Reproductive Pathology

*Chronic inflammation of TUNICA albuginea>ABNORMAL curvature of penis due to FIBROUS plaque within TUNICA ALBUGINEA.vs*Forced bEnding>rupture of corpora cavErnosa in the case of penile fracture.

PAINFUL erection that lasts MORE than 4 hours is giveaway for ISHCHEMIC PRIAPISM, board fav drug tested in this context is TRAZODONE(TCA used for anxiety/depression)but Sildenafil is another frequently tested cause, Sickle cell disease is the board fav disease that causes this condition as Sickled RBCs obstruct small vessels blocking the venous outflow of corpus CAVERNOSUM, thus treatment primarily targets this region and involves corporal aspiration, intracavernosal phenylephrine(a1 agonist)

*SCC is most common type of penile cancer SOUTH America(like in Brazil).Other important associations include HPV (Double-stranded circular Non-enveloped DNA virus)and being uncircumcised also seems to put you at higher risk of SCC.

*CARCINOMA in Situ with unclear malignant potential, note the reddish papules characteristic for bowenoid papulosis....

*ERYTRHOPLASIA of QUEYRAT note that it is SCC of GLANS of penis and presents as ERYTHROPLAKIA(smooth, velvety, granular or nodular lesions often with a well-defined margin that can't be described as any other lesion)...

*First of all in both cases FSH goes up because Inhibin B goes down(Because Sertoli cells are affected by increased temperature in the abdomen)...Now testosterone levels are decreased with BIlateral cryptoorchidism while Testosterone levels are usually NORMAL with unilateral cryptoorchidism(because leyding cells secrete Testosterone and they are relatively insensitive to temperature changes)As we remember T serves as negative feedback on LH secretion so if bilateral cryptoorchidism is present low T will lead to High LH vs in unilateral case LH levels are usually normal.*Cryptoorchidism increases risk of testicular GERM cell tumors(can present as testicular mass that doesn't transilluminate)

*The condition described is known as Testicular torsion-abnormal rotation of testicle around spermatic cord and vascular pedicle.*Testicular torsion can be due to congenital failure of testes to attach to INNER lining of the scrotum, basically you have Inadequate fixation of LOWER pole of the testis to TUNICA vaginalis.*They love the fact that Gonadal arteries arise from ABDOMINAL aorta at the L2 level Below renal arteries and this card gives you good idea of how they can test you on this one.You should know everything about this condition because this is EMERGENCY and this condition is common in young people(12-18 year old boys),it is emergency because if there is no correction within 6 hours the tesicle basically dies so you don't want to miss this and leave young boy without testicle, so surgical correction (ORCHIOPEXY-where you attach testes to scrotum properly) should be done within first 6 hours(Untill blockade of venous outflow from the testicle due to compression of the vein results in hemorrhagic infarction of the testes) another important thing is that orchipexy should also be done on the other side too(even if another testicle isn't affected) because those patients are at higher risk of developing torsion on that side as well

*Varicocele is MCC of scrotal enlargement-Dilation of PAMPINIFORM plexus>Bag of worm appearance.*More common on left side(Left gonadal vein drains into left renal vein instead of draining to IVC directly like right gonadal vein would)*INCREASED temperature>Decreased spermatogenesis>INFERTILITY*Use Doppler ultrasound and remember that variocecele does NOT transilluminate(No fluid present,contrast this with hydrocele)*Retroperitoneal high ligation and embolization of vessels can be used for treatment(Embolization has LESS recurrence rate) we do treatment primarily to prevent infertility.

*Remember sacrococcygeal teratoma is EXTRAgonadal germ cell tumor that grows at the base of the coccyx and develops from primitive streak....contrast this with usual mediastinal/retropertoneal locations of extragonadal germ cell tumors in adults.

*First one will TRANSIlluminate due to presence of fluidvssecond one is classic description of hematocele and blood is too dense to transilluminate so it does NOT transilluminate.

*PARAtesticular fluctuant nodule on step1 should make you think of Spermatocele which is result of cyst formation due to dilation of epididymal duct or RETE TESTES....*You expect to find Spermatozoa in accumulated substance.

*First when you see testicular mass in a boy under age of 3(even age 5, genereally in a child)think of ENDODERMAL SINUS(Yolk Sact) tumor, now if you also see AFP you are lucky as it is characteristic findings, but they can be generous and give you complete giveaway which are Schiller-duval bodies(Can be described as GlomeruLOID like structures)..note that This Non-seminoma is overall most common cause of testicular tumor in CHILDREN(overall most common is seminoma).

*Overall MCC testicular cancer is Testicular germ cell tumor known as SEMINOMA(important exceptions in children below age of 3 MCC is yolk sac tumor while in those older than 60 years mcc of testicular mass is DIFFUSE large B-cell lymphoma).*Classic histologic findings for seminoma include LARGE cells that grow in lobules and have CLEAR cytoplasm with central nuclei(Fried-egg appearance),someone said that on real deal they also mentioned GRANULOMA which is possible histological feature(along with lymphocytes), so don't get confused*SUPER HY:Gross findings inclue:HOMOGENOUS MASS with NO hemorrhage or necrosis.*Rare cases can produce B-hcg but more specific(Testable) finding is presence of Placental Alkaline phosphatase.*Analog of Seminoma in females is Dysgerminoma.*Seminoma has good prognosis because it responds well to radiotherapy and even though it is malignant it metastasizes LATE int he course of the disease.

*patient likely has Malignant tumor of cytotrophoblasts and synctiotrophoblasts known as choriocarcinoma(Not that multinucleated synctiotrophoblasts do NOT produce villi in this cancer while normally they would have villus which is structural unit of placenta)...Signs of hyperthyroidism(like hyperthermia,tachycardia) can be due to fact that hCG is structurally similar to TSH, gynecomastia is likely due to fact that hCG is structurally similar to LH.(alpha subunit of B-hcg is similar to alpha subunits of LH,FSH and TSH)*SUPER HY this hCG(B-hcg) is produced by SYNCITIOtrophoblasts.*metastases to LIVER and LUNGS is common and HY to know is that metastases in this case is HEMATOGENOUS(Choriocarcinoma is tumor of cells that were meant to find and penetrate blood vessels-syncitriotrophoblasts)

*This germ tumor is TERATOMA which is MALIGNANT in Males and is benign in females .