male Flashcards

1
Q

Most hyperplastic lesions arise in?

A

inner transitional zone

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2
Q

Most carcinomas (70-80%) arise
in?

A

the peripheral zones

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3
Q

What syndrome presents w/ fever, chills and dysuris.
Rectal examinations: Tender and boggy organ?

A

Acute Bacterial Prostatits

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4
Q

CF of Chronic Bacterial Prostatits

A

Low back pain, dysuria, perineal and suprapubic discomfort

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5
Q

Epi of Benign prostatic hyperplasia

A

Incidence: 90% –> 80yrs of age

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6
Q

causes/ pathogenesis of Benign prostatic hyperplasia

A
  • Excessive androgen (oestrogen) dependent growth of stromal and glandular elements
  • Synthesis of Dihydrotestosterone (DHT) in the prostate, from circulating testosterone → DHT binding to nuclear androgen receptors (causes cell proliferation) → Regulation of growth of prostatic epithelium and stromal cells
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7
Q

Macroscopic Features:
* Large organ (weight: 60-100gr)
* Numerous well-circumscribed nodules, with solid and cystic areas
* Slit-like appearance of the urethra, due to compression by the hyperplastic nodules

Microscopic features:
* Proliferating glandular elements and fibromuscular stroma
* Lining of hyperplastic glands -> Inner layer of tall columnar epithelial cells and outer layer of flattened basal cells
* Intraluminal presence of corpora amylacea (proteinaceous secretory material)

features of?

A

Benign Prostatic hyperplasia

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8
Q

CF of benign prostatic hyperplasia

A
  • Difficulty starting or stopping urine stream
  • straining while urinating
  • Urinary Urgency
  • Nocturia (increased urination frequency at night)
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9
Q

Treatment of benign prostatic hyperplasia

A

1) Inhibit DHT formation
2) Block alpha-adrenergic blockers → Relaxation of smooth muscles

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10
Q

Subcalssification of intra-epithelial neoplasia

A

1) Low-Grade PIN (LGPIN) and
2) High-Grade PIN (HGPIN)

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11
Q

Types of HGPIN

A

1) Flat pattern
2) Tufting pattern
3) Micro-papillary
4) Cribrifrom pattern

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12
Q

Epi of prostatic carcinoma

A

Men >50 years
* Most common form of cancer in men

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13
Q

behaviour of prostatic carcinoma

A

Ranges from aggressive and rapidly fatal to indolent
(‘latent”) disease of no clinical significance

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14
Q

70-80% of prostatic cancers arise in the —————

A

peripheral zone

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15
Q

Who is at Risk of developing Prostatic cancer

A

1) Increased incidence in blacks and Scandinavians
2) family History of prostate cancer

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16
Q

Microscopic Findings:
* Small glands, crowded together (“back-to-back” appearance)
* Glands lined by a single layer of cuboidal or low
columnar cells

* Absence of the basal cell layer
* pale-clear or typical amphophilic Cytoplasm
* Enlarged nuclei, with prominent nucleoli

Macroscopic Features:
* Firm, gray-white lesions
* Not well-defined margins
* Infiltrative growth into the adjacent prostatic parenchyma

features of?

A

Prostatic carcinoma

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17
Q

what does the presence of Cribriform glands, sheets of cells ,or individual infiltrating cells in microscopic findings of a prostatic carcinoma indicate?

A

High-grade tumour

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18
Q

Prostatic Carcinoma is ass. w?

A

Co-existence of HGPIN (80% of cases)

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19
Q

Which Gleason pattern best corresponds to the following histopatho findings?

  • Fused , Cribifrom glands w/ irregular or ragged contours
  • Ill-defined, poorly-formed glands with slit-like lumens
  • Glands with intraluminal glomerulations
A

Gleason pattern 4

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20
Q

Which Gleason pattern best corresponds to the following histopatho findings?

  • Tumour cells infiltrating as small nests, cords or individual cells
  • focally, Solid nests of tumour w/ “Comdeo” necrosis
A

Gleason pattern 5

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21
Q

Clinical features of Prostatic carcicoma

A

small, non-palpable asymptomatic lesions

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22
Q

Progression of Prostatic carcinomas

A
  • Locally advanced cancers →** Infiltration of the seminal vesicles and, adjacent soft tissues and organs** (i.e. bladder and rectum)
  • Osteoblastic metastases to the axial skeleton
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23
Q

Labratory findings of Prostatic Carcinoma

A

↑ total PSA w/ ↓ free PSA
(notes Free PSA: Total PSA is lower in men w/ prostatic cancer than men w/ being prostatic disease)

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24
Q

“Watchful waiting” for Cancers in?

A
  • Older men
  • Patients with substantial comorbidity
  • Young patients, with low serum PSA and small low grade cancers
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25
Q

The most common Penile Neoplasm?

A

Squamous cell carcinoma >95%

26
Q

Epi of Sqamous cell carcinoma in situ (of the penis)

A

Associated w/ uncircumcised men >40yrs and HPV (16/18)

27
Q

Squamous cell carcinoma is aka?

A

Bowen disease

28
Q

Macroscopic Features:
* Solitary plaque on the penis’ shaft

Microscopic Findings:
* Malignant cells within the epidermis, without invasion of the underlying stroma
* Large pale keratinocytes with abundant ground cytoplasm (“pagetoid cells”)
* lymphocytic infiltrates

features of?

A

Bowen disease (SCC)

*SCC: squamous cell carcinoma in situ

29
Q

Macroscopic Features:
* Gray, crusted, papular lesion; Occasionally, ulcerated with irregular margins
Microscopic Findings:
* Keratin pearls

features of?

A

Invasive squamous cell carcinoma

30
Q

Microscopic Findings:
* Bulbous (rounded), pushing deep margins, and no atypia
* Thin fibrovascular cores
* Thick acanthotic epithelium

features of?

A

Verrucous carcinoma

* Varient of SCC (papillary architecture)

31
Q

Complications of Cryptorchidism

A

1) Sterility (impaired spermatogenesis)
2) 3-5-fold increased risk for development of testicular cancer

32
Q

Microscopic Findings:
* Tubular atrophy (age: 5-6yrs); Hyalinisation (puberty)
* Foci of Intratubular Germ Cell Neoplasia (IGCN)

features of?

A

Cryptorchidism

33
Q

Causes of Epididymitis?

* inflammation of the epididymis

A
  • Children–> Coliforms
  • Young men –> Neisseria gonorrhoeae and Chlamydia trachomatis
  • Older men –> E. coli and Pseudomonas
34
Q

Pathogenesis of Epididymitis

A

Primary urinary tract infection → Vas deferens or the lymphatics of the spermatic cord → Spread to the Testis

35
Q

Macroscopic Findings:
* Swollen and tender organ (Epididymus)
* Creamy fibrino-purulent exudate
Microscopic Findings:
* Neutrophilic inflammatory infiltrate

features of?

A

Epididymitis

36
Q

cause of Orchitis

* Inflammation of the testis

A

Mumps virus

37
Q

Macroscopic Features:
* Oedematous and congested testes

Microscopic Findings:
* Lympho-plasmacytic inflammatory infiltrate
* Extensive necrosis, atrophy, fibrosis and sterility (severe cases)

features of?

A

Mumps Orchitis

*Lympho-plasmacytic infiltrates = Virus

38
Q

Cause of Spermatic Cord Torsion in Adults

A

Failure of normal posterior anchoring (positioning) of the gubernaculum testis (“scrotal ligament”), epididymis and testis (bell clapper deformity) → Increased mobility of testes

39
Q

CF of Torsion of the Spermatic cord

A

Sudden onset of testicular pain

40
Q

Complications of Spermatic Cord Torsion

A

Obstruction of testicular venous drainage → Vascular engorgement & Venous infarction

  • Urologic Emergency!!
41
Q

Epi of testicular Neoplasms

A
  • Peak incidence: 15-35 years
  • Germ cell tumours account for 95% of testicular tumours in post-pubertal males
42
Q

Risk factors of Testicular tumours

A
  • History of Cryptorchidism
  • Brothers of males with Germ Cell Tumours –> 8-10-fold increased risk
43
Q

Calssification of Testicular Neoplasms

A

1) Germ Cell Tumours
2) Sex Cord-Stromal tumours

44
Q

Germ cell Tumours examples

A

1) Seminomas (“Classic” Seminomas, Spermatocytic Seminoma)
2) Non-seminomatous Germ Cell Tumours (i.Embryonal Carcinomas, ii. Yolk-Sac Tumours, iii. Choriocarcinomas, iv.Teratomas)

45
Q

Sex Cord-Stromal Tumours

A
  • Sertoli-Cell Tumours
  • Leydig-Cell Tumours
46
Q

Macroscopic Features:
* Soft, well-demarcated, gray-white lesions (on the surface of the testicle)
* Large tumours: Foci of coagulation necrosis
* Lobular pattern

Microscopic Findings:
* Large, uniform cells with distinct cell borders
* Clear, glycogen-rich cytoplasm
* Round nuclei, with prominent nucleoli
* Arrangement of cells in small lobules, separated by fibrous septa
* Usually, lymphocytic infiltrates
* Sometimes, accompanying ill-defined granulomatous reaction
* Presence of syncytiotrophoblastic giant cells in 15% of cases;

feature of?

A

Seminomas

* Germ Cell tumour (Testicular neoplasm)

47
Q

what Hormon levels are elevated in Seminomas?

A

β-hCG (10% of patients) and PALP

* beta-human chorionic gonadotropin

48
Q

* Germ cell tumour

Epi of Spermatic Seminoma

A

> 65 years

49
Q

Microscopic Findings:
* Polygonal cells of variable size (i.e. lymphocyte-like cells, intermediate cells and giant cells)
* Arrangement of cells in nodules or sheets
* Absent lymphocytic infiltrates, granulomas and syncytiotroph.
* No association to Intratubular Germ Cell Neoplasia (IGCN)
* No metastatic potential

features of?

A

Spermatocytic Seminoma

* Gram cell tumour

50
Q

Macroscopic Features:
* Large and well-demarcated lesions
* Low cuboidal to columnar cells
* Formation of microcysts, sheets, glands and papillae
* Schiller-Duvall bodies: Structures resembling primitive glomeruli
* Identification of PAS positive eosinophilic hyaline globules

features of?

A

Yolk Sac Tumours

51
Q

What Hormones are Elevated in Yolk Sac Tumours?

A

α1-antitrypsin and AFP (90% of patients)

52
Q

Macroscopic Features:
* Small, non palpable lesions
* lobulated and Haemorrhagic and necrotic lesions

Microscopic Findings:
* Sheets of small cuboidal cells, admixed with cytotrophoblast and syncytiotrophoblast-like cells

features of?

A

Choriocarcinomas

53
Q

Hormone levels elevated in Choriocarcinomas

A

hCG (+) in syncytiotrophoblast-like
cells
(100% of patients)

54
Q

Epi of Teratomas

A

Pure forms: Common in infants and children; Rare in adults (only 2-3% of Germ Cell Tumours)

55
Q

Microscopic Findings:
* Heterogenous collection of differentiated cells or organoid structures (e.g. neural tissue, muscle bundles, foci of cartilage and thyroid resembling tissue, brain substance, etc.) within a fibrous or myxoid stroma
* tissues may be mature (resembling adult tissues) or immature (resembling fetal tissues)

features of?

A

Teratomas

56
Q

List the 4 types of Teratomas

A

A. Neural (Ectodermal)
B. Glandular (Endodermal)
C. Cartilage (Mesodermal)
D. Squamous Epithelial

57
Q

Prognosis of Seminomas

A

Excellent prognosis (>90%)

58
Q

Prognosis of Non-seminomatous tumours

A

Excellent prognosis
(~90% of patients –> Complete remission and cure, with aggressive chemotherapy )

59
Q

Prognosis of Pure Choriocarcinoma

A

Poor prognosis

60
Q

CF of Seminomas and non-seminomatous tumours

A

Painless testicular mass