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Clinical Pathology > Kidney and Urinary Tract Disease - Urogenital Pathology (32) > Flashcards

Kidney and Urinary Tract Disease - Urogenital Pathology (32) Flashcards

1
Q

Enlargement of the prostate is also known as

A

Nodular hyperplasia or benign prostatic hyperplasia

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2
Q

Enlargement of prostate consists of

A

Overgrowth of epithelium and fibromuscular tissue of the transition zone and periurethral area

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3
Q

Symptoms of enlarged prostate are caused by

A

Interference with muscular sphincteric function and obstruction of urine flow through prostatic urethra

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4
Q

Symptoms of enlarged prostate include

A

Urgency, difficulty in starting urination, diminished stream size and force, increased frequency, incomplete bladder emptying and nocturia

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5
Q

4 distinct regions of prostate

A
  1. Central zone (CZ)
  2. Peripheral zone (PZ)
  3. Transitional zone (TZ)
  4. Periurethral zone
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6
Q

Most carcinomas arise from which part of the organ

A

Peripheral glands, may be palpable during digital examination of rectum

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7
Q

Where does nodular hyperplasia occur?

A

More central glands, more likely to produce urinary obstruction earlier than carcinoma

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8
Q

Three pathological changes in development of nodular hyperplasia

A
  1. Nodule formation
  2. Diffuse enlargement of the TZ and periurethal tissue
  3. Enlargement of nodules
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9
Q

Which pathological changes predominate among

A

Diffuse enlargement of the TZ and periurethral tissue

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10
Q

Which pathological changes predominate among >70yrs?

A

Nodule formation and enlargement

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11
Q

Aetiology of enlarged prostate

A
  • Impaired cell death > accumulate of ageing cells

- Androgens cause development BPH > increase cellular proliferation and inhibit cell death

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12
Q

Prostatic adenocarcinoma affects which age and ethnicity group?

A

Over 40 years, African ancestry

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13
Q

Management

A

Surgery, radiation therapy, hormone manipulations (90% 15 yrs)

  • Radical prostatectomy
  • External-beam radiation therapy
  • Interstitial radiation therapy (brachytherapy)
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14
Q

Risk factors

A

Age, race, family history, hormone levels (androgens), environmental influences (increased fat), inherited polymorphisms, germline mutations of tumour suppressor BRCA2

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15
Q

If inherit BRCA2 gene, how much more likely are you to get prostate cancer?

A

20 times

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16
Q

Grading system

A

Gleason

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17
Q

Screening

A

None available - limited benefits/false positives and negatives

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18
Q

Testicular cancer epidemiology

A

Highest among men of northern European ancestry

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19
Q

Pre-existing medical conditions associated with Testicular germ cell tumours

A

Prior TGCT in contralateral testicle, cryptorchidism, impaired spermatogenesis, inguinal hernia hydrocele, disorders of sex development, atopy, testicular atrophy

20
Q

Seminoma common in

A

35-45 year olds

21
Q

Teratoma common in

A

First and second decades of life

22
Q

Seminoma clinical presentation

A

Testicular enlargement (with/without pain) and metastases, asymptomatic

23
Q

Rare symptoms of seminoma

A

Gynecomastia, exophthalmos, infertility

24
Q

Teratoma clinical presentation

A

Gradual testicular swelling with/without pain

25
Q

Seminoma tumour markers

A

Elevated serum PLAL and hCG (gynecomastia)

26
Q

Teratoma tumour markers

A

None

27
Q

Macroscopically seminoma

A

Well-demarcated, cream-coloured, homogeneous and coarsely lobulated

28
Q

Microscopically seminoma

A

Monotonous polygonal cells - clear cytoplasm and central nuclei divided into lobules by thin bands of fibrovascular stroma

29
Q

Macroscopically teratoma

A

Well-demarcated solid/multicystic

30
Q

Microscopically teratoma

A

Admixture of ectoderm, endoderm and mesoderm

31
Q

Acute and chronic epididymoorhcitis

A

Infarcted seminiferous tubules, purulent exudate (neutrophils)

32
Q

Idiopathic granulomatous orchitis occurs in

A

Older adults

33
Q

Idiopathic granulomatous orchitis symptoms

A

Like-UTI/trauma/flu-like illness, testis become swollen, painful and tender > residual mass indistinguishable from neoplasm (orchiectomy)

34
Q

Sarcoidosis of the testis

A

Mimic malignancy, non-necrotising granulomas involving testicular parenchyma (acid-fast bacilli and fungal negative)

35
Q

Malakoplakia of testis

A

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)

36
Q

Myofibroblastic pseudo tumour of testis

A

Atypical inflammatory and myofibroblastic reaction, fasciitis-like large cells (benign reactive and proliferative process)

37
Q

Sperm Granuloma

A

Foreign body giant cell reaction to extravasated sperm, pain and swelling upper pole of epididymis, spermatic cord, testis, history of trauma, epididymitis and orchitis

38
Q

How common is sperm granuloma?

A

42% patients after vasectomy

39
Q

TB orchitis

A

Renal TB - epididymal infection, caveating granulomatous inflammation is prominent, fibrous thickening, enlargement of epididymis

40
Q

Signs and symptoms of TB orchitis

A

Painless scrotal swelling, unilateral/bilateral mass, infertility, scrotal fistula

41
Q

Cryptorchidism

A

Tests most frequently in inguinal canal/upper scrotum/abdomen, right/18% bilateral

42
Q

Congenital cryptorchidism

A

Anomalies in anatomic development/hormonal mechanisms involved in testicular descent

43
Q

Acquired cryptorchidism

A

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

44
Q

Primary hypogonadism causes

A

Undescended testis, Klinefelter syndrome, hemochrombtosis, mumps, orchitis, trauma, CF, testicular torsion and varicocele

45
Q

Secondary hypogonadism causes

A

Pituitary failure, drugs (glucocorticoids, ketoconazole, chemotherapy, opioids), obesity and aging

Clinical Pathology (60 decks)

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