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Flashcards in pathoma male repro pathology Deck (30)
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1

hypospadias

opening of urethra on inferior surface of penis; due to failure of the urethral folds to close

2

epispadias

opening of the urethra on superior surface of the penis; due to abnormal positioning of the genital tubercle
--associated with bladder exstrophy

3

condyloma acuminatum

benign warty growth on genital skin; due to hpv 6 or 11; characterized by koilocytic change

4

lymphogranuloma venerum

necrotizing granulomatous inflammation of the inguinal lymphatics and lymph nodes
-this STD is caused by chlamydia trachomatis (serotypes L1-L3)
--eventually heals with fibrosis; if perianal, can cause a rectal stricture

5

squamous cell carcinoma of penis

malignant proliferation of squamous cells on penis
-risk factors: high risk HPV (16,18,31,33) or lack of circumcision (foreskin acts as a nidus for inflammation and irritation)

6

precursor lesions of penis squamous cell carcinoma

1) bowen disease - in situ carcinoma of penile shaft, presents as leukoplakia
2) erythroplasia of queyrat - in situ carcinoma on glans; presents as erythroplakia
3) bowenoid papulosis - in situ carcinoma; presents as reddish papules; younger patients (40s); does NOT progress to invasive carcinoma

7

cryptorchidism

failure of testicle to descend into the scrotal sac (testicles normally develop in the abdomen and then descend into the scrotal sac as fetus grows)

-either resolves spontaneously OR treat with orchiopexy before 2 yrs of age

8

orchitis

inflammation of the testicle
causes:
--chlamydia or gonorrhea - young adults
--e coli or pseudomonas - older adults
--mumps virus - teenage males
--autoimmune - you see granulomas involving the seminiferous tubules

9

testicular torsion

twisting of the spermatic cord; thin-walled veins become obstructed leading to congestion and hemorrhagic infarction
-due to congenital failure of testes to attach to the inner lining of the scrotum (via processus vaginalis)
-presents in adolescents with sudden testicular pain and absent cremasteric reflex

10

varicocele

dilation of the spermatic vein due to impaired drainage; presents as scrotal swelling with a bag of worms appearance
-usually left sided; associated with left sided renal cell carcinoma
-seen in many infertile males

11

hydrocele

fluid collection in tunica vaginalis(serous membrane that covers testicle and internal surface of scrotum)
-due to incomplete closure of the processus vaginalis leading to communication with the peritoneal cavity (infants) or blockage of lymphatic drainage (adults)

presents as scrotal swelling that can be transilluminated

12

two types of testicular germ cell tumors

seminoma = responsive to radiotherapy, metastasize late, excellent prognosis

nonseminoma = variable response to radiotherapy, metastasize early

13

risk factors for testicular germ cell tumors?

-cryptorchidism
-klinefelter syndrome

14

seminoma

malignant tumor comprised of large cells with clear cytoplasm and central nuclei; forms homogenous mass with no hemorrhage or necrosis

good prognosis; responds to radiotherapy

15

embryonal carcinoma

malignant tumor of immature, primitive cells that may produce glands; forms hemorrhagic mass with necrosis
-aggressive with early hematogenous spread; chemo could transform into a teratoma
-increased AFP or B-hCG

16

yolk sac (endodermal sinus) tumor

malignant tumor that resembles yolk sac; most common testicular tumor in kids
-schiller-duval bodies present; AFP elevated

17

choriocarcinoma

malignant tumor of syncytiotrophoblasts and cytotrophoblasts (placenta like tissue without villi)
-early hematogenous spread
-elevated B-hCG
-can cause hyperthyroidism or gynecomastia

18

teratoma

tumor of mature fetal tissue derived from 2-3 embryonic layers
malignant in males; benign in females
-AFP or B-hCG may be elevated

19

prognosis of mixed germ cell tumors

prognosis is based on the worst component

20

sex cord-stromal tumors (non germ cell)

tumors that resemble sex cord-stromal tissues of the testicle; usually benign
-leydig cell tumor - usually produces androgen, causing precocious puberty in kids or gynecomastia in adults; displays reinke crystals
-sertoli cell tumor - comprised of tubules and is usually clinically silent

21

reinke crystals

sex-cord stromal tumor --> leydig cell tumors

22

lymphoma

most common cause of a testicular mass in males >60 yo; often bilateral
-usually of diffuse large B-cell type; not primary, it metastasizes

23

acute prostatitis

acute inflammation of the prostate, usually due to bacteria
---young adults: chlamydia or ghonnorhea
--older adults: e coli or pseudomonas
presents as dysuria with fever and chills; prostate is tender and boggy on DRE; prostatic secretions show WBCS and culture shows bacteria

24

chronic prostatitis

chronic prostate inflammation
presents as dysuria with pelvic or low back pain
-secretions show WBCs but culture does NOT show bacteria

25

BPH (benign prostatic hyperplasia)

hyperplasia of prostatic stroma and glands in the central periurethral zone of prostate; age related change (usually present after 60) and not increased risk of cancer

related to DHT (dihydrotestosterone) --> DHT acts on the androgen receptor of stromal and epithelial cells resulting in hyperplastic nodules

presents with issue starting and stopping urine stream, impaired bladder emptying (risk for infection and hydronephrosis), dribbling, hypertrophy of bladder wall SM, hematuria, and elevated PSA (prostate specific antigen)

26

treatment of BPH

alpha1 antagonist (terazosin) to relax smooth muscle
----can pair with selective alpha1A antagonist (tamsulosin) to avoid 1B effects on blood vessels

or

5alpha reductase inhibitor - blocks conversion of testosterone to DHT; takes months for results
side effects: gynecomastia and sexual dysfunction

27

prostate adenocarcinoma

malignant proliferation of prostatic glands
----small invasive glands with prominent nucleoli
most often clinically silent -- usually in the peripheral posterior region and so it doesn't cause urinary symptoms until later -- can metastasize to the lumbar spine or pelvis

screening begins at 50 with DRE and PSA
--normal PSA increases with age due to BPH
--PSA>10 is worrisome at any age
--decreased % free-PSA suggests cancer (cancer makes BOUND PSA)

28

risk factors for prostate adenocarcinoma

age
race (African americans>Caucasians>Asians)
diet high in saturated fats

29

priapism

painful sustained erection not associated with sexual desire or stimulation

can be caused by: trauma, sickle cell disease (trapped in vascular channels), medications (anticoagulants, PDE5 inhibitors, alpha blockers)

30

spermatocele

dilated epididymal duct; testicular mass that can be transilluminated