BRS Path Ch. 18

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Hypospadias: -an anomaly in which the urethral meatus opens on the ventral surface of the penis
Epispadias More or less common than hypospadias?: -an anomaly in which the urethral meatus opens on the dorsal surface of the penis

-less common than hypospadias
Phimosis -results from?: -an abnormally tight foreskin that is difficult or impossible to retract over the glans penis

-may be congenital or result from inflammation or from trauma
Peyronie disease -age of people who get it?: -is subcutaneous fibrosis of the dorsum of the penis

-occurs in older age group

-is of unknown etiology
Priapism -sometimes associated with?: -an intractable, often painful erection

-sometimes associated with venous thrombosis of the corpora cavernosa
Balantis: -inflammation of the glans penis

-often associated with poor hygiene

-rare in circumcized people
Syphyllis (lues) -visualized by? -primary stage? -secondary stage? -tertiary stage: -is caused by spirochetes of Treponema pallidum
-demonstrated by dark-field examination
-chancre is seen: an elevated, painless, superficially ulcerated, firm papule located most commonly on the glans penis or prepuce; heals in 2-6 weeks
-bacteremic stage occurs about 6 weeks after primary chancre has healed; small red macular flat lesions symmetrically distributed over the body, particularly involving the palms, soles, and mucous membranes of the oral cavity; see condyloma latum in warm moist sites
-3 categories: gummatous (granulomatous lesion in skin and bones) 2) cardiovascular (anyeurism in ascending aorta) 3) neurosyphillis (subacute meningitis, meningovascular syphillis, or tabes dorsalis, general paresis including Argyll-Robertson pupil)
-Gonorrhea caused by? classified as a? -manifest by? -can extend to?: -caused by Neisseria gonorrhoeae, an intracellular gram-negative diplococci
-manifest by acute purulent urethritis
-can extend to prostate and seminal vesicles and can also involve the epididymis, but only rarely the testes
-Chlamydial infection causes?: -a common cause of nongonococcal urethritis
-should be suspected when bacteria are not demonstrated in a purulent urethral discharge
-can also cause epididymitis
Bowen disease -presentation? -on whom? -malignancy risks?: -a carcinoma in situ
-presents as a single erythematous plaque, most often on the shaft of the penis or on the scrotum
-predominantly affects uncircumcized men
-peak incidence after the fifth decade
-becomes invasive carcinoma in <10%
-assoc. with an increased risk of visceral malignancy
Erythroplasia of Queyrat -occurs in? -malignancy association?: -a carcinoma in situ
-usually presents as a single erythematous plaque, most often involving the glans penis or prepuce.
-occurs predominantly in uncircumcised men
-median incidence in the 5th decade
-progresses to invasive squamous cell carcinoma in approximately 10% of cases
-may be a variant of Bowen disease
-NOT associated with visceral malignancy
Bowenoid papulosis presentation?: -a carcinoma in situ
-presents as multiple verrucoid (wart-like) lesions often resembling condyloma accuminatum and HPV type 16 viral sequences
-affects younger people than in Bowen and Erythroplasia of Queyrat
-generally considered premalignant but not known to progress to invasive carcinoma
Carcinoma of the Penis -what type is it usually? -increased in incidence where? -predisposed by? -associated with what?: -most frequently associated with squamous cell carcinoma
-rare in circumcised men; predisposed by poor personal hygiene and venereal diseases
-the Far East, Africa, and Central America
-associated with HPV infection types 16, 18, 31, and 33
Cryptorchidism -Associations?: -developmental failure of a testis to descend into the scrotum
-associated, even after surgical correction, with a greatly increased incidence of germ cell tumors, especially seminoma and embryonal carcinoma
-asscociated with testicular atrophy and sterility
Torsion of the spermatic cord can________: -compromise blood supply
-cause testicular gangrene
Hydrocele -possible origins? -how do we distinguish it clinically from solid testicular tumors: -serous fluid filling and distending the tunica vaginalis
-is most often idiopathic
-sometimes congenital in origiin due to persistence of the continuity of the tunica vaginalis with the pertoneal cavity
-can be secondary to infection or to lymphatic blockage by tumor
-can usually be distinguished clinically from solid testicular tumors by physical examination and transillumination
Hematocele -caused by?: -an accumulation of blood distending the tunica vaginalis
-most often causeed by trauma
-occasionally due to tumor
Varicocele: is a varicose dilation of multiple veins of the spermatic cord
Spermatocele -often found where?: -a sperm-containing cyst
-is most often intratesticular
Testicular atrophy -caused/associated with?: -is often of unknown cause
-may be caused or associated with:
1) Orchitis, especially mumps orchitis
2) Trauma
3) Hormaonal excess or deficiency due to either disorders of the hypothalamus or pituitary; hormonal therapy, especially with estrogens; cirrhosis of the liver
4) Cryptochordism
5) Klinefelter syndrome
6) Chronic debilitating disease
7) Old age
Orchitis -associated with? -what happens when it is bilateral?: -when bacterial, is often associated with epididymitis
-when viral, is most often due to mumps virus (my be caused by syphillis as well)
-when bilateral, may result in sterility due to atrophy of the seminiferous tubules; serum testosterone is decreases, while pituitary FSH and LH are increased
Epididymitis -most often caused by?: -more common than orchitis
-most often caused by Neisseria gonorrhoeoa, Chlamydia trachomatis, E. Coli, M. tuberculosis
Germ Cell tumors: -Germ cell tumors account for more than 90% of testicular tumors
-among the germ cell tumors theare seminoma, embryonal carcinoma, endodermal sinus (yolk sac) tumor, teratoma, choriocarcinoma, and mixed germ cell tumors
Non-Germ cell tumors: -Leydig cell (interstitial) tumor: derived from testicular stroma
-Sertoli cell tumor (androblastoma): derived from sex cord stroma
Seminoma -type of tumor? -benign or malignant? -analogous to? -accounts for what % of germ cell tumors -age group of peak incidence -presentation? -serum tumor marker? -is seminoma treatable?: -malignant germ cell tumor
-analogous to dysgerminoma, a tumor of the ovary
-is the most frequently occuring germ cell tumor, accounting for 40%
-mid-30s age group
-presents as a painless, enlargement of the testis
-hCG
-yes, it is very radiosensitive and can often be cured, even with metastasis to abdominal lymph nodes
Embryonal carcinoma -type of tumor? malignant or benign? -accounts for what % of germ cell tumors? -presentation? -prognosis? -serum tumor marker?: -malignant germ cell tumor
-analogous to a similar tumor occuring in the ovary
-is the second most common germ cell tumor, accounting fopr 20-30%
-often presents with pain or metastasis
-much worse than seminoma
-can often have increased serum hCG
Endodermal sinus (yolk sac) tumor -type of tumor? malignant or benign? -peak incidence when? -analogous to? -serum tumor marker?: -malignant germ cell tumor
-peak incidence in infancy and early childhood--the most common testicular tumor in this age group
-analogous to endodermal sinus tumor of the ovary
-alpha-fetoprotein (just like in hepatocellular carcinoma)
Teratoma -type of tumor? derived from? -benign or malignant -composition? -subclassifications?: -germ cell tumor derived from 2 or more embryonic layers
-most frequently malignant
-contains multiple tissue types, such as cartilage islands, ciliated epithelium, liver cells, neuroglia, embrionic gut, or striated muscle
-mature teratoma: almost always malignant, while the corresponding ovarian tumor (dermoid cyst) is almost always benign;
immature teratoma;
teratoma with malignant transformation: contains malignant tissue such as squamous cell carcinoma
Choriocarcinoma -type of tumor? malignant or benign? -analogous to? -peak incidence? -notable histology? -serum tumor marker?: -a malignant germ cell tumor
-analogous to choriocarcinoma of the ovary
-can occur as an element of other germ cell tumors
-has peak incidence in second to thrid decades
-characterized by cells resemnling synctiotrophoblasts and cytotrophoblasts
-hCG
Leydig cell (interstitial) tumor -type of tumor? -similar to? -benign or malignant? -histological characteristics? -produces? -associated clinically with?: -a non-germ cell tumor derived from testicular stroma
-similar to the Sertoli-Leydig cell tumor of the ovary
-is most often benign
-intracytoplasmic Reinke crystals
-characteristically androgen-producing but sometimes produces both androgens and estrogens and somestimes corticosteroids
-most often associated with precocious puberty and with gynecomastia in adults
Sertoli cell tumor (androblastoma) -type of tumor? benign or malignant -similar to? -endocrine manifestations?: -a non-germ cell tumor derived from sex-cord stroma that's usually benign
-similar to Sertoli-Leydig cell tumor of the ovary
-actually, a paucity of endocrine manifestations
Adenocarcinoma of the prostate -frequency? -in whom? -course: aggressive or indolent? -what part of the prostate? -main serum tumor marker? -other serum tumor markers? -therapy?: -extremely common
-older age group
-can have either an indolent or aggressive course depending on level of differentiation (Gleason system)
-arises most often from the peripheral group of glands
-increase in serum PSA--complexed form of it (increase in total PSA but decreased fraction of free-PSA)
-increased serum prostatic acid phosphatase if capsule has been penetrated; alkaline phosphatase if bone metastasis has occured (osteoblastic lesions)
-may respond to endocrine therapy because tumor growth is related to the activity of androgens

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