Zaman 11-30-07 Male Genital Tract

Front 1

1. Know the diseases of penis/urethra/scrotum such as
phimosis, balanitis, venereal diseases, trauma,
balanoposthitis, hypospadias, and Peyronie's disease.
2. Understand the various neoplastic penile diseases such
as condyloma acuminatum, Erythroplasia of Queyrat/
Bowen's disease and Carcinoma of the penis
3. Understand the differences and similarities between
Gonococcal urethritis and nongonococcal urethritis.
4. Understand the relationship of sterility to the various
infection, trauma, and cryptorchidism.
5. Know the general classification scheme for testicular
neoplasms paying particular attention to the relationship
of intratubular germ cell neoplasia, unclassified
(ITGCN)as a precursor lesion.

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Learning Objectives
6. Know that ITGCN does not give rise to Spermacytic
seminoma, pediatric yolk sac tumor and teratoma.
7. Know that Seminoma is most common testicular tumor
and is called "dysgerminoma" in women.
8. Be familiar with the various special characteristic of
the germ cell neoplasm such as their
immunohistochemical and chromosomal profiles.
9. Be familiar with the classification of the neoplasms of
gonadal stroma
10. Understand that the characteristics of secondary
neoplasms of the testes.
11. Understand the general characteristics of the lesions
of the epididymis and tunica

Front 2

What is a Prepubital orifice of the foreskin (prepuce) is too small
to permit retraction behind the glans?

Back 2

PHIMOSIS

Front 3

Is phimosis congenital or acquired?

Back 3

congenital condition or acquired.

Front 4

___-phimosis is a condition in which the retracted
foreskin cannot be reduced. It is usually a complication
of inflammation of the glans penis (balanitis), venerealdiseases, or trauma.

Back 4

Para

Front 5

_________ is a nonspecific infection/ inflammation
h the foreskin and the glans of the penis. It is
usually associated with a phimosis and may be caused
by a number of diverse organisms.

Back 5

Balanoposthitis

Front 6

________ is a developmental arrest in which the
meatus is present on the underside of the penis
as a result of imperfect closure of the urethral groove.

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Hypospadias

Front 7

Hypospadias has been shown to be associated with
maternal exposure to _________
and is commonly associated with a high incidence of
urogenital tract anomalies.

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sex hormones in early pregnancy

Front 8

Epispadias is also frequently associated with other genital
rinary tract anomalies, the most extreme examples
include absence of the ______ gland and exstrophy of
the urinary bladder.

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prostate

Front 9

Lichen ____________ et atrophicus (Balanitis Xerotica
Obliterans)

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sclerosis

Front 10

Lichen sclerosis et atrophicus (Balanitis Xerotica
Obliterans)
An inflammatory atrophy of epithelium most commonly
seen on the glans but which may extend into the
_______.

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urethra

Front 11

Premalignant lesions -Erythroplasia of Queyrat/____'s
disease:

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Bowen

Front 12

Carcinoma of the penis is most common on what continent?

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Asia

Front 13

Strictures of the urethra may be congenital or acquired
but are most commonly the result of _______.

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urethritis

Front 14

The common presenting symptom of the patient with a
urethral stricture is _____

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urinary retention.

Front 15

Classically associated with ______ infection. However,
"nonspecific urethritis" (NGU)is exceedingly common.

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Gonococcal

Front 16

What percent of NGU?

a pathogen is not identified by routine
screening and culture methods but is now most commonly
associated with chlamydia1 and mycoplasmal infection;
Trichomonas, Candida and Coliform infections.

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90

Front 17

Common symptoms of urethritis are dysuria, discharge
and _______

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urinary frequency.

Front 18

Which lasts longer?
GU or NGU?

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NGU

Front 19

Spontaneous purulent discharge is more common in GU or NGU?

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GU

Front 20

NGU patients have no discharge or mucoid discharge
obtained only after penile _______.

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stripping

Front 21

1. Fluid in the sac of the tunica vaginalis is called what?

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a. Hydrocele
b. Hematocele

Front 22

Lesions of spermatic cord and epididymis are called what?

Back 22

a. Spermatocele (cyst of epididymis)
b. Varicocele (dilated veins of the parnpiniform plexus)

Front 23

What is most common virus of testes followed by Coxasackie
B ?

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mumps virus

Front 24

Epididymis is infected by what things?

Back 24

(Tuberculosis, Gonorrhea, E. coli)

Front 25

Cause of Epidymo-orchitis -

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coliforms

Front 26

Most common cause of infertilty in young men is
_________

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infection (GC or chlamydia)

Front 27

Spermacytic granuloma: sperm engulfed by
__________ and foreign body giant cells

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macrophages

Front 28

Inguinal hernia -which side is most common?

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left more than right

Front 29

Crytporchidism could be confused with what?

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retractile testicle.

Front 30

What is the most frequent complication of cryptordchidism?

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Infertility

Front 31

What tumors are 4-10X more likely in the
cryptorchid testes.

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Germ cell

Front 32

Orchidopexy definition?

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Surgical fixation of a testis

Front 33

Crytporchidism :
Histologically, there is a progressive loss of _____ cell
elements with resultant spermatogenesis failure;

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germ

Front 34

Crytporchidism :
Prepurbertal testis often shows a Sertoli cell nodule
called a _____ adenoma.

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Pick’s

Front 35

Crytporchidism:
Postpubertal testes show fibrosis and tubular s______

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sclerosis

Front 36

Testicular neoplasms
What are the 5 classifications?

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(1) Germ cell origin
(2) Sex cord-stromal origin
(3) Mixed germ cell and sex cord-stromal origin
(4) Hematopoietic tumors
(5) Metastasis

Front 37

95% of all testicular tumors are of ______ origin and
are highly aggressive.

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germ cell

Front 38

Non germ cell tumors are generally benign and elaborate
_______.

Back 38

steroids

Front 39

Can testicular tumors be cured?

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most surgically cured even
aggressive ones.

Front 40

Germ Cell Neoplasms:
These constitute a relatively large group of neoplasms
seen in persons of ______ age.

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reproductive

Front 41

Germ Cell Neoplasms
They are bound all along the __________(anatomic line) -i.e. base of
brain(near pituitary), mediastinum, midline of abdomen,
gonads, and sacral region.

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mid-line

Front 42

Germ Cell Neoplasms:
Most of the tissues they mimic are found in the early
____

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embryo

Front 43

Types of germ cell tumors

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1. Intratubular germ cell neoplasia (ITGCN or ITGCU)
2. Seminoma
3. Non-seminoma
a. Endodermal sinus (yolk sac tumor)
b. Choriocarcinoma
c. Teratoma
4. Mixed tumors
5. Teratocarcinoma

Front 44

Precursor to invasive germ cell tumors is ____.

Back 44

ITGCN

Front 45

Seminoma, non-seminomas arise from _____.

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ITGCN

Front 46

************
ITGCN does NOT give rise to Spermacytic seminoma,
pediatric yolk sac tumor and _______.

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teratoma

Front 47

Seminoma is most common testicular tumor and is called
"______" in women.

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dysgerminoma

Front 48

Non-Seminoma Germ Cell Composed of embryonal,
endodermal(yolk sac) sinus tumor, _____.

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teratoma

Front 49

ITGCN, unclassified: Germ cells show abundant clear cytoplasm, atypical
pleomorphic nuclei and prominent nucleoli. No ________-genesis present

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spermatogenesis

Front 50

Seminoma: nests of tumor cells with clear cytoplasm, mild nuclear pleomorphism,
delicate fibrous trabeculae, lymphocytic infiltrate and ______ invasion

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vascular

Front 51

What color is a Seminoma with strong PLAP reactivity

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brown membranes

Front 52

Seminoma: showing punctate cytokeratin reactivity of what color?

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brown

Front 53

Spermacytic seminoma: small, intermediate and large
cells. Nuclei show "s_____ chromatin” ( similar in
appearance to meiotic chromatin)

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“spireme

Front 54

Embryonal carcinoma: Gland-like structure formed by cells with
markedly pleiomorphic nuclei. Nuclei are crowded and more vesicular
than seminoma. Nuclei are also more prominent than seen in ______

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seminoma

Front 55

germ cell neoplasms tend to be
grossly hemorrhagic and necrotic except which ones?

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Seminoma
Yolk sac tumor

Front 56

1. Teratoma is almost always benign in women, usually
malignant in postpubertal _____.

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males

Front 57

.All tumors that arise frm ITGCN have an
isochromosome __p and are aneuploid.

Back 57

12

Front 58

________ is an unique and very rare
adult (>50 yrs) tumor and none of the
immunohistochemical markers used to identify other
testicular tumors are positive (c-kit, PLAP, cytokeratins,
etc). Also, ring chromosome 9 abnormality.

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Spermacytic seminoma

Front 59

Choricarcinoma does not occur in _____.

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children

Front 60

Embryonal carcinoma is usually CD____ positive
immunohistochemically,

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30

Front 61

BhCG is produced by
__________ and is seen in choriocarcinoma as
well as other germ cell neoplasms that have these cells.

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syncytiotrophoblasts

Front 62

Cytokeratin positivity is seen in all non_________
tumors (embryonal carcinoma, YST, choriocarcinoma,
teratoma)

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seminomatous

Front 63

Neoplasms of gonadal stroma: Name the types

Back 63

Leydig (interstitial) cell tumors, Sertoli cell tumors,
Granulosa cell tumors and gonadoblastoma.

Front 64

. _______ is the most common secondary neoplasm of
the testes and is the most common testicular tumor in
older men.

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Lymphoma

Front 65

Bilateral testicular involvement suggests
______ over a testicular primary.

Back 65

lymphoma

Front 66

Metastatic carcinoma involving the testes is rare (2%).
The most common sites of origin are ________

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lung and prostate.

Front 67

______ is the most
common testicular neoplasm in elderly men

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Lymphoma

Front 68

Adenomatoid tumor: well circumscribed with ______ color

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yellow
gray

Front 69

Adenomatoid tumor: Irregular nests with small nuclei,
vacuolated cytoplasm apprearing like a "______ web”

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“spider

Front 70

Spermatic cord lesions

Back 70

Nodular fibrous periorchitis
Vasitis nodosa
Proliferative funiculitis
Sarcoma
(Rhabdomyosarcoma)
Liposarcoma

Front 71

Which Spermatic cord lesion?

Benign, aka inflammatory pseudotumor
May involve tunica, epididymis
Patient presents with testicular mass; may also have a hydrocoele; any age.

Back 71

Nodular fibrous periorchitis

Front 72

Which Spermatic cord lesion?

Usually seen post-vasectomy
Nodular blunt end of vasectomy;
May resemble adenocarcinoma (invasive)

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Vasitis nodosa

Front 73

Which Spermatic cord lesion?

Benign; etiology may be related to ischemia or torsion.
Presents as swelling in inguinal area, or incidental to inguinal herniorraphy
Wide age range.
Nodular/ diffusely thickened spermatic cord
Microscopically similar to pseudotumor like lesions

Back 73

Proliferative funiculitis

Front 74

Most tumors before age 10.
What type of sperm cord lesion?

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(Rhabdomyosarcoma)

Front 75

Most common partesticular sarcoma in adults.
Most often well differentiated (sclerosing) type seen.
Dedifferentiated types also seen.

What type of lesion?

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Liposarcoma

Front 76

____________: mass arises from dartos smooth
muscle; no testis or epidydimis is present (inset).
Fibroblasts with a tissue culture appearance, hemosiderin and
hemorrhage (main image)

Back 76

Nodular fibrous periorchitis

Front 77

_________ is Lymphohistiocytic infiltrate in the
smooth muscle of the vas deferens with
extravasated sperm.

Back 77

Vasitis nodosa: