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Questions and Answers

Which of the following is considered a pre-malignant condition of the penis?

  • Prostatitis
  • Squamous cell carcinoma
  • Condyloma accuminatum
  • Bowen Disease (correct)

    • What is the primary cause of Condyloma accuminatum?

  • High-risk HPV
  • Low-risk HPV subtypes, especially type 6 and 11 (correct)
  • Fungal infection
  • Bacterial infection

    • Which of the following is NOT a common neoplasm of the penis?

  • Bowenoid Papulosis
  • Giant condyloma
  • Prostatic carcinoma (correct)
  • Bowen Disease

    • What is the typical age range for young males affected by bowenoid papulosis?

    <p>16-35 years</p> Signup and view all the answers

    What is the primary oncogenic HPV strain associated with bowenoid papulosis?

    <p>HPV 16</p> Signup and view all the answers

    What is the most common site for genital condylomas?

    <p>Coronal sulcus</p> Signup and view all the answers

    What is the likelihood of untreated Bowen disease transforming into squamous cell carcinoma?

    <p>5-33%</p> Signup and view all the answers

    What type of cancer is primarily associated with the penis?

    <p>Squamous cell carcinoma</p> Signup and view all the answers

    Which of the following is a characteristic feature of Condyloma accuminatum?

    <p>Cytologic atypia is minimal</p> Signup and view all the answers

    Which of the following features is associated with squamous cell carcinoma of the penis?

    <p>Indurated white plaque leading to ulceration</p> Signup and view all the answers

    In which demographic is Bowen disease most commonly observed?

    <p>Older males with an average age of 61 years</p> Signup and view all the answers

    Which of the following is a defined characteristic of benign prostatic enlargement (BPE)?

    <p>It does not usually progress to malignancy</p> Signup and view all the answers

    Which condition is associated with hyperkeratosis, parakeratosis, and koilocytosis?

    <p>Condyloma accuminatum</p> Signup and view all the answers

    What is a significant risk factor for the development of squamous cell carcinoma of the penis?

    <p>Presence of smegma due to lack of circumcision</p> Signup and view all the answers

    Which HPV strains are primarily identified in penile intra-epithelial neoplasia (IEN)?

    <p>HPV 16 and 18</p> Signup and view all the answers

    What is the survival rate for men with limited squamous cell carcinoma to the shaft of the penis after undergoing penectomy?

    <p>95-100%</p> Signup and view all the answers

    What percentage of cases with prostatic intra-epithelial neoplasia (PIN) may progress to cancer within approximately 10 years?

    <p>33%</p> Signup and view all the answers

    Which stage classification indicates the presence of distant metastases in prostate cancer?

    <p>Stage D</p> Signup and view all the answers

    In cases of prostate cancer, which treatment is typically indicated for patients classified under stages A and B?

    <p>Radical prostatectomy</p> Signup and view all the answers

    What role do androgen receptors play in prostate cancer development?

    <p>They are involved in the progression of malignancy</p> Signup and view all the answers

    What is the typical Gleason score for well-differentiated prostate cancer?

    <p>6 or lower</p> Signup and view all the answers

    What condition is characterized by numerous small dark blue lymphocytes in the stroma between the glands?

    <p>Chronic bacterial prostatitis</p> Signup and view all the answers

    Which type of prostatitis can mimic cancer due to firm induration on physical examination?

    <p>Granulomatous prostatitis</p> Signup and view all the answers

    Benign prostatic enlargement often occurs due to which hormonal change?

    <p>Increase in DHT concentration</p> Signup and view all the answers

    Which complication is NOT associated with benign prostatic enlargement?

    <p>Prostate cancer</p> Signup and view all the answers

    Which of the following is a significant risk factor for developing prostate cancer?

    <p>Family history</p> Signup and view all the answers

    What is the typical incidence of benign prostatic enlargement by age 60?

    <p>70%</p> Signup and view all the answers

    Granulomatous prostatitis has been associated with which of the following conditions?

    <p>Tuberculosis</p> Signup and view all the answers

    Which age group has the highest incidence rate of prostate cancer?

    <p>70-75 years</p> Signup and view all the answers

    What is the most common type of tumor found in the urinary bladder?

    <p>Transitional cell carcinoma</p> Signup and view all the answers

    Which of the following is NOT a risk factor for urinary bladder cancer?

    <p>Lower dietary fat intake</p> Signup and view all the answers

    What is the classification of testicular tumors that includes seminomas and non-seminomatous germ cell tumors?

    <p>Germ cell tumors</p> Signup and view all the answers

    What is a key feature distinguishing seminomas from non-seminomatous germ cell tumors in clinical presentation?

    <p>Non-seminomatous tumors metastasize earlier</p> Signup and view all the answers

    Which staging classification indicates testicular cancer is confined to the testes?

    <p>Stage 1</p> Signup and view all the answers

    Which type of prostatitis is characterized by acute inflammation and the presence of neutrophils?

    <p>Acute suppurative prostatitis</p> Signup and view all the answers

    In cases of acute suppurative prostatitis, what common organisms might be responsible?

    <p>Escherichia coli</p> Signup and view all the answers

    What characterizes the histological presentation of acute suppurative prostatitis?

    <p>Acini distended by neutrophils</p> Signup and view all the answers

    Which of the following types of tumors is classified as a mesenchymal tumor?

    <p>Lymphoma</p> Signup and view all the answers

    Which form of metastatic spread is more likely to occur with non-seminomatous germ cell tumors?

    <p>Haematogenous spread only</p> Signup and view all the answers

    Study Notes

    Common Neoplasms of the Penis

    • Condyloma Accuminatum: Benign, caused by low-risk HPV subtypes 6 and 11, commonly found on the coronal sulcus and inner surface of the prepuce. Appears as single or multiple sessile or pedunculated red papillary excrescences.

    • Pre-malignant Lesions:

      • Bowenoid Papulosis: Found in young sexually active males (16-35 years old), characterized by small, multicentric, smooth, velvety lesions, primarily on the glans. Associated with oncogenic HPV subtypes 16, 18, and 33-35. Histologically, it's Penile Intraepithelial Neoplasia (IEN) grade III - in situ carcinoma.
      • Bowen Disease: Found in older males, associated with HPV strains 16, 18, 34, and 48. Appears as a single, well-demarcated, red papule/plaque. Untreated, it can transform into squamous cell carcinoma in 5-33% of cases.
      • HPV & Penile Intraepithelial Neoplasia (IEN): High-risk HPV subtypes (16 and 18) cause this condition. Graded I-III, based on the proportion of atypical cells replacing the epithelial thickness.

    • Squamous Cell Carcinoma: Accounts for 1% of cancers in the USA. Risk factors include lack of circumcision, HPV subtypes 16/18, and age (40-70 years). Most commonly affects the glans and inner surface of the prepuce. Often presents as an indurated white plaque that progresses to an ulcerating/fungating tumor.

    Spread and Staging of Penile Squamous Cell Carcinoma

    • Clinical Presentation: Slow-growing. Metastasizes to inguinal and iliac lymph nodes.
    • Survival: 95-100% 5-year survival if limited to the shaft, treated with penectomy. 30-50% survival with regional lymph node involvement.

    Tumours of the Urinary Tract

    • Ureter, Bladder, and Urethra: Common in the 6th-7th decade of life. Most commonly transitional cell carcinoma.
    • Urinary Bladder: Risk factors include cigarette smoking, prolonged exposure to cyclophosphamide, analgesic use, and bladder irradiation. Squamous cell carcinoma is uncommon, but can be linked to bilharzia.
    • Pathology: Papillary, polypoid, sessile or ulcerated lesions. Microscopically, invasive irregular aggregates, small clusters, and single neoplastic transitional cells are common.

    Tumours of the Testis

    • Classification:

      • Germ Cell Tumors: Seminoma, Embryonal Carcinoma, Yolk Sac Tumor, Trophoblastic Tumors, Teratomas
        • Mixed: Any combination of the above.
      • Sex-Cord Stromal Tumors: Leydig cell tumor, Sertoli cell tumor, Granulosa cell tumor.
      • Mixed Sex-Cord - Germ Cell Tumors
      • Mesenchymal Tumors
      • "Passenger" Cell Tumors: Lymphoma, Leukemia.

    • Germ Cell Tumors: Two main categories: Seminoma and Non-Seminomatous Germ Cell Tumors (NSGCT).

      • Presentation: Both present with a painless mass. ALL PAINLESS TESTICULAR MASSES SHOULD BE CONSIDERED A TUMOR UNTIL PROVEN OTHERWISE.
      • Seminoma Compared to NSGCT:
        • Seminoma: Remains localized for longer. Lymphatic spread is predictable. Radio and chemosensitive. Less aggressive and has a better prognosis.
        • NSGCT: Metastasizes earlier. Haematogenous spread is less predictable. Less sensitive to radiation and chemotherapy. More aggressive and has a poorer prognosis.

    Spread and Staging of Testicular Tumors

    • Lymphatic Spread: Retroperitoneal lymph nodes (internal iliac and para-aortic) to mediastinal and supraclavicular nodes.
    • Haematogenous Spread: Lung and liver
    • Staging (TNM Classification):
      • Stage 1: Confined to the testes.
      • Stage 2: Retroperitoneal lymph nodes below the diaphragm.
      • Stage 3: Metastases beyond retroperitoneal lymph nodes or above the diaphragm
      • Stage 4: Visceral metastases

    Pathology of the Prostate Gland

    Prostatitis

    • Types:
      • Acute Suppurative (Bacterial) Prostatitis: Secondary to urethritis or cystitis, often caused by coliforms (E. coli), staphylococci, and gonococci. May occur after urethral catheterization or endoscopy. Rarely, blood-borne infection.
      • Chronic Bacterial Prostatitis: Secondary to acute prostatitis. Commonly associated with sexually transmitted infections like chlamydia trachomatis.
      • Granulomatous Prostatitis: Heterogeneous group with enlargement of the gland and urethral obstruction. Aetiology: Idiopathic, tuberculosis, post-transurethral resection for BPH, allergic (eosinophilic), and post-BCG therapy.
      • Post-Biopsy Granuloma: Area of fibrinoid necrosis often seen in prostate biopsies.

    Benign Prostatic Enlargement (BPE)

    • Definition: Benign proliferation of all elements (hypertrophy and hyperplasia).
    • Incidence: Common, increasing with age. Only a small percentage require intervention.
    • Aetiology:
      • Hormonal Imbalance: Increased expression of testosterone receptors with aging, increasing sensitivity despite decreasing testosterone levels. Dehydrotestosterone (DHT) accumulates in the prostate, which is more potent than testosterone.
    • Pathology: Enlarged prostate, typically nodular, with yellowish-pink to fibrous white nodules. The transition zone is most commonly affected, compressing the urethra.

    Complications of BPE

    • Hypertrophy of the bladder leading to trabeculations (muscle bundles) and diverticula.
    • Urinary tract infections (UTIs).
    • Hydronephrosis (dilation of the renal pelvis due to obstruction).
    • While BPE is not pre-malignant, it is associated with prostate cancer as both commonly occur in the same age group.

    Tumors of the Prostate

    Prostate Carcinoma

    • Incidence: Most common cancer in men. Incidence increases significantly with age.
    • Aetiology:
      • Risk Factors: Age, race (blacks > whites), family history, environmental factors (fat consumption may influence testosterone levels), and vitamin A/β-carotene.
      • Endocrine Factors: Androgens play a permissive role. Castration or estrogen therapy can be used for treatment. Tumor cells express androgen receptors.

    Prostatic Intraepithelial Neoplasia (PIN)

    • Prevalence: Found in 80% of cases of adenocarcinoma.
    • Prognosis: 33% of cases progress to cancer within approximately 10 years. PIN shares the same molecular changes as carcinoma. Maligancy results from cumulative molecular changes.

    Diagnosis of Prostate Cancer

    • Symptoms: Urinary obstruction.
    • Digital Rectal Examination (DRE): Craggy, firm gland.
    • Transrectal Ultrasound (TRUS)
    • Serum Prostate-Specific Antigen (PSA): Elevated levels (above 4 ng/µl) often indicate cancer.
    • Biopsy: Confirms the diagnosis.

    Prognosis of Prostate Cancer

    • Histological Grading (Gleason's Score):
    • Clinical Staging:
      • Stage A: Incidental/unsuspected clinically. A1: <5% resected tissue; A2: >5%.
      • Stage B: Palpable on DRE, confined to prostate. B1: 1 lobe; B2: Both lobes.
      • Stage C: Beyond prostate, no metastases. C1: Not involving seminal vesicles; C2: Seminal vesicle involvement.
      • Stage D: Distant metastases

    Treatment of Prostate Cancer

    • Surgery:
      • Stage A and B: Radical prostatectomy, with a 15-year survival rate.
      • Stage C and D: Palliative.
    • Radiotherapy
    • Disseminated Disease: Palliative treatment may include:
      • Orchidectomy (Castration):
      • Estrogen Administration

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