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ACP GI and HBP system, Urogenital system > L26 Pathology of male genital system > Flashcards

L26 Pathology of male genital system Flashcards

1
Q

Prostatic specific antigen is produced by __________, secreted and hence detected in semen.

A

Prostatic epithelium

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2
Q

____________ is produced from testosterone via 5a reductase, which enhances the development of prostate.

A

Dihydrotestosterone

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3
Q

What are the 4 zones of prostate?

A
  1. Peripheral
  2. Transitional
  3. Central
  4. Periurethral zone
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4
Q

Which zone is palpable during DRE? Why is this zone significant?

A

Peripheral zone;

It is the primary site for CA prostate

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5
Q

Which zone is the primary site for glandular component of BPH?

A

Transitional zone

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6
Q

What is the significance of periurethral zone of prostate?

A

Primary site for stromal (fibromusclar) component of BPH

> urethral obstruction

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7
Q

Which zone is free of Ca prostate or BPH?

A

Central zone

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8
Q

What can be seen in a normal prostate histological slide? (4)

A
  • Glandular structures
  • Lined by inner columnar (luminal cell) and outer flattened epithelium (basal cells)
  • Presence of corpora amylacea, which are small hyaline masses of unknown significance found in the glandular lumen of prostate
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9
Q

_________ is the most common cause of enlarged prostate in > 50 years old and Prostate carcinoma is the 1/2/3 MC cancer in HK adult male?

A

Benign prostate hyperplasia;

3rd

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10
Q

What are the risk factors of BPH and CA prostate respectively? (4)

A

BPH
- increased sensitivity of prostate tissue to DHT

Prostatic carcinoma

  • Age, smoking, high fat diet
  • Hormonal: DHT-dependent
  • Genetics: TMPRSS2: ERG fusion gene in 50% of the cases, may disrupt androgen receptor signalling > castration-resistant CA prostate
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11
Q

What is the pathologic changes of BPH? (PP***) (2)

A
  • Nodular hyperplasia of glands and stromal cells in transitional zone
  • Nodular hypertrophy of muscles
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12
Q

Microscopic difference between BPH and CA prostate?

A

BPH
- glandular and fibromuscular proliferate with basal cell intact (+ presence of corpora amylacea)

CA prostate
- Glandular differentiation with lack of basal cells (ie. stromal invasion) > 1 cell type only

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13
Q

What is the MC CA prostate?
Which zone is affected?
Pathological changes?

A
  • Adenocarcinoma;
  • Peripheral zone;
  • Prostate intraepithelial neoplasia (PIN): precursor lesion; basal cells still intact
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14
Q

What are the clinical symptoms of BPH? (6)

A

Obstructive (DISH)

  • due to bladder outflow obstruction
    1. Dribbling
    2. Incomplete stream
    3. Hesitancy

Irritative (FUN)

  • caused by detrusor muscle thickening and instability due to fibrosis and muscle hypertrophy as a result of bladder outflow obstruction
    4. Frequency
    5. Urgency
    6. Nocturia
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15
Q

Which of the following regarding BPH is incorrect?
A. It can cause post-renal azotaemia
B. it can cause cystitis
C. It can cause AROU
D. It is a risk factor for prostate cancer
E. It is diagnosed by transrectal ultrasound (TRUS) ad increased in PSA (30-50%)

A

D is incorrect

A-C: obstructive uropathy

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16
Q

How is prostate cancer diagnosed?

A
  • Transrectal USG + Transrectal biopsy
  • Serum PSA - sensitive but not specific highly predicitive if >10 ng/mL

DRE: negative in 10% cases

17
Q

What are the treatment options for benign prostate hyperplasia? (3)

A
  1. alpha-blockers: tamsulosin
  2. 5alpha-reductase: finasteride
  3. Transurethral resection of the prostate
18
Q

Treatment options of prostate cancer

A

Early: surgery, radiotherapy
Advanced: hormonal (medical castration), chemotherapy , radiotherapy

19
Q

If the prostatic cancer is palpable in DRE, it belongs to stage _________ in TNM staging?

A

T2

20
Q

Briefly describe what is Gleason score.

A

For prediction of prognosis in CA prostate.

Gleason grade = histologic pattern
Gleason score = common pattern + highest pattern

Grading is based on the sum of the 2 most prominent histological patterns in prostate biopsy, with the score of 1 (well-differentiated) to 5 (poorly differentiated)

21
Q

What is the congenital testis disorder named?

Briefly describe.

A

Cryptorchidism

- failed descent of testes

22
Q

Which of the following about cryptorchidism is incorrect?
A. It is mostly bilateral
B. if unilateral, complications appear for both cryptorchid +/- normal testis
C. It may cause infertility due to arrest in Ferm cell maturation
D. Testicular atrophy may occur
E. Seminoma may arise

A

A is incorrect

90% unilateral

23
Q

Vascular torsion of testis may be due to trauma or cryptorchidism.
Symptoms include? (3)
Tx? (2)

A
  • Acute testicular pain
  • Absent cremasteric reflex
  • Hemorrhagic infarction
  • Due to spontaneous remission, orchidectomy is required
24
Q

What are the causative agents causing Epididymitis and orchitis? (5)

A

Specific

  • N.gonorrhoeae,
  • Chlamydia trachomatis
  • TB
  • Mumps

Non-specific: secondary to UTI

25
Q

Testicular tumors are painless masses found in young male.

It can be divided into which 2 types of tumors? Which is the majority?

A

Germ cell tumors (GCT) 95% (Malignant)

Sex cord-stromal tumors 5% (Benign)

26
Q

What are the subtypes of germ cell tumors?

A
  1. Seminoma (40%)
  2. Embryonal (25%)
  3. Teratoma (5%)
  4. Choriocarcinoma (1%)
27
Q

Which of the following about seminoma is incorrect?

A. It is histologically identical germinoma in CNS and dysgerminoma in female

B. It is the most common testicular tumor

C. It originates from the epithelium of seminiferous tubule

D. It has clear cytoplasm and neutrophilic infiltrate

E. Placental alkaline phosphatase (PLAP), Oct-4 and CD117 are tumor markers

A

D
Should be lymphocyte infiltrate!

Also appears as white-yellow potato tumor

28
Q

Which of the following about non-seminoma germ cell tumor of the testicles are correct?

A. Yolk sac tumor occurs before ages of 4, with Schiller-Duval bodies that resemble primitive glomeruli

B. AFP is the tumor marker for yolk sac tumor

C. beta-HCG is the tumor marker for chiocarcinoma

D. Teratoma is originated from trigeminal layers

E. Embryonal carcinoma is a bulk tumor with hemorrhage and necrosis

A

All of the above

29
Q

Sex cord stromal tumors can be divided into which 2 types?

A

Leydig cell tumor

Sertoli cell tumor

30
Q

What are the differences between Leydig and Sertoli cell tumors? (morphological, hormonal)

A

Leydig

  1. Tan brown
  2. Produces sex hormone: gynaecomastia, sexual precocity

Sertoli

  1. White-yellow
  2. May produce hormone
31
Q

How are testicular tumors staged? (2)

A

TNMS staging
S = Serum tumor markers (AFP, beta HCG, LDH)

3 stages
I: testis, spermatic cord
II: LN below diaphragm
III: LN above diaphragm

ACP GI and HBP system, Urogenital system (10 decks)

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