Block 15 Path Male Repro System

1.

A 55-year-old man presents with a fungating lesion on his penis. The gross and microscopic appearance of the lesion is shown for your evaluation. Which of the following is the most likely diagnosis?

A.

Primary syphilis
B.

Condyloma acuminatum
C.

Carcinoma in situ
D.

Verrucous carcinoma
E.

Squamous cell carcinoma

Correct Answer
C. Carcinoma in situ

Explanation
if only he had listented to his mother. She told him that girl was trash.

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2.

A 22-year-old Caucasian male presents with a scrotal mass, which does not trans-illuminate. Laboratory investigations reveal elevated serum levels of hCG and AFP. Orchidectomy is performed and the microscopic appearance of the lesion is shown for your evaluation. Which of the following is the most likely diagnosis?

A.

Seminoma
B.

Embryonal carcinoma
C.

Yolk sac tumor
D.

Sertoli cell tumor
E.

Leydig cell tumor

Correct Answer
B. Embryonal carcinoma

Explanation
The correct answer is Embryonal carcinoma. This is the most likely diagnosis based on the patient's presentation of a scrotal mass, elevated serum levels of hCG and AFP, and the microscopic appearance of the lesion. Embryonal carcinoma is a type of testicular germ cell tumor that often presents in young adults and is associated with elevated levels of hCG and AFP. The microscopic appearance of embryonal carcinoma typically shows large, pleomorphic cells with irregular nuclei and prominent nucleoli.

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3.

A male infant was examined and found not to have testes in his scrotum. If a malignant tumor develops, it will most likely metastasize to

A.

Lungs
B.

Bones
C.

Inguinal lymph nodes
D.

Retroperitoneal para-aortic lymph nodes
E.

Virchow lymph nodes

Correct Answer
D. Retroperitoneal para-aortic lymph nodes

Explanation
If a malignant tumor develops in the male infant, it is most likely to metastasize to the retroperitoneal para-aortic lymph nodes. This is because the testes originate in the abdomen during fetal development and then descend into the scrotum. The retroperitoneal para-aortic lymph nodes are the primary drainage pathway for the testes, making them a common site for metastasis in testicular cancer cases.

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4.

A 69-year-old African American male presents to the emergency room with difficulty urinating. The patient reports a long history of urinary frequency, nocturia, and dribbling. Rectal examination reveals enlarged prostate of wooden consistency. Transrectal prostate biopsy is performed and its microscopic appearance is shown for your evaluation. Which of the following is the most likely diagnosis?

A.

Benign prostate hyperplasia
B.

Acute prostatitis
C.

Chronic bacterial prostatitis
D.

Chronic abacterial prostatitis
E.

Prostate carcinoma

Correct Answer
E. Prostate carcinoma

Explanation
The patient's symptoms of difficulty urinating, urinary frequency, nocturia, and dribbling, along with the finding of an enlarged prostate on rectal examination, are indicative of a prostate disorder. The microscopic appearance of the prostate biopsy is crucial in determining the diagnosis. Prostate carcinoma is the most likely diagnosis because it is a common cause of urinary symptoms in older males and is associated with an enlarged prostate. The wooden consistency of the prostate suggests the presence of fibrosis, which is a characteristic feature of prostate carcinoma.

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5.

A 45-year-old man presents with gynecomastia. Physical examination reveals a non-tender testicular mass and oriectomy is performed. Examination of the surgical specimen reveals a 2 cm well circumscribed brown mass built of large polygonal cells with homogenous eosinophilic cytoplasm. A few neoplastic cells contain elongated cytoplasmic crystals. Which of the following is the most likely diagnosis?

A.

Varicocele
B.

Cryptorchidism
C.

Yolk sac tumor
D.

Embryonal carcinoma
E.

Leydig cell tumor
F.

Sertoli cell tumor

Correct Answer
E. Leydig cell tumor

Explanation
The presence of gynecomastia in a 45-year-old man, along with a non-tender testicular mass, suggests a hormonal imbalance. Leydig cell tumors are known to produce estrogen and can lead to gynecomastia. The description of a well-circumscribed brown mass composed of large polygonal cells with eosinophilic cytoplasm is consistent with Leydig cell tumors. The presence of elongated cytoplasmic crystals is also a characteristic feature of Leydig cell tumors. Therefore, Leydig cell tumor is the most likely diagnosis in this case.

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6.

A 65-year-old man complains of increased urgency to void. He cannot completely empty his bladder and felt “distended” and “irritated” all the time. Rectal digital exam reveals an enlarged, rubbery in consistency prostate. The biopsy discloses prostatic glands lined by slightly pleomorphic columnar epithelium surrounded by intact layer of basal cells. Which of the following is the most likely diagnosis?

A.

Acute bacterial prostatitis
B.

Chronic bacterial prostatitis
C.

Chronic abacterial prostatitis
D.

Benign prostate hyperplasia
E.

Prostate adenocarcinoma

Correct Answer
D. Benign prostate hyperplasia

Explanation
The most likely diagnosis in this case is benign prostate hyperplasia (BPH). BPH is a non-cancerous enlargement of the prostate gland that commonly occurs in older men. The symptoms described, such as increased urgency to void, incomplete bladder emptying, and feeling distended and irritated, are consistent with BPH. The rectal digital exam finding of an enlarged, rubbery prostate further supports this diagnosis. The biopsy results showing prostatic glands lined by slightly pleomorphic columnar epithelium surrounded by intact basal cells are also consistent with BPH. Acute and chronic bacterial prostatitis, chronic abacterial prostatitis, and prostate adenocarcinoma would have different clinical and histological presentations.

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7.

A 51-year-old man presents with complaints of perineal pain and increased frequency of urination over the past six months. Rectal examination shows a mildly enlarged and tender prostate. Microscopic examination of prostatic secretions reveals the presence of leukocytes. No bacteria are isolated in cultures of expressed prostatic secretions. Which of the following is the most likely diagnosis?

A.

Acute bacterial prostatitis
B.

Chronic bacterial prostatitis
C.

Chronic abacterial prostatitis
D.

Benign prostate hyperplasia
E.

Prostate adenocarcinoma

Correct Answer
C. Chronic abacterial prostatitis

Explanation
The most likely diagnosis in this case is chronic abacterial prostatitis. This is suggested by the patient's symptoms of perineal pain and increased frequency of urination, as well as the findings of a mildly enlarged and tender prostate on rectal examination. The presence of leukocytes in the prostatic secretions indicates inflammation, but the absence of bacteria in cultures suggests that the inflammation is not due to a bacterial infection. Chronic abacterial prostatitis is a common condition characterized by chronic pelvic pain and is often difficult to treat.

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