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Block 2 PATH Exam -- Male Genital System Lecture


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When the urethra opens on the inferior surface of the penis
Abnormal urethral opening on the dorsal penis
Invariably associated with defects in urethral valve (incontinence)
When the foreskin cannot be retracted over the glans
Most common penile malformation
Bacteria in this area have been shown to be carcinogenic
When phimotic foreskin is forcibly retracted and cannot be restored
Medical emergency
Potential for necrosis of the glans
Often associated with urinary retention
Non-specific penile infection
Usually in an uncircumsized individual
Frequently Staph or Strep
Peyronie's Disease
Abnormal proliferation of benign fibrous tissue within the shaft
Persistent erection due to thrombosis of corpora cavernosa
Condyloma Accuminatum
Wart-like growth
Due to a viral infection (HPV)
Condyloma Lata
Form of secondary syphilis
Giant Condyloma of Buschke-Lowenstein
Misnomer, this actually is:
Well-differentiated, verrucous squamous cell carcinoma
Erythroplasia of Queyrat or Bowen's Disease
A.K.A. Carcinoma in Situ of the penis
Pink-red velvety plaques
Pts. are almost invariably uncircumsized
NO metastatic potential
Failure of a testis to descend normally

Two important sequelae:
Failure of spermatogenesis
Increased risk of germ cell tumors
Testicular torsion
Testis becomes twisted on its cord
Young child with excruciating pain following activity
May also occur during sleep
Testis must frequently be excised
Enlargement of the venous vascular plexus
Associated with infertility due to temp. increase
Most common germ cell tumor of testis (35 - 70%)
Tend to occur in 4th decade
Gross -- uniform tan color; little or no necrosis
Histo -- uniform sheets of UNDIFFERENTIATED germ cells
Highly sensitive to radiation
Occasionally have beta-hCG elevations, NEVER alpha-FP
Anaplastic Seminoma
Seminoma in which cells are more pleomorphic and have more mitoses

Metastases tend to initially be to regional LNs, then systemic
Spermatocytic Seminoma
Very rare
More differentiated form of seminoma
Affects older individuals
Virtually never metastasizes
Excellent prognosis
Embryonal Cell Carcinoma
Gross -- often hemorrhagic and necrotic
Histo -- PLEOMORPHIC, form glands, tubules, etc.
Metastasizes early and widely
BOTH lymphatic and hematogenous routes
Radiation NOT as effective as with seminomas
Often present at high stage
Still, VERY good prognosis (90-95% 5-yr)
Yolk Sac Tumor
A.K.A. Endodermal Sinus Tumor
Pure form occurs in very young boys
Mixed form occurs in post-pubertal boys
Produce large amounts of ALPHA-FP and alpha-1-antitrypsin
Behavior is similar to embryonal carcinoma
In children, almost alway benign
In post-pubertal pts. MUST be considered potentially malignant
Mature and Immature forms
Spread via BOTH hematogenous and lymphatic routes
When embryonal carcinoma and teratoma are seen together in the same tumor
Pure form is extremely rare (frequently fatal)
Associated with hemorrhage and necrosis
Patients are typically adolescents or young adults
Pulmonary involvement is COMMON (hemoptysis)
Produce BETA-HCG
Respond very well to chemo, BUT still a high mortality rate
When occurs as mixed tumor, prognosis is better (unusual)
Staging of Testicular Cancer
Stage I -- Local Disease
Stage II -- Retroperitoneal LN disease
Stage III -- Distant Disease
Nodular hyperplasia (prostate)
Considered "normal"
95% of males > 70 have this
Probably results from imbalance of sex hormones
Primarily effects CENTRAL gland (spares periphery)
Patients present with urinary retention, bladder infections, even hydronephrosis
Does NOT predispose to carcinoma
Treated by inhibiting 5-alpha-reductase
Adenocarcinoma of Prostate
Most common carcinoma in males
Rare before the age of 50
Limited biological potential
Primarily effects PERIPHERY of gland
Prognosis and treatments depends on clinical circumstances
No good therapy once it escapes the prostate
Stage dependent survivals (5-yr) for Prostate Cancer
Stage A -- 90+%
Stage B -- 80%
Stage C -- 35 - 40%
Stage D -- 20%
Prostatic Acid Phosphatase
Typically elevated in patients with extraglandular disease
Cannot be used reliably to test intraglandular
Prostatic Specific Antigen
Elevated in prostatic carcinoma
BUT, also may be increaed in some benign conditions

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