Fung > GU Path Flashcards
what are the 3 layers of a urinary tract tube (generally)?
inner to outer
- transitional epithelium
- lamina propria
- smooth muscle
T/F: congenital defects in the ureters are commonly clinically significant
FALSE
unless they cause an obstruction
what are the 3 congenital defects assoc w/ the bladder?
- exstrophy
- diverticula
- vesicoureteral reflux
what is bladder inflammation called?
cystitis
what 4 bugs cause acute & chronic cystitis?
- E coli
- Proteus
- Klebsiella
- Enterobacter
what are the 4 types of metaplastic lesions in the urinary system?
- cystitis cystica et glandularis
- squamous metaplasia
- intestinal metaplasia
- nephrogenic adenoma
what are the 5 grades of urothelial tumors (this is long, sorry)
- urothelial papilloma
- urothelial neoplasm w/ low malignant potential
- low grade papillary urothelial carcinoma
- high grade papillary urothelial carcinoma
- urothelial carcinoma in-situ
what are the 2 sex cord-stromal tumors?
- Leydig cell tumor
2. Sertoli cell tumor
what type of testicular tumor is more common: germ cell or sex cord/stromal?
GERM CELL! makes up 95% of testicular tumors
what are the 2 types of germ cell tumors?
- seminomatous tumors
2. non
what are the 2 types of seminomatous tumors?
- seminoma
2. spermatocytic seminoma
what are the 4 types of non-seminomatous tumors?
- embryonal carcinoma
- yolk sac (endodermal sinus) tumor
- choriocarcinoma
- teratoma
what are the 3 main causes of testicular neoplasms?
- env
- genetics
- testicular dysgenesis syndrome
what are the 3 sx of testicular dysgenesis syndrome?
- cryptorchidism
- hypospadias
- Klinefelter
what % of germ cell tumors are seminomas?
50%
what is the most common testicular tumor?
seminoma
what is a seminoma called if it’s in a woman?
dysgerminoma (happens in the ovary)
what is unique about the female trigone & urethra?
it has squamous epithelium, not transitional
here are the questions from her lecture, not her powerpoint, so brace yourself
HERE WE GO
what is urothelium?
transitional epithelium
is urothelium simple or stratified?
stratified
what are umbrella cells?
protect the bladder epithelium from osmosis d/t hypertonicity of urine
how does urine get from the kidney to the bladder (thru the ureter, but what propels it)?
peristalsis via smooth muscle
T/F: bladder has the same layers as the ureter
true
what is the muscular layer in the bladder called?
detrusor muscle
what is the majority of the bladder pathology?
neoplasm
what is exstrophy?
birth defect where the bladder is outside of the body
is interstitial cystitis acute or chronic?
chronic (chronic pain syndrome)
what are the sx of cystitis?
urinary urgency, frequency, hematuria
what will you see on UA of interstitial cystitis pts?
NO LEUKOCYTE ESTERASE or nitrites on UA (not d/t a pathogen; not an infection)
what is malakoplakia d/t?
defect in macrophages
bacteria overwhelms them and plaques develop
what are the sx of malakoplakia?
plaques in the bladder
hematuria
T/F: polypoid & papillary cystitis are both benign
true
they’re just d/t irritation
what is the diff btwn a papilla & a polyp?
a papilla has a fibrovascular core
what does cystitis cystica form from?
nests of von Brunn
what are nests of von Brunn?
urothelial invagination into the lamina propria
are nests of von Brunn malignant?
no
why does cystitis cystica et glandularis happen?
irritation
T/F: the bladder does not undergo squamous metaplasia
FALSE
yes it does
what can cause squamous metaplasia & cancer in the bladder?
schistosomiasis
what causes nephrogenic adenoma?
shedding of renal tubular cells from the kidney & then implant into the bladder
neoplasms of the bladder are normally (__?__)
papillary
what does nephrogenic adenoma mimic?
papillary neoplasm in the bladder
is urothelial carcinoma in situ flat or papillary?
flat
T/F: urothelial papilloma is the most common urothelial tumor
FALSE
it’s the most RARE
T/F: you can have a non-invasive high grade lesion
TRUE
how many layers does the urothelium have?
3-6
how can you differentiate benign cells from malignant cells?
malignant cells are not uniform, cells are discohesive & diff sizes, hyperchromatic, no umbrella cells on surface
which cancer is malignant?
urothelial carcinoma in situ (“in situ” = no invasion, but this can invade)
if you see PINK on histology in this section, what should you think?
squamous lesion
what is epispadias?
urethral opening on dorsal aspect/top of penis
what is phimosis?
foreskin scarring st the foreskin can’t be retracted > predisposes to squamous cell carcinoma of penis
what does condyloma look like?
cauliflower (it’s warts)
what is condyloma d/t?
HPV 6 & 11
what is the viral cytopathic effect of HPV?
clears the cells out
does condyloma acuminatum lead to cancer?
no
what is Bowen’s dz?
squamous cell carcinoma in situ on the peeenissssss
what does Bowen’s dz look like on histo?
hyperchromasia
abn maturation of squamous cells
what is Bowen’s dz a precursor to?
squamous cell carcinoma
what is the testicle mostly made up of?
seminiferous tubules
where does spermatogenesis happen?
seminiferous tubules
what is the lining of the testicle?
- tunica vaginalis (parietal & visceral layers)
2. tunica albuginea
what lines the tunica vaginalis?
mesothelium
which layer of the testicle is thicker: vaginalis or albuginea?
albuginea
what do Sertoli cells do?
give nourishment to spermatogonia
Sertoli = Support
what do Leydig cells do?
produce hormones
when the spermies leave the seminiferous tubule, where do they go?
rete testes > vasa eferentia > epididymis > vas deferens
what is cryptochidism?
failure of the testicle to descend, either unilateral or bilateral
what is orchiopexy?
surgery to put the testicle in the scrotal sac (treatment for cryptochidism)
why does cryptochidism cause infertility?
high temp > testicular atrophy (w/ or w/o RX)
what is the point of a testicle?
to make sperm
where are Leydig cells found in the testes (generally)?
interstitium
what direction does spermatogenesis occur in?
from the base to the lumen
what are the spermatogenic cells that undergo mitosis?
spermatogonia type A
what are the spermatogenic cells that undergo meiosis?
spermatogonia type B
what are the primary spermatocytes?
S1
how long does it take a spermatogonia to become a spermatid?
~70 days
how long after spermatogonia generation does the first meiotic division occur?
~3 weeks later
how soon after the first meiotic division does the second meiotic division occur?
VERY quickly
how many spermies do you get from one meiosis event?
4
none of them degenerate
histologically, what does an atrophic testicle look like?
no spermatids in lumen few Sertoli cells few spermatogonia reactive hyperplasia of Leydig cells atrophy of seminiferous tubules
what does a hydrocele look like grossly?
big and shiny
they transilluminate
where do the -celes occur in the testicle?
btwn the visceral & parietal layers of the tunica vaginalis (i think)
what is the ONLY painful testicular mass?
torsion
what does testicular torsion look like grossly?
it’s BLACK
d/t hemorrhagic infarction from venous stuff
when do most testicular neoplasms occur (what age)?
15-34 yo
do you biopsy testicles?
nope
what is the genotype of Klinefelter’s?
XXY
Fung says also XYY but that’s not true
what is intratubular germ cell neoplasia?
like a germ cell carcinoma in situ
what is the precursor lesion to testicular tumors?
intratubular germ cell neoplasia (ITGCN)
T/F: you can also get seminomas in the mediastinum and in ovaries
TRUE
what is a seminoma in the mediastinum called?
germinoma
what is a seminoma like grossly?
fleshy
what does a seminoma look like microscopically?
nodules of tumor
lymphocytes that infiltrate btwn tumor
what is the most common germ cell tumor?
seminoma
T/F: most germ cell tumors occur w/ other tumors (i.e. not alone)
TRUE
what does embryonal carcinoma look like grossly?
looks high grade
hemorrhagic
what does embryonal carcinoma usu occur w/i?
mixed germ cell tumors
what pt population usu gets yolk sac/endodermal sinus tumors?
children
i.e. “3 yo w/ a testicular mass”
what does a yolk sac tumor produce?
AFP
how can you track response to therapy w/ a yolk sac tumor?
measure AFP or hCG (can identify recurrence)
what does a yolk sac tumor look like on histo?
SCHILLER-DUVAL BODIES
microcysts
what does a schiller-duval body look like?
an endodermal sinus
what do choriocarcinomas make?
hCG
what 2 trophoblasts do choriocarcinomas have?
syncytio-
cyto-
T/F: choriocarcinoma is high grade
TRUE
how do you differentiate a mature teratoma from an immature teratoma?
teratomas have endoderm, mesoderm, & ectoderm w/ MATURE elements (i.e. cartilage, glands, skin)
can a mature teratoma undergo malignant transformation?
yes
what kind of tissue does an immature teratoma have?
immature :)
sometimes neural
how do Leydig cell tumor pts present?
sometimes w/ gynecomastia d/t hormone pdtion
what do Leydig cell tumors make?
crystals of Reinke
what are the zones of the prostate
peripheral
transitional
central
which prostate zone is most affected by cancer?
peripheral
which prostate zone is affected by BPH?
central
does prostate cancer form a mass?
NOT USUALLY
it’s really weird
if you’re a male and you have bladder cancer, what will they surgically remove?
bladder & prostate
surely not the WHOLE bladder
what is the NORMAL prostatic concretion?
corpora amylacea
what are the 2 layers of the prostate?
epithelial
basal
how do you tell the diff btwn seminal vesicle & prostatic glands?
seminal vesicles make pigment
do you biopsy prostatitis?
nope
what can cause GRANULOMATOUS prostatitis?
BCG
fungal infxn
how is PSA affected by prostatitis?
PSA increases during prostatitis
what does nodular hyperplasia look like microscopically?
nodule w/ surrounding fibrous tissue
stromal proliferation
what causes nodular hyperplasia?
testosterone basically
T > DHT > growth factors > stromal cell growth & epithelial cell survival > nodules
what are the 3 treatments for nodular prostatic hyperplasia?
finasteride
flomax
TURP
how does finasteride act?
inhibits DHT formation via inhibition of 5α-reductase
how does flomax work?
α blocker which affects smooth muscle > reduces tone
what is TURP?
transurethral resection of the prostate
shave down the prostate to reduce nodularity
what are the clinical features of nodular hyperplasia?
hesitancy & intermittent stream d/t obstruction
urgency & frequency d/t bladder irritation
what are the clinical features of prostatic adenocarcinoma?
- palpable or non
- asymptomatic
- clinically significant or not
- PSA
what is the major side effect of prostatectomy?
ED
why do you use “watchful waiting” with prostate cancers?
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
what is “elevated PSA”?
PSA >4
T/F: adenocarcinoma produces nodules
TRUE
aren’t Gleason scores interesting
hm oh yes
scale is 1-5
what are the 3 main prostate treatments?
- watchful waiting
- androgen deprivation
- radical prostatectomy
