Renal Tumors, Lower UT And Male Genital Pathology Flashcards Preview

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

Flashcards in Renal Tumors, Lower UT And Male Genital Pathology Deck (56):

Benign tumors of the kidney

Renal ademona


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
Wilm's tumor


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

Cigarette smokers
Gene deletions
Hippel-Lindau disease

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

Flank pain
Palpable mass

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

Urinary frequency
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

Papilloma (benign)
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
Transurethral resection
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

Five times


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


Balantis is

Local inflammation of the glans penis


Balanoposthitis is

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

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.


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.


Treatment of testicular neoplasias

Radical orchiectomy and/or chemotherapy.