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22. CPR Exam 2 > 5.5 Renal Path 4 > Flashcards

5.5 Renal Path 4 Flashcards

1
Q

RECALL
Urothelial carcinoma of the renal pelvis.
The renal pelves, ureters, bladder and urethra are lined by special transitional epithelium called urothelium.
These can be considered what type of GU cancers?

A

field effect

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2
Q

What are paired smooth muscle ducts which are channels for urine flow from the kidneys to the urinary bladder, usually 10-12in long and 3-4mm in diameter?

A

Ureters

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3
Q

There are three points of slight narrowing, at the ureteropelvic junction, where they cross the iliac vessels and as they?

A

enter the bladder (all places where renal stones might get stuck)

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4
Q

Congenital anomalies of the ureters mostly have little clinical significance and are found incidentally on autopsy. What anomaly come off double renal pelvis or bifed pelvis and are mainly unliateral with no clinical sig?

A

Double and bifid ureters

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5
Q

What anomaly is the MCC of hydronephrosis in infants and kids, early cases are bilateral in males, in adults is more common in women and unilateral?

A

Ureteropelvic junction (UPJ) obstruction

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6
Q

What anomaly is a saccular outpouching of the ureteral wall, most are asymptomatic but stasis can lead to infection, can be associated with dilation, elongation and tortuosity of the ureters?

A

Diverticulae

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7
Q

What is associated with inflammation and is typically not associated with infection and is of little clinical consequence?

A

Ureteritis

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8
Q

ureteritis collicularis is when there are elevations in the mucosa producing a fine granular mucosal surface. What is mucosa sprinkled with fine cysts with flattened urothelium?

A

Urethrisis cystica

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9
Q

Primary tumors of the ureters are rare as well as primary malignant tumors, what is the most common ?

A

urothelial carcinomas

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10
Q

What is a tumor like lesion that presents as a small mass projecting into the lumen often in children ?

A

fibroepithelial polyp

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11
Q

What fibrosis is uncommon cause of ureteral narrowing or obstruction, chracterized by fibrotic proliferative inflammatory process encasing the retroperitoneal structures (SAD PUCKERS) and causing hydronephrosis?

A

Sclerosing retroperitoneal fibrosis

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12
Q

Sclerosing retroperitoneal fibrosis is uncommon but more common in middle to late age men and can be *idiopathic or associated with IgG4 diseases, involves other exocrine organs including salivary glands and?

A

pancreas

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13
Q

On LM, Sclerosing retroperitoneal fibrosis has fibrous tissue containing prominent infiltrate of lymphocytes often with germinal centers, plasma cells (IgG4), and eosinophils, treat with?

A

corticosteroids and surgery

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14
Q

Intrinsic causes of ureteral obstruction include calculi, strictures, tumors, blood clots, and extrinsic includ tumors, endometriosis, periureteral inflammation and?

A

pregnancy (due to pressure from enlarging fundus)

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15
Q

The urinary bladder wall from top to deep has urothelium, lamina propria, muscularis propria and adventitia, in the urothelium one can see characteristic ?

A

umbrella cells (expand !)

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16
Q

What is the MC and serious congenital anomaly of the urinary bladder?

A

Vesicoureteral reflux VUR (causes pyelonephritis)

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17
Q

What is a pouchlike evagination of the bladder wall which may arise as a congenital anomaly but more likely are acquired due to persistent urethral obstruction?

A

Diverticulae

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18
Q

The congential form of bladder diverticulae is due to focal failure of devel. of normal musculature during fetal devel. Acquired is most often seen with?

A

prostatic enlargement (producing obstruction to urine outlfow and thickening of the bladder wall)

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19
Q

Diverticulae of the bladder allow for urine stasis causing infection, may predispose to VUR if they impinge the ureter, and carcinomas may ?

A

metastasize quicker due to the thin wall

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20
Q

What is a developmental failure in the anterior abdominal wall and bladder, with the bladder projecting directly through a large defect to the body surface or lies as an unopened sac (M=F, W»B)?

A

Exstrophy

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21
Q

Exstrophy causes exposed mucosa to undergo colonic granular metaplasia and is subject to infection, patients also have an increased risk of what?

A

adenocarcinoma

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22
Q

VUR = urine from bladder exhibits retrograde flow into the ureter and kidney due to valve malfunction, usually caused by the ureter entering the bladder at a?

A

unusual angle or when length of ureter through the bladder wall is too short

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23
Q

What is a fistulous urinary tract when totally patent, or when only the center part is patent and is lined by urothelium or metaplastic glandular epithelium?

A

Patent Urachus/Urachal Cyst

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24
Q

Patent Urachus/Urachal Cyst can be seen on CT as heterogenous mass in midline anterior to bladder with peripheral enhancement and central low attenuation within mass. Infections and what may arise from the cysts?

A

Carcinomas (RARE)

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25
Q

Acute/chronic cystitis are infections in the urinary bladder that have retrograde spread of infxn into the kidneys and collecting system, MC is E coli, followed by proteus klebsiella, enterobacter… where is this MC?

A

in females because they have a shorter urethra

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26
Q

Clasical symptoms of cystitis include occasionally hematuria or turbid urine, low grade fever, frequency, dysuria (burning) and?

A

pelvic/abdominal pain

triad is pain/dysuria/frequency

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27
Q

What usually occurs in pts with anatomic/functional urinary tract abnormalities, disease states that reduce natural urinary tract defenses, UTIs caused by resisitant pathogens?

A

Complicated urinary tract infection

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28
Q

Acute cystitis can also be caused by staph saprophyticus in 10-15% of time, bladder calculi, urinary obstruction, diabetes, immune deficiency and what can all predispose to infection?

A

instrumentation/catheter (radiation of bladder may also cause acute infection)

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29
Q

most cases of cystitis produce nonspecific acute or chronic inflammation of the bladder. In acute cystitis there is hyperemia of the mucosa and what infiltrate?

A

neutrophilic (sometimes associated with exudate)

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30
Q

Patients receiving cytotoxic anti tumor drugs (cyclophospahamide) or infection with adenovirus may cause what type of cystitis?

A

Hemorrhagic cystitis

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31
Q

What forms from chornic bacterial infection associated with MONONUCLEAR cells?

A

Chronic cystitis

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32
Q

Acute and chornic differe because acute has neutrophils while chronic is mononuclear cells and what else is different?

A

the clinical sequale

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33
Q

Follicular cystitis is characterized by the presence of lymphoid follicles within the bladder mucosa and underlying wall. What cystitis is manifested by infiltration of submucosal eosinophils ?

A

Eosinophilic cystitis (both are patters of chronic)

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34
Q

What type of cystitis is a chronic, persisten , painful form, most frequent in 30-40y/o women, with intermittent severe suprapubic pain, urinary frequency/urgency, hematuria, dysuria without evidence of bacterial infxn?

A

Interstitial cystitis (hunner ulcer)

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35
Q

Interstitial cystitis (hunner ulcer) is idiopathic but may be auto-immune, inflammation and fibrosis of the bladder wall and fissues seen, what is increased in the mucosa?

A

Mast cells (sometimes lymphocytes)

can see glomerulations (petechiae)

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36
Q

What is a chronic bacterial cystitis due to E coli or Proteus with a peculiar pattern of bladder inflammatory reaction characterized by 3-4cm soft yellow slightly raised mucosal plaques which my involve entire bladder?

A

Malacoplakia

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37
Q

Malacoplakia is due to defective phagosome function, F»M, middle aged occurs in Immunocomp. patients, MC in bladder but may present?

A

In the genitourinary tract

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38
Q

Malacoplakia shows bladder wall thickening with inflammatory exudate and broad flat plaques. On LM infiltrates of foamy mø are seen with multinuclear giant cells in areas forming?

A

granulomas

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39
Q

What are laminated mineralized concretions that are typically present in the macrophages resulting from deposition of abnormal enlarged lysosomes seen in Malacoplakia?

A

Michaelis-Gutmann Bodies

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40
Q

What type of cystitis is and inflammatory condition resulting from irritation of the bladder mucosa- MCC by indewlling catheters?

A

Polypoid Cystitis

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41
Q

Polypoid Cystitis has polypoid urothelium resulting from extensive submucosal edema, which is commonly confused with?

A

papillary urothelial carcinoma

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42
Q

What are two special forms of cystitis which are common chronic reactive inflammatory conditions which occur in the setting of chronic irritation?

A

Cystitis Glandularis & Cystitis Cystica

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43
Q

Epithelial cells undergo metaplasia and take on cuboidal/columnar appearance (Cystitis Glandularis) or epi cells retract to produce cystic spaces lined by flattened urothelium as seen in?

A

Cystitis Cystica

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44
Q

CC and CG the urothelium forms buds (nests of von Brunn) which then grow into the two types. on histo, both forms are present and occurs at any age with male predominance, symptoms include chornic irritation such as frequency, dysuria and?2

A

urgency

hematuria

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45
Q

Most bladder cancers are of the epithelial origin, non-epithelial tumors are quite uncommon, the most common being?

A

Leiomyoma

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46
Q

Urothelial tumors account for 90% of tumors, which have two distinct precursor lesions including flat noninvasive urothelial carcinoma (in situ) and what, which is the most common?

A

Noninvasive papillary tumors

origin from papillary urothelial hyperplasia

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47
Q

There are many clinical risk factors for urothelial carcinoma including, cigarette smoking, exposure to arylamines, schistosoma hematobium, long term use of analgesics, long term exposure to cyclophosphamide, and?

A

radiation

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48
Q

urotherlial carcinoma is more common in males than females (4:1) and whites than blacks. there are also common genetic factors including, chr9 deletion (superficial/non- invasive and some invasive) and chr17p deletions in invasive and in situ- which is due to mutation in what?

A

loss of p53!

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49
Q

Most urothelial tumors arise from the lateral and posterior walls at the bladder base. papillary lesions are red and elevated and are?

A

low grade

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50
Q

What are rare bladder cancer found in young patients which ‘grow out’ arising singly as a delicate urothelium cover over finger like papillae with a loose fibrovascular core histologically identical to normal urothelium?

A

Papillomas (benign-low grade)

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51
Q

What is a malignant mesenchymal tumor, typically of children, avg 4 y/o, M=F, pretty rare with gross appearance of tumor mass filling in the lumen?

A

Botryoides Rhabdomysarcoma

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52
Q

Botryoides Rhabdomysarcoma on LM shows polypoid mass protruding beneath a flattened epithelium. In what layer can one see clusters of tumor cells immediately beneath the epithelium resulting in a ‘nevoid’ apearance?

A

Cambium layer

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53
Q

What is a malignant mesenchymal tumor, typicall of adults- 60y/o M:F 2:1, some occuring post radiation or chemo in the urinary bladder?

A

Leiomyosarcoma

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54
Q

What is a non-epithelial malignancy of the bladder which is see in adults 65y/o M1:F6 most with chronic cystitis, radiosensitive and good prognosis?

A

Primary malignant lymphoma (usually nonhodgkin lymphoma seen with diffuse large B cell and MALT)

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55
Q

What neoplasms share many histologic features with papilloma except slightly larger and have *THICKER urothelium?

A

papillary urothelial neoplasia of low malignant potential (PUNLMP)

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56
Q

There are 4 morphologic patterns of bladder tumors, invasive papillary carcinoma, flat invasive carcinoma, flat noninvaseive carcinoma (CIS) and papilloma-papillary carcinoma, which is the most common pattern?

A

Papilloma-papillary carcinoma

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57
Q

Grade 0 urothelial neoplasia is normal
Grade 1 is thick
Grade 2 atypical hyperplasia
grade 3 carcinoma in situ - many invasive bladder cancers arise in what?

A

flat carcinoma in situ (preceded by flat non invasive lesions)

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58
Q

In flat lesions of bladder cancers discomfort is likely which papillary lesions are more likely to cause?

A

hematuria

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59
Q

What carcinomas have orderly cytology and architecture, minimal atypic, rarely invade and rarely fatal?

A

Low grade papillary urothelial carcinoma

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60
Q

What carcinomas have discohesive cells with anaplastic features, dissary/loss of polarity, large hyperchromatic nuclei, atypical mitotic features and a HIGH risk of invasion into the musclular layer, high risk of progression and significant metastatic potential?

A

High grade papillary urothelial cancer

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61
Q

urothelial carcinoma median age is 73years but 25% less than 65, with occasional frequency, urgency, dysuria and uncommonly ureteral orifice is blocked by tumor. What is the DOMINANT clinical finding and typically the only finding?

A

Painless Hematuria

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62
Q

urothelial carcinomas usuall have (40%) multiple tumors at diagnosis. Tx for non invasive includes transurethral resection TUR and surveillance of?

A

intravesical therapy - chemotherapy for bacillus calmetter guerin (BCG?)

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63
Q

Treatment for a minority of patients with invasive urothelial carcinoma includes either segmental cystectomy, radical cystectomy w urinary diversion or what?

A

immunotherapy and photodynamic therapy (clinical trials)

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64
Q

In invasive transitional cell carcinoma, the lamina propria is invaded as well as the?

A

muscle (muscularis propia)

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65
Q

What type of carcinoma is cytologically malignant cells within a flat urothelium , ranging from full thickness atypia to scattered malignant cells in normal urothelium (pagetoid spread)?

A

Carcinoma in Situ CIS = flat urothelial carcinoma

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66
Q

Carcinoma in Situ CIS = flat urothelial carcinoma lack cohesiveness leading to shedding of malignant cells into urine, there may be mucosa reddening, granularity, or thickening but there will be no?

A

mass projecting into the lumen cause flat

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67
Q

Carcinoma in Situ CIS = flat urothelial carcinoma have no evident intraluminal mass, is multifocal, flat urothelial lesions are always carcinoma in situ, if untreated what occurs?

A

50-75% will invade

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68
Q

What cancer is associated with papillary urothelial cancer, high grade or adjecent to CIS with INVASION of muscularis mucosae (detrusor muscle)?

A

Invasive urothelial cancer

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69
Q

biopsy understaging is a problem with Invasive urothelial cancer, staging at the intial diagnosis is the most important factor in determining the outlook for the patient, extent of spread =?

A

staging

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70
Q

Stage is the critical prognostic factor, hitologic grade to a lesser extent. TIS Ta and T1 are low stage, T2-T4 means what and there is a 50% 5year disease survival?

A

T2-T4 are associated with muscle invasion - depth of muscle invasion is the major prognostic issue to be established

71
Q

Grossly in high grade invasive urothelial carcinoma (T3) one can see huge nodular tumor filling bladder lumen, yellow areas of ulceration and necrosis as well as hemorrhagic tan tumor that?

A

extends full thickness of the bladder wall

72
Q

One can follow progression/reocurrence of bladder cancers with urine cytology which has a poor sensitivity but a high specificity for what type of carcinoma?

A

HIGH GRADE (95%)

Sensitivity: 20% low grade/50% high grade

73
Q

What type of carcinoma increased in incidence in countries with endemic schistosomiasis (middle east) **only place v unusual for US?

A

SCC of the bladder (seen w irritation and infection)

74
Q

What is the difference in staging between T 1 and T4?

A

T1 is invasion of the lamina propria

T4 is invasion of adjacent structures

75
Q

Noninvasive high grade urothelial carcinoma (either papillary or flat) is associated with the loss of what, and frequently progresses to muscle - invasive disease with potention for systemic spread?

A

Loss of TP53 and RB tumor suppressor

76
Q

Noninvasive low grade papillary urothelial carcinoma is associated with what GOF mutations, which are infrequently life threatening but the tumor may locally recur and subset may progress to high grade?

A

FGFR3 and HRAS

77
Q

What is the MCC of bladder obstruction in females, in which the bladder bulges into the vagina due to weakened support?

A

Cystocele of the bladder

78
Q

Urethritis can either be gonococcal or non-gonococcal. What type has an early manifestation of Neisseria gonorrhea infections (gram- diplococcus) often with a purulent discharge?

A

Gonococcal urethritis

79
Q

Nongonococcal urethritis is most commonly caused by chlamydia trachomatis (gram negative, ovoid and nomotile) often with a more serous discharge/no discharge, serotypes A-C are the leading cause of?

A

Blindness in the world

80
Q

D-K serotypes of chlamydia trachomatis is the GU one- cause urethritis, pelvic inflammatory dz, ectopic pregnancy, neonatal pneumonia and?

A

neonatal conjuctivitis

81
Q

L1-L3 of chlamydia trachomatis are lymphogranuloma venereum (painless lesion) a chancre is painful, all are associated with cystitis in women and what in men?

A

prostatitis

82
Q

What is a painful small red inflammatory lesion of external urethral meastus (older females), with granulation tissue with friable mucosa covering, bleed easy d/t ulceration and excision is curative?

A

Urethral caruncle

83
Q

What is an uncommon lesion of the urethra where the proximal part shows urothelial differentiation like in the bladder, the distal part is more commonly SCC and adenocarcinoma are uncommon but may occur in women?

A

Primary carcinomas of the urethra

84
Q

What occurs when the urethral opening for the penis is on the ventral aspect of the penis, more common than epispadias?

A

Hypospadias

85
Q

What occurs when the urethral opening for a penis is on the dorsal surface of the penis?

A

Epispadias

86
Q

both epi/hypospadias are associated with abnormalities of the normal descent of the testes and comorbid w other malformations of the urinary tract. What may be hindered if there are openings near the base of the penis?

A

ejaculation

87
Q

What occurs when the prepuce orifice is too small to permit normal retraction, usually secondary to inflammation?

A

Phimosis

88
Q

Balanoposthitis is infection of the glans and prepuce by nonspecific organisms (not STDs) such as anaerobic bacteria, gardnerella, pyogenic bacteria and?

A

Candida Albicans

89
Q

What is a benign sexually transmitted wart which is usually due to HPV6>11, which are single sessile or pedunculated red papillary excresences?

A

Condyloma Acuminata

90
Q

Condyloma Acuminata recurs but rarely transforms to malignancy, what is characteristic of HPV seen on LM as cytoplasmic vacuolization of the squamous cells?

A

Koilocytosis

91
Q

Acanthosis is superficial hyperkeratosis and thickening of underlying epidermis associated with?

A

the branching villous papillary CT stroma in codyloma acuminata

92
Q

What are malignant tumors strongly associated with HPV 16 which have two distinct types: bowen dz and bowenoid papulosis?

A

Carcinoma in situ CIS

93
Q

What disease is common in M/F over 35 years old and is a solitary thickened gray-white plaques over penile shaft or red shiny lesions on the glans and prepuce?

A

Bowen disease

94
Q

Bowen disease epidermis is hyperproliferative with many mitosises, atypia, dysplasia, hyperchromatic nulcei, there is intact basement membrane but?

A

10% can turn into invasive SCC

95
Q

What is a multiple, pigmented (redish brown) papular lesion(s) on external genitalia seen in YOUNGER sexually active adult patients ?

A

Bowenoid papules

96
Q

Bowenoid papules are histologically indistinguishable from bowen disease, use age and number of lesions**, bowen occurs in 35 years or older and are usually solitary lesions while Bowenoid papulesare?

A

younger people with many lesions (rarely evolves to invasive carcinoma)

97
Q

SCC of the penis is associated with poor genital hygiene and HPV 16*, seen in 40-70 year old, what increases the risk?

A

Smoking

98
Q

SCC of the penis can have many patterns including flat whihc progresses to ulcerated papule usually on glans penis or inner surface or prepuce and what type, which is associated with graying and fissuring of the mucosal surface, possibly producing a cauliflower like fungating mass?

A

Papillary type/pattern

99
Q

What type of SCC is exophytic, well differentiated variant of SCC< locally invasive and rarley metastasizes?

A

Verrucous carcinoma

100
Q

What is the most common congeital anomaly of the testes assoc with increased risk of testicular germ cell tumors, and is failure of the testes to decend causing tubular atrophy and sterility?

A

Cryptorchidism

101
Q

Cryptorchidism is seen 75% of the time unilateral and 25% bilateral, found in 1% of 1 year old boys, on LM you can see dec. germ cell development, thickening and hyalinization of seminerfierous tubule basement membranes and fibrosis sparing the?

A

leydig cells** prominent

102
Q

Cryptorchidism is completely asymptomatic and comes to attention when the scrotal sac is discovered to be empty, most will descend by what age?

A

age 1, otherwise need surgery before 2 years

103
Q

Inflammation of the testicles is much more common in the epididymis, gonorrhea and TB goes from the epididymis to the testes while what goes from the tests to the epididymis?

A

Syphillis (epididymis usually spared)* unique

104
Q

What orchitis occurs in middle age, painless or moderately tender testicular mass of sudden onset w fever, granulomas are within the spermatic tubules?

A

Granulomatous (autoimmune) orchitis

105
Q

What bug causes retrograde expansion of infection from posterior urethra to prostate, seminal vesicles and epididymis, considered a ascending infection ?

A

Gonorrhea (putoff has an obsession with squeezing the epididymis and the boy yelling)

106
Q

What is a systemic viral infection in children with rare testitcular involvement, 20-30% post pubertal men who are infected present with orchitis 1 week after inflammation of the parotid glands?

A

Mumps

107
Q

What bug begins in the epidid and causes secondary testis involvement with caeseating granulomas?

A

Tuberculosis

108
Q

What bug is congeital or acquired, with testes involved but not epidid and show either nodular gummas or diffuse interstitial inflammation the produces the histologic hallmark of syphilitic infections, obliterative endarteritis associated with perivascular cuffs of lymphocytes and plasma cells?

A

Syphilis

109
Q

What is twisting of the spermatic cord, cutting of the testicular venous drainage ocurring in utero or shortly after birth or in adults caused by anatomic defect that leads to increased mobility of testes (bell clapper abnormality)?

A

Torsion

110
Q

Torsion may cause vascular engorgement with potential for hemorrhage, arterial supply remains patent because torsion usually occlude?

A

the venous outflow tract

111
Q

What is the most common benign paratesticular neoplasm with small nodules of mesothelial cells near the upper epidydimal pole, well circumscribed?

A

Adenomatoid tumor

112
Q

What is the most common paratesticular tumor in childre? in adults?

A 
Rhabdomyosarcoma
Liposarcoma (adults)
113
Q

What type of tumors are generally malignant (95% of testicular tumors), are are the most common malignancy in men 15-34, more common white than black (5:1) and can be divided into seminomas and nonseminomas?

A

BGerm cell tumors

114
Q

Germ cell tumors have many risk factors including testicular dysgenesis syndrome (TDS-cryptochidism), klinefelters, and genetics including KAT and?

A

BAK (receptor tyrosine kinase)

115
Q

Most testicular germ cell tumors arise from the precursor lesion what?

A

intratubular germ cell neoplasia (ITGCN)

116
Q

Seminomatous tumors are composed of cells that look like primordial germ cells or early gonadocytes while what are composed of undifferentiated cells that look like embryonic stem cells?

A

Nonseminomatous tumors (makes yolk sac tumors, choiriocarcinomas, teratomas)

117
Q

intratubular germ cell neoplasia (ITGCN) occurs in utero, dormant until puberty, and has a reduplication of the short arm of chr 12 which is always found in?

A

all invasive germ cell tumors

118
Q

Seminoma (classic) are the most common type of germ cell tumors seen in 20-30s almost never in infants, expresses isochromosome 12p and OCT3/4 and?

A

NANOG

119
Q

Seminoma cell is a large and round to polyhedral and has a distinct cell membrane, clear to watery appearing cyotplasm, and a large, central nucleus with?

A

one or two prominent nucleoli

120
Q

Seminoma are homogenous, lobulate, gray-white masses devoid of hemorrhage or necrosis with intact tunica albuginea which some contain syncytiotrophoblasts which can result in an increased level of?

A

HCG in the blood*

121
Q

What type of seminoma are rare and slow growing in pts 65+, have an excellent prognosis (doesnt metastasize) and is a soft gray cut surface with mucoid cysts?

A

Spermatocytic Seminoma

122
Q

Spermatocytic Seminoma has medium sized cells with round nucleus and eosinophillic cytoplasm, secondary spermatocytes and scattered giant cells but have NO association with?

A

ITGCN

123
Q

What are more agressive than seminomas, in 20-30s, poorly demarcated small gray white mass with hemorrhage or necrosis?

A

Embryonal Carcinoma

124
Q

Embryonal Carcinoma extend through the tunica albuginea, on LM the cells grow in alveolar or tubular patterns, sometimes with papillary convolutions/ undifferentiated sheets of cells… test positive for OCT3/4, PLAP, CD30 and?

A

cytokeratin

negative for cKIT

125
Q

What is the most common testicular tumor in children less than 3 years old and comes with a good prognosis, morph is infiltrative, homogenous, and yellow white mucinous tumor?

A

Yolk sac tumor (endodermal sinus tumor)

126
Q

Yolk sac tumor have cuboidal or flat neoplastic cells in a lace like network. 50% have what, which resemble endodermal sinuses and consist of mesodermal core with a central capillary and a visceral and parietal layer of cells?

A

Schiller Duval Bodies

127
Q

If a cell has eosinophilic hyaline globules with AFP , what is it high characteristic of?

A

Yolk sac tumor

128
Q

What is a highly malignant neoplasm seen as a small palpable nodule without testicular enlargement containing cytotrophoblasts and syncytiotrophoblasts?

A

Choriocarcinoma

129
Q

In a choriocarcinoma (less than 1% of germ cell tumors), what reaches a very high level in the serum?

A

hCG

130
Q

What tumor can occur at any age, pure forms being benign in children and malignant in adults, contain all 3 germ layers embedded in a fibrous or myxoid stroma?

A

Teratoma

131
Q

Testicular germ cell tumors clinical features include painless enlargement of testis, tumor spillage during bx = malignant start with radical orchiectomy, retroperitoneal paraortic LN are first involve and there may be a hematogenous?

A

spread to the lungs (MC) liver brain bones

132
Q

The following is characteristic of?
• Remain localized to testis for long time
• Typically radiosensitive
• 70% of patients present with stage 1 disease
• 95% present with stage 1 or 2 disease (cured)
• Lymph nodes typically involved
• Hematogenous spread later in disease
• Best prognosis, with 95% stage I and II cure rate

A

Seminoma Clinical features

133
Q

The follow is characteristic of?
• More aggressive
• Radioresistant
• Metastasize early
• Hematogenous spread more frequently
• 60% of patients present with advanced disease (II or III)
• 90% achieve remission with chemotherapy, except for pure choriocarcinoma has a worse prognosis
• histological subtype does not influence prognosis significantly, thus all NSGCTs are considered as a group

A

Nonseminomatous germ cell tumors (NSGCTs)

134
Q

In stage 1 tumor is confined to testis/epi/ spermatic cord. Stage 2 distant spread confined to retroperitoneal nodes below the diaphragm, persistent elevation of hCG or AFP concentrations following orchiectomy even if LN appear normal indicates?

A

Stage 2

stage 3 mets outside LN/above diaphragm

135
Q

AFP elevatd for yolk sac tumor, hCG for choriocarcinoma and 15% seminomas, what biomarker elevation correlates with mass of tumor cells ?

A

lactate dehydrogenase

136
Q

The other 5% of testicular tumors are from leydig/sertoli cell tumors. Which is 2% of all tumors, most being benign, 10% invade in pt 20-60, tumor produces androgens,estrogens and or corticosteroids and present with testicular SWELLING?

A

Leydig Cell tumors

137
Q

Leydig Cell tumors grossly circumscribed nodules with homogenous folden brown cut surface, polgonal cells with abundant granular eosinophlilic cytoplasm/indistinct cell borders, lipid droplets, vacuoles, lipofuscin pigment and 25% have esosinophilic?

A

rod shaped Reinke crystalloids

138
Q

What tumor is hormonally silent and present as testicular mass, firm and small, 10% malig, homogenous gray white to yellow masses of tall/columnar cells in trabeculae- may form cords or tubules?

A

Sertoli cell tumor

139
Q

What are rare neoplasms comprised of a mixture of germ cells and gonadal stromal elements, arise in gonads with testicular dysgenesis?

A

Gonadoblastoma

140
Q

Testicular lymphoma is the MC form of testicular tumor in patients older than 60**, usually diffuse large B cell non hodgkin lymphomas which disseminate widely and have a high incidence of?

A

CNS involvement

141
Q

Tunica vaginalis is mesothelial lined surface exterior to the testis. What is an accumulation of serous fluid within the mesothelial lined tunica vaginalis?

A

Hydrocele (enlarges scrotal sac-illuminate)

142
Q

What is an accumlation of blood secondary to trauma, torsion, or generalized bleeding diathesis?

A

Hematocele

143
Q

What is an accumlation of lymphatic fluid secondary to lymphatic obstructions such as elephantiasis?

A

Chyocele

144
Q

What is a local cysstic accumulation of semen in dilated efferent ducts or ducts of the rete testis?

A

spermatocele

145
Q

Prostate weighs 20 grams and has four zones, peripheral (MC area for carcinomas), central, peri urethral and transitional where most?

A

hyperplasia occurs (more common than tumors)

146
Q

Acute bacterial prostatitis are cause by E coli, gram negs, enteroccoci, staphylococci, seen w dyuria fever chills perianal pain and on morph is minute disseminated abscesses or large coalescent focal areas of necrosis are as diffuse edema congestion and?

A

boggy suppuration of the entire gland

bx contraindicated may lead to sepsis

147
Q

Chronic bacterial prostatitis is due to frequent UTI, same as acute but with low back pain, hx recurrent UTI, diagnosis is based on leukocytosis in the ?

A

expressed prostatic secretions with positive bacterial cultures

148
Q

What is the most common prostatitis w sx sim to chronic bacterial prostatitisdysuria, pelvic pain, low back pain, with secretions showing more than 10 leukocytes but cultures are negative, usually no hx of UTI?

A

Nonbacterial chronic prostatis (likely mycoplasma or chlamydia)

149
Q

Granulomatous prostatitis has the most common cause in the US of being from instillation of BCG into the bladder for treatment of?

A

superficial bladder cancer (no clin sig)

150
Q

Benign prostatic hyperplasia is MC disorder of prostate causing urinary obstruction, stromal proliferation. 20% of men get BPH by age 40 and 90% by age?

A

80 can almost be thought of as sign of aging

151
Q

BPH has increased number of epithelial cells and stromal compoenent in the periurethral area of the prostate d/t impaired cell death via androgens allowing accumulation of?

A

senescent cells (inc prolife, dec cell death)

152
Q

Test to DHT via SAR (1/2), 2 is mainly prostate, DHT activates FGF/TGFb, increasing fibroblasts and?

A

increase proliferation of stromal cells and dec. death of epithelial cells

153
Q

BPH enlargement begins in transitional zone, what is it called when nodular enlargement projects into floor of urethra as a hemispheric mass directly beneath the mucosa?

A

median lobe hypertrophy

154
Q

BPH nodules usually consist of stroma and glands, = hyperplastic glands which are lines by two cell layers including inner columnar layer and an outer?

A

layer composed of flattened basal cells

155
Q

BPH presents with nocturia, urgency, hesitancy, dribbling, dysuria, inability to completely void bladder causing reservoir of residual urine leading to?

A

common source of infection (stasis)

*NOT PREMALIGNANT

156
Q

Adenocarcinoma of the prostate is the MCC in men, tied with colorectal cancer, more common in blacks. Genetic mutations include rearrangement of ETS family transcription factor gene (ERG or ETV1) next to the androgen regulated?

A

TMPRSS2 promotor

NOTE: TMPRSS2-ERG fusion DNA with PCA3 screening in urine much better than PSA alone

157
Q

if a first degree relative has adenocarcinoma of the prostate increase risk 2x, if 2 first degree relatives do then it increases risk to?

A

5x the risk

**mutation in BRCA2 = 20X risk

158
Q

genomic deletions and amplifications are more common in prostate cancer than point mutaitons involving oncogenes, in contrast to breask and colon cancers. What causes a rare neurodegenerative disorder called kennedy disease characterized by muscle cramping and fatigue?

A

long trinucleotide expansions of CADs in X linked androgen receptor gene

159
Q

Adenocarcinoma of the prostate begins with prostatic intraepithelial neoplasia (PIN) in the peripheral zone, however PIN is not?

A

carcinoma in situ

160
Q

Adenocarcinoma of the prostate is associated with eating red meat, sex at early age, STDs, vasectomy, high fat diets, urban dwelling, cadmium*, and what, which is northern european descent and countries get it more often, there mucst be associated with vitD / sunlight?

A

North south gradient

smoking not associated

161
Q

Adenocarcinoma of the prostate clinically due to obstruction of urinary tract like BPH but arise peripherally away from the urethra and therefore urinary symptoms occur late, one can feel what on DRE?

A

firm discrete nodules (need bx for diagnosis since DRE and ultrasonography is low sensistivity/specitivity) b4 bx do PSA

162
Q

finding of osteoblastic metastases by skeletal surveys or the much more sensitive radionuclide bone scanning is virtually diagnostic of prostate cancer in men; bony metastases are typically osteoblastic and this feature in men points strongly to?

A

prostatic origin (anemia bone pain and hypercalcemia)

163
Q

PSA and PAP are elevated with both BPH and adenocarcinoma, PSA lacks sensitivity and specificity- not cancer specific. What is also used as a biomarker which is overexpressed in 95% prostate cancers?

A

PCA3 noncoding RNA

164
Q

prostate cancer without qualifications= common acinar variant of prostate cancer. Carcinoma of the prostate arises from what zone of the gland in 70% of cases, usually posterior location?

A

peripheral zone

165
Q

prostate cancer mets spread via LN to obturator nodes and to paraarotic nodes, and via blood mainly to axial bones. Glands are usually smaller, lined by a single layer of cuboidal/low columnar epithelium and the outer basal layer?

A 
is ABSENT 
(benign = basal cells | Malig= no basal cells)
166
Q

on histo, one can seen prominent nucleoli, blue mucin, and perineural invasion (specific for prostate cancer). What is the precursor lesion seen in 80% of cases?

A

High grade prostatic intraepithelial neoplasia (PIN)

167
Q

Biomarkers for adenocarinoma of the prostate include alpha methylacyl coenzyme A racemase (AMACR). Gleason grading is based on cellular architechture while staging is based on?

A

invasion and metastasis

168
Q

Gleason grading from 1-5, 1 being orderly packed round and circumscribed and 5 showing no glandular differentiation with tumor cells infiltrating the strom in the form of cords, sheets and nests. What if there is more than one type of gland?

A

grade dominant pattern 1-5 and then grade secondary pattern 1-5 and then add them together

169
Q

Scores of 2-6 with gleason have excellent prognosis, while 10 is highest and least differentiated meaning?

A

less likely to be cured

170
Q 
Gleason
2= minimal, well differentiated
3+4=7 moderately differentiated tumors
4+3=7 mod to poor differentiated
8-10 = poorly differentated tumors
A

MEOW

171
Q

What carcinoma of the prostate reveals abundant mucinous secretions and is associated with thrombotic complications?

A

colloid carcinoma of the prostate

172
Q

What is the most aggressive variant of prostate cancer aka neuroendocrine carcinoma, all cases being rapidly fatal?

A

Small-cell cancer

173
Q

What is most common tumor to secondarily involve the prostate either via direct invasion or CIS extension into prostatic urethra down into prostatic duct and acini?

A

Urothelial cancer

22. CPR Exam 2 (20 decks)

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