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Flashcards in Urogenital pathology Deck (43):

What is nodular hyperplasia?

Enlargement of the prostate or benign prostatic hyperplasia (BPH), consists of overgrowth of the epithelium and fibromuscular tissue of the transition zone and periurethral area.


What are the symptoms of nodular hyperplasia and what is their aetiology?

Lower urinary tract symptoms (LUTS)
- urgency
- difficulty in starting urination
- diminished stream size and force
- increased frequency
- incomplete bladder emptying
- nocturia

Caused by interference with muscular sphincteric function and by obstruction of urine flow through the prostatic urethra.


What are the names given to the different zones of the prostate gland?

- Central zone
- Peripheral zone
- Transitional zone
- Periurethral zone


In which zone do most carcinomas of the prostate arise which makes them easily palpable in the rectum?

Peripheral zone


In which zone does nodular hyperplasia usually arise which makes it more likely to produce urinary obstruction early than carcinoma?

Central zone


What are the three pathological changes seen in nodular hyperplasia?

1. Nodule formation
2. Diffuse enlargement of the transition zone and periurethral tissue
3. Enlargement of nodules


What is the aetiology of prostatic hyperplasia?

- It is believed that the main component of the “hyperplastic” process is impaired cell death.
- It has been proposed that there is an overall reduction of the rate of cell death, resulting in the accumulation of senescent cells in the prostate.

- In keeping with this androgens (mainly DHT) which are required for the development of BPH, can not only increase cellular proliferation, but also inhibit cell death.


What is the incidence of carcinoma of the prostate?

- 95% of prostatic malignancies
- rare in 40s incidence rises sharply
- PMs of men show very high level of latent cancer
- incidence much higher in men of African ancestry


How is carcinoma of the prostate treated?

- Surgery
- Radiotherapy
- hormonal manipulations

- most common treatment for localised is radical prostatectomy
Also: brachytheraphy, external beam radiotherapy


What are the risk factors for prostate cancer?

- Age
- Race
- FHx
- Hormone levels
- Environmental influences


What is the role of androgens in prostate cancer?

The importance of androgens in maintaining the growth and survival of prostate cancer cells can be seen in the therapeutic effect of castration or treatment with anti-androgens, which usually induce disease regression.


What are the risk factors for carcinoma of the prostate?

- Inherited polymorphisms
- FHx
- Germline mutations of BRCA2


What is the name of the grading system used for carcinoma of the prostate?



Why is there currently no screening programme in the UK for prostate cancer?

- PSA test can produce false positives and negatives
- Limited benefits
- Reduced mortality vs risks of overtreatment


What is the epidemiology of testicular cancer?

Globally, testicular cancer incidence is highest among men of northern European ancestry and lowest among men of Asian and African descent.


What pre-existing conditions have been associated with the development of testicular germ cell tumours?

- Prior TGCT in the contralateral testicle
- Cryptorchidism
- Impaired spermatogenesis
- Inguinal hernia
- Hydrocele
- Disorders of sex development
- Prior testicular biopsy
- Atopy
- Testicular atrophy


What is the clinical presentation of a seminoma?

Testicular enlargement, with or without pain (>70%) and metastases (10%). Some patients with seminoma have no symptoms. Rare symptoms: gynecomastia, exophthalmos, and infertility


What identifying markers are secreted by seminomas?

Elevated serum PLAP and hCG seen in 40% and 10% of patients, respectively; the latter is the cause of gynecomastia.


What is the macroscopic appearance of seminomas?

Well-demarcated, cream-colored, homogeneous, and coarsely lobulated.


What is the microscopic appearance of seminomas?

Monotonous polygonal cells with mostly clear cytoplasm and central nuclei divided into lobules by thin bands of fibrovascular stroma.


What is the epidemiology of seminomas?

Most commonly in 35-45 years old, uncommon in men over 50 years of age, and rare in children.


What is the clinical presentation of teratomas?

Gradual testicular swelling with or without pain. Although mature teratoma is almost always benign in prepubertal patients, it can pursue an aggressive clinical course after puberty (e.g. metastasis). Immature teratoma is a common component of NSGCTs but its pure form is very rare.


What identifying markers are secreted by teratomas?

Pure teratomatous tissues do not secrete tumour markers.


What is the macroscopic appearance of teratomas?

Well-demarcated solid or multicystic.


What is the microscopic appearance of teratomas?

A mixture of ectoderm, endoderm, and mesoderm.


What is epididymoorchitis?

Inflammation of the testicle and epididymis (acute or chronic).


What is the microscopic appearance of epididymoorchitis?

The ghostly outlines of infarcted seminiferous tubules, surrounded by purulent exudate containing neutrophils and other inflammatory cells.


What is idiopathic granulomatous orchitis?

Idiopathic granulomatous orchitis is a rare inflammatory process of the testis of unknown etiology. It is characterized by presence of non-specific granulomatous inflammation and admixed multinucleated giant cells.


What is the clinical presentation of idiopathic granulomatous orchitis?

Typically in older adults, often with associated symptoms of UTI, trauma, or flu-like illness. The testis becomes swollen, painful, and tender initially but later may have a residual mass indistinguishable from a neoplasm, prompting orchiectomy.


What is sarcoidosis of the testis often mistaken for if accompanied by radiologic pulmonary abnormalities?



What is the microscopic appearance of sarcoidosis of the testis?

Non-necrotizing granulomas involving testicular parenchyma. Special stains for fungal organisms and acid-fast bacilli are negative.


What is malakoplakia of the testis?

Malakoplakia is a rare granulomatous disease of infectious etiology. It is believed to result from the inadequate killing of bacteria by macrophages or monocytes that exhibit defective phagolysosomal activity.


What is the microscopic appearance of malakoplakia of the testis?

Soft yellow, tan, or brown nodules that replace normal testicular parenchyma. The tubules and interstitium are extensively infiltrated by large histiocytes that have abundant eosinophilic granular cytoplasm (von Hansemann histiocytes)


What is a myofibroplastic pseudotumour of the testis?

An atypical inflammatory and myofibroblastic reaction with fasciitis-like large cells. Features of malignancy are absent. The process is regarded as a benign reactive and proliferative process of uncertain aetiology


What is a sperm granuloma?

An exuberant foreign body giant cell reaction to extravasated sperm, and occurs in up to 42% of patients after vasectomy and 2.5% of routine autopsies. Patients may have no symptoms, but often present with a history of pain and swelling of the upper pole of the epididymis, spermatic cord, and, rarely, the testis. Others have a history of trauma, epididymiditis, and orchitis.


What is tuberculous orchitis?

The epididymis is the reservoir for tuberculous involvement in the male genital tract, with secondary testicular involvement and other local sites of involvement in about 80% of cases; for example, 40% of cases of renal tuberculosis are accompanied by epididymal infection.


What is the presentation of tuberculous orchitis?

Patients usually present with painless scrotal swelling, but other signs and symptoms include unilateral or bilateral mass, infertility, and scrotal fistula. Caseating granulomatous inflammation is prominent, with fibrous thickening and enlargement of the epididymis and adjacent structures.


What is cryptorchidism?

- Undescended testes
- 25% of cases of empty scrotum.
- These testes most frequently are found in the inguinal canal or upper scrotum; arrest within the abdomen is less frequent.
- Slightly more frequent on the right; 18% are bilateral.


What are the congenital causes of cryptorchidism?

Caused by anomalies in anatomic development or hormonal mechanisms involved in testicular descent.


What are the acquired causes of cryptorchidism?

- postoperative or spontaneous ascent due to various mechanisms
- inability of the spermatic blood vessels to grow adequately
- anomalous insertion of the gubernaculum, failure in reabsorption of the vaginal process and failure in postnatal elongation of the spermatic cord.


What are the complications of cryptorchism?

- Testicular atrophy
- infertility
- carcinoma (TGCTs)


What are the causes of primary hypogonadism?

- undescended testis
- Klinefelter syndrome
- hemochromatosis
- mumps
- orchitis
- trauma
- cystic fibrosis
- testicular torsion and varicocele.


What are the causes of secondary hypogonadism?

- pituitary failure
- drugs (glucocorticoids, ketoconazole, chemotherapy, and opioids)
- obesity
- aging.

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