Male Pathology Part 2

Question 1

What are the three erectile bodies of the penis?

What is contained in each?

Answer 1

There are two corpora cavernosa which each contain a deep artery and a corpora spongiosum through which the urethra traverses

Question 2

What is the most common penis malformation? What causes it?

Answer 2

Hypospadias

An abnormal opening on the ventral surface of the penis due to faulty closure of the urethral folds

Question 3

What is an Epispadias? What causes it?

Answer 3

An abnormal opening on the dorsal surface of the penis due to a defect in the genital tubercle

Question 4

What is Phimosis? What causes it?

Answer 4

Phimosis is when the orifice of the prepuce is too small to retract over the head of the penis due to prepuce scarring from prior infection

Question 5

Describe the difference between Balanitis and Balanoposthitis

Answer 5

• Balanitis – inflammation/infection of the glans
• Balanoposthitis – Inflammation/infection of glans and prepuce (usually uncircumcised males with poor hygiene)

Question 6

What leads to infection in Balanoposthitis? What are some common organisms?

Answer 6

• Accumulation of smegma leads to infection
• Candida, pyogenic bacteria, and anaerobes

Question 7

What are some features of balanoposthitis on histology?

Answer 7

• Thin epidermis
• Glassy dermis
• Keratin
• Inflammation

Question 8

What is Peyronie’s disease (what can result from it)?

Answer 8

A type of fibromatosis causing painful contractures of the penis

May result in infertility

Question 9

What neoplasms of the penis are classified as squamous cell carcinoma in situ (CIS)?

Answer 9

Bowen’s disease

Erythroplasia of Queryrat

Bowenoid papulosis

Question 10

Bowen’s Disease (Leukoplakia)

Age:

Parts of the penis involved:

Virus association:

Answer 10

• Age: Usually over 35 years old
• Parts of the penis involved: Involves the shaft of the penis and scrotum
• Virus association: associated with HPV type 16 and 18

Question 11

What is the appearance of Erythroplasia of Queyrat and where is it located?

What virus is it associated with?

Answer 11

• Erythroplasia of Queyrat is a redness located on the mucosal surface of the glans and prepuce
• It is associated with HPV type 16

Question 12

What is the only squamous cell carcinoma in situ with no predisposition for invasion?

Answer 12

Bowenoid papulosis

Question 13

What is the appearance of Bowenoid papulosis and where is it located?

What virus is it associated with?

Answer 13

Multiple pigmented reddish brown papules on external genitalia associated with HPV type 16

Question 14

What is the most common cancer of the penis?

Answer 14

Invasive Squamous Cell Carcinoma

Question 15

Invasive Squamous Cell Carcinoma

Age:

Most common sites:

Virus association:

Risk factors:

Answer 15

• Age: 40-70 years old
• Most common sites: Glans or mucosal surface of prepuce
• Virus association: HPV 16 and 18
• Risk factors: Smoking, lack of circumcision, CIS

Question 16

Invasive Squamous Cell Carcinoma

Where does the cancer metastasize?

What is important in terms of staging?

Histology?

Answer 16

• Metastasizes to inguinal and iliac nodes
• Corpus spongiosum/cavernosum invasion is important for staging
• Histology: keratin pearls, nuclear atypia

Question 17

What is a scrotal varicocele?

Answer 17

An abnormal enlargement of the vein that is in the scrotum draining the testicles

Most common cause of left-sided scrotal enlargement in adult

“Bag of worms” appearance

Question 18

What are some examples of varicoceles in the scrotum and their possible pathologies? (2)

Answer 18

Blockage of left renal vein (renal cell carcinoma invading renal vein)

Blockage of right spermatic vein produces right-sided varicocele (retroperitoneal fibrosis)

Question 19

A hydrocele results from fluid secreted into a potential space called the _______ _______

Why is ultrasound used to diagnose hydrocele?

Answer 19

A hydrocele results from fluid secreted into a potential space called the **tunica vaginalis **(TV)

Ultrasound distinguishes fluid in the TV vs. a testicular mass causing scrotal enlargement

Question 20

How is Invasive Squamous Cell Carcinoma of the penis staged?

Answer 20

• Tis: carcinoma in situ, no invasion
• Ta: non-invasive, Verrucous wart-like carcinoma (broccoli)
• T1: tumor grown into subepithelial connective tissue (partial penectomy)
• T2: tumor grown into corpus spongiosum or corpora cavernosum (total penectomy)
• T3: tumor grown into urethra
• T4: tumor grown into other nearby structures

Question 21

What is the effect of HPV on penile skin?

Answer 21

Clear cytoplasmic halos

Nuclei large & irregular

Increased mitosis