GU Flashcards
1 extratesticular neoplasm
spermatic cord lipoma
1 infection related urethral stricture
gonococcal
1 cause urethral stricture
iatrogenic
1 epididymis neoplasm
adenomatoid neoplasm
sites of urothelial cancer
bladder (90%), kidney (8%), ureter/urethra (2%)
1 non-organ based retroperitoneal malignancy
lymphoma
most common retroperitoneal soft tissue sarcoma subtype
liposarcoma
nerve sheath tumor (neurofibroma) sign
T2 target sign
difference between bicornuate and didelphys uterus
bicornuate: partial fusion of the lower uterine segment, with single cervix
didelphys: two separate lower uterine segments and two cervices
jack/mulberry stone composition
calcium oxalate
most common abnormality co-existing with mullerian duct abnormality
renal agenesis
most common uterine anomaly
septate uterus
most common location ectopic
ampullary fallopian tube
hypoenhancing subtype of RCC
papillary RCC
dot dash pattern pelvic ultrasound
short & long echogenic lines within an ovarian dermoid cyst
due to the presence of hair
Wunderlich syndrome
spontaneous nontraumatic renal hemorrhage
2/2 to:
- renal tumor (ex AML)
- vascular pathology (AVM, vasculitis)
- coagulopathy
- other renal pathology (cystic renal disease, nephritis)
causes medullary nephrocalcinosis
- medullary sponge kidney
- hyperparathyroidism
- renal tubular acidosis
- hypervitaminosis D
- milk-alkali syndrome
avascular plane of Brodel
renal parenchyma btwn 2/3 anterior and 1/3 posterior kidney on cross-section that is relatively avascular
- represents plane where anterior and posterior segmental renal artery branches meet
- relatively safe access route to pelvicalyceal system for nephrostomy insertion
teratoma def’n
germ cell tumour that originates from pluripotent germ cells that have been interrupted in their normal migration to the genital ridges
<10% in retroperitoneum
more common in females
bimodal age distrib: <6mo & early adult
mature vs immature teratoma
mature CYSTIC teratoma
- well-diff tissues from at least 2 germ cell layers
- predominantly CYSTIC but commonly have calc’n or fat
immature teratoma
- predominantly SOLID with scattered areas of calc’n and fat
- uncommon, young age group (<20yo)
ganglioneuroma def’n
- benign tumors from ganglion cells within sympathetic ganglia
- occur in retroperitoneum (extra-adrenal > adrenal) or posterior mediastinum
paraganglioma def’n
neoplasm of extra-adrenal chromaffin tissue
- in either sympathetic or parasympathetic paraganglia
- retroperitoneal paragangliomas usu from sympathetic paraganglia
- MC at organs of Zuckerkandl or paravertebral regions
syndromes with paraganglioma
multiple endocrine neoplasia 2 (MEN2)
neurofibromatosis 1 (NF1)
von Hippel Lindau (VHL)
hereditary paraganglioma syndromes (SDH mutations)
male urethral segments
prostatic, membranous, bulbous, penile
“Pet My Beautiful Pig”
- posterior urethra: prostatic & membranous
- anterior urethra: bulbous & penile
most common urethral neoplasm
squamous cell carcinoma (of anterior urethra)
anterior vs posterior urethra develops what kind of cancer
anterior urethra (lined by stratified squamous epithelium) develops squamous cell carcinoma
posterior urethra (lined by uroepithelium) develops urothelial carcinoma
Cowper’s glands & glands of Littre (lined by glandular epithelium) develop adenocarcinoma
compartments of female pelvic floor
anterior compartment: bladder, urethra
middle compartment: uterus, cervix, vagina
posterior compartment: rectum, anus
Isolated right sided varicocele
Evaluate for cancer (CT Abdo)
Hypo vascular RCC
Papillary
2nd most common (clear CSLL #1)
critical stage endometrial cancer
stage 2 –> cervical stroma invasion –> high risk lymph node mets & changes mgmt from TAH to radical
IA (<50% myometrium) to IB (>50%) also increases risk
critical stage cervical cancer
IIb parametrial invasion or involvement lower 1/3 of vagina (NOT ext to pelvic sidewall) = chemo/rads
IIa and below = spread beyond cervix = surgery
met to anterior wall upper 1/3 vagina is…
met to posterior wall lower 1/3 is…
90% upper genital tract
90% GI tract
ovarian follicle
dominant follicle
cyst
<1 cm follicle
1-2 cm dom’t follicle
>3 cm cyst
cancer transformation subtypes:
- endometrioma
- dermoid
- endometrioma - clear cell carcinoma (1%)
2. dermoid - squamous cell carcinoma (1%)
Meigs syndrome
- ascites
- pleural effusion
- benign ovarian tumor
distinguishing stages of prostate cancer
- stage II is confined by capsule
- stage IIIa extends through capsule
(IIIb involves seminal vesicles, nerve bundle)
determines treatment
Gleason grade, score, group
grade = histological pattern, 1-5 score = sum of 2 most common grades, most common goes first ex. 3+5=8 group = pattern scores to reflect risk, 3+4=grade2, 4+3=3, 1-5
money sequences for pirads
transitional zone = T2
peripheral zone = DWI
prostate cancer locations
peripheral = 70% transition = 20% central = 10%
acquired and congenital causes of seminal vesicle cyst
acquired:
- obstruction from BPH, chronic infxn
- prior prostate sx
congenital associations
- renal agenesis
- vas deferens agenesis
- ectopic ureter insertion
- polycystic kidney dz
testicular cancer spread
lymphatic (RP nodes level of renal hilum)
EXCEPT choriocarcinoma = hematogenous
risk factors testicular cancer
- cryptorchidism (both testicles)
- gonadal dysgenesis
- klinefelters
- trauma
- orchitis
- testicular microlithiasis
elevated betaHCG testicular cancers
seminoma
choriocarcinoma (nonS)
elevated AFP testicular cancer
mixed germ cell (nonS) yolk sac (nonS)
sertoli leydig seen in what syndrome & causes what?
seen in peutz jegers
causes gynecomastia
cystic fibrosis associated with what male congenital GU anomaly
congenital bilateral absence vas deferens
most common correctable cause infertility
varicocele
major complications associated with cryptorchidism
- malignant degeneration (both)
- infertility
- torsion
- bowel incarceration (indirect inguinal hernia)
NOT orchitis
RCC associated with sickle cell trait
Medullary RCC
Renal masses associated with Birt Hogg Dubé
Chromophobe RCC
Bilât oncocytomas
RCC in VHL
Clear cell
Associations of papillary RCC
Hereditary papillary RCC Transplant kidney (native kidney most commonly gets the cancer)
RCC staging
1 - kidney only and <7 cm
2 - kidney only and >7 cm
3 - in Gerota’s fascia but A) renal vein invasion B) IVC below diaphragm C) IVC above diaphragm
4 - beyond gerotas, ipsilat adrenal
Retroperitoneal contents
SADPUCKER
Suprarenal Aorta/IVC Duodenum (2nd/3rd) Pancreas (NOT tail) Ureters Colon (ascending/descending) Kidneys Esophagus (distal) Rectum (upper 2/3)
ddx striated nephrogram
- acute ureteral obstruction
- acute pyelonephritis
- medullary sponge kidney
- acute renal vein thrombosis
- radiation nephritis
- acute post contusion
- infantile polycystic kidney
1 location extra pulmonary Tb
kidneys
uric acid stone dx
HU <500 (lower than others)
little change in HU on dual energy CT
change of non uric acid stones on dual energy CT
higher HU at 80 kvp
lower HU at 140 kvp
uric acid ≠ change, or slight higher at 140
stone with biggest change on dual energy CT
calcium >1.25 low/high energy ratio
- 1 uric acid
- 25 cystine
stone type not seen on xray
ct
uric acid xray
indanivir ct
most common cause renal vein thrombosis in kids & adults
kids - umbilical vein catheter
adults - nephrotic syndrome
normal kidney RI
<0.7
PSV-EDV/PSV
leukoplakia vs malakoplakia
leukoplakia - premalignant, chronic irritation metaplasia, squamous cell
malakoplakia - not pregmalig, e coli, better w. abx
risk factors for TCC
- smoking
- azo dye
- cyclophosphamide
- aristolochic acid (balkan nephropathy)
- horseshoe kidney
- stones
- ureteral pseudodiverticulosis
- hereditary non polyposis colon cancer (type 2)
upper tract TCC risk lower
bladder TCC risk upper
upper tract TCC 40% risk lower
bladder TCC 4% risk upper
associations with squamous cell cancer of bladder
schistosomiasis suprapubic catheter (longstanding)
cancer type in:
urethra
prostatic urethra
urethral diverticulum
urethra - squamous
prostatic - TCC
diverticulum - adenocarcinoma
cushing disease vs syndrome
disease = pituitary adenoma making too much ACTH syndrome = every other cause
absolute washout
C+ - delayed/C+ - C-
>60% is adenoma
if C+ >120 HU do not call adenoma
relative washout
C+ - delayed/C+
>40% is adenoma
if C+ >120 HU do not call adenoma
pheo associated syndromes
VHL
MEN 2a/b
NFI, sturge weber, TS
wolman disease
aunt minnie
bilateral enlarged Ca2+ adrenals
risk factor adenoca of bladder
- urachus
- bladder exstrophy
