Fung: GU Pathology

Question 1

What are the three layers of the urinary tract?

Answer 1

urothelium
lamina propria
smooth muscle

Question 2

What is the epithelium of the urinary tract called? What is located at the top (superior end) of this layer?

Answer 2

urothelium; umbrella cells

Question 3

What are some congenital anomalies of the urinary bladder?

Answer 3

extrophy
diverticula
vesicoureteral reflux

Question 4

What bugs can cause acute & chronic cystitis?

Answer 4

E. Coli
Proteus
Klebsiella
Enterobacter

Question 5

What is interstitial cystitis? How will it present?

Answer 5

thickening of the bladder wall due to nonspecific inflammation - not due to a bug
will get chronic pelvic pain, hematuria, urgency, frequency of urination
BUT no leukocyte esterase or nitrates, bc no infection

Question 6

What is malacoplakia? How does it present?

Answer 6

malacoplakia is caused by a defect in macrophages, which typically gobble up debris - when there is a defect, they become filled with bacteria & present as plaques or nodules that irritate the bladder

Question 7

What is polypoid cystitis? How does it differ from papillary cystitis?

Answer 7

formation of polyps due to reactive process as a response to irritation;
papillary will have fibrovascular cords

**both are benign, reactive changes to irritation

Question 8

Four metaplastic lesions of the urinary system?

Answer 8

cystitis cystica (et glandularis)
squamous metaplasia
intestinal metaplasia
nephrogenic adenoma

Question 9

What is one characteristic feature of cystitis cystica?

Answer 9

Nests of von Brunn - groups of proliferating urinary tract mucosal cells isolated in the urinary tract submucosa.

**urothelium can cystically dilate and take on glandular features

Question 10

Malignant proliferation of squamous cells, usu involving the bladder
Arises in a background of squamous metaplasia

Answer 10

squamous cell carcinoma of the bladder

Question 11

RIsk factors for squamous cell carcinoma of the bladder?

Answer 11

chronic cystitis
Schistosoma hematobium (in Egypt)
long standing nephrolithiasis

Question 12

Malignant proliferation of glands, usu involving the bladder

Answer 12

adenocarcinoma

Question 13

Benign adenoma caused by the shedding of renal tubular cells from the kidney that implant in the bladder

Answer 13

nephrogenic adenoma

Question 14

Urothelial cell carcinoma can arise in one of two ways - what are they?

Answer 14

flat - develops as a high grade flat tumor & then invades

papillary - develops as a low-grade papillary tumor –> high grade papillary tumor –> invades

Question 15

Discuss the 5 grades of urothelial tumors

Answer 15

urothelial papilloma
urothelial neoplasms of low malignant potential
papillary urothelial carcinoma (low grade)
papillary urothelial carcinoma (high grade)
urothelial carcinoma in-situ

Question 16

What differentiates a low grade lesion from a high grade lesion in regard to the urothelial cells?

Answer 16

low grade lesion will have thickened layers, and a bit of atypia, but not enough to call it a neoplasm

high grade lesion, cell size and polarity will be different, marked atypia

Question 17

What will urothelial carcinoma in situ look like histologically?

Answer 17

malignant cells, which are disadhesive (shed easily), but no invasion yet of the lamina propria

Question 18

What happens when a urothelial cell carcinoma becomes invasive?

Answer 18

it invades the lamina propria & the detrusor muscle

Question 19

How would you differentiate a squamous cell carcinoma of the bladder from an adenocarcinoma?

Answer 19

squamous - keratin & intercellular bridges - PINK

adenocarcinoma - glandular

Question 20

Benign warty growth on genital skin
Due to HPV type 6 or 11
Characterized by koilocytic changes

Answer 20

condyloma

Question 21

What will you see in the nuclei of cells of a condyloma?

Answer 21

raisin-like nuclei - koilocytic changes

Question 22

Opening of the urethra on the inferior surface of the penis

Due to failure of the urethral folds to close

Answer 22

Hypospadias

Question 23

Opening of the urethra of the superior surface of the penis
Due to abnormal positioning of the genital tubercle
Associated w bladder extrophy

Answer 23

Epispadias

Question 24

Inflammation of the glans penis, due to poor hygiene, leading to bacteria and fungal build up by candida, anaerobic bacteria, gardnerella, pyogenic bacteria

Answer 24

balanitis

Question 25

(blank) can lead to scarring of the foreskin, which can prevent the foreskin from being retracted.

Answer 25

smegma

Question 26

Smegma can predispose males to (blank) of the penis

Answer 26

squamous cell carcinoma

Question 27

The testes are made up of (blank), which is the location of spermatogenesis.

Answer 27

semineferous tubules

Question 28

Describe the pathway of sperm from the semineferous tubules to the urethra

Answer 28

tubules –> rete testes –> ductus efferentes –> epididymis –> ductus deferens

Question 29

What are the two layers of the testes?

Answer 29

tunica vaginalis on the outside
tunica albuginea closer to the testes

**space in between is called serous space

Question 30

What are the cell types within the semineferous tubules? What does each do?

Answer 30

sertoli cells - support, nourish, and protect the spermatids

Leydig cells - secrete testosterone, found in the interstitial space

Question 31

Failure of the testicle to descend into the scrotal sac
Normally, the testicles develop in the abdomen and then descend into the scrotal sac as the fetus grows
Most cases resolve spontaneously, but nay need orchiopexy
Can cause testicular atrophy with infertility

Answer 31

cryptorchidism

Question 32

Where are spermatids located within the sertoli cells?

Answer 32

Mature spermatids are closer to the lumen of the cell, while spermatogonia in the beginning stages are along the border of the cell

Question 33

Fluid collection within the tunica vaginalis

Associated with incomplete closure of the processus vaginalis

Answer 33

hydrocele

Question 34

What will happen when you shine light on a hydrocele?

Answer 34

it will transilluminate

Question 35

This occurs when the testicle twists on itself and blocks venous drainage
Presents as sudden testicular pain and absent cremasteric reflex

Answer 35

testicular torsion

Question 36

What are the two major types of testicular tumors?

Answer 36

germ cell tumors (95%)

sex-cord stromal tumors (5%)

Question 37

What are the two main forms of germ cell tumors? What is the difference between the two?

Answer 37

seminomatous vs non-seminomatous

seminomatous tumors are highly responsive to chemotherapy, while nonseminomas are not (worse prognosis)

Question 38

50% of all testicular germ cell tumors
Most common testicular tumor
Called dysgerminoma in the ovary
Malignant tumor comprised of large cells with clear cytoplasm and central nuclei
Form a homogenous mass with no hemorrhage or necrosis

Answer 38

seminoma

Question 39

Malignant tumor of the testes comprised of immature, primitive cells that may produce glands
Forms a hemorrhagic mass with necrosis
Aggressive, higher grade neoplasm
Increased AFP or beta-HcG

Answer 39

embryonal germ cell carcinoma

Question 40

Most common testicular tumor in kids
Schiller-Duval bodies (glomerulus like structures on histology)
Produced AFP

Answer 40

yolk sac tumor

Question 41

Malignant testicular tumor of syncytiotrophoblasts & cytotrophoblasts (placenta like tissue)
Produce beta-HcG

Answer 41

choriocarcinoma

Question 42

Tumor composed of mature fetal tissue derived from two or three embryonic layers
Malignant in males

Answer 42

mature teratoma vs immature teratoma (can contain immature neurologic tissue)

Question 43

This sex-cord stromal tumor produces androgen, causing precocious puberty in kids or gynecomastia in adults

Answer 43

leydig cell tumor

Question 44

What is the characteristic feature of a leydig cell tumor?

Answer 44

Reinke crystals

Question 45

This sex-cord stromal tumor is comprised of tubules & it usu clinically silent

Answer 45

sertoli cell tumor

Question 46

What makes up the prostate?

Answer 46

glands and stroma

glands have inner layer and outer layer of basal cells

Question 47

What do the glands of the prostate produce?

Answer 47

milky fluid that is added to sperm and seminal vesicle fluid to make semen

Question 48

Acute inflammation of the prostate
Usu due to Chlaydia and Neisseria gonorrhoeae in young adults, or E.Coli and pseudomonas in older adults
Presents as dysuria with fever and chills
Prostate secretions will have WBCs, cultures will reveal bacteria

Answer 48

acute prostatitis

vs chronic prostatitis, in which cultures would be negative

Question 49

Hyperplasia of the prostate stroma and glands

Answer 49

BPH

Question 50

Does BPH increase the risk for cancer? What is it caused by?

Answer 50

no!

it is related to production of DHT –> testosterone is converted to DHT in the stromal cells, and DHT acts on the androgen receptors of stromal and epithelial cells resulting in hyperplastic nodules

Question 51

In what area of the prostate does BPH occur?

Answer 51

in the central zone (periurethral)

Question 52

Clinical features of BPH?

Answer 52

problems starting & stopping urine
impaired bladder emptying
dribbling

Question 53

How to treat BPH?

Answer 53

alpha 1 antagonists - to relax smooth muscle

5alpha reductase inhibitors, which block conversion of testosterone to DHT, also useful for male pattern baldness

Question 54

Malignant proliferation of prostate glands
The most common cancer in men
Usu clinically silent, but may present as low back pain if it spreads to the lumbar spine or pelvis

Answer 54

prostate adenocarcinoma

Question 55

How do you screen for prostate cancer?

Answer 55

digital rectal exam

PSA (PSA > 10 is worrisome, but Fung says greater than 4 is bad)

Question 56

If you suspect prostate adenocarcinoma, you should do a prostatic biopsy and this grading system…

Answer 56

Gleason grading system

Scoring: From 1-5, look at distribution of glands (look at the two most common presentations, and give them a score of 1-5, then add the score)
Ex: 1 = small, uniform glands (well differentiated)
2 = distinct glands but they infiltrate
3 = still distinct gland formation
4 = no distinct gland formation, blending
5 = high grade cells, with necrosis - lack of or occasional glands (poorly differentiated)