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Pathology Sp 16 > Genitourinary disease > Flashcards

Genitourinary disease Flashcards

1
Q

what are hypospadias?

A

abnormal openings along the ventral aspect of the penis can be constricted resulting in INC UT infections

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2
Q

what are epispadias?

A

less common, abnormal openings along the dorsal aspect of the penis: result in UT obstruction and urinary incontinence

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3
Q

What is the most common penile neoplasm? what % of cancer does it account for in US males? what groups is this cancer prominent in?
what is it associated with?
what does this cancer precede?

A

Squamous cell carcinoma and its precursors= most common penile neoplasm= account for .4% of cancers in males
Most common in uncircumscribed men over age 40
associated wit HPV 16/18 infection
precedes premalignant lesion, red white plaque

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4
Q

Describe the clinical findings of Squamous cell carcinoma of the penis. Who is this cancer rare amongst? Are metastases common? 5 year survival rate?

A

Squamous cell carcinoma of the penis clinically is seen with crusted plaque, nodule ulceration and irregular margins less commonly as a papillary mass.
Rare amongst young, circumcised males
does NOT commonly metastasize to distant sites.
5 Year survival localized= 66%,
5 year survival metastasized= 27%

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5
Q

what is the first human cancer associated with occupational (environmental factors) like chimney sweeps

A

scrotal squamous cell carcinoma - rare neoplasm

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6
Q

what is cryptorchidism? prevalence? what may this disorder be? what may it lead to?

A

incomplete descent of the testes from the abdomen to the scrotum
cryptorchidism occurs in 1% of 1 year old males
may be uni or bilateral
may lead to Sterility

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7
Q

What does cryptorchidism INC? what tx is used to reduce risk of cancer and sterility in patients with cryptorchidism?

A

Cryptorchidism leads to 3-5 x INC risk for testicular cancer which is a intratubular germ cell neoplasia that develops within the atrophic tubules
Orchiopexy reduces risk of sterility and cancer

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8
Q

inflammatory lesions of the testes are more common in epididymitis or orchitis?

A

inflammation of the testes is more common in epipidymitis

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9
Q

inflammatory lesions of the testes are often associated with what? arise from complications of what?

A

inflammatory lesions of the testes are often associated with STDs and often arise from UTI complications and mumps in adults (20%)

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10
Q

What is a vascular disturbance of the testes that results in twisting of the spermatic cord? what must happen or infarction will occur?

A

Torsion- must be surgery relieved within 6-8 hours

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11
Q

torsion is a true urologic emergency that results in what? happens when and does what clinically?

A

torsion results in obstruction of venous drainage resulting in rapid, intense vascular engorgement
torsion occurs in adolescence and results in sudden onset of testicular pain

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12
Q

what is the most common cause of painless testicular enlargement? what is its incidence rate? predominant in who?

A

Testicular neoplasms occurs in 6:100,000 males with a peak incidence of 15-34 years

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13
Q

Describe the heterogeneous groups of testicular neoplasms

A

35% arise from germ cells and are malignant

5% arise from sertoli or leydig cells and are generally benign

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14
Q

Germ cell tumors of the tests are divided into what two groups? what INC the risk for testicular cancer and how much? what percent of pts have a history of cryptorchidism?

A

testicular germ cell cancer = seminomas and non seminomatous tumors
INC frequency in undescended testis w a 3-5 X INC risk
only 10% of pts have history of cryptorchidism

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15
Q

What is the histologic appearance of testicular germ cell cancers?

A

may be pure, single cell type but often mixed multiple cell types

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16
Q

What are testicular cancers that arise from the epithelium of the seminiferous tubules? what is the common location of this cancer? what is the tx of it? what is a important note about this cancer?

A

Seminomas= arise from epithelium of seminiferous tubules, indolent, often remain confined to the testis, may eventually spread via lymphatics
respond well to chemotherapy, and radiosensitive.
One of the MOST CURABLE cancers

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17
Q

whats a cancer that has several types and tends to spread early via lymphatics and blood? What are the important tumor markers for this cancer?

A

Non seminomatous tumor: even small ones may present with extensive metastases to liver and lungs
Tumor markes: A-fetoprotein (AFP) and human chronic gonadotropin (HCG)

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18
Q

what is the prognosis of testicular germ cell tumors: how many new cases per year? deaths per year? % of early stage cured for seminomas?
% cured of nonseminomatous tumor into remission?
what is the one germ cell tumor that has bad prognosis due to less chemosensitivity?

A

8000 new cases per year, 400 deaths annually
seminomas: 95% cured
non seminomatous tumors: 90% pts have remission
Exception is pure chrolocarcinoma (less than 1% tho)= worse prognosis

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19
Q

what are the important categories of prostate disorders

A

inflammatory lesions (prostatitis)
nodular hyperplasia
carcinoma

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20
Q

prostatitis caused the prostate to do what? minority of these cases are associated with what and can be what?

A

prostatitis causes an enlarged tender prostate that is associated sometimes with UTI infection from E coli and can be acute or chronic

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21
Q

Describe chronic prostatitis

A

90-95% of chronic prostatitis cases are non bacterial: aka chronic pelvic pain syndrome, unknown etiology and no response to ABs

22
Q

Prostatitis causes what clinical symptoms?

A

dysuria, frequency, low back or pelvic pain

23
Q

Benign prostatic hyperplasia affects what of the prostate? what causes enlargement and urinary obstruction with this neoplasm?

A

BPH affects the inner periurethral zone of the prostate and compresses the prostatic urethra. The stream and glandular proliferation results in enlargement and urinary obstruction

24
Q

BPH aka nodular hyperplasia occurs in what % of men at age 40? what % of men at age 70? what are the clinical symptoms of BPH?
chronic obstruction due to BPH leads to what?
what do we know about BPH etiology?

A

at age 40 20% of men have BPH
at age 70 90% of men have BPH
BPH clinical symptoms: hesitancy, urgency, nocturia, poor urinary system
BPH chronic obstruction leads to recurrent UTIs
BPH etiology is unknown but we know there is a local INC in androgens - hormonal stimulus

25
Q

what is the TX of BPH?

A

Drugs, and surgical tx known as TURP

26
Q

what is the most common cancer of men over age of 50in US? what % of cancer? what % of cancer deaths? what % of men over age 80 have it, and what may it be? what may be seen with this cancer?

A

Adenocarcinoma of the prostate= most common cancer in men over age 50! 25% of all cancer, but 9% of cancer deaths
may be clinically latent in 50% of men over age 80
metastasis to lymph nodes and skeleton may be seen

27
Q

carcinoma of the prostate is caused by what? where does it begin and how is it detected?

A

carcinoma of the prostate has unknown causes maybe: androgens, genes, environmental
most commonly arises in the outer (peripheral) glands of the prostate detected by digital rectal exam

28
Q

what is elevated in carcinoma of the prostate?
what is the tx?
what is the prognosis? what is prognosis dependent on?

A

carcinoma of the prostate has elevated serum prostate specific antigen (PSA) useful for diagnosis but seen in non neoplastic conditions also
tx: surgery, radiation and hormonal
Prognosis: depends on anatomic extent of diseases
10 year survival: 98% if localized
10 year survival with disseminated: 30%

29
Q

Bladder cancer is most common in who? majority of bladder cancers are what? present with what? detected by what?

A

bladder cancer most common in men 50-80 years old majority are urothelial carcinomas that present with painless hematuria and detected via cytology as tumor cells shed into urine

30
Q

what are the risk factors for bladder cancers?

A

smoking, chronic cystitis, infection w schistosomiasis, exposure to various carcinogens

31
Q

describe the two progression types of bladder cancers

A

type 1: papilloma papillary carcinoma progressing to invasive papillary carcinoma
type 2: flat non invasive carcinoma progressing to flat invasive carcinoma

32
Q

what is the tx of bladder cancers? prognosis of bladder cancer?

A

bladder cancer tx: transurethral resection, immunotherapy, radical cystectomy
prognosis: dependent on tumor grade and stage: degree of atypic and extend of invasion

33
Q

how many new cases of STDS annually?
peak incidence when? 2nd peak incidence age?
of the 10 infectious diseases reported to CDC how many are STDs?
most common STDs?

A

15 million new cases of STDs annually
peak incidence at 20-24, then 15-19 y/o
5 of the CDC reported diseases are STDs
most common STDs: genital herpes, genital HPV

34
Q

what is a chronic infection caused by spirochete T palladium? how many cases in 2014? more prevalent in who? transmitted how?

A

Syphilis (lues), 20,000 new cases in the US. 30 times more prevalent in blacks than whites
transmitted by direct contact with cutaneous or mucosal lesions during primary or secondary stages. HIGHLY INFECTIOUS!!

35
Q

describe primary syphilis, clinical signs, incubation period, resolution period, and resolution

A

primary syphilis: painless ulcers develops at site of inoculation in 9-90 days after infection.
system dissemination of organism while host mounts immune response
resolves in 4-6 weeks
if untreated 25% of pts develop secondary disease

36
Q

describe secondary syphilis: inoculation period, clinical signs, resolution period, and resolution if untreated

A

secondary syphilis occurs within 2 months following resolution of primary syphilis: generalized lymphadenopathy and various mucocutaneous lesions
maculopapular rash affecting skin (palms and soles), condyloma late and mucous patches may affect genital and oral mucos.
resolves in several weeks and pt enters latent phase. if untreated 1/3 of pts develop tertiary syphilis in 5-20 years

37
Q

Describe the 3 components of tertiary syphilis

A

Aortitis: cardio syphilis
Neurosyphilis: 10% involvement of the brain, meninges, and spinal cord
gummas: focal granulomatous lesions develop in bone, skin, and mucous membranes of the upper airway and mouth, pts less likely to be infectious

38
Q

what is congenital syphilis

A

maternal transmission of syphilis across the placenta

39
Q

what are the 3 patterns of congenital syphilis

A

stillbirth
infantile syphilis: live born infants with clinical manifestations similar to secondary syphilis at birth or first few months of life
late congenital syphilis: untreated > 2 years of duration
Hutchinson Triad: hutchinson’s teeth, interstitial keratitis, 8th CN deafness

40
Q

in congenital syphilis what is hutchinson’s teeth

A

notched incisors and mulberry molars

41
Q

how is syphilis diagnosed?

tx?

A

syphilis is diagnosed by ID of bacteria within primary or secondary lesions, screening tests of RPR and VDRL (often negative in early stages of disease w 15% false positives)
specific tests: FTA (give positive later in disease course and remain positive indefinitely even after tx)
tx: ABs penicilin

42
Q

what is very common in the US caused by Neisseria gonorrhoeae? how many new cases in the US? what does this disease do? diagnosis how? tx?

A

Gonorrhea, 350,000 new cases per year in US. provokes an intense, suppurative inflammatory`rxn of purulent exudate however 40% males asymptomatic and 80% of females asymptomatic
diagnosis by culture
tx: penicillin but emergent strains have complicated surgery

43
Q

what can untreated gonorhea lead to? what do ascending infections result in? what can result in infants birthed to a mother with gonorrhea?

A

untreated gonorrhea can lead to sterility
ascending gonorrhea infections results in: males: acute prostatitis, epididymitis, or orchitis. females: inflammation of uterus, fallopian tubes, and ovaries (acute salpingitis)
infant blindness from gonococci contamination at birth- gonococcal ophthalmia and neonatorum

44
Q

what is the most common STD reported to CDC? what are the majority of these STDs caused by?

A

nongonococcal urethritis and cervicitis: majority caused by `Chlamydia trachomatis

45
Q

how is chlamydia usually recognized? tx? complication?

A

chlamydia is usually recognized by persistent disease following AB tx for suspected gonorrhea and molecular tests for diagnosis

tx: cefriaxone and doxyclycine
complication: development of reactive arthritis

46
Q

what is reactive arthritis? aka what?

A

reactive arthritis is aka reiter syndrome
immune mediated condition that develops in response to genitourinary or gastrointestinal infections may be complication of C trachomatis infection
arthritis may be seen in combination w urethritis/ cervicitis, conjunctivitis and mucocutaneous lesions

47
Q

what is extremely common STD that affects 50 million in the US? most caused by what? transmitted how?

A

Genital herpes simplex, most caused by HSV2 (less commonly HSV1) transmitted by direct contact

48
Q

neonatal herpes occurs in children born to mothers with genital herpes what is the mortality rate for these children?

A

60%

49
Q

diagnosis of genital herpes simplex is how

A

exfoliative cytology or biopsy show viral cytopathic effect, ballooning degeneration of epithelial cells w large, multinucleate Tzanck cells

50
Q

what is a extremely common Std that is responsible for a number of proliferative lesions on the genital mucosa that ca be benign or malignant? what is the most common form of this?

A

Human papillomavirus infection: HPV

most common condyloma acuminatum

51
Q

what is condyloma acuminatum? what is it caused by

A

caused by HPV 6 and 11. benign papillary nodules, frequently appear in clusters. anogenital region and oral mucosa. mother fetus transmission possible with vaginal delivery. malignant transformation of genital lesions can occurs but rare

52
Q

histology of condyloma acuminatum?

tx?

A

histology: papillary proliferation of squamous epithelium exhibiting koilocytic change
tx: surgical excision, laser tx, cryotherapy, imiquimod

Pathology Sp 16 (7 decks)

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