Week 4: Prostate and Testicular Pathology Flashcards

Question

Features of mature teratoma

Answer 1

* Teratoma * Seminoma * Yolk sac tumor * embryonal carcinoma * Choriocarcinoma

Answer 2

Choriocarcinoma is a fast-growing cancer that occurs in a woman's uterus (womb). The abnormal cells start in the tissue that would normally become the placenta. This is the organ that develops during pregnancy to feed the fetus. Choriocarcinoma is a type of gestational trophoblastic disease

Answer 3

**Embryonal carcinoma** is a germ cell tumor characterized by primitive epithelial cells with marked pleomorphism and various histologic patterns. It may present in pure form but often is part of a mixed germ cell tumor

Answer 4

Germ Cell Tumors

Answer 5

Yolk sac tumors are those that resembles the yolk sac, allantois, and extraembryonic mesenchyme. They are also known as endodermal sinus tumors.

Answer 6

Yolk sac tumors (YSTs) can be seen in males and females, involving the testis, ovary, and other sites, such as the mediastinum. Yolk sac tumors (YSTs) of the testis are observed in 2 forms or age groups: pure YST in young children and mixed type in adults. In children, yolk sac tumors (YSTs) are more common in Asians than in white or black persons. In adults, these tumors are more common in white individuals than in other races.

Answer 7

**The typical presentation in testicular seminoma is as follows:** * A male aged 15-35 years presents with a painless testicular lump that has been noticeable for several days to months * Patients commonly have abnormal findings on semen analysis at presentation, and they may be subfertile [3] * Patients may present with a hydrocele, and scrotal ultrasonography may identify a nonpalpable testis tumor **Uncommon presentations include the following:** * Testicular pain, possibly with an acute onset; may be associated with a hydrocele * A metastatic testis tumor may manifest as large retroperitoneal and/or chest lesions, while the primary tumor is nonpalpable

Answer 8

The risk of testis cancer is 10-40 times higher in patients with a history of cryptorchidism; 10% of patients with GCTs have a history of cryptorchidism

Answer 9

Seminoma (50%)

Answer 10

peak in 30's, almost never in infants

Answer 11

Seminom is morphologically identical tumor to dysgerminoma of the ovary in females

Answer 12

An ovarian tumor that is morphologically identical tumor to seminoma of the testis in males

Answer 13

* Uniform tumor cells with abundant clear cytoplasm * distinct cell border * large central nuclei with prominent 1-2 nucleoli * separated into nests by fibrous septa * Lymphocytic and plasmacytic infiltrates in fibrous septa * Multinucleated giant cells (syncytiotrophoblasts) may be seen, especially in patients with elevated hCG

Answer 14

is a severe type of anemia found in some people wit diseases that affect bone marrow

Answer 15

Myelopthisis refers to the displacement of hemopoietic bone marrow tissue by fibrosis, tumors or granulomas

Answer 16

Nodular prostatic hyperplasia

Answer 17

Benign prostatic hyperplasia

Answer 18

Benign prostatic hyperplasia

Answer 19

common condition in olfer men

Answer 20

The prostate becomes more sensitive to androgenic stimulation with age causing: proliferation of both prostatic glands and stroma

Answer 21

This often incorrectly refers to benign prostatic hyperplasia or Nodular prostatic hyperplasia but is technically incorrect because the number of glands and stromal cells increase rather than just the size

Answer 22

Proliferation of prostatic glands and stroma

Answer 23

Prostate specific antigen

Answer 24

Prostate specific antigen

Answer 25

* difficulty with urination * feeling of urgency * enlarged to twice the normal size * not tender to palpation * Slight elevation in PSA level

Answer 26

5α-reductase inhibitor Decreases the formation of Dihydrotestosterone (DHT)

Answer 27

Decreases the formation of Dihydrotestosterone (DHT) that binds to androgen receptors in prostatic stromal and epithelial cells driving proliferation with prostate gland enlargement

Answer 28

* diminish smooth muscle tone and somewhat more effective in trating nodular hyperplasia

Answer 29

* Doxazosin * terazosin * alfuzosin * tamsulosin

Answer 30

Androgens are the major hormonal stimuli of glandular and stromal proliferation resulting in nodular prostatic hyperplasia Testosterone production decreases with age, prostatic hyperplasia increases probably because of an increased expression of prostatic hormonal receptors that enhance the effect on any DHT that is present

Answer 31

* 5α-reductase inhibitors (finasteride) - diminish the prostate volume, specifically the glandular component leading to improved urine flow * α1-adrenergic receptor blockers (doxazosin, terazosin, alfuzosin, tamsulosin) - cause smooth muscle in the bladder neck and prostate to relax which relieves symptoms and improves urine flow immediately

Answer 32

* Hesitancy and increased frequency * difficulty with urination * palpably enlarged prostate to 2x normal size * microscope appearance of "chips" nodules of glands with intervening stroma **Medscape** * Urinary frequency * Urinary urgency * Nocturia- Needing to get up frequently at night to urinate * Hesitancy - Difficulty initiating the urinary stream; interrupted, weak stream * Incomplete bladder emptying - The feeling of persistent residual urine, regardless of the frequency of urination * Straining - The need strain or push (Valsalva maneuver) to initiate and maintain urination in order to more fully empty the bladder * Decreased force of stream - The subjective loss of force of the urinary stream over time * Dribbling - The loss of small amounts of urine due to a poor urinary stream as well as weak urinary stream

Answer 33

Clinical symptoms & Digital rectal examination for prostate enlargment not tender to palpation

Answer 34

* Severe and constant back pain * 6-kg weight loss * firm and irregular prostate * Alkaline phosphatase is elevated * PSA is 25 **Medscape** * Urinary complaints or retention * Back pain * Hematuria

Answer 35

**PSA levels** * No PSA level guarantees the absence of prostate cancer. * The risk of disease increases as the PSA level increases, from about 8% with PSA levels of ≤1.0 ng/mL to about 25% with PSA levels of 4-10 ng/mL and over 50% for levels over 10 ng/mL * The most common site of prostatic carcinoma is bone **Digital rectal exam** * DRE is examiner-dependent, and serial examinations over time are best * Most patients diagnosed with prostate cancer have normal DRE results but abnormal PSA readings **Biopsy** * Biopsy establishes the diagnosis * False-negative results often occur, so multiple biopsies may be needed before prostate cancer is detected

Answer 36

* 50 years of age for men at average risk who have at least a 10-year life expectancy * 40 or 45 years of age for African Americans and men who have had a first-degree relative diagnosed with prostate cancer before age 65 years * 40 years of age for men with several first-degree relatives who had prostate cancer at an early age

Answer 37

A normal PSA level is considered to be 4.0 nanograms per milliliter (ng/mL) of blood. For men in their 50s or younger, a PSA level should be below 2.5 in most cases. Older men often have slightly higher PSA levels than younger men.

Answer 38

The following are some general PSA level guidelines: 0 to 2.5 ng/mL is considered safe. 2.6 to 4 ng/mL is safe in most men but talk with your doctor about other risk factors. 4.0 to 10.0 ng/mL is suspicious and might suggest the possibility of prostate cancer.

Answer 39

* Typically most prostatic carcinomas are adenocarcinomas that form small glands packed back-to-back * May adenocarcinomas of the prostate do not produce obstructive symptoms (because mostly the tumors are in the peripheral zone)

Answer 40

* PSA is increased in prostatic adenocarcinoma * Total PSA is increased while free PSA is decreased * PSA can also increase with inflammation and nodular hyperplasias although not to a high level that increases significantly over time

Answer 41

The Gleason score is calculated by adding together the two grades of prostate cancer cells that make up the largest areas of the biopsied tissue sample. The Gleason score usually ranges from 6 to 10. The lower the Gleason score, the more the cancer cells look like normal cells and are likely to grow and spread slowly

Answer 42

ISUP grading (International Society of Urological Pathology)

Answer 43

ISUP = Grade group 1 Gleason score = ≤6 (3+3)

Answer 44

ISUP = Grade Group 2 Gleason score = 7 (3+4)

Answer 45

ISUP = Grade Group 3 Gleason Score = 7 (4+3)

Answer 46

ISUP = Grade group 4 Gleason Score = 8

Answer 47

ISUP = Grade Group 5 Gleason Score = 9-10

Answer 48

Distinct, discrete glands

Answer 49

Prostatic Carcinoma

Answer 50

* Surgery * radiation therapy * hormonal manipulations * active surveillance * 90% of patients expected to live 15 years

Answer 51

90% of patients expected to live 15 years

Answer 52

* Morphogenically identical tumor in ovaries are called "dysgerminoma" * Uniform tumor cells with abundant clear cytoplasm, distinct cell border and large central nuclei with prominent 1-2 nucleoli * Separated into nests by fibrous septa * Lymphocytic and plasmacytic infiltrates in fibrous septa * Multinucleated giant cells (Syncytiotrophoblasts) may be seen, \*especially in patients with elevated HCG\*

Answer 53

2 age peaks * 16-18 months (Pure YST) * 25-35 years (YST in Mixed germ cell tumor)

Answer 54

\>95% of YST patients have an elevated AFP level (100's-1000's of ng/mL)

Answer 55

**NOT** associated with ITGCN or cryptorchidism

Answer 56

16-18 month old boys

Answer 57

25-35 year old men

Answer 58

* Multiple or variable growth patterns (12 patterns) * Most common are microcystic, solid and myxomatous * PAS+ (periodic-Acid-Schiff stain) Hyaline-like globules * Schiller-Duval body

Answer 59

mumps infection tends to produce patchy bilateral testicular atrophy, usually without infertility

Answer 60

* Hemorrhagic mass * Early metastases * Three cell types: syncytiotrophoblast, cytotrophoblast, intermediate trophoblast

Answer 61

High AFP - YST, Embryonal Carcinoma, Teratoma High hCG - Choriocarcinoma, Seminoma \*can\*, Nonseminomatous germ cell tumors - \*seen in tumors that comprise pure or mixed embryonal carcinoma or choriocarcinoma\*

Answer 62

AFP stands for alpha-fetoprotein. It is a protein made in the liver of a developing baby. AFP levels are usually high when a baby is born, but fall to very low levels by the age of 1. Healthy adults should have very low levels of AFP. An AFP tumor marker test is a blood test that measures the levels of AFP in adults. Tumor markers are substances made by cancer cells or by normal cells in response to cancer in the body. High levels of AFP can be a sign of liver cancer or cancer of the ovaries or testicles, as well as noncancerous liver diseases such as cirrhosis and hepatitis.

Answer 63

2 age peaks: * \< 4 years old * 20's-40's

Answer 64

Pure mature teratoma

Answer 65

often occur as mixed germ cell tumor (50%)

Answer 66

* well-circumscribed * heterogenous * solid and cystic features * cysts with flaky or mucoid materials * mature tissue with hair, cartilage, bone or teeth * fleshy or hemorrhagic foci may indicate primtive elements or non-teratomous components

Answer 67

* Ectoderm: neuronal tissue or epidermis * Endoderm: GI or respiratory mucosa or glands * Mesoderm: cartilage, bone or muscles

Answer 68

* large pleomorphic tumor cells * ugly cells

Answer 69

serum AFP and hCG may be elevated

Answer 70

Embryonal carcinoma