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M2 Pathology > Male Repro Pathology > Flashcards

Male Repro Pathology Flashcards

1
Q

What are the common conditions of prostate gland? (2)

A

BPH and Prostatic carcinoma

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2
Q

State the histological features of BPH

A
  1. proliferation of acinar and stromal tissue in nodular configuration
  2. hyperplastic fibromuscular stroma
  3. intact basal cell layer
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3
Q

State the pathogenesis of BPH

A

Type 2 5-alpha reductase converts T to DHT -> DHT binds to AR in epithelial and stromal cells -> proliferation of stromal cells & decrease in cell death of epithelial cells

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4
Q

State everything you know about BPH.

A

nodular hyperplasia of stromal and epithelial cells

  • men above 50
  • mainly occurs in transitional zone
  • causes LUTS (voiding and filling problems)
  • enlarged smooth prostate on DRE
  • SYMMETRIC
  • treat by 5 alpha reductase inhibitors, alpha blockers
    causes urinary obstruction

IS NOT PRE-MALIGNANT DOES NOT RESULT IN PROSTATIC CARCINOMA!!!

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5
Q

State the histological features of prostatic cancer

A
  1. effacement of normal architecture of gland
  2. nuclear atypia
  3. infiltrative malignant cancer cells
  4. absent basal cells
  5. tumour can invade into extraprostatic fat
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6
Q

State everything you know about prostatic cancer.

A
  • common in men over 50
  • acinar adenocarcinoma >ductal carcinoma
  • presents with LOW, LOA, lethargy
  • can metastasise to bones and lymphatics -> obturator node > para-aortic LN > bloodstream
  • elevated PSA levels
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7
Q

What is tumour staging and grading?

A

Staging - architecture (degree of how tumour cells mimic normal cells)
- Gleason staging
- TNM

Grading - tumour extent

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8
Q

State how we should treat prostatic cancer for..
1. localised disease
2. locally advanced disease
3. advanced, metastatic disease

A
  1. localised disease = radical prostatectomy
  2. locally advanced disease = radiotherapy
  3. advanced, metastatic disease = androgen deprivation therapy (orchdectomy + synthetic analogues of LHRH, AR blockers)
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9
Q

State the common conditions of penis and scrotum. (2)

A
  1. Condyloma acuminatum
  2. SCC
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10
Q

State the histological features of condyloma acuminatum.

A
  1. acanthosis
  2. koilocytosis
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11
Q

State everything you know about condyloma acuminatum.

A
  • Associated with HPV 6, 11
  • Occurs in penile/perineal areas
  • Gross: sessile/predunculated papillary tumour
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12
Q

State the histological features of SCC.

A
  1. keratin pearls
  2. nests of tumour cells with squamous differentiation
  3. nuclear atypia
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13
Q

State everything you know about SCC.

A
  • Associated with HPV 16, 18, poor hygiene and smoking
  • Presents as slow growing and locally invasive mass
  • Preceded by non-invasive precursor lesion = penile intraepithelial neoplasia (PeIN)
  • Patho: Early gene coding regions of HPV genome codes for viral proteins - > E6 and E7 -> p53 and Rb respectively -> inactivation of genes -> cell proliferation
  • Gross: Glans penis replaced by large truncating mass, infiltrative tumour invades into underlying erectile tissue
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14
Q

How do we differentiate between HPV-associated and HPV-independent SCC?

A

p16 immunohistochemistry!

(surrogate marker for high risk HPV infection)

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15
Q

State some common conditions of the testis and epididymis.

A
  • cryptochordism
  • hydrocoele
  • testicular torsion
  • orchitis
  • germ cell tumours (seminoma, embryonal, yolk sac, choriocarcinoma, teratoma, sex-cord tumours)
  • lymphoma
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16
Q

How do we differentiate between a communicating and non-communicating hydrocoele?

A

For communicating hydrocoele, th scrotal size will change in size throughout the day being larger in the day and normal sized when patient first wakes up. (fluid enters into perineal cavity through lack of obliteration of processus vaginalis)

Scrotal size remains enlarged throughout the day for non-communicating hydrocoele

17
Q

When can the testicular torsion lead to an emergency?

A

If testicular torsion has occurred for more than 24 hours -> leads to testicular infarction and infertility

18
Q

What are the common bacterias associated with infections for each group of patients? (children, sexually-active, old)

A

children - gram negative rods
sexually-active - chlamydia and gonorrhoea
older - E.coli, pseudomonas

19
Q

State the pathogenesis of germ cell tumours.

A

Originate from germ cell neoplasia in-situ (GCNIS)

20
Q

State the differences between seminomatous and non-seminomatous GCT.

A

Seminomatous:
- tumour cells resemble primordial germ cells
- slow growing, good prognosis
- lymphatic spread
- sensitive to radiotherapy

Non-seminomatous
- undifferentiated tumour cells
- poor prognosis, aggressive
- haematogenous spread
- not sensitive to radiotherapy

21
Q

State the histological features of seminoma.

A
  1. polygonal tumour cells with clear cytoplasm containing glycogen
  2. admixed lymphocytic infiltrate
  3. large pleomorphic nuclei
22
Q

State everything you know about seminoma.

A
  • raised LDH, mild elevation for beta-HCG
  • common in middle aged
  • OCT4 positive immunohistostain
  • Gross: Relatively homogenous, fleshy, lobulated, tan-cut surface
23
Q

State the histological features of embryonal carcinoma.

A
  1. pleomorphic polygonal tumour cells
  2. high grade nuclear features
  3. solid, glandular, papillary growth pattern
24
Q

State everything you know about embryonal carcinoma.

A
  • common in young population
  • no serum markers
  • gross: solid fleshy tan-cut surface
25
Q

State the histological features of yolk sac tumour.

A
  1. Remarkably heterogenous
  2. Schiller-Duval bodies
  3. Reticular, microcystic, myxomatous spindle cell, glandular
26
Q

State everything you know about yolk sac tumour.

A
  • common in infants, found in adults as mixed GCT
  • raised AFP
27
Q

State the histological features of choriocarcinoma.

A
  1. Fibrosis and haemorrhage
  2. Lymphovascular invasion
  3. Nest of multinucleated synctiotrophoblasts and mononucleated trophoblasts
28
Q

State everything you know about choriocarcinoma.

A
  • elevated beta-HCG
  • associated with haematogenous metastasis
  • arises from trophoblastic tissues
29
Q

Teratoma contains a vartiety of ____ and ____ tissue from more than ____ germ layer

A

Teratoma contains a vartiety of MATURE and IMMATURE tissue from more than 1 germ layer

30
Q

State the difference between prepubertal and postpubertal teratoma.

A

Prepubertal = benign, not associated with GCNIS

Postpubertal = malignant, derived from GCNIS

31
Q

State the 4 non-seminomatous germ cell tumours of testis

A
  1. embryonal carcinoma
  2. yolk sac tumour
  3. choriocarcinoma
  4. teratoma
32
Q

CState the difference between seminoma (pure GST) and mixed GCT

A

Pure GCT = MORE homogenous
Mixed GCT = MORE heterogenous, variegated cut surface

33
Q

State the different treatment types for GCT.

A
  1. radical orchidectomy (initial treatment)
  2. adjuvant radiotherapy (for some seminomas)
  3. chemotherapy (for non-seminomatous and metastatic tumours)
34
Q

State the 2 sex-cord stromal tumours in testis.

A
  1. leydig cell tumour
  2. sertoli cell tumour
35
Q

Leydig cell tumor can secrete ____ and ____ and ____, resulting in hromonal effects presenting in patients such sexual ____

A

Leydig cell tumor can secrete ANDROGENS and OESTROGEN and CORTICOSTEROIDS, resulting in hromonal effects presenting in patients such sexual PRECOCITY

36
Q

Are there any hormonal effects seen in Sertoli cell tumours?

A

NO. Only presents as mostly benign testicular mass

37
Q

What demographic is affected most by lymphomas of the testis.

A

ELDERLY! suffer from non-hodgkin lymphoma and B cell lymphoma

38
Q

What serum marker is raised in lymphomas.

A

Elevated LDH

M2 Pathology (21 decks)

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