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1F-MALE PATHOLOGY Flashcards

1
Q

Normal weight of prostate gland

A

30 to 40 g

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2
Q

At which prostate zone does Focal Atrophy typically present?

A

Peripheral zone

  • others:
  • Chr. inlfam
  • High grade PIN
  • CA
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3
Q

At which prostate zone does BPH typically present?

A

Transition zone

  • others:
  • Focal atrophy
  • Chr. inlfam
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4
Q

Histological characteristics of prostate gland

A
  • Glands in lobular architecture
  • Intervening Fibromuscular stroma
  • Corpora amylacea (w/in glandular lumen)
  • Glands: types of cells:
  • Secretory cell
  • Basal cell
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5
Q

Testis normal measurements

A

Mean volume: 20 mL
Weight:
- Right: 21.6 g
- Left: 20 g

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6
Q

Cells in seminiferous tubules

A
  • Germ cells

- Sertoli cells

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7
Q

Cells that produce testosterone

A

Leydig cells

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8
Q

Highly convoluted and tightly packed tubules

A

Seminiferous tubules

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9
Q

Connects the seminiferous tubules with the efferent ducts

A

Rete testis

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10
Q

Consists of vas deferens and blood vessels

A

Spermatic cord

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11
Q

Carries and stores sperm cells to bring the sperm to maturity

A

Epididymis

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12
Q

Anatomy of a penis

A
  • 3 cylindrical masses of vascularized erectile tissue
  • – 2 Corpora cavernosa: dorsal aspect
  • – Corpus spongiosum: ventral midline
  • Glans penis
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13
Q

Most common benign tumor

A

Benign prostatic hyperplasia

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14
Q

BPH pathophysiology

A

Glandular and stromal hyperplasia

  • eptih: d/t incr. prolif’n & decr. apop.
  • stroma: d/t incr. prolif’n
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15
Q

Cause of hyperplasia in BPH

A

Androgen steroids/ testosterone, more specifically DIHYDROTTESTOSTERONE

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16
Q

MC area where BPH occurs

A

Transition & periurethral zone

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17
Q

50/M complained of obstructive sx (frequency, urgency, incontinence, retention), upon DRE prostate is enlarged and nodular

A

BPH

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18
Q

T or F:

BPH shows multiple circumscribed nodules without true capsule

A

TRUE

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19
Q

Gross features of BPH

A
  • Predominantly glandular: Yellow, soft consistency

- Predominantly stromal: Pale gray, firm/hard

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20
Q

IHC in BPH

A

Glandular cells:

  • Basal cells: (+) HWWCK & p63
  • Secretory cells: (+) PSA, PSAP, PSMA
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21
Q

Typical characteristic pf BPH microscopically

A
  • Combination of stromal and glandular hyperplasia

Others:
- Pure stromal

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22
Q

Malignant lesion arising form the cells that line the prostatic gland

A

Prostatic Adenocarcinoma

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23
Q

Two histologic categories of Prostatic AdenoCA

A
  • Acinar: has prostatic secretory cell differentiation

- Ductal: large glands lined w/ tall pseudostratified columnar tumor cells

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24
Q

MC area where Prostatic AdenoCA occurs

A

Peripheral zone

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25
Q

Microscopic characteristics of Prostatic AdenoCA that differentiates it from normal prostate and BPH

A

Small glands with straight luminal border

*Normal & BPH: large glands w/ irregular papillary undulations

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26
Q

Pathognomonic features of Prostatic AdenoCA

A
  • Mucinous fibroplasia
  • Glomeruli formation
  • Perinueral invasion
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27
Q

IHC used for Prostatic AdenoCA

A

(+) AMCR (racemase)

(-) basal cell markers

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28
Q

PSA values in px w/ Prostatic AdenoCA

A

70 to 75% have PSA >4 ng/mL

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29
Q

T or F: Pxs with PSA value of >4 ng/mL points to a diagnosis of prostate CA

A

FALSE

*PSA > 4ng/mL is not discriminatory bet. benign and malignant. Only tells you that there is probably an ongoing lesion in the prostatic gland

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30
Q

The ratio between the serum PSA

value and volume of the prostate gland.

A

PSA density

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31
Q

The rate of change in PSA value

with time.

A

PSA velocity

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32
Q

PSA velocity that best

distinguishes between cancer and benign lesions of prostate.

A

0.75 ng/mL/year

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33
Q

Gleason grading

A

GG 1-2: Benign

GG 3-5: Malignant

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34
Q

Gleason patterns

A

GP 1-3 : Discrete well-formed glands
GP 4: Cribriform/ poorly-formed/ fused glands
GP 5: Sheets/ cords/ single cells/ solid nests/ necrosis

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35
Q 
Sum of the 2 most prevalent
Gleason grades (primary and secondary).
A

Gleason score

*Radical Prostatectomy
○ Primary grade - most predominant pattern
○ Secondary grade - 2nd most predominant

*Needle biopsy
○ Primary grade - most predominant pattern
○ Secondary grade - worst pattern

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36
Q

Gleason grade groups

A

● Grade Group 1 (Gleason score = 6) - Only individual discrete well-formed glands
● Grade Group 2 (Gleason score 3+4=7) -
Predominantly well-formed glands with a lesser component of poorly formed/ fused/ cribriform glands
● Grade Group 3 (Gleason score 4+3=7) -
Predominantly poorly-formed/ fused/ cribriform glands with lesser component of well-formed glands
● Grade Group 4 (Gleason score 8) - Only poorly-formed/ fused/ cribriform glands
or - Predominantly well-formed glands with a lesser component lacking glands
or - Predominantly lacking glands with a lesser component of well-formed glands
● Grade Group 5 (Gleason scores 9-10) - Lacks gland formation (or with necrosis) with or w/o poorly-formed/fused/cribriform glands.

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37
Q

Most common defect of the male genital tract

A

Cryptorchidism

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38
Q

Failure of testis to descend into the scrotum

A

Cryptorchidism

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39
Q

Risks involved in Cryptorchidism

A
  • Infertility

- Torsion

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40
Q

Major complication of undescended abdominal testis

A

Development of germ cell tumor

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41
Q

Treatment for Cryptorchidism

A

Orchidopexy: a surgery to move an undescended testicle into the scrotum and permanently fix it there.

*80% descend on the 1st yr of life: watchful waiting

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42
Q

T or F: Orchidopexy, when done, eliminates the risk for malignancy

A

FALSE

*Only decreases the risk –does not eliminate

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43
Q

T or F: With progression of age, the cryptorchid testis is larger than normally descended testis

A

FALSE

*As px gets older, it becomes smaller than normal

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44
Q

Microscopic characteristics of Cryptorchidism

A

Pre-pubertal testis:
- Immature seminiferous tubules and reduced number of germ cells

Post-pubertal testis:
- Tubules reduced in size containing only sertoli cells (absence of germ cells)

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45
Q

Comprises 90% of testicular tumors

A

GCTs

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46
Q

GCT presentation

A

Painless testicular enlargement, unilateral

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47
Q

Seminomatous vs non-seminomatous GCT

A

SEMINOMATOUS

  • 35 to 45 y/o
  • Localized for a longer time
  • Sensitive to radiation therapy

NON-SEMINOMATOUS

  • Childhood (10 y/o or younger)
  • Can metastasize earlier
  • Resistant to radiotherapy
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48
Q

Most common testicular tumor

A

Seminoma

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49
Q

GCT that is composed of cells with an enlarged round or polygonal nuclei, prominent nucleoli, discrete cell borders, and clear cytoplasm.

A

Seminoma

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50
Q

Painless palpable mass

A

Seminoma

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51
Q

Counterpart of Seminoma in females

A

Dysgerminoma

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52
Q

Prognosis of Seminoma

A

Very good prognosis

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53
Q

Microscopic characteristics of Seminoma

A

Sheet or lobules of seminoma cells separated by fibrous septae, infiltrated by lymphocytes

*Cells are round to polygonal, nuclei are large and vesicular with prominent nucleoli; presence of mitosis

54
Q

IHC in Seminoma

A

Nuclear: (+) OCT3/4 & SALL4
Membranous: CD117 & PLAP

55
Q

Second most common purely occurring GCT

A

Embryonal carcinoma

56
Q

GCT composed of primitive epithelial cells that recapitulates an early phases of embryogenesis

A

Embryonal carcinoma

57
Q

Gross features of Embryonal carcinoma

A

Variegated with soft hemorrhagic and necrotic foci

58
Q

MC growth pattern of Embryonal carcinoma

A

Solid

Others:

  • Glandular
  • Papillary
59
Q

T or F: EC cells are generally larger than seminoma cells

60
Q

Primary treatment for Embryonal carcinoma

A

Surgical orchiectomy

61
Q

Impt microscopic characteristics of Embryonal carcinoma

A

Nuclei are pleomorphic and overlaps, prominent nucleoli

62
Q

IHC in Embryonal carcinoma

A

(+) CD30, OCT3/4, SALL4, PLAP, and Keratins

63
Q

GCT that display a variety of morphologic patterns that resemble the embryonic yolk sac, allantois, and extraembryonic mesenchyme.

A

Yolk sac tumor/ Endodermal sinus tumor

64
Q

Most common testicular tumor

in children

65
Q

Mean age of onset of pure YST

A

16-18 months

66
Q

Tumor marker elevated in Yolk sac tumor

67
Q

Most common pattern for Yolk sac tumor

A

Reticular or Microcystic pattern

  • Others:
  • Endodermal sinus (2nd MC; contains SDB)
  • Papillary (resemble EC)
  • Solid (resemble seminoma)
  • Glandular-alveolar (resemble intestinal or endometrial glands)
68
Q

IHC for Yolk sac tumor

A

(+) AFP and Glypican 3

69
Q

Eosinophilic round bodies that secrete AFP

A

Hyaline-like globules

70
Q

Central blood vessels lined with YST cells which are cuboidal to columnar with prominent nuclei

A

Schiller duval bodies

71
Q

Malignant GCT composed of syncytio, cyto, and intermediate trophoblast cells

A

Choriocarcinoma

72
Q

Typical age of presentation of Choriocarcinoma

A

25 to 30 y/o

73
Q

Symptoms of Choriocarcinoma

A

Metastatic symptoms:

  • Hemoptysis
  • Hematemesis
  • CNS dysfunction
  • Anemia
  • Hypotension
74
Q

2 impt gross features seen in Choriocarcinoma

A
  • Hemorrhage

- Necrosis

75
Q

Large irregular cells with multiple nuclei and eosinophilic cytoplasm

A

Syncytiotrophoblasts

76
Q

Round and polygonal cells with single round nuclei, prominent nucleoli, and
pale cytoplasm

A

Cytotrophoblasts

77
Q

Larger than cytotrophoblasts with irregular and smudged nuclei and eosinophilic cytoplasm

A

Intermediate trophoblasts

78
Q

IHC in Choriocarcinoma

A

All cell types: (+) PLAP & cytokeratin

Syncytiotropho: (+) HCG

79
Q

Germ cell neoplasm derived from

ectoderm, endoderm, and mesoderm (the 3 germinal layers)

80
Q

2nd most common GCT among children

81
Q

Are Teratomas benign or malignant?

A

Prepuberty: benign
Postpuberty: malignant

82
Q

Teratoma components

A

Mature: skin, cartilage, muscle
Immature: neuroepithelium, tubules

83
Q

Sex cord stromal tumor that comprises 1-3% of testicular tumors

A

Leydig cell tumor

84
Q

T or F: 10 to 15% of Leydig cell tumors are malignant. Malignant LCTs are relatively aggressive, patients die within 5 years

85
Q

Characteristic rectangular and eosinophilic inclusions seen in Leydig cell tumors

A

Reinke crystals

86
Q

IHC in Leydig cell tumor

A

(+) Inhibin, Calretinin, Melan-A, S100

87
Q

Sex cord stromal tumor that is rare (<1% of testicular tumors)

A

Sertoli cell tumor

88
Q

T or F: Mean age of presentation of Sertoli cell tumor is 45, even though it mostly occurs in adults it is mostly benign

89
Q

T or F: Sertoli cell tumors (or Sex cord stromal tumors, in general) are resistant to radiation and chemotherapy

90
Q

Most common pattern in Sertoli cell tumor

A

Tubular pattern

*Others: cord, sheet, nest, retiform

91
Q

microscopic characteristics of Sertoli cell tumor cells

A

Cuboidal or columnar cells, often with

prominent cytoplasmic lipid vacuoles

92
Q

IHC in Sertoli cell tumor

A

(+) Inhibin, Calretinin, CK

93
Q

Precursor lesions of invasive squamous cell carcinoma of the penis; characterized by your atypical or dysplastic squamous epithelium but still have intact basement membrane.

A

PENILE INTRAEPITHELIAL NEOPLASIA (PeIN)

94
Q

Cytologic atypia limited to lower 3rd

of the epithelium

A

Penile Intraepithelial Neoplasia

(PeIN): Low Grade PeIN-I

95
Q

Cytologic atypia limited to lower 2/3rd of the epithelium

A

Intermediate Grade PeIN II

96
Q

Cytologic atypia >2/3rd or the full thickness

A

High grade PeIN III/SCC in situ

97
Q

Similar with PeIN III. however with more spotting distribution of atypical cells and greater maturation of keratinocytes.

A

Bowenoid Papulosis

98
Q

Strains in HPV-related PeIN

A

HPV 16 & 18

99
Q

2 types of high grade PeIN III

A
  • Erythroplasia of Queyrat

- Bowen disease

100
Q

Penile lesion exclusively in uncircumsiced men

A

Erythroplasia of Queyrat

101
Q

Penile lesion usually seen in young, sexually active adults

A

Bowenoid papulosis

102
Q

Penile lesion manifested as sharp, demarcated, bright red and shiny plaque

A

Erythroplasia of Queyrat

103
Q

Penile lesion manifested as crusted, sharply demarcated, scaly plaque

A

Bowen disease

104
Q

Penile lesion manifested as multiple, small, red papules

A

Bowenoid papulosis

105
Q

High grade PeIN III vs Bowenoid Papulosis: Site

A

EQ: glans, prepuce
BD: shaft
BP: shaft

106
Q

High grade PeIN III vs Bowenoid Papulosis: Age of onset

A

PeIN: 4th-6th decade
BP: younger (3rd-4th decade)

107
Q

High grade PeIN III vs Bowenoid Papulosis: Lesion

A

EQ: Erythematous plaque
BD: Scaly
BP: Papules

108
Q

High grade PeIN III vs Bowenoid Papulosis: Maturation

A

PeIN: (-)
BD: (+)

109
Q

High grade PeIN III vs Bowenoid Papulosis: Sweat gland involvement

A

PeIN: (-)
BD: (+)

110
Q

High grade PeIN III vs Bowenoid Papulosis: Pilosebaceous involvement

A

PeIN: (+/-)
BD: (-)

111
Q

High grade PeIN III vs Bowenoid Papulosis: Pre-cancerous potential

A

PeIN: 5 to 10%
BD: (-) –> benign

112
Q

High grade PeIN III vs Bowenoid Papulosis: Spontaneous regression

A

PeIN: (-)
BD: (+)

113
Q

PeIN III vs Bowenoid papulosis: microscopic features

A

PeIN: complete absence of maturation, atypical cells distribution is more diffused

BD: there is maturation but is delayed, more spotty distribution of atypical cells

114
Q

MC malignant tumor of the penis

A

Squamous cell carcinoma

115
Q

Growth pattern of SQCC:
● Most common
● Presents as flat white lesions

A

Superficial spreading

116
Q

Growth pattern of SQCC:
● Present as ulceration, fungating
● Expect hemorrhage

A

Vertical growth

117
Q

Growth pattern of SQCC:
● Well differentiated
● Best prognosis

A

Verruciform growth

118
Q

MC malignant neoplasm of the penis

119
Q

MC type of all penile tumors

A

SCC (usual type?)

120
Q

Invasive lesion of the penis with nonpapillary differentiation and varying degree of keratinization; typically occurs in: 60 yrs old, uncircumcised

A

Usual type SCC

121
Q

T or F: Usual type-SCC are non-HPV related

122
Q

SCC location

A

Glans > foreskin > coronal sulcus

123
Q

T or F: SCCs are usually poorly differentiated

A

FALSE

*Usually well or moderately differentiated

124
Q

IHC in SCC

A

(+) Cytokeratins

125
Q

An aggressive variant of SCC

A

Basaloid carcinoma

126
Q

T or F: Basaloid type-SCC are HPV related

127
Q

HPV strain in basaloid carcinoma

128
Q

55/M presented with large, ulcerated mass in the glans, with inguinal lymphadenopathy

A

Basaloid carcinoma

129
Q

Microscopic features seen in basaloid carcinoma

A
  • Small monotonous cells
  • Brisk mitotic rate & apoptotic bodies
  • Abrupt keratinization w/ necrosis
130
Q

Unique microscopic characteristics of basaloid carcinoma

A
  • Starry sky appearance (apoptotic bodies)

- Central comedo type necrosis (d/t abrupt keratinization)

131
Q

IHC in basaloid carcinoma

A

(+) Cytokeratins

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