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P&T Block 5 Renal > L67 > Flashcards

Flashcards in L67 Deck (44)
1

What is hypospadias

Urethra opens on bottom of penis (ventral - bottom = ventral when erect)

2

What is epispadias

Urethra opens on top of penis (dorsal)

3

Complications of untreated hypo/epispadias

Obstruction/UTI
Problems ejaculating -> sterile

4

What is phimosis? Cause? Complications?

Foreskin too small to tract over glans
Cause: after repeated infections -> scar
↑s risk for infection

5

What is paraphimosis?

Foreskin gets stuck retracted
PAIN
Medical emergency - causes urine retention

6

What is balanoposthitis? Cause/pt pop?

Glans + foreskin = infected
Uncircumcised
Causes:
- Candida
- Anaerobics
- Gardnerella

7

What is condyloma acuminatum? Cause?

Benign neoplasm = genital warts
Aka NOT going to progress to cancer
HPV 6 + 11

8

Histo condyloma acuminatum

Poly/finger like shapes - almost vili like
Lined by squamous epi
Nuclei = big w/ clear space (viral accum)

9

What is squamous carcinoma in situ of the penis? Benign vs malignant? Cause? Treat?

Malignant change @ epithelium
NO invasion (in situ)
Cause = HPV 16
Surgically remove w/ clear margins

10

Cause + pt pop for penis squamous cell cancer. Histo + most common site for mets

SCC - see keratin invading on histo
Uncircumcised middle aged men
HPV 16 + 18
Met to inguinal + iliac LNs

11

What are the 3 things that can cause inflammation of the prostate - think generally

Bacteria - bacterial prostatitis
Abacterial
Granulomatous
1. Post-BCG treatment of bladder cancer
2. Fungal
3. TB

12

Describe normal prostate histo

Glands w/ 2 layers epithelium lining
SM surrounds glands

13

Histo changes in BPH

Hyperplasia prostate stroma + SM -> into nodules

14

What is the most common type of prostate cancer?

Adenocarcinoma

15

3 features of prostate adenocarcinoma histo

1. Small glands infiltrate normal tissue
2. Malignant epi - glands have only 1 layer epi
3. Large nuclei + prominent nucleoli

16

What is prostatic intraepi neoplasia?

"Adenocarcinoma precursor"
Aka abnormalities in normal glands
vs adenocarcinoma = entire glands are abnormal

17

Do you treat PIN?

Nah - freq repeat biopsies for progression check

18

TESTQ: what is the basis of grading prostate cancer? (Gleason score)

ARCHITECTURE
NOT nuclei (normal grading criteria)

19

Where will prostate adenocarcinoma met to?

Inguinal LN
BONE - L vertebrae: look for sclerotic nodules within the vertebrae

20

Options to treat prostate carcinoma

Surg - remove it
Radiotherapy - brachy or external beam
Hormonal
Chemo for mets

21

What is cryptorchidism? Treat?

Undescended testicles
If don't descend on own before 2, surgery to prevent infertility + cancer

22

Describe normal testicle histo

Seminiferous tubules - germ cells at base, prolif as move into lumen as mature sperm
Sertoli cells here = nurturing
Leydig cells between tubules to provide androgens

23

What inflammatory diseases of the testes?

Epididymo-orchitis: acute vs tuberculous (will see granulomas in the testes!)

24

What is testicular torsion? Pt pop

Testes twist in sac - collapse the thin walled vein
Blood still entering through the artery
Painful + hemorrhagic infarct
EMERGENCY
Peaks during 1 yo + puberty

25

Pt population and presentation of germ cell tumors

White, young pts (15-30)
Painless testicular mass

26

What is a seminoma? Gross appearance + treat

Pure germ cell tumor
Homogen gray/white mass
Treat = sen to rad + chemo

27

Histo seminoma

Looks like the germ cells:
1. Clear cytoplasm + large nucelus w/ nucleoli
2. Cell divided by fibrous stroma w/ lymphocytes

28

What lab value is positive in seminomas?

PLAP = placental alk phos +

29

What is a spermatocytic seminoma?

NOT A SEMINOMA TUMOR
1. No lymphocytes
2. PLAP neg
3. 55 yo +
4. Treat by removing testicle - no chemo/rad

30

What are non-seminomatous germ cell tumors?

Tumors of germ cells in different stages of development to mature sperm
Usually mixed for this reason
Might have seminoma component - just starts at an earlier step (no change treat)

31

What is unique about non-sem germ cell tumor mets?

Met can be different cell type than the 1ary tumor

32

Name the 4 non-sem germ cell tumors

Teratoma
Embryonal carcinoma
Yolk sac
Choricarcinoma
*Since most tumors are mixed, think about these types together in 1 tumor*

33

What is a teratoma? Pt age

From multiple (all 3) germ layers (neuro, ecto, endoderm)
Tissue can be either embryonal (immature) or fetal/adult (mature)
Kids - benign
Post-puberty men - MALIGNANT (vs adult women = benign) *TESTQ*

34

What is an embryonal carcinoma? Stain used?

Embryonal tissue aka very dysmorphic
Cells form epithelial structures - tubules or sheets of cells
Stain w/ cytokeratin

35

What is a yolk sac tumor? Pt age? Marker

Endoderm - homog yellow/white timor
*INFANTS - 3 YO*
Elevated AFP

36

TESTQ: the presentation is a testicular mass with elevated AFP. How does the ddx change if pt is 0-3 yo vs 20 yo?

0-3 = pure yolk sac tumor
20 = mixed tumor w/ yolk sac component

37

Yolk sac histo

Schiller Duval bodies = papillae w/ central vascular core (looks like flower)
Eosinophilic globules = pink dot

38

What is a choriocarcinoma? What is the serum/tissue marker?

V MALIGNANT - 1ary tumor is small, more likely to find the met first
Cyto + syncytio-trophoblast
High bHCG

39

If you get a testicular mass with +bHCG, what should you be thinking?

Chorio
OR mixed w/ chorio component

40

What are intratubular germ cell neoplasia?

Look for atypical cells in base of steroli tubules
Precursor of germ cell tumors
Look like seminoma, but are in the normal location for sertoli cells aka base of tubule

41

Common mets for germ cell tumors + exception

Met to LN - retroperitoneal, aortic, mediastinal, supraclav
Via blood to organs
Exception = chorio, earlier mets than all others!!

42

Stage 1 vs 2 vs 3 testicular tumors

1 = in testis
2 = mets below diaphragm
3 = mets above

43

Treat germ cell tumors

Remove tesicle
Adj - chemo/rad
No adj for spermatocytic seminoma or teratomas in kids

44

Compare seminoma vs non-sem
1. Local vs met
2. Stage at presentation
3. Route of mets
4. Treament

Seminoma = localized for long time, present st 1, met to local LN, v radiosens w/ good cure rate
Non-sem = met early via blood, therefore st 2/3 at presentation, need aggressive chemo, good remission rates