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Urology Pathology Flashcards

(65 cards)

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1
Q

Name the parts of the penis

A
  • foreskin
  • glans
  • urethra
  • corpus cavernosum
  • corpus spongiosum
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2
Q

What types of HPV can cause genital warts?

A

HPV6 and 11

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3
Q

Name the two types of penile neoplasia

A

Differentiated (non HPV)

Dedifferentiated (HPV related)

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4
Q

What is the function of the testes?

A

To make sperm

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5
Q

Where is sperm made?

A

Seminiferous tubules from germ cells

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6
Q

Describe the influence of FSH and LH on the testes

A

FSH - stimulates sertoli cells and controls the tubule environment
LH - stimulates leydig cells which produce a precursor that then gets converted into testosterone

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7
Q

Define hydrocele

A

Accumulation of fluid around the testes between the two layers of the tunica vaginalis -mesothelial lining

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8
Q

Describe the clinical features of a hydrocele

A

Unicystic, smooth and fluid filled

Will transluminate

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9
Q

Describe spermatocoele

A

Cystic changes in the vas of the epididymis - asymptomatic felt on examination

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10
Q

What is varicocele?

A

Varicosities of venous plexus that drains the testis usually asymptomatic

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11
Q

Describe a testicular torsion?

A

Emergency twisting of testes and cord around the arterial supply causing ischaemia and cell death

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12
Q

How long after torsion are the testes irretrievable?

A

6 hours

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13
Q

When can torsion occur?

A

Sports but often during sleep

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14
Q

Name a type of deformity that can occur in the testes

A

Bell Clapper Deformity

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15
Q

Describe Bell Clapper deformity

A

Insertion of the tunica vaginalis is high and the testes can rotate and sit laterally

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16
Q

How heavy is the average prostate?

A

20g

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17
Q

Describe the apex of the prostate

A

Inferior and continuous with the striated sphincter

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18
Q

Describe the base of the prostate

A

Superior and continuous with the bladder neck

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19
Q

What kind of cell covers the prostatic urethra?

A

Transitional epithelium

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20
Q

Name the three zones of the prostate

A
  • transitional
  • central
  • peripheral
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21
Q

Where is the transitional zone?

A

Surrounds the prostatic urethra and is proximal to the verumontanum

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22
Q

What pathology arises from the transitional zone?

A

BPH

20% of prostate cancer

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23
Q

Describe the central zone

A

Cone shaped region surrounds the ejaculatory ducts

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24
Q

What percentage of cancers arise from the central zone?

A

1-5%

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25
Where is the peripheral zone?
Posterolateral, majority of glandular tissue
26
What pathology presents in the peripheral zone?
70% of prostate adenocarcinoma
27
What happens in benign prostate hyperplasia?
Central and transitional zones get bigger under hormonal influence and can obstruct urine flow
28
At the age of 70 what percentage of men have prostate cancer?
70%
29
State the risk factors for prostate cancer
- age - geographic location (western world) - race (black) - family history (BRCA2 gene)
30
How to people with prostate cancer present?
``` Most often asymptomatic Haematuria Haemtospermia Bone pain Weight loss Anorexia ```
31
What can a DRE of prostate cancer show?
Asymmetry, nodule, craggy mass
32
Describe PSA
Glycoprotein enzyme in the secretory epithelium of the prostate gland that is involved in the liquefaction of semen
33
In what circumstances does PSA increase?
``` Prostate cancer BPH UTI Urinary retention Catheterisation DRE Drugs - spironolactone Exercise Sex ```
34
What is the advantage of PSA?
It can prevent the need for biopsy
35
What are the indications for a prostate biopsy?
- Men with abnormal DRE and elevated PSA - Previous biopsy atypia - Previous normal biopsy but rising PSA trends
36
How is a prostate biopsy carried out?
USS probe passed through rectum and prostate visualised in transverse and sagittal sections
37
What are the complications associated with prostate biopsy?
Sepsis, bleeding, vaso-vagal fainting, haematospermia, haematuria
38
What type of cancer are most prostate cancers?
Multifocal adenocarcinoma
39
What is multifocal adenocarcinoma characterised by?
Sclerotic lesions
40
Where does prostate cancer spread?
Local invasion - urethra, bladder base, seminal vesicles Perineurial invasion - autonomic nerves Metastases - pelvic lymph nodes and skeleton
41
Name the scoring system for prostate cancer?
Gleason - based on architectural appearance
42
Describe the gleason scoring system
``` Microscopically graded 1-5 - loss of BM - loss of glandular structure - replacement by malignant growth Two most abundant are added together to give a score out of 10 ```
43
State the TNM classification for prostate cancer
``` T1 - clinically apparent not palpable T2 - confined to prostate T3 - extends through prostatic capsule T4 - invades adjacent structures N0/N1 - no/regional nodes M0/M1 - no/distant mets ```
44
What investigations can be done in addition to prostate biopsy?
Bone scan MRI CT
45
If the tumour is confined to the prostate what is the treatment?
Radical surgery Radiotherapy Watch and wait (particularly in elderly)
46
In locally advanced prostate cancer what is the management?
Radiotherapy and hormonal therapy
47
What is the management in metastatic prostate cancer?
Androgen deprivation therapy Diethylstilbestrol/steroids Cytotoxic chemotherapy
48
What is the mechanism of androgen deprivation therapy?
If prostate cells are deprived of androgenic stimulation they undergo apoptosis
49
Name two types of androgen deprivation therapy
- LHRH | - Anti-androgens
50
How do LHRH agonists works?
Chronic exposure leads to down regulation of LHRH receptors and therefore suppression of LH and FSH.
51
What is the initial risk of LHRH agonists? How is this avoided
Initially causes testosterone surge and this can cause spinal cord compression so anti-androgen is given to cover first week and two weeks after treatment
52
What are the side effects of LHRH agonists?
Loss of libido, weight gain, hot flushes, anaemia, osteoporosis, gynaecomastia
53
How do anti-androgens work?
Compete with testosterone and DHT for binding sites on the receptor in the prostate cell nucleus leading to apoptosis
54
What are the two types of anti-androgen? What are there associated side effects?
Steroidal (loss of libido, ED, cardio/hepatotoxic) | Non-steroidal (maintains libido, gynaecomastia, hot flushes, hepatoxic, breast pain)
55
What tumours arise from the bladder?
Uroepithelial
56
Name two uroepithelial tumours
- transitional cell | - squamous cell
57
What is the epidemiology of bladder cancer?
Usually middle to old aged, strong association with smoking and lung cancer, more common in men
58
What are most transitional cell carcinomas?
Papillary (finger like projections)
59
What imaging is done for a suspected transitional cell carcinoma?
``` Excretory urogram Sonography Retrograde pyelogram CT urography and cystoscopy Angiography ```
60
What are the different variations of transitional cell carcinoma?
Single lesion Multiple discrete Diffuse and confluent Tends to be multi centric and bilateral
61
What cancer is bladder carcinoma associated with?
Lung Ureter Pelvic
62
Signs on imaging
halo and calcification?
63
How can adenocarcinoma present?
Can occur from background metaplasia but can also be colon cancer invasion
64
Name the bladder remnant and describe the pathology that can arise
Urachus - from dome of bladder may remain patent and adenocarcinoma can arise
65
What causes squamous cell carcinoma?
Persistent inflammation leading to squamous metaplasia

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