Flashcards in Renal Tumors, Lower UT And Male Genital Pathology Deck (56):
Benign tumors of the kidney
Renal adenomas are derived from
Rental tubules. They are small, benign, asymptomatic and slow growing. They may be a precursor lesion to renal carcinoma.
An angiolipoma is a benign tumor of the kidney that is
A hamartoma consisting of fat, smooth muscle and blood vessels.
It is associated with tuberous sclerosis syndrome.
The most common renal malignancy in adults is
Renal cell carcinoma; it is most common in men ages 50 - 70.
Malignant tumors of the kidney include
Renal cell carcinoma
Renal cell carcinoma originates in the renal tubules and is associated with
It frequently invaldes renal veins or the vena cava
The appearance of renal cell carcinomas is characterized by
Polygonal clear cells.
Renal cell carcinoma presents with
It may also be manifest by: secondary polycythemia and ectopic production of various hormones
The most common renal malignancy of early childhood is
Wilm's tumor (nephroblastoma)
Presentation and origin of Wilms tumor
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
Wilms tumor WT-I and WT-2 genes are
Cancer suppressor genes
Acute and chronic cystitis of the bladder is caused by the bacteria
E. Coli, proteus, klebsiella, and enterobacter.
Risk factors are: bladder caluli, urinary obstruction, diabetes and instumentation
Presentation of bladder acute and chronic cystitis is
Lower abdominal pain
It may lead to pyelonephritis
Malakaoplakia, an inflammatory disease of the bladder, is associated with
Soft, yellow mucosal plaques seen with E. coli infects. Histology are large foamy macrophages with Michaelis-Gutmann bodies (laminated mineralized concretions).
The most common malignant tumor of the urinary collecting system is
Urothelial carcinoma. It can occur in the kidneys or the bladder.
Urothelial carcinoma (malignant) presents as and is associated with
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.
The tumors of the urothelium (transitional cell epithelium) are
Grade I (urothelial neoplasms of low malignant potential)
Grade II (low grade urothelial carcinoma)
Grade III (high grade urothelial carcinoma)
Similarities and differences of grade II and grade III tumors of the urothelium
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.
Treatment of tumors of urothelium (bladder):
In situ: bacullus calmette guerin
Surgery and chemotherapy
Squamous cell carcinoma is a minority of urinary tract malignancies that can result from
Chronic inflammatory processes such as chronic bacterial infection or schistosoma haematobium infection
Acute bacterial prostatitis: presentation, etiology, diagnosis
Presention: fever, dysuria, tender/boggy prostate
Etiology: E. coli, entercocci, staphylococci
Diagnosis: urine culture, DRE
Chronic bacterial prostatitis: presentation, etiology, diagnosis
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
Granulomatous prostatitis: presentation, etiology, diagnosis
Presentation: recurrent UTI
Etiology: BCG for treatment of bladder cancer, systemic tuberculosis
Diagnosis: multiple granulomas
Benign prostatic hypertrophy: presentation, morphology, etiology
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
Diagnosis of benign prostatic hypertrophy
Diagnosis: digital rectal exam, high prostate-specific antigen levels (PSA), prostatic needle biopsies
Benign prostatic hypertrophy: treatment
Alpha blockers for decrease muscle tone
5-alpha-reductase inhibitors for shrinking the prostate
Transurethral resection of the prostate
Prostatic adenocarcinoma: epidemiology
70% of men 70 - 80 years old
Most common form of cancer in men
Screening recommended at 40 - 45
Most common in black population
There is a __ risk of prostatic adenocarcinoma if a patient has two first degree relatives with prostate cancer
Prostatic adenocarcinoma: presentation
Firm mass on digital rectal exam
PSA: >10 (4 - 10% is grey zone)
Small single layer glands
Gleason's score is used to grade
Prostatic adenocarcinomas. The scores range from 1 - 5, and a total score of 5 - 7 is potentially treatable.
TNM staging is used to determine the stage of
Prostatic adenocarcinoma (tumor/node/metastasis)
Metastases often occur to the lumbar spine.
Prostatic adenocarcinoma: treatment
Radical prostatectomy or radiotherapy
PSA levels done following treatment
Penis: malformations of the urethral grooves include
Hypospadia: ventral surface defect (more common)
Epispadia: dorsal surface defect
Penis: disorders of the foreskin include
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
Local inflammation of the glans penis
Inflammation of glans and prepuce
Balantis and balanoposthitis are both due to
Poor hygiene in uncircumcised males with accumulation of epithelital cells, sweat, bacteria and smegma
Condyloma acuminatum is a benign tumor of the
It is single or multiple, with benign, papillary nodules.
It is caused by HPV 6 and 11
It is spread by direct contact
An in situ tumor of the penis is
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.
Invasive squamous cell carcinoma of the penis is rare in
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.
Cryptorchidism is undescended testicle. It is usually unilateral. The treatment and signifance are
Treatment: orchiopexy or orchiectomy
Significance: greater chance for trauma and crush injury, sterility, testicular tumors
Causes and significance of orchitis/epididymitis
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.
Torsion of the testes presents with
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.
General categories of neoplasma in the testes
Germ cell tumors (95%) - aggressive, but curable
Stromal-sex cord tumors - benign, occurs before puberty
Lymphoma - poor prognosis that occurs in >60 yo
Germ cell tumors most commonly occur in
White males 15 - 34 yo.
Risk factors include cryptoorchidism and testicular dysgenesis. The presenation is a non-painful testicular mass/increase in size.
Types of germ cell tumors
Seminoma (remain localized)
Nonseminomatous tumors (aggressive)
60% of these tumors are mixed
The most common type of germ cell tumor is the
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.
The most common type of germ cell tumor in infants and children <3 y/o is
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
The peak occurrence of the germ cell tumor "embryonal carcinoma" is
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.
The most aggressive germ cell tumor is
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).
Teratoma (germ cell tumor) can occur at
Any age; prepubertal teratomas are benign, but postpubertal teratomas are all malignant.
It has derivaties of cells from more than one germ layer.
Sex cord stromal tumors are usually
Bening, non-germ cell tumors derived from the testicular interstitium.
They may produce androgens, estrogens or corticosteroids.
Stages of testicular neoplasia
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.
Progression of testicular neoplasia
Lymphatic spread is common (para-aortic)
Hematogenous spread to lungs
Metastases may resemble a completely different type
Prognosis of testicular neoplasias
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.