PA28.1-6 | Male Genital Tract — Practice Quiz

A 28-year-old man presents with a painless swelling of the right testis for 3 months. Ultrasound shows a hypoechoic intratesticular mass. Orchiectomy specimen reveals a homogeneous, cream-white tumour with no haemorrhage or necrosis. Serum AFP is normal; β-hCG is mildly elevated; LDH is raised. Histology shows sheets of uniform polygonal cells with clear glycogen-rich cytoplasm, round nuclei, prominent nucleoli, and a lymphocytic stroma with fibrous septa. Which is the MOST likely diagnosis?

A 24-year-old man presents with a rapidly enlarging right testicular mass over 6 weeks, low-grade fever, and bilateral gynaecomastia. Serum AFP is 3,400 ng/mL and β-hCG is 82,000 mIU/mL. CT scan shows retroperitoneal lymphadenopathy at the level of L1–L2 vertebrae. Which set of lymph nodes receives the PRIMARY lymphatic drainage from a testicular tumour?

A 26-year-old man is found to have a right testicular mass. Histology shows a tumour with both seminomatous and embryonal carcinoma components. Serum AFP is markedly elevated at 4,200 ng/mL. What is the correct classification of this tumour?

A 55-year-old man presents with a 2-year history of difficulty initiating urination, poor stream, nocturia ×3, and a sensation of incomplete bladder emptying. Digital rectal examination reveals a smooth, symmetrically enlarged prostate. PSA is 4.2 ng/mL. Transrectal ultrasound biopsy of the inner (transition) zone shows nodular proliferation of fibromuscular stroma and glands, some with papillary infoldings. Which hormone is the PRIMARY driver of this condition?

A 58-year-old man with BPH undergoes TURP for refractory urinary retention. The surgeon describes 'chippings' of pale yellow-white tissue from the periurethral zone. Histology shows nodular hyperplasia of fibromuscular stroma admixed with enlarged glands lined by two cell layers (secretory luminal cells over a basal cell layer). Which zone of the prostate is the PRIMARY site of BPH?

A 70-year-old man presents with severe low-back pain. His PSA is 85 ng/mL. Bone scan shows multiple areas of increased uptake in the lumbar spine and pelvis. X-ray of the lumbar spine demonstrates dense, sclerotic vertebral bodies. Histology from a needle core biopsy of the prostate reveals small acinar glands with a single layer of cells, absent basal layer, prominent nucleoli, and perineural invasion. Which Gleason/ISUP pattern combination would place this tumour in the HIGHEST grade group?

A 68-year-old man undergoes radical prostatectomy for PSA 12 ng/mL. On histological examination of the specimen, the pathologist identifies small glands with a single layer of columnar cells, absent basal cells, prominent nucleoli, and glands that wrap around a nerve bundle within the prostatic stroma (as shown in the diagram). This histological feature is most consistent with which diagnosis and what is its significance?

A 72-year-old man with a long history of indwelling catheter use presents with fever (39.1°C), dysuria, and a tender, boggy prostate on DRE. Urine culture grows Escherichia coli. PSA is transiently elevated at 18 ng/mL. The most likely diagnosis is:

A 65-year-old man who underwent BCG intravesical immunotherapy for bladder carcinoma 8 months ago now presents with obstructive urinary symptoms. PSA is 3.1 ng/mL. Prostate biopsy shows non-caseating granulomas centred on prostatic ducts and acini, with epithelioid histiocytes and multinucleated giant cells but no necrosis. AFB stain is negative. What is the MOST likely diagnosis?

A 45-year-old man presents with a verrucous, cauliflower-like warty lesion on the glans penis that has been growing for 18 months. He is uncircumcised and has a history of multiple sexual partners. Biopsy shows well-differentiated keratinising squamous epithelium with prominent koilocytic change (nuclear enlargement, perinuclear halo), minimal stromal invasion, and pushing borders at the deep margin. Which virus is the PRIMARY aetiological agent?

A 60-year-old man presents with an ulcerative lesion at the glans penis with raised indurated edges. He reports phimosis for many years. Inguinal lymph nodes are palpable bilaterally. Histology confirms invasive squamous cell carcinoma. To which lymph node group does penile carcinoma FIRST metastasise?

A pathology trainee is examining a slide from an orchiectomy specimen from a 32-year-old man. The microscopic image shows large cells arranged in solid sheets and tubular structures; the cells have high nuclear-to-cytoplasmic ratio, indistinct cell borders, amphophilic cytoplasm, large irregular nuclei with macronucleoli, and prominent apoptotic bodies and mitotic figures. There are areas of geographic necrosis and haemorrhage. Which tumour type and expected marker profile BEST matches this morphology?