Male Genital Tract
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| Hypospadias ? | * Abnormal single openings on the ventral surface of the penis... * increased risk of UTI and sterility depending on where the opening is
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| Epispadias ? | * Abnormal opening on the dorsal surface of the penis
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| Phimosis ? | * Orifice of the prepuce is too small to permit normal retraction.... * Can't retract foreskin over the glans, due to scarring from repeated infection..... * increase risk of a secondary infection or cancer
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| Paraphimosis ? | * Forceful retraction of a narrow prepuce strangulating the glans and impeding the outflow of venous blood.....* Foreskin is basically stuck behind the glans
........ * Circumcision fixes both of these issues
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| Inflammation of the glans penis ? | * Balanitis
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| Inflammation of the glans penis and the prepuce ? | * Balanoposthitis ..... * persistence can lead to phimosis and scarring
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| Group at risk for highest STD rates ? | * Adolescents; men who have sex with
men; illegal drug users ...... * If you see STDs in younger kids, think CHILD ABUSE
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| Genital Herpes basics ? | * see oral and genital lesions (HSV 1 and 2) ..... * can get during latent or active phases.... * Looks like groups of vesicles on the penis and see intranuclear inclusions on micro and see inclusion-bearing multinucleated syncytia
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| Chlamydia trachomatis infection ? | * most common bacterial STD in the US ..... * and test for Gono too .... * See Urethritis, epididymitis, prostatitis
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| Condyloma acuminata ? | * From HPV ....* See flat-topped warts on shaft; small polyps on glans and urethral meatus ..... * see koilocytosis .... * Malignant = Types 16 and 18..... *Benign = 6 and 11
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| Gonorrhea ? | * Neisseria gonorrhoeae infection – gram negative intracellular diplococci.... * see GREEN discharge
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| Syphilis ? | * From Treponema pallidum ...... * Has primary, secondary and tertiary forms.... * Primary ulcer is painless and hard edges with a soft middle...* Tertiary = has Gummas and plasma cells around the edges
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| Peyronie Disease ? | * Penile fibromatosis, where we see a mass that causes a curvature of the penis when it is erect.... * Can be painful during erection or coitus.... * Bad Thing = Cut them out, and they grow back
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| Carcinoma in Situ (CIS) - Bowen Disease ? | * Is Malig. .... * related to HPV 16...... * In people over 35.... * see Erythroplasia of Queyrat ( see gray/white plaque).... * can progress to SCCA..... * proliferation of epidermis with numerous mitoses ..... * Basement Mem. is INTACT
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| Bowenoid Papulosis (another CIS) ? | * Is malig...... * related to HPV 16 also ..... * See in Sexually active adults, but YOUNGER than 35.... * Never develops in to invasive carcinoma
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| Invasive Carcinoma ? | * Seen in Uncircumcised males usu over 40... * assoc. with smoking ang HPV 16, sometimes 18..... * fungating mass, which makes the penis almost look unrecognizable.... * If mets to LN, the higher mortality rate..... * Is Squamous Cell Carc.
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| **Prostate to Follow** | .
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| Zone with most tumors ? Where BPH occurs ? | * Peripheral = Tumors .... * Transitional = BPH
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| Acute Bacterial Prostatitis (Inflammation) ? | * See just wayyyy too many cells ..... * Don't biopsy, just massage and collect fluid.... * Yell during a rectal exam..... * See bacteria similar to those in UTIs
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| Chronic Bacterial Prostatitis ? | * Men w/History of recurrent UTI (cystitis or urethritis) caused by same organism.... * CxSx:low back pain, dysuria & perineal and
suprapubic discomfort..... * See leuokocytes in prostatic discharge we get from stimulation
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| Chronic Abacterial Prostatitis ? | * No Hx of UTIs.... * Dx by more than 10
leukocytes/high power field (hpf) in prostatic fluid
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| Granulomatous Prostatitis ? | * US most common cause is instillation of BCG within the bladder
as treatment for superficial bladder cancer..... * See granulomas on microscopy... * if caseating, think TB
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| Benign Prostatic Hyperplasia - BPH ? | * Glandular & stromal hyperplasia resulting in overall prostate enlargement
...... * Start to see over 40 y/o..... * see a slit instead of a hole.... * Also see nodules and lobules.... * NOT PREMALIGNANT (no progression to Pros. Cancer)
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| BPH Pathogenesis ? | * Test is made in to DHT and binds to the A. rec.... * causes stromal cell prolif and epi. cell apoptosis inhibition
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| BPH Clinical Presentation with Labs ? | * See Urgency, frequency, nocturia, dysuria...... * Before tests, do not manipulate bc can increase PSA levels.... * PSA = what we measure and Normal is <4.0 ng/ml....* If PSA is not 0 after prostectomy, then there is recurrence of the tumor
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| BPH Complications ? | * See prostate chips..... * see pylonephritis and an increase in residual urine
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| Adenocarcinoma (prostatic neo.) ? | * mostly in men over 50, but can see in younger men..... * See glandular tissue..... * Can cause it: Androgens, germline mutations of BRCA2 , ETS fusion, and hypermethylation of glutathione S-transferase (GSTP1) ...... * so it is Multifactorial
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| Adenocarcinoma and PIN ? | * prostatic intraepithelial neoplasia , NOT carcinoma in-situ...... * sometimes we see this before it advances to Adenocarc., but we can not make a connection yet...* See nuclei in the cells that surround the glands
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| Adenocarcinoma Morphology ? | * Palpable on DRE.... * 1 cell layer, can mets to LN, leave blastic lesions in bones, and see in nerves. .... * Mets first to obturator nodes, para-aortic nodes then bones ....* IHC = + in AMACR (alpha-methylacyl-coenzyme A-racemase)
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| Adenocarcinoma Morphology in bone lesions ? | * not bloody or cavitating.... * See little white nodules
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| Adenocarcinoma - PSA & Treatment ? | * normal is <4.0ng/ml .... * ALWAYS confirm an abnormal test..... * Usu have 3 different measurements made.... * If radical prostatectomy or radiotherapy – rising PSA level indicates recurrence... * Tmt = surgery, pharm., and radiotherapy
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