Chapter 18 - Male Genital system

What is the ultimate mediator of prostatic growth in BPH? A. Testosterone B. Dihydrotestosterone C. Estrogen D. Prolactin

B. Dihydrotestosterone is the ultimate mediator of prostatic growth in BPH. Although testosterone can also bind to androgen receptors and stimulate growth, DHT is 10 times more potent. The text mentions that DHT is synthesized in the prostate from circulating testosterone by the action of the enzyme 5α-reductase, type 2, and binds to nuclear androgen receptors, which regulate the expression of genes that support the growth and survival of prostatic epithelium and stromal cells.

What is the usual location of BPH in the prostate, and what is the histological composition of the hyperplastic nodules? A. Outer peripheral zone, composed of adipose tissue and smooth muscle B. Inner transition zone, composed of proliferating glandular elements and fibromuscular stroma C. Central zone, composed of dilated blood vessels and connective tissue D. BPH occurs uniformly throughout the prostate, with no characteristic histology

B. Inner transition zone, composed of proliferating glandular elements and fibromuscular stroma. The text clearly states that BPH virtually always occurs in the inner transition zone of the prostate, and that the hyperplastic nodules are composed of variable proportions of proliferating glandular elements and fibromuscular stroma, with tall, columnar epithelial cells and flattened basal cells. The other answer choices are incorrect based on the information provided in the text.

What is the most common clinical presentation of testicular germ cell neoplasms? A. Painful testicular mass B. Nontranslucent testicular mass C. Palpable testicular lesion D. Hydrocele

B. Nontranslucent testicular mass. Testicular germ cell neoplasms present most frequently with a painless testicular mass that is nontranslucent, unlike enlargements caused by hydroceles.

A 70-year-old male patient presents with difficulty in starting urination, weak urinary stream, and increased frequency of urination, especially at night. Digital rectal examination reveals an enlarged, rubbery prostate gland that is symmetrically enlarged. A biopsy of the prostate gland reveals nodular hyperplasia of the stromal and glandular elements with compression of the glandular lumens. Based on these findings, what is the most likely diagnosis? A. Prostate adenocarcinoma B. Prostatic hyperplasia C. Prostatitis D. Testicular cancer E. Urethral stricture

B. Prostatic hyperplasia Explanation: The patient's clinical presentation and biopsy findings are consistent with BPH. BPH is a common condition in aging men that involves hyperplasia of the stromal and glandular elements of the prostate gland, leading to compression of the glandular lumens and obstructive urinary symptoms. Digital rectal examination typically reveals an enlarged, rubbery prostate gland that is symmetrically enlarged. The other options listed are less likely based on the patient's clinical presentation and biopsy findings.

A 3-year-old boy presents with a left testicular mass. A biopsy of the mass reveals primitive glomeruli, Schiller-Duval bodies, and eosinophilic hyaline globules containing α1-anti-trypsin and AFP. What is the most likely diagnosis? A) Embryonal carcinoma B) Teratoma C) Yolk sac tumor D) Choriocarcinoma

C) Yolk sac tumor. Yolk sac tumor is the most common primary testicular neoplasm in children younger than 3 years of age and is characterized by primitive glomeruli, Schiller-Duval bodies, and eosinophilic hyaline globules containing α1-anti-trypsin and AFP.

What is the most common primary testicular neoplasm in children under 3 years of age? A) Embryonal carcinoma B) Teratoma C) Yolk sac tumor D) Choriocarcinoma

C) Yolk sac tumor. Yolk sac tumor is the most common primary testicular neoplasm in children younger than 3 years of age with a very good prognosis. It is often admixed with embryonal carcinoma in adults. Yolk sac tumors are composed of low cuboidal to columnar epithelial cells that form microcysts, lacelike patterns, sheets, glands, and papillae. They have a distinctive feature, the presence of structures resembling primitive glomeruli, the so-called Schiller-Duval bodies. These tumors often have eosinophilic hyaline globules containing α1-anti-trypsin and alpha fetoprotein (AFP).

Which of the following is not a risk factor for testicular neoplasms? A. Cryptorchidism B. Family history of germ cell tumors C. African American race (גזע) D. Intersex syndromes

C. African American race is not a risk factor for testicular neoplasms. In fact, testicular tumors are more common in whites than in blacks. Cryptorchidism, a family history of germ cell tumors, and intersex syndromes, including androgen insensitivity syndrome and gonadal dysgenesis, are all risk factors for testicular neoplasms.

What is retroperitoneal fibrosis? a. A type of malignant tumor of the ureter b. A congenital disorder resulting in hydronephrosis c. An uncommon cause of ureteral narrowing or obstruction characterized by d. a fibrous proliferative inflammatory process e. None of the above

C. An uncommon cause of ureteral narrowing or obstruction characterized by a fibrous proliferative inflammatory process Explanation: The text states that retroperitoneal fibrosis is characterized by a fibrous proliferative inflammatory process encasing the retroperitoneal structures and causing hydronephrosis.

What is the most common cause of granulomatous prostatitis in the United States? A. Prostatic tuberculosis B. Fungal infection C. BCG instillation for bladder cancer D. Immunocompromised state

C. BCG instillation for bladder cancer is the most common cause of granulomatous prostatitis in the United States. BCG produces a granulomatous immune reaction that is histologically indistinguishable from tuberculosis. Prostatic tuberculosis is rare in the Western world, while fungal granulomatous prostatitis is seen only in immunocompromised hosts. Postsurgical prostatic granulomas also may be seen.

A 45-year-old male presents with chronic pelvic pain, localized to the perineum, suprapubic area, and penis, which is worsened during and after ejaculation. Digital rectal examination is unremarkable, and urine cultures are negative. What is the most likely diagnosis? A. Acute bacterial prostatitis B. Chronic bacterial prostatitis C. Chronic pelvic pain syndrome D. Prostate cancer

C. Chronic pelvic pain syndrome Explanation: The presentation of chronic pelvic pain localized to the perineum, suprapubic area, and penis, along with pain during and after ejaculation is suggestive of chronic pelvic pain syndrome. The etiology of this condition is uncertain, and the diagnosis is one of exclusion. Negative urine cultures and unremarkable digital rectal examination help rule out acute and chronic bacterial prostatitis. Prostate cancer would typically present with other symptoms, such as urinary retention or hematuria, and would be detected on imaging studies.

Which of the following is true regarding the metastasis of nonseminomatous germ cell neoplasms? A. Metastasis occurs late in the course of the disease B. Metastasis occurs only through lymphatic routes C. Hematogenous metastases are most common in the liver and lungs D. Metastatic lesions do not contain elements of other germ cell tumors

C. Hematogenous metastases are most common in the liver and lungs The text states that nonseminomatous germ cell neoplasms tend to metastasize earlier, by lymphatic as well as hematogenous routes. It also mentions that hematogenous metastases are most common in the liver and lungs. Therefore, option C is correct. Option A is incorrect because it is true for seminomas, not nonseminomatous tumors. Option B is incorrect because nonseminomatous tumors metastasize through both lymphatic and hematogenous routes. Option D is incorrect because metastatic lesions of nonseminomatous tumors may contain elements of other germ cell tumors.

What genetic aberration is commonly seen in prostate cancer and leads to activation of the PI3K/AKT signaling pathway? A. Gene amplifications in androgen receptors B. Mutations in the TMPRSS2 gene C. Loss-of-function mutations involving the tumor suppressor PTEN D. Gene rearrangements in ETS family transcription factors

C. Loss-of-function mutations involving the tumor suppressor PTEN Gene rearrangements involving TMPRSS2 and ETS family transcription factors are also common in prostate cancer, but they create fusion genes rather than activating the PI3K/AKT pathway.

What type of inflammatory infiltrate is typically seen in the microscopic examination of a primary syphilis chancre? A. Neutrophilic B. Eosinophilic C. Lymphocytic and plasmacytic D. Macrophagic

C. Lymphocytic and plasmacytic. The text states that microscopic examination of the chancre reveals the typical lymphocytic and plasmacytic inflammatory infiltrate and endarteritis.

A 65-year-old African-American man presents with urinary retention and elevated serum prostate-specific antigen (PSA) levels. A biopsy of the prostate reveals the presence of TMPRSS2-ETS fusion genes. What is the most likely diagnosis, and what is a potential complication of this condition? A. Prostatitis; infertility B. Benign prostatic hyperplasia (BPH); urinary tract infection C. Prostate cancer; metastasis D. Seminal vesicle cysts; erectile dysfunction

C. Prostate cancer. The most likely complication of this condition is metastasis, which can occur to the lymph nodes, bones, and other organs.

What is a distinctive feature of Choriocarcinoma? A. Presence of Schiller-Duval bodies B. Structures resembling primitive glomeruli C. Sheets of small cuboidal cytotrophoblast cells D. Undifferentiated, solid sheets or primitive glandular structures

C. Sheets of small cuboidal cytotrophoblast cells irregularly intermingled with or capped by large, eosinophilic syncytiotrophoblast cells containing multiple dark, pleomorphic nuclei are a distinctive feature of Choriocarcinoma. This tumor arises from pluripotential neoplastic germ cells and differentiates into cells resembling placental trophoblasts. The primary tumors are often small and nonpalpable. HCG can be identified in the syncytiotrophoblastic cells by immunohistochemical staining.

Define Phimosis

Condition in which the prepuce cannot be retracted easily over the glans penis. Phimosis may be a congenital anomaly, but most cases stem from scarring of the prepuce caused by balanoposthitis. (the inability to retract the skin (foreskin or prepuce) covering the head (glans) of the penis)

Balanitis and Balanoposthitis: Main cause

Consequence of poor hygiene in uncircumcised males, leading to the accumulation of desquamated epithelial cells, sweat, and debris, termed smegma, which acts as a local irritant.

A 25-year-old male presents with a testicular mass that has been enlarging over the past few months. Upon examination, the mass is non-tender and appears to be a hard, solid nodule. Imaging studies reveal multiple pulmonary nodules and liver metastases. A biopsy of the testicular mass is performed and reveals a tumor composed of small cuboidal cytotrophoblast-like cells irregularly intermingled with large eosinophilic syncytiotrophoblast-like cells containing multiple dark, pleomorphic nuclei. Which of the following markers would be expected to be positive on immunohistochemical staining of this tumor? A) Cytokeratin B) S-100 C) Alpha-fetoprotein D) Human chorionic gonadotropin (HCG)

Correct Answer: D) Human chorionic gonadotropin (HCG) Explanation: Choriocarcinoma is a tumor that resembles placental trophoblasts and produces human chorionic gonadotropin (HCG). Immunohistochemical staining for HCG can be used to confirm the diagnosis of choriocarcinoma. Cytokeratin and S-100 are not specific for this tumor. Alpha-fetoprotein is not typically produced by choriocarcinoma, but can be seen in other germ cell tumors such as yolk sac tumors. The presence of metastases in this case is indicative of an aggressive tumor with poor prognosis.

Bladder Metaplasia: Cystitis Cystica

Cystic spaces filled with clear fluid lined by fattened urothelium

A 65-year-old male presents with a gray, crusted, papular lesion on the glans penis with irregular margins. A biopsy reveals a typical keratinizing squamous cell carcinoma. What is the next step in management for this patient? A) Perform a lungs biopsy B) Perform a bone biopsy C) Perform a lumbar lymph node biopsy D) Perform a inguinal lymph node biopsy

D) Perform an inguinal lymph node biopsy. The next step in management for a patient with a diagnosed keratinizing squamous cell carcinoma on the glans penis with irregular margins is to perform an inguinal lymph node biopsy. The inguinal lymph nodes are the first lymph nodes to which the lymphatic drainage of the penis flows, and the presence of metastatic carcinoma in these nodes indicates a worse prognosis. Performing a lung or bone biopsy would not be indicated at this point unless there were clinical indications of metastasis to these organs. Similarly, a lumbar lymph node biopsy would not be the first choice in management as it is not in the drainage area of the glans penis.

What is the most common form of bladder metaplasia? A) Cystitis glandularis B) Cystitis cystica C) Intestinal metaplasia D) Squamous metaplasia

D) Squamous metaplasia Explanation: Squamous metaplasia is the most common form of bladder metaplasia, often occurring in response to injury. Other forms of bladder metaplasia include cystitis glandularis, cystitis cystica, and intestinal metaplasia.

What is the characteristic morphology of a primary syphilis chancre? A. Painful, with irregular margins B. Painful, with well-defined margins C. Painless, with irregular margins D. Painless, with well-defined margins

D. Painless, with well-defined margins

Nonspecific epididymitis and Orchitis: Definition, Etiology, Morphology (3) and Complications

Definition: Inflammation of the epididymis or testis Etiology: Primary urinary tract infection or spread through the vas deferens or lymphatics Morphology: 1. Swollen and tender testis with neutrophil infiltration in nonspecific epididymitis and orchitis 2. Edematous and congested testes with lymphoplasmacytic inflammatory infiltrate in mumps orchitis 3. Granulomatous inflammation and caseous necrosis in testicular tuberculosis Complications: Sterility in severe mumps orchitis

Bladder Metaplasia: Cystitis Glandularis

Epithelial cells may differentiate into cuboidal/columnar epithelium

Define Elephantiasis

Extreme cases of lymphatic obstruction, caused, for example, by filariasis, the scrotum and the lower extremities may enlarge to grotesque sizes

A 35-year-old male presented with a testicular mass and an increased level of AFP. He underwent radical orchiectomy, and histologic examination revealed a yolk sac tumor. Which of the following tumor markers would be expected to be elevated in this case? A. HCG B. CA-125 C. LDH D. CEA

HCG Explanation: According to the text, an increased level of AFP in the setting of a testicular neoplasm indicates a yolk sac tumor component, and HCG may be minimally elevated in individuals with other germ cell tumors containing syncytiotrophoblastic cells. Therefore, option A is the most likely tumor marker to be elevated in this case.

Define Hematocele and Chylocele

Hematocele = Accumulation of blood within the tunica vaginalis Chylocele = Accumulation of lymphatic fluid within the tunica vaginalis

Condylomata Lata vs Condyloma Acuminata

In secondary Syphilis, moist skin areas, such as the anogenital region, inner thighs, and axillae, broad-based, elevated lesions termed condylomata lata may appear (not to be confused with condyloma acuminata caused by HPV)

Benign Prostatic Hyperplasia (BPH): Microscopically (1)

Microscopically, hyperplastic nodules are composed of variable proportions of proliferating glandular elements and fibromuscular stroma, with tall, columnar epithelial cells and flattened basal cells

Where Inflammatory lesions of the testis are more common?

More common in the epididymis than in the testis proper

Neoplasms of the scrotal sac: Most common type

Neoplasms of the scrotal sac are unusual. Squamous cell carcinoma, the most common of these

Does Prostate cancer have poor prognosis?

No, currently causes only 10% of cancer deaths in the United States. Indeed, prostate carcinoma commonly is found incidentally at autopsy in men dying of other causes, and many more men die with prostate cancer than of prostate cancer

Penile Neoplasms: Most common in what ages?

Older than 40 years

Explain the "Teratoma with malignant transformation" phenomenon

Rarely, non-germ cell tumors may arise in teratoma Examples of such neoplasms include squamous cell carcinoma, adenocarcinoma, and various sarcomas. These non- germ cell malignancies do not respond to therapies that are effective against metastatic germ cell tumors; thus, the only hope for cure in such cases resides in surgical resection.

Define Epispadias

Same as Hypospadias but the abnormal urethral orifice is on the dorsal aspect of the penis and it is less common

Squamous cell carcinoma of the bladder.: Risk Factor

Schistosoma haematobium infection is a risk factor for squamous cell carcinoma of the bladder. - Background of chronic inflammation

Where are the most common penile neoplasms arise on?

Squamous epithelium (squamous cell carcinoma)

Define Hypospadias

The abnormal urethral opening is found on the ventral aspect of the penis anywhere along the shaft. This anomalous orifce is sometimes constricted, resulting in urinary tract obstruction and an increased risk for urinary tract infections. Hypospadias occurs in 1 in 300 live male births and may be associated with other congenital anomalies, such as inguinal hernia and undescended testis.

Testicular Germ Cell Tumors: Subclassification and Incidence (2)

The most common type of testis cancer is a germ cell tumor. There are two main types of GCT: seminoma and nonseminomatous germ cell tumors (NSGCT) - Subclassified into seminomas and nonseminomatous germ cell tumors 1. Seminomas are the most common, accounting for about 50% of testicular germ cell neoplasms 2. Histologically identical to dysgerminomas and germinomas

What is the most important prognostic factor in Noninvasive papillary urothelial neoplasms?

Their Grade which is based on both architecture and cytologic features. LOW* malignant potential in PUNLMP

Bladder Metaplasia: Intestinal Metaplasia

Transitional epithelium lining the bladder changes into Goblet cells resembling intestinal mucosa

Mixed tumor: 1. Tumor Peak Patient Age (years): 2. Morphology: (2) 3. Tumor Marker: (1)

Tumor Peak Patient Age (years): 15-30 Morphology: Variable, depending on mixture; commonly teratoma and embryonal carcinoma Tumor Marker(s): 90% of patients have elevated hCG and AFP

Embryonal carcinoma: 1. Tumor Peak Patient Age (years): 2. Morphology: (3) 3. Tumor Marker: (1)

Tumor Peak Patient Age (years): 20-30 Morphology: (1)Poorly differentiated, (2)pleomorphic cells in cords, sheets, or papillary formation; (3)most contain some yolk sac and choriocarcinoma cells Tumor Marker(s): Negative (pure embryonal carcinoma)

Choriocarcinoma: 1. Tumor Peak Patient Age (years): 2. Morphology: (1) 3. Tumor Marker: (1)

Tumor Peak Patient Age (years): 20-30 Morphology: Cytotrophoblast and syncytiotrophoblast without villus formation Tumor Marker(s): 100% of patients have elevated hCG

Yolk sac tumor: 1. Tumor Peak Patient Age (years): 2. Morphology: (1) 3. Tumor Marker: (1)

Tumor Peak Patient Age (years): 3 Morphology: Poorly differentiated endothelium-like, cuboidal, or columnar cells (Schiller-Duval bodies). Tumor Marker(s): 90% of patients have elevated AFP

Seminoma: 1. Tumor Peak Patient Age (years): 2. Morphology: (2) 3. Tumor Marker: (1)

Tumor Peak Patient Age (years): 40-50 Morphology: Sheets of uniform polygonal cells with cleared cytoplasm; lymphocytes in the stroma Tumor Marker(s): 10% of patients have elevated hCG

Spermatocytic tumor: 1. Tumor Peak Patient Age (years): 2. Morphology: (2) 3. Tumor Marker: (1)

Tumor Peak Patient Age (years): 50-60 Morphology: Small, medium, and large polygonal cells; no inflammatory infiltrate Tumor Marker(s): Negative

Teratoma: 1. Tumor Peak Patient Age (years): 2. Morphology: (1) 3. Tumor Marker: (1)

Tumor Peak Patient Age (years): All ages Morphology: Tissues from all three germ cell layers with varying degrees of differentiation Tumor Marker(s): Negative (pure teratoma)

What are the most common malformations of the penis?

When the Distal Urethral Orifice (פתח השופכה) is abnormally located

A 28-year-old male presented with a testicular mass, which was later diagnosed as a nonseminomatous germ cell tumor. He underwent radical orchiectomy followed by chemotherapy. A year later, he developed lung nodules and a biopsy confirmed metastatic nonseminomatous germ cell tumor. What is the most likely site of origin for the lung nodules? A. Seminoma B. Yolk sac tumor C. Embryonal carcinoma D. Teratoma

Yolk sac tumor Explanation: According to the text, metastatic lesions may contain elements of other germ cell tumors. Yolk sac tumor is one of the nonseminomatous germ cell tumors that tend to metastasize early and by hematogenous routes, and metastases to the lungs are common. Therefore, option B is the most likely site of origin for the lung nodules in this case.

A 3-year-old male presents with a testicular mass. On histological examination, the tumor is composed of poorly differentiated endothelium-like cells. Which of the following tumor markers is most likely to be elevated in this patient? a) AFP b) hCG c) CA-125 d) CEA

a) AFP #Yolk Sac Tumor: Tumor Peak Patient Age (years): 3 Morphology: Poorly differentiated endothelium-like, cuboidal, or columnar cells (Schiller-Duval bodies). Tumor Marker(s): 90% of patients have elevated AFP

A 20-year-old male presents with a testicular mass. On histological examination, the tumor is composed of tissues from all three germ cell layers with varying degrees of differentiation. Which of the following tumor markers is most likely to be negative in this patient? a) AFP b) hCG c) CA-125 d) CEA

a) AFP (pure teratoma) The tumor described is a teratoma, which is a germ cell tumor that can contain tissues from all three germ cell layers (ectoderm, mesoderm, and endoderm). Pure teratomas are not associated with elevated levels of any tumor markers, including AFP and hCG, which are typically elevated in other germ cell tumors such as yolk sac tumors and choriocarcinomas. CA-125 and CEA are not typically elevated in testicular tumors. #Teratoma: Tumor Peak Patient Age (years): All ages Morphology: Tissues from all three germ cell layers with varying degrees of differentiation Tumor Marker(s): Negative (pure teratoma)

Which of the following complications is associated with tertiary syphilis? a) Aortic aneurysm b) Interstitial nephritis c) Ophthalmic involvement d) Hepatitis

a) Aortic aneurysm Explanation: Tertiary syphilis can cause aortic aneurysm, which can lead to life-threatening complications if not treated promptly. Other complications of tertiary syphilis include neurosyphilis, gummatous lesions, and Argyll Robertson pupil.

A 25-year-old man presents with a testicular mass. Pathological examination of the mass reveals poorly differentiated, pleomorphic cells in cords, sheets, or papillary formation, most of which contain some yolk sac and choriocarcinoma cells. Which of the following is the most likely diagnosis? a) Embryonal carcinoma b) Spermatocytic tumor c) Yolk sac tumor d) Choriocarcinoma e) Seminoma

a) Embryonal carcinoma #Embryonal carcinoma: Tumor Peak Patient Age (years): 20-30 Morphology: (1)Poorly differentiated, (2)pleomorphic cells in cords, sheets, or papillary formation; (3)most contain some yolk sac and choriocarcinoma cells Tumor Marker(s): Negative (pure embryonal carcinoma)

Which testicular germ cell tumor subtype has the best prognosis? a) Seminoma b) Choriocarcinoma c) Teratoma d) Mixed tumor

a) Seminoma Explanation: Seminoma is the testicular germ cell tumor subtype that has the best prognosis. It is extremely radiosensitive and tends to remain localized for long periods. More than 95% of patients with early-stage disease can be cured. Nonseminomatous germ cell tumors have a cure rate of approximately 90% with aggressive chemotherapy, while choriocarcinoma is associated with a poorer prognosis. Recurrences, typically in the form of distant metastases, usually occur within the first 2 years after treatment

What is the most common presentation of bladder tumors? a. Painless Hematuria b. Painful Hematuria b. Dysuria c. Urinary frequency

a. Hematuria. Bladder tumors typically present with painless hematuria.

Germ Cell Tumors: Importance of Tumor Markers (3)

- Assay of tumor markers is important diagnostically and for following response to therapy 1. HCG is always elevated in choriocarcinoma and may be minimally elevated in other germ cell tumors containing syncytiotrophoblastic cells 2. Increased AFP indicates a yolk sac tumor component 3. Levels of LDH correlate with tumor burden ** Table 18.1 summarizes tumor markers, clinical and morphologic features

Sexually transmitted diseases (STDs): Syphilis: Tertiary Syphilis: Manifestations (4)

- Defined as being more than 1 year after the initial infection 1. Occurs in untreated patients after the early latent phase 2. Presents with lesions in the cardiovascular and/or central nervous system 3. Spirochetes are much more difficult to demonstrate in this stage 4. Patients are much less likely to be infectious than in the primary or secondary stages

Carcinoma in situ (CIS) of Urothelial Tract: Definition and Morphology (6)

- Definition: Presence of overtly malignant cells within a flat urothelium 1. Tumor cells lack cohesiveness and shed into urine 2. CIS is commonly multifocal and may involve most of the bladder surface or extend into the ureters and urethra 3. Without treatment, 50% to 75% of CIS cases progress to invasive cancer 4. Invasive urothelial cancer associated with papillary urothelial cancer or CIS may superficially invade the lamina propria or extend into underlying muscle 5. Almost all infiltrating urothelial carcinomas are high grade 6. The extent of invasion and spread (staging) at the time of initial diagnosis is the most important prognostic factor

Teratoma: Definition and Morphology (3) and Special Features (2)

- Neoplastic germ cells differentiate along multiple somatic cell lineages 1. Tumors form firm masses containing cysts and areas of cartilage 2. Composed of a heterogeneous collection of differentiated cells or organoid structures, such as neural tissue, muscle bundles, islands of cartilage, clusters of squamous epithelium, structures reminiscent of thyroid gland, bronchial epithelium, and bits of intestinal wall or brain substance, all embedded in a fibrous or myxoid stroma 3. Elements may be mature (resembling various tissues within the adult) or immature (sharing histologic features with fetal or embryonal tissues). - Common in infant and children and rare in adults - In prepubertal males (גברים לפני גיל ההתבגרות), teratomas are benign, whereas the majority of teratomas in postpubertal males are malignant, being capable of metastasis regardless of whether they are composed of mature or immature elements.

Sexually transmitted diseases (STDs): Syphilis: Primary Syphilis: Manifestations (4)

- Several weeks after infection (21 days): 1. A chancre (a painless genital ulcer most commonly formed during the primary stage of syphilis) appears at the site of spirochete entry 2. Systemic dissemination of organisms occurs 3. Host elicit an immune response but it fails to eradicate the organisms 4. Two types of antibodies are formed: nontreponemal and treponemal antibodies

Testicular Torsion: Definition, Types, and Complications

- Twisting of the spermatic cord obstructs testicular venous drainage a. Neonatal torsion occurs in utero or shortly after birth with no associated anatomic defect b. Adult torsion typically occurs in adolescence and results from a bilateral congenital anomaly (bell clapper abnormality) leading to increased mobility of the testis - Torsion constitutes one of the few urologic emergencies - If not treated within 6 hours, torsion may result in testicular infarction and loss of the testis - Orchiopexy is typically performed to prevent torsion in the contralateral testis

A 65-year-old male presented with complaints of urinary hesitancy (difficulty urinating) and dribbling (involuntary loss of urine immediately after they have finished passing urine) for the past 6 months. On digital rectal examination, a hard nodule was palpable in the left lobe of the prostate gland. The prostate-specific antigen (PSA) level was elevated at 12 ng/mL. Transrectal ultrasound-guided biopsy of the prostate was performed, and histopathological examination revealed moderately differentiated adenocarcinoma of the prostate gland. 1. What is the expected morphology finding in the biopsy specimen of the prostate gland? A) Crowded glands lacking branching and papillary infolding B) Large benign glands lined by a single layer of epithelium C) Pleomorphic glands with numerous mitotic figures D) Small benign glands with branching and papillary infolding 2. What is the complication of this condition? A) Proteinuria B) Urinary incontinence C) Metastasis to the Brain D) Hypoalbuminemia

1. A) Crowded glands lacking branching and papillary infolding The expected morphology finding in the biopsy specimen of the prostate gland described in the case report is crowded glands lacking branching and papillary infolding. This finding is characteristic of prostate adenocarcinoma, which is the most common type of prostate cancer. The malignant glands are crowded together, with ill-defined margins, and lack the basal cell layer seen in benign glands. The cytoplasm of the tumor cells ranges from pale-clear to a distinctive amphophilic (dark purple) appearance. Nuclei are enlarged and often contain one or more prominent nucleoli. Some variation in nuclear size and shape is usual, but in general, pleomorphism is not marked. 2. B) Urinary incontinence The complication of prostate cancer described in the case report is urinary incontinence, which is the involuntary leakage of urine. Urinary incontinence is a common complication of prostate cancer treatment, particularly radical prostatectomy (surgical removal of the prostate gland). This complication can occur due to damage to the sphincter muscles or nerves that control the bladder, which can result in leakage of urine. Other complications of prostate cancer may include erectile dysfunction, metastasis to other organs (such as the lungs), and an increased risk of heart disease. However, in this case, the expected complication of the condition is urinary incontinence.

Prostatitis: Classification, and Clinical Features (3)

1. Acute bacterial prostatitis presents with sudden onset of fever, chills, dysuria, perineal pain, and bladder outlet obstruction, and may be complicated by sepsis - If acute prostatitis is suspected, digital rectal examination is contraindicated 2. Chronic bacterial prostatitis usually is associated with recurrent urinary tract infections bracketed by asymptomatic periods 3. Chronic pelvic pain syndrome is characterized by chronic pain localized to the perineum, suprapubic area, and penis with pain during or after ejaculation

Prostatitis: Definition and Classification (3)

1. Acute bacterial prostatitis: 2%-5% of cases Caused by same organisms associated with other acute urinary tract infections 2. Chronic bacterial prostatitis: 2%-5% of cases Also caused by common uropathogens 3. Chronic pelvic pain syndrome: 90%-95% of cases Inflammatory cases associated with leukocytes in prostatic secretions Noninflammatory cases in which leukocytes are absent

Prostate Carcinoma: Morphology (7)

1. Advanced lesions appear as firm, gray-white lesions with ill-defined margins that infiltrate the adjacent gland 2. Most prostate cancers are Moderately differentiated adenocarcinomas that produce well-defined glands 3. Malignant glands are smaller than benign glands and are lined by a single uniform layer of cuboidal or low columnar epithelium 4. Malignant glands lack branching and papillary infolding 5. Nuclei are enlarged with one or more prominent nucleoli 6. Irregular or ragged glandular structures, cribriform glands, sheets of cells or infiltrating individual cells are present with increasing grade 7. High-grade prostatic intraepithelial neoplasia (HGPIN) is a precursor lesion found in approximately 80% of cases

Androgens and Prostate Cancer Development: (5)

1. Androgens provide the cellular context for prostate cancer development 2. Prostate cancer is dependent on androgens for survival but not for initiation 3. Resistance to anti-androgen therapy can occur via gene amplifications or mutations in androgen receptors 4. Heredity and environment are risk factors for prostate cancer - First-degree relatives of patients with prostate cancer have an increased risk of developing the disease. 5. Genetic aberrations, such as copy number variations and gene rearrangements, are drivers of cellular transformation in prostate cancer - Mutations commonly lead to activation of the PI3K/AKT signaling pathway.

Benign Prostatic Hyperplasia (BPH): Clinical Manifestations and Treatment: (7)

1. BPH involves inner portions of the prostate 2. Common manifestations are related to lower urinary tract obstruction 3. Symptoms include hesitancy, intermittent interruption of urinary stream, urinary urgency, frequency, and nocturia 4. Clinical manifestations occur in only about 10% of men with pathologic evidence of BPH 5. Presence of residual urine in the bladder due to chronic obstruction increases risk for UTIs 6. BPH can lead to complete urinary obstruction and Hydronephrosis 7. Initial treatment is pharmacologic with targeted therapeutic agents that inhibit formation of DHT from testosterone or relax prostatic smooth muscle by blocking α1-adrenergic receptors

Benign Prostatic Hyperplasia (BPH): Morphology (6)

1. BPH usually occurs in the inner transition zone of the prostate 2. Enlarged prostate 3. Prostate contains well-circumscribed nodules that may appear solid or contain cystic spaces 4. Hyperplastic nodules compress the urethra, often to a narrow slit 5. Hyperplastic glandular and stromal elements can project into the bladder lumen, causing a ball-valve type of urethral obstruction 6. Microscopically, hyperplastic nodules are composed of variable proportions of proliferating glandular elements and fibromuscular stroma, with tall, columnar epithelial cells and flattened basal cells

Nonneoplastic conditions of the Urinary Bladder: Cystitis forms: (6)

1. Bacterial cystitis is common, particularly in women, with coliform bacteria as the most common etiologic agent. 2. Hemorrhagic cystitis may occur in patients receiving cytotoxic anti-tumor drugs or adenovirus infection. 3. Interstitial cystitis is a chronic pelvic pain syndrome that typically affects women, characterized by suprapubic pain, increased frequency of urination, hematuria, urgency, and dysuria. Cystoscopic findings include petechial hemorrhages. - Late in the course, transmural fibrosis may ensue, leading to a contracted bladder. 4. Malakoplakia is an uncommon inflammatory disease that results from macrophages' defects, leading to the accumulation of undigested bacterial products and the formation of Michaelis-Gutmann bodies. 5. Polypoid cystitis is an inflammatory condition resulting from irritation to the bladder mucosa that causes broad bulbous polypoid projections due to submucosal edema.

Urinary bladder: Neoplasms: Epidemiology (4)

1. Bladder cancer is a rare cancer accounting for 5% of cancers and 3% of cancer deaths in the United States. 2. Most of the bladder cancer are urothelial carcinomas. 3. Adenocarcinomas of the bladder are rare. 4. Adenocarcinomas are more common in men between 50 and 80 years old, industrialized nations, urban dwellers, and whites.

Bladder Tumors: Clinical Features (6)

1. Bladder tumors typically present with painless hematuria 2. Urothelial tumors tend to develop new tumors after excision (לאחר כריתה) 3. Risk for recurrence is related to tumor size, stage, grade, multifocality, mitotic index, and associated dysplasia and/or CIS 4. Many recurrent tumors arise at sites different than that of the original lesion, yet share the same clonal abnormalities as those of the initial tumor 5. High-grade papillary (aggressive) urothelial carcinomas are frequently associated with either concurrent or subsequent (במקביל או לאחר מכן) invasive urothelial carcinoma 6. Lower-grade papillary urothelial neoplasms often recur but infrequently invade

Balanitis and Balanoposthitis: Common agents (4)

1. Candida albicans 2. Anaerobic bacteria 3. Gardnerella 4. Pyogenic bacteria.

Secondary Syphilis: Clinical Manifestations and Histologic Findings (6)

1. Characterized by mucocutaneous lesions and generalized lymph node enlargement 2. Symmetrically distributed maculopapular (rash with both flat and raised parts), scaly or pustular skin lesions involve the palms of the hands and soles of the feet. 3. Broad-based, elevated lesions called condylomata lata in moist skin areas 4. Mucosal lesions resembling condylomata lata can occur anywhere 5. Lymphadenopathy most commonly found in the neck and inguinal areas 6. Histologic examination reveals proliferative endarteritis and spirochetes, which are often abundant

Sexually transmitted diseases (STDs): Diseases (5)

1. Chlamydial infection 2. Gonorrhea 3. AIDS 4. Syphilis 5. Hepatitis B

Benign prostatic hyperplasia (BPH): Common cause (1) Common Age (1) Pathogenesis (1) Important cause of (1) Does not occur in males at what condition (2) DHT Features (2)

1. Common cause of prostatic enlargement resulting from proliferation of stromal and glandular elements 2. Presents in a significant number of men by 40 years of age, reaching 90% by the eighth decade of life 3. Excessive androgen-dependent growth of stromal and glandular elements has a central role 4. The enlargement of the prostate in men with BPH is an important cause of urinary obstruction 5. Does not occur in males who are castrated before the onset of puberty or in males with genetic diseases that block androgen activity 6. Dihydrotestosterone (DHT) is the ultimate mediator of prostatic growth and synthesized in the prostate from circulating testosterone by the action of the enzyme 5α-reductase, type 2 7. DHT binds to nuclear androgen receptors, which regulate the expression of genes that support the growth and survival of prostatic epithelium and stromal cells

Cryptorchidism: Morphologic Findings (2)

1. Cryptorchid testes may have germ cell neoplasia in situ, which is a precursor of germ cell tumors 2. Atrophic changes similar to those in cryptorchid testes may be caused by chronic ischemia, trauma, irradiation, anti-neoplastic chemotherapy, and chronic estrogen levels

Cryptorchidism: Risks and Management (4)

1. Cryptorchidism associated with infertility and increased risk of testicular cancer 2. Unilateral cryptorchidism increases cancer risk in the contralateral descended testis 3. Orchidopexy (a surgical procedure that moves an undescended testicle into the scrotum) recommended by 18 months of age to reduce risks 4. Cryptorchid testis may undergo atrophy by puberty Tubular atrophy appears by 5 to 6 years of age

Cryptorchidism: Definition and Characteristics (5)

1. Cryptorchidism is a failure of testicular descent into the scrotum 2. The testes normally descend into the scrotum by the third month of gestation 3. Diagnosis is established with 1 year of age, especially in premature infants (because testicular descent into the scrotum is not always complete at birth) 4. Undescended testes become atrophic, and bilateral cryptorchidism results in sterility 5. Even unilateral cryptorchidism may be associated with atrophy of the contralateral descended gonad

Prostatitis Diagnosis and Granulomatous Prostatitis: (6)

1. Diagnosis of prostatitis is typically not based on biopsy due to nonspecific findings and risk of sepsis 2. Granulomatous prostatitis is an exception and may produce prostatic induration, leading to biopsy to rule out prostate cancer (in cases of granulomatous prostatitis, biopsy may be needed to rule out prostate cancer because it can cause hardening of the prostate.) 3. BCG instillation for treatment of superficial bladder cancer is the most common cause of granulomatous prostatitis in the United States 4. Fungal granulomatous prostatitis is seen only in immunocompromised hosts 5. Nonspecific granulomatous prostatitis is relatively common and stems from a foreign-body reaction to fluids that leak into tissue from ruptured prostatic ducts and acini. 6. Postsurgical prostatic granulomas also may be seen.

Disorders of the Ureter (4)

1. Disorders of the ureter are rare and include congenital disorders, neoplasms, and reactive conditions. 2. Ureteropelvic junction (UPJ) obstruction results in Hydronephrosis, and it is the most frequent cause of hydronephrosis in infants and children. 3. Malignant tumors of the ureter are pathologically similar to those arising in the renal pelvis, calyces, and bladder (Most are urothelial carcinomas.) 4. Retroperitoneal fibrosis is an uncommon cause of ureteral narrowing or obstruction characterized by a fibrous proliferative inflammatory process encasing the retroperitoneal structures and causing hydronephrosis. - The disorder occurs in middle to old age - Occur in association with IgG4-related

Urothelial Carcinoma: Risk Factors (5)

1. Environmental factors and genetic aberrations contribute to the development of urothelial carcinoma. - Environmental: 1. Smoking, occupational carcinogens, and prior cyclophosphamide or radiation therapy are known environmental risk factors. - Genetics: 2. Deletions of tumor-suppressor genes on 9p and 9q may lead to the formation of superficial papillary tumors, which may then progress to invasive disease. 3. TP53 mutations may initiate a second pathway leading to carcinoma in situ, which may progress to invasion 4. Superficial tumors may have mutations in telomerase, FGFR3, and components of the RAS and PI3K/AKT pathways. 5. Muscle invasive tumors often have mutations involving both TP53 and RB.

Bladder Cancer: Squamous cell carcinoma: Morphology (2)

1. Extensive keratinization 2. Associated with chronic bladder irritation and infection

Invasive Squamous Cell Carcinoma of the Penis: Main characteristics (4)

1. Gray, crusted, papular lesion, usually on the glans penis or prepuce 2. Infiltration of underlying connective tissue produces an indurated, ulcerated lesion with irregular margins 3. Histologically, it is a typical keratinizing squamous cell carcinoma 4. Prognosis is related to the stage of the tumor: 5-year survival rate is 66% with localized lesions, while metastasis to inguinal lymph nodes carries a 27% 5-year survival rate

Bladder Cancer: Adenocarcinoma: Morphology (2)

1. Histologically identical to adenocarcinomas in the GI tract 2. Some arise from urachal remnants in the dome of the bladder or in association with extensive intestinal metaplasia

What is the most common cause of scrotal swelling? (2)

1. Hydrocele - most common caused by an accumulation of serous fluid within the tunica vaginalis. 2. Hematocele and Chylocele

Embryonal Carcinoma of the Testis: Definition and Morphology (4)

1. Ill-defined (לא מוגדר), invasive masses with hemorrhage and necrosis 2. Large cells with basophilic cytoplasm, indistinct cell borders, large nuclei, and prominent nucleoli 3. Can form primitive glandular structures and irregular papillae 4. Often admixed with cells characteristic of other germ cell tumors - Rare in children and occurs mostly in 30+

Yolk Sac Tumor: Definition and Morphology (6)

1. Most common primary testicular neoplasm in children <3 years with good prognosis. 2. Often admixed with embryonal carcinoma in adults. 3. These tumors often are large and may be well demarcated 4. Low cuboidal to columnar epithelial cells that form microcysts, lacelike patterns, sheets, glands, and papillae. 5. Presence of Schiller-Duval bodies. 6. Eosinophilic hyaline globules containing α1-anti-trypsin and alpha fetoprotein (AFP).

Prostate Cancer: Clinical Presentation: (6)

1. Most prostate cancers are small, nonpalpable, and asymptomatic lesions 2. 70-80% of prostate cancers arise in the peripheral glands 3. A minority of carcinomas is discovered unexpectedly during histologic examination of prostate tissue removed by transurethral resection for BPH 4. Prostate cancer is less likely than BPH to cause urethral obstruction in its initial stages 5. Locally advanced cancers often infiltrate the seminal vesicles and periurethral zones of the prostate and may invade the adjacent soft tissues, the wall of the urinary bladder, or (less commonly) the rectum 6. Bone metastases are frequent late in the disease and typically cause osteoblastic (bone-producing) lesions that can be detected on radionuclide bone scans

Verrucous carcinoma of the penis: Main characteristics (5)

1. Non-HPV related variant of squamous cell carcinoma 2. Papillary architecture 3. Virtually no cytologic atypia -the presence of nuclei that are large, regularly shaped and hyperchromic, at times showing binucleation and dyskeratosis and presenting with absence of a perinuclear halo 4. Rounded, pushing deep margins 5. Locally invasive but does not metastasize

Invasive Urothelial Carcinoma: Precursor (2)

1. Noninvasive Papillary Tumor - Most common 2. Carcinoma In Situ (CIS) - 50% of cases where a patient has invasive bladder cancer, no identifiable precursor lesion can be found. It is believed that in these cases, the precursor lesion (such as a non-invasive papillary tumor or carcinoma in situ) was present at an earlier stage, but was overgrown by the high-grade invasive component of the cancer. Essentially, the precursor lesion was not detected because it had already progressed to the point of being overshadowed by the invasive cancer. This highlights the importance of early detection and treatment of precursor lesions, as they can progress to invasive cancer if left untreated.

Causes of Testicular Inflammation (3)

1. Nonspecific epididymitis and orchitis 2. Mumps (חַזֶרֶת) 3. Tuberculosis

Sexually transmitted diseases (STDs): Syphilis: Secondary Syphilis: Manifestations (4)

1. Occurs after the resolution of primary syphilis 2. Presents with mucocutaneous lesions and generalized lymphadenopathy 3. Lesions are full with spirochetes (spiral-shaped bacteria) and are highly infectious - Also in primary phase 4. Resolves even without antimicrobial therapy, at which point patients are said to be in early latent-phase syphilis

Bowen's disease (squamous cell carcinoma in situ of the penis): Main characteristics (4)

1. Occurs in older uncircumcised males 2. Grossly appears as a solitary plaque on the shaft of the penis 3. Histologically shows dysplastic cells throughout the epidermis without invasion of the underlying stroma 4. Has a 10% risk of progression to invasive squamous cell carcinoma - Bowen's disease is a very early form of skin cancer that's easily treatable. The main sign is a red, scaly patch on the skin. It affects the squamous cells, which are in the outer layer of skin, and is sometimes referred to as squamous cell carcinoma in situ

Testicular Germ Cell Neoplasms: Clinical Presentation and Biopsy Risks (4)

1. Painless testicular mass in patients with testicular germ cell neoplasms that is not translucent (unlike enlargements caused by hydroceles) 2. Biopsy associated with tumor spillage risk, necessitating additional excision 3. Radical orchiectomy as standard management for solid testicular mass 4. Some tumors may have metastasized widely by the time of diagnosis (especially nonseminomatous germ cell neoplasms)

Noninvasive Papillary Tumors: Grading System (4)

1. Papilloma 2. Papillary urothelial neoplasm of low malignant potential (PUNLMP) 3. Low-grade papillary urothelial carcinoma 4. High-grade papillary urothelial carcinoma - These exophytic papillary neoplasms are to be distinguished from inverted urothelial papilloma, which is entirely benign and not associated with an increased risk for subsequent carcinoma.

Penile Neoplasms: Factors that increasing the risk of having the disease (3)

1. Poor hygiene (with resultant exposure to potential carcinogens in smegma) 2. Smoking 3. Infection with human papillomavirus (HPV), particularly types 16 and 18.

Primary Syphilis: Morphology (5)

1. Primary syphilis is characterized by a painless ulcer called Chancre - Male: on the glans, corona, or perineal region. - Female: on the labia, vagina, or perineal region 2. Chancre has well-defined, indurated margins and a "clean," moist base 3. Microscopic examination reveals lymphocytic and plasmacytic inflammatory infiltrate and endarteritis 4. Spirochetes can be detected in histologic sections of early lesions 5. Secondary syphilis lesions appear approximately 2 months after resolution of the chancre

Syphilis: Common Morphology (3)

1. Proliferative endarteritis with an accompanying inflammatory infiltrate rich in plasma cells. - Endarteritis is inflammation of the inner lining (endothelium) of an artery 2. Not the Spirochetes are damaging the tissue, but the host immune response that is responsible for endothelial cell activation and proliferation that is the hallmark of endarteritis 3. Eventually leads to Perivascular Fibrosis and Luminal Narrowing

Prostate cancer grading - Gleason System

1. Prostate cancer is graded by the Gleason system 2. Five grades based on glandular patterns of differentiation - Grade 1: well-differentiated tumors - Grade 5: tumors with no glandular differentiation 3. Most tumors are patterns 3, 4, or 5 4. Primary and secondary grades are assigned to the dominant and the next most frequent pattern 5. The two numerical grades are then added to obtain a combined Gleason score 6. Tumors with only one pattern have their primary and secondary grades doubled 7. The most differentiated tumors have a Gleason score of 2 (1+1), and the least differentiated tumors merit a score of 10 (5+5) In the Gleason system for grading prostate cancer, most tumors have more than one pattern of glandular differentiation. Therefore, a primary grade is assigned to the pattern that is most common or dominant in the tumor, and a secondary grade is assigned to the pattern that is next most frequent. The two numerical grades are then added together to obtain a combined Gleason score. 8. A new grading system recently accepted by WHO ranges from 1 (excellent prognosis) to 5 (poor prognosis)

Prostate: Division, Normal Anatomy, and Disorders (5)

1. Prostate is divided into peripheral and transition zones, which have different types of proliferative lesions. 2. Most carcinomas arise in peripheral zones and can be detected by rectal examination. 3. Most hyperplastic lesions arise in the inner transition zone and can cause urinary obstruction. 4. Normal prostate contains glands with two cell layers, basal cell layer and columnar secretory cell layer. 5. Prostate is involved by infectious, inflammatory, hyperplastic, and neoplastic disorders.

Prostate cancer diagnosis and management limitations (3)

1. Prostate-Specific Antigen (PSA) Test is the most widely used test for prostate cancer diagnosis and management 2. PSA has limitations, such as not being cancer-specific and detecting clinically insignificant cancers 3. Overtreatment of indolent cancers can cause significant morbidity

Testicular Germ Cell Neoplasms: Prognosis (Seminoma, Nonseminomatous, Choriocarcinoma)

1. Seminoma has the best prognosis and is extremely radiosensitive 2. Nonseminomatous germ cell tumors have a cure rate of 90% with aggressive chemotherapy 3. Choriocarcinoma is associated with a poorer prognosis 4. Recurrences usually occur within the first 2 years after treatment

Seminomas vs Nonseminomatous Tumors of Testis

1. Seminomas: confined to testis for long periods, metastases to iliac and paraaortic lymph nodes, hematogenous metastases occur late 2. Nonseminomatous germ cell neoplasms: tend to metastasize earlier, by lymphatic and hematogenous routes, metastatic lesions may contain elements of other germ cell tumors Hematogenous metastases are most common in the liver and lungs.

Seminoma: Morphology (7)

1. Soft, well-demarcated, gray-white tumor 2. Large tumors may contain foci of coagulative necrosis 3. Composed of large, uniform cells with distinct cell borders, clear, glycogen-rich cytoplasm, round nuclei, and conspicuous nucleoli 4. Cells often are arrayed in small lobules with intervening fibrous septa 5. A lymphocytic infiltrate usually is present and may overshadow the neoplastic cells 6. May elicit a granulomatous reaction 7. In approximately 15% of cases, syncytiotrophoblasts are present

Congenital Syphilis: Manifestations and Morphology (4)

1. Stillbirth, infantile syphilis, and late (tardive) congenital syphilis are the manifestations of congenital syphilis. 2. Among stillborn infants, the most common manifestations are hepatomegaly, bone abnormalities, pancreatic fibrosis, and pneumonitis. 3. Infants with syphilis present with chronic rhinitis (snuffles) and mucocutaneous lesions. 4. Late congenital syphilis (more than 2 years) can cause the Hutchinson triad: notched central incisors, interstitial keratitis with blindness, and deafness from eighth cranial nerve injury.

Syphilis Diagnosis: Serologic Tests

1. Syphilis is treated with antibiotics like penicillin 2. Serologic tests are used to diagnose syphilis 3. Nontreponemal antibody tests detect antibody to cardiolipin 4. Nontreponemal antibody tests are usually positive 4-6 weeks after infection 5. Nontreponemal antibody tests can revert to negative or be persistently positive

Sexually transmitted diseases (STDs): Syphilis: Definition and Epidemiology (6)

1. Syphilis or "Lues" is a chronic venereal (זיהום מין) infection caused by the spirochete Treponema pallidum 2. The usual source of infection is contact with a cutaneous or mucosal lesion in a sexual partner in the early (primary or secondary) stages of syphilis 3. Once introduced into the body, the organisms rapidly disseminate to distant sites through lymphatics and the blood, even before the appearance of lesions at the primary inoculation site 4. Syphilis can be divided into primary, secondary, and tertiary stages. 5. Increased incidence in men who have sex with men 6. In congenital cases, T. pallidum is transmitted across the placenta

Congenital Syphilis: Transmission and Manifestations (5)

1. T. pallidum can be transmitted from an infected mother to the fetus via placenta during pregnancy. 2. The risk of transmission is highest during primary and secondary stages when the spirochetes are most numerous. 3. Routine serologic testing for syphilis is mandatory in all pregnancies due to subtle maternal disease manifestations. 4. Congenital syphilis stigmata typically develop after the fourth month of pregnancy. 5. In the absence of treatment, up to 40% of infected infants die in utero, usually after the fourth month.

Tertiary Syphilis: Categories and Morphology (5)

1. Tertiary syphilis develops after a latent period of 5 years or more. 2. Divided into cardiovascular syphilis, neurosyphilis, and benign tertiary syphilis. 3. Cardiovascular syphilis is the most common and takes the form of syphilitic aortitis. 4. Neurosyphilis accounts for 10% of cases of tertiary syphilis overall but occurs at increased frequency in those with concomitant HIV infection 5. Tertiary syphilis may result in the formation of a Gumma (large areas of parenchymal damage) - Gummas contain a central zone of coagulative necrosis surrounded by dense fibrous tissue with an inflammatory infiltrate (delayed hypersensitivity reaction IV).

Testicular Neoplasms: Incidence and Risk Factors (10)

1. Testicular neoplasms incidence: 6 per 100,000 males 2. Most common tumors in men aged 15-34 years 3. Heterogeneous tumors include germ cell tumors and sex cord-stromal tumors 4. 95% of postpubertal testicular tumors arise from germ cells, and almost all are malignant 5. Sex cord-stromal tumors derived from Sertoli or Leydig cells are uncommon and usually benign 6. Cryptorchidism is associated with a 3- to 5-fold increase in the risk for cancer in the undescended testis, as well as an increased risk for cancer in the contralateral descended testis 7. A history of cryptorchidism is present in approximately 10% of cases of testicular cancer 8. Intersex syndromes, including androgen insensitivity syndrome and gonadal dysgenesis, also are associated with an increased frequency of testicular cancer 9. Brothers of males with germ cell tumors have an 8- to 10-fold increased risk 10. Extra copies of the short arm of chromosome 12, usually due to the presence of an isochromosome 12 >i(12p)@, are found in virtually all germ cell tumors

Bladder Metaplasia:

1. Transitional epithelium in the bladder can undergo metaplasia 2. Nests of urothelium (Brunn nests) can grow downward into the lamina propria 3. Urothelium often undergoes squamous metaplasia in response to injury

Treatment of Bladder Cancer (3)

1. Transurethral resection is used for small, localized papillary tumors that are not high-grade 2. BCG (Bacillus Calmette-Guérin) is an attenuated strain of the tuberculosis bacillus used for topical immunotherapy - BCG elicits a granulomatous reaction and triggers an effective local anti-tumor immune response 3. Radical cystectomy is reserved for: a. Tumors invading the muscularis propria b. CIS or high-grade papillary cancer refractory to BCG. c. CIS extending into the prostatic urethra and down the prostatic ducts

Spermatocytic Tumor: Clinical and Histologic Characteristics (7)

1. Uncommon testicular tumor 2. Occurs in older men beyond 50 years 3. Lack lymphocytic infiltrates, granulomas, and syncytiotrophoblasts 4. Not admixed with other germ cell tumor histologies 5. Not associated with germ cell neoplasia in-situ 6. Does not metastasize 7. Comprises polygonal cells of variable size arranged in nodules or sheets

What is the most common cause of hydronephrosis in infants and children? 1. Ureteropelvic junction (UPJ) obstruction 2. Retroperitoneal fibrosis 3. Malignant tumors of the ureter 4. None of the above

1. Ureteropelvic junction (UPJ) obstruction

Sexually transmitted diseases (STDs): Epidemiology (2)

1. Women are more likely to become infected and asymptomatic 2. 5 out of 10 leading infectious diseases in the US are STDs

A 25-year-old sexually active male presents with a painless ulcer on the glans of his penis that gradually enlarged over the past 2 to 4 weeks after sexual exposure. The ulcer has well-defined, indurated margins and a "clean," moist base. On examination, the regional lymph nodes are slightly enlarged and firm. Microscopic examination of the ulcer reveals the typical lymphocytic and plasmacytic inflammatory infiltrate and endarteritis, and spirochetes are readily demonstrable in histologic sections. 1. What is the most likely diagnosis of the patient based on the clinical presentation and histologic findings? a) Primary Syphilis b) Secondary Syphilis c) Chancroid d) Genital Herpes 2. What is the possible complication that can arise from untreated syphilis? a) Cardiovascular disease b) Neurosyphilis c) Congenital Syphilis d) All of the above

1. a) Primary Syphilis The diagnosis of primary syphilis is based on the characteristic clinical presentation and the histologic findings. The patient in this case report has a painless ulcer on the glans of his penis, with well-defined, indurated margins, and a "clean," moist base. These are the characteristic features of a chancre, which is the hallmark of primary syphilis. The histologic examination of the ulcer shows a typical lymphocytic and plasmacytic inflammatory infiltrate and endarteritis, and spirochetes are readily demonstrable in histologic sections. These findings are consistent with the diagnosis of primary syphilis, which is caused by the bacterium Treponema pallidum.

A 45-year-old male presents with a painless, non-healing ulcer on the shaft of his penis. The lesion started as a small papule 4 months ago, and gradually enlarged into a non-tender ulcer with an indurated border. The patient denies any history of recent sexual exposure, but admits to occasional unprotected sex with multiple partners in the past. Physical examination reveals a single, well-defined ulcer with a clean base and raised borders. There is no regional lymphadenopathy. Serologic testing for syphilis is positive. 1. What is the most likely diagnosis of the patient based on the clinical presentation and serologic testing? a) Primary Syphilis b) Secondary Syphilis c) Latent Syphilis d) Tertiary Syphilis

1. b) Secondary Syphilis Explanation: The clinical presentation of the patient with a painless, non-healing ulcer on the penis shaft, along with positive serologic testing, is highly suggestive of secondary syphilis. The indurated border and clean base of the ulcer are also consistent with secondary syphilis. -Option a) is unlikely as primary syphilis usually presents with a painless, indurated ulcer called a chancre, which occurs at the site of inoculation (usually the genitalia). The patient in this case report has a non-tender ulcer that developed several months after the initial papule, which is more consistent with secondary syphilis.

Choriocarcinoma: Definition and Morphology (4)

A tumor that arises from pluripotential neoplastic germ cells 1. Cells resembling placental trophoblasts 2. Primary tumors often small and nonpalpable 3. Tumor composed of sheets of small cuboidal cytotrophoblast cells irregularly intermingled with or capped by large, eosinophilic syncytiotrophoblast cells containing multiple dark, pleomorphic nuclei 4. HCG can be identified in the syncytiotrophoblastic cells by immunohistochemical staining

A 55-year-old uncircumcised male presents with a solitary plaque on the shaft of his penis. Biopsy shows dysplastic cells throughout the epidermis with no invasion of the underlying stroma. What is the most likely diagnosis? A) Bowen's disease B) Invasive squamous cell carcinoma C) Basal cell carcinoma D) Melanoma

A) Bowen's disease (squamous cell carcinoma in situ of the penis) is the most likely diagnosis. This is characterized by a solitary plaque on the shaft of the penis with dysplastic cells throughout the epidermis but without invasion of the underlying stroma. It has a 10% risk of progression to invasive squamous cell carcinoma.

What is the difference between cystitis glandularis and cystitis cystica? A) Cystitis glandularis is characterized by goblet cells, while cystitis cystica is characterized by cystic spaces filled with clear fluid lined by fattened urothelium. B) Cystitis glandularis is characterized by cystic spaces filled with clear fluid lined by fattened urothelium, while cystitis cystica is characterized by goblet cells. C) Both are characterized by goblet cells. D) Both are characterized by cystic spaces filled with clear fluid lined by fattened urothelium.

A) Cystitis glandularis is characterized by goblet cells, while cystitis cystica is characterized by cystic spaces filled with clear fluid lined by fattened urothelium. Explanation: Cystitis glandularis and cystitis cystica are two distinct forms of metaplasia in the bladder. Cystitis glandularis is characterized by the differentiation of epithelial cells into cuboidal or columnar epithelium, often accompanied by the presence of goblet cells. Cystitis cystica, on the other hand, is characterized by the formation of cystic spaces filled with clear fluid, lined by fattened urothelium.

What is the most common complication associated with bilateral cryptorchidism? A) Infertility B) Testicular cancer C) Epididymitis D) Hydrocele

A) Infertility is the most common complication associated with bilateral cryptorchidism. Undescended testes become atrophic, resulting in sterility. Unilateral cryptorchidism may also lead to atrophy of the contralateral descended gonad. There is an increased risk of testicular cancer associated with cryptorchidism, but this is more common in cases of unilateral cryptorchidism. There is no significant association with epididymitis or hydrocele.

A 60-year-old man presents with hematuria and dysuria. A biopsy of the bladder lesion reveals squamous cell carcinoma. Which of the following factors is most likely associated with the development of squamous cell carcinoma of the bladder? A) Urinary schistosomiasis B) Smoking C) Chemical exposure D) Genetic predisposition

A) Urinary schistosomiasis Explanation: Squamous cell carcinoma of the bladder is more common in countries where urinary schistosomiasis is endemic. Urinary schistosomiasis is a disease caused by infection of people with the parasitic worm Schistosoma haematobium

A 35-year-old male presented with painless swelling of his left testis for the past 2 months. Physical examination revealed a palpable, non-tender mass in the testis. Ultrasound of the scrotum showed a solid, hypoechoic mass in the left testis. Tumor markers, including alpha-fetoprotein, lactate dehydrogenase, and beta-human chorionic gonadotropin, were within normal limits. The patient underwent left radical orchiectomy, and gross examination revealed a well-demarcated, gray-white tumor that bulged from the cut surface of the affected testis. What is the most likely diagnosis based on the morphology findings? A. Seminoma B. Embryonal carcinoma C. Yolk sac tumor D. Choriocarcinoma E. Teratoma

A. Seminoma. The well-demarcated, gray-white tumor that bulges from the cut surface of the affected testis is a classic morphologic finding of seminoma. In addition, the presence of a lymphocytic infiltrate and possible granulomatous reaction supports the diagnosis of seminoma. The normal tumor marker levels also suggest a diagnosis of seminoma, which is typically associated with normal levels of alpha-fetoprotein and lactate dehydrogenase and only minimally elevated levels of beta-human chorionic gonadotropin in some cases. Embryonal carcinoma, yolk sac tumor, choriocarcinoma, and teratoma may also occur in the testis but would have different morphologic features and/or tumor marker profiles.

What is the most common cause of granulomatous inflammation in the testis? A. Tuberculosis B. Autoimmune injury C. Infections D. Trauma

A. Tuberculosis. Testicular tuberculosis is the most common cause of granulomatous inflammation in the testis. The histological examination reveals granulomatous inflammation and caseous necrosis, which is identical to that seen in active tuberculosis in other sites.

What is the most common form of cancer in men?

Adenocarcinoma of the prostate (Developing in the acini of prostatic ducts) - Accounting for 27% of cancer cases in the United States in 2014

A 60-year-old male presents with recurrent urinary tract infections and bladder discomfort. Imaging reveals a large bladder diverticulum. A biopsy of the bladder mucosa is taken during cystoscopy. Histologic examination reveals broad bulbous polypoid projections of the urothelium, with marked submucosal edema. Question 1: What is the likely diagnosis of the bladder condition in this patient? A. Bladder diverticulum B. Interstitial cystitis C. Polypoid cystitis D. Malakoplakia

Answer 1: C. Polypoid cystitis. The histologic examination findings of broad bulbous polypoid projections of the urothelium and marked submucosal edema are characteristic of polypoid cystitis. Answer: B. Bladder outlet obstruction. Polypoid cystitis can lead to bladder outlet obstruction due to the presence of the polypoid projections. This can result in urinary retention, recurrent urinary tract infections, and even renal failure if left untreated.

What is the most common cause of squamous metaplasia in the bladder? A) Injury B) Infection C) Age D) Congenital malformation

Answer: A) Injury Explanation: Squamous metaplasia in the bladder is a common response to injury, such as chronic inflammation or irritation. It is important to differentiate squamous metaplasia from normal glycogenated squamous epithelium, which can be commonly found at the trigone in women.

A 62-year-old man presents with a history of urinary frequency, urgency, hesitancy, and weak stream for the past year. A digital rectal examination reveals an enlarged, non-tender prostate. His serum prostate-specific antigen (PSA) level is within the normal range. Which of the following is the most likely diagnosis for this patient? A) Prostate cancer B) Benign prostatic hyperplasia (BPH) C) Prostatitis D) Urinary tract infection E) Bladder cancer

B) Benign prostatic hyperplasia Explanation: The clinical presentation and findings on digital rectal examination are consistent with BPH. Prostate cancer typically presents with an elevated PSA level and may have nodularity on digital rectal examination. Prostatitis may present with similar symptoms, but the prostate is usually tender on examination. Urinary tract infection and bladder cancer may cause similar symptoms but are less likely in the absence of other specific findings.

Which of the following is a common complication of bladder cancer? A) Acute renal failure B) Metastasis to the lung C) Bowel obstruction D) Urinary tract infection

B) Metastasis to the lung Explanation: Bladder cancer can metastasize to other organs, with the lungs being one of the most common sites.

A patient with a noninvasive papillary urothelial neoplasm is diagnosed. What is the most important prognostic factor? A) The size of the tumor B) The grade of the tumor C) The presence of a precursor lesion D) The age of the patient

B) The grade of the tumor

Which of the following is a characteristic microscopic finding in a cryptorchid testis? A) Epithelial cell hyperplasia B) Tubular atrophy C) Glomerular collapse D) Cardiomyocyte hypertrophy

B) Tubular atrophy Explanation: Microscopic examination of a cryptorchid testis usually reveals tubular atrophy, which begins to appear by 5 to 6 years of age and is usually advanced by the time of puberty. Epithelial cell hyperplasia and glomerular collapse are findings seen in kidney diseases, not related to cryptorchidism. Cardiomyocyte hypertrophy is a finding in cardiac disease and not related to cryptorchidism.

What is the most common cause of urinary obstruction in a 65-year-old male presenting with difficulty urinating and an enlarged prostate on rectal examination? A. Prostate cancer B. Benign Prostatic Hyperplasia (BPH) C. Chronic prostatitis D. Urethral stricture

B. Benign Prostatic Hyperplasia (BPH) Benign Prostatic Hyperplasia (BPH) is the most common cause of urinary obstruction in older men, and is characterized by an enlarged prostate with hyperplastic nodules that compress the urethra. Prostate cancer can also cause urinary obstruction, but is less common than BPH. Chronic prostatitis and urethral stricture can cause urinary symptoms, but typically present with other signs and symptoms that were not mentioned in the question stem. The expected morphology finding would be an enlarged prostate with well-circumscribed nodules on cut surface and histologically composed of proliferating glandular elements and fibromuscular stroma, as described in the text.

A 30-year-old pregnant woman presents to her obstetrician for a routine check-up. Serologic testing for syphilis reveals a positive result, and further evaluation shows that the woman has primary syphilis. What is the risk of transmission of T. pallidum to the fetus in this case, and what is the expected manifestation of congenital syphilis? a. High risk of transmission during primary syphilis, with expected stigmata of congenital syphilis at birth. b. Low risk of transmission during primary syphilis, with no expected stigmata of congenital syphilis. c. High risk of transmission during tertiary syphilis, with expected stigmata of congenital syphilis at birth. d. Low risk of transmission during tertiary syphilis, with no expected stigmata of congenital syphilis.

a. High risk of transmission during primary syphilis, with expected stigmata of congenital syphilis at birth. When a pregnant woman has syphilis, there is a risk of transmitting the bacteria T. pallidum to the fetus, which can lead to congenital syphilis. The risk of transmission is highest during the primary and secondary stages of syphilis, and lower during the latent and tertiary stages. "Stigmata of congenital syphilis at birth" means that a newborn baby has physical signs or symptoms that are characteristic of syphilis, which is a sexually transmitted infection that can be passed from a pregnant woman to her unborn child.

What factors are associated with the risk of recurrence of bladder tumors? a. Tumor size, stage, and grade b. Tumor type, location, and duration c. Patient age, sex, and race

a. Tumor size, stage, and grade. The risk for recurrence of bladder tumors is related to several factors, including tumor size, stage, grade, multifocality, mitotic index, and associated dysplasia and/or CIS.

What is the most common location for lymphadenopathy in patients with secondary syphilis? a) Abdomen b) Neck c) Chest d) Lower extremities

b) Neck Explanation: Lymphadenopathy is most commonly found in the neck and inguinal areas in patients with secondary syphilis.

A 55-year-old man presents with a testicular mass. Pathological examination of the mass reveals small, medium, and large polygonal cells without an inflammatory infiltrate. Which of the following is the most likely diagnosis? a) Embryonal carcinoma b) Spermatocytic tumor c) Yolk sac tumor d) Choriocarcinoma e) Seminoma

b) Spermatocytic tumor #Spermatocytic tumor: Tumor Peak Patient Age (years): 50-60 Morphology: Small, medium, and large polygonal cells; no inflammatory infiltrate Tumor Marker(s): Negative

A 25-year-old male presents with a testicular mass. On histological examination, the tumor is composed of cytotrophoblast and syncytiotrophoblast without villus formation. Which of the following tumor markers is most likely to be elevated in this patient? a) AFP b) hCG c) CA-125 d) CEA

b) hCG #Choriocarcinoma Tumor Peak Patient Age (years): 20-30 Morphology: Cytotrophoblast and syncytiotrophoblast without villus formation Tumor Marker(s): 100% of patients have elevated hCG

What is the most common risk factor for developing squamous cell carcinoma of the bladder? a. Genetic mutations b. Chronic bladder irritation and infection c. Exposure to industrial chemicals

b. Chronic bladder irritation and infection. Squamous cell carcinoma of the bladder is nearly always associated with chronic bladder irritation and infection.

What is the typical histological finding in squamous cell carcinoma of the bladder? a. Neuroendocrine differentiation b. Extensive keratinization c. Psammoma bodies

b. Extensive keratinization is a typical histological finding in squamous cell carcinoma of the bladder. Squamous cell carcinomas of the bladder are nearly always associated with chronic bladder irritation and infection and are characterized by extensive keratinization. Neuroendocrine differentiation and psammoma bodies are not typically seen in squamous cell carcinoma of the bladder.

Which part of the prostate do most prostate cancers arise from? a. Central glands b. Peripheral glands c. Transition zone d. Periurethral glands

b. Peripheral glands The text states that 70-80% of prostate cancers arise in the outer (peripheral) glands.

If the patient has elevated levels of AFP, what will be your diagnosis? a. Teratoma b. Yolk sac tumor c. Tumor burden d. Choriocarcinoma

b. Yolk sac tumor

What is the most common manifestation of tertiary syphilis? a) Gumma b) Neurosyphilis c) Cardiovascular Syphilis d) Malignant Syphilis

c) Cardiovascular Syphilis Explanation: The text states that cardiovascular syphilis takes the form of syphilitic aortitis and accounts for more than 80% of cases of tertiary disease.

Which type of prostatitis is associated with leukocytes in prostatic secretions? a) Acute bacterial prostatitis b) Chronic bacterial prostatitis c) Inflammatory chronic pelvic pain syndrome d) Noninflammatory chronic pelvic pain syndrome

c) Inflammatory chronic pelvic pain syndrome. This type of prostatitis is characterized by the presence of leukocytes in prostatic secretions, while noninflammatory chronic pelvic pain syndrome is characterized by the absence of leukocytes. Acute and chronic bacterial prostatitis are caused by common uropathogens and are not associated with leukocytes in prostatic secretions.

What is the appearance of advanced prostate carcinoma? a. Firm, gray-white lesions with well-defined margins b. Soft, yellow lesions with well-defined margins c. Firm, gray-white lesions with ill-defined margins d. Soft, yellow lesions with ill-defined margins

c. Firm, gray-white lesions with ill-defined margins

A 60-year-old male presents with painless hematuria. Cystoscopy reveals a mass in the dome of the bladder. Biopsy shows adenocarcinoma of the bladder. What is the expected morphology finding in this patient? a. Extensive keratinization b. Psammoma bodies c. Glandular structures

c. Glandular structures. Adenocarcinomas of the bladder are histologically identical to adenocarcinomas seen in the gastrointestinal tract, and are characterized by glandular structures. Explanation: Adenocarcinoma of the bladder is characterized by the presence of glandular structures, which are identical to those seen in adenocarcinomas of the gastrointestinal tract. It may arise from urachal remnants in the dome of the bladder or in association with extensive intestinal metaplasia. The presence of glandular structures is a key diagnostic feature of adenocarcinoma, as opposed to other types of bladder cancer such as squamous cell carcinoma, which typically shows extensive keratinization. Psammoma bodies, on the other hand, are typically seen in papillary carcinoma of the bladder.

A 45-year-old man presents with right-sided flank pain and hematuria. Imaging studies reveal hydronephrosis and ureteral obstruction. A biopsy of the obstructed segment of the ureter shows a thickened fibrous wall with plasma cell-rich infiltrate. Immunohistochemistry shows a high number of IgG4-secreting plasma cells. 1. What is the most likely diagnosis? a) Ureteropelvic junction (UPJ) obstruction b) Malignant ureteral tumor c) Retroperitoneal fibrosis d) IgG4-related disease

d) IgG4-related disease, as the biopsy findings suggest a fibroinflammatory process with a high number of IgG4-secreting plasma cells, which is a characteristic feature of IgG4-related disease.

What is the most common disorder that affects the prostate? a) Infectious diseases b) Inflammatory diseases c) Hyperplastic disorders d) Neoplastic disorders

d) Neoplastic disorders, particularly prostate cancer, is the most important clinically. While the prostate can be affected by various infectious, inflammatory, and hyperplastic disorders, prostate cancer is the most significant disorder. It is important to note that most carcinomas arise in the peripheral zones of the prostate and can be detected by rectal examination.

What is a common site of metastasis in late-stage prostate cancer? a. Brain b. Lungs c. Liver d. Bones

d. Bones Explanation: The text mentions that bone metastases, particularly to the axial skeleton, are frequent late in the disease and typically cause osteoblastic (bone-producing) lesions that can be detected on radionuclide bone scans.

What is the morphology of malignant glands in prostate carcinoma? a. Larger than benign glands with branching and papillary infolding b. Smaller than benign glands with branching and papillary infolding c. Larger than benign glands without branching and papillary infolding d. Smaller than benign glands without branching and papillary infolding

d. Smaller than benign glands without branching and papillary infolding

A 43-year-old man presents with a testicular mass. Pathological examination of the mass reveals sheets of uniform polygonal cells with cleared cytoplasm and lymphocytes in the stroma. Which of the following is the most likely diagnosis? a) Embryonal carcinoma b) Spermatocytic tumor c) Yolk sac tumor d) Choriocarcinoma e) Seminoma

e) Seminoma #Seminoma: Tumor Peak Patient Age (years): 40-50 Morphology: Sheets of uniform polygonal cells with cleared cytoplasm; lymphocytes in the stroma Tumor Marker(s): 10% of patients have elevated hCG

A 62-year-old male patient presents with difficulty initiating urination, a weak urinary stream, and frequent urination, especially at night. Digital rectal examination reveals an enlarged prostate gland that is smooth and firm to palpation. Laboratory tests reveal a mildly elevated prostate-specific antigen (PSA) level of 5.6 ng/mL. Transrectal ultrasound demonstrates enlargement of the prostate gland. Based on these findings, which of the following is the most likely diagnosis for this patient and what will be the most likely location of the enlarged prostate? A. Prostate adenocarcinoma particularly in the inner transition zone. B. Prostatic hyperplasia, particularly in the inner transition zone. C. Prostatitis, particularly in the inner transition zone. D. Testicular cancer, particularly in the outer transition zone. E. B. Prostatic hyperplasia, particularly in the outer transition zone.

B. Prostatic hyperplasia, particularly in the inner transition zone. The symptoms of difficulty initiating urination, weak urinary stream, and frequent urination, especially at night, along with an enlarged prostate gland that is smooth and firm to palpation and elevated PSA levels, are consistent with BPH. The location of the enlarged prostate in BPH is typically in the inner transition zone of the prostate. Therefore, option B is the correct answer. Option A is incorrect because adenocarcinoma is associated with a hard, irregular prostate gland on palpation. Option C is incorrect because prostatitis is associated with a tender prostate gland on palpation. Option D is incorrect because testicular cancer does not involve the prostate gland. Option E is incorrect because BPH is typically located in the inner transition zone of the prostate.

Define Balanitis and Balanoposthitis

Balanitis = Local inflammation of the glans penis Balanoposthitis = Inflammation of the head of your penis and foreskin

Nonneoplastic conditions of the Urinary Bladder: Bladder or Vesical diverticulum: Definition

Bladder or vesical diverticulum is an evagination of the bladder wall that can be acquired and result from persistent urethral obstruction.

A 35-year-old man presents with a painless testicular mass. On examination, a well-defined, solid mass is palpable in the right testis. The patient undergoes radical orchiectomy, and the pathology report reveals an embryonal carcinoma. Which of the following morphologies is most likely to be observed in the tumor cells? A) Small cells with scanty cytoplasm and round nuclei B) Large cells with clear cytoplasm and central nuclei C) Large cells with basophilic cytoplasm, indistinct cell borders, large nuclei, and prominent nucleoli D) Cells forming papillary structures with cuboidal epithelium

C) Large cells with basophilic cytoplasm, indistinct cell borders, large nuclei, and prominent nucleoli are the characteristic features of embryonal carcinoma. While embryonal carcinoma cells can form primitive glandular structures and irregular papillae, they can also be arranged in undifferentiated, solid sheets. Cells characteristic of other germ cell tumors can also be admixed with embryonal carcinoma areas. Small cells with scanty cytoplasm and round nuclei are more typical of a seminoma, while large cells with clear cytoplasm and central nuclei are more typical of a yolk sac tumor. Cells forming papillary structures with cuboidal epithelium are more typical of a teratoma.

What are the two precursor lesions of invasive urothelial carcinoma? A) Noninvasive papillary tumor and invasive papillary tumor B) Carcinoma in situ and invasive papillary tumor C) Noninvasive papillary tumor and carcinoma in situ D) Carcinoma in situ and noninvasive solid tumor

C) Noninvasive papillary tumor and carcinoma in situ Explanation: The text states that noninvasive papillary tumor and carcinoma in situ are the two precursor lesions of invasive urothelial carcinoma.

A 12-year-old male patient presented with a palpable mass in his right testis. The mass had been gradually increasing in size over the past few months, and the patient had been experiencing mild pain and discomfort in the area. Ultrasound imaging revealed a heterogeneous mass with cystic areas and calcifications. Tumor markers, including alpha-fetoprotein and beta-human chorionic gonadotropin, were within normal limits. A right radical orchiectomy was performed, and the excised tissue was sent for histopathological analysis. Diagnosis Question: What is the most likely diagnosis for the patient's testicular mass? A) Seminoma B) Leydig cell tumor C) Teratoma D) Embryonal carcinoma E) Yolk sac tumor

C) Teratoma.

What is the most common type of bladder cancer in the United States? A) Adenocarcinoma B) Squamous cell carcinoma C) Urothelial carcinoma D) Neuroendocrine carcinoma

C) Urothelial carcinoma