Male Patho

What is phimosis?

congenital or acquired inability to retract prepuce, increasing risk of gland and prepuce inflammation

treated with circumcision

What causes phimosis?

residual of previous infection and scarring of prepuce

What is balanitis?

localized or diffuse redness, swelling, or ulceration of the glans

What causes balanitis?

herpes or syphilis

What are usual causes of urethritis?

gonorrhea, chlamydia, e coli, or mycoplasma

prostatitis complication

What are symptoms of urethritis?

urinary frequency, dysuria, urethral discharge

What is the appearance of condyloma acuminatum?

venereal warts of penis that are circumscribed, exophytic, and cauliflower-like on the glans and shaft of pens

What causes condyloma acuminata?

sexual transmission of HPV 6 and 11

What is the histologic appearance of condyloma acuminatum?

papillomatous and exhibit epidermal hyperkeratosis, parakaratosis, and koilocytosis without atypia

What patient demographics are associated with prostatitis?

older men

What causes prostatitis?

stagnant urine with e coli or proteus

What causes epididymitis?

ascending chlamydia or gonorrhea

What is orchitis?

inflammation of tests and epididymis

What is the most common acute orchitis?

gram negative orchitis secondary to UTI

What are viral causes of orchitis?

syphilis and mumps

What causes chronic orchitis?

tuberculous or fungal infection

What is the physical presentation of peyronie disease?

focal and asymmetric induration of penile shaft (ill defined fibrous nodule), leading to curvature

pain during erection

no change in overlying skin

What patient demographics are associated with peyronie disease?

young or middle aged men

What is the histologic appearance of peyronie disease?

dense dermal fibrosis with non-specific chronic infiltrate

collagen slowly replaces muscle

What practices make penile carcinoma more common in other parts of the world?

no circumcision, poor hygiene

What is smegma?

product of penile coronal glands, desquamated cells, and keratin debris

What are risk factors of penile carcinoma?

smegma and HPV 16/18

How is smegma a risk factor of penile cancer?

smegma accumulates under prepuce of uncircumcised males

prolonged contact of carcinogen for mucosal cells

How does squamous cell carcinoma of the penis present?

ulcerated and hemorrhagic mass on glans or prepuce

possible exophytic fungating

How does squamous cell carcinoma of the penis appear histologically?

well differentiated and focally keratinizing, possible invasion into dermis

How does penile cancer metastasize?

spread locally to inguinal and iliac lymph nodes, rarely to distant organs

How is penile cancer treated?

surgical amputation and radiation

What is cryptochordism?

congenital malpositioning of testes outside of normal scrotal location, usually unilateral

How are testes supposed to descend normally?

testes descend from abdominal cavity through inguinal canal to scrotum

What is the histologic appearance of cryptochordism up until 5 years old?

reduced diameter of seminiferous tubules with decreased germ cells

What is the histologic appearance of cryptochordism if surgical correction is delayed past puberty?

hyaline thickening of tubular basement membrane with stromal fibrosis

Where are cryptorchid testes usually located?

high in scrotal sac, inguinal canal, abdominal cavity

What are possible complications of cryptochordism?

infertility, germ cell tumors

What germ cell tumors are seen with cryptochordism?

seminomas and embryonal carcinoma if untreated

no tumor risk if orchiopexy done before age 5

What is testicular torsion?

torsion of the spermatic cord, usually shortly after vigorous exercise

What is the presentation of testicular torsion?

abrupt onset scrotal pain and swelling

hemorrhagic infarction

What patient demographics are associated with testicular tumors?

rare before puberty and in older men (age 20-40)

What are the most common testicular tumors?

germ cell origin

What are characteristics of seminomas?

most common type of germ cell tumor, not found before puberty

normally classic type

How does a seminoma present?

firm intratesticular poorly demarcated mass that bulges from cut surface of testes

What is the gross appearance of seminomas?

tumor is yellow-white with possible hemorrhage and necrosis

What is the histologic appearance of seminomas?

solid nests of proliferating tumor cells between fibrovascular trabeculae and lymphocytes

cells have well defined borders with glycogen, rich clear cytoplasma, normal appearance nuclei

What is the prognosis for seminomas?

very radiation sensitive, so high survival rate

How do embryonal carcinomas compare to seminomas?

more aggressive and lethal

What is the gross appearance of embryonal carcinomas?

small tumor replacing entire testis

gray white, poorly demarcated, bulging, varying hemorrhage and necrosis

What is the histologic appearance of embryonal carcinomas?

sheets of cells with clefts, acini, and papillary structures

indistinct cell borders, dense nuclei with prominent nucleoli, marked pleomorphism, mitotic activity

What tumor markers are positive in embryonal carcinomas?

HCG and AFP

What is the prognosis of embryonal carcinomas?

early metastasis to lymph nodes, liver, and lung

chemo is successful if no mets

What are the types of testicular teratomas?

mature, immature, malignant

What is the gross appearance of a mature teratoma?

solid and multicystic, mucinous cysts with solid cartilaginous and osseous foci

What is the histologic appearance of a mature teratoma?

haphazard arrangement of cells and organoid structures (neural, skeletal bone, cartilage, thyroid, epithelium) or tissues with fibrous or myxoid matrix

What is the biological behavior of a testicular teratoma in adult men?

commonly malignant and metastasize

What is the biological behavior of a testicular teratoma in infants and children?

benign

What is the most common germ cell tumor in children?

yolk sac tumor

What is the gross appearance of yolk sac tumors?

enlarged testes with poorly defined, lobulated mass

yellow gray with focal hemorrhage and necrosis

What is the histologic appearance of yolk sac tumors?

dilated tubular spaces lined by flattened cells with edematous stroma

cells surround schiller-duval body

What is a Schiller-Duval Body?

microcyst containing a glomerulus like structure with a central fibrovascular core

What tumor markers are associated with yolk sac tumors?

AFP

What is the gross appearance of choriocarcinoma?

no testicular enlargement, small painless nodule

marked hemorrhage and necrosis

What is the microscopic appearance of choriocarcinoma?

trophoblastic tissues in areas of hemorrhage

What are syncytiotrophoblasts?

large multinucleated giant cells with abundant vacuolated cytoplasm, contains HCG

What are cytotrophoblasts?

polygonal cells with round, hyperchromatic nuclei, and sparse cytoplasm

How do germ cell tumors present?

testicular swelling or pain

How do germ cell tumors metastasize?

first invade epididymis and metastasize to regional nodes and the lungs

choriocarcinoma disseminates to lungs via bloodstream

What is the functionality of leydig cell tumors?

active and secrete androgens, estrogens, or both

What patient demographics are associated with leydig cell tumors?

boys older than 4 or men in 3rd to 6th decade

What is the gross appearance of leydig cell tumors?

well circumscribed, appears encapsulated

yellow brown and lobulated

What is the histologic appearance of leydig cell tumors?

sheets of polygonal cells with abdunant eosinophilic cytoplasm

What are symptoms of a leydig cell tumor?

precocious physical and sexual development in prepubertal boys

feminization and gynecomastia in other adults

How are sex cord tumors cured?

orchiectomy

What patient demographics are associated with sertoli cell tumors?

first 4 decades of life

What is the gross appearance of sertoli cell tumors?

well circumscribed and yellow gray

What is the histologic appearance of sertoli cell tumors?

tubular arrangement with solid cords of cells with fibrous trabecular network

What is the clinical presentation of sertoli cell tumors?

scrotal mass or gynecomastia

What is the cause of acute bacterial prostatitis?

gram negative bacteria (e coli)

What is the histologic presentation of acute bacterial prostatitis?

inflammatory infiltrate in acini and stroma

What is the presentation of acute bacterial prostatitis?

intense discomfort on urination, fever, chills, perineal pain

What is the presentation of chronic bacterial prostatitis?

suprapubic, perineal, and low back pain

dysuria and nocturia

What is the histologic presentation of chronic bacterial prostatitis?

mononuclear cells

What is nodular hyperplasia of the prostate?

enlargement of periurethral prostate at the neck of the bladder, causing urinary impedance

What is the status of the prostate in a young man who was castrated before puberty?

small and non-functional

How does estrogen impact the prostate

sensitizes cells to testosterone

What is the gross appearance of BPH?

enlarged and nodular

distort urethra and compress peripheral portions of the gland

What does BPH feel like on palpation?

uneven tissue, soft and pliable

What is the histologic appearance of BPH?

tissue with numerous hyperplastic glands surrounded by increased fibromuscular stroma

What predisposes men with BPH to infection?

proliferated glands dilate and accumulate prostatic secretions

What is the clinical presentation of BPH?

urinary urgency but difficulty urinating, weak stream

What are complications of urinary pressure in BPH?

reflux of urine into ureters, dilation of ureters, dilation of renal collecting system, end stage renal disease

How can BPH be treated?

transurethral resection of the prostate or retrograde transurethral balloon dilation of prostate

What is the role of testosterone in prostate carcinoma?

stimulates growth of cancer

anti-testosterone meds slow growth

testosterone receptors seen on prostatic cancer cells

What patient demographics are associated with prostate cancer?

white American males

black (high mortality)

What are protective factors related to prostate cancer?

intake of yelloe and green vegetables

What environmental factors increase the risk of prostate cancer?

high fat diet, exposure to cadmium, rubber, or textiles

How does prostate cancer progress?

originates in peripheral (posterior lobes) glands, but locally invades fibromuscular stroma

perineural invasion occurs and then spreads to lymphatics and adjacent organs

mets to lumbosacral, liver, and lungs

How are prostate cancers classified?

gleason score

How is the Gleason score interpreted?

best differentiated tumors have score of 2

worst differentiated tumors have score of 10

What is the role of PAP in prostate cancer?

PAP made by prostate and tumor cells, tumor releases PAP into circulation

high levels in serum seen in cancer patients

What is the role of PSA in prostate cancer?

PSA made by malignant and normal prostate cells, tumor releases PSA into circulation

positive result should be interpreted with other findings

if detected after prostatectomy, eval for mets

What is the role of ALP in prostate cancer?

abundant in osteoblasts, released from bone when prostate cancer mets to the bone

What tumor markers are diagnostics together for prostate cancer?

ALP and PAP