Male Reproductive System Pathology
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Questions and Answers
- 1.
A patient presents with dysuria, increased frequency and urgency, low back and pelvic pain, fever chills, with loss of sex drie and painful erections and ejaculations. He has infection of the prostate. What is the most common cause of acute prostitis?
- A.
E. coli
- B.
Strep.
- C.
Staph
- D.
Fungi
- E.
None of the above
Correct Answer
A. E. coliExplanation
The most common cause of acute prostatitis is E. coli. E. coli is a type of bacteria that commonly resides in the gastrointestinal tract. It can enter the prostate gland through the urethra, leading to infection and inflammation. This can result in symptoms such as dysuria, increased frequency and urgency, low back and pelvic pain, fever chills, and sexual dysfunction. Other bacteria such as Strep and Staph can also cause prostatitis, but E. coli is the most common culprit. Fungi are not a common cause of acute prostatitis.Rate this question:
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- 2.
A patient presents with an enlarged prostate gland that is not premalignant. Micrscopically, there is an increased proliferation of stromal and epithelial cells. Corpora amylacea are also seen. The patients complains of difficulty starting or stopping urination, with dribbling, nocturia, and fullness of bladder. Which of the following is decreased in this patient?
- A.
Testosterone
- B.
Estrogen
- C.
Pancreatic enzymes
- D.
None of the above
- E.
All of the above
Correct Answer
A. TestosteroneExplanation
In this patient with an enlarged prostate gland, the increased proliferation of stromal and epithelial cells suggests benign prostatic hyperplasia (BPH). BPH is a common condition in older men where the prostate gland enlarges, causing urinary symptoms such as difficulty starting or stopping urination, dribbling, nocturia, and bladder fullness. Testosterone, a male hormone, plays a role in the growth and development of the prostate gland. However, in BPH, the conversion of testosterone to dihydrotestosterone (DHT) within the prostate gland is increased, leading to prostate cell proliferation. Therefore, the levels of testosterone are decreased in this patient.Rate this question:
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- 3.
A patient presents with hematuria, and bone pain in the back. Like the previous patient, he also has dysuria and interrupted urine flow. He is diagnosed with prostate cancer. What is the most important marker of his disease?
- A.
PSA
- B.
BRCA1
- C.
None of the above
- D.
All of the above
- E.
Who cares
Correct Answer
A. PSAExplanation
PSA, or prostate-specific antigen, is the most important marker for prostate cancer. PSA is a protein produced by both normal and cancerous prostate cells. Elevated levels of PSA in the blood can indicate the presence of prostate cancer. Therefore, monitoring PSA levels is crucial in diagnosing and monitoring the progression of prostate cancer. The other options, BRCA1 and None of the above, are not relevant markers for prostate cancer. "All of the above" and "Who cares" are not valid options.Rate this question:
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- 4.
Is serum PSA cancer specific?
- A.
No, it is also found in hyperplasia and prostitis
- B.
Yes
- C.
Not sure
- D.
Who cares
- E.
All of the above
Correct Answer
A. No, it is also found in hyperplasia and prostitisExplanation
The correct answer is "No, it is also found in hyperplasia and prostitis." This is because prostate-specific antigen (PSA) is a protein produced by both cancerous and noncancerous cells in the prostate gland. Elevated levels of PSA can indicate the presence of prostate cancer, but it can also be caused by benign conditions such as benign prostatic hyperplasia (enlarged prostate) and prostatitis (inflammation of the prostate). Therefore, serum PSA is not specific to cancer and can be found in other noncancerous conditions as well.Rate this question:
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- 5.
A fetus presents with only one testes because the other one has not completely descended. The baby has Pader Willi syndrome. Microscopically, there is leydig cell hyperplasia and hyalinised tubules. The patient has an increased risk of which of the following?
- A.
Prostate cancer
- B.
Seminoma of the testes
- C.
Gynecomastia
- D.
All of the above
- E.
None of the above
Correct Answer
B. Seminoma of the testesExplanation
The fetus in this case has only one testes because the other one has not completely descended, which is a characteristic of Pader Willi syndrome. Microscopically, there is leydig cell hyperplasia and hyalinised tubules. This combination of findings suggests an increased risk of seminoma of the testes. Therefore, the correct answer is seminoma of the testes.Rate this question:
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- 6.
A patient presents with a unilateral testicular mass and feeling of heaviness in the scrotum. He also has hydrocele of the testes. AFP levels are normal, however, the HCG levels are increased. Grossly the tumor appears as a tan lobulated mass. What is a key microscopic feature seen in this tumor?
- A.
Fried egg appearance
- B.
Polygonal cells
- C.
Spindle shaped cells
- D.
None of the above
- E.
All of the above
Correct Answer
A. Fried egg appearanceExplanation
The key microscopic feature seen in this tumor is a "fried egg appearance". This term refers to the characteristic appearance of the tumor cells, which have a central round nucleus resembling the yolk of a fried egg and a clear cytoplasm resembling the egg white. This feature is commonly seen in certain types of testicular germ cell tumors, such as seminomas. The other options, polygonal cells and spindle-shaped cells, are not associated with this specific tumor.Rate this question:
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- 7.
A 2 year old child presents with a well demarcated tumor with cuboidal columnar cells in sheets and papillae, called Schiller duval bodies. Which of following levels are increased?
- A.
Hcg
- B.
Afp
- C.
Alpha1antitrypsin
- D.
Rbc
- E.
Giant cells
Correct Answer
B. AfpExplanation
AFP (alpha-fetoprotein) levels are increased in a 2-year-old child presenting with a well-demarcated tumor with cuboidal columnar cells in sheets and papillae, called Schiller duval bodies. AFP is a tumor marker commonly associated with certain types of cancer, including hepatocellular carcinoma and germ cell tumors. In this case, the presence of Schiller duval bodies suggests a germ cell tumor, which is a type of cancer that can cause an increase in AFP levels.Rate this question:
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- 8.
Malformation of the urethral groove and urethral canal at the ventral surface is _ and at the dorsal surface is _
Correct Answer
hypospadias; epispadiasExplanation
Hypospadias is a condition characterized by the malformation of the urethral groove and urethral canal on the ventral surface of the penis. In hypospadias, the urethral opening is located on the underside of the penis instead of the tip. On the other hand, epispadias is a condition where the urethral opening is located on the dorsal surface of the penis. So, the correct answer states that malformation at the ventral surface is hypospadias, and at the dorsal surface is epispadias.Rate this question:
- 9.
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 situExplanation
if only he had listented to his mother. She told him that girl was trash.Rate this question:
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- 10.
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 carcinomaExplanation
The most likely diagnosis based on the given information is embryonal carcinoma. This is supported by the elevated serum levels of hCG and AFP, which are both tumor markers associated with testicular germ cell tumors. Additionally, the microscopic appearance of the lesion shown in the image is consistent with embryonal carcinoma. Seminoma is another type of testicular germ cell tumor, but it typically presents with a painless mass that transilluminates on examination, which is not the case in this patient. Yolk sac tumor, Sertoli cell tumor, and Leydig cell tumor are less likely based on the clinical presentation and laboratory findings.Rate this question:
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- 11.
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 nodesExplanation
If a male infant does not have testes in his scrotum, it suggests that they may be undescended or absent. In such cases, there is a higher risk of developing a malignant tumor called testicular cancer. Testicular cancer commonly spreads through the lymphatic system. The retroperitoneal para-aortic lymph nodes, located in the abdomen, are the primary drainage pathway for the testicles. Therefore, if a malignant tumor develops, it is most likely to metastasize to the retroperitoneal para-aortic lymph nodes.Rate this question:
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- 12.
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 carcinomaExplanation
The most likely diagnosis in this case is prostate carcinoma. The patient's symptoms of difficulty urinating, urinary frequency, nocturia, and dribbling, along with the finding of an enlarged prostate on rectal examination, are consistent with prostate carcinoma. Additionally, the fact that a prostate biopsy was performed suggests that there was suspicion for malignancy. The microscopic appearance of the biopsy sample would provide further confirmation of the diagnosis.Rate this question:
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- 13.
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 tumorExplanation
The presence of gynecomastia, a non-tender testicular mass, and the histological findings of a well-circumscribed brown mass composed of large polygonal cells with homogenous eosinophilic cytoplasm, along with the presence of elongated cytoplasmic crystals in some neoplastic cells, are consistent with a Leydig cell tumor. Leydig cell tumors are rare testicular tumors that can produce estrogen, leading to gynecomastia. The histological features described are characteristic of Leydig cell tumors. Varicocele, cryptorchidism, yolk sac tumor, embryonal carcinoma, and Sertoli cell tumor are not associated with these findings.Rate this question:
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- 14.
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 hyperplasiaExplanation
The patient's symptoms of increased urgency to void, inability to completely empty the bladder, and feeling distended and irritated all point towards a diagnosis of benign prostate hyperplasia (BPH). The enlarged, rubbery prostate on rectal digital exam further supports this diagnosis. The biopsy findings of prostatic glands lined by slightly pleomorphic columnar epithelium surrounded by an intact layer of basal cells are consistent with BPH, as this condition is characterized by an increase in the number of glandular and stromal cells in the prostate. This is in contrast to prostate adenocarcinoma, which would typically show more significant pleomorphism and loss of basal cells.Rate this question:
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- 15.
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 prostatitisExplanation
The most likely diagnosis in this case is chronic abacterial prostatitis. The patient's symptoms of perineal pain and increased frequency of urination, along with the mildly enlarged and tender prostate, are consistent with chronic prostatitis. The presence of leukocytes in the prostatic secretions indicates inflammation, but the absence of bacteria in cultures suggests that the inflammation is not caused by an infection. Chronic abacterial prostatitis is the most common type of prostatitis and is characterized by persistent inflammation of the prostate without evidence of infection.Rate this question:
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- 16.
A young male (8-years-old) comes to year office and presents with full development of male pubertal hair and growth of the penis. Which of the following explanations would account for his precocious puberty?
- A.
Atrophy of GnRH producing cells of the pituitary gland
- B.
Atrophy of LH producing cells of the anterior pituitary gland
- C.
Hyperplasia of Sertoli cells
- D.
Adenoma of GnRH producing cells of the hypothalamus
- E.
Adenoma of FSH producing cells of the anterior pituitary gland
Correct Answer
D. Adenoma of GnRH producing cells of the hypothalamusExplanation
Adenoma of GnRH producing cells of the hypothalamus can lead to precocious puberty because GnRH is responsible for the release of hormones that stimulate the production of sex hormones (such as LH and FSH) from the pituitary gland. If there is an adenoma (tumor) in the GnRH producing cells of the hypothalamus, it can cause an overproduction of GnRH, leading to early activation of the reproductive system and the onset of puberty at an abnormally young age.Rate this question:
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- 17.
A 55-year-old male was diagnosed with prostate cancer 5 years ago. He chose to undergo a radical prostatectomy which included removal of the prostate gland, seminal vesicles, Cowper's glands, and lymph nodes immediately adjacent to the prostate. He subsequently had an inability to achieve and/or maintain an erection whereas this was not the case prior to the prostatectomy. Choose the most likely explanation for this problem and why the drug Viagra helped correct his erectile dysfunction.
- A.
Surgical damage to parasympathetic nerves to the penis; reduced breakdown of cGMP in vascular smooth muscle
- B.
Surgical damage of sympathetic nerves to the penis; increased production of nitric oxide by endothelial cells
- C.
Surgical damage to the parasympathetic nerves to the penis; increased production of nitric oxide by endothelial cells
- D.
Damage to endothelial cells of the penis; blockade of nitric oxide synthase
- E.
Damage to endothelial cell of the penis; blockade of inositol trisphosphate synthesis
Correct Answer
A. Surgical damage to parasympathetic nerves to the penis; reduced breakdown of cGMP in vascular smooth muscleExplanation
The most likely explanation for the patient's inability to achieve and/or maintain an erection after the prostatectomy is surgical damage to the parasympathetic nerves to the penis. These nerves are responsible for initiating the release of nitric oxide, which then leads to the production of cyclic guanosine monophosphate (cGMP) in the smooth muscle of the penis. cGMP is responsible for relaxing the smooth muscle and allowing increased blood flow into the penis, resulting in an erection. The drug Viagra helps correct his erectile dysfunction by inhibiting the breakdown of cGMP, allowing it to accumulate and maintain the erection.Rate this question:
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- 18.
A predominantly male patient mentions that his childhood sexual development was a bit unusual because of 5a-reductase deficiency. What is the function of 5-alpha reductase?
- A.
Makes testosterone in the testis
- B.
Is needed for the synthesis of glucocorticoids and mineralocorticoids
- C.
Turns testosterone into dihydrotestosterone
- D.
Turns androgens into estrogens
- E.
Catalyzes the conversion of cholesterol into pregnenolone
Correct Answer
C. Turns testosterone into dihydrotestosteroneExplanation
The function of 5-alpha reductase is to convert testosterone into dihydrotestosterone. This conversion is important for the development of male sexual characteristics during puberty. Dihydrotestosterone is a more potent form of testosterone and plays a crucial role in the development of the male external genitalia, prostate, and other androgen-dependent structures. In individuals with 5-alpha reductase deficiency, this conversion is impaired, leading to incomplete or abnormal development of male sexual characteristics.Rate this question:
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- 19.
In the organ shown in the photomicrograph below, the major site of malignancy is
- A.
The lactiferous duct
- B.
The ductus epididymous
- C.
The central zone
- D.
The peripheral zone
- E.
The endocervix
Correct Answer
D. The peripheral zoneExplanation
Structure and function of the prostate depend on the level of testosterone.
READ. Zones- ducts from individual glands may converge but all empty direclty into the prostatic urethra (running through the center of the prostate). Central zone- 25% of glands volume and has submucosal galnds with longer ducts. Peripheral zone- occupies 70% of prostate gland with still longer ducts. Glands in this zone are the most common locatino of both inflammation and cancer.
(Slide 39-Thompson -Male Repro)Rate this question:
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- 20.
A 1-year-old boy with undescended testes was given a hormonal treatment to correct the problem. Which of the following hormones was most likely administered to him?
- A.
Follicle stimulating hormone
- B.
Human chorionic gonadotropin
- C.
Testosterone
- D.
Leptin
- E.
Cortisol
Correct Answer
B. Human chorionic gonadotropinExplanation
Human chorionic gonadotropin (hCG) is the most likely hormone administered to the 1-year-old boy with undescended testes. hCG is a hormone that is normally produced during pregnancy and plays a role in the development of the male reproductive system. In the case of undescended testes, hCG can be used to stimulate the descent of the testes into the scrotum. This hormone helps to promote the production of testosterone, which is necessary for the normal development and functioning of the testes. Therefore, administering hCG can help correct the problem of undescended testes in this young boy.Rate this question:
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- 21.
Which of the following drugs can decrease the synthesis of dihydrotestosterone from testosterone?
- A.
Bicalutamide
- B.
Flutamide
- C.
Finasteride
- D.
Exemestane
- E.
Spironolactone
Correct Answer
C. FinasterideExplanation
Finasteride is a drug that can decrease the synthesis of dihydrotestosterone from testosterone. It works by inhibiting the enzyme 5-alpha reductase, which is responsible for converting testosterone into dihydrotestosterone. By blocking this enzyme, finasteride reduces the levels of dihydrotestosterone in the body. This can be beneficial in the treatment of conditions such as benign prostatic hyperplasia and male pattern baldness, which are associated with high levels of dihydrotestosterone.Rate this question:
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- 22.
Which of the following potential drug targets would provide the most appropriate treatment for a man with benign prostatic hyperplasia?
- A.
Aromatase activity
- B.
Adenylate cyclase activity
- C.
Androgen receptors
- D.
5a-reductase activity
- E.
GnRH receptors
Correct Answer
D. 5a-reductase activityExplanation
The most appropriate treatment for a man with benign prostatic hyperplasia would be targeting 5a-reductase activity. Benign prostatic hyperplasia is characterized by an enlargement of the prostate gland, which is dependent on the conversion of testosterone to dihydrotestosterone (DHT) by the enzyme 5a-reductase. Inhibiting 5a-reductase activity would reduce the production of DHT, which would help in reducing the size of the prostate gland and alleviate symptoms associated with benign prostatic hyperplasia.Rate this question:
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.JPG "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?")
.JPG "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?")
.JPG "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?")
.JPG "In the organ shown in the photomicrograph below, the major site of malignancy is")
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