

- Bowen disease
- erythroplasia of Queyrat
- bowenoid papulosis
they are three distinct forms of squamous carcinoma in situ, but share same histo features
- full thickness of dysplasia of squamous epithelium
- disordered maturation
- marked nuclear pleomorphism
- basement membrane intact
What is this disease?

gross
- solitary gray-white plaque on skin of penis or scrotum
Micro
- full thickness dysplasia of squamous epithelium
- basement membrane intact
Bowen disease (CIS)
What is this disease?

gross
- shiny, red velvety plaques on penis and prepuce
Micro
- full thickness dysplasia of squamous epithelium
- basement membrane intact
erythroplasia oif Queyrat
- histo the same as Bowen's
What is this disease?

gross
- multiple red-brown papules, some verrucous
Micro
- full thickness dysplasia of squamous epithelium
- basement membrane intact
Bowenoid papulosis
- histo is the same as Bowen's
What is this tumor?
- 1% of male carcinomas in U.S.
- begins on glans or inner surface of prepuce
invasive squamous carcinoma (HPV16, 18)
- ulcerated flat lesion or exophytic papillary lesion
What is the prognosis of invasive carcinoma of penis?
- slow growing, metastasize to inguinal and iliac lymph nodes
- if no lymph node involvement: 66% 5 yr survival
- if lymph node involvement: 27% 5 yr survival
What are some causes of epididymitis in children?
- congenital anomalies
- GNB
What are some causes of epididymitis in sexually active men?
- chlamydia
- gonorrhea
What are some causes of epididymitis in older men?
- urinary tract pathogens (E. coli, pseudomonas)
What is this disease?

micro
- inflammation with variable fibrosis
epidydimitis
- gonorrhea (supprative): acute
- TB (granulomatous): chronic
Sequelae of epidydimitis.
- abscess formation
- sterility
What are some causes of orchitis (inflammation of the testes)?
- mumps: school aged children, one week after parotid gland swelling
- syphilis: affect testes first then epidydimis
- TB: affect epidydimis first then testes
- gonorrhea: only in untreated cases
What is the cause of this?

- school aged children deveoped lumpy jaw
- a week later developed orchitis
mumps
What is the cause of this?

- orchitis first, then epidydimitis
syphilis
What is the cause of this?

- epidydimitis first, then orchitis
TB
Pathogenesis of torsion of testes.
venous outflow from testes cut off -> marked congestion -> hemorrhage, infarction (if not treated)
Who are more prone to get torsion of testis?
- incomplete descent of testes
- absent scrotal ligaments
- atrophy of testis 9more mobile)
What is another name for undescended testes?
cryptorchidism
- 1% of 1 yr old boys
- often palpable in inguinal canal
- 75% unilateral
Pathogenesis of cryptorchidism.
- failure of intra-abdominal testes to descend to scrotum
- deficient LH-RH
- trisomy 13
- other UG anomalies
Sequelae of crytorchidism.
- progressive tubular atrophy: decreased germ cells, infertility
- increased risk of neoplasm: 5x-10x, orchiopexy (surgical placement of testes in scrotum) can decrease the risk
What is sequelae of crytorchidism called?
tubular atrophy
- sertoli cells only
- thickened basement membrane
Germ cell or sex cord stromal neopalsm of testes?

- malignant
- 95% of all neoplasms of testes
- cured with surgery + chemo
germ cell tumors
Germ cell or sex cord stromal neopalsm of testes?

- benign
- 5% of all neoplasms of testes
- cured with excision
- may secrete hormones
sex cord stromal tumors
What is the main predisposing factor of germ cell neoplasms of testes?
crytorchidism

others
- genetic (familial clustering)
- testicular dysgenesis (testicular geminization XY with androgen insensitivity, Klinefelter syndrome 47XXY)
What are the two types of germ cell neoplasms of testes?
1) seminoma
2) non-seminoma
- embryonal carcinoma
- yolk sac tumor: AFP positive
- choriocarcinoma: hCG positive
- teratoma
When is the peak incidence of germ cell tumor of testes?
age 15-34
Is germ cell tumor more prevalent in whites or blacks?
whites
What is the origin of germ cell tumors?
intratubular multipotential germ cells
What is the most common germ cell tumor?
seminoma
- postpubertal males, incidence peaks in 30s
- histologically similar to ovarian dysgerminoma
What are the three histologic subtypes of seminoma?
- typical (85%): placental alkaline posphatase +
- anaplastic (5-10%): pelomorphic cells, > 3 mitoses/hpf
- spermatocytic (5%): three intermixed cell populations
What is this disease?

Gross
- bulky, replaces entire testes
- confined within tunica albuginea
- lobulated surface
- little hemorrhage or necrosis
seminoma
What is this disease?

Micro
- sheets of uniform cells divided by thin septae of fibrous tissue
- large distinct cell borders with lots of cytoplasm (glycogen)
- scattered reactive lymphocytes
seminoma
- APF -
- hCG -, 15% seminomas contain syncytiotrohpoblastic giant cells that secretes hCG
What is this disease?

Micro
- 3 mixed cell populations showing features of spermatocytes by EM
Spermatocytic seminoma
- older men (>age65)
What germ cell tumor is this?

- poorly demarcated
- zones of hemorrhage and necrosis
embryonal carcinoma
- AFP -
- hcG -
What germ cell tumor is this?

- solid syncytial sheets
- glandular or tubular patterns
- large anaplastic cells with scattered tumor giant cells
- indistinct cell borders
- frequent mitoses
embryonal carcinoma
- AFP -
- hCG -
What is the most common testicular tumor in children < 3?
yolk sac tumor (endometrial sinus tumor)
What is this testicular cancer?

- AFP +
- alpha-antitrpysin +
yolk sac tumor
What is this testicular cancer?

- hCG +
choriocarcinoma
What is this testicular cancer?

- endodermal sinuses (core with central capillary, covered by visceral and parietal cells, resemble primitive glomerulus)
- hyaline globules
yolk sac tumor
What is this testicular cancer?

- endodermal sinuses (core with central capillary, covered by visceral and parietal cells, resemble primitive glomerulus)
- hyaline globules
yolk sac tumor
What is this testicular cancer?

- composed of both cytotrophoblasts and syncytiotrophoblasts
- aggressive, produce hemorrhage and necrosis
- hCG +
choriocarcinoma
What is this testicular cancer?

- germ cell tumor containing elements from more than one embryonic layer
- gross: heterogeneous texture with solid and cystic areas
teratoma
- pure form mainly in children
Which of the three vaiants of teratoma?

- all elements differentiated: mature epithelial, connective, neural cells)
mature teratoma
Which of the three vaiants of teratoma?

- incomplete differentiation
- primitive mesechymal cells, neuroblasts, etc
immature teratoma
Which of the three vaiants of teratoma?

- mainly differentiated cells
- one mature component transformed into malignancy
teratoma with malignant transformation
Seminoma vs. non-seminoma.

- usually stage 2 and 3 at diagnosis
- metastaze to lymph nodes
- radiosensitive
- good prognosis
seminoma
Seminoma vs. non-seminoma.

- usually stage 1 at diagnosis
- metastaze early by hematogenous route
- radioresistant
- aggressive
non-seminoma
Which stage os testicular cancer is this?

- tumor confined to testis, epidydimis or spermatic cord
stage 1
Which stage os testicular cancer is this?

- distant metastases confined to retroperitoneal nodes below diaphragm
stage 2
Which stage os testicular cancer is this?

- metastasize outside the retroperitoneal nodes or above the diaphragm
stage 3
What testicular cancer is this?

- precocious children or gynecomastia in adults
- 90% benign
sex cord stromal tumor - leydig cell tunor
- polygonal cells with red cytoplasm containing rod like crystalloids of Reinke
What testicular tumor is this?

- secrete estrogens or androgens
- no clinical endocrine symptoms
- tendency to form immature seminiferous tubules
- 90% benign
sex cord stromal tumor - sertoli cell tumor (androblastoma)
What is this testicular tumor?

- most common testicular cancer in men >60
- poor prognosis
malignant lymphoma of testis
- diffuse large B cell
What are the 4 histologic zones of normal prostate?
- central (CZ)
- peripheral (PZ)
- transitional (TZ)
- periurethral
Describe the lining of normal prostate gland.
2 layers of epithelium
- flat basal cells
- columnar secretory cells
Etiology of prostatitis?
- bacterial: GNB (E.coli)
- chronic abacterial: culture -
What is the cause of this prostitis?
TB or sterile
Nodular prostate hyperplasia originate from which 2 of the 4 histologic zones?
- transitional
- periurethral
How does nodular prostate hyperplasia look histologically?
- glandular hyperplasia: cystic dilation, papillary budding
- stromal hyperplasia: fibromuscular
- 2 layers of epithelium preserved
These are symptoms of which prostate disease?

- difficulty urinate
- urine retention, bladder distention, risk of infection
- difficulty start and stop urine stream
- nocturia, dysuria
nodular hyperplasia
What is the most common cancer in U.S. men?

What is the most common cause of cancer death in US men?
- prostate cancer

- lung cancer #1, prostate cancer #2
Who has higher incidence of prostate cancer? (african americans or caucasians)
African Americans:
- shortest CAG repeats make prostate epithelium more sensitive to androgen.
What is this called?

asymptomatic prostate cancer discovered at autopsy or removed sugically for treatment of benign prostatic hypertrophy.
latent prostate cancer
What is the current NIH dietary recommendation on prostate cancer prevention?
multiple servings of fruit and vegetables each day.
Patterns of spread of prostatic carcinoma.

- into seminal vesicles, base of bladder
direct extension
Patterns of spread of prostatic carcinoma.

- obturator, iliac, perivesical, hypogastric nodes
lymphatic
Patterns of spread of prostatic carcinoma.

- to bones, visceral organs (less likely)
hematongenous
What is this tumor?

Micro
- haphazardly distributed neoplastic glands invading fibromuscular stroma
prostate carcinoma
- nearly all are adenocarcinoma
- malignant glands often crowded tighly together and usually are usually smaller
What is this tumor?
prostate carcinoma
- single layer of epithelium (basal layer absent)
- enlarged nuclei with prominent nucleoli
- mitoses uncommon
- red "crystalloids"
This is a complication of what tumor?
Perineural invasion
- a complication of invasive prostate cancer
Which Gleason grading score is prostate cancer?
Gleason 3
- small and medium sized glands
- glands are separated by stroma
Which Gleason grading score is prostate cancer?
Gleason 4
- small glands fused together into solid aggregates without intervening stroma
Which TNM stage is this prostate cancer?

- cancer incidentally found by TURP or needle biopsy in <5% of tissue fragments
T1a
- treatment unnecessary
- 95% 10 yr survival
Which TNM stage is this prostate cancer?

- cancer incidentally found by TURP or needle biopsy in >5% of tissue fragments
T1b
- 80% 10 yr survival
Which TNM stage is this prostate cancer?

- cancer confined within prostate
T2
- 80% 10 yr survival
Which TNM stage is this prostate cancer?

- cancer invade outside prostate
T3a
Which TNM stage is this prostate cancer?

- cancer invades outsidde prostate with seminal vesicle involvement
T3b
- 60% 10 yr survival
Which TNM stage is this prostate cancer?

- cancer directly invades contiguous organs
T4
- incurable
- 10%-40% 10 yr survival
What is tumor?

- precursor of prostate carcinoma
- preserved basal cell layer and intact basement membrane
PIN
- dysplastic columnar cells with nucleomegaly and prominent nucleoli
- IHS for anti-cytokeratin antibody
What is this tumor?

- immunohistologic stain positive for anti-cytokeratin antibody
PIN
What is the most common bacterial STD worldwide?
chlamydia
Which stage of syphilis is this?

- painless chancre 3 wks after contact (organism already spread through body by lymph and blood)
stage 1
Which stage of syphilis is this?

- maculopapular scaly rash on palms and soles
- condyloma lata (broad raised plaques in anogenital, inguinal and axillary region)
- gray superficial erosions on mucous membrames (mouth, pharynx, genitalia)
- lymphadenopathy
stage 2
- 2-10 wks after chancre
Which stage of syphilis is this?

- aorititis: dilation of aortic root and arch, aortic insufficiency and aneurysms
- neurosyphilis: tabes dorsalis, general paresis
- gummas: nodular sites of delayed hypersensitivity to bacteria in bone, skin, mucous membranes
stage 3
What is the cause of this?

- ulcerative STD
- painful ulcers 4-7 days after contact
- regiional adenopathy (buboes)
chancroid (hemophilus ducreyi)
- most prevalent in tropics
What is the disease?

- lymphedema (elephatiasis)
- extensive scarring of external genitalia
- biopsy showed "Donovan bodies": encapsulated coccobacilli within macrohoages and neutrophils
Granuloma inguinale
- klebsiella (GNB)
What is the cause?

- pruritic dermatosis
- linear streaks on skin of hands, wrists, genital area
scabies
What is the cause?

- pruritic lesions in pubic region
- louse or eggs become attached to hair shafts after sexual contact
pediculosis
- phthruis pubis