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Clinical Pathology > 33 - Urogenital pathology > Flashcards

33 - Urogenital pathology Flashcards

1
Q

Nodular hyperplasia what is it?

A

Enlargement of prostate aka benign prostatic hyperplasia (BPH)

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

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2
Q

Clinical presentation of BPH

A 
Lower urinary tract symptoms
Urgency
Difficulty starting urination
Diminished stream size and force
Increased frequency
Incomplete bladder emptying
Nocturia
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3
Q

Zone of prostate

A

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

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4
Q

Where do most carcinomas arise in prostate?

A

Peripheral zone

Palpable during digital examination of rectum

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5
Q

How would nodular hyperplasia initially present?

A

Urinary obstruction

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6
Q

Pathological changes for development of nodular hyperplasia

A

Nodule formation

Diffuse enlargement of the transition zone and periurethral tissue (

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7
Q

Aetiology of nodular hyperplasia

A

Impaired cell death
Reduction in rate of cell death = accumulation

Androgens increase cellular proliferation but inhibit cell death

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8
Q

Incidence of nodular hyperplasia

A

95% of prostatic malignancies are prostatic adenocarcinoma - rare in

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9
Q

Treatment of prostate cancer

A

Surgery
Radiation therapy
Hormonal manipulations

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

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10
Q

Risk factors for prostatic carcinoma

A 
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

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11
Q

How is prostatic carcinoma graded?

A

Gleason scoring system

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12
Q

Testicular tumour - epidemiology

A

Men of northern european ancestry

Cryptorchidism
Impaired spermatogenesis
Inguinal hernia
Hydrocele
Disorders of sexual development
Prior testicular biopsy
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13
Q

Two types of testicular tumours

A

Seminoma

Teratoma

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14
Q

Seminoma - epidemiology

A

35-45 yo

Uncommon in above 50 and in children

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15
Q

Seminoma - clinical presentation

A 
Test enlargement
Pain (70%)
Mets (10%)
Gynecomastia
Exophalmos
Infertility
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16
Q

Seminoma - test results

A

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

hCG is seen in gynecomastia

17
Q

Seminoma - macro appearance

A

Well-demarcated
Cream-coloured
Homogenous
Coarsely lobulated

18
Q

Seminoma - micro appearance

A

Monotonous polygonal cells with clear cytoplasm, central nuclei

Divided into lobules by thin bands of fibrovascular stroma

19
Q

Teratoma - epidemiology

A

First and second decades of life

20
Q

Teratoma - presentation

A

Gradual testicular swelling

Pain

21
Q

Teratoma - test results

A

Pure teratomatous tissues have no tumour markers

22
Q

Teratoma - macro appearance

A

Well-demarcated solid or multicystic

23
Q

Teratoma - micro appearance

A

Mixture of ectoderm, mesoderm and endoderm

24
Q

Inflammatory conditions of testis

A

Acute/chronic epididymoorchitis

Idiopathic granulomatous orchitis

Sarcoidosis

Malakoplakia

Myofibroblastic pseudotumour

Sperm granuloma

Tuberculous orchitis

25
Q

Orchitis definition

A

Inflammation of testis

26
Q

Acute/chronic epididymoorchitis

A

Infarcted seminiferous tubules

Surrounded by pirulent exudate with neutrophils and inflammatory cells

27
Q

Idiopathic granulomatous orchitis

A

Symptoms of UTI, trauma and flu like illness

Swollen, painful and tender testis

May later leave residual mass indistinguishable from neoplasm = unnecessary orchiectomy

28
Q

Sarcoidosis of testis

A

May mimic malignancy

Non-necrotising granulomas involving testicular parenchyma

Special stains for fungi, acid-fast bacilli are negative

29
Q

Malakoplakia of testis

A

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

30
Q

Myofibroblastic pseudotumour of testis

A

Atypical inflammatory and myofibroblastic large cells

Features of malignancy are absent

Benign reactive + proliferative process of uncertain aetiology

31
Q

Sperm granuloma

A

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

32
Q

Tuberculous orchitis

A

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

33
Q

Cryptorchidism definition

A 
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

34
Q

Testicular failure - primary

A 
Undescended 
Klinefelter syndrome
Haemochromatosis
Mumps
Orchitis
Trauma
CF
Testicular torsion
Varicocele
35
Q

Testicular failure - secondary

A

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

Clinical Pathology (65 decks)

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