Kidney and Urinary Tract Disease - Urogenital Pathology (32) Flashcards
Enlargement of the prostate is also known as
Nodular hyperplasia or benign prostatic hyperplasia
Enlargement of prostate consists of
Overgrowth of epithelium and fibromuscular tissue of the transition zone and periurethral area
Symptoms of enlarged prostate are caused by
Interference with muscular sphincteric function and obstruction of urine flow through prostatic urethra
Symptoms of enlarged prostate include
Urgency, difficulty in starting urination, diminished stream size and force, increased frequency, incomplete bladder emptying and nocturia
4 distinct regions of prostate
- Central zone (CZ)
- Peripheral zone (PZ)
- Transitional zone (TZ)
- Periurethral zone
Most carcinomas arise from which part of the organ
Peripheral glands, may be palpable during digital examination of rectum
Where does nodular hyperplasia occur?
More central glands, more likely to produce urinary obstruction earlier than carcinoma
Three pathological changes in development of nodular hyperplasia
- Nodule formation
- Diffuse enlargement of the TZ and periurethal tissue
- Enlargement of nodules
Which pathological changes predominate among
Diffuse enlargement of the TZ and periurethral tissue
Which pathological changes predominate among >70yrs?
Nodule formation and enlargement
Aetiology of enlarged prostate
- Impaired cell death > accumulate of ageing cells
- Androgens cause development BPH > increase cellular proliferation and inhibit cell death
Prostatic adenocarcinoma affects which age and ethnicity group?
Over 40 years, African ancestry
Management
Surgery, radiation therapy, hormone manipulations (90% 15 yrs)
- Radical prostatectomy
- External-beam radiation therapy
- Interstitial radiation therapy (brachytherapy)
Risk factors
Age, race, family history, hormone levels (androgens), environmental influences (increased fat), inherited polymorphisms, germline mutations of tumour suppressor BRCA2
If inherit BRCA2 gene, how much more likely are you to get prostate cancer?
20 times
Grading system
Gleason
Screening
None available - limited benefits/false positives and negatives
Testicular cancer epidemiology
Highest among men of northern European ancestry
Pre-existing medical conditions associated with Testicular germ cell tumours
Prior TGCT in contralateral testicle, cryptorchidism, impaired spermatogenesis, inguinal hernia hydrocele, disorders of sex development, atopy, testicular atrophy
Seminoma common in
35-45 year olds
Teratoma common in
First and second decades of life
Seminoma clinical presentation
Testicular enlargement (with/without pain) and metastases, asymptomatic
Rare symptoms of seminoma
Gynecomastia, exophthalmos, infertility
Teratoma clinical presentation
Gradual testicular swelling with/without pain
Seminoma tumour markers
Elevated serum PLAL and hCG (gynecomastia)
Teratoma tumour markers
None
Macroscopically seminoma
Well-demarcated, cream-coloured, homogeneous and coarsely lobulated
Microscopically seminoma
Monotonous polygonal cells - clear cytoplasm and central nuclei divided into lobules by thin bands of fibrovascular stroma
Macroscopically teratoma
Well-demarcated solid/multicystic
Microscopically teratoma
Admixture of ectoderm, endoderm and mesoderm
Acute and chronic epididymoorhcitis
Infarcted seminiferous tubules, purulent exudate (neutrophils)
Idiopathic granulomatous orchitis occurs in
Older adults
Idiopathic granulomatous orchitis symptoms
Like-UTI/trauma/flu-like illness, testis become swollen, painful and tender > residual mass indistinguishable from neoplasm (orchiectomy)
Sarcoidosis of the testis
Mimic malignancy, non-necrotising granulomas involving testicular parenchyma (acid-fast bacilli and fungal negative)
Malakoplakia of testis
Affects testis +/- epididymis, soft yellow/tan/brown nodules, replaced normal testicular parenchyma, tubules and interstitial infiltrated by large histiocytes (abundant eosinophilic granular cytoplasm) (Von Hansemann histiocytes)
Myofibroblastic pseudo tumour of testis
Atypical inflammatory and myofibroblastic reaction, fasciitis-like large cells (benign reactive and proliferative process)
Sperm Granuloma
Foreign body giant cell reaction to extravasated sperm, pain and swelling upper pole of epididymis, spermatic cord, testis, history of trauma, epididymitis and orchitis
How common is sperm granuloma?
42% patients after vasectomy
TB orchitis
Renal TB - epididymal infection, caveating granulomatous inflammation is prominent, fibrous thickening, enlargement of epididymis
Signs and symptoms of TB orchitis
Painless scrotal swelling, unilateral/bilateral mass, infertility, scrotal fistula
Cryptorchidism
Tests most frequently in inguinal canal/upper scrotum/abdomen, right/18% bilateral
Congenital cryptorchidism
Anomalies in anatomic development/hormonal mechanisms involved in testicular descent
Acquired cryptorchidism
Post-op/spontaneous ascent - inability of spermatic blood vessels to grow adequately, anomalous insertion of gubernaculum, failure in reabsorption of vaginal process, failure in postnatal elongation of spermatic cord
Primary hypogonadism causes
Undescended testis, Klinefelter syndrome, hemochrombtosis, mumps, orchitis, trauma, CF, testicular torsion and varicocele
Secondary hypogonadism causes
Pituitary failure, drugs (glucocorticoids, ketoconazole, chemotherapy, opioids), obesity and aging
