1F-MALE PATHOLOGY Flashcards
(131 cards)
1
Q
Normal weight of prostate gland
A
30 to 40 g
2
Q
At which prostate zone does Focal Atrophy typically present?
A
Peripheral zone
- others:
- Chr. inlfam
- High grade PIN
- CA
3
Q
At which prostate zone does BPH typically present?
A
Transition zone
- others:
- Focal atrophy
- Chr. inlfam
4
Q
Histological characteristics of prostate gland
A
- Glands in lobular architecture
- Intervening Fibromuscular stroma
- Corpora amylacea (w/in glandular lumen)
- Glands: types of cells:
- Secretory cell
- Basal cell
5
Q
Testis normal measurements
A
Mean volume: 20 mL
Weight:
- Right: 21.6 g
- Left: 20 g
6
Q
Cells in seminiferous tubules
A
- Germ cells
- Sertoli cells
7
Q
Cells that produce testosterone
A
Leydig cells
8
Q
Highly convoluted and tightly packed tubules
A
Seminiferous tubules
9
Q
Connects the seminiferous tubules with the efferent ducts
A
Rete testis
10
Q
Consists of vas deferens and blood vessels
A
Spermatic cord
11
Q
Carries and stores sperm cells to bring the sperm to maturity
A
Epididymis
12
Q
Anatomy of a penis
A
- 3 cylindrical masses of vascularized erectile tissue
- – 2 Corpora cavernosa: dorsal aspect
- – Corpus spongiosum: ventral midline
- Glans penis
13
Q
Most common benign tumor
A
Benign prostatic hyperplasia
14
Q
BPH pathophysiology
A
Glandular and stromal hyperplasia
- eptih: d/t incr. prolif’n & decr. apop.
- stroma: d/t incr. prolif’n
15
Q
Cause of hyperplasia in BPH
A
Androgen steroids/ testosterone, more specifically DIHYDROTTESTOSTERONE
16
Q
MC area where BPH occurs
A
Transition & periurethral zone
17
Q
50/M complained of obstructive sx (frequency, urgency, incontinence, retention), upon DRE prostate is enlarged and nodular
A
BPH
18
Q
T or F:
BPH shows multiple circumscribed nodules without true capsule
A
TRUE
19
Q
Gross features of BPH
A
- Predominantly glandular: Yellow, soft consistency
- Predominantly stromal: Pale gray, firm/hard
20
Q
IHC in BPH
A
Glandular cells:
- Basal cells: (+) HWWCK & p63
- Secretory cells: (+) PSA, PSAP, PSMA
21
Q
Typical characteristic pf BPH microscopically
A
- Combination of stromal and glandular hyperplasia
Others:
- Pure stromal
22
Q
Malignant lesion arising form the cells that line the prostatic gland
A
Prostatic Adenocarcinoma
23
Q
Two histologic categories of Prostatic AdenoCA
A
- Acinar: has prostatic secretory cell differentiation
- Ductal: large glands lined w/ tall pseudostratified columnar tumor cells
24
Q
MC area where Prostatic AdenoCA occurs
A
Peripheral zone
25
Microscopic characteristics of Prostatic AdenoCA that differentiates it from normal prostate and BPH
Small glands with straight luminal border
*Normal & BPH: large glands w/ irregular papillary undulations
26
Pathognomonic features of Prostatic AdenoCA
- Mucinous fibroplasia
- Glomeruli formation
- Perinueral invasion
27
IHC used for Prostatic AdenoCA
(+) AMCR (racemase)
| (-) basal cell markers
28
PSA values in px w/ Prostatic AdenoCA
70 to 75% have PSA >4 ng/mL
29
T or F: Pxs with PSA value of >4 ng/mL points to a diagnosis of prostate CA
FALSE
*PSA > 4ng/mL is not discriminatory bet. benign and malignant. Only tells you that there is probably an ongoing lesion in the prostatic gland
30
The ratio between the serum PSA
| value and volume of the prostate gland.
PSA density
31
The rate of change in PSA value
| with time.
PSA velocity
32
PSA velocity that best
| distinguishes between cancer and benign lesions of prostate.
0.75 ng/mL/year
33
Gleason grading
GG 1-2: Benign
| GG 3-5: Malignant
34
Gleason patterns
GP 1-3 : Discrete well-formed glands
GP 4: Cribriform/ poorly-formed/ fused glands
GP 5: Sheets/ cords/ single cells/ solid nests/ necrosis
35
```
Sum of the 2 most prevalent
Gleason grades (primary and secondary).
```
Gleason score
*Radical Prostatectomy
○ Primary grade - most predominant pattern
○ Secondary grade - 2nd most predominant
*Needle biopsy
○ Primary grade - most predominant pattern
○ Secondary grade - worst pattern
36
Gleason grade groups
● Grade Group 1 (Gleason score = 6) - Only individual discrete well-formed glands
● Grade Group 2 (Gleason score 3+4=7) -
Predominantly well-formed glands with a lesser component of poorly formed/ fused/ cribriform glands
● Grade Group 3 (Gleason score 4+3=7) -
Predominantly poorly-formed/ fused/ cribriform glands with lesser component of well-formed glands
● Grade Group 4 (Gleason score 8) - Only poorly-formed/ fused/ cribriform glands
or - Predominantly well-formed glands with a lesser component lacking glands
or - Predominantly lacking glands with a lesser component of well-formed glands
● Grade Group 5 (Gleason scores 9-10) - Lacks gland formation (or with necrosis) with or w/o poorly-formed/fused/cribriform glands.
37
Most common defect of the male genital tract
Cryptorchidism
38
Failure of testis to descend into the scrotum
Cryptorchidism
39
Risks involved in Cryptorchidism
- Infertility
| - Torsion
40
Major complication of undescended abdominal testis
Development of germ cell tumor
41
Treatment for Cryptorchidism
Orchidopexy: a surgery to move an undescended testicle into the scrotum and permanently fix it there.
*80% descend on the 1st yr of life: watchful waiting
42
T or F: Orchidopexy, when done, eliminates the risk for malignancy
FALSE
*Only decreases the risk --does not eliminate
43
T or F: With progression of age, the cryptorchid testis is larger than normally descended testis
FALSE
*As px gets older, it becomes smaller than normal
44
Microscopic characteristics of Cryptorchidism
Pre-pubertal testis:
- Immature seminiferous tubules and reduced number of germ cells
Post-pubertal testis:
- Tubules reduced in size containing only sertoli cells (absence of germ cells)
45
Comprises 90% of testicular tumors
GCTs
46
GCT presentation
Painless testicular enlargement, unilateral
47
Seminomatous vs non-seminomatous GCT
SEMINOMATOUS
- 35 to 45 y/o
- Localized for a longer time
- Sensitive to radiation therapy
NON-SEMINOMATOUS
- Childhood (10 y/o or younger)
- Can metastasize earlier
- Resistant to radiotherapy
48
Most common testicular tumor
Seminoma
49
GCT that is composed of cells with an enlarged round or polygonal nuclei, prominent nucleoli, discrete cell borders, and clear cytoplasm.
Seminoma
50
Painless palpable mass
Seminoma
51
Counterpart of Seminoma in females
Dysgerminoma
52
Prognosis of Seminoma
Very good prognosis
53
Microscopic characteristics of Seminoma
Sheet or lobules of seminoma cells separated by fibrous septae, infiltrated by lymphocytes
*Cells are round to polygonal, nuclei are large and vesicular with prominent nucleoli; presence of mitosis
54
IHC in Seminoma
Nuclear: (+) OCT3/4 & SALL4
Membranous: CD117 & PLAP
55
Second most common purely occurring GCT
Embryonal carcinoma
56
GCT composed of primitive epithelial cells that recapitulates an early phases of embryogenesis
Embryonal carcinoma
57
Gross features of Embryonal carcinoma
Variegated with soft hemorrhagic and necrotic foci
58
MC growth pattern of Embryonal carcinoma
Solid
Others:
- Glandular
- Papillary
59
T or F: EC cells are generally larger than seminoma cells
TRUE
60
Primary treatment for Embryonal carcinoma
Surgical orchiectomy
61
Impt microscopic characteristics of Embryonal carcinoma
Nuclei are pleomorphic and overlaps, prominent nucleoli
62
IHC in Embryonal carcinoma
(+) CD30, OCT3/4, SALL4, PLAP, and Keratins
63
GCT that display a variety of morphologic patterns that resemble the embryonic yolk sac, allantois, and extraembryonic mesenchyme.
Yolk sac tumor/ Endodermal sinus tumor
64
Most common testicular tumor
| in children
Pure YST
65
Mean age of onset of pure YST
16-18 months
66
Tumor marker elevated in Yolk sac tumor
AFP
67
Most common pattern for Yolk sac tumor
Reticular or Microcystic pattern
* Others:
- Endodermal sinus (2nd MC; contains SDB)
- Papillary (resemble EC)
- Solid (resemble seminoma)
- Glandular-alveolar (resemble intestinal or endometrial glands)
68
IHC for Yolk sac tumor
(+) AFP and Glypican 3
69
Eosinophilic round bodies that secrete AFP
Hyaline-like globules
70
Central blood vessels lined with YST cells which are cuboidal to columnar with prominent nuclei
Schiller duval bodies
71
Malignant GCT composed of syncytio, cyto, and intermediate trophoblast cells
Choriocarcinoma
72
Typical age of presentation of Choriocarcinoma
25 to 30 y/o
73
Symptoms of Choriocarcinoma
Metastatic symptoms:
- Hemoptysis
- Hematemesis
- CNS dysfunction
- Anemia
- Hypotension
74
2 impt gross features seen in Choriocarcinoma
- Hemorrhage
| - Necrosis
75
Large irregular cells with multiple nuclei and eosinophilic cytoplasm
Syncytiotrophoblasts
76
Round and polygonal cells with single round nuclei, prominent nucleoli, and
pale cytoplasm
Cytotrophoblasts
77
Larger than cytotrophoblasts with irregular and smudged nuclei and eosinophilic cytoplasm
Intermediate trophoblasts
78
IHC in Choriocarcinoma
All cell types: (+) PLAP & cytokeratin
| Syncytiotropho: (+) HCG
79
Germ cell neoplasm derived from
| ectoderm, endoderm, and mesoderm (the 3 germinal layers)
Teratoma
80
2nd most common GCT among children
Teratoma
81
Are Teratomas benign or malignant?
Prepuberty: benign
Postpuberty: malignant
82
Teratoma components
Mature: skin, cartilage, muscle
Immature: neuroepithelium, tubules
83
Sex cord stromal tumor that comprises 1-3% of testicular tumors
Leydig cell tumor
84
T or F: 10 to 15% of Leydig cell tumors are malignant. Malignant LCTs are relatively aggressive, patients die within 5 years
TRUE
85
Characteristic rectangular and eosinophilic inclusions seen in Leydig cell tumors
Reinke crystals
86
IHC in Leydig cell tumor
(+) Inhibin, Calretinin, Melan-A, S100
87
Sex cord stromal tumor that is rare (<1% of testicular tumors)
Sertoli cell tumor
88
T or F: Mean age of presentation of Sertoli cell tumor is 45, even though it mostly occurs in adults it is mostly benign
TRUE
89
T or F: Sertoli cell tumors (or Sex cord stromal tumors, in general) are resistant to radiation and chemotherapy
TRUE
90
Most common pattern in Sertoli cell tumor
Tubular pattern
*Others: cord, sheet, nest, retiform
91
microscopic characteristics of Sertoli cell tumor cells
Cuboidal or columnar cells, often with
| prominent cytoplasmic lipid vacuoles
92
IHC in Sertoli cell tumor
(+) Inhibin, Calretinin, CK
93
Precursor lesions of invasive squamous cell carcinoma of the penis; characterized by your atypical or dysplastic squamous epithelium but still have intact basement membrane.
PENILE INTRAEPITHELIAL NEOPLASIA (PeIN)
94
Cytologic atypia limited to lower 3rd
| of the epithelium
Penile Intraepithelial Neoplasia
| (PeIN): Low Grade PeIN-I
95
Cytologic atypia limited to lower 2/3rd of the epithelium
Intermediate Grade PeIN II
96
Cytologic atypia >2/3rd or the full thickness
High grade PeIN III/SCC in situ
97
Similar with PeIN III. however with more spotting distribution of atypical cells and greater maturation of keratinocytes.
Bowenoid Papulosis
98
Strains in HPV-related PeIN
HPV 16 & 18
99
2 types of high grade PeIN III
- Erythroplasia of Queyrat
| - Bowen disease
100
Penile lesion exclusively in uncircumsiced men
Erythroplasia of Queyrat
101
Penile lesion usually seen in young, sexually active adults
Bowenoid papulosis
102
Penile lesion manifested as sharp, demarcated, bright red and shiny plaque
Erythroplasia of Queyrat
103
Penile lesion manifested as crusted, sharply demarcated, scaly plaque
Bowen disease
104
Penile lesion manifested as multiple, small, red papules
Bowenoid papulosis
105
High grade PeIN III vs Bowenoid Papulosis: Site
EQ: glans, prepuce
BD: shaft
BP: shaft
106
High grade PeIN III vs Bowenoid Papulosis: Age of onset
PeIN: 4th-6th decade
BP: younger (3rd-4th decade)
107
High grade PeIN III vs Bowenoid Papulosis: Lesion
EQ: Erythematous plaque
BD: Scaly
BP: Papules
108
High grade PeIN III vs Bowenoid Papulosis: Maturation
PeIN: (-)
BD: (+)
109
High grade PeIN III vs Bowenoid Papulosis: Sweat gland involvement
PeIN: (-)
BD: (+)
110
High grade PeIN III vs Bowenoid Papulosis: Pilosebaceous involvement
PeIN: (+/-)
BD: (-)
111
High grade PeIN III vs Bowenoid Papulosis: Pre-cancerous potential
PeIN: 5 to 10%
BD: (-) --> benign
112
High grade PeIN III vs Bowenoid Papulosis: Spontaneous regression
PeIN: (-)
BD: (+)
113
PeIN III vs Bowenoid papulosis: microscopic features
PeIN: complete absence of maturation, atypical cells distribution is more diffused
BD: there is maturation but is delayed, more spotty distribution of atypical cells
114
MC malignant tumor of the penis
Squamous cell carcinoma
115
Growth pattern of SQCC:
● Most common
● Presents as flat white lesions
Superficial spreading
116
Growth pattern of SQCC:
● Present as ulceration, fungating
● Expect hemorrhage
Vertical growth
117
Growth pattern of SQCC:
● Well differentiated
● Best prognosis
Verruciform growth
118
MC malignant neoplasm of the penis
SCC
119
MC type of all penile tumors
SCC (usual type?)
120
Invasive lesion of the penis with nonpapillary differentiation and varying degree of keratinization; typically occurs in: 60 yrs old, uncircumcised
Usual type SCC
121
T or F: Usual type-SCC are non-HPV related
TRUE
122
SCC location
Glans > foreskin > coronal sulcus
123
T or F: SCCs are usually poorly differentiated
FALSE
*Usually well or moderately differentiated
124
IHC in SCC
(+) Cytokeratins
125
An aggressive variant of SCC
Basaloid carcinoma
126
T or F: Basaloid type-SCC are HPV related
TRUE
127
HPV strain in basaloid carcinoma
HPV 16
128
55/M presented with large, ulcerated mass in the glans, with inguinal lymphadenopathy
Basaloid carcinoma
129
Microscopic features seen in basaloid carcinoma
- Small monotonous cells
- Brisk mitotic rate & apoptotic bodies
- Abrupt keratinization w/ necrosis
130
Unique microscopic characteristics of basaloid carcinoma
- Starry sky appearance (apoptotic bodies)
| - Central comedo type necrosis (d/t abrupt keratinization)
131
IHC in basaloid carcinoma
(+) Cytokeratins
