Pathology 3 Flashcards
What is the most common type of tumour affecting the penis ?
Sqamous cell carcinoma
What are the risk factors for developing a squamous cell carcinoma of the penis ?
- Being uncircumcised - almost exclusively in uncircumsied
- HPV infection
- Higher incidence in Latin America, Africa, Far East.
- Linchenoid sclerosus - bowman’s disease
Where on the penis does SCC tend to arise ?
- Glans mainly
- Also the prepuce (foreskin)
What is the first recognised tumour caused by occupational exposure to carcinogens ?
SCC of the scrotum in chimney sweeps
Describe the pathogenesis of benign nodular hyperplasia/ BPH of the prostate
Arises hormone inbalance (Androgen/Oestrogen ratio) causing excessive growth of the prostate
Where in the prostate does benign nodular hyperplasia arise ?
Transitional and central zones of the prostate (therefore it arises in the cental areas of the prostate)
What are some of the signs/symptoms of benign nodular hyperplasia of the prostate ?
- Hesitancy
- Poor stream
- Overflow incontinence
- Terminal dribbling
What are some of the complications of BNH of the prostate ?
Can result in obstruction which can cause:
- Bladder hypertrophy, diverticulum formation.
- Hydroureter, hydronephrosis, infection. due to backflow of pressure/urine
- Acute and chronic urinary retention
Is BNH of the prostate premalignant ?
NO!
What is the treatment for BNH of the prostate ?
If significant bother:
- 1st line = alpha-1 antagonist (tamulosin, alfuzosin etc) think osin
- 2nd line = 5 alpha-reductase inhibitors e.g. finasteride
- 3nd line = surgery - transurethral ressection
What are the side effects of alpha blockers ?
dizziness, postural hypotension, dry mouth, depression
What are the side effects of 5 alpha-reductase inhibitors e.g. finasteride?
- Sexual dysfunction - erectile dysfunction, reduced libido, ejaculation problems
- Gynaecomastia
Where in the prostate does carcinomas of the prostate tend to occur ?
Peripheral zone
What is done if a small focus of cancer is found in the prostate and what is it classified as ?
Called a ‘‘latent’’ carcinoma and if this was found in an old person it would be monitored
What areas does prostate cancer often spread to ?
- The structures closely related to it e.g. urethra, bladder, rectum
- Spreads to nearby lymph nodes e.g. sacral, iliac, para-aortic nodes
- Metastases to bone (lumbosacral area), lungs, liver
When prostate cancer metastases to the bone what is unusual about its appearance ?
Has an osteosclerotic appearance (due to causing thickening of the bone)
How is a carcinoma of the prostate diagnosed ?
- Rectal examination.
- Measure PSA (prostate specific antigen) as this is increased in most
- Transurethral biopsy US guided
What is the management of prostate cancer ?
Often prostate cancers have metastasised on finding
- If they have no metastasied - Surgery – Radical Prostatectomy
- If they have metastasised - then Surgery – Radical Prostatectomy + radiotherapy
2nd line - add Hormonal Therapy – anti-androgen treatment ± docetaxel
What is the commonest solid organ malignancy in young adult males ?
Testicular tumours
What is the typical presentation of testicular tumours ?
Painless testicular enlargement
What is the cell of origin for most testicular tumours ?
Germ cell
What are the main germ cell tumours (hence the main testicular tumours)
- Seminomas (40% of germ cell tumours)
- Teratomas (32% of germ cell tumours)
- Mixed (both semioma and teratoma)
What is the difference in age presentation of seminomas and teratomas ?
- Seminomas tend to be 30-50 years old and are very rare before puberty
- Whereas teratomas tend to occur 20-30 years old and can occur in childhood
What is the typical appearance of seminomas ?
Solid, homogenous, pale macroscopic appearance – “potato” tumour.
What is the treatment of seminomas and why ?
Radiotherapy as they are very very sensitive to radiotherapy
What is the tumour marker associated with seminomas ?
PLAP - placental alkaline phosphatase
What is the treatmeant used for teratomas ?
Chemotherapy
Where do seminomas tend to spread to ?
Para-aortic lymph nodes
What is the typical microscopic appearance of seminomas ?
Large, clear tumour cells with variable stromal lymphocytic infiltrate - this is a good prognostic factor
What is the microscopic appearance of teratomas ?
Variable macroscopic appearance – solid areas, cysts, haemorrhage, necrosis
Why do teratomas have a worse prognosis ?
As they have the potential to be more malignant - due to being able to differentiate into a wide number of embryonic tissues e.g. those seen in placenta or yolk sacs
What is the tumour markers associated with teratomas ?
- α-fetoprotein (AFP)
- hCG - beta human chorionic gonadotrophin (this is also tested for in pregnancy tests)
What is a mixed seminoma/teratoma?
Seminoma with any variant of teratoma.
