(From Robbins, 5 Feb 2001, by Brian Buschman)
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Malformations of the penis include abnormal urethral openings. On the ventral side is the most common and called hypospadias (downward) and on the dorsal side is epispadias. They are often associated with other congenital anomalies of the genitals. Increased UTIs and possible obstructions are outcomes of this problem.
Penis inflammations are usually a result of not cleaning properly occurring more often in non-circumcised males. Inflammation is called balanitis and balanoposthitis if inflammation of the glans penis.
In phimosis the prepuce is restricted, often from scaring from poor balanitis. It means the glans penis cannot pass the prepuce.
The penis can also get fungal infections like Candida, epically with diabetics.
Most penile neoplasms are squamous cell carcinoma. Mostly in non-circumcised males and is often related to HPV 16/18. Bowen’s disease is a non-invasive hard squamous cell carcinoma of the penis (or of other mucosal surfaces).
Verrucous carcinoma has a papillary pattern with squamous cell carcinoma with raged margins.
The scrotum has a low incidence of cancer except in chimney sweeps.
Cryptochidism is a failure of testicular descent. Cryptochidism leads to testicular atrophy and sterility as well as increased rate of neoplasms later in life.
Most orchitises are results of UTIs that spread. Some are related to diseases like mumps or TB.
Testicular neoplasms are almost always of the germ cells and almost always painless, hard masses.
Germ cell tumors may differetiate into different types of neoplasms classified as either one cell type of multiple cell types.
1) Seminomas are masses of gray tumor covered within the tunica albugenia. The cells have distinct boarders, glycogen-rich cytoplasm and round nucli.
2) Embryonal carcinoma are poorly defined with necrosis and hemorrhage. Cells are large and primitive looking. They make hCG and AFP (alpha fetoprotein).
3) Yolk sac tumors appear in boys younger than 3. They show a large endodermal sinus and .make AFP.
4) Choriocarcinomas show cytotrophoblastic and syncytiotrophoblastic differentiation. They also make hCG (since it is made by this cell type).
5) Teratomas develop somatically. Mature tetratomas show different tissues. Immature tetratomas show developing tissues. Teratomas are usually benign but malignant transformation can be seen as squamous cell carcinoma, adenocarcinoma or whatever within the teratoma. Having all layers it makes hCG and AFP.
6) Mixed cell tumors are about 60% of testicular tumors. They can make hCG and AFP.
Testicular tumors metastize readily, often before diagnosis. Staging is:
I – Confined to the testis
II – Testis and retroperitoneal nodes below the diaphragm.
III – Post retroperitoneal nodes.
Prostatitis is often related to gram – rods that come up from UTIs. It’s change is based on the offending agent. Signs are of prostate hypertrophy.
The prostate is ade of the central zone around the ejaculatory duct, the transitional zone around the proximal urethra and the periurethral zone around the distal urethra. BPH is based on lobular hypertrophy.
Hypertrophy is a factor of androgens and is age related. The most common BPH is of periurethral glands. It can also grow into the bladder making a ball-valve obstruction.
Carcinoma of the prostate is most often seen in old men more often in blacks or Scandinavians.
Most are in the outer glands and can be felt by DRE. It may spread early but goes into other GU structures not to the rectum because of Denovillier’s fascia.
Most are adenocarcinomas with all types of differentiation.
They often present because of metastasis especially to bone. All prostates make prostatic specific antigen but it is elevated with hyperplasia. Staging is based on:
A) Microscopic (A1-focused, A2-diffuse)
B) Macroscopic (B1-1 lobe, B2-both sides)
C) Extracapsular (C1-<70g, C2>70g)
D) Metastatic (D1-in pelvis, D2 – extrapelvic)
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