(33) Urogenital Pathology Flashcards Preview

7. CP - Kidney and Urinary Tract Disease > (33) Urogenital Pathology > Flashcards

Flashcards in (33) Urogenital Pathology Deck (76)
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What is nodular prostatic hyperplasia also know as?

Benign prostatic hyperplasia (BPH)


What is nodular prostatic hyperplasia/BPH?

Enlargement of the prostate - overgrowth of the epithelium and fibromuscular tissue of the transition zone and periurethral area


What are the lower urinary tract symptoms (LUTS) of BPH?

- urgency
- difficulty starting urination
- diminished stream size and force
- increased frequency
- incomplete bladder emptying
- nocturia


What causes the LUTS in BPH?

Interference with the muscular sphincteric function and by obstruction of urine flow through the prostatic urethra


The normal prostate contains several distinct regions. Name 4 regions

- central zone
- peripheral zone
- transitional zone
- periurethral zone


Where do most carcinomas of the prostate arise from?

The peripheral glands of the organ - may be palpable on digital examination of rectum


In contrast to carcinomas, where does nodular prostatic hyperplasia arise?

More centrally situated glands - more likely to produce urinary obstruction earlier than carcinoma


Development of nodular hyperplasia includes what 3 pathologic changes?

- nodule formation
- diffuse enlargement of the transition zone and periurethral tissue
- enlargement of nodules


Which feature of nodular hyperplasia is predominant among under 70s

Diffuse enlargement of transition zone and periurethral tissue


Which feature of nodular hyperplasia is predominant among older men?

Nodule formation and enlargement of nodules


Describe 2 histologically different types of nodules you can get in nodular hyperplasia

- pure stromal nodule (uniform and circumscribed with stromal fibroblasts and scattered lymphocytes)
- mixed epithelial-stromal nodule


What is the aetiology behind BPH?

- impaired cell death = accumulation of senescent cells in prostate
- androgens (mainly DHT) involved in BPH can increase cellular proliferation and inhibit cell death


95% of prostatic malignancies are what type?

Prostatic adenocarcinoma


At what age does the incidence of prostatic adenocarcinoma rise quickly?

40 years


What is the different between autopsy-based prevalence and clinical incidence of prostatic adenocarcinoma?

Autopsy studies of prostates from men without clinical evidence of cancer have sown a very high level of latent cancer

autopsy > clinical


The incidence of prostatic adenocarcinoma is much higher in men of what ancestry?

African (100 per 100,000)

compared to European (70.1 per 100,000)


How is cancer of the prostate treated?

- surgery
- radiation
- hormonal manipulations


How long can those receiving treatment for prostate cancer expect to live?

More than 90% of patients who receive such therapy can expect to live for 15 years


What is the most common treatment for clinically localised prostate cancer?

Radical prostatectomy


What is the prognosis following radical prostatectomy based on?

- pathologic stage
- margin status
- Gleason grade


What are the alternative treatments for localised prostate cancer? (other than radical prostatectomy)

- external-beam radiation therapy
- interstitial radiation therapy (brachytherapy)


External-beam radiation therapy is also used to treat prostate cancer that is what?

Too locally advanced to be cured by surgery


What are the risk factors involved in carcinoma of the prostate?

- age
- race
- family history
- hormone levels (androgens)
- environmental influence eg. increased consumption of fats


Which hormones play a big part in prostate cancer?



What role do androgens play in prostate cancer?

Maintain growth and survival of prostate cancer cells


How can the effects of androgens in prostate cancer be seen?

In the therapeutic effect of castration or treatment with anti-androgens, which usually induce disease regression


How does family history (inherited polymorphisms) affect risk of prostate cancer?

- 1 first-degree relative with prostate cancer = 2x the risk
- 2 first-degree relatives = 5x the risk

Strong family history also = develop disease at earlier age


Men with germline mutations of which gene have a 20-fold increase in risk of prostate cancer?

tumour suppressor BRCA2 gener


What is currently the only accepted grading system for prostate carcinoma?

Gleason scoring system (recommended by WHO)


What are the 5 stages of prostate cancer according to Gleason scoring system?

1. Small, uniform glands. Well differentiated
2. More stroma between glands
3. Distinctly infiltrative margins. Moderately differentiated
4. Irregular masses of neoplastic cells
5. Only occasional gland formation. Poorly differentiated/anaplastic


Why might screening for prostate cancer not be beneficial?

- role of PSA - false positives and false negatives
- complications of treatment (impotence, incontinence etc)
- unnecessary treatments
- limited benefits
- consideration in high risk groups
- reduced mortality vs. risks of over treatment


Who is the incidence of testicular tumours highest amongst globally?

Among men of northern European ancestry

Lowest among men of Asian and African descent


What pre-existing medical conditions have been associated with development of testicular germ cell tumours (TGCT)?

- prior TGCT in the contralateral testicle
- cryptorchidism
- impaired spermatogenesis
- inguinal hernia
- hydrocele
- disorders of sex development
- prior testicular biopsy
- atopy
- testicular atrophy


What is cryptorchidism?

The absence of one or both testes from the scrotum. It is the most common birth defect of the male genitalia


Name 2 types of testicular cancer

- seminoma
- teratoma


At what age is seminoma most common?

35-45 yrs
- uncommon in men >50
- rare in children


At what age is teratoma most common?

In the 1st and 2nd decades of life


Describe the typical clinical presentation of seminoma

- testicular enlargement
- with or without pain
- metastases
- some patients have no symptoms
- rare symtoms = gynaecomastia, exophthalmos, infertility


What is the typical clinical presentation of teratoma?

- gradual testicular swelling
- with or without pain


Can mature teratoma be benign?

Mature teratoma is almost always benign in prepubertal patients

However, it can pursue an aggressive clinical course after puberty i.e. metastasis


Immature teratoma is a common component of what?

NSGCTs (non-seminomatous germ cell tumours)

Teratoma in its pure form is very rare


What are the tumour markers in seminoma?

- elevated serum PLAP (40%)
- elevated hCG (10%) - cause of gynaecomastia


What are the tumour markers in teratoma?

Purely teratomatous tissues do not secrete tumour markers


Describe the macroscopic appearance of seminoma

- well-demarcated
- cream-coloured
- homogeneous
- coarsely lobulated


Describe the microscopic appearance of teratoma

- monotonous polygonal cells with mostly clear cytoplasm and central nuclei divided into lobules by thin bands of fibrovascular stroma


Describe the microscopic appearance of teratoma

- mixture of ectoderm, endoderm, and mesoderm


Name 7 inflammatory conditions of the testis

- acute and chronic epididymoorchitis
- idiopathic granulomatous orchitis
- sarcoidosis of the testis
- malakoplakia of testis
- myofibroblastic pseudo tumour of testis
- sperm granuloma
- tuberculous orchitis


What do you seen on histology in acute/chronic epididymoorchitis?

- ghostly outlines of infarcted seminiferous tubules
- surrounded by purulent exudate containing neutrophils and other inflammatory cells


Idiopathic granulomatous orchitis typically presents in older adults, with associated symptoms of what?

- trauma
- flu-like illness


What happens to the testis in idiopathic granulomatous orchitis?

Becomes swollen, painful and tender initially but later may have a residual mass indistinguishable from a neoplasm, prompting orchiectomy


What causes the granulomatous appearance in idiopathic granulomatous orchitis?

No granulomas present but the interstitial and intratubular aggregation of epithelioid histiocytes, lymphocytes and plasma cells imparts a granulomatous appearance


Sarcoidosis can affect the testis. What may it mimic?

Malignancy, particularly if accompanied by radiologic pulmonary abnormalities


What may you see on histology in sarcoidosis of the testis?

- non-nectrotising granulomas involving testicular parenchyma
- special stains for fungal organisms and acid-fast bacilli are negative


What may malakoplakia affect?

Only the testis, or less commonly, both the testis and the epididymis


What does malakoplakia of the testis result in the formation of?

Soft yellow, tan, or brown nodules that replace normal testicular parenchyma


What is seen on histology in malakoplakia of the testis?

The tubules and interstitium are extensively infiltrated by large histiocytes that have abundant eosinophilic granular cytoplasm


What are the histiocytes called in malakoplakia?

von Hansemann histiocytes


What is myofibroblastic pseudotumour of testis?

An atypical inflammatory and myofibroblastic reaction with fasciitis-like large cells

Features of malignancy are absent

A benign reactive and proliferative process of uncertain aetiology


What is a sperm granuloma?

An exuberant foreign body giant cell reaction to extravasated sperm


How common is sperm granuloma?

Occurs in up to 42% of patients after vasectomy

2.5% of routine autopsies


What are signs and symptoms of sperm granuloma?

May have no symptoms

Often present with history of pain and swelling of the upper pole of the epididymis, spermatic cord, and rarely, the testis

Others have a history of trauma, epididymiditis and orchitis


Where is the reservoir for tuberculous involvement in the male genital tract?

The epididymis

With secondary testicular involvement and other local sites of involvement in about 80% of cases


How many cases of renal tuberculosis are accompanied by epididymis infection?



How do patients usually present with tuberculous orchitis?

With painless scrotal swelling

Other signs include unilateral or bilateral mass, infertility, and scrotal fistula


What kind of inflammation do you get in tuberculous orchitis?

Caseating granulomatous inflammation is prominent, with fibrous thickening and enlargement of the epididymis and adjacent structures


What makes up 25% of cases of empty scrotum?



In, cryptorchidism, where are the testes most frequently found?

In the inguinal canal or upper scrotum; arrest within the abdomen is less frequent


On which side is cryptorchidism more common?

Slightly more common on the right; 18% are bilateral


What is the causes of congenital cryptorchidism?

Anomalies in anatomic development or hormonal mechanisms involved in testicular descent


What are the causes of acquired cryptorchidism?

Postoperative or spontaneous ascent
- inability of spermatic vessels to grow adequately
- anomalous insertion of the gubernaculum
- failure in reabsorption of the vaginal process
- failure in postnatal elongation of the spermatic cord


What are the potential complications associated with cryptorchidism?

- testicular atrophy
- infertility
- carcinoma (TGCTs)


What is hypogonadism?

Reduction or absence of hormone secretion or other physiological activity of the gonads (testes or ovaries).


What are the primary causes of hypogonadism/testicular failure?

- undescended testis
- Klinefelter syndrome
- haemochromatosis
- mumps
- orchitis
- trauma
- CF
- testicular torsion
- variocele


What are the secondary cause of hypogonadism/testicular failure?

- pituitary failure
- drugs (glucocorticoids, ketoconazole, chemotherapy, opioids)
- obesity
- aging


What is Klinefelter syndrome?

Set of symptoms that arise from 2 or more X chromosomes in males

47 XXY


What is variocele?

An abnormal enlargement of the pampiniform venous plexus in the scrotum