Lower Urinary Tract and Male Genital Tract Flashcards
MCC of hydronephrosis in infants and children
MALES
bilateral
Ureteropelvic junction obstruction
MC and most serious congenital anomaly of the urinary bladder d.t. predisposition to infection and scarring
Vesicoureteral Reflux
Chronic inflammation reaction secondary to acquired DEFECTS in PHAGOCYTE function
chronic bacterial infection
immunosuppression
MALAKOPLAKIA
soft, yellow, slightly raided mucosal plaques
HISTOLOGY:
foamy macrophages
MICHAELIS-GUTMANN BODIES
Malformation of urethral groove –> abnormal opening on the VENTRAL shaft
Seen in 5-a reductase deficiency
HYPOSPADIAS
ASSOCIATIONS:
inguinal hernia
cryptorchidism
chordee
Malformation of urethral groove –> abnormal opening on the DORSAL shaft
EPISPADIAS
ASSOCIATIONS:
exstrophy of bladder
Benign sexually transmitted wart caused by LOW risk HPVs
HPV 6 (more common) and 11
CONDYLOMA ACUMINATUM
HISTOLOGIC:
superficial hyperkeratosis and acanthosis
KOILOCYTES - perinuclear cytoplasmic vacuolization
Malignant squamous lesion CONFINED to the epithelium by an INTACT basement membrane
Squamous Carcinoma In situ - Penile Intraepithelial Neoplasia (PEIN)
HPV related - HPV 16
*Bowen disease
NON-HPV related
*balanitis xerotica obliterans
*(+) squamous differentiation
Squamous cell carcinoma of the penis usually originates in
glans or inner surface of the prepuce near the coronal sulcus
irregular, fungating cauliflower-like masses; flat, indurated lesions; or large verruciform/papillary tumors
Complete or partial failure of the intra-abdominal testes to descend into the scrotal sac
associated with testicular dysfunction
increased risk of testicular cancer
Cryptorchidism
UNILATERAL
INGUINAL CANAL - MC site of undescended testes
MC phase of arrest of Cryptorchidism
INGUINOSCROTAL (4th-7th mo AOG)
Current recommendations for orchiopexy to be performed at
6 to 12 months of age
This disorder, which appears to be reactive rather than
neoplastic, is characterized by HARD PENILE PLAQUES that result from the deposition of COLLAGEN in the connective tissue between the corpora cavernosa and the tunica albuginea
Peyronie Disease
Mimics testicular tumor
tender mass w/ or w/o fever
NON CASEATING GRANULOMAS in seminiferous tubules
Granulomatous (Autoimmune) Orchitis
Undifferentiated PeIN
OLDER men
PRECURSOR to INVASIVE CA
BOWEN DISEASE
shaft and scrotum - SOLITARY THICKENED, GRAY WHITE, opaque plaque
glans - VELVETY RED
Undifferentiated PeIN
OLDER men
PRECURSOR to INVASIVE CA
BOWEN DISEASE
shaft and scrotum - SOLITARY THICKENED, GRAY WHITE, opaque plaque
glans - VELVETY RED
True urologic emergency
Twisting of spermatic cord –> impaired venous drainage –> congestion –> hemorrhagic infarction
TESTICULAR TORSION
6 hrs - GOLDEN period
MCC of PAINLESS testicular enlargement
ANY testicular mass should be considered MALIGNANT unless proven otherwise
TESTICULAR TUMORS
Germ cell - 95%
Sex-Cord stromal - 5%
Most important associated condition in GERM CELL TUMORS
Cryptorchidism
Germ Cell Tumors Classification
SEMINOMATOUS - BETTER prognosis
NON-SEMINOMATOUS - UNFAVORABLE prognosis
MCC of painless testicular enlargement
Testicular tumors
MC germ cell tumor
4th decade
HISTOLOGY:
LARGE round to polyhedral cells with DISTINCT CELL MEMBRANE, CLEAR or watery appearing CYTOPLASM and CENTRAL NUCLEI w/ 1-2 PROMINENT NUCLEOLI
LYMPHOCYTIC INFILTRATE
Seminoma
(+) KIT
(-) cytokeratin
FAVORABLE BEHAVIOR
MC testicular germ cell tumor in infants and children up to 3 years
Prepubertal Yolk Sac Tumor
2nd MC testicular germ cell tumor in infants and children
Testicular teratoma
2nd MC germ cell tumor in adults
Mixed germ cell tumor
MC testicular neoplasm in men > 60 years
Testicular lymphoma - MC form: DLBCL
Peak incidence - 20- to 30-year-old age group
MORE AGGRESSIVE than seminoma
may occur as a pure tumor or mixed with other germ cell components
HEMORRHAGIC MASS
EMBRYONAL CARCINOMA
large and anaplastic
hyperchromatic nuclei with prominent nucleoli
LYMPHOVASCULAR INVASION
(-) KIT
(+) cytokeratin, OCT3/4, Podoplanin
Also known as endodermal sinus tumor
MC testicular tumor in infants and children up to 3 years of age - very good prognosis
YOLK SAC TUMOR
SCHILLER-DUVAL (glomeruloid bodies) - structures resembling
endodermal sinuses
(+) AFP
HIGHLY MALIGNANT type of GCT
composed of 2 intimately juxtaposed cell types - syncytiotrophoblasts and cytotrophoblasts
CHORIOCARCINOMA
(+) hCG
Germ cell tumors composed of elements derived from >1 germ cell layer
2nd MC testicular tumors in infants and children
TESTICULAR TERATOMA
AGE - most important predictor of biologic behavior
PREPUBERTAL - BENIGN
POSTPUBERTAL - MALIGNANT
2nd MC GCT in ADULTS
MIXED GERM CELL TUMOR
TUMOR MARKERS
LDH - assesses tumor burden
AFP - yolk sac tumor
hCG - syncytiotrophoblasts; choriocarcinoma
Sex Cord Stromal Tumors
most cases display a BENIGN behavior
Leydig cell tumor
Sertoli cell tumor
Associated with:
Klinefelter syndrome
Cryptorchidism
Hereditary leiomyomatosis and RCC syndrome
(+) functional ESTROGENS and ANDROGENS
LEYDIC CELL TUMORS
gynecomastia
sexual precocity in children
HISTOLOGY:
Crystalloids of Reinke - 25%
Associated with:
Carney complex (caused by germline mutations in the gene PRKAR1A, which encodes a cyclic adenosine monophosphate–dependent
protein kinase)
Peutz-Jeghers syndrome
familial adenomatosis polyposis syndrome
SERTOLI CELL TUMORS
testicular swelling
HISTOLOGY:
tumor cells arranged in trabeculae forming cord-like structures and tubules - resemble seminiferous tubules)
MC testicular neoplasm in men >60 y/o
AGGRESSIVE tumors
BILATERAL with SPERMATIC CORD
frequent CNS
TESTICULAR LYMPHOMA
DLBCL - MC form
The most common benign prostatic disease in men older than age
50 years
NOT a premalignant lesion
Benign Prostatic Hyperplasia
TRANSITIONAL ZONE
urinary obstruction
enlarged prostate often increases 3- to 5fold (60 to 100 g)
well-defined nodules of BPH compress the urethra into a SLIT LIKE LUMEN
hyperplastic glands with papillary epithelial infoldings
Histologic hallmark of BPH
NODULARITY
MC genetic alteration of Prostatic Adenocarcinoma
ETV1-TMPRSS2 rearrangement
Risk Factors of Prostatic Adenocarcinoma
advancing AGE
ANDROGEN excess
GENETIC - race, family history of prostate cancer in 1st degree relatives, inherited mutations
DIET - charred red meats, animal fat
Histologic findings of Prostatic Adenocarcinoma
smaller than benign glands, single layer of epithelium (NO OUTER BASAL LAYER), tightly packed cells, usually ROUND (no branching and papillary infoldings)
ENLARGED nuclei + 1 or more large nucleoli
(-) pleomorphism and mitosis
Common sites of metastasis of Prostatic ca
obturator – para-aortic nodes
BATSON PLEXUS – BONES (axial skeleton) (BLASTIC lesions)
LUMBAR SPINE
proximal femur
pelvis
thoracic spine
ribs
Most important prognostic factors in Prostatic ca
GRADE AND STAGE
GLEASON SYSTEM
