System Pathology 2 - Exam 3 (Part 1)

Where is the dorsal aspect of an erect penis? Ventral aspect?

Dorsal would be the top; Ventral would be the bottom

What is an abnormal urethral orifice in males that occurs in 1 in 300, with risk for obstruction or UTI?

Penile Malformations

What is a congenital abnormality of males that result in the displacement of the urethral meatus ventrally and is MC?

Hypospadias

What is urethral opening on the dorsal surface of the penis?

Epispadias

What opens anywhere along the urethral groove running form the tip along the ventral aspect of the shaft to the junction of the penis and scrotum (or perineum)?

Urethra

What is a congenital condition resulting form abnormal development of the penis occurring in 1/200 male births, where the penis usually curves downward (sharp curvature), most notably during erection, with the curvature starting anywhere from the base of the penis near the testicle to the beginning of the glans, w/ minor surgery during an erection?

Chordee

What is Chordee often associated with?

HYPOSPADIAS

-- Urinary opening may be on ventral side fo penis

What condition is an "inside-out" bladder that protrudes out of the abdomen, with the inside of the bladder exposed to the outside environment?

Bladder Exstrophy

What is inflammation of the glans of the penis?

Balanitis

What is inflammation of the prepuce (foreskin)?

Posthitis

What is nonspecific inflammation of BOTH the glans and prepuce with erythema, pain, and odor?

Balanoposthitis

What are 4 causes of Penile Inflammation?

1) Trauma

2) Poor hygiene (smegma; irritation)

3) Infection

4) Contact dermititis

What is a risk of balanoposthitis?

Not having been circumcised

What congenital condition is constriction of the opening of the foreskin which PREVENTS it from being pulled back over the head of the penis, with infection, inflammation, or scarring?

Phimosis

How is Phimosis treated?

Steroid cream & Stretching; circumcision

What condition occurs when the foreskin is retracted behind the head of the penis and CANNOT be returned to the un-retracted position?

Paraphimosis

How is Paraphimosis treated?

Ice, Bandage, drainage, injections, circumcision

What is the MC penile neoplasm (95%), making up <1% of CA diagnosis, presenting with abnormal texture, pain, erythema, and failing to heal (2-4 weeks), needed to be treated via excision, chemo, radiation, or penectomy?

Squamous cell carcinoma

What is the surgical removal of the penis?

Penectomy

What are some risks of the penile neoplasm Squamous Cell Carcinoma?

>40 years old, uncircumcised, smoking (3x), poor hygiene, developing countries, HPV (16/18/31/33), or AIDS

What penile neoplasm is an In Situ Squamous Cell Carcinoma (solitary red plaque on the shaft or scrotum) due to arsenic ingestion and HPV infection?

Bowen Disease

Who is MC affected by In Situ SCC?

>50 years old; uncircumcised

What type of SCC shows gray, crusted, hardened, irregular borders that can be raised/ulcerated, with lymphatic metastasis and a <30% 5 year survival? What percent of Bowen disease cases leads to this?

Invasive SCC

10% --> invasive

T/F: Delay in diagnosis of penile neoplasms makes the treatment more aggressive (increases risk of treatment)

TRUE

What 2 things can lead to inflammation of the scrotum?

1) Fungal infection

2) Dermatoses

What is the MC neoplasia in the scrotum?

SCC

What is an increase in serous fluid in tunica vaginalis and is the MC cause of scrotal enlargement due to infection, tumor, or idiopathic?

Hydrocele

How is a hydrocele diagnosed?

Transiluminescence

What is blood in the scrotum due to trauma?

Hematocele

What is lymph and fatty acid (chyle) in the Scrotum?

Chylocele

What is a group of tropical diseases caused by various thread-like parasitic round worms (nematodes; filarioidea spp. (wuchereria bancrofti)) and their larvae, with the larvae transmitted to humans through a mosquito bite (also flies/arthropods) leading to fever, chills, headache, skin lesions?

Filariasis

When filariasis is left untreated, there is gross enlargement of the limbs and genitals, called what?

Elephantiasis

What is failure of the testicle to descend, MC idiopathic in 3% of live births and 10% bilateral, diagnosed at age 1?

Cryptorchidism

When does testicular descent usually occur during embryological development?

During last 2 months of gestation

Cryptorchidism is associated with ___________________________, can lead to _____ & ______ by age 5, and is a 3-5x risk for ________________.

Congenital inguinal hernia

Atrophy & Sterility

Testicular Cancer

What treatment is done for Cryptorchidism to reposition the testis and decrease the risk of cancer?

Orchiopexy

NOTE: risk of cancer not directly related to fact testicle does not descend, but believed abnormality in descent indicates abnormality in testicle that makes cancer more likely

What condition of the teste can be due to ischemia, trauma, increased estrogens, irradiation, chemotherapy, and can lead to infertility or sterility?

Testicular atrophy

What is inflammation of the epididymis?

Epididymitis

What is inflammation of the testis, with bloody ejaculate?

Orchitis

Orchitis is swelling/inflammation secondary to ____________ viral infection or ___________ bacterial infection.

Viral = mumps

Bacterial = associated w/ epididymitis

Inflammation w/ acute onset (neutrophils, edema, and tenderness of the epididymis or testis commonly begins as _________, and is spread via _________ or _________

UTI (NOTE: d/t STI)

Spread via VAS DEFERENS or LYMPHATICS

Escherichia coli & Mycobacterium tuberculosis are associated with what age group? Neisseria gonorrhaeae & Chlamydia trachomatis?

Escherichia coli & Mycobacterium tuberculosis = prepubertal males & older males

Neisseria gonorrhaeae & Chlamydia trachomatis = Sexually active males under 35

Mumps virus can lead to _____% of orchitis (adults), with the necrosis leading to sterility, while tuberculosis (TB) can lead to _____________

20%

caseous granulomas

What condition is spermatic cord twisting leading to obstruction of venous drainage leading to sever scrotal congestion, obstruction of arterial blood supply, acute engorgement & pain, and is a urologic emergency?

Testicular torsion

_____ of testicular torsions will self resolve, but it is a urologic emergency in less that ___ hours.

1/3

6 hours

What type of testicular torsion occurs in utero or perinatal (rare) with no anatomical defects, infarcted, and Extravaginal torsion?

Neonatal Testicular Torsion

NOTE: nEonatal & Extravaginal torsion

What type of testicular torsion occurring is MC from ages 12-18 years with a bell-clapper deformity and intravaginal torsion?

Adult Testicular Torsion

How is Testicular Torsion diagnosed? How are they treated?

Diagnosed = Physical exam & ultrasound

Treated = Surgical repair (if unresolved w/in 6 hours)

What is an enlarged pampiniform venous plexus of the scrotum (varicose vein) and is a COMMON cause of low sperm production and decreased sperm quality, which can cause infertility with risks such as vascular defects and family history?

Varicocele

What malignancy can arise from a varicocele since they can decrease venous damage?

Testicular or renal cell carcinoma

Testicular neoplasia is the MC cancer in what age group, with ____ being the average age of diagnosis?

15-35

MC = 33

What are some risks of testicular cancer?

Family history (8-10x risk)

Cancer in contralateral testicle

Cryptorchidism (10% of cases)

Caucasians

Gonadal dysgenesis

What are 7 possible signs/symptoms of testicular cancer?

1) Lump/enlargement in either testicle

2) Feeling of heaviness in scrotum

3) Dull ache in abdomen or groin

4) A sudden colleciton of fluid in scrotum

5) Pain/discomfort in testicle/scrotum

6) Enlargement or tenderness of breasts

7) Back pain

T/F: Cancer usually affects only one testicle

TRUE

What testicular tumor is malignant, making up 95% of post pubertal testicular tumors? What is it from?

Germ Cell Tumors (GCTs)

From intratubular germ cell neoplasia (in situ)

Which of the 2 types of Germ Cell Tumors (GCTs) is a small mass that remains localized to the testis, grows large, is painless, and well-demarcated, with cells that are large, uniform, and have a round nuclei?

Seminomas

Seminomas make up ______% of all GCTs, has a _____________ prognosis, affects age ____-____, and has an increase in ________ in 7-10% of cases.

50%

More Favorable

30-40 years

increased hCG

T/F: Seminomas are not radiosensitive, so this makes it hard to be cured

FALSE

-- radiosensitive; often cured

What are some characteristic features of seminomas?

Large round cells (w/ abundant clear cytoplasm & large nuclei)

-- distinct borders; lack anaplastic changes; less aggressive

Which of the two types of GCTs are more AGGRESSIVE, have a poorer prognosis, and are smaller, making them difficult to palpate and metastasize sooner, leading to extension to the epididymis, spermatic cord, or scrotal sac?

Nonseminoma

Which of the 4 types of Nonseminoma GCTs makes up 40% (MC) and are aggressive, quick to metastasize, invasive, anaplastic, indistinct borders, grow rapidly and spread outside the testicle, occurs from ages 20-30 and has increased AFP and hCG?

Embryonal Carcinoma

NOTE: AFP = alpha fetal protein; think embryo & fetal together

Which of the 4 types of Nonseminoma GCTs are rare & MOST aggressive, quick to metastasize via the blood, and is a small mass but spreads fast (lungs, brain, bones), from age 20-30 with increased hCG, responds poorly to radiation & chemo, and usually require a radical orchiectomy (high mortality)?

Choriocarcinoma

Which of the 4 types of Nonseminoma GCTs are in CHILDREN (age 3), palpable, large, anaplastic, increased AFP, but a favorable prognosis?

Yolk Sac Tumor

Which of the 4 types of Nonseminoma GCTs are a frim mass that can occur in all ages with NO tumor marker?

Teratoma

T/F: Mature teratomas in males are benign, but in females they are often associated with mixed immature elements resulting in a worse prognosis.

FALSE

Women = benign

Men = mixed immature elements (yolk sac & embryonal carcinoma) = worse prognosis

Testicular Cancer Summary

Seminimas

- Large & Palpable

- Well-contained mass

- Late lymphatic metastisis

- Radiosensitive

Nonseminomas GCTs

- Small & less palpable

- Earlier lymphatic/hematogenous metastasis (lungs/liver)

- Chemosensitive

What are some key features of testicular cancer? How is it treated?

Painless testicular mass that is NON-translucent

-- blood in semen or dull/achy pain in groin/abdomen

Treated = radical orchiectomy (assumed malignancy)

What type of Testicular Tumors are benign (in situ) and include Sertoli (nurse) & Leydig (testosterone) cells?

Sex Cord-Stromal Tumors / Nongerm Cell Testicular Tumor

What is a nongerm cell tumor derived from testicular stroma (interstitium) which may cause elevated androgens and other steroids, presenting as a testicular mass and changes secondary to hormonal abnormalities?

Leydig cell tumor

What is the histological feature of Leydig cell tumor?

Intracytoplasmic Reinke crystals

What 2 things is Leydig cell tumor typically associated with?

1) Precocious puberty in children

2) Gynecomastia in adults

T/F: Sertoli cell tumor can be composed of Sertoli cells & granulosa cells

TRUE

--- can be only sertoli cells or a mixture of sertoli & granulosa

T/F: Sertoli cell tumor can secrete both androgens and estrogen, and often leads to sufficient quantities to produce feminization or precocious puberty

FALSE

-- RARELY sufficient to produce feminization/precocious puberty

How often should a testicular self-exam be done, checking for size, shape, mobility, lumps/swelling?

Monthly

What doctor specializes in the male and female urinary tract and the reproductive system of males, which is the doctor who should be referred to for a diagnostic evaluation for anyone with a testicular mass?

Urologist

What 3 tissues make up the prostate gland?

Glandular, Fibrous, Smooth Muscle

What location of the prostate is the area surrounding the ejaculatory duct?

Central Zone (CZ)

What is the largest area of the prostate with glandular tissue, easily felt by the doctor during a digital rectal exam?

Peripheral zone (PZ)

What is the area of the prostate that surrounds the urethra as it enters the prostate gland (prostatic urethra)?

Transitional zone (TZ)

Which area of the prostate is where carcinomas occur (cancers)? Hyperplasia? Only 5% of cancers, but AGGRESSIVE?

Peripheral zone

Transitional Zone

Central Zone

T/F: Most prostate cancers start in the transitional zone

FALSE

-- Peripheral zone

What is swelling and inflammation of the prostate gland in 50 years or younger with symptoms that can include pain/burning w/ urination (dysuria), difficulty urinating, frequent urination, urgent need to urinate, cloudy urine, blood in urine, pain in abdomen/groin/lower back, pain in area between scrotum & rectum, pain of penis/testicles, painful ejaculation, flu-like signs/symptoms (w/ bacterial)

Prostatitis

Which NIH classification of prostatitis is acute infection of prostate, identified as an increased WBC and bacteria in urine, with chills, fever, body aches, fatigue, pain in lower back/genital, urinary frequency and urgency (often at night), burning sensation or painful urination and ejaculation?

Type I

Acute Bacterial prostatitis

Which NIH classification of prostatitis is recurrent infection of the prostate similar to type I but does not respond to initial antibiotic therapy, with the same symptoms as type I, and is more common and usually treatable with antibiotics, although the infection can be persistent, requiring several courses of therapy, and has the same symptoms as type I but often less pronouced?

Type II

Chronic Bacterial Prostatitis

Which NIH classification of prostatitis has no demonstrable bacterial infection and has two types, one being inflammatory and one non-inflammatory, with symptoms such as pain in the lower back and genital area (perineum), urinary frequency and urgency (often at night), burning or painful urination and ejaculation?

Type III (chronic nonbacterial prostatitis/chronic pelvic pain syndrome)

Which type of Type III (chronic nonbacterial prostatitis/chronic pelvic pain syndrome) is inflammatory with white blood cells in the urine, prostate secretions, and semen, but no evidence of an infectious agent? Which is non-inflammatory so no white blood cells are in the urine or prostate secretions with no evidence of infection?

Type A

Type B

Which NIH classification of prostatitis is when white blood cells are present, but usually found during tests for another medical condition (such as infertility) since there are no symptoms?

Type IV (asymptomatic inflammatory prostatitis)

What is the MC cause of bacterial prostatitis?

E. Coli (Bacterial)

In ______% of cases bacterial prostatitis is acute, and in _______% of cases its chronic bacteria.

2-5% for BOTH

What are some differential diagnosis for acute bacterial prostatitis?

Benign prostatic hypertrophy

Chronic bacterial prostatitis

Chronic pelvic pain syndrome

Cystitis

Diverticulitis

Epididymitis

Orchitis

Proctitis

Prostate Cancer

What is the MC cause of Prostatitis, making up 90-95% of cases?

Chronic nonbacterial prostatitis (Prostatodynia, Chronic Pelvic Pain Syndrome)

T/F: When a urinary sample is collected, if there is bacteria and WBC then its the bacterial form of prostatitis, but if neither are high in levels then it is the nonbacterial form

FALSE

-- Nonbacterial form = High in WBC but NO bacteria

What are the 3 types of symptoms that can be seen in Chronic nonbacterial prostatitis (Prostatodynia, Chronic Pelvic Pain Syndrome)?

1) Pain upon urination

2) Urinary voiding difficulties

3) Sexual dysfunction

NOTE: NIH outcome measures (pain, urinary symptoms, quality of life)

What is the treatment for Chronic nonbacterial prostatitis (Prostatodynia, Chronic Pelvic Pain Syndrome)?

3 A's

Antibiotics, Anti-inflammatory, Alpha blockers

How is bacterial prostatitis transferred to the prostate? (4)

1) Blood

2) Lymph

3) Urethra/bladder

4) Rectum