33 Urogenital pathology

Question 1

What is nodular hyperplasia (benign prostatic enlargement)?

Answer 1

Benign overgrowth of the epithelium and fibromuscular tissue in the transition zone and periurethral area.

Question 2

What are the symptoms of benign hyperplasia? (6)

Answer 2

Urgency
Diminished stream size and force
Hesitancy
Increased frequency
Incomplete emptying
Nocturia

Question 3

What are the three pathological changes in nodular hyperplasia? (3)

Answer 3

Nodule formation.
Diffuse enlargement of transition zone and periurethral area.
Nodule enlargement.

Question 4

What is the incidence of carcinoma of the prostate?

Answer 4

Rises over 40 years old.

More in African ancestry.

Question 5

What is the management of prostate carcinoma? (3)

Answer 5

Surgery.
Radiation therapy.
Hormonal manipulation.

Question 6

What are the risk factors for prostate carcinoma? (6)

Answer 6

Age.
African ancestry.
High androgen levels.
Family history. 
BRCA2: 20x risk increase.
Increased fat consumption.

Question 7

How is carcinoma of the prostate graded?

Answer 7

Gleason system.

Question 8

Which medical conditions have been related to the development of testicular germ cell tumours? (9)

Answer 8

Previous TCGT in contralateral testicle.
Inguinal hernia.
Impaired spermatogenesis.
Cryptochordism.
Hydrocele.
Disorders of sex development.
Prior testicular biopsy.
Atopy.
Testicular atrophy.

Question 9

Who gets seminomas vs teratomas?

Answer 9

Seminoma: 35-45 year olds.
Teratoma: first and second decades of life.

Question 10

What are the clinical presentations of seminomas and teratomas?

Answer 10

Testicular swelling ± pain.

Rare seminoma: gynecomastia, exophthalmos + infertility.

Question 11

What does epididymoorchitis cause?

Answer 11

Infarcted seminiferous tubules.

Question 12

Who gets idiopathic granulomatous orchitis and how does it present?

Answer 12

Older adults.

Flu-like/UTI presentation. Swollen and painful testis.

Question 13

Which inflammatory condition of the testis may mimic malignancy?

Answer 13

Sarcoidosis.

Question 14

What is myofibroblastic pseudotumor of testis?

Histology?

Answer 14

Benign inflammatory condition of unknown aetiology.

Atypical inflammatory and myofibroblastic reaction with fasciitis-like large cells.

Question 15

What is a sperm granuloma?

What does it result from?

Answer 15

Exuberant foreign body giant cell reaction to extravasated sperm.
Vasectomy/routine autopsy.

Question 16

How does tuberculosis affect the testis?
Reservoir?
Symptoms? (4)

Answer 16

Causes tuberculous orchitis.
Epididymis are reservoir for TB in male genital tract.
Painless swelling with masses, infertility and scrotal fistula.

Question 17

What are the complications of cryptochordism?

Answer 17

Testicular atrophy, carcinoma, infertility.

Question 18

What are the primary causes of testicular failure? (9)

Answer 18

Undescended testis.
Haemachromatosis.
Kleinfelter syndrome.
Mumps.
Orchitis.
Trauma.
CF.
Testicular torsion, varicocele.

Question 19

What are the secondary causes of testicular failure? (3, 4 drugs)

Answer 19

Pituitary failure.
Obesity.
Ageing.
Drugs: glucocorticoids, ketoconazole, chemotherapy, opioids.