20 - Lower urinary tract and male genital tract Flashcards
An abnormal opening of the urethra along the ventral or dorsal aspect of the penis, respectively.
Hypospadia (more common); epispadia
Inflammation of the glans and of overlying prepuce, respectively; cause by Gardnerella, Candida, anaerobic and pyogenic bacteria.
Balanitis; balanoposthitis
Appears grossly as a solitary, plaque-like lesion on the shaft of the penis; histologic examination reveals morphologically malignant cells throughout the epidermis with no invasion of the underlying stroma; has potential for malignant transformation.
Bowen disease/Squamous cell carcinoma in situ of the penis
Occurs in young, sexually active males; histologically identical to Bowen disease; presents with multiple reddish brown papules on the glans and is most often transient; virtually never progresses to carcinoma in immunocompetent patients.
Bowenoid papulosis
Appears as a gray, crusted, papular lesion, most commonly on the glans penis or prepuce, which infiltrates the underlying connective tissue to produce an indurated, ulcerated lesion with irregular margins; histologically similar to Bowen disease but with infiltration of the underlying stroma.
Squamous cell carcinoma of the penis
Represents failure of testicular descent into the scrotum, which involves the right testis more commonly than the left; causes increased risk of sterility and development of testicular cancer; most common phase of arrest: inguinoscrotal (4-7th month AOG).
Cryptorchidism
Inflammatory disorders most commonly affect: testis or epididymis? Clue: Gonorrhea and TB usually affect this organ first.
Epididymis
Tumors most commonly involve: testis or epididymis? Clue: Syphilis usually affects this organ first.
Testis
One of the few true urologic emergencies, which involves twisting of spermatic cord, which can ultimately lead to hemorrhagic infarction of the testis; golden period for intervention is 6 hours.
Testicular torsion
Most common cause of painless testicular enlargement.
Testicular tumors
Main difference between biologic behavior of testicular germ cell and sex cord-stromal tumors.
- Germ cell tumors are usually aggressive;
- sex cord-stromal tumors are usually benign
Most common germ cell tumor; Composed of sheets of large, uniform cells with distinct cell borders, clear, glycogen-rich cytoplasm, and round nuclei with conspicuous nucleoli. The cells are often arrayed in small lobules with intervening fibrous septa infiltrated with lymphocytes; 15% have increased hCG due to presence of syncytiotrophoblasts; tumors markers are CD117 (c-kit) and PLAP.
- Seminoma (Classic)
Note: Female counterpart is Dysgerminoma
Ill-defined invasive masses with foci of necrosis and hemorrhage; Large and primitive-looking with indistinct cell borders, large nuclei, and basophilic cytoplasm; negative for tumor markers.
Embryonal carcinoma
Most common primary testicular neoplasm in children younger than 3 years of age; histologically, low cuboidal to columnar epithelial cells forming microcysts, sheets, glands, and papillae, often associated with eosinophilic hyaline globules; glomeruli-like structures (Schiller-Duvall bodies) are present; tumor marker is AFP.
Yolk sac tumor/Endodermal sinus tumor/Infantile embryonal carcinoma
A highly aggressive tumor of the trophoblastic lineage; grossly presents as small, nonpalpable masses but with extensive systemic metastases; histologically characterized by presence of cytotrophoblasts (small cuboidal cells) and syncytiotrophoblasts (large, eosninophilic syncytial cells, containing multiple dark pleomorphic nuclei); without villus formation; tumor marker is HCG.
Choriocarcinoma
Tissues from all three germ-cell layers with varying degrees of differentiation; can contain fully differentiated tissues from one or more germ cell layers (e.g., neural tissue, cartilage, adipose tissue, bone, epithelium) in a haphazard array (mature); or immature somatic elements reminiscent of those in developing fetal tissue (immature).
Teratoma
The most important predictor of biologic behavior in testicular teratomas.
Age (all teratomas in postpubertal males are regarded as malignant)
Non-germ cell malignancy arising in a teratoma; malignant component is chemoresistant; usual cancers include SCCA, mucin-secreting adenoCA, sarcoma).
Teratoma with malignant transformation
Most common form of testicular neoplasm in men > 60 years of age; most common form is DLBCL; with higher rate of CNS involvement than tumors arising in other areas.
Testicular lymphoma
Most common form of prostatitis.
Chronic abacterial prostatitis
Composed of proliferating prostatic glandular elements and fibromuscular stroma that form nodules through connective tissue septa; the glandular lumina often contain inspissated, proteinaceous secretory material, termed corpora amylacea; stimulus for proliferation is increased circulating androgens (dihydrotestosterone); most commonly occurs is the transition zone.
Nodular Prostatic Hyperplasia/Benign Prostatic Hyperplasia
MC cancer in men; most commonly occurs in the peripheral zone; grossly, may appear as firm gray-white lesions with ill-defined margins invading the gland; histologically, may form gland-like structures without basal cell layer, appears crowded, and without branching and papillary infoldings; tumor marker is PSA that is used for adjunct for screening and surveillance.
Prostatic Adenocarcinoma
Grading systems used in prostatic adenocarcinoma.
Gleason and WHO group grade system
Most common cause of hydronephrosis in children.
Ureteropelvic junction obstruction
Most common and most serious congenital anomaly of the urinary bladder, due to predisposition to infection and scarring.
Vesicoureteral reflux
Bladder exstrophy, and urachal anomalies predispose patients into what histologic type of bladder cancer?
Bladder adenocarcinoma
Most common presentation of bladder cancer.
Painless hematuria
Most common type of bladder cancer; has two premalignant lesions: 1. Noninvasive papillary tumor; and 2. Flat noninvasive carcinoma (CIS); associated with cigarette smoking and occupational carcinogens.
Urothelial (Transitional cell) carcinoma (90%)
Current advancement in the treatment of non-invasive urothelial carcinomas; also a vaccine that is part of EPI, but is administered intravesically.
Bacille-Calmette-Guerin (BCG)
Histologic type of bladder cancer associated with Schistosoma haematobium infection.
Squamous cell carcinoma
Most common cause of urinary bladder obstruction in males and females, respectively.
Nodular prostatic hyperplasia, cystocele
Changes that occur in the bladder with obstruction.
Thickening of wall, Trabeculations, and Diverticula
