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Flashcards in Male Genital II Deck (55):
1

What serum markers do we use to work up a testicular mass? Is there a role for biopsy?

1. AFP and HCG
2. No role for biopsy

2

What are 4 differential diagnosis for a testicular mass?

1. inflammation
2. torsion
3. Neoplasms
4. Hydrocel etc.

3

True or false- epididymitis is only caused by sexually transmitted organisms?

False - E.Coli and pseudomonas are common too

4

What is torsion precipitated by? is it an emergency?

1. violent movement or trauma
2. yes, must be surgically corrected within 4 hours

5

T-F-- in torsion cases we may see contralateral spermatogenic abnormalities too?

True- autoimmune possibly

6

What type of testicular neoplasm makes up for 95% of them? What age do they peak at?

1. germ cell tumors
2. 15-34

7

What are 4 main risk factors for germ cell tumors of the testes?

1. cryptochidism
2. prior testicular germ cell tumor
3. Family history
4. Testicular dysgenesis: ie. Klinefelter's

8

T-F---most cases of cryptorchidism are bilateral? Where do they mostly get hung up?

1. False- 25%
2. Inguinal canal

9

What does cryptorchidism look like microscopically?

atrophied, decreased spermatogenesis, peritubular fibrosis, INCREASED LEYDIG CELLS

10

What is the most important distinction in germ cell tumors?

seminomas and non-seminomatous tumors

11

What are a couple gross characteristics of seminomas?

homogenous nodules, gray-white/tan, without hemorrhage or necrosis

12

What does a seminoma look like microscopically?

1. sheets of seminoma cells divided in lobules by fibrous septa with infiltration of lymphocytes

13

What is described by, large, round to polygonal, well defined, clear cytoplasm, round nucleus and prominent central nucleolus?

seminoma cell

14

What is a main gross difference of non-seminomatous germ cell tumors?

hemorrhagic cut surfaces, necrosis

15

What type of non-seminomatous germ cell tumor may show cartilaginous areas and cystic spaces?

teratoma

16

what is described by large, pleomorphic, amphiphilic cytoplasm, overlapping angry-looking nucleus, and hyper chromatic nuclei, prominent nucleoli?

embryonal carcinoma

17

What is the most common yolk sac tumor pattern?

reticular network of cuboidal/elongated cells

18

What does the yolk sac solid pattern look like?

sheets of polygonal cells with pale eosinophilic or clear cytoplasm

19

The endodermal sinus patter of the yolk sac tumor is characterized by what?

schiller-duval body (micro cyst that looks like glomeruli)

20

What stain is frequently positive in yolk sac tumor?

AFP- alpha fetoprotein

21

What is the overall microscopic structure of a choriocarcinoma?

syncytiotrophoblasts are intimately associated with cytotophoblasts within areas of extensive hemorrhage

22

What is described as large, multinucleate, abundant eosinophilic cytoplasm, vacuolated?

syncytiotrophoblasts

23

What are characterized by small polygonal cells, distinct borders, uniform round nuclei and sparse cytoplasm?

cytotrophoblasts

24

What does choriocarcinoma stain positive for?

HCG

25

Does a mature or immature teratoma more commonly have neuroepithelial tubules?

immature

26

How many testicular tumors are a mixture of two or more patterns?

32-54%

27

T-F-- any solid intratesticular mass is considered neoplastic?

True- until proven otherwise

28

Are testicular neoplasms painful?

Usually not

29

Why is LDH an important tumor marker?

correlates with tumor burden and has a prognostic value in patients with metastatic disease

30

Can testicular cancers spread to lungs and liver?

Yes-hematogenously

31

Review staging of testicular cancer

I confined in testes
II confined to retroperitoneal nodes below diaphragm
III outside of retroperitoneal nodes or above diaphragm

32

What is treatment and prognosis of seminoma?

Radiation and prognosis is very good

33

What are problems with the non-seminomatous carcinomas?

1. present advanced
2. metastasize earlier and hematogenously
3. some may not cause enlargement at all (choriocarcinoma)

34

Is adenocarcinoma of the prostate more commonly periurethral or posterior?

Posterior/peripheral zone

BPH is periurethral/transitional zone

35

A benign prostatic gland has how many cell layers?

1. cuboidal secretory cells
2. flattened basal cells

36

What are the 3 differentials of prostate nodules?

1. prostatitis
2. nodular hyperplasia
3. adenocarcinoma

37

Prostatitis is commonly caused by which organism? what about in chronic cases

1. E. Coli
2. Can be same, but usually bacterial- chlamydia, mycoplasma, ureaplasma.

38

What is the incidence of BPH at 40? 60? 70?

20%, 70%, 90%

39

Is BPH a precursor of adenocarcinoma?

NO!!!!

40

What does BPH look like grossly?

multiple variable sized nodules encroaching on the urethra, making it slit like

41

What does nodular hyperplasia look like microscopically?

papillary structures with preserved 2 cell layers

42

In an enlarged prostate from hyperplasia, what are some common upstream effects?

hypertrophied bladder, hydrouretor and hydronephrosis

Also, increased UTIs

43

What is the #2 cause of male cancer deaths?

Prostate- although it is the number 1 type of cancer

44

T-F- PSA is cancer specific?

False- organ specific
IT IS INCREASED IN BPH AND CANCER

45

What is the cut off for PSA?

4

46

What does a gross prostatic adenocarcinoma look like?

gritty, yellow nodule, at the peripheral zone

47

What does a microscopic adenocarcinoma look like?

1. crowded hyperchromatic nodules
2. architectural disarray
3. single layer of cuboidal cells
4. enlarged nucleus/prominent nucleoli

48

Does prostatic cancer have basal cells microscopically??

No

49

What is the gleason grading system based on?

glandular patterns and degree of differentiation

50

What are the main characteristics of gleason pattern 5?

single cells and cords, necrosis the glands are largely missing (pattern 3 had small glands, pattern 4 had long glands)

51

What stage matches the following description- confined within prostate? extraprostatic extension into fat or vesicle? invasion of adjacent structures?

T2
T3
T4

52

What is a very common metastases of prostatic cancer?

osteoblastic bone metastases- vertebrae, ribs, pelvic bones

53

What is the tx for prostatic cancer?

surgery and radiation

54

What is the treatment for metastatic prostate cancer/

orchiectomy (remove testes) or anti-androgen therapy

55

Review the criteria for active surveillance of prostate cancer-

Gleason score <50% involvement of any positive core of 12