Genitourinary 2

Question 1

What leads to nonfunctional testes?

Answer 1

lack of descent of testes into scrotum

Question 2

When does the descent begin? When does the testes really start to move?

Answer 2

7 mos. of gestation

Question 3

Where does the testes migrate down through and what is it guided by during its descent?

Answer 3

migrates through inguinal ring into scrotum, guided by gubernaculum

Question 4

cryptorchidism

Answer 4

no descent into scrotum; maldescent of testes

Question 5

percent of testes migration fails; arrested somewhere along the route

Answer 5

4%

Question 6

where is the most common location where the testes arrests during maldescent?

Answer 6

inguinal ring/canal

Question 7

What percent is the maldescent of testes unilateral (just one testes fails to descend)?

Answer 7

75%

Question 8

What causes maldescent of testes?

Answer 8

genetic + environmental factors

Question 9

Atrophy and sterility are common if testes don’t descend, unless it is corrected by what age?

Answer 9

age 2

even after surgical correction, greatly increased incidence of germ cell tumors (seminoma + embryonal carcinoma)

Question 10

orchitis

Answer 10

infection of the testes

• if bilateral, may result in sterility
• often associated with infection from epididymis (epididymitis)

Question 11

3 testes infections + a rare one

Answer 11

1. acute bacterial epididymoorchitis
2. viral orchitis
3. TB epididymorchitis
4. tertiary syphilis- rare, gumma formation

Question 12

viral orchitis

Answer 12

forms mumps, occurs after puberty

-if bilateral after puberty, infertility and sterility possible

Question 13

testicular tumors

Answer 13

high proportion seen in early adult life (20-45 years)

Question 14

2 groups of testicular tumors

Answer 14

1 germ cell

2 sex cord stromal tumors

Question 15

germ cell testicular tumors

Answer 15

malignant, 97 % more common, derived from multipotential germ cells of testes

Question 16

sex cord stromal testicular tumors

Answer 16

3% of tumors, benign, from specialized support cells of testis

Question 17

seminoma

Answer 17

common in mid 30s

- painless, progressive enlargement of ONE testes (rarely bilateral)

Question 18

**what is the most common malignant testicular tumor (50% of malignant germ cell tumors?

Answer 18

seminoma

Question 19

prostate anatomy

Answer 19

1. peripheral zone- location of carcinomas
2. transitional zone- location of hyperplasia
3. central zone
4. periurethral zone

Question 20

prostate gland pathology

Answer 20

1. benign prostate hypertrophy (BPH)

2. prostate cancer- adenocarcinoma

Question 21

older men and Benign prostate hypertrophy

Answer 21

• almost always enlargement of prostate most commonly due to BPH
• obstruction of urinary flow in the prostatic part of the urethra
• rarely, the obstruction is caused by carcinoma

Question 22

Benign prostatic hypertrophy (BPH)

Answer 22

• most common disorder of the prostate
• affects almost all men over 70 yrs
• more often, more severe in 45yr olds
• difficulty w/ micturation (frequency, hesitancy, dysuria) due to compression of prostatic urethra by the enlarged prostate gland

Question 23

*What is the most frequent cause of urinary tract obstruction?

Answer 23

Benign Prostatic hypertrophy

Question 24

What is the part of the prostate most sensitive to hormones

Answer 24

periurethral group of glands

Question 25

not a risk factor for carcinoma, but can coexist w/ it

Answer 25

Benign Prostatic hypertrophy

Question 26

Gross BPH

Answer 26

- rubbery, nodular enlargement especially the periurethral and transitional zones - some cystic dilations that have calcifications causing corpora amylacea

Question 27

urinary tract obstruction and does not relate to cancer

Answer 27

Benign prostate hypertrophy

Question 28

prostate cancer (adenocarcinoma)

Answer 28

increasing frequency after age 55 - 70% of men > 70 yrs - occurs in periphery zone- delays symptoms (difficulty w/ micturition) until tumor is well established

Question 29

what is the 2nd most common type of cancer death in males?

Answer 29

prostate cancer (adenocarcinoma)

Question 30

What approach to prostate cancer gives the most accurate finding?

Answer 30

transrectal approach b/c of local spread through the capsule before it infiltrates medially towards the urethra

Question 31

preventative strategy for prostate cancer?

Answer 31

NO primary preventative strategy so screening is paramount | - latenet behavior= 90%= incidental findings are confined to the prostate

Question 32

histology of prostate cancer

Answer 32

gleason system= usually well differentiated glandular pattern w/ epithelial cells w/ clear cytoplasm forming gland like spaces -well differentiated glands are back to back

Question 33

prostate cancer metastasis

Answer 33

1st manifestation is vertebral spread w/ spinal cord compression

Question 34

most common location of prostate cancer metastasis?

Answer 34

BONE (radiodense + radioluscent)

Question 35

tumor marker for prostate cancer

Answer 35

serum prostate specific antigens (PSA)

Question 36

serum prostate specific antigens (PSA)

Answer 36

serum/tissue prostate specific phosphatase - PSA is not specific= does not distinguish b/w aggressive and indolent types or other cancers - PSA is low in some men w/ prostate cancer

Question 37

Bowen disease

Answer 37

-single erythematous plaque -shaft or scrotum -usually uncircumsized - median 5th decade 10% evolve into invasive carcinoma

Question 38

Bowenoid papulosis

Answer 38

- carcinoma in situ - multiple verrucoid lesoins resembling condyloma acuminatum (HPV 16) - histologically resembles Bowen disease and erythroplasia of Queyrat, but younger age group affected - *premalignant, but not reported to result in invasive carcinoma

Question 39

squamous cell carcinoma

Answer 39

- most typical carcinoma of the entire genital region | - cauliflower appearance w/ bleeding

Question 40

erythoplasia of queyrat

Answer 40

single erythematous plaque - glans or prepuce - usually uncircumcised - median 5th decade - 10% evolve into invasive carcinoma