33 - Urogenital pathology Flashcards by David Thomas

Nodular hyperplasia what is it?

Enlargement of prostate aka benign prostatic hyperplasia (BPH)

Overgrowth of epithelium and fibromuscular tissue of transition zone and periurethral area

How well did you know this?

Not at all

Perfectly

Clinical presentation of BPH

Lower urinary tract symptoms
Urgency
Difficulty starting urination
Diminished stream size and force
Increased frequency
Incomplete bladder emptying
Nocturia

How well did you know this?

Not at all

Perfectly

Zone of prostate

CZ - central zone
PZ - peripheral zone
TZ - transitional zone

How well did you know this?

Not at all

Perfectly

Where do most carcinomas arise in prostate?

Peripheral zone

Palpable during digital examination of rectum

How well did you know this?

Not at all

Perfectly

How would nodular hyperplasia initially present?

Urinary obstruction

How well did you know this?

Not at all

Perfectly

Pathological changes for development of nodular hyperplasia

Nodule formation

Diffuse enlargement of the transition zone and periurethral tissue (

How well did you know this?

Not at all

Perfectly

Aetiology of nodular hyperplasia

Impaired cell death
Reduction in rate of cell death = accumulation

Androgens increase cellular proliferation but inhibit cell death

How well did you know this?

Not at all

Perfectly

Incidence of nodular hyperplasia

95% of prostatic malignancies are prostatic adenocarcinoma - rare in

How well did you know this?

Not at all

Perfectly

Treatment of prostate cancer

Surgery
Radiation therapy
Hormonal manipulations

90% who receive this therapy can expect to live for 15 years

How well did you know this?

Not at all

Perfectly

Risk factors for prostatic carcinoma

Age
Race
Family history
Hormone levels
Environmental influences (increased consumption of fats)
Androgens

Inherited polymorphisms
BRCA2 have a 20-fold increased risk of prostate cancer

How well did you know this?

Not at all

Perfectly

How is prostatic carcinoma graded?

Gleason scoring system

How well did you know this?

Not at all

Perfectly

Testicular tumour - epidemiology

Men of northern european ancestry

Cryptorchidism
Impaired spermatogenesis
Inguinal hernia
Hydrocele
Disorders of sexual development
Prior testicular biopsy

How well did you know this?

Not at all

Perfectly

Two types of testicular tumours

Seminoma

Teratoma

How well did you know this?

Not at all

Perfectly

Seminoma - epidemiology

35-45 yo

Uncommon in above 50 and in children

How well did you know this?

Not at all

Perfectly

Seminoma - clinical presentation

Test enlargement
Pain (70%)
Mets (10%)
Gynecomastia
Exophalmos
Infertility

How well did you know this?

Not at all

Perfectly

Seminoma - test results

Elevated serum PLAP and hCG seen in 40% and 10% of patients

hCG is seen in gynecomastia

Seminoma - macro appearance

Well-demarcated
Cream-coloured
Homogenous
Coarsely lobulated

Seminoma - micro appearance

Monotonous polygonal cells with clear cytoplasm, central nuclei

Divided into lobules by thin bands of fibrovascular stroma

Teratoma - epidemiology

First and second decades of life

Teratoma - presentation

Gradual testicular swelling

Pain

Teratoma - test results

Pure teratomatous tissues have no tumour markers

Teratoma - macro appearance

Well-demarcated solid or multicystic

Teratoma - micro appearance

Mixture of ectoderm, mesoderm and endoderm

Inflammatory conditions of testis

Acute/chronic epididymoorchitis

Idiopathic granulomatous orchitis

Sarcoidosis

Malakoplakia

Myofibroblastic pseudotumour

Sperm granuloma

Tuberculous orchitis

Orchitis definition

Inflammation of testis

Acute/chronic epididymoorchitis

Infarcted seminiferous tubules Surrounded by pirulent exudate with neutrophils and inflammatory cells

Idiopathic granulomatous orchitis

Symptoms of UTI, trauma and flu like illness Swollen, painful and tender testis May later leave residual mass indistinguishable from neoplasm = unnecessary orchiectomy

Sarcoidosis of testis

May mimic malignancy Non-necrotising granulomas involving testicular parenchyma Special stains for fungi, acid-fast bacilli are negative

Malakoplakia of testis

May effect testis (mainly) but also epididymus Formation of soft yellow/tan/brown nodules which replace testicular parenchyma Extensive infiltration of large histiocytes (von Hansemann histiocytes) - appear eosinophilic granular

Myofibroblastic pseudotumour of testis

Atypical inflammatory and myofibroblastic large cells Features of malignancy are absent Benign reactive + proliferative process of uncertain aetiology

Sperm granuloma

Exuberant foreign body giant cell reaction to extravasated sperm 42% of patients after vasectomy; 2.5% of routine autopsies No symptoms, history of pain and swelling of upper pole of epididymus

Tuberculous orchitis

Tuberculous of testis Painless scrotal swelling Uni/bilateral mass Infertility Scrotal fistula Caseating granulomatous inflammation is prominent, with fibrous thickening and enlargement of epididymus and adjacent structures

Cryptorchidism definition

``` Failure of testes to descend 25% of empty scrotum Most common found in inguinal canal More on right testis 18% bilateral ``` Congenital - anatomic / hormonal Acquired - postop or spontaneous for many reasons Complications - testicular atrophy, infertility, carcinoma

Testicular failure - primary

``` Undescended Klinefelter syndrome Haemochromatosis Mumps Orchitis Trauma CF Testicular torsion Varicocele ```

Testicular failure - secondary

Pit. failure Drugs - glucocorticoids, ketoconazole, chemo, opiods Obesity Ageing