MALE Genital I

Question 1

What is the differential diagnosis of hematuria? 3

Answer 1

cystitis
urolithiasis
neoplasms

Question 2

What is the most common cause of cystitis?

Answer 2

Gram negative bacteria (E. coli)

Question 3

What is the symptoms triad of cystitis?

Answer 3

frequency, dysuria, and lower abdominal pain

+/- hematuria

Question 4

What is granulomatous cystitis secondary to? where is it mostly found?

Answer 4

1. Renal tuberculosis

2. trigone- ureteral orifices

Question 5

What is BCG- induced granulomas? Are the necrotizing?

Answer 5

1. intravesicular administration of bacillus calmette-guerin (BCG) used for the Tx: of superficial bladder carcinoma
2. No

Question 6

What is malakoplakia due to? what do they look like grossly? What do we see microscopically?

Answer 6

1. defects of phagocytic functions of macrophages
2. 3-4 cm, soft, yellow, raised plaques
3. PAS+ granules in large foamy macro., giant cells, lymphocytes, basophilic remnants in macrophages (michaelis-gutmann bodies)

Question 7

What is the symptom of small stones passing into ureter?

Answer 7

Renal colic

Question 8

Large stones may remain silent within the renal pelvis or give rise to what? 2

Answer 8

1. hematuria
2. superimposed infections
   by obstruction and trauma

Question 9

Is urinary bladder cancer more common in men or women?

Answer 9

men 3:1 50-80 years old

Question 10

Review the epidemiology of bladder cancer

Answer 10

tobacco
arylamines- anilines
cyclophosphamide
analgesic abuse
bladder radiation
schistosoma hematobium

Question 11

What is the most common type of bladder cancer? 2nd?

Answer 11

Urothelial carcinoma

squamous cell carcinoma

Question 12

What is an infectious cause of squamous cell carcinoma of the bladder?

Answer 12

schistosoma hematobium

Question 13

What does urothelial carcinoma in situ look like grossly? what happens due to lack of cell cohesiveness? what happens if untreated?

Answer 13

1. flat, reddened, thickened/granular
2. Shedding into urine
3. 50-75% progress to muscle invasive disease

Question 14

What do we see microscopically in urothelial carcinoma in situ?

Answer 14

flat lesion, atypical cells with large, irregular hyper chromatic nuclei and mitoses

Question 15

How many of bladder cancers are low grade papillary urothelial carcinoma? What does low stage mean? does it have a high recurrence rate? very progressive? What chromosome is involved?

Answer 15

1. 2/3
2. <10% invade
3. yes
4. No
5. 9

Question 16

What does low grade papillary urothelial carcinomas look like microscopically?

IS mitosis frequently seen?

Answer 16

1. -fragile branching papillae
   - covered by orderly urothelial cells with min. crowding or loss of polarity, round oval nuclei, mild variation,
2. Mitosis is infrequent

Question 17

How many high grade papillary urothelial carcinomas invade? progressive?

Answer 17

1. 80%

2. very progressive and high mortality

Question 18

What does high grade urothelial carcinomas look like microscopically?

Answer 18

1. -delicate branching or fused papillae

- covered by disorderly urothelial cells, loss of polarity, pleomorphic, nucleoli and mitoses.

Question 19

What is the biggest prognostic factor in bladder cancer?

Answer 19

depth of invasion (stage)

others include- grade, multifocality, prior recurrence rate

Question 20

In bladder cancer what stage corresponds to the following depths- muscular is propria? perivesical tissue? lamina propria? pelvic wall?

Answer 20

II
III
I
IV

Question 21

What is the main clinical finding of urothelial carcinoma?

Answer 21

1. painless hematuria

others include- frequency, urgency and dysuria
- obstruction of orifice, multiple recurrences, metastases

Question 22

How do we treat bladder cancer if it is small, localized and low grade? What if it is multifocal?

Answer 22

1. transurethral resection

2. resection then topical chemo

Question 23

How do we treat high risk patients with high grade tumors etc.?

Answer 23

1. Resection then topical immunotherapy- BCG bacillus calmette-guerin

Question 24

Review the following indications for radical cystectomy

Answer 24

• invading muscularis propria
• CIS or high grade papillary cancer refractory to BCG
• extension into prostate