Kidney and Urinary Tract Disease - Urogenital Pathology (32) Flashcards Preview

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Flashcards in Kidney and Urinary Tract Disease - Urogenital Pathology (32) Deck (45):
1

Enlargement of the prostate is also known as

Nodular hyperplasia or benign prostatic hyperplasia

2

Enlargement of prostate consists of

Overgrowth of epithelium and fibromuscular tissue of the transition zone and periurethral area

3

Symptoms of enlarged prostate are caused by

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

4

Symptoms of enlarged prostate include

Urgency, difficulty in starting urination, diminished stream size and force, increased frequency, incomplete bladder emptying and nocturia

5

4 distinct regions of prostate

1. Central zone (CZ)
2. Peripheral zone (PZ)
3. Transitional zone (TZ)
4. Periurethral zone

6

Most carcinomas arise from which part of the organ

Peripheral glands, may be palpable during digital examination of rectum

7

Where does nodular hyperplasia occur?

More central glands, more likely to produce urinary obstruction earlier than carcinoma

8

Three pathological changes in development of nodular hyperplasia

1. Nodule formation
2. Diffuse enlargement of the TZ and periurethal tissue
3. Enlargement of nodules

9

Which pathological changes predominate among

Diffuse enlargement of the TZ and periurethral tissue

10

Which pathological changes predominate among >70yrs?

Nodule formation and enlargement

11

Aetiology of enlarged prostate

- Impaired cell death > accumulate of ageing cells
- Androgens cause development BPH > increase cellular proliferation and inhibit cell death

12

Prostatic adenocarcinoma affects which age and ethnicity group?

Over 40 years, African ancestry

13

Management

Surgery, radiation therapy, hormone manipulations (90% 15 yrs)

- Radical prostatectomy
- External-beam radiation therapy
- Interstitial radiation therapy (brachytherapy)

14

Risk factors

Age, race, family history, hormone levels (androgens), environmental influences (increased fat), inherited polymorphisms, germline mutations of tumour suppressor BRCA2

15

If inherit BRCA2 gene, how much more likely are you to get prostate cancer?

20 times

16

Grading system

Gleason

17

Screening

None available - limited benefits/false positives and negatives

18

Testicular cancer epidemiology

Highest among men of northern European ancestry

19

Pre-existing medical conditions associated with Testicular germ cell tumours

Prior TGCT in contralateral testicle, cryptorchidism, impaired spermatogenesis, inguinal hernia hydrocele, disorders of sex development, atopy, testicular atrophy

20

Seminoma common in

35-45 year olds

21

Teratoma common in

First and second decades of life

22

Seminoma clinical presentation

Testicular enlargement (with/without pain) and metastases, asymptomatic

23

Rare symptoms of seminoma

Gynecomastia, exophthalmos, infertility

24

Teratoma clinical presentation

Gradual testicular swelling with/without pain

25

Seminoma tumour markers

Elevated serum PLAL and hCG (gynecomastia)

26

Teratoma tumour markers

None

27

Macroscopically seminoma

Well-demarcated, cream-coloured, homogeneous and coarsely lobulated

28

Microscopically seminoma

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

29

Macroscopically teratoma

Well-demarcated solid/multicystic

30

Microscopically teratoma

Admixture of ectoderm, endoderm and mesoderm

31

Acute and chronic epididymoorhcitis

Infarcted seminiferous tubules, purulent exudate (neutrophils)

32

Idiopathic granulomatous orchitis occurs in

Older adults

33

Idiopathic granulomatous orchitis symptoms

Like-UTI/trauma/flu-like illness, testis become swollen, painful and tender > residual mass indistinguishable from neoplasm (orchiectomy)

34

Sarcoidosis of the testis

Mimic malignancy, non-necrotising granulomas involving testicular parenchyma (acid-fast bacilli and fungal negative)

35

Malakoplakia of testis

Affects testis +/- epididymis, soft yellow/tan/brown nodules, replaced normal testicular parenchyma, tubules and interstitial infiltrated by large histiocytes (abundant eosinophilic granular cytoplasm) (Von Hansemann histiocytes)

36

Myofibroblastic pseudo tumour of testis

Atypical inflammatory and myofibroblastic reaction, fasciitis-like large cells (benign reactive and proliferative process)

37

Sperm Granuloma

Foreign body giant cell reaction to extravasated sperm, pain and swelling upper pole of epididymis, spermatic cord, testis, history of trauma, epididymitis and orchitis

38

How common is sperm granuloma?

42% patients after vasectomy

39

TB orchitis

Renal TB - epididymal infection, caveating granulomatous inflammation is prominent, fibrous thickening, enlargement of epididymis

40

Signs and symptoms of TB orchitis

Painless scrotal swelling, unilateral/bilateral mass, infertility, scrotal fistula

41

Cryptorchidism

Tests most frequently in inguinal canal/upper scrotum/abdomen, right/18% bilateral

42

Congenital cryptorchidism

Anomalies in anatomic development/hormonal mechanisms involved in testicular descent

43

Acquired cryptorchidism

Post-op/spontaneous ascent - inability of spermatic blood vessels to grow adequately, anomalous insertion of gubernaculum, failure in reabsorption of vaginal process, failure in postnatal elongation of spermatic cord

44

Primary hypogonadism causes

Undescended testis, Klinefelter syndrome, hemochrombtosis, mumps, orchitis, trauma, CF, testicular torsion and varicocele

45

Secondary hypogonadism causes

Pituitary failure, drugs (glucocorticoids, ketoconazole, chemotherapy, opioids), obesity and aging

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