0430 - Male Urogenital Tract Tumours Flashcards
What is the standard approach to a lesion or mass in any organ system?
Is it neoplastic or non-neoplastic?
If non-neoplastic - congenital, hamartomatous, infective, inflammatory, or a deposit?
If neoplastic, is it benign or malignant?
If malignant, is it a primary or a secondary
If a primary is it epithelial or mesenchymal?
What is the type of malignancy?
Which part of the prostate is more prone to BPH, which to prostatic cancer?
Central zone more prone to BPH. Peripheral more prone to malignancy.
Describe the macro appearance of the normal prostate.
A pear-shaped organ weighing around 20 grams.
Consists of a central prostatic urethra, surrounded by glandular tissue divided into central, transitional, and periopheral prostatic tissue.
Very smooth and uniform.
Describe the histology of a normal prostate.
Consists of glands lined with fibromuscular stroma.
The glands have 2 layers - basal and luminal. Loss of basal layer defines malignancy in the prostate.
May contain corpora amylacea - calcified concretions within the glands.
What are some non-neoplastic prostatic conditions?
Infection - bacterial or tuberculous prostatitis
Inflammation - Chronic, Granulomatous, or xanthogranulomatous prostatitis.
Deposits - Calculi or amyloid.
Describe the histological appearance of chronic prostatitis
Like normal prostate, but much busier.
Glands still have 2 layers, but not much fibromuscular stroma left due to infiltration by leukocytes.
What are some benign prostatic neoplasms?
Epithelial - Adenosis
Mesenchymal - Leiomyoma
Mixed epithelial and mesenchymal - BPH
What are some malignant neoplasms of the prostate?
Epithelial - Acinar adenocarcinoma
Mesenchymal - Leiomyosarcoma, stromal sarcoma
Mixed - Epithelial stromal sarcoma.
Also invasion from nearby organs (bladder, urethra, rectum)
Describe the micro and macro appearance of BPH. How can it be differentiated from cancer?
Macro - Generally in central zone, producing hyperplastic nodules which are pale on the cut surface.
Micro - Hyperplasia of both glands and stroma, but glands are still lined by 2 layers of cell (epithelial and basal)
The cells look bland. Can do an IHC stain for the basal layer - if present, it’s BPH.
Describe the histology of prostatic adenocarcinoma
Glands lose their shape to become ‘bland’, and proliferate to minimise the stroma. Cells have prominent nucleoli.
MOST IMPORTANT - complete absence of the basal layer in glands.
Describe neoplastic squamous carcinoma of the penis.
Macro - large, fungating mass.
Micro - infiltrating islands of squamous cells with keratin pearls and inter-cellular bridges.
Associated with HPV. Most tumours arise from glans or inner foreskin.
Describe the normal histology of the testis
Consists of seminiferous tubules containing maturing spermatocytes, with Leydig cells interlying.
How can testicular tumours be classified.
Seminomatous or non-seminomatous.
Seminomatous tumours are radiosensitive, non-seminomatous are radio-resistant.
Describe a seminoma (symptoms, macro, micro)
Painless, unilateral, bulky testicular enlargement. Spreads via lymph nodes.
Macro - homogenous, creamy white tumour without haemorrhage or necrosis.
Micro - sheets of tightly packed cells with dark, central nuclei, prominent nucleolus and clear cytoplasm. Characteristic lymphoid infiltrate where malignant cells can mingle with the lymphocytes.
What are the non-seminomatous (Germ-cell) tumours of the testis
60% of germ cell tumours are mixed type, and all spread early, via bloodstream.
- Teratoma (any age) - Heterogenous collection of various tissue types
- Embryonal carcinoma (20-30yrs) - Sheets of pleomorphic cells with mitosis, necrosis, and tumour giant cells.
- Yolk Sac tumour (<3yr old) - Solid papillary and microcystic patterns, secrete AFP.
- Choriocarcionoma - Haemmorhagic and highly malignant. Secrete HCG.
