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Pathology > Chapter 21- Lower Urinary Tract And Male Genital System > Flashcards

Chapter 21- Lower Urinary Tract And Male Genital System Flashcards

1
Q

What is the lower UT lined with?

A

Urothelium/transitional epithelium

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2
Q

What three points of narrowing predispose the urinary system to stone formation?

A
  1. Ureteropelvic junction
  2. Entrance of bladder
  3. Crossing of the iliac vessels
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3
Q

What is vesicureteral reflux?

A

Defect in the intravesicle portion of the bladder sphincter

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4
Q

What congenital anomalies are associated with the ureters?

A

Double ureters

Uteropelvic junction obstruction (disorganized muscle or excess matrix)

Diverticula

Hydroureter (dilation, elongation, tortuosity)

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5
Q

Double ureters are normally bilateral or unilateral?

A

Unilateral

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6
Q

Uteropelvic junction obstruction is an important cause of what?

A

Hydronephrosis

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7
Q

What tumours are associated with the ureters?

A

Fibroepithelial polyps

Urothelial carcinoma

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8
Q

What are the cause of unilateral and bilateral ureteral obstructive lesions?

A

Unilateral- proximal

Bilateral- distal

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9
Q

What is sclerosing retroperitoneal fibrosis caused by?

A

Retroperitoneal inflammation and fibrosis that encases the ureters

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10
Q

What are the most important complications of ureteral obstructive lesions?

A

Hydronephrosis

Pyelonephritis

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11
Q

What congenital anomalies are associated with the urinary bladder?

A

Vesicoureteral reflux

Diverticula

Exstrophy- bladder communicates with overlying skin or is an exposed sac

Urachal anomalies- persistent remnant tracts

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12
Q

Vesicoureteral reflux is a major cause of what?

A

Infection and scarring

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13
Q

Urinary stasis caused by diverticula in the bladder results in what?

A

Infection and calculi formation

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14
Q

Colonic glandular metaplasia in the urinary bladder increases the risk of what malignancy?

A

Adenocarcinoma

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15
Q

What are causes of bladder inflammation?

A

UTI

Radiation/chemo

Interstitial cystitis/chronic pelvic pain syndrome

Malakoplakia

Polypoid cystitis- irritation of bladder mucosa

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16
Q

What type of bacteria causes the majority of UTIs?

A

Coliform (GI NF)

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17
Q

What are the characteristics of interstitial cystitis?

A

Normally occurs in women

Pain and dysuria in the absence of infection

Punctate hemorrhage

Hunner ulcer

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18
Q

What are the characteristics of malakoplakia?

A

Chronic bacterial cystitis with soft, yellow, mucosal plaques

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19
Q

Polypoid cystitis is associated with the use of what?

A

Indwelling catheters

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20
Q

What malignancy can polypoid cystitis be confused with?

A

Papillary urothelial carcinoma

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21
Q

What are the different metaplastic lesions of the bladder? And what are the changes seen in the epithelium?

A

Cystitis glandularis- urothelium to cuboidal epithelium (Brunn nests)

Cystitis cystica- flattened cells lining fluid filled cysts

Squamous metaplasia- urothelium to squamous

Nephrogenic adenoma- shed tubular cells implant and proliferate (tubular cells)

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22
Q

What precursor lesions are associated with bladder neoplasms?

A

Noninvasive papillary tumours

CIS

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23
Q

What environmental factors are associated with bladder neoplasms?

A

Urban populations

Industrialized nations

Smoking

Schistosoma haematobium

Chronic analgesic use

Bladder radiation

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24
Q

What urothelial malignancies are associated with the bladder?

A

Exophytic papillomas

Inverted papillomas

Papillary urothelial neoplasms of low malignant potential

Low grade papillary urothelial carcinomas

High grade papillary urothelial cancers

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25
Q

Why is the most common mesenchymal tumour of the bladder?

A

Leiomyoma

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26
Q

Sarcomas of the bladder present as what type of mass?

A

Large, exophytic

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27
Q

What are the bladder sarcomas presenting in children vs those presenting in adults?

A

Children- embryonal rhabdomyosarcoma

Adults- leiomyosarcoma

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28
Q

T-staging in bladder cancer is dependent on what feature?

A

Depth of invasion

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29
Q

What is the mortality of high grade bladder cancer?

A

25%

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30
Q

What are the most common causes of bladder obstruction in men vs women?

A

Men- prostate nodular hyperplasia

Women- bladder cystocele (prolapse into vagina)

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31
Q

What is the morphology of bladder obstruction?

A

Trabeculated pattern (rugae destroyed)

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32
Q

What are the different areas of the male urethra?

A

Prostatic

Membranous

Spongy

External orifice

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33
Q

What are the most common causes of ureteral inflammation in men vs women?

A

Men- prostatitis

Women- cystitis

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34
Q

What tumours are associated with the urethra and what are their characteristics?

A

Caruncles- small, red lesions of the external urethral meatus (women)

Benign epithelial- papillomas, inverted papillomas and condylomas (low risk HPV)

Primary carcinoma of the urethra

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35
Q

What are the two forms of primary urethral carcinoma?

A
  1. Proximal- urothelial

2. Distal- squamous

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36
Q

What congenital anomalies are associated with the urethra?

A

Hypospadias (opening on ventral surface)

Epispadias (opening on dorsal surface)

Phimosis (foreskin orifice to small to permit retraction)

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37
Q

Phimosis predisposes patients to what disorders?

A

Infection

Carcinoma

38
Q

Penile inflammation characteristically involves why structures?

A

Glans penis and prepuce

39
Q

What causes penile inflammation?

A

STIs

Balanoposthitis- nonspecific (poor hygiene)

40
Q

What are the different forms of benign penis tumours and their characteristics?

A

Condyloma acuminatum- epithelial proliferation due to HPV 6 and 11

Peyronie disease- fibrosis of corpus cavernosum, curvature, pain during sex

41
Q

What are the forms of CIS of the penis and how are they differentiated?

A

Bowen disease- shiny plaques on penile shaft

Bowenoid papulosis- pigmented popular lesions on genitalia, in younger, sexually active patients

Identical histologically, must be distinguished grossly

42
Q

What are the characteristics of invasive carcinoma of the penis?

A

Penile SCC

More common in uncircumcised

Associated with HPV 16 and 18

43
Q

What congenital anomalies are associated with the testis?

A

Cryptorchidism (failure of descent)

Atrophy and decreased fertility

44
Q

What is the most common defect resulting in cryptorchidism?

A

Inguinal canal descent

45
Q

What are the primary and secondary causes of atrophy and reduced fertility?

A

Primary- developmental (Klinefelter)

Secondary- cryptorchidism, vascular disease, inflammation, malnutrition, etc

46
Q

Inflammation in the male genital tract is most common in what location?

A

The epididymis

47
Q

What is the only infection that begins in the testis (not the epididymis)?

A

Syphilis

48
Q

What is the major lesion associated with the testicles?

A

Tumours

49
Q

What is the cause of nonspecific epididymitis and orchitis?

A

Primary UTI travels along the vas deferens or spermatic cord lymphatics

50
Q

Granulomatous orchitis is also called what?

A

Autoimmune orchitis

51
Q

How does specific/gonorrhoeal inflammation spread in the testis?

A

Retrograde extension from the posterior urethra to prostate, seminal vesicles and epididymis

52
Q

What are the two forms of syphilis?

A
  1. Gumma formation

2. Diffuse interstitial inflammation

53
Q

What is the morphology of testicular torsion?

A

Spermatic coed twisting cuts off venous drainage resulting in congestion

54
Q

What are the causes of testicular torsion in neonates and adults?

A

Neonatal- not associated with an anatomical defect

Adult- bell clapper abnormality (not fixed to scrotum)

55
Q

What is orchiopexy?

A

Surgical fixation of the testes to the scrotum

56
Q

What tumours are associated with the spermatic cord?

A

Lipomas (proximal cord)

Adenomatoid tumours- nodules if mesothelial cells

Rhabdomyosarcoma- skeletal muscle tumour in children

Liposarcoma- skeletal muscle tumour in adults

57
Q

What are the two broad categories of testicular tumours?

A
  1. Germ cell

2. Sex cord stromal

58
Q

What are the differences between seminomatous and non-seminomatous germ cell tumours?

A

Seminomatous- cells resemble primordial germ cells, localized, better prognosis

Nonseminomatous- undifferentiated cells (resemble stem cells), metastasize earlier

59
Q

What is the most common form of germ cell tumours?

A

Seminomas

60
Q

What is the ovarian equivalent of seminoma?

A

Dysgerminoma

61
Q

What are the morphological characteristics of seminomas?

A

Bulky mass increasing testis size

Grey-white, lobulated surface

No hemorrhage or necrosis

Clear cytoplasm

62
Q

What are the different cell types seen with spermatic seminomas?

A
  1. Small cells
  2. Medium cells
  3. Giant cells
63
Q

What are the ages associated with germ cell tumours?

A

15-34yrs

64
Q

What are the ages affected by spermatic seminoma?

A

> 65yrs

65
Q

What are the types of nonseminomatous germ cell tumours?

A

Embryonal sarcomas

Yolk sac tumours

Choriocarcinomas

Teratomas

Mixed tumours

66
Q

What are the characteristics of embryonal sarcomas?

A

Aggressive

20-30yrs

Poorly demarcated grey-white mass

Hemorrhage and necrosis

Extension common (higher grade)

67
Q

What are the characteristics of yolk sac tumours?

A

Most common testicular tumours <3yrs

Infiltrative, homogenous, yellow-white mucinous tumours

Schiller-Duval bodies (resemble endodermal sinuses)

68
Q

What is another name for yolk sac tumours?

A

Endometrial sinus tumours

69
Q

What are the characteristics of choriocarcinomas?

A

Highly malignant

Rare

Placental cell types

Small

Hemorrhagic masses to small lesions

70
Q

What are the placental cell types that make up choriocarcinomas?

A
  1. Cytotrophoblastic cells (central nuclei)

2. Synctiotrophoblastic cells (multiple dark nuclei)

71
Q

What are the characteristics of teratomas?

A

Differentiation along endodermal, mesodermal and ectodermal lines

Heterogenous collection of differentiated/organoid structures in fibrous/myxoid stroma

72
Q

What forms of teratomas are benign and which are malignant?

A

Mature- benign in children and women

Immature- always malignant

All are malignant in postpubescent males

73
Q

The prognosis of mixed tumours is based on which type?

A

The most aggressive

74
Q

What is the morphology of mixed testicular tumours?

A

Painless testicular enlargement

75
Q

What are the organs most commonly associated with metastasis in mixed testicular tumours?

A

Lung > liver > brain > bone

76
Q

What are the types of sex cord stromal tumours and what are their characteristics?

A
  1. Leydig cell tumours- produce hormones (cause symptoms), circumscribed nodules, golden brown surface, crystalloids of Reinke in cytoplasm
  2. Sertoli cell tumours- hormonally silent, testicular mass, small nodules with homogenous grey/white/yellow cut surface
77
Q

What is the most common testicular neoplasm in men over 60?

A

Testicular lymphomas

78
Q

What is the most common form of testicular lymphoma?

A

Diffuse large B-cell NHL

79
Q

Testicular lymphomas show a high incidence in the involvement of what organ?

A

The brain

80
Q

What are the regions of the prostate?

A

Central zone

Peripheral zone

Transitional zone

Periurethral zone

81
Q

What can cause prostatic inflammation?

A

Acute bacterial infection (UTI)

Chronic bacterial infection (recurrent UTI)

Chronic abacterial (no UTI hx)

Granulomatous (Tb/BCG treatment)

82
Q

What is the most common cause of prostatic inflammation?

A

Chronic abacterial

83
Q

What is BCG therapy used for?

A

Bladder cancer

Attenuated strain causes inflammation that kills tumour cells

84
Q

What is the most common prostatic disease in men >50yrs?

A

Benign prostatic hyperplasia

85
Q

What is the morphology of BPH?

A

Enlarged nodules in the transitional and periurethral zones

86
Q

What are the symptoms of BPH?

A

Outlet syndrome (urinary outflow obstruction)

87
Q

What is the treatment for BPH?

A

Transurethral resection of the prostate (TURP)

88
Q

What is the most common cancer in men?

A

Prostatic adenocarcinoma

89
Q

What is the precursor lesions of prostatic adenocarcinoma?

A

Prostatic intraepithelial neoplasia (PIN)

90
Q

What is the morphology of prostatic adenocarcinoma?

A

Poorly demarcated, gritty, firm, yellow lesions

91
Q

What is used to diagnose prostatic adenocarcinoma?

A

Gleason score

92
Q

Where are mets commonly found in prostatic adenocarcinoma?

A

The spine

Pathology (25 decks)

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