Male Genital System Pathoma

Front 1

Opening of urethra on inferior surface of penis

Back 1

Hypospadias

- due to failure of urethral folds to close

Front 2

Opening of urethra on superior surface of penis

Back 2

Epispadias

- due to abnormal positioning of genital tubercle

- associated with bladder extrophy

Front 3

Benign warty growth on genital skin

Back 3

Condyloma acuminatum

- HPV 6/11

- characterized by koilocytic change

Front 4

Necrotizing granulomatous inflammation of the inguinal lymphatics and lymph nods

Back 4

Lymphogranuloma venereum

Front 5

What causes lymphogranuloma venerum?

Back 5

Chalmydia trachomatis

- eventually heals with fibrosis

- perianal involvement may result in stricture

Front 6

Malignant proliferation of squamous cells of penile skin

Back 6

Squamous cell carcinoma

Front 7

Risk factors for penile squamous cell carcinoma

Back 7

High risk HPV types (2/3 of cases)

Lack of circumcision - foreskin acts as a hiatus for inflammation and irritation if not properly maintained

Front 8

In situ carcinoma of the penile shaft or scrotum that presents as leukoplakia

Back 8

Bowen disease

Front 9

In situ carcinoma of the glans that represents as erythroplakia

Back 9

Erythroplasia of Queyrat

Front 10

In situ carcinoma that presents as multiple reddish papules

Back 10

Bowenoid papulosis

- seen in younger patients relative to bowen disease and erythroplasia of Queyrat

- DOES NOT progress to invasive carcinoma

Front 11

Failure of testicles to descend into the scrotal sac

Back 11

Cryptochordism

- testicles normally develop in the abdomen and then descend into the scrotal sac as the fetus grows

Front 12

Most common congenital male reproductive abnormality

Back 12

Cryptochordism

Front 13

Most cases of cryptochordism resolve

Back 13

spontaneously

Front 14

If it doesn't resolve spontaneously, ______________ is performed before 2 years of age

Back 14

orchiopexy

Front 15

Complications of cryptochoridsm

Back 15

testicular atrophy with infertility and increased risk for seminoma

Front 16

Inflammation of the testicle

Back 16

Orchitis

Front 17

Cause of orchitis in young adults

Back 17

Chlamydia trachomatis (D-K serotypes)

Gonorrhea

Increased risk of sterility but libido is not affected because LEYDIG cells are spared

Front 18

Cause of orchitis in older adults

Back 18

E coli and Pseudomonas

- UTI spread into reproductive tract

Front 19

Viral cause of orchitis in teenagers

Back 19

Mumps

- increased risk for sterility

- testicular inflammation usually not seen after 10 years old

Front 20

characterized by granulomas involving the seminiferous tubules

Back 20

autoimmune orchitis

Front 21

twisting of the spermatic cord causing thin walled veins to become obstructed leading to congestion and hemorrhagic infarction of the testis

Back 21

Testicular torsion

Front 22

Cause of testicular torsion

Back 22

congenital failure of testes to attach to the inner lining of the scrotum via the processus vaginalis

Front 23

Testicular torsion appears in adolescents as ______________

Back 23

sudden testicular pain and absent cremasteric reflex

Front 24

Dilation of the spermatic vein due to impaired drainage

Back 24

Varicocele

Front 25

Varicocele presents as

Back 25

swelling with a bag of worms appearance

Front 26

Varicocele tend to occur on the _____________ side

Back 26

left side

- left testicular vein drains into the renal vein

- right testicular vein drains into the IVC

Front 27

Varicocele is associated with _____________

Back 27

left sided renal cell carcinoma that can invade the renal vein

seen in a large % of infertile males

Front 28

Fluid collection within the tunica vaginalis

Back 28

Hydrocele

Front 29

Serous membrane that covers the testicle as well as the internal surface of the scrotum

Back 29

tunica vaginalis

Front 30

In children, hydrocele is associated with ________________

Back 30

incomplete closure of the processus vaginalis leading to communication with peritoneal cavity

Front 31

In adults, hydrocele is caused by

Back 31

blockage of lymphatic drainage

Front 32

Hydroceles present as ______________

Back 32

scrotal swelling that can be transilluminated

Front 33

Testicular tumors arise from ________________

Back 33

germ cells or sex cord stroma

Front 34

What age range does testicular cancer occur

Back 34

15-40

Front 35

Risk factors for germ cell tumors

Back 35

cryptochordism and Klinefelters

Front 36

Most common type of testicular tumor

Back 36

Germ cell tumors

Front 37

Testicular tumors in general present as

Back 37

painless testicular mass that cannot be transilluminated

Front 38

Are testicular tumors biopsied?

Back 38

NO due to risk of seeding the scrotum, removed via radical orchiectomy

Most testicular tumors are malignant germ cell tumors

Front 39

Germ cell tumors are divided into _____________

Back 39

seminomas (55%)

Non-seminomas (45%)

Front 40

Germ cell tumor highly responsive to radiotherapy, metastasize late, and have an excellent prognosis

Back 40

Seminomas

Front 41

Germ cell tumor with variable response to treatment and often metastasize early

Back 41

Non-seminoma

Front 42

Malignant tumor composed of large cells with clear cytoplasm and central nuclei that resemble spermatagonia

Back 42

Seminoma

- forms a homogenous mass with no hemorrhage or necrosis

Front 43

What is the most common testicular tumor?

Back 43

Seminoma

- resembles ovarian dysgerminoma

- good prognosis, responds to radiotherapy

Front 44

Rare cases of seminoma may produce __________

Back 44

hCG

Front 45

Malignant tumor comprised of immature, primitive cells that may produces glands and forms a hemorrhagic mass with necrosis

Back 45

Embryonal carcinoma

- aggressive with early HEMATOGENOUS spread

Front 46

Embryonal carcinoma treated with chemo may result in _______________

Back 46

differentiation into another type of germ cell tumor (teratoma)

Front 47

what markers are increased in embryonal carcinoma?

Back 47

AFP and 3-hCG

Front 48

Malignant testicular tumor that resembles yolk sac remnants

Back 48

Yolk sac tumor

Front 49

What is the most common testicular tumor in children?

Back 49

Yolk sac

Front 50

Histological hallmark of yolk sac tumors

Back 50

Schiller-Duval bodies - glomerulus like structures

Front 51

What is characteristically elevated in yolk sac tumors?

Back 51

AFP

Front 52

Malignant tumor of syncytiotrophoblasts and cytotrophoblasts (placenta like tissue, but villi are absent)

Back 52

Choriocarcinoma

- early hematogenous spread

Front 53

What is characteristically elevated in choriocarcinoma?

Back 53

3-hCG

- may lead to hyperthyroidism or gynecomastia

Front 54

Tumor composed of mature fetal tissue derived from two or three embryonic layers

Back 54

Teratoma

- malignant in males

- AFP or hCG may be elevated

Front 55

Germ cell tumor with mixed components

Back 55

Mixed germ cell tumor

- prognosis based on worst component

Front 56

Tumors that resemble sex cord stromal tissues of the testicle that are usually benign

Back 56

Sex cord stromal tumor

Front 57

Leydig cell tumors usually produce androgens causing _____________

Back 57

precocious puberty in children and gyneocomastia in adults

Front 58

What is the hallmark histological feature?

Back 58

Reinke crystals

Front 59

Sertoli cell tumors are composed of ___________

Back 59

tubules and clinically silent

Front 60

Most common cause of testicular mass in men over 60, often bilateral

Back 60

Lymphoma

- diffuse large B cell

Front 61

Small round organ that lies at the base of the bladder encircling the urethra

Back 61

Prostate

- sits anterior to the rectum

Front 62

What part of the prostate is palpable on digital rectal exam?

Back 62

Posterior peripheral

Front 63

Prostate consists of ________ and _________

Back 63

glands and stroma

Front 64

______________ are composed of an inner layer of luminal cells and an outer layer of basal cells

Back 64

Glands

Front 65

What do prostate glands secrete?

Back 65

Alkaline, milky fluid that is added to sperm and seminal vesicle fluid to make semen

Front 66

Glands and stroma are maintained by _______________

Back 66

androgens

Front 67

Acute inflammation of the prostate usually due to bacteria

Back 67

Acute prostatitis

Front 68

Acute prostatitis causes in young adults

Back 68

Chlamydia and Gonorrhea

Front 69

Acute prostatitis causes in older adults

Back 69

E coli and Pseudomonas

Front 70

Acute prostatitis presents as

Back 70

Dysuria with fever and chills

Prostate is tender and boggy on digital rectal exam

Prostatic secretions show WBCs and culture reveals bacteria

Front 71

chronic inflammation of the prostate

Back 71

Chronic prostatitis

- presents as dysuria with pelvic/low back pain

- prostatic secretions show WBC

- cultures are NEGATIVE

Front 72

Hyperplasia of prostatic stroma and glands

Back 72

Benign prostatic hyperplasia

- age related change

- NO increased risk of cancer

Front 73

BPH is related to what androgen?

Back 73

DHT

- testosterone is converted to DHT by 5-alpha-reductase in STROMAL cells

Front 74

Mechanism of action of DHT?

Back 74

DHT acts on androgen receptor of stromal and epithelial cells resulting in hyperplastic nodules

Front 75

What portion of the prostate does BPH occur?

Back 75

Central periurethral zone

Front 76

Clinical features of BPH

Back 76

Problems starting and stopping urine stream

Impaired bladder emptying with increased risk for infection and hydronephrosis

Dribbling

Hypertrophy of the bladder wall smooth muscle increasing the risk for bladder diverticula

Microscopic hematuria may be present

Front 77

Why is PSA slightly elevated in BPH?

Back 77

Increased number of glands

PSA is made by prostatic glands and liquefies semen

Front 78

Tx of BPH

Back 78

alpha-1-antagonist (terazosin)

- relaxes smooth muscle

- relaxes vascular smooth muscle, decreases BP

Front 79

What selective alpha-1 antagonist is used in normotensive adults to avoid effects on blood vessels?

Back 79

Tamsulosin - Flomax

Front 80

Blocks conversion of testosterone to DHT

Back 80

5-alpha-reductase inhibitor

- takes months to see results

- also useful in male pattern baldness

Front 81

Side effects of 5-a-reductase inhibitor

Back 81

gynecomastia and sexual dysfunction

Front 82

Malignant proliferation of prostate gland

Back 82

Prostate adenomcaricinoma

- most common cancer in men

- 2nd most common cause of cancer related death

Front 83

Risk factors for prostate cancer

Back 83

Age

Race

- Blacks > Whites > Asians

Diet

- high in saturated fats

Front 84

Prostatic carcinoma is most often clinically __________

Back 84

silent

Front 85

Where does prostatic carcinoma arise?

Back 85

posterior peripheral region of the prostate gland

- urinary symptoms DO NOT occur early on

Front 86

Screening begins at age 50 with _____________

Back 86

DRE and PSA

Normal PSA increases with age due to BPH

- 2.5 ng/mL for 40-49

- 7.5 ng/mL for 70-79

Front 87

PSA greater than ___________ is worrisome at any age

Back 87

greater than 10

Front 88

Decreased _______________ is suggestive of cancer

Back 88

decreased % free PSA

cancer makes BOUND PSA

Front 89

What is required to confirm presence of carcinoma

Back 89

Prostatic biopsy

- small invasive glands with prominent nucleoli

Front 90

Gleason grading system is based on _____________

Back 90

Architecture

NOT based on nuclear atypia

Multiple regions of the tumor are assessed because architecture varies from area to area

Front 91

Gleason grading system scoring

Back 91

1 - 5 is assigned for two distinct areas then added to produce a final score of 2-10

Higher score suggests worse prognosis

Front 92

Spread to the ______________ is common

Back 92

Lumbar spine and pelvis

Front 93

Spread to the lumbar spine results in ___________

Back 93

osteoblastic metastases that present as low back pain

Front 94

What markers are increased in metastasized prostatic adenocarcinoma?

Back 94

Serum Alkaline phosphatase

PSA

Prostatic acid phosphatase

Front 95

What procedure is performed for localized disease?

Back 95

Prostatectomy

Front 96

Advance disease is treated with _____________

Back 96

hormone suppression to reduce testosterone and DHT

Continuous GnRH analogs (Leuprolide) shut down the hypothalamus

- LH and FSH are reduced

Front 97

________________ acts as a competitive inhibitor at the androgen receptor

Back 97

Flutamide