Renal Pathology Chapter 21 part 3 Flashcards Preview

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Flashcards in Renal Pathology Chapter 21 part 3 Deck (68)
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Germ cell tumors of the testis often secrete hormones and certain enzymes that can be detected in blood by sensitive assays, including

-HCG, AFP, and lactate dehydrogenase
-the elevation of lactate dehydrogenase correlates withe the mass of tumor cells, and provides a tool to assess tumor burden


Hormones produced by yolk sac tumor



Hormone produced by choriocarcinoma



Approximately 15% of summons have

-syncytiotrophoblastic giant cells and minimal elevation of HCG levels, which does not affect prognosis


In the context of testicular tumors, the value of serum markers is 4-fold:

-in the evaluation of testicular masses
-in the staging of testicular germ cell tumors
-in assessing tumor burden
-in monitoring the response to therapy


Leydig Cell Tumors

-may elaborates androgens and in some cases both androgens and estrogens, and even corticosteroids
-may arise at any age, but most common age 20-60
-testicular swelling, some patients have gynecomastia
-in children, hormonal effects, manifested primarily as sexual precocity, are the dominant features
-form circumscribed nodules usually less than 5 cm in diameter
-distinctive golden brown, homogeneous cut surface
-large in size
-cytoplasm frequently contains lipid droplets, vacuoles, or lipofuscin pigment and rod-shaped crystalloids of Reinke


Sertoli Cell Tumors

-most are hormonally silent and present as a testicular mass
-appear as firm, small nodules with a homogeneous gray-white to yellow cut surface
-arranged in distinctive trabeculae that tend to form cordlike structures and tubules
-most are being, but approximately 10% malignant



Gonadoblastoma -rare neoplasms comprised of a mixture of germ cells and gonadal stromal elements that almost always arise in gonads with some form of testicular dysgenesis
-in some cases, the germ cell component becomes malignant, giving rise to seminoma


Testicular Lymphoma

-aggressive non-Hodgkin lymphomas account for 5% of testicular neoplasms, most common form in testicular neoplasms in men older than age 60
-affected patients may present with only a testicular mass, mimicking other, more common, tumors
-most common are diffuse large B-cell lymphoma, Burkitt lymphoma, and EBV-positive extra nodal NK/T cell lymphoma
-have a higher propensity for CNS involvement than do similar tumors arising at other sites


Tunica Vaginalis

-mesothelial lined surface exterior to the testis that may accumulate serous fluid (hydrocele) causing considerable enlargement of the scrotal sac


Hydrocele sacs

-frequently lined by mesothelial cells



Hematocele -indicates presence of blood in the tunica vaginalis
-uncommon condition usually encountered following testicular trauma or torsion, or in individuals with systemic bleeding disorders



-accumulation of lymph in the tunica and is almost always found in patients with elephantiasis who have widespread, severe lymphatic obstruction caused by filariasis or other organisms



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



-dilated vein in the spermatic cord
-may be asymptomatic but have also been implicated in some men as a contributing factor to infertility


In normal adult, the prostate weighs

approximately 20 gm


Prostate is

-a retroperitoneal organ encircling the neck of the bladder and urethra and is devoid of a distinct capsule


In the adult, prostatic parenchyma can be divided into 4 biologically and anatomically distinct zones or regions

-peripheral, central, transitional, and periurethral zones
-types of proliferative lesions are different in each region


Most hyperplasias arise in the

transitional zone


Most carcinomas originate in

the peripheral zone


Histologically, the prostate is composed of

-glands lined by 2 layers of cells; a basal layer of low cuboidal epithelium covered by a layer of columnar secretory cells
-in many areas there are small papillary infolding of the epithelium
-glands are separated by abundant fibromuscular stroma


Control the growth and survival of prostatic cells

-testicular androgens


Acute bacterial prostatitis

-typically results from bacteria such as E. coli, gram-negative rods, enterococci, and staphylococci
-organisms become implanted in the prostate usually by intraprostatic reflux of urine from the posterior urethra or form the urinary bladder, but occasionally seed the prostate by lymphohematogenous routes from distant foci of infection
-fever, chills, dysuria
-on rectal exam the prostate is tender and boggy


Chronic bacterial prostatitis

-may present with low back pain, dysuria, and perineal and suprapubic discomfort or may be virtually asymptomatic
-often have a history of recurrent UTIs caused by same organism


Diagnosis of chronic bacterial prostatitis depends on

demonstration of leukocytosis in the expressed prostatic secretions, along with positive bacterial cultures


Chronic abacterial prostatitis

-most common form of prostatitis
-indistinguishable from chronic bacterial prostatitis in terms of signs and symptoms, but there is no history of recurrent UTIs
-negative bacteria cultures, but leukocytes in prostatic secretions


Granulomatous prostatitis

may be specific or nonspecific
-most common cause in U.S. is instillation of BCG within the bladder for treatment of superficial bladder cancer


Nonspecific granulomatous prostatitis

-relatively common and represents a reaction to secretions from ruptured prostatic ducts and acini


Acute prostatitis morphology

-may appear as minute, disseminated abscesses; as large, coalescent focal areas of necrosis; or as diffuse edema, congestion, and boggy suppuration of the entire gland


Benign Prostatic Hyperplasia

-the most common engine prostatic disease in men older than age 50
-results from nodular hyperplasia of prostatic stromal and epithelial cells and often leads to urinary obstruction
-characterized by formation of large, fairly discrete nodules in the periurethral region of the prostate, which, when sufficiently large, compress and narrow the urethral canal to cause partial, or sometimes virtually complete, obstruction of the urethra