a study guide for the pathology quiz on male genitalia. we started with a review of various conditions that can affect the male genitalia: phimosis refers to an inability to retract the foreskin of the penis, often due to adhesions formed from undifferentiated tissue in children less than 3 years old. paraphimosis is an inability of the foreskin to fold over the glans. condyloma acuminata are genital warts, caused by HPV strains 6 and 11, appearing as sessile or pedunculated, red papillary outgrowths on the coronal sulcus, inner prepuce, glans, or perianal area.
bowen's disease is commonly caused by HPV 16 and 18 and manifests as single, gray-white plaques with shallow ulcerations and crusting, either on the shaft of the penis or the scrotum. histologically, one might see dysplastic epithelium, scattered mitosis above the basal layer, and nuclear atypia.
bowen's might lead to squamous cell carcinoma, which might also be caused by HPV strains 16 / 18, or simply poor hygeine. SCC typically affects men 40-70 and manifests as painless lesions that may bleed. early lesions may just be epithelial thickening with some fraying / fissuring, while late or untreated lesions may develop into papules, ulcers with ragged and heaped up margins.
some assorted testicular disorders that we've already covered in CPD: cryptorchidism is an undescended testicle which can be associated with hormonal disorders of deficient LHRH and "trisomy 13". it might also be related to exposure to anti-androgenic compounds such as phthalates in plastics and tagamet, which is used to treat plantar warts and peptic ulcers. cryptorchidism increases the risk for infertility as well as testicular cancer of the fully descended side. hydroceles are serous fluid filled masses that can be caused by inflammation (sports) as well as structural / developmental abnormalities. varicoceles result from dilatation of the panpiniform plexus and is also associated with sports such as extreme mountain biking or soccer.
benign prostatic hypertrophy is nodular hyperplasia of the periurethral region of the prostate. it is associated with some dietary factors: deficiency of lycopene, nettles, zinc, EFA's, and amino acids- as well as dietary excess of alcohol, cadmium, cholesterol, and pesticides. the main growth factor for the prostate is DHT, which is converted from testosterone by 5-alpha reductase; cadmium and cholesterol both increase 5-alpha reductase activity, thus contributing to BPH. two other hormonal influences: estrogen increases stroma susceptibility to hyperplasia and prolactin increases androgen uptake.
prostate cancer is the most common type of cancer in men, generally of the type adenocarcinoma. it affects men over 50 with some racial demographic trends: asians tend to have a lower incidence and african americans have a higher incidence. genetic factors that have been identified are the p53 gene and hypermethylation of glutathione S-transferase. a diet high in arachidonic acid (found in meat products) can also be a risk factor. dietary protective factors might include lycopene, vitamin A and E, selenium, soy, and possibly fish oil. the lesions themselves are gritty and firm nodules on the posterior aspects of the lateral lobes, and if metastasis occurs, the bones are a high possibility-- osteoblastic lesions are a common finding in the lumbar / thoracic spine, femur, pelvis, ribs.
questions
various conditions...
1. what is phimosis?
2. how is phimosis related to age?
3. what is paraphimosis?
4. what is the etiology of condyloma acuminata?
5. what is the morphology of condyloma acuminata?
6. what locations are condyloma acuminata commonly found?
7. ∂escribe the histopathology of condyloma acuminata.
bowen's disease...
8. what age does bowen's disease usually affect?
9. what are the most common etiological agents for bowen's disease?
10. describe the morphology of the lesions in bowen's disease.
11. what locations are affected in bowen's disease?
12. what are some histopathological features of bowen's disease?
SCC...
13. what are the most common etiologies for SCC?
14. where are SCC lesions located?
15. describe the morphology of early SCC lesions.
16. describe the morphology of late SCC lesions.
17. what age does SCC generally occur in?
18. what is the relationship to regional lymph nodes and metastasis of SCC?
19. what is the clinical presentation of SCC?
various testicular disorders...
20. what are some intrinsic risk factors for cryptorchidism?
21. what are some extrinsic risk factors for cryptorchidism?
22. what are the sequelae for cryptorchidism?
23. what is a hydrocele and what is it commonly due to?
24. how common in a varicocele?
25. what are examples of types of hobbies that are associated with varicoceles?
26. which side is more commonly affected by varicoceles?
benign prostatic hypertrophy...
27. what are some etiological factors for BPH related to dietary deficiency?
28. what are some etiological factors for BPH related to dietary excess?
29. what is the mechanism by which cadmium and cholesterol are related to BPH?
30. what are DHT and 5-alpha reductase and how are they involved in BPH pathophysiology?
31. what is the effect of estrogen and prolactin in the prostate?
prostate cancer...
32. how common is prostate cancer?
33. what age group does prostate cancer affect?
34. what are the demographic groups that have high and low risks for developing prostate cancer?
35. what are two genetic factors that have been identified as etiological agents in prostate cancer?
36. what is a dietary risk factor for prostate cancer?
37. what are some protective factors for prostate cancer?
38. what is the most common location for prostate cancer?
39. what is the morphology of the lesions in prostate cancer?
40. what is a common area for metastasis and what are the type of lesions found?
testicular cancer...
41. testicular cancer cells are most commonly derived from which cell line?
42. germ cell vs. non germ cell derived testicular cancer: which is more likely malignant?
43. what is the racial trend for incidence of testicular cancer?
44. what is the serum marker for a seminoma?
45. which condition is a seminoma associated with?
46. what is the prognosis for a seminoma?
47. what is the prognosis for an embryonal carcinoma?
48. what are the serum markers for an embryonal carcinoma?
49. which age group does the yolk sac tumor affect?
50. what are the serum markers for a yolk sac tumor?
51. are teratomas considered benign or malignant?
52. what are the serum markers for a teratoma?
53. what is the prognosis for a choriocarcinoma?
54. which age group is lymphoma most common?
answers
1. abnormal tightness of the prepuce that prevents retraction over the glans.
2. may be related to adhesions from lack of tissue differentiation that occurs before ~3 years.
3. tissue gets stuck behind the glans.
4. HPV 6 and 11
5. sessile or pedunculated, red papillary outgrowths that may be verrucous or flat.
6. coronal sulcus, inner prepuce, glans, perianal.
7. acanthosis, koilocytosis, intact basement membrane.
8. over 35yo.
9. HPV 16 and 18.
10. solitary thickened gray/white plaque with shallow ulcerations and crustin.
11. the shaft or scrotum.
12. dysplastic epithelium
scattered mitosis above basal layer
nuclear abnormalities: large, odd shaped, or multiple.
13. bowen's disease, HPV 16 + 18
14. most on the glans or the inner surface of the prepuce.
15. epithelial thickening with fraying and fissuring.
16. papules and large, infected ulcers with ragged, heaped up margins.
17. 40-70yo.
18. regional nodes may be swollen without spread of SCC.
19. painless lesions that bleed.
20. hormonal disorders of deficient LHRH
trisomy 13
21. phthalates (in plastic)
tagamet (used to treat plantar warts and peptic ulcers)
22. increased risk for testicular cancer
increased risk for infertility
23. build up of serous fluid in the scrotum, from trauma or due to structural abnormalities.
24. 10% of men have them.
25. extreme mountain biking and soccer players.
26. mostly left side.
27. lycopene
nettles
zinc
EFA's
amino acids
28. alcohol
pesticides
cadmium
cholesterol
29. increase in 5-alpha reductase activity.
30. testosterone is converted by 5-alpha reductase to DHT, which is the main prostatic growth factor.
31. estrogen increases stroma susceptibility and prolactin increases androgen uptake.
32. the most common cancer in males.
33. after 50 years old.
34. low risk in asians, high risk in african americans.
35. loss of p53 gene, hypermethylation of glutathione S-transferase.
36. high arachidonic acid content.
37. lycopene
vitamin A, E
fish oil
soy, selenium
38. posterior aspect of lateral lobes.
39. gritty, firm nodules.
40. osteoblastic bone lesions characteristic of boney metastasis to lumbar/thoracic, femur, pelvis, ribs.
41. germ cells.
42. germ cells.
43. whites: blacks 5:1
44. HCG.
45. cryptorchidism.
46. good with removal of affected testes. >95%.
47. worse than seminoma; tends to grow rapidly and spread outside the testicle.
48. HCG or AFP.
49. children under 3yo.
50. AFP.
51. benign until puberty, malignant afterwards.
52. no increase in HCG or AFP levels.
53. poor; fast growing.
54. over 65yo.
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