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CPR II Week 7/8/9 > Robbins Ch 21 > Flashcards

Robbins Ch 21 Flashcards

1
Q

Bladder cancers are staged on the basis of invasion of what structure?

A

Detrusor muscle

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2
Q

What is the most common cause of hydronephrosis in infants and kids?

A

Ureteropelvic junction obstruction

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3
Q

What are the most common primary malignant tumors of the ureters?

A

Urothelial carcinomas

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4
Q

What is characterized by a fibrotic proliferative inflammatory process encasing the retroperitoneal structures?

What does it cause?

A

1) Sclerosing Retroperitoneal Fibrosis

2) Hydronephrosis

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5
Q

Sclerosing Retroperitoneal Fibrosis involves other tissues as well, particularly?

A

Pancreas and salivary glands

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6
Q

What is the most common and serious congenital anomaly of the urinary bladder?

A

Vesicoureteral Reflux

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7
Q

Exstrophy of the Bladder is due to developmental failure of the?

It causes an increased risk of?

A

1) Anterior abdominal wall

2) Adenocarcinoma

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8
Q

What is the most common cystitis infectious agent?

A

E. coli

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9
Q

What is the triad of symptoms associated with acute and chronic cystitis?

A

1) Frequency (need to go every 15-20 minutes)
2) Lower abdominal pain
3) Dysuria (pain/burning with urination)

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10
Q

Interstitial Cystitis (Chronic Pelvic Pain Syndrome) is most common in which sex?

A

Female

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11
Q

Malakoplakia is due to?

They are characterized by macrophages with intralysosomal laminated calcified concentrations known as?

A

1) Chronic bacterial cystitis from E. coli or Proteus

2) Michaelis-gutmann bodies

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12
Q

Polypoid Cystitis is most commonly due to?

What can it be confused with both clinically and histologically?

A

1) Indwelling catheters

2) Papillary urothelial carcinoma

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13
Q

What are the most common precursor lesion to urothelial tumors?

A

Noninvasive papillary tumors

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14
Q

50-80% of all bladder cancers are assocaited with use of?

A

Cigarette smoking

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15
Q

Most urothelial tumors arise from what location?

A

Lateral and posterior walls at bladder base

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16
Q

Papillary Urothelial Neoplasms of Low Malignant Potential share many histological features with papilloma, except they have?

A

Thicker urothelium

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17
Q

High Grade Papillary Urothelial Cancer have a high risk of invasion into?

A

Muscular layer

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18
Q

What can range from full thickness atypia to scattered malignant cells in an otherwise normal urothelium (pagetoid spread)?

A

Carcinoma In Situ (flat urothelial carcinoma)

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19
Q

In regards to carcinoma in situ, what leads to shedding of malignant cells into urine?

What characteristic feature does it have that gives it the flat appearance?

A

1) Lack of cohesiveness

2) No mass projection into lumen

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20
Q

Invasion of what structure is prognostically important for invasive urothelial cancer?

What is the most important factor in determining the outlook for the patient?

A

1) Muscularis mucosae (detrusor muscle)

2) Staging at the initial diagnosis

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21
Q

What has increased incidence in countries with endemic schistosomiasis such as the Middle East?

A

Squamous Cell Carcinoma of the bladder

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22
Q

What is an important clinical sign of bladder cancer?

A

Painless hematuria

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23
Q

While bladder cancer responds well to chemotherapy what option is curative?

A

Surgery

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24
Q

What sarcoma of the bladder are most common in kids?

What can it grow into?

Which sarcoma of the bladder is most common in adults?

A

1) Embryonal rhabdomyosarcoma
2) Grape-like mass
3) Leiomyosarcoma

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25
Q

What is the most common cause of obstruction of the bladder outlet in males?

What is the most common cause in females?

A

1) Prostate Enlargement

2) Cystocele of the bladder

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26
Q

What is characteristic of gonococcal urethritis from Neisseria gonorrhoeae infection?

A

Purulent discharge

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27
Q

Nongonococcal urethritis is most commonly caused by?

What serotypes are related to GU tract?

A

1) Chlamydia trachomatis

2) D-K

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28
Q

What are characterized by painful, small, red inflammatory lesion of the external urethral meatus in (older) females?

A

Urethral Caruncle

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29
Q

Hypospadias is a congenital anomaly that causes the urethral opening on what aspect of the penis?

Epispadia causes the urethral opening on what aspect?

Which is more common?

A

1) Ventral
2) Dorsal
3) Hypospadias

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30
Q

Balanoposthitis is characterized by infection of what areas of the penis by non specific organisms (not STD’s)?

A

Glans and prepuce

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31
Q

Condyloma Acuminata (Penile tumor) is associated with what HPV strains?

Which strain is more common?

What characteristic of HPV is due to cytoplasmic vacuolization of the squamous cells?

A

1) HPV 6 and 11
2) HPV 6
3) Koilocytosis (Halo cells)

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32
Q

Peyronie disease is characterized by benign proliferation of fibroblasts which causes?

A

Penile curvature and pain during sex

33
Q

Because Bowenoid Papulosis and Bowen disease are histologically indistinguishable how are each diagnostically identified?

A

1) Bowen -> Older than 35, solitary lesion, and chance of evolving into invasive carcinoma
2) Bowenoid -> Younger, multiple lesions, rarely evolves into invasive carcinoma

34
Q

How does invasive squamous cell carcinoma of the penis present clinically?

A

Slow-growing and locally-invasive

35
Q

What is the most common congenital anomaly of the testes?

A

Cryptorchidism

36
Q

What does cryptorchidism lead to morphologically?

A

1) Decreased germ cell development

2) Fibrosis with sparing of prominent Leydig cells

37
Q

Most cases of cryptorchidism will descend on their own by what age?

A

1 year old

38
Q

In what order are the testis and epididymis hit for inflammation due to gonorrhea and TB?

What infection is the exception to this pattern?

A

1) Epididymis first, then to testes

2) Syphilis causes testis hit first, then to epididymis

39
Q

What is characterized by painless or moderately tender testicular mass of sudden onset sometimes associated with fever?

A

Granulomatous (autoimmune) Orchitis

40
Q

Granulomatous (autoimmune) Orchitis causes granulomas to be restricted to?

A

Spermatic tubules

41
Q

What causes a retrograde expansion of infection from posterior urethra to prostate, seminal vesicles and epididymis?

A

Gonorrhea

42
Q

20-30% of post-pubertal men who are infected with mumps present with?

A

Orchitis 1 week after inflammation of parotid gland

43
Q

Nodular gummas is characteristic of?

A

Syphilis

44
Q

Diffuse interstitial inflammation can produce the histologic hallmark of syphilitic infections which causes?

A

Obliterative endarteritis associated with perivascular cuffs of lymphocytes and plasma cells

45
Q

Testicular torsion occludes what vascular supply?

A

Venous outflow

46
Q

What is the most common benign paratesticular neoplasm?

A

Adenomatoid Tumor

47
Q

What is the most common paratesticular tumor in children?

In adults?

A

1) Rhabdomyosarcoma

2) Liposarcoma

48
Q

What makes up 95% of testicular tumors?

What categories can it be divided into?

A

1) Germ Cell Tumors

2) Seminomas and nonseminomas

49
Q

Seminomatous tumors are composed of cells that look like?

Nonseminomatous tumors are composed of undifferentiated cells that look like?

A

1) Primordial germ cells or early gonocytes

2) Embryonic stem cells and cells that have differentiated along different lineages

50
Q

Testicular Germ Cell Tumors pathogenesis mostly comes from what precursor lesion that occurs in utero and is dormant until puberty?

This lesion commonly has what mutation?

A

1) Intratubular germ cell neoplasia

2) Duplication of the short arm of 12

51
Q

Seminomas which are the most common type of germ cell tumor and occur in 20-30 year olds while almost never in infants expresses?

A

1) Isochromosome 12p
2) OCT3/4
3) NANOG

52
Q

Embryonal Carcinoma which also occur in 20-30 year old, but are more aggressive than seminomas express?

A

1) OCT3/4
2) PLAP
3) CD30
4) Cytokeratin

53
Q

What is the most common testicular tumor in children < 3 years and comes with a very good prognosis?

What are found in 50% of the tumors?

A

1) Yolk Sac Tumor (endodermal sinus tumor)

2) Primitive glomeruli (Schiller-Duval bodies)

54
Q

What are highly malignant neoplasm (occur in < 1% of all germ cell tumors) and are small palpable nodules without testicular enlargement?

What reaches very high levels in the serum?

A

1) Choriocarcinoma

2) hCG

55
Q

How are teratomas characterized in children?

In post-pubertal individuals?

Between endodermal, mesodermal and ectodermal layers, which are differentiated?

They are embedded in?

A

1) Benign
2) Malignant
3) All three
4) Fibrous or myxoid stroma

56
Q

Testicular germ cell tumors hematogenously spread to what area most commonly?

A

Lungs

57
Q

What is the most aggressive Non-Seminomatous Germ Cell Tumor?

A

Choriocarcinoma

58
Q

What indicates stage II of testicular tumor?

A

Persistent elevation of hCG or AFP concentrations following orchiectomy

59
Q

AFP is markedly elevated in?

hCG is markedly elevated in?

What biomarker elevation correlates with the mass of tumor cells?

A

1) Yolk sac tumor
2) Choriocarcinoma and 15% of seminomas
3) Lactate Dehydrogenase

60
Q

Leydig Cell Tumors which make up 2% of all testicular tumors produces?

How does it present?

25% of them have what morphologic appearance?

A

1) Androgens, estrogens and/or corticosteroids
2) Testicular swelling
3) Eosinophilic Reinke crystalloids (rod shaped)

61
Q

What is the most common form of testicular tumor in patients older than 60 years?

They have a high incidence of what involvement?

A

1) Testicular Lymphoma

2) CNS

62
Q

Accumulation of serous fluid within the mesothelial lined tunica vaginalis is known as?

Accumulation of blood secondary to trauma, torsion, or generalized bleeding diathesis is known as?

Accumulation of lymphatic fluid secondary to lymphatic obstruction is known as?

Local cystic accumulation of semen in dilated efferent ducts or ducts of the rete testis is known as?

Dilated vein in the spermatic cord is known as?

A

1) Hydrocele
2) Hematocele
3) Chylocele
4) Spermatocele
5) Varicocele

63
Q

Where is the most common zone in the prostate for carcinomas to arise?

Where does most hyperplasia occurs?

A

1) Peripheral zone

2) Transitional zone

64
Q

Chronic Bacterial Prostatitis is associated with?

Diagnosis is based on?

A

1) History of recurrent UTI

2) Leukocytosis in the expressed prostatic secretions

65
Q

What is the most common prostatitis?

A

Nonbacterial Chronic Prostatitis

66
Q

Instillation of BCG (Bacillus Calmette Guerin) into the bladder for treatment of superficial bladder cancer is the most common cause of?

A

Granulomatous Prostatitis

67
Q

What is the most common prostatic disorder?

It is characterized by?

A

1) Benign Prostatic Hyperplasia

2) Stromal proliferation in periurethral region of prostate

68
Q

What is the common cause of infection related to BPH?

A

The inability to completely void bladder which leads to reservoir of residual urine

69
Q

What genetic risk factor occurs in 50% of white prostate cancer patients?

A

Rearrangement of ETS family transcription factor gene (ERG or ETV1) next to the androgen regulated TMPRSS2 promotor

70
Q

What genetic risk factor of prostate cancer causes a rare neurodegenerative disorder called Kennedy disease characterized by muscle cramping and fatigue?

A

Long trinucleotide expansions of CAGs in X-linked androgen receptor gene

71
Q

There is an inverse relationship to the length CAG expansion to?

Rank the following races in terms of CAG expansion length from shortest to longest: Asians, African Americans, and Caucasians

What does this parallel in these groups?

A

1) Androgen sensitivity (short expansion, more sensitivity)
2) African Americans, Caucasians, Asians
3) Incidence and mortality of prostate cancer

72
Q

What is the possible precursor lesion for Adenocarcinoma of the prostate?

A

Prostatic intraepithelial neoplasia

73
Q

Most prostate cancers present with obstruction of the urinary tract like BPH but the urinary symptoms occur late because?

A

Most prostatic cancers arise peripherally away from the urethra

74
Q

What is virtually diagnostic of prostate cancer in men?

A

Finding of osteoblastic metastases

75
Q

Carcinoma of the prostate arises in the what zone of the gland in 70% of cases?

Classically in what location of that zone?

A

1) Peripheral zone

2) Posterior

76
Q

How do benign prostate glands and malignant prostate glands differ in terms of morphology?

A

1) Benign prostate glands contain basal cells

2) Malignant prostate glands have absent basal cells

77
Q

Histology of prostate cancer shows prominent nucleoli, blue mucin, and what other feature that is specific for prostate cancer?

A

Perineural invasion

78
Q

What scores on the Gleason score have excellent prognosis for prostate cancer?

A

2-6

79
Q

What prostate cancer reveals abundant mucinous secretions?

A

Colloid carcinoma of the prostate

CPR II Week 7/8/9 (14 decks)

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