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Pathology II Exam II > Male Genital II > Flashcards

Male Genital II Flashcards

1
Q

What serum markers do we use to work up a testicular mass? Is there a role for biopsy?

A
  1. AFP and HCG

2. No role for biopsy

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2
Q

What are 4 differential diagnosis for a testicular mass?

A
  1. inflammation
  2. torsion
  3. Neoplasms
  4. Hydrocel etc.
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3
Q

True or false- epididymitis is only caused by sexually transmitted organisms?

A

False - E.Coli and pseudomonas are common too

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4
Q

What is torsion precipitated by? is it an emergency?

A
  1. violent movement or trauma

2. yes, must be surgically corrected within 4 hours

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5
Q

T-F– in torsion cases we may see contralateral spermatogenic abnormalities too?

A

True- autoimmune possibly

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6
Q

What type of testicular neoplasm makes up for 95% of them? What age do they peak at?

A
  1. germ cell tumors

2. 15-34

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7
Q

What are 4 main risk factors for germ cell tumors of the testes?

A
  1. cryptochidism
  2. prior testicular germ cell tumor
  3. Family history
  4. Testicular dysgenesis: ie. Klinefelter’s
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8
Q

T-F—most cases of cryptorchidism are bilateral? Where do they mostly get hung up?

A
  1. False- 25%

2. Inguinal canal

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9
Q

What does cryptorchidism look like microscopically?

A

atrophied, decreased spermatogenesis, peritubular fibrosis, INCREASED LEYDIG CELLS

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10
Q

What is the most important distinction in germ cell tumors?

A

seminomas and non-seminomatous tumors

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11
Q

What are a couple gross characteristics of seminomas?

A

homogenous nodules, gray-white/tan, without hemorrhage or necrosis

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12
Q

What does a seminoma look like microscopically?

A
  1. sheets of seminoma cells divided in lobules by fibrous septa with infiltration of lymphocytes
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13
Q

What is described by, large, round to polygonal, well defined, clear cytoplasm, round nucleus and prominent central nucleolus?

A

seminoma cell

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14
Q

What is a main gross difference of non-seminomatous germ cell tumors?

A

hemorrhagic cut surfaces, necrosis

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15
Q

What type of non-seminomatous germ cell tumor may show cartilaginous areas and cystic spaces?

A

teratoma

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16
Q

what is described by large, pleomorphic, amphiphilic cytoplasm, overlapping angry-looking nucleus, and hyper chromatic nuclei, prominent nucleoli?

A

embryonal carcinoma

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17
Q

What is the most common yolk sac tumor pattern?

A

reticular network of cuboidal/elongated cells

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18
Q

What does the yolk sac solid pattern look like?

A

sheets of polygonal cells with pale eosinophilic or clear cytoplasm

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19
Q

The endodermal sinus patter of the yolk sac tumor is characterized by what?

A

schiller-duval body (micro cyst that looks like glomeruli)

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20
Q

What stain is frequently positive in yolk sac tumor?

A

AFP- alpha fetoprotein

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21
Q

What is the overall microscopic structure of a choriocarcinoma?

A

syncytiotrophoblasts are intimately associated with cytotophoblasts within areas of extensive hemorrhage

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22
Q

What is described as large, multinucleate, abundant eosinophilic cytoplasm, vacuolated?

A

syncytiotrophoblasts

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23
Q

What are characterized by small polygonal cells, distinct borders, uniform round nuclei and sparse cytoplasm?

A

cytotrophoblasts

24
Q

What does choriocarcinoma stain positive for?

A

HCG

25
Q

Does a mature or immature teratoma more commonly have neuroepithelial tubules?

A

immature

26
Q

How many testicular tumors are a mixture of two or more patterns?

A

32-54%

27
Q

T-F– any solid intratesticular mass is considered neoplastic?

A

True- until proven otherwise

28
Q

Are testicular neoplasms painful?

A

Usually not

29
Q

Why is LDH an important tumor marker?

A

correlates with tumor burden and has a prognostic value in patients with metastatic disease

30
Q

Can testicular cancers spread to lungs and liver?

A

Yes-hematogenously

31
Q

Review staging of testicular cancer

A

I confined in testes
II confined to retroperitoneal nodes below diaphragm
III outside of retroperitoneal nodes or above diaphragm

32
Q

What is treatment and prognosis of seminoma?

A

Radiation and prognosis is very good

33
Q

What are problems with the non-seminomatous carcinomas?

A
  1. present advanced
  2. metastasize earlier and hematogenously
  3. some may not cause enlargement at all (choriocarcinoma)
34
Q

Is adenocarcinoma of the prostate more commonly periurethral or posterior?

A

Posterior/peripheral zone

BPH is periurethral/transitional zone

35
Q

A benign prostatic gland has how many cell layers?

A
  1. cuboidal secretory cells

2. flattened basal cells

36
Q

What are the 3 differentials of prostate nodules?

A
  1. prostatitis
  2. nodular hyperplasia
  3. adenocarcinoma
37
Q

Prostatitis is commonly caused by which organism? what about in chronic cases

A
  1. E. Coli

2. Can be same, but usually bacterial- chlamydia, mycoplasma, ureaplasma.

38
Q

What is the incidence of BPH at 40? 60? 70?

A

20%, 70%, 90%

39
Q

Is BPH a precursor of adenocarcinoma?

A

NO!!!!

40
Q

What does BPH look like grossly?

A

multiple variable sized nodules encroaching on the urethra, making it slit like

41
Q

What does nodular hyperplasia look like microscopically?

A

papillary structures with preserved 2 cell layers

42
Q

In an enlarged prostate from hyperplasia, what are some common upstream effects?

A

hypertrophied bladder, hydrouretor and hydronephrosis

Also, increased UTIs

43
Q

What is the #2 cause of male cancer deaths?

A

Prostate- although it is the number 1 type of cancer

44
Q

T-F- PSA is cancer specific?

A

False- organ specific

IT IS INCREASED IN BPH AND CANCER

45
Q

What is the cut off for PSA?

A

4

46
Q

What does a gross prostatic adenocarcinoma look like?

A

gritty, yellow nodule, at the peripheral zone

47
Q

What does a microscopic adenocarcinoma look like?

A
  1. crowded hyperchromatic nodules
  2. architectural disarray
  3. single layer of cuboidal cells
  4. enlarged nucleus/prominent nucleoli
48
Q

Does prostatic cancer have basal cells microscopically??

A

No

49
Q

What is the gleason grading system based on?

A

glandular patterns and degree of differentiation

50
Q

What are the main characteristics of gleason pattern 5?

A

single cells and cords, necrosis the glands are largely missing (pattern 3 had small glands, pattern 4 had long glands)

51
Q

What stage matches the following description- confined within prostate? extraprostatic extension into fat or vesicle? invasion of adjacent structures?

A

T2
T3
T4

52
Q

What is a very common metastases of prostatic cancer?

A

osteoblastic bone metastases- vertebrae, ribs, pelvic bones

53
Q

What is the tx for prostatic cancer?

A

surgery and radiation

54
Q

What is the treatment for metastatic prostate cancer/

A

orchiectomy (remove testes) or anti-androgen therapy

55
Q

Review the criteria for active surveillance of prostate cancer-

A

Gleason score <50% involvement of any positive core of 12

Pathology II Exam II (16 decks)

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