Lower Urinary Tract and Male Genital Tract Flashcards
How can tumors of the testis be divides?
Tumors of the testis can be divided into two major categories. Germ cell tumors and Sex Cord Stromal tumors. Germ cell tumors are subdivided into seminomas and non seminomas.
What are germ cell tumors?
Most GC tumors originated from a precursor lesion called Intratubular Germ Cell Neoplasia. The lesions consists in atypical primordial GC with large nuclei and clear cytoplasm. They express OCT3.4 and NANOG. Virtually every patients with ITGCN will develop an invasive tumor. Clinically testicular tumors spread through lymph.
Which are seminomatous tumors?
• Seminoma : Most common GC tumor, about 50%. Express OCT3.4 and NANOG. It presents inflammatory infiltrates which is useful to distinguish it. The tumor cells are large and polyhedral, clear cytoplasm and large nucleus.
• Spermatocytic Tumor : Rare, slow growing GC tumor affecting older men. Almost never metastasizes, does not present lymphocytic infiltration.
Which are non seminomatous tumors?
• Embryonal Carcinoma : Most frequent GC tumor after seminoma. Cells look undifferentiated with big nuclei. High mitotic index and necrosis. Positive to OCT3.4 and CD30.
• Yolk Sac Tumor : Common in infants and children. Good prognosis.
• Choriocarcinoma : Highly malignant. It is very rare. It is characterized by lymphoma vascular invasion and metastasis, it has very poor prognosis. Abundant necrosis and hemorrhage.
• Teratoma : Derives form germ cells and various forms of cellular components reminiscent of more than one germ layer. Rarely it can transform into a non GC tumor like SCCs.
• Mixed Tumors : About 60% of testicular tumors are composed of more than one of the pure patterns. Common mixtures include teratoma with embryonal Carcinoma and yolk sac tumor.
What is a gonadoblastoma?
Rare neoplasms composed of GCs and gonads stromal elements.
Which are sex cord Stromal tumors?
• Sertoli Cell Tumors : Very rare malignant tumor with distinctive microscopic finding such as uniform rounded nuclei, clear eosinophilic cytoplasm. the physician may feel a solid mass (1 to 20 cm in size): larger masses often becomes sclerotic and may or not present calcifications They usually occur unilaterally.
• Leydig Cell Tumors : They elaborate androgens and in some cases estrogens and corticosteroids. The most common feature is testicular swelling but in some patients gynecomastia might be the first symptom.
• Paratesticular Tumors : Adenomatoid tumors , leiomyosarcoma, liposarcomas etc. Adenomatoid tumor is by far the most common among paratesticular tumors; it gives rise to a small, asymptomatic mass which is well circumscribed and ranges 2-5 cm in diameter.
Which are the layers of the bladder?
• Urothelium : Made of about seven layers of cells. Umbrella cells in the luminal surface, basal cells at the basement membranes.
• Lamina Propria : Include muscle and adipose tissue and a vascular plexus.
• Muscularis Propria : Thick muscle layer for contractility.
• Serous/adventitia
What are some inflammations of the bladder?
• Interstitial Cystitis : Occurs most frequently a woman and is characterized by intermittent, often severe suprapubic pain, hematuria and the urinary frequency.
• Malakoplakia : Chronic inflammatory reaction because of bacterial infection mostly E. coli.
• Polypoid Cystitis : Inflammatory lesion arising from mucosa. DDX papillary urothelial carcinoma.
What are some metaplastic lesions of the bladder?
• Cystitis Glandularis and Cystitis Cystica : Common lesions of urinary bladder in which nests of urothelium grow downward into the lamina propria.
• Squamous Metaplasia : Response to injury. Can give rise to SCC.
• Nephrogenic Adenoma : Lesion due to damage. Seen in kidney transplants recipients.
What are some general information of malignant bladder neoplasms?
Bladder cancer is responsible for 7% of cancers in the United States. 95% of bladder tumors are of epithelial origin the rest being mesenchymal Tumors. Typical patient is a male between 50 and 80 years old, risk factors include cigarette smoking and long-term use of analgesics. Have FGFR3 and HRAS gain in functions and P53 and RB loss in function.
Morphologically they can be of two types. Muscle Invading Bladder Carcinoma or Non-Muscle Invading Bladder Carcinoma.
What is carcinoma in situ in the bladder?
CIS, Defined by the presence of malignant cells within a flat urothelium. It’s my range from a full thickness cytological atypia or scattered malignant cells. More than 50% of patients will progress to invasive carcinoma within five years. The mitotic index is high. P53+, CK20 and CD44 expression reduced causing bad cell surface binding. Can be initially NMBIC and then invade.
What are some other bladder tumors?
SCCs, adenocarcinoma, Paraganglioma and carcinoid of the bladder.
Prostate recap?
In the adult macroscopically the prostate can be divided into three main areas: a transition area wrapped around the urethra, a central zone, and a peripheral zone found more posteriorly. 85% of carcinoma’s arise from the peripheral zone. Microscopically the prostate is composed of glands lined by pseudostratified columnar secretory cells, basal cells, neuroendocrine cells and stromal cells.
What is benign prostatic hyperplasia?
Aka Nodular Hyperplasia. It is the most common benign prostatic disease in men older than 50 years old. It results from nodular hyperplasia of prostatic stromal and epithelial cells which often leads to urinary obstruction. It’s originates in the transition zone. Bladder hypertrophy and urinary retention can lead to a recurrent infections.
What is prostatitis?
Inflammation may be caused by infectious agents such as bacteria causing urinary track infection. The prostate parenchymal is poorly penetrated by antibiotics therefore causing it recurrent infections. It may lead to sepsis. Chronic abacterial prostatitis is the most common form, it shows Leukocytosis with negative bacterial culture, it may be due to hormonal changes or physical trauma.
Sustained inflammation can result in different types of a traffic patterns: simple atrophy, simple atrophy with cysts, partial atrophy and proliferative inflammatory atrophy which is a cancer precursor.
