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NYCPM Pathology > Renal Tumors, Lower UT And Male Genital Pathology > Flashcards

Renal Tumors, Lower UT And Male Genital Pathology Flashcards

1
Q

Benign tumors of the kidney

A

Renal ademona

Angiomyolipoma

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2
Q

Renal adenomas are derived from

A

Rental tubules. They are small, benign, asymptomatic and slow growing. They may be a precursor lesion to renal carcinoma.

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3
Q

An angiolipoma is a benign tumor of the kidney that is

A

A hamartoma consisting of fat, smooth muscle and blood vessels.

It is associated with tuberous sclerosis syndrome.

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4
Q

The most common renal malignancy in adults is

A

Renal cell carcinoma; it is most common in men ages 50 - 70.

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5
Q

Malignant tumors of the kidney include

A

Renal cell carcinoma

Wilm’s tumor

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6
Q

Renal cell carcinoma originates in the renal tubules and is associated with

A

Cigarette smokers
Gene deletions
Hippel-Lindau disease

It frequently invaldes renal veins or the vena cava

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7
Q

The appearance of renal cell carcinomas is characterized by

A

Polygonal clear cells.

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8
Q

Renal cell carcinoma presents with

A

Flank pain
Palpable mass
Hematuria

It may also be manifest by: secondary polycythemia and ectopic production of various hormones

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9
Q

The most common renal malignancy of early childhood is

A

Wilm’s tumor (nephroblastoma)

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10
Q

Presentation and origin of Wilms tumor

A

Presentation: palpable flank mass (huge), with immature stroma, tubules, glomeruli, and containing mesencymal elements such as fibrous connective tissue, cartilage and bone.

Origin: primitive metanephric tissue

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11
Q

Wilms tumor WT-I and WT-2 genes are

A

Cancer suppressor genes

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12
Q

Acute and chronic cystitis of the bladder is caused by the bacteria

A

E. Coli, proteus, klebsiella, and enterobacter.

Risk factors are: bladder caluli, urinary obstruction, diabetes and instumentation

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13
Q

Presentation of bladder acute and chronic cystitis is

A

Urinary frequency
Lower abdominal pain
Dysuria

It may lead to pyelonephritis

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14
Q

Malakaoplakia, an inflammatory disease of the bladder, is associated with

A

Soft, yellow mucosal plaques seen with E. coli infects. Histology are large foamy macrophages with Michaelis-Gutmann bodies (laminated mineralized concretions).

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15
Q

The most common malignant tumor of the urinary collecting system is

A

Urothelial carcinoma. It can occur in the kidneys or the bladder.

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16
Q

Urothelial carcinoma (malignant) presents as and is associated with

A

Associated with phenacetin and presents with meaturia. It spreads with local extension to surrouding tissues.

It is also associated with exposure to aniline dye, cigarette smoking, and long-term treatment with cyclophosphamide.

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17
Q

The tumors of the urothelium (transitional cell epithelium) are

A 
Papilloma (benign)
Grade I (urothelial neoplasms of low malignant potential)
Grade II (low grade urothelial carcinoma)
Grade III (high grade urothelial carcinoma)
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18
Q

Similarities and differences of grade II and grade III tumors of the urothelium

A

Grade II and III both have papillary, flat or mixed tumors with increased atypia and mitoses. Grade II does not usually metastasize to other organs, but the grade III can invade the muscularis and the lymph nodes.

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19
Q

Treatment of tumors of urothelium (bladder):

A

In situ: bacullus calmette guerin
Transurethral resection
Surgery and chemotherapy

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20
Q

Squamous cell carcinoma is a minority of urinary tract malignancies that can result from

A

Chronic inflammatory processes such as chronic bacterial infection or schistosoma haematobium infection

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21
Q

Acute bacterial prostatitis: presentation, etiology, diagnosis

A

Presention: fever, dysuria, tender/boggy prostate

Etiology: E. coli, entercocci, staphylococci

Diagnosis: urine culture, DRE

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22
Q

Chronic bacterial prostatitis: presentation, etiology, diagnosis

A

Presentation: same as acute, with lower back pain and recurrent UTIs

Etiology: same bacteria as in acute

Diagnosis: leukocytosis of prostatic secretions and positive cultures

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23
Q

Granulomatous prostatitis: presentation, etiology, diagnosis

A

Presentation: recurrent UTI

Etiology: BCG for treatment of bladder cancer, systemic tuberculosis

Diagnosis: multiple granulomas

24
Q

Benign prostatic hypertrophy: presentation, morphology, etiology

A

Presentation: in men >70 with inability to urinate.

Morphology: can cause stenosis of the prostatic urethra

Etiology: dihydrotestosterone (DHT); is 10 times more potent than testosterone in causing growth

25
Q

Diagnosis of benign prostatic hypertrophy

A

Diagnosis: digital rectal exam, high prostate-specific antigen levels (PSA), prostatic needle biopsies

26
Q

Benign prostatic hypertrophy: treatment

A

Alpha blockers for decrease muscle tone
5-alpha-reductase inhibitors for shrinking the prostate
Transurethral resection of the prostate

27
Q

Prostatic adenocarcinoma: epidemiology

A

70% of men 70 - 80 years old

Most common form of cancer in men

Screening recommended at 40 - 45

Most common in black population

28
Q

There is a __ risk of prostatic adenocarcinoma if a patient has two first degree relatives with prostate cancer

A

Five times

29
Q

Prostatic adenocarcinoma: presentation

A

Firm mass on digital rectal exam
PSA: >10 (4 - 10% is grey zone)

Small single layer glands

30
Q

Gleason’s score is used to grade

A

Prostatic adenocarcinomas. The scores range from 1 - 5, and a total score of 5 - 7 is potentially treatable.

31
Q

TNM staging is used to determine the stage of

A

Prostatic adenocarcinoma (tumor/node/metastasis)

Metastases often occur to the lumbar spine.

32
Q

Prostatic adenocarcinoma: treatment

A

Radical prostatectomy or radiotherapy

PSA levels done following treatment

33
Q

Penis: malformations of the urethral grooves include

A

Hypospadia: ventral surface defect (more common)
Epispadia: dorsal surface defect

34
Q

Penis: disorders of the foreskin include

A

Phimosis: orifice of prepuce is too small, cannot retract and increases chances for infection or cancer.

Paraphimosis: prepuce is retracted, causing constriction and can lead to ischemia and penile necrosis

35
Q

Balantis is

A

Local inflammation of the glans penis

36
Q

Balanoposthitis is

A

Inflammation of glans and prepuce

37
Q

Balantis and balanoposthitis are both due to

A

Poor hygiene in uncircumcised males with accumulation of epithelital cells, sweat, bacteria and smegma

38
Q

Condyloma acuminatum is a benign tumor of the

A

Penis.

It is single or multiple, with benign, papillary nodules.
It is caused by HPV 6 and 11
It is spread by direct contact

39
Q

An in situ tumor of the penis is

A

Bown disease. It is a squamous cell carcinoma that presents as dysplasia without invasia.

It affects uncircumcised men >50 y/o and is associated with increased risk of other visceral malignancies.

40
Q

Invasive squamous cell carcinoma of the penis is rare in

A

Circumcised men.

It has increased incidence in Africa, East Asia and South America. Risk factors are poor hygein and venereal disease, and is associated with HPV 16, 18, 31 and 33.

41
Q

Cryptorchidism is undescended testicle. It is usually unilateral. The treatment and signifance are

A

Treatment: orchiopexy or orchiectomy

Significance: greater chance for trauma and crush injury, sterility, testicular tumors

42
Q

Causes and significance of orchitis/epididymitis

A

They are common related to infections in the urinary tract.

Causes: <35 yo: chlamydia trachomatis & neisseria gonorrhoeae
>35 yo: escherichia coli and pseudomonas

Significance: can lead to sterlity, and the granulomas are confused with cancer.

43
Q

Torsion of the testes presents with

A

Sudden onset of pain that may occur during sleep.

It is a urological emergency that must be surgically corrected within 6 hours or else swelling, hemorrhage or necrosis of the testis may occur.

44
Q

General categories of neoplasma in the testes

A

Germ cell tumors (95%) - aggressive, but curable

Stromal-sex cord tumors - benign, occurs before puberty

Lymphoma - poor prognosis that occurs in >60 yo

45
Q

Germ cell tumors most commonly occur in

A

White males 15 - 34 yo.

Risk factors include cryptoorchidism and testicular dysgenesis. The presenation is a non-painful testicular mass/increase in size.

46
Q

Types of germ cell tumors

A

Seminoma (remain localized)

Nonseminomatous tumors (aggressive)

60% of these tumors are mixed

47
Q

The most common type of germ cell tumor is the

A

Seminoma. It occurs around 30 y/o. It is a gray white lobular mass that causes the testis to be 10x normal size.

They are large round cells with a large central nucleus and clear cytplasm.

48
Q

The most common type of germ cell tumor in infants and children <3 y/o is

A

Yolk sac tumor

It prsents as a yellow/white mucinous mass

Microscopic examination shows Schiller-Duval bodies (visceral and parietal layers of cells around a central capillary) and eosinophilic hyaline like granules

49
Q

The peak occurrence of the germ cell tumor “embryonal carcinoma” is

A

20 - 30 y/o.

It presents as small masses with hemorrhage and necrosis.

Microscopic examination shows sheets of cells that are large and anaplastic with prominent nucleoli and no distinct cell borders.

50
Q

The most aggressive germ cell tumor is

A

Choriocarcinoma. It is rare and occurs in 30s

It is a small palpable mass.

Microscopic examination reveals: syncytiotrophoblastic cells (large with hyperchromatic nuclei) and cytotrophoblastic cells (regular polygonal cells with distinct borders, central nuclei and clear cytoplasm).

51
Q

Teratoma (germ cell tumor) can occur at

A

Any age; prepubertal teratomas are benign, but postpubertal teratomas are all malignant.

It has derivaties of cells from more than one germ layer.

52
Q

Sex cord stromal tumors are usually

A

Bening, non-germ cell tumors derived from the testicular interstitium.

They may produce androgens, estrogens or corticosteroids.

53
Q

Stages of testicular neoplasia

A

I: confined to testis, epididymis or spermatic cord.

II: confined to retroperitoneal nodes below the diaphragm

III: spread outside of retroperitoneal nodes or above the diaphragm.

54
Q

Progression of testicular neoplasia

A

Lymphatic spread is common (para-aortic)
Hematogenous spread to lungs
Metastases may resemble a completely different type

55
Q

Prognosis of testicular neoplasias

A

Seminoma: 95% of patients with localized disease or spread to nodes below the diaphragm can be cured.

Nonseminomatous: 90% can enter remission with aggressive treatment.

56
Q

Treatment of testicular neoplasias

A

Radical orchiectomy and/or chemotherapy.

NYCPM Pathology (4 decks)

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