Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

RC > GU > Flashcards

GU Flashcards

1
Q

Stains to differentiate nephrogenic adenoma from bladder adenoCA and prostate adenoCA

A

Nephrogenic adenoma: AMACR+ PAX8+ NKX3.1-
Bladder adenoCA: AMACR- PAX8- NKX3.1-
Prostate adenoCA: AMACr+ PAX8- NKX3.1+

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Histologic features of nephrogenic adenoma

A

Thick basement membrane surrounding glands
tubular/glandular pattern
can appear pseudo-infiltrative
hobnail and single lining cells
eosinophilic intraluminal secretions

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Etiology of nephrogenic adenoma

A

Urothelial injury - infection, instrumentation, surgery, calculi
Reno-tubular seeding/metaplasia
Frequent in transplant patients

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Common locations of inflammatory myofibroblastic tumor

A

Mesentery, omentum, retroperitoneum most common
Can also happen in H&N, lung, bladder, gyne, CNS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Most common bladder tumor of childhood

A

Embryonal rhabodomyosarcoma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

4 criteria for urachal carcinoma

A

Tumor primarily located at dome or anterior wall
Epicentre of carcinoma is in muscularis propria with demarcation between tumor and overlying bladder mucosa
Lack of extensive cystitis cystica et glandularis
Absence of carcinoma of similar histology at another primary site

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Risk factors for bladder SCC

A

Schistosomiasis hematobium
bladder diverticula
Nonfunctioning bladder
transplant patients

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Squamous bladder lesions

A

SCC
Verrucous carcinoma
Squamous cell papilloma
Squamous metaplasia
Squamous diff in urothelial CA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

High risk subtypes of Urothelial CA

A

Nested
Micropapillary
Signet ring/plasmacytoid
Sarcomatoid
Undifferentiated

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Gene mutations associated with low grade and high grade urothelial CA

A

Low grade: FGFR3, HRAS
High grade: TP53, RB

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

T-staging for bladder CA

A

pTa - non-invasive papillary carcinoma
pTis - carcinoma in situ
pT1 - tumor invades LP
pT2a - invades superficial MP
pT2b - invades deep MP
pT3a - microscopically invades perivesicle soft tissue
pT3b - macroscopically invades perivesicle soft tissue
pT4a - extravesicle tumor invades prostatic stroma, uterus, vagina
pT4b - invades pelvic wall, abdominal wall

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

N-staging for bladder

A

pN1 - single LN met in true pelvis
pN2 - multiple LN mets in true pelvis
pN3 - LN mets to common iliac LNs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Morphologic features of invasion in urothelial CA

A

Irregularly shaped nests
Single cell infiltration
Absent basement membrane
Fingerlike projections in LP
Desmoplastic stromal response
Paradoxical differentiation
Pseudosarcomatous stroma
Myxoid stroma
Retraction artifact
Inflammation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Risk factors for urothelial CA

A

Smoking
Drugs (cyclophosphamide, phenacetine)
Exposures (aryl amines, radiation)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Helpful stains in diagnosing Urothelial CIS

A

CK20 - full thickness (normal is umbrella cells only)
p53 - strong nuclear
CD44 - absent or in basal cells only

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Morphologic patterns of urothelial CIS

A

Pleomorphic
Small cell
Pagetoid
Clinging
Undermining

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

DDx inverted papilloma

A

Inverted papilloma
Nested urothelial CA
Florid von Brunn nests
Florid cystitis cystica
Carcinoid tumor

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Spectrum of papillary urothelial lesions and how to distinguish them

A

Papilloma - PUNLMP - LGPUC - HGPUC

Features - thickness, mitoses, pleomorphism, disorganization, fusion/branching of papillae

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Causes of ureteral obstruction

A

Intrinsic - calculi, strictures, tumors, clots, neurogenic
Extrinsic - pregnancy, periureteral inflammation, endometriosis, tumors

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Hereditary renal tumors and their associated genes

A

VHL - renal cysts and CCRCC
Hereditary papillary RCC (MET oncogene) - bilateral PRCC
HLRCC (FH) - FH-deficient RCC
Birt-Hogg-Dube (BHD) - kidney oncocytoma & RCC
Tuberous Sclerosis (TSC1/2) - angiomyolipomas

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Stains to differentiate PRCC from CCRCC

A

PRCC: CK7+ CAIX cup-shaped
CCRCC: CK7- CAIX surrounds whole cell

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Grading of CCRCC

A

1 - nucleoli absent or inconspicuous & basophilic
2 - nucleoli conspicuous & eosinophilic at 40x but not 10x
3 - Nucleoli visible & eosinophilic at 10x
4 - extreme pleomorphism/tumor giant cells/sarcomatoid or rhabdoid diff

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What is a MEST and how to ddx from cystic nephroma

A

Mixed epithelial and stromal tumor
MEST is unencapsulated, variable cystic and solid while cystic nephroma is entirely cystic, encapsulated, and inhibin+

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Extrarenal manifestation of ARPKD

A

Congenital hepatic fibrosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Extrarenal manifestations of ADPKD

A

Liver cysts
Pancreas cysts
Lung cysts
Berry aneurysms
Mitral valve prolapse
DIverticuli

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Risk factors for penile SCC

A

BXO
UV exposure
Smoking
Phimosis
HPV

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Most common type of testicular lymphoma and age at presentation

A

DLBCL, >65yo

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Prognostication for mixed malignant teratoma and embryonal tumors

A

Clinical stage
Invasion
Proportion of components (More embryonal is worse, more mature teratoma better)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Characteristic histological finding in yolk sac tumor

A

Schiller-Duval body (papillae containing central blood vessel surrounded by clearing)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Variants of yolk sac tumor

A

Reticular/microcystic (most common)
Endodermal sinus
Papillary
Solid
Glandular
Polvesicular vitelline
Parietal
Hepatoid

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

DDx for high AFP

A

Yolk sac tumor
Pregnancy
HCC
Cirrhosis
Active hepatitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

Histologic features and staining pattern for choriocarcinoma

A

Blood lakes, two cell populations (large multi-nucleated syncytiotrophoblastic cells and mononuclear cytotrophoblasts)
Stains: SALL4+ Oct3/4- CD30-

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

Stain to differentiate embryonal from seminoma

A

Both OCT3/4+
CD30- in seminoma
CD30+ in embryonal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

Histologic features of embryonal carcinoma

A

3 main growth patterns: solid, glandular, papillary
Large, cohesive, highly pleomorphic tumor cells
Indistinct cell borders
hemorrhage and necrosis common

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

GCNIS associated and non-associated GCTs

A

GCNIS-associated: Seminoma, embryonal CA, Chorio CA, yolk sac, post-pub teratoma
Non-GCNIS-associated: spermatocytic tumor, prepubertal yolk sac, prepubertal teratoma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

+ stains in GCNIS

A

OCT3/4
PLAP
CD117
D2-40

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

Staining profile of seminoma

A

OCT3/4+
CD117+
D2-40+
PLAP+
CD30-
CK-
Inhibin-F

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

Features of regressed seminoma

A

Fibrous scar - necrosis or intratubular calcification
GCNIS
Atrophic background testicular parenchyma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

Histologic features of seminoma

A

Fibrous septae divide sheets/nests of tumor cells
Large round polygonal tumor cells with clear cytoplasm
Distinct cell membranes
Lymphoplasmacytic infiltrate in fibrous septae

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

Malignant features of Leydig and Sertoli cell tumors

A

Size >5cm
Mits >5/hpf
Necrosis
Hemorrhage
Nuclear pleomorphism
Invasive edges

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

Features of Leydig cell tumor

A

Histology: diffuse/nodular growth of polygonal cells with eosinophilic cytoplasm, uniform round nuclei and prominent central nuceoli, may have Reinke crystals
IHC: Inhibin+ MelanA+ Calretinin+ AR+ CD99+ WT1+
Clinical: gynecomastia, decreased libido, precocious puberty
Bimodal age distribution: 5-10, 30-35

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

Syndromes associated with Sertoli cell tumor

A

Carney complex
Peutz-Jegher
FAP

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

Causes of testicular atrophy

A

Cryptorchidism
Atherosclerosis
Cachexia
Chemo/rads
Female sex hormones
Exhaustion from FSH stimulation
Kleinefelter syndrome
Mumps/inflammatory orchitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

Features of testicular atrophy

A

Thickening of seminiferous tubule basement membrane
Intertubular fibrosis
Increased leydig cells
Decreased sperm
Decreased gross size

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

DDx for paratesticular tumors

A

Adenomatoid tumor
Mesothelioma
Lipoma/liposarcoma
Embryonal rhabdomyosarcoma
AdenoCA of rete testes/epididymis
Papillary serous CA
Leiomyoma/leiomyosarcoma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

Sites of adenomatoid tumors and cell of origin

A

Paratesticular
Epididymis
Spermatic cord
Uterus
Fallopian tube
Adrenal gland

Mesothelial origin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

Etiology of spermatic granuloma and clinical name of nodules

A

Hx of vasectomy
Vasitis nodosa

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

Causes of granulomatous orchitis and workup

A

Traumatic
TB
Syphilis
Sarcoid
BCG treatment
Seminoma
PAS, ZN, GMS, Silver

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

Risk factors for RCC

A

Smoking
Obesity
HTN
Unopposed estrogen therapy
Asbestos, petroleum products, heavy metals
Chronic renal failure
Acquired cystic disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

Syndromes associated with RCC

A

Birt-Hogg-Dube (BHD)
Tuberous sclerosis (TSC1/2)
Von Hippel Linday (VHL)
Hereditary (Familial) clear cell carcinoma
Hereditary papillary RCC
Familial leiomyomatosis and renal cell carcinoma syndrome (FH)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

Paraneoplastic syndromes associated with RCC

A

Polycythemia
Hypercalcemia
HTN
Hepatic dysfunction
Feminization or masculinization
Cushing syndrome
Eosinophilia
Leukemoid reactions
Amyloidosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

Critical areas to sample when grossing a kidney tumor

A

Margins: rein vein, ureter, renal artery, soft tissue margins
Tumor: 1 section per cm, specifically any areas that stand out to look for grade 4 features
Upstaging: Large vessel invasion, renal sinus fat invasion, collecting duct involvement, perinephric fat invasion
Background normal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

Gross appearance of common renal cell tumors

A

Clear cell: solitary, well-circumscribed with golden yellow colour, may have cystic change, hemorrhage, necrosis, calc, fibrous areas
Sarcomatoid areas of RCC: grey-white “fish flesh”
Papillary: Well-circumscribed, fibrous pseudocapsule, necrosis, hemorrhage, more likely than the others to be bilateral or multifocal
Chromophobe: Solitary, round, well-circumscribed, unencapsulated, tan to light brown colour, may have central scar
Oncocytoma: well circumscribed, mahogany-brown to tan with central or eccentric scar
Angiomyolipoma: well-demarcated, unencapsulated, colour depends on proportions of different components

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
54
Q

Features to include in RCC report

A

Histotype
Involvement of renal vein/branches, renal sinus, perinephric adipose tissue, collecting system
WHO/ISUP nuclear grade
Vascular invasion
Sarcomatoid morphology and quatity
Geographic necrosis
Margins
Any other tissue involved
Background kidney parenchyma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
55
Q

Grading for RCCs

A

I: Nucleoli not prominent even at 40x
II: Nucleoli apparent but not prominent at 10x
III:: Nucleoli prominent at 10x
IV: Rhabdoid, sarcomatoid diff, tumor giant cells/bizarre pleomorphism

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
56
Q

Immunoprofile for clear cell RCC

A

CAIX +
CD10/vimentin+
CK7- (usually)
AMACR+
CD117-

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
57
Q

Prognosis of clear cell RCC

A

1/3 of patients with localized disease develop local and distant recurrence. Half die of disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
58
Q

Distinguish papillary adenoma vs papillary RCC

A

<1.5cm
Low nuclear grade

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
59
Q

Histologic features of chromophobe RCC

A

Solid with occasional tubulocystic architecture
Broad fibrous septae
Nuclei are irregular, hyperchromatic, wrinkled contours and occasional multinucleation
Chromophobe cell - large poygonal with thick plantlike cell borders and finely vesicular cytoplasm
Eosinophilic cell - less abundant granular eosinophilic cytoplasm and perinuclear halo

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
60
Q

Histologic features of oncocytoma

A

well circumscribed, compact nested growth
Eosinophilic cells with indistinct membrane, granular cytoplasm, round to ovoid nuclei
Small and conspicuous nucleoli may be present
May have bizarre degenerative atypia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
61
Q

Prognosis for chromophobe RCC

A

better than clear cell
Mortality <10%
5 year disease survival >90%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
62
Q

Genetic syndrome associated with multiple chromophobe RCCs and oncocytomas

A

Birt-Hogg-Dube
Cutaneous fibrofolliculomas, pulmonary cysts, multifocal renal tumors
Can have hybrid tumors (HOCTs) associated with FLCN gene

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
63
Q

Histologic features of rhabdoid tumor of kidney

A

Sheets of large cells with vesicular nuclei, eosinophilic cytoplasmic inclusions, and infiltrative borders

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
64
Q

IHC for rhabdoid tumor of kidney

A

Vimentin+
Focal EMA+
CK+

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
65
Q

DDx for rhabdoid tumor of kidney

A

Nephroblastoma
Neuroblastoma
Mesoblastic nephroma
Medullary RCC
Clear cell sarcoma of kidney with focal rhabdoid features

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
66
Q

Reporting of sarcomatoid features in nephrectomy specimens

A

Give % of sarcomatoid element
Should be classified as unclassified RCC if: pure sarcomatoid CA or sarcomatoid CA associated with epithelial elements that do not confirm to usual types of RCC

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
67
Q

Sections to assess for microscopic tumor extension in RCC

A

Perinephric soft tissues
Renal sinus
Gerota Fascia
Major vein
Pelvicalyceal system
adrenal gland
other organs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
68
Q

Common location for underrecognized extrarenal extension

A

Renal sinus fat

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
69
Q

Margins in partial and radial nephrectomy

A

Partial: renal parenchyma, perinephric fat
Radical: ureteric, vascular, soft tissue

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
70
Q

T classification of RCC

A

pT1: <7cm limited to kidney
pT1a: <4cm, limited to kidney
pT1b: 4 cm < tumor <7 cm, limited to kidney
pT2: >7cm limited to kidney
pT2a: 7 < tumor < 10cm
pT2b: >10cm
pT3: Extends into major veins or perinephric tissues but not into adrenal gland or beyond Gerota’s
pT3a: renal vein or segmental branches, perirenal/renal sinus fat
pT3b: extends into vena cava below diaphragm
pT3c: extends into vena cava above diaphragm
pT4: beyond Gerota’s, including into adrenal gland

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
71
Q

Risk factors for testicular germ cell tumors

A

Caucasian
Previous contralateral GCT
Testicular dysgenesis syndrome
Cryptorchidism
Testicular microlithiasis
FHx

72
Q

Molecular abnormality in GCTs

A

Isochromosome 12p

73
Q

Classification of testicular GCTS

A

Seminomatous tumors
Non-seminomatous tumors: Embryonal CA, yolk sac tumor, chorioCA, Teratoma, spermatocytic tumor
Mixed GCTs

74
Q

Biomarkers for testicular GCTs

A

LDH
AFP
B-HCG

75
Q

Precursor lesions of GCTs

A

GCNIS
Intratubular seminoma
Intratubular nonseminoma

76
Q

IHC positive in GCNIS

A

PLAP
OCT3/4
CD117
D2-40

77
Q

Non-GCNIS associated GCTs

A

Prepubertal type yolk sac tumor
Prepubertal type teratoma, including dermoid cyst, epidermoid cyst and well diff NET
Prepubertal type mixed teratoma and yolk sac tumor
Spermatocytic tumor

78
Q

IHC to differentiate major GCTS

A

GCNIS pattern: Pos PLAP, OCT3/4, CD117, D2-40
Seminoma: GCNIS pattern, CK variable, CD30-, AFP-, BHCG-
Embryonal: GCNIS pattern, CK+, CD30+, AFP variable
Teratoma: non-GCNIS pattern, CK+, focal AFP
Yolk sac: Non-GCNIS, CK+, CD30 variable, AFP+
Chorio: CK+ PLAP+ OCT3/4- B-HCG+
Spermatocytic tumor: PLAP variable, otherwise neg

79
Q

You are about to sign out a pure seminoma and check the serum markers to find the AFP is very elevated. How can this be explained? Assume the tumor is fully submitted

A

After ruling out other systemic causes of elevated AFP, consider if the seminoma has metastasized and acquired a yolk sac component. It’s not uncommon that seminomas will differentiate into other GCTs after metastasis.

80
Q

You are about to sign out a non-chorio GCT and check the serum markers to find the B-HCG is mildly elevated. How can this be explained? Assume the tumor is fully submitted

A

Non-ChorioCA GCTs can have syncytiotrophoblast components, which can cause a mild increase in B-HCG. Chorios should have a much higher serum B-HCG

81
Q

Recommendations for sampling a testicular tumor

A

SIT if </=10 blocks, if >10, 1 block/cm
Sample tumor, interface with surrounding testis and tunica albuginea (best for LVI)
All grossly unique appearing areas
testicular hilum/mediastinum testis
uninvolved testis, including tunica albuginea
epididymis
spermatic cord, including cord margin
any other lesions
all identifiable lymph nodes

82
Q

Features to report for testicular GCTs

A

Tumor types and quantities of each
Tumor size
Involved structures
LVI
Margin status
Background parenchyma - GCNIS and spermatogenesis

83
Q

Features of testicular scar
Significance of testicular scar

A

May represent regressed/burnt out GCT
If residual disease, partial regression may signify that one of the components has regressed
Criteria for diagnosis: Scar associated with GCNIS or intratubular calcs
Other features: lymphoplasmacytic infiltrate, hemosiderin-lade macrophages, testicular atrophy

84
Q

Clinical behaviour of sertoli cell and leydig cell tumors

A

Most are benign
~10% are malignant

85
Q

Histologic features of classic seminoma

A

Sheets and lobules of loosely cohesive cells divided by fibrous septa containing lymphocytes and plasma cells
Round or polygonal cells with sharp cell membrane, clear-to-eosinophilic cytoplasm
Large and vesicular nuclei with prominent nucleoli
Possible areas of necrosis, syncytiotrophoblasts

86
Q

Typical presentation of pure classic seminoma

A

Peak incidence between 4th and 5th decade
In 75% of patients, disease confined to testis at presentation
in 20% of patients, disease involves retroperitoneum
in 5%, involvement above diaphragm, or visceral mets

87
Q

Variant of seminoma associated with elevated serum B-HCG

A

Seminoma with syncytiotrophoblasts
Variant of classic seminoma NOT a mixed GCT
Prognosis similar to classic seminoma

88
Q

Prognosis for patients with classic seminoma

A

Excellent
Very responsive to radiotherapy

89
Q

Histologic features of spermatocytic tumor

A

Cells arranged in sheets in an edematous stroma
Three cell types (three bears appearance): small with smudged chromatin and scant cytoplasm, intermediate with scant cytoplasm and round nuclei with granular/filamentous chromatin, large/giant uni/multinucleate
Little or no interventing stroma and no or scant lymphocytic infiltrate
Absence of GCNIS

90
Q

Prognosis for spermatocytic tymor

A

Excellent prognosis
Treated with resection

91
Q

IHC pattern of spermatocytic tumor

A

PLAP: variable, rare pos
CD117: 40-50% pos
other GCT markers: neg
Keratins: neg
Cam5.2: 40% pos

92
Q

Behaviour of adult vs childhood testicular teratomas

A

Childhood: mature teratoma considered benign, immature requires close follow up
Postpubertal males: majority regarded as malignant and capable of mets regardless of maturity of tumor elements

93
Q

Common sites of teratomas in adults and children

A

Adults: testes and ovaries
Children: Sacrococcygeal sites

94
Q

Most common types of testicular lymphoma in order of frequency

A

Most: DLBCL
Burkitt
Least: EBV+ extranodal NK/T cell lymphoma

95
Q

Behaviour of testicular lymphomas vs lymphomas arising at different sites

A

Testicular lymphomas have higher propensity for CNS involvement than similar histology lymphomas at other sites

96
Q

Most common benign spermatic cord tumor

A

Lipoma

97
Q

Most common benign paratesticular tumor

A

Adenomatoid tumor

98
Q

Most common malignant paratesticular tumor in children

A

Rhabdomyosarcoma

99
Q

Most common malignant paratesticular tumor in adults

A

Liposarcoma

100
Q

Margins in testicular resection

A

Spermatic cord margin
Parietal layer of tunica vaginalis
Scrotal skin

101
Q

Staging of tumors involving rete testis, epididymis, testicular hilar soft tissue, tunica vaginalis

A

Rete testis: Does not upstage if limited to testis and no vascular invasion
Epididymis/hilar soft tissue/penetration of visceral mesothelial layer of tunica vaginalis: pT2

102
Q

Significance of venous or lymphatic vessel invasion

A

LVI associated with increased risk of distant mets

103
Q

Reporting criteria for lymph nodes in GCTs

A

Number of nodes
Size of largest involved node
Size of largest metastatic deposit
Extranodal extension
Histologic subtypes

104
Q

Staging of testicular tumors

A

pTis - GCNIS
pT1 - tumor limited to testis without LVI
Seminoma only: pT1a: <3cm
Seminoma only: pT1b: >3cm
pT2: tumor limited to testis with LVI or invasion into hilar soft tissue or epididymis or visceral mesothelium of tunica albuginea
pT3: tumor invades spermatic cord
pT4: tumor invades scrotum

105
Q

Common additional pathologic findings reported in testicular neoplasms

A

Leydig cell hyperplasia (may be correlated with B-HCG elevation)
Regressed tumor
Intratubular calcs
Testicular atrophy
Abnormal testicular development

106
Q

Importance of differentiating metastatic residual teramtoma from nonteratomatous GCTs in the postneoadjuvant setting

A

Pure teratomatous mets are generally treated with surgical excision
Other residual GCTs usually need additional chemo

107
Q

Nodal staging for testicular neoplasms

A

pN0: no regional nodal mets
pN1: Lymph node mass </=2cm and </=5 nodes positive none >2cm in max dimension
pN2: Met >2cm and </=5cm, >5 nodes positive, none >5cm or evidence of extranodal extension of tumor
pN3: mets >5cm

108
Q

Types of metaplasia in the urinary bladder and their significance

A

Intestinal metaplasia in cystitis cystica and cystitis glandularis - w/o dysplasia has no adenoCA risk, with dysplasia has increased risk
Squamous metaplasia - nonkeratinizing usually not associated with increased SCC risk, keratinizing risk factor for SCC
Nephrogenic metaplasia/adenoma - benign process that is a malignant mimic

109
Q

Pathogenesis of nephrogenic adenoma/metaplasia

A

Derived from renal tubular epitheluial cells and not actually metaplasia
Associated with: calculi, instrumentation, trauma, cystitis

110
Q

Histologic features of nephrogenic adenoma

A

Tubular (most common), cystic, polypoid, papillary, and polypoid patterns
Cuboidal to low columnar epithelium to scant cytoplasm; hobnail cells
Hyalin around tubules in basement membrane

111
Q

Anatomic sites where nephrogenic adenoma may be found

A

Urinary bladder
Ureter
Urethra
Renal pelvis

112
Q

Risk factors for urothelial CA

A

Smoking
Aryl amine exposure
Long time analgesic use
Cyclophosphamid exposure
Irradiation

113
Q

Prognosis of flat urothelial lesions

A

Urothelial proliferation of uncertain malignant potential - if not associated with any papillary lesions, no follow up needed
AUS - predominantly good outcomes
Urothelial dysplasia, low grade - marker of urothelial instablity denoting progression and recurrence
CIS - Mortality if 7-15% is not associated with invasion

114
Q

Prognosis of papillary urothelial lesions

A

Urothelial proliferation of uncertain malignant potential - continued monitoring required, due to associated with papillary neoplasia
Papilloma - favourable clinical course
PUNLUMP - Excellent prognosis, lower recurrence rate that LGPUC
LGPUC - Recurrence in 50-70%, progression and death in <5%
HGPUC - Profession to invasion in 15-40% of cases

115
Q

Prognosis of invasive urothelial carcinoma

A

5y survival ~70% in pT1
Variable survival rates in pT2-T4

116
Q

Common variants of urothelial CA known to behave more aggressively

A

Small nested
Micropapillary
Sarcomatoid
Plasmacytoid/signet ring
Undifferentiated

117
Q

Common alterations found in urothelial CA

A

LGPUC - FGFR3
HGUC/invasive CA - TP53, RB1

118
Q

Prognostic factors to report in urothelial CA cystectomy specimens

A

Grade
Tumor extension/depth of invasion
Associated flat CIS
Resection margins
LVI and lymph node mets

119
Q

Morphologic features that suggest invasion of urothelial CA

A

Irregularly shaped nests and single cell infiltration
Absent basement membrane
Fingerlike projections into LP
“Paradoxical differentiation”
Desmoplastic stromal response
Myxoid stroma
Pseudosarcomatous stroma
Retraction artifact
Inflammation

120
Q

Nonurothelial carcinoma of the bladder and their risk factors

A

SCC - Schistosomiasis hematobium, bladder diverticuli, nonfunctioning bladder, transplant patients
AdenoCA - nonfunctioning bladder, exstrophy, intestinal metaplasia, urachal remnant

121
Q

Location of urachal adenoCA

A

Muscular wall of bladder dome

122
Q

Subtypes of urachal adenoCA

A

Mucinous
Enteric
Signet ring cell
NOS
Mixed

123
Q

Importance of distinguishing urachal and nonurachal adenoCA in the urinary bladder

A

Resection of urachal adenoCA must include removal of entire urachal remnant
Urachal CAs are frequently amenable to partial cystectomy as they are usually found along the free surface of the bladder

124
Q

IHC to distinguish urachal and colonic adenoCA

A

no reliable IHC
B-catenin typically nuclear in colonic and non-nuclear in urachal

125
Q

Clinical settings of postoperative bladder spindle cell nodules

A

Within three months of previous resection
Nodule at surgical site

126
Q

Histologic features of postoperative spindle cell nodule in the bladder

A

Interlacing fascicles of mitotically active spindle cells with uniform nuclei and little pleomorphism
Delicate vasculature, scattered inflammatory cells, small foci of hemorrhage, edema, focal myxoid change

127
Q

Main histologic differential diagnosis of postoperative spindle cell nodule in bladder and key IHC to differentiate

A

Inflammatory myofibroblastic tumor
ALK

128
Q

DDx not to miss for postoperative spindle cell nodule of the bladder

A

IMT
Sarcomatoid CA
Leiomyosarcoma

129
Q

Common postoperative lesions/changes in the bladder

A

Spindle cell nodule
Post-surgical necrobiotic granulomata
Nephrogenic adenoma
Eosinophilic inflammation/cystitis

130
Q

Required elements for reporting TURBTs and biopsy

A

Procedure
Tumor tyoe
Histologic type
associated epithelial lesions
Histologic grade
Adequacy of material for determining muscularis propria invasion
LVI
Microscopic tumor extension

131
Q

Reporting of invasion in urothelial CA

A

Extent of LP invasion (eg focal, mm, relation to muscularis mucosae)
Need to denote muscularis mucosa or propria as invaded

132
Q

Significance of tumor next to fat on bladder biopsy

A

No significance. Fat common in LP and submucosa
Can only diagnose extravesical extension on cystectomy

133
Q

Margins in radical cystectomy

A

Ureteral
Distal urethra
Deep soft tissue

134
Q

How to distinguish SCC or adenoCA from urothelial CA with aberrant squamous or glandular differentation

A

Requires pure SCC or adenoCA histology
If papillary, invasive, or flat CIS OR present urothelial component, best to call it urothelial

135
Q

Staging considerations for neoplasms of upper urinary tract

A

Depth of invasion and stage most important for prognosis
In the reval pelvis, tumor type impacts staging (pT3 vs pT4)
LP is absent beneath urothelium that lines renal papillae in pelvis and thin along minor calycesRe

136
Q

Regional LNs for renal pelvis and for ureter

A

Renal pelvis: renal hilar, paracaval, aortic, retroperitoneal
Ureter: renal hilar, iliac, paracaval, periureteral, pelvic

137
Q

Residual Ureter/renal pelvis tumor classification

A

RX: residual tumor cannot be assessed
R0: no residual tumor
R1: microscopic residual tumor
R2: macroscopic residual tumor

138
Q

How to gross segmental ureterectomy

A

Record length and diameter of intact ureter
Ink outer aspect
Take proximal and distal cross section margins
Open ureter longitudinally
Take sections to demonstrate deepest level of invasion
Take a section of uninvolved ureter

139
Q

How to gross radical nephroureterectomy with bladder cuff

A

Document and sample relationship of tumor to adjacent renal parenchyma, peripelvic fat, nearest soft tissue margin, ureter
Ink outer aspect of ureter and open ureter longitudinally
Take sections to demonstrate deepest level of invasion
Submit bladder cuff margin as a shave
Submit section of unremarkable kidney, pelvis, and ureter

140
Q

T staging for renal pelvis tumors

A

pTa: noninvasive papillary tumor
pTis: flat CIS
pT1: tumor invades LP
pT2: tumor invades MP
pT3: renal pelvis only: tumor invades beyond muscularis into peripelvic fat or into renal parenchyma
Ureter only: tumor invades beyond muscularis periureteric fat

141
Q

N staging for renal pelvis and ureter tumors

A

pN1: met in single regional LN </=2cm in greatest dimension
pN2: met in single regional LN >2cm or multiple LNs

142
Q

Impact of anatomic location on tumor type in urethral tumors

A

In women, SCC is most common histologic subtype (75%) and most common in anterior urethral. Urothelial CA next in frequencym followed by adenoCA (10-15% each) including clear cell adenoCA
In men, tumor tumors involve bulbomembranous urethra followed by pensile urethra and prostatic urethra. 80% of CAs of urethra are SCC, followed by urothelial. Urethral adenoCAs rare in men

143
Q

Reporting of depth of invasion in urethral CAs

A

Surrounding anatomic structures vary by location and sex
In prostatic urethra, invasion may arise from a tumor lining urethral lumen or from CIS colonizing prostatic ducts
Invasion arising from prostatic ducts is designated at least pT2

144
Q

Sections to submit in urethral tumors

A

Transurethral specimen - 1 section per cm or more to dx or r/o invasion
Urethrectomy: 1 section per cm focusing on areas of deepest invasion
Document tumor in relation to surrounding structures
Submit distal and proximal margins
Ink and submit radial soft tissue margins
Submit several sections or urinary bladder mucosa as urothelial CA often multifocal
Representative sections of prostate and seminal vesicles to r/o concomitant prostatic CA

145
Q

T staging of urethral CA (non-prostatic urethra)

A

pTa: noninvasive papillary CA
pTis: CIS
pT1: tumor invades subepithelial connective tissue
pT2: tumor invades corpus spongiosum or periurethral muscle
pT3: tumor invades corpus cavernosum or anterior vagina
pT4: tumor invades adjacent organs (eg bladder wall)

146
Q

T staging of urethral CA in prostatic urethra

A

pTa: noninvasive papillary, polypoid, or verrucous carcinoma
pTis: CIS involving prostatic urethra or periurethral or prostatic ducts without stromal invasion
pT1: tumor invades urethral subepithelial connective tissue immediately underlying the urothelium
pT2: tumor invades the prostatic stroma surrounding ducts either by direct extension or by invasion from the prostatic ducts
pT3: tumor invades the periprostatic fat
pT4: tumor invades adjacent organs

147
Q

Subtypes of penile SCC with better prognosis

A

Verrucous CA
Warty CA
Papillary CA
Pseudohyperplastic CA

148
Q

Subtypes of pensile SCC with worse prognosis

A

Basaloid
Sarcomatoid

149
Q

Risk factors for penile SCC

A

Phimosis
Chronic inflammatory conditions (eg BXO)
Smoking
UV radiation
HPV

150
Q

Classification of penile intraepithelial neoplasia (PeIN)

A

Undifferentiated PeIN - HPV-associated, p16 pos
Differentiated PeIN - non-HPV associated, p16 neg, p53 mutant usually

151
Q

Reporting parameters for penile SCC

A

Histologic grade and type
Extent of invasion
Maximum depth measurement
LVI
PNI
Resection margin status
Associated lesions - CIS, dysplasia, BXO etc

152
Q

Grossing of circumcision specimens

A

Measure, describe, identify and describe any abnormality
Identify and ink mucosal and cutaneous margins with different colours
Most SCCs arise from mucosal surface
Lightly stretch and pin specimen. FIx for several hours in formalin. Cut vertically through urethra in 12 to 6 o’clock plane to divide penile glans, foreskin, and shaft into left and right portions

153
Q

Grossing of penectomy specimen

A

Measure, describe, identify and describe any abnormality
Describe foreskin, if present
Cut proximal margin en face, making sure to inlude circumference of urethra (which tends to retract)
Submit skin of shaft with dartos and fascia with corpora cavernosa
Fix remaining specimen
Cut specimen longitudinally and centrally to separate into left and right halves
Serially section

154
Q

Site from which penile SCCs arise

A

Distal epithelium (glans, coronal sulcus, mucosal surface of prepuce)

155
Q

Types of invasion in penile SCC and their significance

A

Infiltrating vs pushing
Infiltrating has higher risk for nodal invasion

156
Q

Histologic subtypes of penile SCC and their prognostic risk groups

A

low-risk: verrucous, papillary, warty/condylomatous, pseudohyperplasia, carcinoma cuniculatum
Intermediate-risk: usual type SCC, mixed neoplasm, high grade variants of warty/condylomatous CA
High-risk: basaloid, sarcomatous, adenosquam, poorly differentiated SCC of usual type

157
Q

Grading of penile SCC

A

Grade 1: extremely well differentiated
Grade 2: more disorganized growth with higher nuclear atypia
Grade 3: any proportion of anaplastic cells, solid sheets or small aggregates with little to no keratinization, more nuclear atypia
Report any proportion of grade 3

158
Q

Tumor depth/thickness measurement in penile SCC

A

Measurement from epithelial-stromal junction of adjacent nonneoplastic epithelium to deepest point of invasion

159
Q

How is DOI correlated with prognosis of penile SCC

A

Minimal risk for mets in tumors <5mm
Tumors invading deeoer into penile anatomical levels are usually associated with higher risk for nodal involvement
Depth usually associated with grae
tumors invading into corpus cavernosum at higher risk than those invading into corpus spongiusum

160
Q

Penile resection margins

A

Proximal urethral and surrounding periurethral cylinder (epithelium LP, corpus spongiosum, and penile fascia)
Proximal shaft with corresponding corpora cavernosa separated and surrounded by tunica albuginea and Buck Fascia
Skin of shaft with underlying dartos and penile fascia
In circumcisions: coronal sulcus margin and cutaneous margin

161
Q

Most important predictive factors of mortality in penile tumors 5-10mm thick

A

Histologic grade
PNI

162
Q

Factors that best predict nodal mets and survival in penile

A

Histologic grade
DOI
PNI

163
Q

T stage for penile CA

A

pTis: CIS (PeIN)
pTa: noninvasive localized SCC
pT1: glans: tumor invade LP
Foreskin: tumor invades dermis, LP or dartos fascia
Shaft: tumor invades connective tissue between epidermis and corpora regardless of location
pT1a: tumor is without LVI or PNI and is not high grade
pT1b: tumor has LVI or PNI or is high grade
pT2: tumor invades into corpus spongiosum with or withour urethral invasion
pT3: TUmor invades into corpora cavernosum with or withour urethral invasiion
pT4: tumor invades adjacent structures

164
Q

Gleason patterns

A

3: discrete glands
4: Fused glands, cribriforming, glomerulations,
5: no glandular formation, comedonecrosis

165
Q

Gleason grade group

A

GG1: 3+3 = 6
GG2: 3+4 = 7
GG3: 4+3 = 7
GG4: 4+4 or 5+3 = 8
GG5: 5+4, 4+5, 5+5 = 9-10

166
Q

Define tertiary gleason pattern

A

<5% of a higher grade pattern in a resection specimen

167
Q

Define prostatic intraductal CA

A

Proliferation of malignant prostatic epithelial cells within ducts and acini that have intact basal cells

168
Q

Histologic criteria for prostatic intraductal CA

A

Expanded duct
>70% of space filed with solid/loose/cribriforming growth
Nucleomegaly (5-6x usual size)
Intact basal cell layer
May have comedonecrosis

169
Q

Association of prostatic intraductal CA

A

High volume, high grade prostate CA
Metastatic disease
Worse prognosis

170
Q

What is the diagnosis when the criteria for prostatic intraductal CA are partially but not completely met?

A

Atypical intraductal proliferation (AIP)

171
Q

Criteria for prostatic intraductal CA

A

Duct 2-3x the size of adjacent gland
At least 70% full of tumor cells
Cribriforming architecture
Basal cells present

172
Q

AMACR negative prostate CAs

A

Pseudohyperplastic (75%)
Atrophic (65%)
Foamy (65%)
Conventional (20%)

173
Q

AMACR positive benign prostate lesions

A

Nephrogenic adenoma (60%)
Atrophy (25%)
Adenosis (10%)

174
Q

IHC to help differentiate primary vesicle adenocarcinoma vs colorectal adenocarcinoma involving the bladder

A

Nuclear B-catenin in CRC (>90%)

175
Q

Pan GCT IHC marker

A

SALL4

176
Q

HPV-associated histotypes of penile SCC

A

Basaloid
Papillary-basaloid
Warty
Warty-basaloid
Clear cell
Lymphoepithelioma-like

177
Q

non-HPV associated histotypes of penile SCC

A

Usual type
Pseudohyperplasic
Pseudoglandular
Verrucous
Papillary
Adenosquamous
Sarcomatoid

RC (20 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions