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Med > LUT & MGT > Flashcards

LUT & MGT Flashcards

1
Q

Diseases of the Ureters

A

-Congenital Anomalies

-Tumors and Tumor-Like Lesions

  • Obstructive Lesions
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2
Q

Diseases of the Urinary Bladder

A
  • Congenital Anomalies
  • Inflammation
  • Metaplastic Lesions
  • Neoplasms
  • Obstruction
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3
Q

Diseases of the Urethra

A
  • Congenital Anomalies
  • Regressive Changes
  • Inflammation and Infections
  • Vascular Disorders
  • Spermatic Cord and Paratesticular Tumors
  • Testicular Tumors
  • Lesions of Tunica Vaginalis
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4
Q

Diseases of the Prostate Gland

A
  • Inflammation
  • Benign Enlargement
  • Neoplasms
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5
Q

Ureter

Mucosa of these organs is lined by the uniquely

A

stratified urothelium or transitional epithelium

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6
Q

Composed of 5-6 layers of cells with oval nuclei with linear nuclear grooves, and a surface layer consisting of umbrella cells with abundant cytoplasm

A

Ureter mucosa

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6
Q

Lamina propria in the bladder form a

A

discontinuous muscularis mucosa

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7
Q

bladder cancers are staged on the basis of invasion of the

A

detrusor muscle (muscularis propria)

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8
Q

due to urine flow obstruction that causes the intravesical pressure to rise

A

Bladder hypertrophy

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9
Q

may entrap and obstruct the ureter

A

Retroperitoneal tumors or fibrosis

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10
Q

most common cause of hydronephrosis in infants and children

A

Ureteropelvic junction (UPJ) obstruction

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11
Q

Cases that present early in life preferentially affect males, are bilateral in 20% of cases, and are often associated with other anomalies

A

Ureteropelvic junction (UPJ) obstruction

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12
Q

More common in women and is most often unilateral

A

Ureteropelvic junction (UPJ) obstruction

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13
Q

Abnormal organization of smooth muscle bundles or excess stromal deposition of collagen between smooth muscle bundles at the UPJ, or in extrinsic compression of the UPJ by abnormal renal vessels

A

Ureteropelvic junction (UPJ) obstruction

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14
Q
  • Typically of renal origin
  • Usually small (5 mm in diameter or less)
  • Impact at loci of ureteral narrowing—ureteropelvic junction, where ureters cross iliac vessels and where
    they enter bladder—and cause excruciating “renal colic”
A

Calculi

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15
Q

May be congenital or acquired

A

Strictures

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16
Q
  • Urothelial carcinomas arising in ureters
  • Rarely, benign tumors or fibroepithelial polyps
A

Tumor (Intrisic)

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17
Q

Massive hematuria from renal calculi, tumors, or papillary necrosis

A

Blood Clots

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18
Q

Interruption of the neural pathways to the bladder

A

Neurogenic

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19
Q

Physiologic relaxation of smooth muscle or pressure on ureters at pelvic brim from enlarging fundus

A

Pregnancy

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20
Q

Salpingitis, diverticulitis, peritonitis, sclerosing retroperitoneal fibrosis

A

Periureteral Inflammation

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21
Q

With pelvic lesions associated with scarring

A

Endemetriosis

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22
Q

Cancers of the rectum, bladder, prostate, ovaries, uterus, cervix; lymphomas, sarcomas

A

Tumor (Extrinsic)

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23
Q

Intrinsic and extrinsic lesions may obstruct the ureters and may give rise to

A

hydroureter, hydronephrosis, and pyelonephritis

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24
Q

results from proximal intrinsic or extrinsic causes (stones, neoplasms etc.)

A

Unilateral obstruction

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25
Q

arises from distal causes, such as nodular hyperplasia of the prostate

A

Bilateral obstruction-

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26
Q

Fibrotic proliferative inflammatory process that encases retroperitoneal structures and causes hydronephrosis

A

Sclerosing Retroperitoneal Fibrosis

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27
Q
  • Occurs in middle to late age and is more common in males
  • IgG4-related disease
A

Sclerosing Retroperitoneal Fibrosis

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28
Q
A

Sclerosing Retroperitoneal Fibrosis

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29
Q

Treatment for this disease are: corticosteroids, ureteral stents or surgical extrication of the ureters (ureterolysis)

A

Sclerosing Retroperitoneal Fibrosis

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30
Q

MORPHOLOGIC FINDING:

Fibrous tissue containing a prominent infiltrate of lymphocytes, often with germinal centers, plasma cells (frequently IgG4-positive), and eosinophils

A

Sclerosing Retroperitoneal Fibrosis

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31
Q

Associated with increased risk of infection or neoplasia

A

Diseases of the Urinary Bladder

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32
Q
  • Most common and serious congenital anomaly
  • Can lead to ascending pyelonephritis and loss of renal function
  • Can give rise to congenital vesicouterine fistulae
A

Diverticula

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33
Q
  • Developmental failure in the anterior wall of the abdomen and the bladder
  • Bladder communicates directly with the abdominal surface
  • Exposed bladder mucosa may undergo colonic glandular metaplasia and is subject to chronic infection that spreads to the upper urinary tract
  • Associated with an increased risk of adenocarcinoma in the bladder remnant
A

Exstrophy of the bladder

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34
Q
  • Urachal canal connects the fetal bladder with the allantois and normally is obliterated at birth
  • Patent urachus creates a fistulous urinary tract connection between the bladder and umbilicus
  • When only a central region of patent urachus persists, a urachal cyst lined by urothelial or metaplastic glandular epithelium is formed
  • Urachal cysts are at increased risk for neoplastic transformation (adenocarcinoma)
A

Urachal Anomalies

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35
Q

Bacterial pyelonephritis is frequently preceded by infection of the urinary bladder, with retrograde spread of microorganisms into the kidneys and their collecting systems

A

Acute and Chronic Cystitis

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36
Q

bladder calculi, urinary obstruction, diabetes mellitus, instrumentation, and immune deficiency

A

Acute and Chronic Cystitis

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37
Q
  • ## Most common: E. coli, Proteus, Klebsiella and EnterobacterWomen are more prone due to shorter urethras
A

Coliform

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38
Q

TB cystitis leading to renal TB

A

Mycobacteria

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39
Q

Candida and cryptococcal cystitis (immunosuppressed)

A

Fungal

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40
Q
  • Bladder schistosomiasis
  • More common in african and middle eastern countries
A

Schistosomiasis haematobium

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41
Q

Hemorrhagic cystitis

A

BK Virus

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42
Q

Emphysematous cystitis

A

Clostridium

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43
Q

Viral (adenovirus), Chlamydia and Mycoplasma

A

Others

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44
Q

Morphologic Findings

hyperemia of the mucosa and neutrophilic infiltrate, sometimes associated with exudate

A

Aute Cystitis

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45
Q

Morphologic Findings

caused by persistent acute cystitis associated with mononuclear inflammatory infiltrates

A

Chronic Cystitis

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46
Q

Morphologic Findings

systemic chemotherapy or pelvic irradiation

A

Iatrogenic Cystitis

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47
Q

Morphologic Findings

cyclophosphamide (hemorrhagic cystitis)

A

Cytotoxic Cystitis

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48
Q

Morphologic Findings

infiltration of the submucosa by eosinophils (nonspecific subacute inflammation) and may also be a manifestation of a systemic allergic disorder

A

Eosinophilic Cystitis

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49
Q

Morphologic Findings

presence of lymphoid follicles within the bladder mucosa and underlying wall

A

Follicular Cystitis

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50
Q

cystitis triad of symptoms

A
  • Frequency (urination every 15 to 20 minutes)
  • Lower abdominal pain localized over the bladder region or in the suprapubic region
  • Dysuria (pain or burning on urination)
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51
Q

Infections may be antecedents to pyelonephritis

A

cystitis

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52
Q

sometimes a secondary complication of an underlying disorder associated with urinary stasis, such as prostatic hypertrophy, cystocele, calculi, or bladder neoplasms

A

Cystitis

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53
Q
  • Disorder of unknown etiology that occurs most frequently in women
  • Unpleasant sensation (pain, pressure, discomfort) related to the urinary bladder, associated with urinary tract symptoms of >6 weeks duration, in the absence of infection or other identifiable causes
A

Interstitial Cystitis (Chronic Pelvic Pain Syndrome)

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54
Q
  • Intermittent, often severe, suprapubic pain; urinary frequency; urgency; hematuria; and dysuria
  • Cystoscopic findings: mucosal fissures and punctate hemorrhages (glomerulations)
A

Interstitial Cystitis (Chronic Pelvic Pain Syndrome)

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55
Q
  • Late (classic ulcerative) phase: associated with chronic mucosal ulcers (Hunner ulcers)
  • Transmural fibrosis may lead to a contracted bladder
A

Interstitial Cystitis (Chronic Pelvic Pain Syndrome)

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55
Q
  • Pathologic findings are non-specific; mast cells are often increased in the submucosa
  • Clinically mimics interstitial cystitis
  • Treatment is largely empiric
A

Interstitial Cystitis (Chronic Pelvic Pain Syndrome)

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56
Q
  • Chronic inflammatory reaction that appears to stem from acquired defects in phagocyte function
  • Arises in the setting of chronic bacterial infection, mostly by E. coli or occasionally Proteus species

-Occurs with setting of immunosuppression

A

Malakoplakia

57
Q

-Soft yellow, slightly raised mucosal plaque (3-4cm)

-Macrophages have abundant granular cytoplasm

  • Michaelis-Gutmann bodies: deposition of calcium in enlarged lysosomes
A

Malakoplakia

58
Q
  • Inflammatory lesion resulting from irritation of the bladder mucosa, most commonly as a result of instrumentation (indwelling catheters)
  • May be mistaken for papillary urothelial carcinoma, both clinically and histologically.
A

Polypoid Cystitis

59
Q
  • Common lesions of the urinary bladder in which nests of urothelium (von Brunn nests) grow downward into the lamina propria
A

Cystitis Glandularis and Cystitis Cystica

60
Q

metaplasia that take on cuboidal or columnar appearance

A

Cystitis glandularis

61
Q

epithelial cells retract to produce cystic spaces

A

Cytitis cystica

62
Q
  • These 2 processes often coexist: cystitis cystica et glandularis
  • Both variants can arise in the setting of inflammation and metaplasia
  • Extensive and multifocal intestinal metaplasia is a precursor to adenocarcinoma
A

Cytitis cystica
Cystitis glandularis

63
Q
  • Response to chronic injury
  • Urothelium is often replaced by non- keratinizing or keratinizing squamous epithelium, which is a more durable lining
A

Squamous Metaplasia

64
Q
  • Extensive multifocal keratinizing squamous metaplasia is a precursor to dysplastic lesions and in situ and invasive squamous cell CA
  • Seen with bladder schistosomiasis
A

Squamous Metaplasia

65
Q
  • May not be a form of true metaplasia
  • Some of these lesions are caused by implantation and growth of renal tubular cells at sites of bladder mucosa erosion
A

Nephrogenic adenoma

66
Q
  • Overlying urothelium is focally replaced by cuboidal epithelium (papillary pattern)
  • Larger lesions can raise a suspicion of cancer
A

Nephrogenic adenoma

67
Q

is the ninth most common cancer type worldwide and is responsible for significant morbidity and mortality

A

Bladder cancer

68
Q

*95% of bladder tumors are of _________, with _________ being by far the most common type followed by _____ and ____________

A

epithelial origin

urothelial neoplasms

squamous

glandular neoplasms

69
Q
  • Non-invasive tumors
  • Infiltrating urothelial carcinoma
  • Variants: nested, microcystic, micropapillary, plasmacytoid, sarcomatoid, giant cell, poorly differentiated, lipid-rich, and clear cell
A

Urothelial (transitional) tumors

70
Q
  • Adenocarcinoma
  • Squamous cell carcinoma
  • Mixed carcinoma
  • Small-cell carcinoma
  • Sarcomas
A

Other tumors of the bladder

71
Q
  • Represent about 90% of all bladder tumors
  • May be seen at any site where there is urothelium, from the renal pelvis to the distal urethra
A

Urothelial Neoplasms

72
Q

most common precursor lesions which originate from papillary urothelial hyperplasia

A

Non-invasive papillary tumors

73
Q

other precursor lesion to invasive carcinoma (CIS)

A

Flat non-invasive urothelial carcinoma

74
Q

term used to describe epithelial lesions that have the cytologic features of malignancy but are confined to the epithelium, showing no evidence of basement membrane invasion

A

Carcinoma in-situ

75
Q
  • Although invasion into the lamina propria worsens the prognosis, the major decrease in survival is associated with invasion of the _______
A

muscularis propria (detrusor muscle)

76
Q
  • higher in men (male-to-female ratio of 3: 1), in higher income nations, and in urban dwellers
  • About 80% of patients are between 50 and 80 years of age
  • ______ is not familial
A

neoplas,

bladder cancer

77
Q

Several factors :

  • Cigarette smoking
  • Industrial exposure to aryl amines (2-naphthylamine)
  • Schistosoma haematobium
  • Long-term use of analgesics
  • Heavy long-term exposure to cyclophosphamide
  • Pelvic irradiation
A

Urothelial Neoplasms

78
Q

gain-of-function alterations that increase signaling through growth factor receptor pathways

A

Non–muscle-invasive papillary cancers

79
Q
  • Amplifications of the FGFR3 tyrosine kinase receptor gene
  • Activating mutations in the genes encoding RAS and PI3-kinase
  • These tumors frequently recur but progress to muscle- invasive bladder cancer in only about 20% of cases
A

Urothelial Neoplasms

80
Q

Flat CIS

A

majority of muscle-invasive bladder cancers

81
Q
  • Gross: can be purely papillary to nodular or flat
  • Papillary lesions are red, elevated excrescences (1-5 cm)
  • Multiple discrete tumors are often present
A

Urothelial Neoplasms

82
Q
  • Represent 1% of bladder tumors and are often seen in younger patients
  • Typically arise singly as small (0.5 to 2 cm)
A

Papilloma

83
Q

delicate structures superficially attached to the mucosa by a stalk

A

Exophytic papillomas

84
Q
  • Finger-like papillae covered by epithelium that is histologically identical to normal urothelium
  • Recurrences and progression are rare but may occur
A

Papillomas

85
Q

completely benign lesions consisting of inter-anastomosing cords of cytologically bland urothelium that extend down into
the lamina propria; they simulate an invasive process

A

Inverted papillomas

86
Q
  • Histologically similar with papillomas, differing only in having thicker urothelium with greater density of cells
  • Tend to be larger than papillomas and may be indistinguishable from papillary cancers
  • Progression to tumors of higher grade may occur but is rare
A

Papillary urothelial neoplasms of low malignant potential (PUNLMP)

87
Q
  • Orderly architectural appearance and low- grade cytologic atypia
  • Cells are evenly spaced (maintain polarity) and cohesive
  • Scattered hyperchromatic nuclei, infrequent mitotic figures toward the base, and slight variation in nuclear size and shape
  • May recur and, infrequently, may also invade
A

Low-grade papillary urothelial carcinomas

88
Q
  • Contain dyscohesive cells with large hyperchromatic nuclei, irregular nuclear chromatin, and prominent nucleoli
  • Highly anaplastic with mitotic figures
  • There is disarray and loss of polarity
  • Can progress to muscle-invasive bladder
    cancer and metastasis to regional LN and systemic spread (and lung)
A

High-grade papillary urothelial carcinomas

89
Q
  • Defined by the presence of cytologically malignant cells within a flat urothelium
  • May range from full-thickness cytologic atypia to scattered malignant cells (pagetoid spread)
  • Common feature shared with highgrade papillary urothelial carcinoma is a lack of cohesiveness, which leads to shedding of malignant cells into the urine
A

Flat urothelial carcinoma (CIS)

90
Q
  • Cystoscopy: area of mucosal reddening, granularity, or thickening
  • Commonly multifocal and may involve most of the bladder surface and extend into the ureters and urethra
  • If untreated, it progresses to invasive cancer
A

Flat urothelial carcinoma (CIS)

91
Q
  • Associated with papillary urothelial cancer, usually high grade, or adjacent CIS
  • Extent of spread (stage), based primarily on depth of invasion in the bladder wall
  • Invasion of the muscularis propria layer is an indication for radical cystectomy or radiation
    therapy with neoadjuvant or adjuvant chemotherapy
A

Invasive urothelial carcinoma

92
Q
  • Urothelial proliferation of uncertain malignant potential (flat hyperplasia)
  • Urothelial dysplasia
  • Urothelial carcinoma in situ
A

Flat Lesions

93
Q
  • Papilloma
  • Urothelial proliferation of uncertain malignant potential (papillary hyperplasia)
  • Papillary urothelial neoplasms of low malignant potential
  • Papillary urothelial carcinoma, low grade
  • Papillary urothelial carcinoma, high grade
A

Exophytic Papillary Lesions

94
Q
  • Painless hematuria is the most common symptom of bladder cancer
  • Frequency, urgency, and dysuria may accompany hematuria
  • Obstruction of the ureteral orifice may lead to pyelonephritis or hydronephrosis.
A

Urothelial Neoplasm

95
Q

Initial treatment of non–muscle-invasive tumors

A
  • Localized low-grade papillary tumors- diagnostic transurethral resection is the only procedure needed
  • CIS and large, high grade, multifocal, recurrence, or are associated with lamina propria invasion are treated with intravesical instillation of an attenuated strain of BCG
96
Q

radical cystectomy or cystoprostatectomy, or radiation with chemotherapy

A

Muscle-invasive bladder carcinoma

97
Q

Radical cystectomy is also indicated in cases of:

A
  • CIS or high-grade papillary cancer refractory to BCG and other intravesical therapies
  • CIS extending into the prostatic urethra and ducts
  • Occasional cases of non–muscle-invasive papillary urothelial high-grade carcinoma
98
Q

Most metastatic tumors respond poorly to chemotherapy, which produces 5-year survival rates of only _____

A

15%

99
Q
  • Make up 3% to 7% of bladder cancers
  • Much more frequent in countries where urinary schistosomiasis is endemic
  • Arise from atypical keratinizing mucosa (squamous dysplasia and CIS)
  • Always associated with chronic bladder irritation and infection
A

Squamous Cell CA

100
Q
  • More frequent than pure squamous cell CA
  • Most are invasive, fungating tumors or are infiltrative and ulcerative
  • Can produce abundant keratin to anaplastic
    tumors with only focal evidence of squamous differentiation
A

Mixed urothelial carcinoma with areas of squamous carcinoma

101
Q
  • Rare and histologically identical to adenocarcinomas seen in the GIT
  • Some arise from urachal remnants or in association w/ extensive intestinal metaplasia
A

Adenocarcinoma

102
Q
  • Indistinguishable from small-cell carcinomas of the lung, occasionally arise in the bladder, often in association with urothelial, squamous, or adenocarcinoma
  • Strongly associated with loss-of-function of TP53 and RB tumor suppressor genes
A

Small Cell Carcinoma

103
Q
  • Most common is leiomyoma
  • They tend to grow as isolated, intramural
    (submucosal), encapsulated, ovalto-spherical masses up to several centimeters in diameter.
A

Benign Tumors

104
Q
  • Inflammatory myofibroblastic tumors and various carcinomas that assume sarcomatoid growth patterns are more common
  • Large masses (15 cm in diameter) that protrude into the vesicle lumen
  • Soft, fleshy, gray-white gross appearance
  • Most common bladder sarcoma in infancy or childhood is embryonal rhabdomyosarcoma
  • Polypoid grape-like mass (sarcoma botryoides)
A

Sarcoma

105
Q

secondary malignant involvement of the bladder is most often due to direct extension of cancers arising in adjacent organs, mainly the cervix, uterus, prostate, and rectum

A

Secondary Tumors

106
Q

Obstruction of the bladder outlet is of major clinical importance because of its eventual effect on the kidney

  • Males- ________
  • Females- __________
A

benign prostatic hyperplasia (BPH)

cystocele of the bladder

107
Q
  • Congenital urethral strictures
  • Inflammatory urethral strictures
  • Inflammatory fibrosis and contraction of the bladder
  • Bladder tumors, either benign or malignant
  • Invasion of the bladder neck by tumors arising in contiguous organs
  • Mechanical obstructions by foreign bodies and calculi
  • Injury of nerves controlling bladder contraction (neurogenic bladder)
A

Obstruction of Bladder Outlet Causes

108
Q

MORPHOLOGIC FINDINGS

  • Early stages: there is only thickening of the bladder wall due to smooth muscle hypertrophy
  • Trabeculation of the bladder wall due to progressive hypertrophy
  • Crypts form and may be converted into diverticula
  • Enlarged bladder may reach the brim of the pelvis or umbilicus
A

Bladder Outlet Obstructions

109
Q

earliest manifestations of venereal infection

A

Gonococcal Urethritis

110
Q

common and can be caused by several different organisms

A

Nongonococcal urethritis

111
Q

Often accompanied by cystitis in women and by prostatitis in men

A

Inflammation of Urethra

112
Q

Reactive arthritis (Reiter syndrome), which is associated with the clinical triad of _____

A

arthritis, conjunctivitis, and urethritis

113
Q
  • inflammatory lesion that presents as a small, red, painful mass about the external urethral meatus, typically in older females
  • It consists of inflamed granulation tissue covered by an intact but friable mucosa, which may ulcerate and bleed with the slightest trauma
  • Surgical excision affords prompt relief and cure
A

Urethral caruncle

114
Q

squamous and urothelial papillomas, inverted urothelial papillomas, and condylomas

A

Benign Epithelial Tumor

115
Q

urothelial differentiation and are analogous to those occurring within the bladder

A

Proximal Urethra

116
Q

squamous cell carcinomas and HPV-related

A

Distal Urethra

117
Q
  • Malformation of the urethral groove and canal may create an abnormal opening either on the ventral surface of the penis (hypospadias) or on the dorsal surface (epispadias)
  • Associated with failure of normal descent of the testes and with malformations of urinary tract
  • Hypospadias- more common of the two
  • Abnormal opening is often constricted, resulting in urinary tract obstruction and an increased risk of ascending infections
  • Normal ejaculation and insemination are hampered and may be a cause of sterility
A

Hypospadias & Epispadias

118
Q
  • Orifice of the prepuce is too small to permit its normal retraction
  • May result from anomalous development but is more frequently the result of repeated bouts of infection that cause scarring of preputial ring
  • It interferes with cleanliness, favoring the
    development of secondary infections and penile carcinoma
A

Phimosis

119
Q

Almost invariably involve the glans and prepuce and include a wide variety of specific and nonspecific infections

A

Penis Inflammation

120
Q

syphilis, gonorrhea, chancroid, granuloma inguinale, lymphopathia venerea, genital herpes

A

Specific Infections are STIs

121
Q

refers to non-specific infection of the glans and prepuce caused by a wide variety of organisms

A

Balanophostits

122
Q
  • More common agents are C. albicans, anaerobic bacteria,
    Gardnerella, and pyogenic bacteria
  • Consequence of poor local hygiene in uncircumcised males
  • Persistence of such infections leads to inflammatory scarring and, is a common cause of phimosis.
A

Balanophostitis

123
Q

benign sexually transmitted wart caused by HPV (serotypes 6 and 11)

A

Condyloma Acuminatum

124
Q
  • It is related to the common wart and may occur on any moist mucocutaneous surface of the external genitals
  • May arise in the external genitalia or perineal areas
  • Penile lesions usually occur in the coronal sulcus and inner surface of the prepuce
A

Condyloma Acuminatum

125
Q

Gross:
- consist of single or multiple sessile or pedunculated, red papillary excrescences

Microscopic:
- branching, villous, papillary connective tissue stroma is covered by epithelium with superficial hyperkeratosis and thickening of the underlying epidermis (acanthosis)

  • Normal orderly maturation of the epithelial cells is preserved
  • Lining cells frequently display perinuclear cytoplasmic
    vacuolization (koilocytosis), characteristic of HPV infection
A

Condyloma Acuminatum

126
Q

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

A

Peyronie Disease

127
Q
  • Fibrosis is the product of microvascular trauma and subsequent organizing sclerosing chronic inflammation
  • Results in penile curvature toward the side of the lesion and pain during intercourse
  • Treatments: surgery and injection of collagenase
A

Peyronie Disease

128
Q
  • These lesions are encompassed by the umbrella term penile intraepithelial neoplasia (PeIN)
  • All are squamous lesions confined to the epidermis by an intact basement membrane
A

Squamous Carcinoma in situ/Penile Intraepithelial Neoplasia

129
Q

Associated with balanitis xerotica obliterans, occurs on the foreskin of older patients, and as the name implies retains a degree of squamous maturation

A

Non–HPV-related (differentiated)

130
Q
  • Composed of more overtly malignant cells
  • May manifest clinically as two distinct lesions:
     Bowen disease
     Bowenoid papulosis
  • Both are associated with high-risk HPV (HPV 16)
A

HPV-related (undifferentiated PeIN)

131
Q
  • Affects the penile shaft and scrotum of older men
  • Solitary, thickened, gray-white, opaque plaque
  • When it affects the glans, the lesion acquires a velvety red appearance
  • Dysplastic squamous cells containing large hyperchromatic irregular nuclei and lacking orderly maturation with atypical numerous mitoses
  • Gives rise to infiltrating squamous cell carcinoma
A

Bowen Disease

132
Q
  • Occurs in sexually active adults
  • It is distinguished from BD by the younger age of affected patients and its presentation as multiple (rather than solitary) reddish brown papular lesions
  • Virtually never develops into invasive carcinoma and usually regresses spontaneously.
A

Bowenoid Papulosis

133
Q

Associated with poor genital hygiene and high-risk HPV infection

  • Affects middle-aged and older patients (40 to 70 years of age)
  • Low income status and poor hygiene habits are salient risk factors
  • Circumcision confers protection, more common in populations in which circumcision is not practiced routinely
A

Invasive Cell Carcinoma

134
Q

TRUE OR FALSE

Availability of vaccines to both low-risk and high-risk subtypes of HPV may help reduce the incidence of penile cancer and condyloma acuminatum

A

TRUE

135
Q

Other risk factors:

cigarette smoking and chronic inflammatory conditions such as lichen sclerosis et atrophicus (balanitis xerotica obliterans)

A

Invasive Squamous Cell Carcinoma

136
Q

PATHOGENESIS:

  • HPV encode E6 and E7 proteins that inactivate the p53 and RB tumor suppressor proteins, leading to genomic instability and increased proliferation, respectively

 E6 protein also stimulates telomerase expression, leading to cellular immortalization

 E7 protein induces feedback loops that increase levels of the CDKi p16

A

Invasive Squamous Cell Carcinoma

137
Q
  • Slowly growing, locally invasive lesion that often has been present for a year or more before
  • Lesions are nonpainful until they undergo secondary ulceration and infection
  • Metastases to inguinal LNs may occur early in its course
  • Only 50% of enlarged inguinal nodes detected in men with penile SCC contain cancer, with the remainder showing only reactive lymphoid hyperplasia
A

Invasive Squamous Cell Carcinoma

138
Q

Morphologic Findings:

Location
- originates in glans or inner surface of the prepuce near the coronal sulcus

Gross:
- may be irregular, fungating cauliflower-like masses; flat, indurated lesions; or large verruciform/papillary tumors

  • Conventional (usual) SCC is the most common HPV-negative type, encompassing almost half of all penile cancers
A

Invasive Squamous Cell Carcinoma

139
Q

Histologic subtypes are associated with distinct grades:

  • Verrucous and papillary carcinomas are well differentiated/grade 1 tumors
  • Sarcomatoid and basaloid carcinomas are poorly differentiated/grade 3 tumors
A

Invasive Squamous Cell Carcinoma

140
Q

exophytic, warty well-differentiated, non–HPV-related variant that invades locally along a broad pushing border, but rarely metastasizes

A

Verrucious Carcinoma

141
Q

HPV-related tumor comprised of
relatively small hyperchromatic cells that has a destructive pattern of invasion and usually pursues an aggressive course

A

Basaloud Carcinoma

Med (6 decks)

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