Penis - Pathoma

Hypospadius
  • Opening of urethra on inferior surface of penis 
  • Failure of closure of urethral folds
  • Embryology
    • Genital tubercle (becomes glans)
    • This grows up and out and urethral folds should close behind it.
Epispadias
  • Opening on superior surface
  • Much rarer
  • Abnormal position of genital tubercle - posterior to folds!
  • Assoc with bladder exstrophy
    • Anterior inferior abdo doesn't form properly
    • So bladder wall exposed
Condyloma Accuminatum
  • Benign warty growth
  • HPV 6 or 11
  • Koilocytic change
    • "raisin like nuclei"
Lymphogranuloma Venereum
  • Necrotising, granulomatous inflammation of
  • Inguinal lymphatics, nodes
  • Due to Chlamydia trachomatis serotypes L1, L2, L3
    • Obligate intracellular (chlam means cloak)
    • So need to grow in tissue culture/chick embryo to test
    • Enters mucosal cells as elementary bodies
    • Replicate, making reticulate bodies
    • The release as elementary bodies so can infect another cell
      • elementary and enfective, reticulate are replicative
    • NB serotypes A to C cause trachoma, D-K causes urogenital infections + conjunctivities
  • Heals with fibrosis
  • Perianal involvement cause rectal strictures

Squamous Cell Carcinoma
  • Malig prolif penile squamous cells
  • 2/3 cases have HPV 16, 18, 31 or 33 (ie high risk)
  • Circumcision dec risk
    • or better care of foreskin!
  • Precursor lesions
    • Bowen disease  - shaft
      • In situ carcinoma - so not yet invaded BM on histo
      • Presents as leukoplakia
    • Erythroplasia of Queyrat - glans
      • In situ carcinoma
      • Erythroplakia - ie red plaques!
    • Bowenoid Papulosis - reddish papules
      • in-situ carcinoma that won't progress to invasion (so bowenoid rather than bowen)
Robbins Basic Pathology, Robbins Pathologic Basis of Disease, Robbins Review of Pathology (MCQs - very path-y), Robbins Flash Cards, Baby Robbins, Robbins Atlas - some exact same images come up in the exam, 100 Cases in ClinicalPathology - possibly the best Qbank for the practical