Male reproductive
What is Klinefelter syndrome?
A condition in which a male has an extra X chromosome: characteristic features include small testicles, infertility, gynecomastia, long legs, and abnormally low intelligence
What is term used for calcifications commonly seen in the central zone
Corpora amylacea
Blood is supplied directly to the epididymis through which artery
Cremasteric
Gonadoblastoma occurs majority with
Cryptorchidism and hypospadia
Which RARE congenital malformation is frequently seen with renal agenesis or dysplasia
Cystic dysplasia
Lyedig cell tumor
Foun in younger boys and produce increased levels of testosterone
Granulosa cell tumor
Found in younger boys and are associated with chromosomal abnormalities
Sertoli cell tumor
Found in younger boys and produce estrogens that results in Gynecomastia
Microlithiasis is seen with
Germ cell tumors, Cryptorchidism, trisomy 21, klinefelter syndrom, previous radio therapy
What is used to score prostate cancer
Gleason score 1-10 with 10 as the most aggressive
Choriocarcinoma can cause
Gynecomastia due to high level of beta hCG
USA of prostatitis
Heterogenous peripheral gland, hypoechoic halo at teh periurethra area, abscess formation can occur, marked hypervascularity
What is the most common cause of painless swelling
Hydrocele
Peripheral zone appears______ ______ to adjacent parenchyma
Hyperechoic slightly
USA of epi Dermoid cysts
Hypoechoic mass, thickened or calcified wall , onion appearance, Avascular, the cyst contains keratin
Labs for choriocarcinoma
Increased levels of beta hCG, AFP level usually normal
What is prehn sign
Is used to differentiate epididymo-orchitis from torsion lifting the painful scrotum above the level of the symphysis pubis will relieve pain when infection is the cause for symptoms no redacted in pain with torsion
Normal prostate volume
Less than 30mL
What is the most common bilateral testicular tumor
Lymphoma
What is the most common secondary malignancy of the testes
Lymphoma
4-10ng.ml is suspicious for
Malignancy
TRUS is used to
Measure the prostate volume, guide biopsy and guide therapy
What is the most common non-seminomatous germ cell tumor
Mixed germ cell tumor
USA of EMbryonal cell carcinoma
More heterogenous than seminoma , can have solid and cystic portions along with coarse calcification
Viral orchitis is most commonly caused by
Mumps
Do all prostate cancers cause an elevated PSA level ?
No
Penile cancer is usually identifies
On the glans penis or on the foreskin in uncircumcised men
Lyedig cell tumors b or m?
Over 85 % are benign
What is measured to assess prostate health
PSA
70% of prostate ca originate where
Peripheral zone
What is teh less common sight for BPH
Peripheral zone
Development of scar tissue and fibrous plaque formation that usually involves the tunica albuginea
Peyronie disease
Unwanted, persisten, painful erection that lasts more than 4 hours is termed
Priapism
What are the two types of Varicocele
Primary- often found on teh left and are palpable during a physical exam Secondary- found on the right which is associated with hepatic mass, marked hydro, hepatomegaly or a retroperitoneal neoplasm like a right sided renal mass
Testicular mets most commonly comes from? (2)
Prostate Lung primary
prostatic acid phosphatase is elevated with ?
Prostate cancer
Peyronie disease causes
Restriction and curvature of teh affected side of the penis during erection
Seminoma spread to the
Retroperitoneal lymph nodes first
Acute epididymitis commonly results from
STI in males 14-35 and UTI in men over 35
What presents as recurrent epididymitis
Sarcoidosis
Most common cancer to affect the penis is
Squamous cell carcinoma
The base of the prostate is located
Superior portion of the gland that is situated below the inferior margin of the urinary bladder
Is is used for infertility screening of teh prostate to try to locate prostate anomalies that may contribute to the problem
TRUS
What is the 2nd most common testicular tumor in infants and young children
Teratoma ( usually benign but can be malignant )
Leydig cell tumros produce
Testosterone and sometimes estrogen can cause endocrine imbalance with estrogen and testosterone leading to precocious puberty, impotence, and gynecomastia
Contraindications for prostate biopsy
UTI
Symptoms of BPH
Urinary frequency, nocturnal, weak urine stream, incomplete emptying
Most common testicular tumor in patients less that 2 yo
Yolk sac tumor
Labs of embryonal cell carcinoma
AFP and beta hCG
Seminomatous tumor afp and bhCG levels
AFP levels normal, cause cause elevated bhCG
Tubular ectasia is usually
Bilateral and seen with a spermatocele
What therapy is used in non-aggressive in situ cancers
Brachytherapy
The penis is covered with a dense fibrous tissue termed
Buck fascia
Normal levels of PSA range from
0-4 ng/ml
Age for choriocarcinoma
20-30
Age for seminomatous tumor
30-50 yr
Extra-capsular carcinoma locations
70% peripheral 20% transitional 10% central
INR levels for biopsy should be
<1.5 to prevent increased risk of hemorrhage from teh biopsy
What level of PSA is usually related to malignant
>10 ng/ml
What cells produce PSA
Acinar cells
What is the most common cause of acute scrotal pain in postpubertal men
Acute epididymitis is
What is the most common benign extratesticular tumor
Adenomatosis tumore
What tumor is associated with Cushing syndrome and adrenal hyperplasia
Adrenal rest
Extra-capsular carcinoma is most common after
Age 65 yrs and in AA men
Hydrocele occurs
Between the two layers of the tunica vaginalis
The majority of blood supplied to the prostate gland is throught the
Capsular artery
What is the rarest type of germ cell tumor
Choriocarcinoma
Which germ cell tumor has the worst prognosis
Choriocarcinoma
Fournier gangrene is usually seen in
Diabetic patients
Labs of yolk sac tumor
Elevated AFP and Beta hCG are usually normal
Teratomas lab
Elevated AFP and beta hCG level with malignancy
What is the most aggressive testicular malignancy
Embryonal cell carcinoma
Postvasectomy changes
Epididymal enlarment , tubular ectasia of the epididymis, spermatocele and cysts, dilated vas deferens
Tubular ecstasia of the rete testis is associated with
Epididymal inflammation or trauma
When the epididymal head measures >17 mm its a sign of
Epididymitis
What else would you evaluate with benign prostatic Hypertrophy
Evaluate the kidney- an enlarged prostate can cause urine retention in teh bladder an associated hydro
What is the most frequently diagnosed malignancy in a male
Extra-capsular carcinoma
Are you able to differentiate the transition and central zones of the prostate via ultrasound?
False
There is no glandular tissue with which region of the prostate?
Fibromuscular region-therefore not affected by cancer, inflammation, or BPH bc it is not functional prostate tissue
What stores sperma no secrete fructose for ejactulation ?
Seminal vesicle
Bacterial orchitis is most commonly caused by ?
Sexually transmitted disease
What is teh Eiffel Tower sign
Shadowing created by dense tissues in the area of the urethra and verumontanum
What are contraindications of TRUS ( Transrectal ultrasound)
Significatn rectal abnormalities that prevent tolerable probe insertion: fissures, neoplasms, hemorrhoids, or prostatitis
Seminal vesicle cyst may be associated with
Sinner syndrome - consists of unilateral renal agenesis, ipsilateral. Seminal vesicle cyst, and ejaculatory duct obstruction patients with sinner syndrome present with perineal pain, recurrent prostatitis, painful ejactualaiton and infertility
The fibromuscular region is made up of
Smooth muscle and fibrous tissues
Seminoma USA
Solid round or oval tumor, uniform low level echoes, WITHOUT calcification , hypoechoic to surrounding tissue , tumors greater thats 1.6cm usually show hypervascularity RARELY become necrotic or cystic
What is the most common scrotal mass
Spermatocele
Seminal vesicles secrete fructose for?
To provide an energy source for sperm and alkalinity to enhance sperm mobility
Seminomas have been associated with
Trisomy 21, Klinefelter syndrome, smoking
Nodule formation within the epididymis is termed
Tuberculosis
95% of BPH's occur where?
transitional zone
