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USMLE 1 Reproductive Penile Pathology

Terms in this set (99)

what are all the penile pathologies
peyronie disease
priapism
squamous cell carcinoma
define peyronie disease
abnormal curvature of penis d/t fibrous plaque within the tunica albuginea
what is peyronie disease associated with
ED
S/S of peyronie disease
pain
anxiety
what should you consider with peyronie disease
surgical repair after curvature stabilizes
what is distinct from penile fracture
peyronie disease (not the same thing
what is a penile fracture
rupture of corpora cavernosa due to forced bending
define priapism
painful sustained erection lasting >4 hrs
whas is priapism associated with
trauma
sickle cell disease (sickled RBCs get trapped in vasculature)
medications (sildenafil, trazodone)
how do you treat priapism
corporal aspiration
intracavernosal phenylephrine
surgical decompression
(to prevent ischemia)
where is squamous cell carcinoma common (countries)
asia, africa, south america
what are the precursor in situ lesions to squamous cell carcinoma
bowen disease
erythroplasia of Queyrat
bowenoid papulosis
what is squamous cell carcinoma associated with
HPV
lack of circumcision
what is bowen disease
in penile shaft
presents as leukoplakia (CIS)
what is erythroplasia of queyrat
cancer of glans
presents as erythroplakia
uncircumcised*
what is bowenoid papulosis
carcinoma in situ of unclear malignant potential
presents as reddish brown papules (cutaneous condition characterized by the presence of pigmented verrucous papules on the body of the penis.They are associated with *human papillomavirus, the causative agent of genital warts)
define erythroplakia
is a clinical term to describe any erythematous (red) area on a mucous membrane, that cannot be attributed to any other pathology
define leukoplakia
a mucous membrane disorder characterized by white patches, especially on the cheek, tongue, vulva, or penis (looks like candidiasis but there is no pathology to rule it in)
what are all the testicular pathologies
cryptorchidism
varicocele
extragonadal germ cell tumors
scrotal masses
testicular germ cell tumors
testicular non-germ cell tumors
characteristics of cryptorchidism
impaired spermatogenesis (sperm develop at temp<37)
can have normal testosterone levels (temp doesn't affect leydig cells)
what is associated with cryptorchidism
increased risk for germ cell tumors
prematurity increases what male pathology
cryptorchidism
hormones in cryptorchidism
decreased inhibin
increased FSH
testosterone normal in unilateral (normal LH) testosterone decreased in bilateral (increased LH)
what is a varicocele
dilated veins in pampiniform plexus due to increased venous pressure (bag of worms! retrograde pressure)
what is the most common cause of scrotal enlargement in adult males
varicocele
where do varicoceles usually occur
on the left side because of increased resistance to flow from left gonadal vein drainage into left renal vein
what can varicoceles cause
infertility due to increased temperature
what does a varicocele feel like on palpation
bag of worms
how do you diagnose a varicocele
ultrasound with dopplar (does not transilluminate)
how do you treat a varicocele
varicocelectomy
embolization by interventional radiologist
where do extragonadal germ cell tumors arise
in midline (b/c of migration of PGCs)
in adults where do extragonadal germ cell tumors usually occur
retroperitoneum
mediastinum
pineal
suprasellar regions
in infants and children where do extragonadal germ cell tumors usually occur
sacrococcygeal teratomas
what are the 3 types of benign scrotal lesions that present as testicular masses and do transilluminate
congenital hydrocele
acquired hydrocele
spermatocele
what is the most common cause of scrotal swelling in infants
congenital hydrocele
what causes a congenital hydrocele
incomplete obliteration of processus vaginalis
characteristic of congenital hydrocele
transilluminating swelling
what is an acquired hydrocele
benign scrotal fluid collection
an acquired hydrocele is 2nd to what
infection
trauma
tumor
if an acquired hydrocele is bloody what is that called
hematocele
what is a spermatocele
cyst due to dilated epididymal duct or rete testis
characteristic of spermatocele
paratestiuclar fluctuant nodule
what are the testicular germ cell tumors
seminoma
yolk sac tumor (endodermal sinus)
choriocarcinoma
teratoma
embryonal carcinoma
what are 95% of all testicular tumors
testicular germ cell tumors
testicular germ cell tumors most often occurs in who
young men
what are risk factors for testicular germ cell tumors
cryptorchidism
Klinefelter syndrome
how can testicular germ cell tumors present
mixed germ cell tumor
what is you differential if you have a testicular mass that does not transilluminate
cancer & varicocele
characteristics of seminoma
malignant
painless
homogenous testicular enlargement
what is the most common testicular tumor
seminoma
when do seminomas most often occur
3rd decade
when do seminomas never occur
infancy
histology of seminoma
large cells in lobules with watery cytoplasm and fried egg appearance
what increases with a seminoma
placental ALP
how do you treat a seminoma
radiosensitive
prognosis of seminoma
excellent
characteristics of yolk sac tumor
yellow
mucinous
aggressive (just like ovarian yolk sac tumor)
histology of yolk sac tumor
schiller-duval bodies resembling primitive glomeruli
what increases with yolk sac tumor
AFP (highly characteristic)
what is the most common testicular cancer in boys <3
yolk sac tumor
charcteristics of choriocarcinoma
malignant
disordered syncytiotrophoblastic and cytotrophoblastic elements
what is elevated in choriocarcinoma
hCG
what pathway of metastases do choriocarcinomas take
hematogenous
where do choriocarcinomas metastasize to
lungs and brain (may present with hemorrhagic stroke due to bleeding into metastasis)
S/S of choriocarcinoma and why
gynecomastia and hyperthyroidism (hCG is similar to LH, FSH, TSH)
what is the difference with teratomas in males and in females
females-not malignant
males-malignant
teratomas in children, characteristics
benign
what is increased in teratomas
hCG and AFP 50% of the time
characteristics of embryonal carcinoma
malignant
hemorrhagic mass with necrosis
painful
what tumor has a worse prognosis than seminoma
embryonal carcinoma
histologoy of embryonal carcinoma
glandular/papillary morphology
what kind of embryonal carcinoma is rare
pure
what kind of embryonal carcinoma is more common
mixed with other tumor tyeps
what can embryonal carcinoma be associated with
-increased hCG
-normal AFP when pure
-increased AFP when mixed
what are the testicular non-germ cell tumors
leydig cell
sertoli cell
testicular lymphoma
what tumors end up to be 5% of all testicular tumors
testiculor non-germ cell tumors
testicular non-germ cell tumors are primarily what
benign
histology of leydig cell tumor
Reinke crystals (eosinophilic cytoplasmic inclusions)
what do leydig cell tumors usually produce
testosterone
s/s of leydig cell tumor
gynecomastia in men
precocious puberty in boys
what color are leydig cell tumors
golden brown
what is a sertoli cell tumors
androblastoma from sex cord stroma
what is the most common testicular tumor in older men
testicular lymphoma
characteristics of testicular lymphoma
not a primary cancer
arises from metastatic lymphoma to testes
aggressive
in what population group is benign prostatic hyperplasia commonly seen
>50
characteristics of BPH
-smooth, elastic, firm nodular enlargement (hyperplasia not hypertrophy) of periurethral lobes
-compresses the urethra (lateral and middle lobes, not anterior!)
-not premalignant
s/s of BPH
increased frequency of urination
nocturia
difficulty starting and stopping urine stream
dysuria
complications of BPH
distention and hypertrophy of bladder
hydronephrosis
UTIs
what increases with BPH
PSA
how do you treat a BPH
alpha-1 antagonists (terazosin, tamsulosin)-relaxes smooth muscle
5-alpha reductase inhibitors (finasteride)
PDE-5 inhibitors
s/s of prostatitis
dysuria
frequency
urgency
low back pain
causes of acute prostatits
bacterial (primarily E coli)
causes of chronic prostatits
bacterial or abacterial (more common)
what population group gets prostatic adenocarcinoma
men >50 years old
where does prostatic adenocarcinoma usually occur
posterior lobe (peripheral zone) of prostate
how is prostatic adenocarcinoma diagnosed
increased PSA and needle core bx
what are useful tumor markers for prostatic adenocarcinoma
prostatic acid phosphatase (PAP)
PSA (increased total with decreased free PSA)
what may develop in late stages of prostatic adenocarcinoma
osteoblastic metastasis in bone
what are the s/s of osteoblastic metastasis in bone in prostatic adenocarcinoma
lower back pain
increased ALP
increased PSA
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