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Block 10 Week 3 > Fung > GU Path > Flashcards

Fung > GU Path Flashcards

1
Q

what are the 3 layers of a urinary tract tube (generally)?

A

inner to outer

  1. transitional epithelium
  2. lamina propria
  3. smooth muscle
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2
Q

T/F: congenital defects in the ureters are commonly clinically significant

A

FALSE

unless they cause an obstruction

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3
Q

what are the 3 congenital defects assoc w/ the bladder?

A
  1. exstrophy
  2. diverticula
  3. vesicoureteral reflux
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4
Q

what is bladder inflammation called?

A

cystitis

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5
Q

what 4 bugs cause acute & chronic cystitis?

A
  1. E coli
  2. Proteus
  3. Klebsiella
  4. Enterobacter
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6
Q

what are the 4 types of metaplastic lesions in the urinary system?

A
  1. cystitis cystica et glandularis
  2. squamous metaplasia
  3. intestinal metaplasia
  4. nephrogenic adenoma
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7
Q

what are the 5 grades of urothelial tumors (this is long, sorry)

A
  1. urothelial papilloma
  2. urothelial neoplasm w/ low malignant potential
  3. low grade papillary urothelial carcinoma
  4. high grade papillary urothelial carcinoma
  5. urothelial carcinoma in-situ
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8
Q

what are the 2 sex cord-stromal tumors?

A
  1. Leydig cell tumor

2. Sertoli cell tumor

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9
Q

what type of testicular tumor is more common: germ cell or sex cord/stromal?

A

GERM CELL! makes up 95% of testicular tumors

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10
Q

what are the 2 types of germ cell tumors?

A
  1. seminomatous tumors

2. non

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11
Q

what are the 2 types of seminomatous tumors?

A
  1. seminoma

2. spermatocytic seminoma

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12
Q

what are the 4 types of non-seminomatous tumors?

A
  1. embryonal carcinoma
  2. yolk sac (endodermal sinus) tumor
  3. choriocarcinoma
  4. teratoma
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13
Q

what are the 3 main causes of testicular neoplasms?

A
  1. env
  2. genetics
  3. testicular dysgenesis syndrome
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14
Q

what are the 3 sx of testicular dysgenesis syndrome?

A
  1. cryptorchidism
  2. hypospadias
  3. Klinefelter
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15
Q

what % of germ cell tumors are seminomas?

A

50%

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16
Q

what is the most common testicular tumor?

A

seminoma

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17
Q

what is a seminoma called if it’s in a woman?

A

dysgerminoma (happens in the ovary)

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18
Q

what is unique about the female trigone & urethra?

A

it has squamous epithelium, not transitional

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19
Q

here are the questions from her lecture, not her powerpoint, so brace yourself

A

HERE WE GO

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20
Q

what is urothelium?

A

transitional epithelium

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21
Q

is urothelium simple or stratified?

A

stratified

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22
Q

what are umbrella cells?

A

protect the bladder epithelium from osmosis d/t hypertonicity of urine

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23
Q

how does urine get from the kidney to the bladder (thru the ureter, but what propels it)?

A

peristalsis via smooth muscle

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24
Q

T/F: bladder has the same layers as the ureter

A

true

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25
Q

what is the muscular layer in the bladder called?

A

detrusor muscle

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26
Q

what is the majority of the bladder pathology?

A

neoplasm

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27
Q

what is exstrophy?

A

birth defect where the bladder is outside of the body

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28
Q

is interstitial cystitis acute or chronic?

A

chronic (chronic pain syndrome)

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29
Q

what are the sx of cystitis?

A

urinary urgency, frequency, hematuria

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30
Q

what will you see on UA of interstitial cystitis pts?

A

NO LEUKOCYTE ESTERASE or nitrites on UA (not d/t a pathogen; not an infection)

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31
Q

what is malakoplakia d/t?

A

defect in macrophages

bacteria overwhelms them and plaques develop

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32
Q

what are the sx of malakoplakia?

A

plaques in the bladder

hematuria

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33
Q

T/F: polypoid & papillary cystitis are both benign

A

true

they’re just d/t irritation

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34
Q

what is the diff btwn a papilla & a polyp?

A

a papilla has a fibrovascular core

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35
Q

what does cystitis cystica form from?

A

nests of von Brunn

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36
Q

what are nests of von Brunn?

A

urothelial invagination into the lamina propria

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37
Q

are nests of von Brunn malignant?

A

no

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38
Q

why does cystitis cystica et glandularis happen?

A

irritation

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39
Q

T/F: the bladder does not undergo squamous metaplasia

A

FALSE

yes it does

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40
Q

what can cause squamous metaplasia & cancer in the bladder?

A

schistosomiasis

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41
Q

what causes nephrogenic adenoma?

A

shedding of renal tubular cells from the kidney & then implant into the bladder

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42
Q

neoplasms of the bladder are normally (__?__)

A

papillary

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43
Q

what does nephrogenic adenoma mimic?

A

papillary neoplasm in the bladder

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44
Q

is urothelial carcinoma in situ flat or papillary?

A

flat

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45
Q

T/F: urothelial papilloma is the most common urothelial tumor

A

FALSE

it’s the most RARE

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46
Q

T/F: you can have a non-invasive high grade lesion

A

TRUE

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47
Q

how many layers does the urothelium have?

A

3-6

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48
Q

how can you differentiate benign cells from malignant cells?

A

malignant cells are not uniform, cells are discohesive & diff sizes, hyperchromatic, no umbrella cells on surface

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49
Q

which cancer is malignant?

A

urothelial carcinoma in situ (“in situ” = no invasion, but this can invade)

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50
Q

if you see PINK on histology in this section, what should you think?

A

squamous lesion

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51
Q

what is epispadias?

A

urethral opening on dorsal aspect/top of penis

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52
Q

what is phimosis?

A

foreskin scarring st the foreskin can’t be retracted > predisposes to squamous cell carcinoma of penis

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53
Q

what does condyloma look like?

A

cauliflower (it’s warts)

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54
Q

what is condyloma d/t?

A

HPV 6 & 11

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55
Q

what is the viral cytopathic effect of HPV?

A

clears the cells out

56
Q

does condyloma acuminatum lead to cancer?

A

no

57
Q

what is Bowen’s dz?

A

squamous cell carcinoma in situ on the peeenissssss

58
Q

what does Bowen’s dz look like on histo?

A

hyperchromasia

abn maturation of squamous cells

59
Q

what is Bowen’s dz a precursor to?

A

squamous cell carcinoma

60
Q

what is the testicle mostly made up of?

A

seminiferous tubules

61
Q

where does spermatogenesis happen?

A

seminiferous tubules

62
Q

what is the lining of the testicle?

A
  1. tunica vaginalis (parietal & visceral layers)

2. tunica albuginea

63
Q

what lines the tunica vaginalis?

A

mesothelium

64
Q

which layer of the testicle is thicker: vaginalis or albuginea?

A

albuginea

65
Q

what do Sertoli cells do?

A

give nourishment to spermatogonia

Sertoli = Support

66
Q

what do Leydig cells do?

A

produce hormones

67
Q

when the spermies leave the seminiferous tubule, where do they go?

A

rete testes > vasa eferentia > epididymis > vas deferens

68
Q

what is cryptochidism?

A

failure of the testicle to descend, either unilateral or bilateral

69
Q

what is orchiopexy?

A

surgery to put the testicle in the scrotal sac (treatment for cryptochidism)

70
Q

why does cryptochidism cause infertility?

A

high temp > testicular atrophy (w/ or w/o RX)

71
Q

what is the point of a testicle?

A

to make sperm

72
Q

where are Leydig cells found in the testes (generally)?

A

interstitium

73
Q

what direction does spermatogenesis occur in?

A

from the base to the lumen

74
Q

what are the spermatogenic cells that undergo mitosis?

A

spermatogonia type A

75
Q

what are the spermatogenic cells that undergo meiosis?

A

spermatogonia type B

76
Q

what are the primary spermatocytes?

A

S1

77
Q

how long does it take a spermatogonia to become a spermatid?

A

~70 days

78
Q

how long after spermatogonia generation does the first meiotic division occur?

A

~3 weeks later

79
Q

how soon after the first meiotic division does the second meiotic division occur?

A

VERY quickly

80
Q

how many spermies do you get from one meiosis event?

A

4

none of them degenerate

81
Q

histologically, what does an atrophic testicle look like?

A 
no spermatids in lumen
few Sertoli cells
few spermatogonia
reactive hyperplasia of Leydig cells
atrophy of seminiferous tubules
82
Q

what does a hydrocele look like grossly?

A

big and shiny

they transilluminate

83
Q

where do the -celes occur in the testicle?

A

btwn the visceral & parietal layers of the tunica vaginalis (i think)

84
Q

what is the ONLY painful testicular mass?

A

torsion

85
Q

what does testicular torsion look like grossly?

A

it’s BLACK

d/t hemorrhagic infarction from venous stuff

86
Q

when do most testicular neoplasms occur (what age)?

A

15-34 yo

87
Q

do you biopsy testicles?

A

nope

88
Q

what is the genotype of Klinefelter’s?

A

XXY

Fung says also XYY but that’s not true

89
Q

what is intratubular germ cell neoplasia?

A

like a germ cell carcinoma in situ

90
Q

what is the precursor lesion to testicular tumors?

A

intratubular germ cell neoplasia (ITGCN)

91
Q

T/F: you can also get seminomas in the mediastinum and in ovaries

A

TRUE

92
Q

what is a seminoma in the mediastinum called?

A

germinoma

93
Q

what is a seminoma like grossly?

A

fleshy

94
Q

what does a seminoma look like microscopically?

A

nodules of tumor

lymphocytes that infiltrate btwn tumor

95
Q

what is the most common germ cell tumor?

A

seminoma

96
Q

T/F: most germ cell tumors occur w/ other tumors (i.e. not alone)

A

TRUE

97
Q

what does embryonal carcinoma look like grossly?

A

looks high grade

hemorrhagic

98
Q

what does embryonal carcinoma usu occur w/i?

A

mixed germ cell tumors

99
Q

what pt population usu gets yolk sac/endodermal sinus tumors?

A

children

i.e. “3 yo w/ a testicular mass”

100
Q

what does a yolk sac tumor produce?

A

AFP

101
Q

how can you track response to therapy w/ a yolk sac tumor?

A

measure AFP or hCG (can identify recurrence)

102
Q

what does a yolk sac tumor look like on histo?

A

SCHILLER-DUVAL BODIES

microcysts

103
Q

what does a schiller-duval body look like?

A

an endodermal sinus

104
Q

what do choriocarcinomas make?

A

hCG

105
Q

what 2 trophoblasts do choriocarcinomas have?

A

syncytio-

cyto-

106
Q

T/F: choriocarcinoma is high grade

A

TRUE

107
Q

how do you differentiate a mature teratoma from an immature teratoma?

A

teratomas have endoderm, mesoderm, & ectoderm w/ MATURE elements (i.e. cartilage, glands, skin)

108
Q

can a mature teratoma undergo malignant transformation?

A

yes

109
Q

what kind of tissue does an immature teratoma have?

A

immature :)

sometimes neural

110
Q

how do Leydig cell tumor pts present?

A

sometimes w/ gynecomastia d/t hormone pdtion

111
Q

what do Leydig cell tumors make?

A

crystals of Reinke

112
Q

what are the zones of the prostate

A

peripheral
transitional
central

113
Q

which prostate zone is most affected by cancer?

A

peripheral

114
Q

which prostate zone is affected by BPH?

A

central

115
Q

does prostate cancer form a mass?

A

NOT USUALLY

it’s really weird

116
Q

if you’re a male and you have bladder cancer, what will they surgically remove?

A

bladder & prostate

surely not the WHOLE bladder

117
Q

what is the NORMAL prostatic concretion?

A

corpora amylacea

118
Q

what are the 2 layers of the prostate?

A

epithelial

basal

119
Q

how do you tell the diff btwn seminal vesicle & prostatic glands?

A

seminal vesicles make pigment

120
Q

do you biopsy prostatitis?

A

nope

121
Q

what can cause GRANULOMATOUS prostatitis?

A

BCG

fungal infxn

122
Q

how is PSA affected by prostatitis?

A

PSA increases during prostatitis

123
Q

what does nodular hyperplasia look like microscopically?

A

nodule w/ surrounding fibrous tissue

stromal proliferation

124
Q

what causes nodular hyperplasia?

A

testosterone basically

T > DHT > growth factors > stromal cell growth & epithelial cell survival > nodules

125
Q

what are the 3 treatments for nodular prostatic hyperplasia?

A

finasteride
flomax
TURP

126
Q

how does finasteride act?

A

inhibits DHT formation via inhibition of 5α-reductase

127
Q

how does flomax work?

A

α blocker which affects smooth muscle > reduces tone

128
Q

what is TURP?

A

transurethral resection of the prostate

shave down the prostate to reduce nodularity

129
Q

what are the clinical features of nodular hyperplasia?

A

hesitancy & intermittent stream d/t obstruction

urgency & frequency d/t bladder irritation

130
Q

what are the clinical features of prostatic adenocarcinoma?

A
  1. palpable or non
  2. asymptomatic
  3. clinically significant or not
  4. PSA
131
Q

what is the major side effect of prostatectomy?

A

ED

132
Q

why do you use “watchful waiting” with prostate cancers?

A

some are benign and don’t kill the pt, & treatment would cause more issues than the cancer itself
some are malignant and CAN kill the pt

133
Q

what is “elevated PSA”?

A

PSA >4

134
Q

T/F: adenocarcinoma produces nodules

A

TRUE

135
Q

aren’t Gleason scores interesting

A

hm oh yes

scale is 1-5

136
Q

what are the 3 main prostate treatments?

A
  1. watchful waiting
  2. androgen deprivation
  3. radical prostatectomy

Block 10 Week 3 (7 decks)

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