Flashcards in Urogenital Pathology Deck (29):
1
What is BPH?
Benign prostatic hyperplasia - enlargement of epithelial and fibromuscular tissue in prostate
2
Where does BPH usually occur?
TRANSITION ZONE and PERIURETHRAL ZONE - more central so compresses urethra
3
What are the symptoms of BPH? (LOWER URINARY TRACT SYMPTOMS)
-Increased urgency/frequency
-Problems starting urination/emptying bladder
-Nocturia
- Diminished stream size and force ('not hitting wall')
4
Where do most carcinomas of the prostate arise?
Peripheral zone - symptoms of BPH do not arise until very advanced
5
What is the pathogenesis of BPH? What is predominant in older men? (*)
Nodule formation*
Enlargement of transitional and periurethral zone
Enlargement of nodules*
6
What is the cause of BPH?
Impaired cell death resulting accumulation of senescent (old) cells in prostate
Hormone imbalance e,g, testosterone (DHT)
7
What is the main type of prostate cancer?
Prostatic adenocarcinoma
8
What is the treat for prostatic adenocarcinoma?
- Surgery - radical prostatectomy
-Radiotherapy
- Hormonal manipulations
9
What are the risk factors for prostatic cancer?
Age, race, family history, environmental (increased consumption of fats)
Androgen exposure - reduced androgen exposure (with castration/anti-androgens) is associated with disease regression
BRCA2
10
What grading system is used for prostatic carcinoma?
Gleason grade
TMN stage
11
Why is there no screening programme for prostatic cancer?
Prostatic specific antigen - associated with false negatives/positives
Complications of treatment e.g. importance, incontinence
Unnecessary treatments/limited benefits
12
What are the two functions of the testes?
Sperm production
Androgen production
13
What are the major aetiological causes of germ cell tumours?
-Prior germ cell tumour in contralateral testicle
-Cryptochordism (absence of testicle(s) in scrotum - e.g undescended)
- Inguinal hernia/hydrocele (anything impairing blood flow to testicle)
- Disorder spermatogenesis
- Testicular atrophy
14
What age group do seminomas most likely effect?
35-45 yr olds (rare >50 yrs)
15
What are the clinical presentations of seminomas?
Pain
Testicular enlargement
Asymptomatic
Metastases
Infertility
Gynecomastia - male breasts
16
What serum markers are associated with seminoma?
PLAP
hCG - cause of gynecomastia
17
When do teratomas most commonly arise?
10-20yrs old
18
If the patient is pre-pubescent, what is a mature teratoma considered?
Benign
19
If the patient is post-pubescent, what is a mature teratoma considered
Malignant
20
What serum tumour markers do teratomas secrete?
none
21
What is the definition of orchitis?
Any inflammatory condition of the testes
22
What are the clinical features and causes for epididymoorchitis?
Infective inflammation of epididymus
Fever, malaise, pain, warm, enlarged
Neutrophil invasion and inflammation
UTI (non-specific)/gonococcal infection
23
What are the clinical features of an idiopathic granulomatous orchitis?
Older people (idiopathic = unknown cause)
Symptoms of UTI, trauma or flu-like lines
Testis = swollen painful and tender
24
What is sarcoidosis of the tests?
Granulomas in the testes
25
What is the pathogenesis and clinical characteristics of a sperm granuloma?
Extraversion of sperm into interstitium, resulting in inflammatory reaction (histiocytes/polymorphs) and fibrosis
Results in swelling in epididymis. Can result from result vasectomy
26
What presents with bilateral/unilateral painless scrotal swelling, infertility and scrotal fistula. Prominent caseating granulomatous inflammation fibrous thickening and enlargement of epididymis and other structures?
TB orchitis
27
What is cryptorchordisn? What is its complications?
Failure of testes to defend into scrotum - acquired or congenital causes
Results in testicular ischaemia and hypoxia -> testicular atrophy -> infertility/testicular cancer
28
Name some primary causes of testicular failure (hypogonadism)
Cryptochoridism
Klinefelter syndrome
Mumps
Orchitis
CF
testicular torsion
29