Male Reproductive

Question 1

Low grade papillary urothelial carcinoma genes?

High grade papillary urothelial carcinoma genes?

Answer 1

FGRR3 (leads to RAS/RAF activation)activating mutation; GOOD PROGNOSIS

Low grade:Others: PIK3CA, PTEN inactivation

High: p53/RB and TP53; leads to muscle invasion

Question 2

Basal Cell Urothelial Markers/Aggressive or not?

Luminal markers

Answer 2

Aggressive: CK5/6+,p63+, EGFR+, CD44+, CK20-, Aggressive but neoadjuvant sensitive

Luminal: ER+, GATA3+, Her2neu (ERRBE)+, FGFR3 alterations, CK20+,CK5/6-, CD44-

Question 3

IHC of CK20, p53 and CD44 in normal urothelium vs CIS?

Genetic and environmental factors for Urothelial carcinoma?

Answer 3

Normal: CK20+ in umbrella cells, p53-, CD44+ in basal layer
CIS: CK20+ diffuse, P53+ diffuse, CD44-

Lynch, Hereditary RB, Smoking (and ocupational smoke), Rads, S. Hematobium, Congenital bladder exstrophy

Question 4

What bland low grade tumor is invasive in bladder?

Mutation?

MIcropapilalry invasive has to be tested for?

Answer 4

Nested variant of invasive urothelial carcinoma (**small and large nests of tumor beneath the urothelium and down in in muscularis)

TERT promoter**
mutation; distinguishes from VB nests/hyperplasia

Her2nu (ERBB2)

Question 5

Plasmacytoid urothelial carcinoma markers (and major pitfall marker)?

Metanephric adenoma staining can mimic?

What IHC helps metanephric adenoma vs prostate?

Answer 5

CD138+ (pitfall!), Loss of E-Cadherin, GATAIII +. Uroplankins II and III +, Pan CK+, CK7 and 20 +, p63+, NEGATIVE FOR LYMPHOID MARKERS

Mimics prostate cancer: Racemase + and loss of Basal Markers!

PAX8+ in metanephric adenoma!; PSA can rarely be +

Question 6

Inflammatory myofibroblastic tumor stains, population?

Answer 6

Females and kids; “spindle tissue culture appearance”; SMA+, ALK1+, CLonal 2p23, CK-

Question 7

Racemase other game?

50% of prostate chancer has what gene fusino?

Prostate ductal adenocarcinoma grade and morphology?

Answer 7

p504S/ AMACAR

TMPRSS2:ERG

4+4=8; tall columnar cell that are pseudostratified and commonly cribiform

Question 8

Seperate dutal adenocarcinoma of prostate from HGPIN?

Answer 8

Same IHC; so look at morphology
HGPIN: Not invasive, no necrosis, smaller cells

Ductal: Necrosis, bigger cells 6x nuclear size

Question 9

Adenomatoid Tumor of Testis is from?

Genetic marker that is commonly positive for invasive germ cell tumor?

Answer 9

Paratesticular tumor (mesothelial cells) w/ gland like spaces

gain of i(12p)

Question 10

Alpha fetoprotein is positive in?

B-HCG positive in?

LDH positive?

PLAP is higher in seminoma or NSGCT?

Answer 10

AFP: YST (Schiller-Duval), embronal

BHCG: NSGCT, Chorio (needs synsytial and cytotrophoblasts). Rare Seminoma

Seminoma and NSGCT; **Good for burden of disease

Sem>NSGCT>​**

Question 12

Pediatric teratoma’s (good or bad); associated with?

Adult teratoma (good or bad)?

Spermatocytic tumor has what gain on chromosome (also good or bad); histology?

Answer 12

Good; benign course; Diploid DNA; Down’s and Kleinfelter’s

Adults: Malignant!!

Gain of Chr 9. No association with GCNIS or GIS, Benign
Sheet of small round cells (with 3 sizes and filamentous chromatin)

Question 13

Sertoli cell tumor associations?

IHC?

Other variants?

What tumor presents with gynocomastia and possible crystals?

Answer 13

Peutz-Jeghers or Carney Complex

Keratin +, Inhibin/calretinin +/-

Large cell calcifying or sclerosing variants

Leydig! Inhibin and Calretinin +, Crystal of Reinke