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Flashcards in Renal Pathology Deck (104)
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1

Nephrotic Syndrome
Major Characteristics (4)

Proteinuria (>3.5 g/day)
Hypoalbuminemia (Plasma < 3 g/dL)
Generalized Edema
Compensatory Hyperlipidemia

2

Nephritic Syndrome
Major Characteristics (3)

Hematuria
HTN
Azotemia

3

In Situ Immune Complex Formation
Mechanisms with Microscopy (2) and Examples (4)

Abs to intrinsic tissue antigens
Linear immunofluorescence
Goodpasture syndrome

Abs to extrinsic antigens planted in glomerulus
Granular immunofluorescence
Postinfectious Glomerulonephritis
Membranous nephropathy
Membranoproliferative Glomerulonephritis

4

Circulating Complex Deposition
Examples (4)

Systemic Lupus Erythematosus
IgA Mediated Nephropathy
HBV/HCV Infections
Allergens

5

Acute Proliferative Glomerulonephritis
Pathogenesis, Morphology (4), Causes (3)

Immune complex mediated damage most often from deposition of postinfectious antigens

Hypercellularity
Leukocyte Infiltration
IgG/IgM/C3 granular deposits
Subepithelial humps

M protein Streptococcus (kids)
Post-staphylococcus
Some viruses and parasites

6

Acute Proliferative Glomerulonephritis Presentations
Kids (5) and Adults (4)

Age 6-10
Post strep pharyngitis/impetigo*
Nephritic syndrome
Dysmorphic RBCs
Periorbital edema

Aggressive and atypical*
Sudden HTN
Edema
Increased BUN
Only 60% fully recover

7

RPGN Type I
Etiology (2), HLA Association, Treatment

Anti-Basement Membrane Abs
Abs to Type IV collagen (Goodpasture)

HLA-DRB1

Plasmapharesis and immunosuppression

8

Rapidly Progressive Glomerulonephritis
Morphology (4) and Presentation (3)

Basement membrane tears (wrinkling)
Crescentic lesions of proliferating epithelial cells
Collapsed glomerular tufts
Macrophage/Leukocyte infiltrates

Rapid progressive renal function loss
Severe oliguria
Nephritic syndrome

9

RPGN Type II
Cause, Microscopy and Treatment

Immune complex deposition (SLE, IgA, APG)

Subendothelial Granular immunofluorescence

Treat the underlying condition

10

RPGN Type III
Diagnosis and Examples (2)

Cirulating ANCA proteins

Granulomatosis with polyangiitis (PR3 ANCA)
Microscopic Polyangiitis (MPO ANCA)

11

Nephrotic Syndrome Causes
Primary (3) and Secondary (5)

Membranous Nephropathy
Minimal Change Disease
Focal Segmental Glomerulosclerosis

Diabetes
Amyloidosis
SLE
Drugs (NSAIDS, Heroin)
Malignancy

12

Membranous Nephropathy
Pathogenesis (3), Morphology (2) and Presentation (3)

Diffuse thickening of glomerular capillary wall
From HLA-DQA1 mutation and PLA2 receptor Abs

Subepithelial IgG4 deposits
Spike formations

Nephrotic syndrome
Non-selective proteinuria
Hematuria

13

Minimal Change Disease
Microscopy, Clinical Features (3), Treatment, Association

Foot Process Effacement
Only visible on Electron Microscopy

*Most common Primary NS in children*
Selective proteinuria
Edema

*Very responsive to corticosteroids*

Secondary to Non-Hodgkin Lymphoma (adults)

14

Focal Segmental Glomerulosclerosis Causes
Primary (1) and Secondary (3)

Primary
Idiopathic: Most common cause of NS in US**

Secondary (glomerular injury)
HIV Associated: collapsing variant possible
Ablation Nephropathy: loss of renal tissue
Genetic Mutation: NPHS, TRPC6, alpha-Actinin

15

Focal Segmental Glomerulosclerosis
Morphology (3), Clinical Features (6), Microscopy (2)

**Foot Process Effacement (electron microscopy)**
Sclerosis
Collapsing Glomerulopathy


Mixed Nephrotic/Nephritic:
Hematuria
Nonselective proteinuria
Decreased GFR
HTN
Progresses to CKD

Focal IgM and C3 immunofluorescence
Focal Segmental Sclerosis (light microscopy)

16

Type I Membranoproliferative Glomerulonephritis
Pathogenesis (3), Presentation (2) and Microscopy (3)

Immune complexes in glomerulus
Activation of classic and alternative complement paths

Mixed GD: hematuria and proteinuria

Mesangial proliferation (Light)
Subendothelial deposits (Electron)
IgG, C3, C1q, C4 granular immunofluorescence

17

Type I MPGN Primary vs Secondary
Age, Prognosis, Associations (2)

Primary
Presents younger
Nephrotic/Nephritic
HTN
50% progress to chronic

Secondary
Presents in adults
Associated with Chronic Antigenemia
Seen in Hep C/SLE/Cancer patients
50% progress to chronic

18

Type II Membranoproliferative Glomerulonephritis
Pathogenesis (2), Presentation (4) and Microscopy (4)

C3 Nephritic Factor binds C3 convertase
C3C activates alternative complement pathway

Hematuria
Nephritic Syndrome
Progression to CKD (poorer prognosis)
Primary disease in kids/young adults

Mesangial proliferation (LM)
GBM splitting (LM)
C3 and IgG deposits (IF)
Dense deposits (EM)

19

IgA Nephropathy
Clinical Features (5), Microscopy (1)

Recurrent Hematuria after mucosal infections**
Most common cause of glomerulonephritis
More common in young adults, whites/asians, males
Familial component
Associated with gluten enteropathy

IgA in mesangium (IF)**

20

Chronic Glomerulonephritis
Description (3), Causes (5), Pathologic Features (3)

End stage glomerular disease
From either Acute or Asymptomatic Glomerulonephritis
Resulting in Uremia

Crescentic GN**
FSGS
MPGN
Membranous nephropathy
IgA nephropathy

Thinned cortex
Collagenous replacement of Glomeruli
Arterial sclerosis

21

Alport Syndrome
Pathologic Features (4), Inheritance (2), Presentation (5)

Irregular thickening/thinning of GBM
Lamina densa lamination
Moth eaten or frayed lamina densa appearance
Mutations in Type IV collagen alpha-molecules

X-Linked: males most affected
Autosomal: males/females equally affected

Hematuria
RBC casts
Proteinuria
Neural deafness
Vision disturbances

22

Thin Basement Membrane Disease
Clinical Feature, Inheritance (2), Pathologic Feature

Familial asymptomatic hematuria**

Most people heterozygous carriers
Homozygous see defective Type IV collagen

Diffuse thinning of GBM

23

Secondary Nephrotic Syndrome Causes (4)

Diabetic Nephropathy
SLE (mixed)
Hepatitis C (MPGN Type I)
HIV Nephropathy (FSGS)

24

Secondary Nephritic Syndrome Causes (4)

SLE (mixed)
Bacterial Endocarditis (Acute Proliferative)
Goodpasture Syndrome (RPGN)
Henoch-Shonlein Purpura (IgA Nephropathy)

25

Diabetic Mellitus
Epidemiology (2) and Common Complications (4)

Leading cause of end stage renal failure in US (30%)**
Happens in 40% of diabetics

Nephropathy
Retinopathy
Cataracts
Neuropathy

26

Diabetic Nephropathy Morphologic Changes
Glomerulus (4), Papilla (2), Vasculature

Thickened GBM
Diffuse mesangial sclerosis
Nodular glomerulosclerosis
Via hyperglycemia and hypertrophy

Necrotizing papillitis (via pyelonephritis)

Arteriolosclerosis

27

Lupus Nephritis
Pathogenesis and Spectrum (I-VI)

Subendothelial immune complex deposits disrupt glomerulus

Minimal mesangial lupus nephritis (class I)
Focal lupus nephritis (class II)
Mesangial proliferative lupus nephritis (class III)
Diffuse lupus nephritis (class IV)
Membranous lupus nephritis (class V)
Advanced sclerosing lupus nephritis (class VI)

28

Henoch-Schönlein Purpura
Description, Presentation (5), Morphology (2)

IgA nephropathy associated with systemic vaculitis

Purpuric skin lesions**
Abdominal pain
Intestinal bleeding
Arthralgias
Recurrent Hematuria**

IgA, IgG and C3 deposition in mesangium (IF)
Mesangial proliferation (LM)

29

Bacterial Endocarditis Glomerulonephritis
Presentation (2) and Microscopy

Hematuria
Proteinuria

Glomerular immune complex deposits

30

Fibrillary Glomerulonephritis
Presentation (3) and Morphology (2)

Nephrotic syndrome
Hematuria
Progressive renal insufficiency

Fibrillar deposits in mesangium and glomerular capillaries

31

Common Histology of Goodpasture, Granulomatosis with Polyangiitis and Microscopic Polyangiitis (2)

Crescent Lesions
Foci of Glomerular Necrosis

32

Acute Tubular Injury
Etiology (2), Pathology (4), Histology (2)

Ischemia
Endogenous/Exogenous Toxic Agents

Tubule cell injury leading to:
Tubuloglomerular feedback
Tubule obstruction (by casts)
Tubular back leak

Focal Tubular epithelial necrosis
Swollen epithelial cells with vacuolization

33

Acute Tubular Injury Clinical Phase Descriptions
Initiation (1), Maintenance (2), Recovery (3)

Initiation: Oliguria

Maintenance: Uremia, Hyperkalemia*

Recovery: Polyuria, Hypokalemia*, Infection susceptibility

34

Tubulointerstitial Nephritis
Presentation (2), Etiologies (5)
and Features of Acute (3) vs Chronic (2)

Azotemia**
Inability to concentrate urine

Infections, Toxins, Metabolic Diseases, Obstruction, Neoplasms

Acute shows edema, eosinophils and neutrophils
Chronic shows fibrosis and tubular atrophy

35

Acute Pyelonephritis
Predisposing Factors (4), Etiologies (5), Morphology (4)

Vesicoureteral reflux**
Diabetes
Pregnancy
Males with BPH

Ascending Cystitis from gram negative bacteria
(E. coli, Klebsiella, Proteus, Enterobacter)

Patchy interstitial inflammation
Intratubular neutrophils
Tubulitis
Tubular necrosis

36

Pyelonephritis Complications (3)

Papillary necrosis
Pyonephrosis
Perinephric abscess

37

Chronic Pyelonephritis
Definition (3), Etiologies (3) and Morphology (3)

Chronic tubulointerstitial inflammation leading to scarring of calyces and pelvis

**Analgesic nephropathy: Vesicoureteral reflux with superimposed UTI
Chronic Obstructive Pyelonephritis: BPH
Xanthogranulomatous: Proteus infections

Polar scarring
Dilated, blunted or deformed calyces
Flattened papillae

38

Papillary Necrosis Etiologies (3)
Ratios, Time course, Infection and Calcification

Diabetes Mellitus
Mostly female, 10 years, Infectious, no calcification

Analgesic Nephropathy
Mostly female, 7 years, Non-Infectious, calcification

Obstruction
Mostly male, variable time, Infectious, Calcification

39

Myeloma Kidney
Etiology (2), Morphology (3) and Clinical Features (2)

Bence-Jones proteinuria and cast nephropathy

Pink/Blue masses distending tubular lumens
Interstitial inflammation and fibrosis

Insidious chronic kidney disease
Proteinuria

40

Nephrolithiasis
Epidemiology (2), Predisposing Factors (4), Minerals (4)

Usually unilateral
Most often in men aged 20-30**

Increased mineral concentration**
pH disturbances
Decreased urine volume
Bacteria

Mostly Calcium**
Also Magnesium, Uric acid, and cystine

41

Benign Nephrosclerosis
Definition, Etiologies (3) and Morphology (3)

General process of hyaline sclerosis of renal arterioles and small arteries (not a diagnosis)

Increasing age
HTN
Diabetes mellitus

Cortical scarring and shrinking
Hyaline arteriolosclerosis
Patchy ischemic atrophy

42

Malignant Hypertension
Pathogenesis (5) and Definition

Renal vascular damage causes endothelial injury
Vascular cell death causes focal hemorrhage
Platelets form thrombus, leads to ischemia
Fibrinoid necrosis causes hyperplastic arteriolitis
Decreased renal perfusion causes continuous RAAS

BP over 180/120

43

Malignant Nephrosclerosis
Morphology (3) and Presentation (5)

"Flea bitten" petechial hemorrhage
Arteriolar fibrinoid necrosis
Interlobular hyperplastic arteriolitis

Early on increased intracranial pressure
Retinal hemorrhage
Papilledema
Encephalopathy (emergency)
Renal failure

44

Renal Artery Stenosis
Etiologies (2), Complications (2) and Treatment

Renal A atheromatous occlusion
Fibromuscular dysplasia

HTN (similar to essential)
Shrunken kidney

Surgical stenting

45

Thrombotic Microangiopathies Descriptions
Typical, Atypical (2) and TTP (2)

Typical Hemolytic-Uremic Syndrome:
Diarrhea from Shiga Toxin exposure

Atypical Hemolytic-Uremic Syndrome:
Inherited mutations in Complement Regulators*
Acquired endothelial injuries

Thrombotic Thrombocytopenic Purpura:
Inherited ADAMTS13 deficiency (von willebrand)
**Neurologic Symptoms**

46

Thrombotic Microangiopathies
Common Pathology (2) and Morphology (4)

Endothelial damage and activation
Excessive platelet activation and aggregation

Cortical necrosis
Thrombotic glomerular capillary occlusion
Mesangiolysis
Interlobular arteriolar fibrinoid necrosis

47

Atheroembolic Renal Disease
Morphology (4) and Risk Factors (3)

Atrophy
Fibrosis
Hemorrhage
Necrosis

Atherosclerosis
AAA repair
Intra-aortic cannulization

48

Renal Infarcts
Pathogenesis, Compounding Risks (2)

Embolism mostly from mural thrombi from left heart

End organ blood supply
Lack of collateral circulation

49

Diffuse Cortical Sclerosis
Etiologies (2) Complications (2) and Morphology (2)

Obstetric surgery or Septic shock

Causes systemic hypoperfusion and hypoxia

Coagulative necrosis of renal glomeruli and tubules

50

Major Renal Congenital Anomalies (4)

Kidney Agenesis (rare)
Unilateral shows hypertrophy and hypertension
Bilateral is death

Kidney Hypoplasia
Usually unilateral, shows low birth weight

Ectopic Kidney
Kidneys in pelvis, increases bacterial UTIs

Horseshoe Kidney (common)
Usually fusion of lower poles, sits across midline vessels

51

Autosomal Dominant Polycystic Kidney Disease
Mutations (2), Pathologic Features (4), Presentation (6) and Prognosis

PKD1 or PKD2 mutations
PKD1 is more common

Always bilateral
Mitral valve prolapse
Liver cysts
Berry aneurysms*

Presents in Adults*
Hematuria
Flank pain
UTIs
Nephrolithiasis
HTN

Chronic renal failure by age 40-60
(PKD2 better prognosis)

52

Autosomal Recessive Polycystic Kidney Disease
Mutation, Pathologic Features (2) and Prognosis

PKHD1 gene defect

Enlarged cystic kidneys at birth
Hepatic fibrosis

Death in infancy/childhood

53

Medullary Sponge Kidney
Pathologic Feature, Presentation (3) and Prognosis

Medullary cysts

Hematuria
UTIs
Recurrent nephrolithiasis

Benign

54

Familial juvenile Nephronophthisis
Inheritance, Pathologic Features (2), Presentation (4) and Prognosis

Autosomal recessive

Corticomedullary cysts
Shrunken kidneys

Salt wasting
Polyuria
Growth retardation
Anemia

Progressive renal failure in childhood

55

Adult Medullary Cystic Disease
Inheritance, Pathologic Features (2), Presentation (2) and Prognosis

Autosomal dominant

Corticomedullary cysts
Shrunken kidneys

Salt wasting
Polyuria

Progressive renal failure in adulthood

56

Multicystic Renal Dysplasia
Pathologic Features (3) and Prognosis (2)

Variable kidney cysts
Ureter agenesis
Ureteropelvic obstruction

Renal failure if bilateral
Surgically curable if unilateral

57

Dialysis Associated Cystic Disease
Pathologic Features (2), Presentation (3)

Numerous cortical and medullary cysts

Hemorrhage
Erythrocytosis
Renal cell carcinoma

58

Simple Renal Cysts
Pathologic Features (2), Presentation

Normal sized kidneys
Cortical cyst with clear fluid

Microscopic hematuria

59

Urinary Tract Obstruction
Main Complication and Clinical Presentations (4)

Hydronephrosis: Dilated renal pelvis/calyces and progressive renal atrophy

Acute: Pain/Bladder issues from underlying cause
Unilateral complete: silent, diagnosed with ultrasound
Bilateral Partial: Polyuria, Nocturia and HTN
Bilateral Complete: Anuria, Postobstructive diuresis

60

Renal Papillary Adenoma
Classification, Cytogenetics (2) and Morphology (3)

Benign if < 1cm
Most common benign renal neoplasm

Trisomies 7 and 17

Appear cortical, discrete and yellow-gray

61

Renal Oncocytoma
Gross Appearance (4), Origin and Histology

Mahogany brown
Well circumscribed
Central stellate scar
Large: 10-15 cm**

Type A Intercalated Cells

Eosinophilic cells with numerous mitochondria

62

Renal Angiomyolipoma
Association, Complication and Morphology (3)

Loss of TSC1/TSC2 tumor suppressor genes
(Tuberous Sclerosis)

Hypovolemic shock via spontaneous hemorrhage

Thick walled vessels
Smooth muscle proliferation
Fat cells

63

Familial Renal Cancer Syndromes
Examples (4) and Clinical Relevancy

Von Hippel-Lindau: Hereditary and sporadic clear cell renal carcinomas

Hereditary Leiomyomatosis: aggressive papillary carcinoma

Hereditary Papillary Carcinoma: MET oncogene causes Sporadic and Hereditary Papillary carcinoma

Birt-Hogg-Dube: see skin, pulmonary and renal tumors

64

Renal Cell Carcinoma Cytogenetic/Genetic Factors
Papillary (2) and Familial (1)

Papillary associated with Trisomy 7
Papillary associated with mutated activated MET

Familial Clear cell have Chr 3 VHL translocation/deletion

65

Renal Cell Carcinoma Morphology
Clear cell (2), Papillary (2), Chromophobe (2)

Clear cell: non-papillary growth and clear cytoplasm

Papillary: papillary growth and multifocal

Chromophobe: pale eosinophilic cytoplasm with nuclear halos

66

Renal Cell Carcinoma
Presentation (3), Prognoses (4) and Main Danger

Hematuria
Costovertebral pain
Palpable flank mass

Chromophobe is best
Papillary and Clear cell are moderate
Collecting Duct/Sarcomatoid/Medullary are worst

Hematogenous metastasis while remaining subclinical

67

Urothelial (Transitional cell) Carcinoma
Presentation (3) Complications (2)

Hematuria
Hydronephrosis
Flank pain

Tubulointerstitial nephropathy
Infiltration of renal pelvis/calyx (poor prognosis)

68

Metastatic Disease to the Kidney
Causes (5) and Description (2)

Metastasis of:
Melanoma or Lung, Breast, GI, Pancreas cancers

Multifocal and bilateral

69

Neuroblastoma
Unfavorable Factors (5)

Stage 3 or 4
Older than 18 months
Poor differentiation
Near diploid
NMYC amplification

70

Wilms Tumor
Precursor, Prognostic Factors (6), Genetic Link

Nephrogenic rests are precursor lesion

Favorable: Blastemal, stromal and epithelial cells all present, older age

Unfavorable: Diffuse anaplasia, p53 mutation

WT1 mutation

71

Ureter Congenital Anomalies (3)

Double and Bifid Ureters
Ureteropelvic Junction obstruction
Diverticula

72

Ureter Inflammatory Conditions (2)

Ureteritis Follicularis
Ureteritis Cystica

73

Ureteral Obstruction Extrinsic Causes (4)

Pregnancy
Periureteral inflammation
Endometriosis

Sclerosing Retroperitoneal Fibrosis (IgG4 related)

74

Urinary Bladder
Congenital Anomalies with Complications (4)

Diverticulae: bladder infections/calculi

Exstrophy: Adenocarcinoma

Vesicureteral reflux: congenital vesicoureteral fistula

Urachal cysts: Adenocarcinoma

75

Bladder Cystitis - Acute and Chronic
Presentation (4) and Morphologic Types (3)

Frequency of urination
Lower abdominal pain
Dysuria (burning)
Low grade fever

Hemorrhagic
Follicular
Eosinophilic

76

Bladder Cystitis
Etiologies (4) and Predisposing Factors (5)

E. coli
Klebsiella
Proteus
Enterobacter

Calculi
Obstruction
Diabetes
Immune Deficiency
Radiation

77

Interstitial Cystitis
Pathologic Features (3) and Presentation (3)

Glomerulations
Hunner's Ulcer
Mast cells

Intermittent severe suprapubic pain
Presents in females 30-40

78

Malacoplakia
Cause Morphology (2) and Population

Defective phagosomes causing chronic E coli infection
Inflammation and plaque formation
Granular macrophages with Michaelis Gutmann bodies

Presents in middle aged women

79

Polypoid cystitis
Cause and Misdiagnosis

Indwelling catheters

Papillary carcinoma

80

Nephrogenic Adenoma
Pathology (2)

Renal tubular cells implanted in urothelium
Urothelium replaced with cuboidal epithelium

81

Cystitis Cystica/Glandularis
Pathogenesis (3) and Population

Nests of Brunn form
Metaplasia into cuboidal/columnar (glandularis)
Urothelium retracts and flattens (cystica)

Mostly male

82

Papillary Urothelial Carcinoma
Stages (5)

Exophytic papilloma
Inverted papilloma
Carcinoma in situ
PUNLMP (thickened epithelium)
Low/High Grade Papillary Urothelial cancers

83

Urothelial Carcinoma
Presentation (2), Risk Factors (4), Morphology (2)

Painless hematuria
Presents in people over 65 years

Smoking
Cyclophosphamide
Phenacetin
p53 mutation

Hyperchromatic cells
Huge nuclei

84

Mesenchymal Bladder Tumors
Adult vs Pediatric

Leiomyomas in adults
(intramural, encapsulated)

Embryonal Rhabdomyosarcoma in kids
(Grape-like mass)

85

Urethritis - Gonococcal and Non-Gonococcal
Main Causes (2) and Male/Female Difference

Gonorrhea
Chlamydia

Males are symptomatic and females are not

86

Reactive Arthritis
Presentation (3) and Description

Arthritis
Conjunctivitis
Urethritis

Non-infectious inflammatory urethritis

87

Primary Carcinoma of the Urethra
Commonness and Proximal/Distal Differences

Not common

Proximal: urothelial differentiation
Distal: Squamous cell carcinoma

88

Epispadias and Hypospadias
Description (3) and Complication

Malformation of urethral groove and canal
Ventral if hypospadias
Dorsal if epispadias

Sterility

89

Phimosis
Description and Complications (2)

Narrowing of the orifice of the prepuce

Increased risk of infections and carcinoma

90

Balanoposthitis
Description, Causes (2), Complication

Infection of the glans and prepuce

Candida albicans
Gardnerella

Smegma

91

Benign Penile Tumor (Condyloma Acuminatum)
Cause and Morphology (3)

HPV

Sessile or pedunculated red papillary excrescences
Acanthosis
Koilocytosis

92

Malignant Penile Tumors
CIS (2) and Squamous Carcinoma (2) Associations

Carcinoma in Situ:
Bowen Disease (over 35, solitary lesion)
Bowenoid Papulosis (younger, multiple lesions)

Squamous Carcinoma: HPV associated
Verrucous carcinoma is a subtype

93

HPV Complications
Common Morphology and Examples with HPV Type (4)

Koilocytosis

Condyloma Acumunatum (6/11)
Squamous Penile Carcinoma (16/18)
Bowen Disease (16)
Bowenoid Papulosis (16)

94

Cryptorchidism
Description, Histology (2), Timeline (3), Complications (2)

Intra-abdominal testis undescended into scrotal sac

Arrested germ cell development
Hyalinization and thickening of Spermatic Tubule BM

Most will spontaneously descend in first year
Orchiopexy required if not descended by two years
After two years histological deterioration happens

Infertility
Testicular Cancer

95

Testis/Epididymis Pathologic Issues (4) with Causes

Atrophy: Mostly from Klinefelter

Inflammation: Msotly from UTIs

Autoimmune: idiopathic granulomatous orchitis

Specific Infections: Gonorrhea, Mumps, TB, Syphilis

96

Testicular Torsion - Adult and Neonatal
Causes (2) and Intervention

Adult caused by bell-clapper abnormality
Neonatal lacks anatomic defect

Orchiopexy

97

Testicular Germ Cell Tumors
Associated Syndrome, Genetics (2) and Precursor Lesion

**Most common tumor in males 15-34

Testicular Dysgenesis Syndrome

KIT and BAK mutations

Intratubular Germ Cell Neoplasia

98

Seminomatous Germ Cell Tumor
Morphology (5)

**Most common germ cell tumor

Large,
Round/polyhedral,
Distinct cell membrane,
Clear cytoplasm,
Central nucleus with nucleoli

99

Non-Seminomatous Germ Cell Tumors
Examples (4)

Embryonal carcinoma
Yolk sac tumor (Schiller duval bodies)
Choriocarcinoma
Teratoma (malignant post puberty)

100

Tunica Vaginalis Lesions (5)

Hydrocele
Hematocele
Chylocele
Spermatocele
Varicocele

101

Prostate Inflammation Types (4)

Acute Bacterial Prostatitis
Chronic Bacterial Prostatitis
Granulomatous Prostatitis
Chronic Abacterial Prostatitis (most common)

102

Benign Prostatic Hyperplasia
Age, Pathogenesis (2), Initial Location

Most common over 50 years

Nodular hyperplasia of stromal and epithelial cells
Influenced by DHT related growth factors

Hyperplasia starts in the transition zone

103

Prostate Adenocarcinoma
Incidence (2), Androgens Role, Genetics (2)

**Most common form of cancer in men**
More common in African Americans

Androgens help cancer grow and survive
(Treat with castration or anti-androgens)

ERG/ETV1 transposed next to TMPRSS2 gene
BRCA2 mutations

104

Prostate Adenocarcinoma Diagnosis
Gleason Score, Biomarkers (2)

Low score = more differentiated (better prognosis)
*10 is the highest score with worst prognosis

Prostate specific antigen (PSA)
PCA3