Lower Urinary Tract and Male Genital Tract

Question 1

MCC of hydronephrosis in infants and children

MALES
bilateral

Answer 1

Ureteropelvic junction obstruction

Question 2

MC and most serious congenital anomaly of the urinary bladder d.t. predisposition to infection and scarring

Answer 2

Vesicoureteral Reflux

Question 3

Chronic inflammation reaction secondary to acquired DEFECTS in PHAGOCYTE function

chronic bacterial infection
immunosuppression

Answer 3

MALAKOPLAKIA

soft, yellow, slightly raided mucosal plaques

HISTOLOGY:
foamy macrophages
MICHAELIS-GUTMANN BODIES

Question 4

Malformation of urethral groove –> abnormal opening on the VENTRAL shaft

Seen in 5-a reductase deficiency

Answer 4

HYPOSPADIAS

ASSOCIATIONS:
inguinal hernia
cryptorchidism
chordee

Question 5

Malformation of urethral groove –> abnormal opening on the DORSAL shaft

Answer 5

EPISPADIAS

ASSOCIATIONS:
exstrophy of bladder

Question 6

Benign sexually transmitted wart caused by LOW risk HPVs

HPV 6 (more common) and 11

Answer 6

CONDYLOMA ACUMINATUM

HISTOLOGIC:
superficial hyperkeratosis and acanthosis
KOILOCYTES - perinuclear cytoplasmic vacuolization

Question 7

Malignant squamous lesion CONFINED to the epithelium by an INTACT basement membrane

Answer 7

Squamous Carcinoma In situ - Penile Intraepithelial Neoplasia (PEIN)

HPV related - HPV 16
*Bowen disease

NON-HPV related
*balanitis xerotica obliterans
*(+) squamous differentiation

Question 8

Squamous cell carcinoma of the penis usually originates in

Answer 8

glans or inner surface of the prepuce near the coronal sulcus

irregular, fungating cauliflower-like masses; flat, indurated lesions; or large verruciform/papillary tumors

Question 9

Complete or partial failure of the intra-abdominal testes to descend into the scrotal sac

associated with testicular dysfunction

increased risk of testicular cancer

Answer 9

Cryptorchidism

UNILATERAL

INGUINAL CANAL - MC site of undescended testes

Question 10

MC phase of arrest of Cryptorchidism

Answer 10

INGUINOSCROTAL (4th-7th mo AOG)

Question 11

Current recommendations for orchiopexy to be performed at

Answer 11

6 to 12 months of age

Question 12

This disorder, which appears to be reactive rather than
neoplastic, is characterized by HARD PENILE PLAQUES that result from the deposition of COLLAGEN in the connective tissue between the corpora cavernosa and the tunica albuginea

Answer 12

Peyronie Disease

Question 13

Mimics testicular tumor

tender mass w/ or w/o fever

NON CASEATING GRANULOMAS in seminiferous tubules

Answer 13

Granulomatous (Autoimmune) Orchitis

Question 14

Undifferentiated PeIN

OLDER men

PRECURSOR to INVASIVE CA

Answer 14

BOWEN DISEASE

shaft and scrotum - SOLITARY THICKENED, GRAY WHITE, opaque plaque

glans - VELVETY RED

Question 14

Undifferentiated PeIN

OLDER men

PRECURSOR to INVASIVE CA

Answer 14

BOWEN DISEASE

shaft and scrotum - SOLITARY THICKENED, GRAY WHITE, opaque plaque

glans - VELVETY RED

Question 15

True urologic emergency

Twisting of spermatic cord –> impaired venous drainage –> congestion –> hemorrhagic infarction

Answer 15

TESTICULAR TORSION

6 hrs - GOLDEN period

Question 16

MCC of PAINLESS testicular enlargement

ANY testicular mass should be considered MALIGNANT unless proven otherwise

Answer 16

TESTICULAR TUMORS

Germ cell - 95%
Sex-Cord stromal - 5%

Question 17

Most important associated condition in GERM CELL TUMORS

Answer 17

Cryptorchidism

Question 18

Germ Cell Tumors Classification

Answer 18

SEMINOMATOUS - BETTER prognosis
NON-SEMINOMATOUS - UNFAVORABLE prognosis

Question 19

MCC of painless testicular enlargement

Answer 19

Testicular tumors

Question 20

MC germ cell tumor

4th decade

HISTOLOGY:
LARGE round to polyhedral cells with DISTINCT CELL MEMBRANE, CLEAR or watery appearing CYTOPLASM and CENTRAL NUCLEI w/ 1-2 PROMINENT NUCLEOLI

LYMPHOCYTIC INFILTRATE

Answer 20

Seminoma

(+) KIT
(-) cytokeratin

FAVORABLE BEHAVIOR

Question 21

MC testicular germ cell tumor in infants and children up to 3 years

Answer 21

Prepubertal Yolk Sac Tumor

Question 22

2nd MC testicular germ cell tumor in infants and children

Answer 22

Testicular teratoma

Question 23

2nd MC germ cell tumor in adults

Answer 23

Mixed germ cell tumor

Question 24

MC testicular neoplasm in men > 60 years

Answer 24

Testicular lymphoma - MC form: DLBCL

Question 25

Peak incidence - 20- to 30-year-old age group MORE AGGRESSIVE than seminoma may occur as a pure tumor or mixed with other germ cell components HEMORRHAGIC MASS

Answer 25

EMBRYONAL CARCINOMA large and anaplastic hyperchromatic nuclei with prominent nucleoli LYMPHOVASCULAR INVASION (-) KIT (+) cytokeratin, OCT3/4, Podoplanin

Question 26

Also known as endodermal sinus tumor MC testicular tumor in infants and children up to 3 years of age - very good prognosis

Answer 26

YOLK SAC TUMOR SCHILLER-DUVAL (glomeruloid bodies) - structures resembling endodermal sinuses (+) AFP

Question 27

HIGHLY MALIGNANT type of GCT composed of 2 intimately juxtaposed cell types - syncytiotrophoblasts and cytotrophoblasts

Answer 27

CHORIOCARCINOMA (+) hCG

Question 28

Germ cell tumors composed of elements derived from >1 germ cell layer 2nd MC testicular tumors in infants and children

Answer 28

TESTICULAR TERATOMA AGE - most important predictor of biologic behavior PREPUBERTAL - BENIGN POSTPUBERTAL - MALIGNANT

Question 29

2nd MC GCT in ADULTS

Answer 29

MIXED GERM CELL TUMOR

Question 30

TUMOR MARKERS

Answer 30

LDH - assesses tumor burden AFP - yolk sac tumor hCG - syncytiotrophoblasts; choriocarcinoma

Question 31

Sex Cord Stromal Tumors most cases display a BENIGN behavior

Answer 31

Leydig cell tumor Sertoli cell tumor

Question 32

Associated with: Klinefelter syndrome Cryptorchidism Hereditary leiomyomatosis and RCC syndrome (+) functional ESTROGENS and ANDROGENS

Answer 32

LEYDIC CELL TUMORS gynecomastia sexual precocity in children HISTOLOGY: Crystalloids of Reinke - 25%

Question 33

Associated with: Carney complex (caused by germline mutations in the gene PRKAR1A, which encodes a cyclic adenosine monophosphate–dependent protein kinase) Peutz-Jeghers syndrome familial adenomatosis polyposis syndrome

Answer 33

SERTOLI CELL TUMORS testicular swelling HISTOLOGY: tumor cells arranged in trabeculae forming cord-like structures and tubules - resemble seminiferous tubules)

Question 34

MC testicular neoplasm in men >60 y/o AGGRESSIVE tumors BILATERAL with SPERMATIC CORD frequent CNS

Answer 34

TESTICULAR LYMPHOMA DLBCL - MC form

Question 35

The most common benign prostatic disease in men older than age 50 years NOT a premalignant lesion

Answer 35

Benign Prostatic Hyperplasia TRANSITIONAL ZONE urinary obstruction enlarged prostate often increases 3- to 5fold (60 to 100 g) well-defined nodules of BPH compress the urethra into a SLIT LIKE LUMEN hyperplastic glands with papillary epithelial infoldings

Question 36

Histologic hallmark of BPH

Answer 36

NODULARITY

Question 37

MC genetic alteration of Prostatic Adenocarcinoma

Answer 37

ETV1-TMPRSS2 rearrangement

Question 38

Risk Factors of Prostatic Adenocarcinoma

Answer 38

advancing AGE ANDROGEN excess GENETIC - race, family history of prostate cancer in 1st degree relatives, inherited mutations DIET - charred red meats, animal fat

Question 39

Histologic findings of Prostatic Adenocarcinoma

Answer 39

smaller than benign glands, single layer of epithelium (NO OUTER BASAL LAYER), tightly packed cells, usually ROUND (no branching and papillary infoldings) ENLARGED nuclei + 1 or more large nucleoli (-) pleomorphism and mitosis

Question 40

Common sites of metastasis of Prostatic ca obturator -- para-aortic nodes BATSON PLEXUS -- BONES (axial skeleton) (BLASTIC lesions)

Answer 40

LUMBAR SPINE proximal femur pelvis thoracic spine ribs

Question 41

Most important prognostic factors in Prostatic ca

Answer 41

GRADE AND STAGE GLEASON SYSTEM