Pathology Flashcards
hypospadias
most comm congenital anomaly of penis, failure of the tissue to properly fuse on the ventral surface of the penis. 1 in 300-500. Can interfere with nml urethral and ejaculatory function. anomalies tend to occur in clusters, if this then look for others as well.
phymosis
difficulty retracting the foreskin, may cause chronic inflammation, remove foreskin to tx,
-paraphymosis is the opp problem.
Can be related to poor hygiene, STDs
circumcision debate
since 1975 the amer. acad. of peds has stated that there is no routine medical indication for circ, but the sociocultural norm dictates that 60-75% of newborn males are still circ. not a medical decision usually.
condyloma
warty-cauliflower-like growths anywhere that sexual contact occurs. Most commonly caused by HPV 6+11. Hist: have papillary app. and are hyperkeratotic, but orderly and no mitoses
Carcinoma in situ, penis (on skin is called Bowen dz) (on glans is erythroplasia of Queyrat) all the same thing.
-most commnly caused by HPV 16 + 18. Hist: heaped up cells in abnomal orgnaziation, hyperkeratotic, mitoses, disorganized maturation of the cells from basal layer upward, elongated rete ridges.
10% progress to carc.
sq. cell carc. of penis
not as comm as that of cervix. assoc with HPV but also with smoking (conc of toxins in urine and also handling of penis with same fingers used to handle cigarettes) and poor hygiene
cryptorchidism
Undescended testicle, us. unilateral, can be true (in normal path) or ectopic (outside of normal path. Risk of infertility (despite the other normal testis), trauma (when in a more exposed area like the pelvic brim), infection, incr. risk of germ cell cancer in both the affected testis and the other (whether or not the first is removed). Correct b4 3 years of age.
Histology of cryptorchidism
the undescended testis will show fairly normal sertoli cells but lack the nml spermatozoa, poss b/c too warm
Kleinfelter syndrome
XXY genotype, mental retardation, feminization incl. no facial hair, breast develpmt, long arms and legs, small testes, infertility.
Hist of kleinfelter in testes
normal leydig cells but no sertoli cells and no sperm. may look like hyperplasia of leydig cells but probably this is just that there are no sertoli cells to compare them too so it looks like more and abnormal organization.
mumps, testes
can lead to orchitis, tubular sclerosis and focal atrophy of part or whole of testis. Can cause infertility in varying degrees. Other infections can cause orchitis or epididymitis
what stage of syphyllis affects the testes?
tertiary, spirochetes visible under special lighting. this progresses the opp. direction of TB or gonorrhea from testis to epidid.
TB in testis is rare
us. retrograde from prostate and epididymis. tthat is all.
Granulomatous orchitis
autoimmune us. following gram - infection, middle aged M, intratublar granuloma form in the histology
testis regression - VINDICATE
Vascular, Inflammation, Neoplasm, Degenerative, Intoxication, Congenital, Autoimmune, Trauma, Endocrine
testis torsion
the spermatic cord becomes twisted, cutting off the blood supply(no alternative blood supply) and causing ischemia and (white) infarction if not corrected w/in 4-6 hrs. (true emergency)
-may be assoc w/ anatomical excess mobility (ballclapper phenom) which means if one side twists, the other is likely to at some point also
Control of testis descent
from abdm to pelvic brim = MIH, from the brim to scrotum = androgen failure occurs in the latter in 90-95% of cases.
age group for test. CA
mid 20s to 30s
the vast majority of test. CA are _______ and should be _________
malignant, removed
most test. CAs are _________ cell tumors and most are ________ lines not pure.
germ, mixed
Most comm germ cell tumor, most commonly appearing “pure” form
Seminoma,
Seminoma characteristics.
us. homogenous “fried egg” cells, not us necrotic or hemorrhagic, us. have no defining architecture but are simply arranged in sheets, grossly tend to be well-circ, tan to white, and bulg out of the plane of the cut
T/F Most testic. CA are very mitotically active.
True. this makes them esp. susceptible to radiation and chemo, which are nevertheless secondary to removal of the testis.
embryonal carcinoma
us mixed, more aggressive than seminoma, more likely to be invasive, hemorrhagic, necrotic.
Hist: cells us. have some architecture (variable), much more anaplastic appearing cells
Which tumor type tends to secrete alpha-fetoprotein (AFP)?
yolk sac tumor (endodermal sinus tumor)
in pure form (rare), yolk sac tumor found in what demographic?
infants and children up to 3 y/o, mixed tumors are by far more comm and more commly found in adults of the usual age group
how is AFP useful?
can be assayed in blood, can tell you about success of tx and helpful in ID’ing presence of mets
Hist of yolk sac tumor
typically arranged in spirals, nests, glomerular-like arrangements.
tumor cell line normally secreting hCG
choriocarcinoma - us. mixed, less than 1% pure.
hist of choriocarcinoma
cells exactly mimic placental cells (synciotrophoblasts), stain + for hCG, extremely vascular and hemorrhage easily. very agressive.
contrast teratomas in ovaries vs. testes
in ovaries almost always benign, in testes almost always malignant.
tissue types and origins in teratomas
all three germ layers us. present, can have virt. any tiss type present in varying stages of dvlpmt, cysts comm.
-rare to find a pure teratoma (children), but us. found with other germ cell tumors in adults.
purpose of the prostate gland
secretes the supporting fluid for the spermatozoa
Prostate CA us. arises in the _________ zone and hyperPLASIA in the ______ zone
peripheral, periurethral (central)
what symptoms does hyperplasia of the prost. cause that CA usually does not?
Urinary symptoms including diff starting/stopping flow, intermittant flow, straining, frequent UTIs
three tiss layers in the prostate
stroma - sm. musc + assoc cells,
glandular basal layer cells - nurse cells (p63 stain)
glandular luminal cells - secretory (PSA stain)
function of PSA
is a serine protease - liquifies the seminal fluid coagulum
specificity of PSA
released into the bloodstream, elevation can reflect a large variety of conditions (inflamm, recent palpation, hyperplasia, CA, etc) not at all specific.
Bacterial Prostatitis cause
most comm. UTI pathogens, E coli most comm, but also enterococci, staph
Abacterial prostatitis
organ. more diff to ID, mycoplasma, ureaplasma, chlamydia, gonorrhea, TB, Syphilis, Pseudomonas etc
charact. of BPH
“benign” - not invasive, not unproblematic - more frequent UTIs can be a source of sig. morbidity and mortality in elderly pts.
- from 70% of 60 y/o and 90% of 70 y/o but many asymptomatic
- resection can cause more problems than the initial problem
Prostate carc demographics
- most comm. CA in men
- rare b4 50 y/o, but after 60 the prob that you have a nodule is roughly equal to age.
- higher incid. in AA, Lower in Japanese
prostate carc. histology
“pale yellow nodule of prostate” = CA on test
probably peripheral
etiology mostly unknown - no assoc w/ T levels
clinical dx of prostate carc
physical exam, elev. PSA, transrectal bx necc for ddx.
Screening PSA for prostate CA controversy
despite the prevalence of prostate CA, tends to be slow growing and PSA screening leads to many false positives and overly aggressive surgeries which have their own risks (impotence, fecal incontinence).
recomm. for prostate screening
- none before age 40
- indiv. decision after 55 if at higher risk
- screen btwn 55-69 every two years
- after 70 they are more likely to die from other causes than prost. CA even if one is present so there is little benefit to screening and potential harm.
histo of prost CA
disorganized crowded glands which sometimes display peri-neural invasion and is invading outside the capsule.
Where does prostate CA met. to?
BONE, and these are BONE-FORMING mets (osteoblastic) easily visible on X-ray.
grading system for prostate CA
gleason grading - is a histologic distinction, not very reliable and not prognostically helpful.
