1. Prostate
   1. Inflammatory
      1. Acute bacterial prostatitis
      2. Chronic bacterial prostatitis
      3. Chronic abacterial prostatitis/prostatodynia - CHRONIC PELVIC PAIN SYNDROME
   2. Tumors
      1. Nodular hyperplasia/Benign prostatic hyperplasia
         1. General
            1. Very common (20% 40's - 70% of 60's)
         2. Pathology
            1. Nodular hyperplasia, stroma&glands
            2. double layer of epithelium preserved
            3. Transition zone
      2. Carcinoma
         1. General
            1. Very common, age (20%-50's, 70%-70's)
            2. Latent vs clinically significant
            3. Problem of overtreatment
            4. LATENT: low grade, low volume, low PSA
            5. DRE/PSA
            6. Utility & Limitations
            7. reference values
            8. the total PSA range of 4.0 to 10.0 ng/mL has been described as a diagnostic "gray zone,"
            9. false+ & false- results
            10. PSA derivatives & kinetics
            11. not specific for disease progression
            12. free: total PSA (F/T ratio)
            13. density
            14. velocity - the rate of change in PSA level
            15. doubling time
         2. Pathology
            1. Adenocarcinoma
            2. architectural distortion (eg small infiltrating glands)
            3. single layer of cells
            4. large nuclei with prominent nucleoli
            5. AdenoCa, LOW MAG
            6. AdenoCa, High MAG
            7. Gleason grading (a method to grade differentiation of prostate carcinoma)
            8. Architectural patterns
            9. 3 - donuts
            10. 4 - pretzels
            11. 5 - solid sheets or single cells
            12. GLEASON SCORE
            13. sum of the two most prevelent patterns eg. Gleason score 3+4=7
            14. Peripheral zone (70% OF GLAND VOLUME, 80% OF CANCERS)
            15. Precursors: HGPIN, Adenosis (AAH)
            16. stong association but the risk of progression unknown
            17. Spread
            18. Role of pathologists
            19. Biopsy, core bx
            20. diagnosis
            21. GS prognostic grouping
            22. I - 3+3
            23. II - 3+4
            24. III - 4+3
            25. IV - 4+4
            26. V - 4+5, 5+4; 5+5
            27. GS and tumor volume
            28. Key factors in management of patients
            29. together with age, PSA level, clinical stage
            30. Transurethral resection of prostate (TURP)
            31. exclusion of neo
            32. Radical prostatectomy
            33. Pathological Stage (pTNM)
            34. Gleason score
            35. Margin status
   3. Anatomy & histology
      1. Zonal anatomy
         1. Zonal anatomy
         2. Histology
         3. Histology
2. Testis & paratesticular tissues
   1. Congenital anomalies
      1. Testicular dysgenesis
         1. abnormal embryonic development of gonads (hypoplastic or incompletely developed + hypogonadism)
            1. result in DISORDERS OF SEX DEVELOPMENT
      2. Cryptorchidism - testis outside scrotum/maldescendent (undescended or ectopic)
         1. component of Testicular Dysgenesis Syndrome
            1. TDS spectrum
            2. ENDOCRINE DISRUPTORS
            3. Xenoestrogens: , PCB, Bisphenol A, Phtalates
         2. NON-PALPABLE ABSENT TESTICLE/TESTES IN THE SCROTUM (EMPTY SCROTUM)
            1. *undescended, *ectopic, *regressed or aplasia (anorchia)
            2. Vanishing testes syndrome/testicular regression syndrome
            3. At least 5% of EMPTY SCROTUM
            4. "vascular accident"(va) during emryo or fetal development leading to disapperance of initially normal testicle
            5. phenotype depends on the time of the va - variants from unilateral anorchia through ambiguous gentilia to female internal& external phenotype
            6. atrophy or fibrous streak or complete lack of testicular structures
         3. ORCHIOPEXY to prevent complications
            1. infertility (<2yo)
            2. germ cell tumors (<5yo)
   2. Inflammatory
      1. Infectious (Non-specific Gram- bacilli and pyogenic cocci, viruses or STD) Non-infectious (vasculitis, trauma, idiopathic)
      2. Epididymo-orchitis
      3. Epididymitis
         1. Tuberculosis
      4. Orchitis
         1. viral: mumps
   3. Vascular
      1. Torsion
         1. anomalous testicular suspension defect
            1. torsion
         2. incompletely descended testis is more prone to torsion during the fetal period
   4. Tumors
      1. GERM CELL NEOPLASIA IN SITU (GCNIS)
      2. Neoplasms
         1. Germ cell tumors (GCTs) >95%
            1. General
            2. Most common cancer in young males
            3. Aggresive but curable
            4. AGE DIFFERENCES
            5. Biomarkers: AFP, bHCG, LDH
            6. Pathology
            7. Pure (40%)
            8. Seminoma (>90% of pure, 35-40% of all)
            9. seminoma
            10. Non-seminomatous
            11. Embryonal carcinoma
            12. EC
            13. Yolk sac tumor
            14. YST
            15. Choriocarcinoma
            16. CCH
            17. Teratoma
            18. Dermoid cyst
            19. Mixed most common (60%)
            20. Precursor: IGCN
            21. Spermatocytic seminoma/SPERMATOCYTIC TUMOR
            22. distinct entity, different molecular pathway, elderly
         2. Sex cord stromal tumors <5%
            1. Leydig cell tumor (most common SCST)
         3. Secondary
            1. Lymphoma (most common testIcular neo in >60 yo)
      3. Celes and cysts of spermatic cord & adnexa
         1. HYDROCELE
         2. SPERMATOCELE
         3. VARICOCELE
      4. Differential diagnosis
         1. Epididymoorchitis
         2. Inguinal hernia
   5. HYPOGONADISM (gonadal failure)
      1. PRIMARY (hypergonadotropic)
         1. genetic syndromes
         2. maldescended testes
         3. vanishing testes syndrome
         4. external insults (eg inflammation, ischaemia)
         5. autoimmune
         6. Sertoli cell only syndrome
      2. SECONDARY (hypogonadotropic)
      3. presentation depends on the age of development
   6. Anatomy & histology
      1. testis
         1. seminiferous ducts
            1. seminiferous ducts
3. Penis & Urethra
   1. Anatomy
      1. Penis histology
   2. Structural/Congenital Abnormalities
      1. Abnormal urethral groove/canal
         1. Hypospadias
         2. Epispadias
      2. Posterior urethral valve
      3. PHIMOSIS - congenital=physiological; aquired=pathological
         1. Paraphimosis - urologic emergency
   3. Inflammatory
      1. Infectious (Non-specific or STD) Non-infectious (Lichen sclerosus et atrophicus/BXO)
      2. Balanoposthitis (glans&prepuce)
      3. Urethritis
   4. Neoplasms
      1. Benign
         1. Condyloma acuminatum/anogenital wart
            1. wart - papillary projection covered by hyperplastic squamous epithelium
            2. wart - hyper and orthokeratosis, koilocytosis
            3. wart -koilocytes
      2. Preinvasive/precursor lesions - PENILE INTRAEPITHELIAL NEOPLASIA (PeIN)/ High grade squamous intraepithelial lesion (HGSIL)/Carcinoma in situ
         1. Clinical presentations (variable)
            1. HPV-related (oncogenic, high-risk types). Glans typically affected.
            2. Bowenoid papulosis - transitional state between a genital wart and Bowen disease, pigmented papules on the shaft, spontaneous regression, younger (30's-40's). Risk of progression 1%.
            3. Bowen's disease - scaly hyperkeratotic plaque, usually on shaft of penis. Risk of progression 10%.
            4. Erytroplasia of Queyrat - erythematous plaque on the glans and prepuce. Risk of progression 30%.
            5. Erytroplakia - if microscopically PeIN than -> EQ
            6. HPV-unrelated
            7. Phimosis with leukoplakia of prepuce (whitish patch or plaque on the glans or prepuce)
            8. Leukoplakia - clinical term (histologically from epithelial hyperplasia through PeIN to invasive carcinoma)
         2. PATHOLOGY
            1. PeIN, histopatho
            2. WARTY OR BASALOID PEIN - HPV-related (particularly (HPV-16 and 18), looks like HGSIL in cervix
            3. 1.TRANSEPIDERMAL CYTOLOGICAL ATYPIA, 2.ABNORMAL PROLIFERATION, 3.ABNORMAL / LACK OF MATURATION
            4. DIFFERENTIATED PEIN - not related to HPV
            5. 1. PARABASAL ATYPIA, 2. ABNORMAL BUT RELATIVELY PRESERVED MATURATION
      3. Malignancy
         1. Squamous cell carcinoma (95%)
            1. 0,5% of male cancers, >50yo
            2. 30-60% are HR-HPV related
            3. HPV - RELATED TUMORS
            4. Subtopic 1
            5. SCC variants
            6. Verrucous SCC - extremely well differentiated but large tumor with expansile growth; special subtype with good prognosis
            7. Clinical&HP
            8. Keratinising, usual SCC
            9. Keratinising, usual SCC
         2. Other possible skin tumors: melanoma, basal cell carcinoma, adenocarcinoma