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CPR III > Renal Pathology 9: Male GU (Dobson) > Flashcards

Renal Pathology 9: Male GU (Dobson) Flashcards

1
Q

How are bladder cancers staged?

A

Staged on the basis of invasion of the detrusor muscle

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2
Q

The three points of slight narrowing of the ureter?

A
  1. uteropelvic junction
  2. where the ureter enters the bladder
  3. where the ureter crosses the iliac vessels
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3
Q

Ureteropelvic junction (UPJ)

A

most common cause of hydronephrosis in infants and children

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4
Q

Retroperitoneal fibrosis

A

(AKA Ormond disease) fibrotic proliferative inflammatory process encasing the retroperitoneal structures (SAD PUCKERS) and causing hydronephrosis; tx is steroids, but will need stents and surgery

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5
Q

Cystitis infectious agents

A

E. coli (most common)
Chlamydia, Mycoplasma, Proteus, Klebsiella

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6
Q

Predisposition to cystitis

A

Bladder stones (calculi)
Urinary obstruction
DM
Instrumentation
Immune deficiency
Irradiation of the bladder

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7
Q

Triad of symptoms in cystitis?

A
  1. increased frequency (need to go every 20 mins)
  2. lower abd pain (localized to suprapubic region)
  3. dysuria
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8
Q

Malakoplakia

A

chronic bacterial cystitis (E. coli or Proteus)
Michaelis-Gutmann bodies

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9
Q

Michaelis-Gutmann bodies

A

macrophages with intra-lysosomal laminated calcified concentrations seen in malakoplakia (chronic bacterial cystitis)

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10
Q

Polypoid cystitis

A

inflammatory lesion from irritation of bladder mucosa; most commonly due to indwelling catheters; marked submucosal edema that can lead to bulbous polypoid projections; confused with papillary urothelial carcinoma

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11
Q

Squamous cell carcinoma of the bladder

A

PAINLESS hematuria; response to chronic inflammation; urothelium replaced by non keratinizing squamous epithelium (more resilient cells); Schistosoma haematobium infections, smoking and chronic UTIs

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12
Q

Urothelium tumors (2 main type)

A
  1. Noninvasive papillary tumors (most common)
  2. Flat noninvasive urothelial carcinoma
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13
Q

Noninvasive papillary tumors

A

most common precursor lesion to urothelial tumors; orginates from papillary urothelial hyperplasia

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14
Q

Urothelial carcinoma risk factors

A

predominantly males; age 50-80 yrs; cigarette smoking (the most important) and cyclophosphamide (drug used cancer tx) is another risk

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15
Q

50-80% of all bladder cancers are associated with what?

A

Cigarette smoking

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16
Q

Papillary Urothelial Neoplasms of Low Malignant Potential (PUNLMP)

A

slightly larger than papillomas; THICKER urothelium; rarely progress to higher grade

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17
Q

High Grade Papillary Urothelial Cancer

A

dis-cohesive cells with anaplastic features; loss of polarity; high risk of invasion into the muscular layer, higher risk of progression and significant metastatic potential

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18
Q

Invasive urothelial cancer

A

Invasive of muscularis mucosae (detrusor muscle) is prognostically important; staging at the initial diagnosis is the most important factor in determining the outlook for the patient

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19
Q

Adenocarcinoma of the bladder

A

PAINLESS hematuria; rare; some arise from urachal remnants or in the setting of intestinal metaplasia; histologically identical to adenocarcinomas of the GI tract

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20
Q

Bladder Cancer Clinically

A

PAINLESS hematuria; tend to recur after excision at a higher grade in different sites; treatment responds to chemo but if not then surgery is curative

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21
Q

Prostate enlargement

A

most common cause of obstruction of the bladder outlet in males due to nodular hyperplasia

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22
Q

Cystocele of the bladder

A

most common cause of obstruction of the bladder in females

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23
Q

Urethral Caruncle

A

PAINFUL, small, red inflammatory lesion of the external urethral meatus in older females, bleed easily due to ulceration; excision is curative

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24
Q

Hypospadias

A

more common than epispadias; congenital anomaly of the penis; urethral opening on the VENTRAL aspect of the penis; incomplete fusion of urogenital folds; can lead to urinary obstruction (severe cases - post renal AKI and hydronephrosis)

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25
Q

Epispadias

A

congenital anomaly of the penis; urethral opening on the DORSAL aspect of the penis; due to abnormal positioning of the genital tubercle during development; present with exstrophy of the bladder

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26
Q

Balanoposthitis

A

infection of the glans and prepuce by non specific organisms (not STD); due to poor local hygiene in uncircumcised males

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27
Q

Common infection in uncircumcised males

A

Balanoposthitis; infection of the glans and prepuce by non specific organisms (not STD); due to poor local hygiene

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28
Q

Condyloma Acuminata

A

Penile tumor; benign sexually transmitted wart, HPV 6>11, recurs after excision, but rarely transforms to malignancy, may display Kolicytosis- cytoplasmic vacuolization of the squamous cells; characteristic of HPV

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29
Q

Kolicytosis

A

cytoplasmic vacuolization of the squamous cells; characteristic of HPV seen in Condyloma Acuminata; Penile tumor; benign sexually transmitted wart

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30
Q

Peyronie Disease

A

benign proliferation of fibroblasts of tunica albuginea; results in fibrous bands involving the penile corpus cavernosum; causes penile curvature and pain during intercourse

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31
Q

Disease that causes penile curvature and pain during intercourse

A

Peyronie Disease; benign proliferation of fibroblasts of tunica albuginea; results in fibrous bands involving the penile corpus cavernosum

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32
Q

Bowenoid Papulosis

A

multiple, pigmented papular lesions on external genitalia (penis); histologically indistinguishable from Bowens disease; so use age and number of lesions; younger patients and multiple (compared to older and solitary lesion); also rarely progresses to carcinoma

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33
Q

Cryptorchidism

A

the most common congenital anomaly of the testes; failure of testes to descent; can lead to tubular atrophy and sterility; 75% unilateral; found in 1% of 1 yr old boys; decreased germ cell development; fibrosis with sparing prominent Leydig cells; completely asymptomatic

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34
Q

most common congenital anomaly of the testes

A

Cryptorchidism; found in 1% of 1 yr old boys; failure of testes to descent

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35
Q

Inflammation of the epididymis and testis

A

more common in epididymis, epididymis is first then testis (gonorrhea/TB) if testis first then epididymis (syphilis - but epididymis is commonly spared altogether)

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36
Q

Granulomatous (autoimmune) Orchitis

A

moderately tender testicular mass of sudden onset; sometimes associated with fever; granulomas are restricted to spermatic tubules

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37
Q

Gonorrhea

A

from neglected gonococcal infection; RETROGRADE expansion of infection from posterior urethra to prostate, seminal vesicles and epididymis

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38
Q

Gonorrhea left untreated

A

testis suppurative orchitis

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39
Q

Severe complication of gonorrhea

A

epididymal abscesses = destruction and scarring

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40
Q

Mumps

A

systemic viral infection; commonly affects children; testicular involvement is rare; 20-30% of post-pubertal men who are infected present with orchitis 1 week after inflammation of parotid glands

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41
Q

Post-pubertal men who have inflammation of parotid glands and one week later present with orchitis, should make you think what?

A

Mumps; systemic viral infection; testicular involvement is rare

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42
Q

Syphilis

A

testes are involved FIRST and the epididymis is commonly spared; nodular gummas; histological hallmark: obliterative endarteritis associated with perivascular cuffs of lymphocytes and plasma cells.

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43
Q

obliterative endarteritis associated with perivascular cuffs of lymphocytes and plasma cells.

A

Syphilis

44
Q

STI in men were testes are involved first and then the epididymis is commonly spared

A

Syphilis

45
Q

Nodular gummas

A

Syphilis

46
Q

Testicular torsion

A

twisting of the spermatic cord cuts off testicular venous drainage; arterial supply remains patent; occludes venous outflow; true urologic emergency (testis can become enlarged and hemorrhagic); surgery < 6 hours

47
Q

Adenomatoid tumor

A

most benign paratesticular neoplasm; small nodules of mesothelial cells near the upper epididymal pole

48
Q

Rhabdomyosarcoma

A

most common paratesticular tumor in children

49
Q

Most common paratesticular tumor in children?

A

Rhabdomyosarcoma

50
Q

Liposarcoma

A

Most common paratesticular tumor in adults

51
Q

Most common paratesticular tumor in adults?

A

Liposarcoma

52
Q

Classification of testicular germ cell tumors

A
  1. Seminomatous tumors: cells that look like primordial germ cells
  2. Nonseminomatous tumors: undifferentiated cells that look like embryonic stem cells
53
Q

Seminomatous tumors

A

testicular germ cell tumor were the cells that look like primordial germ cells; remain localized to testis for long time; radiosensitive; good prognosis

54
Q

Nonseminomatous tumors

A

testicular germ cell tumors were undifferentiated cells that look like embryonic stem cells; more aggressive; radioresistant; metastasize early

55
Q

Intratubular germ cell neoplasia (ITGCN)

A

occurs in utero, dormant until puberty; commonly has a duplication of the short arm of 12 which is always found in all invasive germ cell tumors

56
Q

Seminoma

A

most common type of germ cell tumor, 20-30 yrs; almost never in infants; express isochromosome 12p and OC3/4 and NANOG

57
Q

Most common type of germ cell tumor?

A

Seminoma; 20-30 yrs; almost never in infants; express isochromosome 12p and OC3/4 and NANOG

58
Q

Spermatocytic Seminoma

A

rare and slow growing testicular germ cell tumor; patient > 65 yrs old; excellent prognosis; no associated with ITGCN

59
Q

Embryonal carcinoma

A

more aggressive than seminomas; poorly demarcated, small, gray-white mass, positive for OCT3/4, PLAP, CD30, cytokeratin and negative for cKIT

60
Q

Yolk sac tumor

A

Endodermal sinus tumor; most common testicular tumor in children <3 years and comes with a very good prognosisl Schiller-Duval bodies (primitive glomeruli)

61
Q

Choriocarcinoma

A

highly malignant neoplasm, small palpable nodule without testicular enlargement; derived from chorionic villi in placenta; contains syncytiotrophoblasts - hCG reaches very high levels in the serum; can lead to signs of hyperthyroidism

62
Q

If hCG reaches very high levels in the serum what should be on you differential?

A

Choriocarcinoma; highly malignant neoplasm, small palpable nodule without testicular enlargement; contains syncytiotrophoblasts - hCG reaches very high levels in the serum

63
Q

Teratoma

A

differentiation in all three germ layers; all embedded in a fibrous or myxoid stroma; post-pubertal = all teratoma s are regarded as malignant

64
Q

What is the most aggressive nonseminomatous germ cell tumor (NSGCT)?

A

Pure Choriocarcinoma; rapid hematogenous spread; lungs and liver are involved early; no testicular enlargement

65
Q

Pure Choriocarcinoma

A

most aggressive nonseminomatous germ cell tumor (NSGCT); rapid hematogenous spread; lungs and liver are involved early; no testicular enlargement

66
Q

Stage II of testicular tumor staging

A

persistent elevation of hCG or AFP concentrations following orchiectomy, even if lymph nodes appear normal

67
Q

Persistent elevation of hCG or AFP concentrations following orchiectomy, even if lymph nodes appear normal indicates what?

A

Stage II of testicular tumor staging

68
Q

AFP biomarker

A

biomarker markedly elevated in yolk sac tumor (nonseminous tumor)

69
Q

biomarker markedly elevated in yolk sac tumor

A

AFP biomarker

70
Q

hCG biomarker

A

biomarker markedly elevated in choriocarcinoma; 15% of seminomas have elevated hCG

71
Q

Leydig cell tumors

A

2% of all testicular tumors; most are benign; tumor produces androgens, estrogens and corticoidsteroids; present with testicular swelling

72
Q

Eosinophilic Reinke crystalloids

A

Leydig cell tumors

73
Q

Testicular lymphoma

A

most common form of testicular tumors in >60 yrs; disseminate widely; high incidence of CNS involvement

74
Q

Lymphoma with high incidence of CNS involvement?

A

Testicular lymphoma; most common form of testicular tumors in >60 yrs; disseminate widely

75
Q

Hydrocele

A

accumulation of serous fluid within the tunica vaginalis; leads to enlargement of scrotal sac that contains clear fluid; will transilluminate (a beam of light can pass through)

76
Q

Hematocele

A

accumulation of blood secondary to trauma, torsion or generalized bleeding diathesis; will not transilluminate

77
Q

Chylocele

A

accumulation of lymphatic fluid secondary to lymphatic obstruction

78
Q

Spermatocele

A

local cystic accumulation of semen in dilated efferent ducts or ducts of the rete testis

79
Q

Variococele

A

dilated veins in the spermatic cord; may be asymptomatic; will not transilluminate

80
Q

Peripheral zone of the prostate

A

where most carcinomas arise; classically in a posterior location

81
Q

Transitional zone of the prostate

A

where most hyperplasia occurs (much more common than tumors)

82
Q

Nonbacterial Chronic Prostatitis

A

most common prostatitis; cultures are uniformly negative; no history of recurrent UTI

83
Q

Chronic Bacterial Prostatitis

A

frequent bouts of UTI, hx of recurrent UTI; leukocytosis in the expressed prostatic secretions

84
Q

Granulomatous Prostatitis

A

the most common cause in the US is from instillation of BCG into the bladder for treatment of superficial bladder cancer

85
Q

Benign Prostatic Hyperplasia (BPH)

A

Nodular hyperplasia; most common prostatic disorder; stromal proliferation; can be thought of as a sign as aging; large nodules in the peri-urethral region of the prostate

86
Q

BPH pathogensis

A

increased number of epithelial cells and stromal components in the peri-urethral area of the prostate; believe the hyperplasia is because of impaired cell death; DHT-induced growth factors act by increasing proliferation of stromal cells and decrease death of epithelial cells

87
Q

Diagnosis of BPH

A

need DRE (palpate a firm rubbery mass); cannot be made on needle biopsy; too small to appreciate nodularity and do not biopsy transition zone where BPH occurs

88
Q

Clinical presentation of BPH

A

Nocturia, urgency, hesitancy, difficulty starting and stopping the stream of urine; inability to completely void bladder

89
Q

BPH are at increased risk for what?

A

bacterial infections of the bladder and kidney; inability to completely void bladder, reservoir of residual urine, common source of infection; is NOT a precursor for malignancy.

90
Q

Adenocarcinoma of the prostate

A

most common cancer in men; uncommon in Asians, more common in Blacks; Rearrangement of ETS family transcription factor gene (ERG or ETV1); most important risk factor is increasing age (60-70 yrs); PSA screenings; develops in the posterior lobe of peripheral zone AWAY from urethra so no urinary symptoms (symptoms think BPH)

91
Q

Kennedy disease

A

long trinucleotide expansions of CAGs in x-linked andreogen receptor gene; disease is characterized by muscle cramping and fatigue; shortest expansion = more sensitive= Blacks; intermediate = Whites; Longer = Asians

92
Q

Prostatic intraepithelial neoplasia (PIN)

A

obstruction of the urinary tract presenting like BPH; finding of osteoblastic metastases by skeletal surveys or the much more sensitive radionuclide bone scanning is virtually diagnostic of prostate cancer in men, bony metastases are typically osteoblastic and this feature in men strongly points to prostatic origin; is a precursor for malignancy

93
Q

Benign prostate glands

A

contain Basal cells

94
Q

Malignant prostate glands

A

absent basal cells

95
Q

Histology shows perineural invasion

A

specific for prostate cancer

96
Q

Gleason score of 2-6

A

grading of prostate cancers; 2-6 have excellent prognosis; 2 = minimum Gleason score and most well differentiated

97
Q

If tested are not palpable in the scrotum of a child under 1 yr?

A

Cryptorchidism; did not fully descend from the abdomen; external inguinal ring is the most common location; visible mass in the groin, most spontaneously descend by 6 month

98
Q

Bilateral cryptochidism is commonly associated with what?

A

a genetic disorder; commonly Klinefelter syndrome (47 XXY) this syndrome commonly causes hypogonadism

99
Q

Treatment for cryptochidism

A

Orchiopexy- surgery

100
Q

What reflect is absent in testicular torsion?

A

Cremasteric reflex; normally - pinch skin of upper thigh and see elevation of i/l testis

101
Q

How does testicular torsion present?

A

Acute scrotal pain; this is a true testicular emergency!

102
Q

Diagnosis of hydrocele

A

with an ultrasound; will transilluminate (a beam of light will pass through; differs in varicocele and trauma)

103
Q

Bowen disease

A

penile carcinoma presents with crusting and oozing erythematosis plaques on shaft of penis

104
Q

Phimosis

A

fibrosed foreskin that cannot be retracted from the glans

105
Q

Patent urachus

A

failure of allantois to completely involute/obliterate; abnormal connection between bladder and umbilicus; leakage of urine from the umbilicus in newborns

CPR III (20 decks)

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