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AP reviewer > Male > Flashcards

Male Flashcards

1
Q

Histology of granulomatous prostatitis: Idiopathic type.

A

Giant cells, histiocytes, plasma cells, lymphocytes, and granulocytes form sheets around ruptured ducts and acini.

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2
Q

Histology of granulomatous prostatitis: After therapy with BCG.

A

Mostly histiocytes and giant cells around ducts or acini.

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3
Q

Histology of granulomatous prostatitis: Post-procedural type (2).

A

Palisade of histiocytes and giant cells around fibrinoid necrosis.

Eosinophils may be seen.

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4
Q

Malakoplakia:

A. Presentation.
B. Frequent cause.

A

A. Fever, frequency, dysuria, hematuria.

B. E. coli.

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5
Q

Malakoplakia: Histology.

A

Sheet of von Hansemann’s histiocytes, containing Michaelis-Gutmann bodies, are surrounded by chronic inflammation.

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6
Q

Prostatic infarct: Risk factors (3).

A

Nodular hyperplasia.

Hypotension.

Urinary catheter.

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7
Q

Histology of prostatic infarct: Acute (3).

A

Hemorrhage surrounding coagulative necrosis.

Reactive glands and squamous metaplasia.

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8
Q

Histology of prostatic infarct: Remote.

A

Scar containing hemosiderin and small glands that often show squamous metaplasia.

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9
Q

Basal-cell hyperplasia: Pitfall.

A

Mistaking basal-cell hyperplasia with nucleolomegaly for high-grade PIN.

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10
Q

Sclerosing adenosis vs. prostatic adenocarcinoma (3).

A

Sclerosing adenosis:

− Preserved basal-cell layer.
− Thickened basement membrane.
− Inconspicuous nucleoli.

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11
Q

Atypical adenomatous hyperplasia: Architecture (2).

A

Circumscribed but may have focally infiltrative border.

Tightly packed small glands with admixed large glands.

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12
Q

Atypical adenomatous hyperplasia: Cytology (2).

A

Basal-cell layer may be incomplete in some glands.

Some nucleoli may be large.

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13
Q

Urothelial metaplasia vs. normal urothelium.

A

The former lacks umbrella cells.

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14
Q

Atypical adenomatous hyperplasia vs. prostatic adenocarcinoma (2).

A

Atypical adenomatous hyperplasia:

− No macronucleoli (more than 3 μm).
− Often contains corpora amylacea.

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15
Q

Types of metaplasia of prostatic epithelium (3).

A

Urothelial.

Squamous.

Mucinous.

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16
Q

Chronic abacterial prostatitis:

A. Definition.
B. Possible causes.

A

A. Prostatitis with negative bacterial culture.

B. Chlamydia, Ureaplasma, Mycoplasma.

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17
Q

Bacterial prostatitis:

A. Organisms.
B. Complication.

A

A. Same as those that cause UTI.

B. Antibiotic therapy may fail because the prostate is a “safe haven” for bacteria.

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18
Q

Granulomatous prostatitis: Antecedents (3).

A

A. Therapy with BCG.

B. TURP or biopsy.

C. Infection.

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19
Q

Granulomatous prostatitis: Physical examination.

A

Prostate may be firm, raising suspicion for carcinoma.

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20
Q

Granulomatous prostatitis: Presentation.

A

Obstructive symptoms, dysuria, fever, chills.

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21
Q

High-grade PIN: Duration of progression to adenocarcinoma.

A

About 10 years.

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22
Q

High-grade PIN: Likelihood of adenocarcinoma on rebiopsy.

A

25%.

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23
Q

High-grade PIN: Patterns (4).

A

Tufted.

Cribriform.

Micropapillary.

Flat.

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24
Q

High-grade PIN: Nuclear features.

A

Large nuclei.

Large nucleoli.

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25
Q

High-grade PIN: Immunohistochemistry (3).

A

HMWCK and p63 highlight the basal cells.

AMACR: If positive, staining is less intense than that of carcinoma.

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26
Q

Adenocarcinoma: Typical location.

A

Posterior peripheral zone.

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27
Q

Adenocarcinoma: Activity of metastases to bone.

A

May be either osteoblastic or osteolytic.

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28
Q

Acinar adenocarcinoma: Histologic features that are pathognomonic for malignancy (4).

A

Glomeruloid structures.

Mucinous fibroplasia.

Circumferential perineural invasion.

Extension beyond the prostate.

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29
Q

Acinar adenocarcinoma: Intraluminal structures.

A

Blue or pink blobs and crystalloids are relatively common.

Corpora amylacea are rare.

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30
Q

Mucinous adenocarcinoma:

A. Definition.
B. Histology.
C. Most common pattern.

A

A. At least 25% of the tumor consists of extracellular lakes of mucin.

B. Malignant cells and glands in seas of snot.

C. Cribriform.

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31
Q

Mucinous adenocarcinoma:

A. Association.
B. Gleason’s grade.
C. Behavior.

A

A. Typically seen with acinar adenocarcinoma.

B. Grade 4.

C. Aggressive.

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32
Q

Signet-ring-cell adenocarcinoma:

A. Definition.
B. Association.
C. Gleason’s grade.

A

A. At least 25% of the tumor consists of signet rings.

B. Often seen with other types of adenocarcinoma.

C. Grade 5.

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33
Q

Ductal-type adenocarcinoma: Clinical and gross appearance.

A

May form polypoid mass that extends into the prostatic urethra.

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34
Q

Ductal-type adenocarcinoma: Origin.

A

Larger periurethral prostatic ducts.

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35
Q

Ductal-type adenocarcinoma: Histology (2).

A

Pseudostratified columnar cells form papillae and cribriform structures.

Mitotically active.

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36
Q

Ductal-type adenocarcinoma: Gleason’s grade.

A

Usually grade 4 (grade 5 if there is comedo necrosis).

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37
Q

Carcinosarcoma: Associations (2).

A

Previous or current high-grade prostatic adenocarcinoma.

History of radiation therapy in some cases.

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38
Q

Carcinosarcoma: Laboratory finding.

A

Serum PSA may be normal or only slightly elevated.

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39
Q

Carcinosarcoma: Patterns of the sarcomatous component (7).

A 
The sarcomatous component may resemble
− Fibrosarcoma.
− Leiomyosarcoma.
− Osteosarcoma.
− Rhabdomyosarcoma.
− Chondrosarcoma.
− MFH.
− High-grade sarcoma, NOS.
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40
Q

Carcinosarcoma vs. sarcomatoid carcinoma.

A

Carcinosarcoma: Distinct carcinomatous and sarcomatous areas.

Sarcomatoid carcinoma: There is a histologic transitional between the two elements.

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41
Q

Foamy-gland adenocarcinoma: Significance (2).

A

May be missed because of its bland nuclei.

Usually occurs with higher-grade acinar-type adenocarcinoma.

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42
Q

Pseudohyperplastic adenocarcinoma: Confounding features (2).

A

Pseudo-stratified epithelium.

Large acini in some cases.

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43
Q

Pseudohyperplastic adenocarcinoma: Telltale features.

A

Large nuclei and large nucleoli.

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44
Q

Histologic features of treated adenocarcinoma: Androgen deprivation (3).

A

Residual carcinoma: Loss of nuclear and nucleolar enlargement.

Benign glands: Stromal hyperplasia, basal-cell hyperplasia, squamous metaplasia.

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45
Q

Histologic features of treated adenocarcinoma: Radiation (4).

A

Residual carcinoma: Cytoplasmic vacuoles.

Benign glands: Atrophy, large nuclei, large nucleoli.

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46
Q

Types of prostatic adenocarcinoma that receive no score of Gleason (5).

A

Neuroendocrine.

Squamous.

Adenosquamous.

Sarcomatoid.

Treated.

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47
Q

Immunohistochemistry of prostatic adenocarcinoma: AMACR.

A

Reacts best with higher-grade, untreated, conventional acinar-type adenocarcinomas.

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48
Q

Immunohistochemistry of prostatic adenocarcinoma: PSA and PAP.

A 
Both react with
− Ductal type.
− Mucinous type.
− Signet-ring type.
− Epithelial component of carcinosarcoma.
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49
Q

Immunohistochemistry of prostatic adenocarcinoma: CEA.

A

Reacts with some ductal adenocarcinomas.

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50
Q

Genetics of prostatic adenocarcinoma:

A. Familial locus.
B. Early molecular event.

A

A. 8q24.

B. Fusion of TMPRSS2 and ERG.

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51
Q

Prostatic adenocarcinoma: Relevance of location to clinical behavior.

A

Tumors of the transitional zone are less aggressive than tumors of the peripheral zone.

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52
Q

Proliferations of basal cells in the prostate (4).

A

Basal-cell hyperplasia.

Atypical basal-cell hyperplasia.

Basal-cell adenoma.

Basal-cell carcinoma.

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53
Q

Carcinomas of basal cells: Laboratory findings.

A

Usually normal serum PSA and PAP.

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54
Q

Basal-cell carcinoma: Histology.

A

Clusters of basal cells infiltrate, often with a desmoplastic response.

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55
Q

Basal-cell carcinoma: Clues to malignancy (3).

A

At least one of the following must be present:
− Necrosis.
− Perineural invasion.
− Infiltration beyond the prostatic capsule.

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56
Q

Adenoid-cystic carcinoma: Synonym.

A

Basal-cell carcinoma with cribriform spaces.

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57
Q

Adenoid-cystic carcinoma: Histology.

A

Similar to that of adenoid-cystic carcinoma of the salivary glands.

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58
Q

Adenoid-cystic carcinoma: Behavior (2).

A

Perineural invasion is rare.

Low malignant potential.

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59
Q

Adenoid-cystic carcinoma: Immunohistochemistry (2).

A

Positive: PSA, PAP.

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60
Q

Neuroendocrine carcinoma: Epidemiology.

A

Patients usually have a history of treated prostate cancer.

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61
Q

Neuroendocrine carcinoma: Possible paraneoplastic syndromes (4).

A

Cushing’s syndrome.

Malignant hypercalcemia.

SIADH.

Eaton-Lambert syndrome.

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62
Q

Neuroendocrine carcinoma: Route of metastasis.

A

Hematogenous.

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63
Q

Neuroendocrine carcinoma: Histopathology (2).

A

Resembles small-cell carcinoma of the lung.

Half of cases are accompanied by typical acinar-type adenocarcinoma.

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64
Q

Neuroendocrine carcinoma: Behavior.

A

Aggressive, but even more so if it expresses androgen receptors.

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65
Q

Urothelial carcinoma of the prostate: Origins (2).

A

Prostate: Urethra, ducts, or acini.

Bladder.

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66
Q

Urothelial carcinoma of the prostate: Poor prognostic factor.

A

Infiltration into the prostatic stroma: Makes it stage T4.

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67
Q

Squamous-cell carcinoma of the prostate: Clinical situations (2).

A

De novo.

Following treatment of adenocarcinoma.

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68
Q

Squamous-cell carcinoma of the prostate: Behavior of metastases.

A

Osteolytic.

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69
Q

Squamous-cell carcinoma of the prostate: Types (2).

A

Pure SCC.

Adenosquamous carcinoma.

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70
Q

Pure squamous-cell carcinoma of the prostate: Diagnostic criteria (3).

A

No glands.

No history of radiation or hormonal therapy.

Not a metastasis or direct spread from another organ.

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71
Q

Squamous-cell carcinoma of the prostate: Immunohistochemistry (2).

A

PSA and PAP

− Pure SCC: Usually negative.
− Adenosquamous carcinoma: Usually positive in the glandular component.

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72
Q

Squamous-cell carcinoma of the prostate: Prognosis.

A

Poor.

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73
Q

Phyllodes tumor of the prostate: Histologic predictors of aggressive behavior (3).

A

Stromal hypercellularity.

Cytologic atypia.

High mitotic rate.

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74
Q

Phyllodes tumor of the prostate: Sites of metastasis (2).

A

Lung and bone.

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75
Q

Postoperative spindle-cell nodule of the prostate: Histology (2).

A

Bland spindle cells with variable mitotic rate and no atypical mitotic figures.

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76
Q

Most common sarcoma of the prostate.

A

Rhabdomyosarcoma, particularly the embryonal type.

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77
Q

Rhabdomyosarcoma of the prostate: Prognosis.

A

Occurrence in the prostate or the urinary bladder carries a worse prognosis than usual.

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78
Q

Lymphoma of the prostate gland: Most common type.

A

DLBCL.

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79
Q

Lymphoma of the prostate:

A. Treatment.
B. Prognosis.

A

A. Surgery for relief of obstruction.

B. Death in about 2 years.

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80
Q

Testicles are usually descended by about what age?

A

3 months.

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81
Q

Cryptorchidism:

A. Most common site of undescended testis.
B. More common side.
C. Association of failure of descent.

A

A. Inguinal canal.

B. Right.

C. Inguinal hernia.

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82
Q

Cryptorchidism: Histology (4).

A

Sclerosis or atrophy of seminiferous tubules.

Increased Sertoli cells.

Hyperplasia of Leydig cells.

Contralateral, descended testis may show similar histology.

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83
Q

Cryptorchidism: Main causes (2).

A

Lack of hormonal signal.

Anatomical or mechanical impairment.

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84
Q

Cryptorchidism: Phases of descent.

A

Transabdominal.

Inguinal: Much more likely to have get disrupted.

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85
Q

Cryptorchidism: Rôle of orchiepexy.

A

Facilitates the detection of cancer but does not decrease the risk of it.

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86
Q

Testicular cysts: Types (3).

A

Albugineal.

Epidermoid.

Rete testis.

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87
Q

Albugineal cyst: Histology.

A

Lined by low-cuboidal serosal epithelium.

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88
Q

Epidermal cyst: Histology (2).

A

Similar to that of epidermal inclusion cyst.

No adnexal structures.

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89
Q

Rete testis cyst: Histology.

A

Lined by attenuated, low-cuboidal epithelium.

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90
Q

Hydrocele: Pathogenesis.

A

Serous fluid collects between the parietal and visceral tunica vaginalis.

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91
Q

Hydrocele: Clinical appearance.

A

Transilluminates unless hemorrhagic.

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92
Q

Hydrocele: Histology (2).

A

Lined by mesothelial cells that can be hyperplastic or atypical.

Tunica vaginalis may be thickened in long-standing hydroceles.

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93
Q

Viral orchitis: Causes (2).

A

Mumps virus (#1).

Coxsackie B virus.

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94
Q

How often is the testis involved in cases of mumps?

A

In about 15-30% of cases.

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95
Q

Viral orchitis: Histology (2).

A

Acute infection: Neutrophils.

Later: Atrophy and fibrosis.

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96
Q

Bacterial orchitis:

A. Leading cause.
B. Associations (2).

A

A. Escherichia coli.

B. Urinary-tract infection; bacterial epididymitis.

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97
Q

Bacterial orchitis: Histology (2).

A

Acute infection: Neutrophils and abscesses.

Chronic infection: May show granulomas.

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98
Q

Syphilitic orchitis: Histology (3).

A

Edema.

Obliterative endarteritis with perivascular lymphocytes and plasma cells.

Gummas may be present.

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99
Q

Infectious granulomatous orchitis: Causes (3).

A

Mycobacterium tuberculosis.

Fungi.

Brucella.

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100
Q

Noninfectious granulomatous orchitis: Causes (2).

A

Sarcoidosis.

Idiopathic.

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101
Q

Testicular malakoplakia:

A. Gross pathology.
B. Special stains.

A

A. Firm and tan-yellow.

B. von Kossa’s, Prussian blue, PAS.

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102
Q

Testicular torsion: Window for surgical salvage of the testis.

A

About 8 hours.

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103
Q

Infertility:

A. Definition.
B. Proportion of cases due to defect in the male.

A

A. No conception after a year of unprotected coitus.

B. 40% to 50% of infertile couples.

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104
Q

Male infertility: Functional types (3).

A

Pre-testicular (hormonal).

Testicular (75% of cases).

Post-testicular (obstructive).

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105
Q

Stages of normal development of spermatozoa.

A

Spermatogonia − primary spermatocytes − secondary spermatocytes − spermatids − spermatozoa.

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106
Q

Male infertility: Histologic components of testicular examination.

A

Seminiferous tubules.

Germ cells.

Interstitium.

Blood vessels.

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107
Q

Male infertility: Endocrine causes (3).

A

Diabetes mellitus.

Cushing’s syndrome.

Hyperprolactinemia.

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108
Q

Male infertility: Leydig cells.

A

May be hypoplastic or hyperplastic.

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109
Q

Factors that confer a high risk for tumors of germ cells (5).

A

Cryptorchidism.

Previous germ-cell tumor.

Family history.

Gonadal dysgenesis.

Androgen insensitivity.

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110
Q

Intratubular germ-cell neoplasia: Secondary histologic finding.

A

Severely diminished or absent spermatogenesis in the affected tubule.

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111
Q

Intratubular germ-cell neoplasia: Stains (2).

A

Positive: PLAP, PAS-D.

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112
Q

Intratubular germ-cell neoplasia vs. germinal epithelium with arrest of maturation (2).

A

Arrest of maturation:

− No significant nuclear pleomorphism.
− Usually negative for PLAP.

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113
Q

Intratubular germ-cell neoplasia: Germ-cell tumors in which it is not seen (3).

A

Spermatocytic seminoma.

Yolk-sac tumor.

Teratoma.

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114
Q

Seminoma: Age group.

A

Fourth decade.

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115
Q

Seminoma: Laboratory findings (2).

A

Serum hCG can be elevated.

Serum AFP is usually normal.

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116
Q

Seminoma: Composition of lymphoid infiltrate.

A

T cells.

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117
Q

Seminoma: Non-microscopic clues to a syncytiotrophoblastic component (2).

A

Elevated serum hCG.

Punctate hemorrhages on gross examination.

Note: Syncytiotrophoblasts occur without cytotrophoblasts.

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118
Q

Anaplastic seminoma: Histology (3).

A

Higher cellularity; more nuclear pleomorphism.

Three or more mitotic figures per hpf.

Many giant cells.

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119
Q

Seminoma: Immunohistochemistry (2,1,1).

A

Positive: PLAP, CD117.

Negative: EMA.

Patchy: Cytokeratin.

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120
Q

Seminoma: Cytogenetics.

A

i(12p).

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121
Q

Seminoma: Possibly favorable histologic feature.

A

Brisk lymphocytic infiltrate.

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122
Q

Spermatocytic seminoma: Age group.

A

Sixth decade.

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123
Q

Spermatocytic seminoma: Laboratory finding.

A

No elevation of serum tumor markers.

124
Q

Spermatocytic seminoma: Cells.

A

Small: Lymphocyte-sized, smudged chromatin.

Intermediate: 15-20 μm, granular chromatin.

Giant: 50-100 μm, one or many nuclei.

125
Q

Spermatocytic seminoma vs. classic seminoma (3).

A

Spermatocytic seminoma lacks

− Lymphocytic infiltrate.
− Granulomas.
− Intratubular germ-cell neoplasia.

126
Q

Staining of spermatocytic seminoma for ___.

A. PAS.
B. Cytokeratin.
C. PLAP.

A

A. Negative (no glycogen).

B. May show perinuclear, dotlike positive staining.

C. May be focally positive.

127
Q

Spermatocytic seminoma: Electron microscopy (2).

A

Intercellular bridges.

Filamentous chromosomes.

128
Q

Spermatocytic seminoma: Cytogenetics.

A

Usually no i(12p).

129
Q

Embryonal carcinoma: Presentation.

A

Gynecomastia or clinically evident metastasis in 40% of patients.

130
Q

Embryonal carcinoma: Patterns of growth (3).

A

Solid.

Tubuloglandular.

Papillary.

131
Q

Embryonal carcinoma: Cytology (2,3).

A

Cytoplasm: Ample; indistinct borders.

Nucleus: Large and vesicular; macronucleolus; mitotically active.

132
Q

Embryonal carcinoma: Immunohistochemistry (3,1).

A

Positive: Cytokeratin, PLAP (patchy), CD30.

Negative: EMA.

133
Q

Embryonal carcinoma: Cytogenetics (2).

A

i(12p).

Interstitial del(p13;q22).

134
Q

Yolk-sac tumor: Age groups (2).

A

Pure yolk-sac tumor: Children.

YST as part of a mixed tumor: Adults.

135
Q

Histology of yolk-sac tumor: Microcystic pattern (2).

A

Cytoplasmic vacuoles give lipoblastic appearance.

Cells form thin cords around cystic spaces.

136
Q

Histology of yolk-sac tumor: Macrovesicular pattern.

A

Coalescence of microcysts forms larger cystic spaces.

137
Q

Histology of yolk-sac tumor: Solid pattern (2).

A

Cells have well-defined borders.

Thin-walled vessels may be present.

138
Q

Yolk-sac tumor, solid pattern vs. classic seminoma.

A

YST, solid pattern:

− No lymphocytic infiltrate.
− No fibrous septa.

139
Q

Histology of yolk-sac tumor: Myxomatous pattern (2).

A

Spindle-shaped or epithelioid cells in abundant myxoid matrix.

Conspicuous vascular network.

140
Q

Histology of yolk-sac tumor: Endodermal-sinus pattern.

A

Consists of Schiller-Duval (glomeruloid) bodies.

141
Q

Histology of yolk-sac tumor: Papillary pattern.

A

Papillae with or without well-formed fibrovascular cores.

142
Q

Histology of yolk-sac tumor: Tubuloalveolar pattern.

A

Consists of gland-like structures.

143
Q

Histology of yolk-sac tumor: Polyvesicular-vitelline pattern (2).

A

Round, dumbbell-shaped, or irregular spaces lined by flat, bland cells.

Abundant loose, fibromyxoid stroma.

144
Q

Histology of yolk-sac tumor: Hepatoid pattern (2).

A

Resembles hepatocellular carcinoma.

Many hyaline globules.

145
Q

Hyaline globules of yolk-sac tumor:

A. Location.
B. Size.
C. Staining.

A

A. Intracellular.

B. 1-50 μm.

C. Positive for PAS-D; usually negative for AFP.

146
Q

Yolk-sac tumor: Immunohistochemistry (3).

A

Positive: Cytokeratin.

Variable: PLAP, AFP, α₁-antitrypsin.

147
Q

Yolk-sac tumor: Cytogenetics (2).

A

Adults: i(12p) may be present.

Children: No i(12p).

148
Q

Pure teratoma:

A. Age group.
B. Prognosis.

A

A. Usually in children under 4 years of age.

B. Those in prepubertal children do not metastasize.

149
Q

How many mixed germ-cell tumors of adults have a teratomatous component?

A

About half.

150
Q

Teratoma: Cytogenetics.

A

There may be i(12p).

151
Q

Benign teratoma: Types (3).

A

Epidermoid cyst: No adnexal structures.

Dermoid cyst: Yes adnexal structures.

Non-dermoid benign teratoma.

152
Q

Non-dermoid benign teratoma: Incompatible histologic features (5).

A

Cytologic atypia.

IGCN.

Impaired spermatogenesis.

Sclerosis of seminiferous tubules.

Abnormalities of chromosome 12p.

153
Q

Malignant teratoma: Histology of metastases.

A

May resemble the original teratoma or another germ-cell tumor.

154
Q

Teratoma: Prognosis in the postpubertal male.

A

Any teratoma, other than non-dermoid benign teratoma, may be malignant.

155
Q

Choriocarcinoma:

A. Age group.
B. Presentation.

A

A. Second or third decade.

B. Often with symptoms of metastatic disease.

156
Q

Choriocarcinoma: Laboratory finding.

A

Very high serum hCG.

157
Q

Choriocarcinoma: Gross pathology (3).

A

Testis may appear normal externally.

Tumor may be small.

Regression of the tumor may leave only a fibrous scar.

158
Q

Choriocarcinoma: Cytology.

A

Cytotrophoblasts: Mononucleate; pale cytoplasm with discrete borders.

Syncytiotrophoblasts: Multinucleate, smudged chromatin; eosinophilic, vacuolated cytoplasm.

159
Q

Choriocarcinoma:

A. Route of invasion.
B. Sites of metastases (3).

A

A. Hematogenous.

B. Lungs, brain, gastrointestinal tract.

160
Q

Choriocarcinoma: Immunohistochemistry (3).

A

Positive: Cytokeratin, EMA.

hCG: Strong or absent in syncytiotrophoblasts; weak or absent in cytotrophoblasts.

161
Q

Choriocarcinoma: Treatment.

A

Chemotherapy helps.

Radiation does not.

162
Q

Leydig-cell tumor: Age groups (2).

A

5-10 years of age.

20-60 years of age.

163
Q

Leydig-cell tumor: Presentation (2).

A

Boys: Precocious puberty, sometimes gynecomastia.

Men: Testicular swelling, sometimes gynecomastia.

164
Q

Leydig-cell tumor: Risk factors (2).

A

Testicular atrophy.

Cryptorchidism.

165
Q

Leydig-cell tumor: Possible cytoplasmic contents.

A

Lipofuscin.

Rod-shaped crystals of Reinke.

Lipid vacuoles.

166
Q

Leydig-cell tumor: Histologic clue to malignancy.

A

At least 3 mitotic figures pet 10 hpf.

167
Q

Leydig-cell tumor: Immunohistochemistry (2).

A

Variable: Vimentin, androgens.

168
Q

Leydig-cell tumor: Electron microscopy (2).

A

Much smooth endoplasmic reticulum.

Hexagonal or rhomboidal crystals of Reinke.

169
Q

Leydig-cell tumor vs. hyperplasia of Leydig cells (2).

A

Hyperplasia:

− Presevation of seminiferous tubules.
− No crystals of Reinke.

170
Q

Malignant Leydig-cell tumor:

A. Frequency.
B. Relevance to age.

A

A. About 10% of Leydig-cell tumors.

B. Does not occur in prepubertal boys.

171
Q

Sertoli-cell tumor: Age group.

A

Most common in middle age.

172
Q

Sertoli-cell tumor: Presentation (2).

A

Boys: Gynecomastia sometimes.

Men: Testicular mass; impotence or gynecomastia sometimes.

173
Q

Malignant Sertoli-cell tumor:

A. Frequency.
B. Relevance to age.
C. Relevance to histologic type.

A

A. About 10% of Sertoli-cell tumors.

B. Can occur in prepubertal boys.

C. Sclerosing Sertoli-cell tumor is always benign.

174
Q

Sertoli-cell tumor: Associations with syndromes (2).

A

Carney’s syndrome: Large-cell calcifying.

Peutz-Jeghers: Intratubular large-cell hyalinizing Sertoli-cell neoplasia.

175
Q

Sertoli-cell tumor: General histology.

A

Cells with clear or vacuolated cytoplasm form cords resembling immature seminiferous tubules.

176
Q

Histology of variants of Sertoli-cell tumor:

A. Sclerosing.
B. Large-cell calcifying.

A

A. Dense collagenous stroma.

B. Myxoid or collagenous stroma that is often calcified or ossified; may show intratubular growth.

177
Q

Sertoli-cell tumor: Immunohistochemistry (3).

A

Variable: Inhibin, S100, cytokeratin.

178
Q

Sertoli-cell tumor: Electron microscopy (3).

A

Much smooth endoplasmic reticulum.

Mitochondria with tubular cristae.

Charcot-Böttcher (perinuclear) filaments.

179
Q

Sertoli-cell tumor vs. androgen-insensitivity syndrome.

A

In the latter, there may be nodules of Sertoli cells, but these also contain Leydig cells.

180
Q

Adult granulosa-cell tumor:

A. Presentation.
B. Behavior.

A

A. Testicular mass, often with gynecomastia.

B. Benign.

181
Q

Adult granulosa-cell tumor: Histology.

A

Cells with “coffee-bean” nuclei form Call-Exner bodies.

182
Q

Juvenile granulosa-cell tumor:

A. Age group.
B. Presentation.
C. Behavior.

A

A. Infants under 5 months of age.

B. Testicular mass; no hormonal symptoms.

C. Benign.

183
Q

Juvenile granulosa-cell tumor: Patterns of growth (3).

A

Follicular.

Solid.

Mixed.

184
Q

Juvenile granulosa-cell tumor: Cytology.

A

Nuclei: Hyperchromatic; visible nucleolus.

Cytoplasm: Abundant; pale or eosinophilic.

185
Q

Juvenile granulosa-cell tumor: Histology of follicular pattern.

A

Bland tumor cells form ovarian follicle-like structures containing mucicarmine-positive matter.

186
Q

Granulosa-cell tumors: Mitotic activity.

A

Adult type: Low.

Juvenile type: May be high.

187
Q

Gonadoblastoma: Epidemiology.

A

Patients have abnormal gonads due to intersex syndrome or undescended testes.

188
Q

Gonadoblastoma: Presentation (2).

A

Usually found incidentally in gonads removed for other reasons.

189
Q

Gonadoblastoma: Behavior.

A

Benign, but 10-50% are associated with a germ-cell neoplasm.

190
Q

Gonadoblastoma: Histologic components (3).

A

Germ cells.

Sex cord−stromal cells.

Connective-tissue stroma.

191
Q

Gonadoblastoma: Histology of germ-cell component.

A

Resembles seminoma or immature sperm cells.

Mitotically active.

192
Q

Gonadoblastoma: Histology of sex cord−stromal component (2).

A

Resembles immature Sertoli cells or granulosa cells.

Mitotically inactive.

193
Q

Gonadoblastoma: Possible stromal features.

A

Calcification.

Hyalinization.

194
Q

Gonadoblastoma vs. IGCN in a Sertoli-cell nodule.

A

The latter lesion is microscopic and occurs in a non-dysgenetic testis.

195
Q

Granulosa-cell tumors: Immunohistochemistry (2).

A

Positive: Cytokeratins 8/18, vimentin.

196
Q

Gonadoblastoma: Treatment.

A

Bilateral orchiectomy: Gonadoblastoma is often bilateral and may be associated with a germ-cell neoplasm.

197
Q

Testicular lymphoma:

A. Most common type.
B. Versus chronic orchitis.

A

A. Diffuse large B-cell lymphoma.

B. Lymphoma cells typically spare the tubules.

198
Q

Acute epididymitis:

A. Bacterial agents (3).
B. Viral agents (2).

A

A. Gram-negative bacilli, N. gonorrhoeae, C. trachomatis.

B. Mumps, CMV.

199
Q

Acute epididymitis: Histology of chlamydial infection.

A

Minimally destructive inflammation.

200
Q

Chronic epididymitis:

A. Infectious causes (3).
B. Noninfectious causes (2).

A

A. Tuberculosis, leprosy, fungi.

B. Sarcoidosis, sperm granuloma.

201
Q

Chronic epididymitis: Histology of fungal infection.

A

Necrotizing granulomas and abscesses.

202
Q

Spermatocele:

A. Location.
B. Wall.

A

A. Anywhere along the flow of spermatozoa.

B. Floppy.

203
Q

Epididymal cyst: Wall.

A

Rubbery.

204
Q

Cystic ductuli efferentes:

A. Location.
B. Structure.

A

A. Between the head of the epididymis and the rete testis.

B. Multilocular.

205
Q

Cystic ductuli efferentes: Histology (2).

A

Lined by low-cuboidal epithelium.

No smooth muscle.

206
Q

Adenomatoid tumor: Typical location.

A

Lower pole of epididymis.

207
Q

Adenomatoid tumor: Gross pathology.

A

Firm, gray-white nodule with a solid, whorled cut surface.

208
Q

Adenomatoid tumor: Histologic components (2).

A

Epithelioid cells.

Fibrous stroma.

209
Q

Adenomatoid tumor: Patterns of growth of the epithelioid component.

A

Tubules, cysts, cords.

210
Q

Adenomatoid tumor: Contents of fibrous stroma (2).

A

Hyalinized or smooth muscle.

Lymphocytes in aggregates or in patchy infiltrates.

211
Q

Adenomatoid tumor: Immunohistochemistry (2).

A

Positive: Mesothelial markers, alcian blue.

Negative: CEA, inhibin.

212
Q

Adenomatoid tumor: Electron microscopy (2).

A

Long, slender microvilli.

Desmosomes.

213
Q

Papillary cystadenoma:

A. Frequency of bilaterality.
B. Associated syndrome.

A

A. 40%.

B. von Hippel-Lindau.

214
Q

Papillary cystadenoma: Gross pathology.

A

Well circumscribed and multicystic.

215
Q

Papillary cystadenoma: Histology (2).

A

Cysts contain papillary projections.

Densely fibrous stroma.

216
Q

Papillary cystadenoma: Cytology (2).

A

Cuboidal or columnar and ciliated.

Clear cytoplasm due to glycogen.

217
Q

Papillary cystadenoma vs. papillary carcinoma.

A

Carcinoma: More cells, more pleomorphism, may be solid.

218
Q

Fibrous pseudotumor: Associations.

A

History of trauma or infection in 30% of patients.

219
Q

Fibrous pseudotumor: Gross forms.

A

Localized: One or more nodules.

Diffuse: Diffuse thickening of tissues.

220
Q

Fibrous pseudotumor: Histology (3).

A

Spindle cells.

Mixed inflammatory infiltrate.

Collagenous stroma.

221
Q

Fibrous pseudotumor: Histologic variations (3).

A

Features of

− Fibroxanthoma.
− Sclerosing lipogranuloma.
− Sclerosing hemangioma.

222
Q

Fibrous pseudotumor: Immunohistochemistry (3).

A

Negative: Cytokeratin, SMA, S100.

223
Q

Paratesticular tumors of smooth muscle: Sites (2).

A

Leiomyoma: Epididymis.

Leimyosarcoma: Spermatic cord.

224
Q

Leiomyosarcoma: Clues to malignancy (4).

A

Nuclear pleomorphism.

More than 1-2 mitotic figures per hpf.

Hemorrhage.

Necrosis.

225
Q

Tumors of smooth muscle: Electron microscopy (2).

A

Thin filaments.

Pinocytotic vesicles.

226
Q

Leiomyosarcoma vs. liposarcoma with smooth-muscle differentiation.

A

The latter shows amplification of MDM2.

227
Q

Smooth-muscle hyperplasia of testicular adnexa: Histology (2).

A

Increased bland smooth muscle among epididymal tubules.

Tubules show secondary dilatation and squamous metaplasia.

228
Q

Most common paratesticular sarcoma in ___.

A. Adults.
B. Children.

A

A. Liposarcoma, esp. well-differentiated.

B. Rhabdomyosarcoma.

229
Q

Paratesticular liposarcoma: Sites (2).

A

Scrotum.

Inguinal canal.

230
Q

Dedifferentiated liposarcoma: Histologic types (2).

A

High-grade.

Low-grade, with smooth-muscle differentiation.

231
Q

Well-differentiated liposarcoma: Cytogenetics.

A

Ring chromosome 12.

232
Q

Sclerosing lipogranuloma: Histology (3).

A

Granulomas and scattered giant cells.

Mixed inflammation.

Sclerotic background.

233
Q

Rhabdomyosarcoma: Gross pathology.

A

Displaces but spares testicular parenchyma.

234
Q

Paratesticular rhabdomyosarcoma: Most common subtypes.

A

Embryonal rhabdomyosarcoma, spindle-cell subtype (#1).

Embryonal rhabdomyosarcoma, NOS.

235
Q

Embryonal rhabdomyosarcoma, spindle-cell subtype: Histology (2).

A

Interlacing spindle cells.

Variable numbers of strap cells and “tadpole” cells.

236
Q

Embryonal rhabdomyosarcoma, NOS: Histology (2).

A

Alternating myxoid and cellular areas.

Spindle cells mixed with polygonal cells.

237
Q

Rhabdomyosarcoma vs. leiomyosarcoma: Immunohistochemistry (2,1).

A

Leiomyosarcoma

− Positive: H-caldesmon.
− Negative: Myogenin, myoglobin.

238
Q

Paratesticular rhabdomyosarcoma: Prognosis.

A

Location in this site carries a favorable prognosis.

239
Q

Second most common paratesticular malignancy in adults.

A

Malignant mesothelioma of the tunica vaginalis.

240
Q

Malignant mesothelioma of the tunica vaginalis: Associations (2).

A

Hydrocele.

Asbestos (sometimes).

241
Q

Malignant mesothelioma of the tunica vaginalis: Gross pathology (2).

A

Shaggy, friable nodules

− or −

Diffuse thickening.

242
Q

Malignant mesothelioma of the tunica vaginalis: Most common type and its histology (2).

A

Epithelial type

− Papillae, tubule, and sheets.
− Psammoma bodies sometimes.

243
Q

Malignant mesothelioma: Helpful positive immunohistochemical stains (6).

A

CK 5/6.

EMA.

Calretinin.

GLUT1.

Telomerase.

p53.

244
Q

Malignant mesothelioma vs. florid atypical mesothelial hyperplasia (3).

A

Atypical hyperplasia

− No true invasion of stroma.
− Positive: Desmin.
− Negative: p53, EMA.

245
Q

Carcinoma of the seminal vesicle: Histologic types (3).

A

Papillary adenocarcinoma (most tumors).

Mucinous.

Undifferentiated.

246
Q

Carcinoma of the seminal vesicle: Cytology (2).

A

Nuclei: Vesicular; nucleolus may be prominent.

Cytoplasm: Columnar or polygonal; clear.

247
Q

Carcinoma of the seminal vesicle: Immunohistochemistry (3,3).

A

Positive: CEA, CA-125, CK7.

Negative: PSA, PAP, CK20.

248
Q

Carcinoma of the seminal vesicle: Differential diagnosis.

A

Carcinomas of prostate, bladder, and colon must first be excluded.

249
Q

Carcinoma of the seminal vesicle: Prognosis.

A

Poor.

250
Q

Urethral polyp: Epidemiology (2).

A

Occurs only in males, usually aged 3-9 years.

251
Q

Urethral polyp: Presentation (3).

A

Hematuria.

Urinary retention.

Infection.

252
Q

Urethral polyp: Location.

A

Prostatic urethra next to the verumontanum.

253
Q

Urethral polyp: Histology.

A

Urothelial lining that may show

− Squamous metaplasia.
− Ulceration.

254
Q

Caruncle: Epidemiology.

A

Found only in women, usually later in life.

255
Q

Caruncle: Clinical appearance.

A

Red, painful mass at the urethral meatus.

256
Q

Caruncle: Histology (2).

A

Urothelial or squamous lining.

Fibrovascular core with extravasated red blood cells and mixed inflammation.

257
Q

Nephrogenic adenoma of the urethra:

A. Typical patient.
B. Association.

A

A. Young adult male.

B. Chronic irritation or trauma.

258
Q

Nephrogenic adenoma of the urethra: Histology (3).

A

Flat lesions
− Tubules, similar to renal tubules, containing pink secretions.
− Loose stroma with mixed inflammation.

Papillary lesions: Similar, but with papillae lined by cells similar to those of the tubules.

259
Q

Prostatic urethral polyp: Histology.

A

Lined by bland prostatic acinar cells.

Thin fibrovascular core.

260
Q

Urethral carcinoma: Types (4).

A

Squamous-cell carcinoma.

Squamous-cell carcinoma.

Spindle-cell variants of the both of the above.

Verrucous carcinoma.

261
Q

Urothelial carcinoma of the urethra vs. urothelial carcinoma of the bladder involving the urethra (2).

A

The latter
− Much more common.
− More likely to show pagetoid growth.

262
Q

Carcinoma of the urethra: Behavior.

A

Locally aggressive; occasional metastasis.

263
Q

Adenocarcinoma of the periurethral glands: Sites (2).

A

Glands of Cowper: Posterior urethra or perineum.

Glands of Littre: Anterior urethra.

264
Q

Adenocarcinoma of the periurethral glands: Association.

A

Some cases: Chronic irritation, such as from a urethral diverticulum.

265
Q

Adenocarcinoma of the periurethral glands: Patterns of growth (2).

A

Tubular or papillary.

266
Q

Penile fibromatosis: Associations.

A

Ten to 25% of patients also have palmar or plantar fibromatosis.

267
Q

Penile fibromatosis: Histology (3).

A

Established lesions: Similar to that of other fibromatoses.

Early: More cells, less collagen.

Later: May be hyalinized and contain cartilage or bone.

268
Q

Balanitis xerotica obliterans: Histology.

A

Same as that of lichen sclerosus.

269
Q

Balanitis xerotica obliterans: Significance.

A

Can progress to SCC.

270
Q

Adenocarcinoma of the periurethral glands: Cytology.

A

Nucleus: Large, hyperchromatic.

Cytoplasm: Cuboidal or columnar; may contain mucin or glycogen.

271
Q

Plasma-cell balanitis:

A. Synonym.
B. Clinical appearance.
C. Association.

A

A. Zoon’s balanitis.

B. Bright red patch that resembles SCC.

C. Uncircumcisedness.

272
Q

Plasma-cell balanitis: Histology (2).

A

Upper dermal band of plasma cells.

Telangiectasia of dermal capillaries.

273
Q

Condyloma acuminatum vs. verrucous carcinoma.

A

Verrucous carcinoma:

− Broad, pushing growth at the deep margin.
− No association with HPV.

274
Q

Condylomata acuminatum: Histologic pitfall.

A

Treatment with podophyllin or laser therapy can cause changes that mimic SCC.

275
Q

Erythroplasia of Queyrat:

A. Location.
B. Association.
C. Significance.

A

A. Glans penis or prepuce.

B. Lack of circumcision.

C. About 10% of cases progress to SCC.

276
Q

Erythroplasia of Queyrat: Histology.

A

Squamous cell carcinoma in situ.

277
Q

Erythroplasia of Queyrat: Types of HPV.

A

16, 18.

278
Q

Bowen’s disease:

A. Location.
B. Significance.

A

A. Shaft of penis.

B. 10% to 15% of cases progress to SCC.

279
Q

Bowen’s disease: Histology.

A

Squamous cell carcinoma in situ.

280
Q

Bowenoid papulosis:

A. Age group.
B. Clinical appearance.

A

A. Men 20-40 years of age (younger than those affected by SCC in situ).

B. Multiple papules on the penile shaft or the perineum.

281
Q

Bowenoid papulosis:

A. Significance.
B. Treatment.

A

A. Does not progress to invasive SCC.

B. Topical therapy or local excision; may regress spontaneously.

282
Q

Bowenoid papulosis: Histology (3).

A

Not as dysplastic as SCC in situ.

Scattered atypical keratinocytes.

Scattered mitotic figures.

283
Q

Bowenoid papulosis: Types of HPV.

A

16, 18.

284
Q

Squamous-cell carcinoma of the penis: Relation between growth pattern and location.

A

Ulcerative tumors tend to be on the glans.

285
Q

Squamous-cell carcinoma of the penis: Risk factors (4).

A

Lack of circumcision.

Poor hygiene.

Phimosis.

HPV.

286
Q

Squamous-cell carcinoma of the penis: Types of HPV.

A

11, 16, 18, 30.

287
Q

Squamous-cell carcinoma of the penis: Prognostic factors (2).

A

Stage.

Depth of invasion.

Status of lymph nodes.

288
Q

Squamous-cell carcinoma of the penis: Behavior (2).

A

Metastasis to inguinal lymph nodes is present in 40% at diagnosis.

Widespread metastasis typically occurs late.

289
Q

Verrucous carcinoma of the penis:

A. Typical location.
B. Clinical appearance.

A

A. Coronal sulcus.

B. Often ulcerated.

290
Q

Verrucous carcinoma of the penis:

A. Histologically incompatible finding.
B. Behavior.

A

A. True koilocytes.

B. Locally aggressive; does not metastasize.

291
Q

Verrucous carcinoma of the penis: Variant.

A

Hybrid tumor that also includes features of well-differentiated SCC.

292
Q

Epithelioid hemangioendothelioma: Behavior (2).

A

Low-grade: Usually indolent.

High-grade: May metastasize to lymph nodes, lung, liver, bone.

293
Q

Leiomyosarcoma of the penis: Behavior (2).

A

Tumors of dermal smooth muscle: May recur locally after excision.

Tumors of the corpora: Poor prognosis.

294
Q

Fibrosarcoma: Electron microscopy (2).

A

No intercellular junctions.

Rough endoplasmic reticulum, mitochondria.

295
Q

Epithelioid sarcoma of the penis:

A. Age group.
B. Presentation.

A

A. 20-40 years.

B. Slow-growing painless mass that may ulcerate the overlying skin.

296
Q

Epithelioid sarcoma of the penis: Gross pathology.

A

Gray-tan, firm nodules.

297
Q

Epithelioid sarcoma of the penis: Pattern of growth (3).

A

Cellular nodules in a hyalinized stroma.

Centers of nodules may be necrotic.

Infiltrative border.

298
Q

Epithelioid sarcoma of the penis: Cytology (2).

A

Epithelioid cells with vesicular nucleus and large nucleolus.

Many mitotic figures.

299
Q

Epithelioid sarcoma of the penis: Immunohistochemistry (2).

A

Positive: Vimentin.

Usually positive: Cytokeratin, EMA.

300
Q

Paget’s disease of the penis or scrotum: Primary sites of associated malignancies (5).

A

Bladder.

Prostate.

Urethra.

Rectum.

Adnexa of perineal skin.

301
Q

Paget’s disease of the penis or scrotum: Stains (4,1).

A

Positive: CEA, PAS, mucicarmine, alcian blue.

Negative: S-100.

302
Q

Scrotal calcinosis:

A. Possible etiology.
B. Gross appearance.

A

A. Calcification of eccrine ducts.

B. Skin is usually intact but may be ulcerated.

303
Q

Squamous-cell carcinoma of the scrotum: Risk factors.

A

Exposure to

− Chimney dust.
− Coal.
− Petroleum.

304
Q

Squamous-cell carcinoma of the scrotum: Prognosis (2).

A

There is ipsilateral inguinal lymphadenopathy in half of patients at presentation.

Overall poor.

305
Q

Granulomatous prostatitis:

A. Bacterial causes (3).
B. Fungal causes (3).
C. Parasitic causes (2).
D. Viral cause.

A

A. M. tuberculosis, T. pallidum, Brucella.

B. Cryptococcus, Blastomyces, Coccidioides.

C. Schistosomes, Echinococcus.

D. Herpes viruses.

AP reviewer (17 decks)

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