33 - Urogenital pathology Flashcards
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
Clinical presentation of BPH
Lower urinary tract symptoms Urgency Difficulty starting urination Diminished stream size and force Increased frequency Incomplete bladder emptying Nocturia
Zone of prostate
CZ - central zone
PZ - peripheral zone
TZ - transitional zone
Where do most carcinomas arise in prostate?
Peripheral zone
Palpable during digital examination of rectum
How would nodular hyperplasia initially present?
Urinary obstruction
Pathological changes for development of nodular hyperplasia
Nodule formation
Diffuse enlargement of the transition zone and periurethral tissue (
Aetiology of nodular hyperplasia
Impaired cell death
Reduction in rate of cell death = accumulation
Androgens increase cellular proliferation but inhibit cell death
Incidence of nodular hyperplasia
95% of prostatic malignancies are prostatic adenocarcinoma - rare in
Treatment of prostate cancer
Surgery
Radiation therapy
Hormonal manipulations
90% who receive this therapy can expect to live for 15 years
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 is prostatic carcinoma graded?
Gleason scoring system
Testicular tumour - epidemiology
Men of northern european ancestry
Cryptorchidism Impaired spermatogenesis Inguinal hernia Hydrocele Disorders of sexual development Prior testicular biopsy
Two types of testicular tumours
Seminoma
Teratoma
Seminoma - epidemiology
35-45 yo
Uncommon in above 50 and in children
Seminoma - clinical presentation
Test enlargement Pain (70%) Mets (10%) Gynecomastia Exophalmos Infertility
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
