Pathology 3

Question 1

What is the most common type of tumour affecting the penis ?

Answer 1

Sqamous cell carcinoma

Question 2

What are the risk factors for developing a squamous cell carcinoma of the penis ?

Answer 2

• Being uncircumcised - almost exclusively in uncircumsied
• HPV infection
• Higher incidence in Latin America, Africa, Far East.
• Linchenoid sclerosus - bowman’s disease

Question 3

Where on the penis does SCC tend to arise ?

Answer 3

• Glans mainly
• Also the prepuce (foreskin)

Question 4

What is the first recognised tumour caused by occupational exposure to carcinogens ?

Answer 4

SCC of the scrotum in chimney sweeps

Question 5

Describe the pathogenesis of benign nodular hyperplasia/ BPH of the prostate

Answer 5

Arises hormone inbalance (Androgen/Oestrogen ratio) causing excessive growth of the prostate

Question 6

Where in the prostate does benign nodular hyperplasia arise ?

Answer 6

Transitional and central zones of the prostate (therefore it arises in the cental areas of the prostate)

Question 7

What are some of the signs/symptoms of benign nodular hyperplasia of the prostate ?

Answer 7

• Hesitancy
• Poor stream
• Overflow incontinence
• Terminal dribbling

Question 8

What are some of the complications of BNH of the prostate ?

Answer 8

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

Question 9

Is BNH of the prostate premalignant ?

Answer 9

NO!

Question 10

What is the treatment for BNH of the prostate ?

Answer 10

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

Question 11

What are the side effects of alpha blockers ?

Answer 11

dizziness, postural hypotension, dry mouth, depression

Question 12

What are the side effects of 5 alpha-reductase inhibitors e.g. finasteride?

Answer 12

• Sexual dysfunction - erectile dysfunction, reduced libido, ejaculation problems
• Gynaecomastia

Question 13

Where in the prostate does carcinomas of the prostate tend to occur ?

Answer 13

Peripheral zone

Question 14

What is done if a small focus of cancer is found in the prostate and what is it classified as ?

Answer 14

Called a ‘‘latent’’ carcinoma and if this was found in an old person it would be monitored

Question 15

What areas does prostate cancer often spread to ?

Answer 15

• 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

Question 16

When prostate cancer metastases to the bone what is unusual about its appearance ?

Answer 16

Has an osteosclerotic appearance (due to causing thickening of the bone)

Question 17

How is a carcinoma of the prostate diagnosed ?

Answer 17

• Rectal examination.
• Measure PSA (prostate specific antigen) as this is increased in most
• Transurethral biopsy US guided

Question 18

What is the management of prostate cancer ?

Answer 18

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

Question 19

What is the commonest solid organ malignancy in young adult males ?

Answer 19

Testicular tumours

Question 20

What is the typical presentation of testicular tumours ?

Answer 20

Painless testicular enlargement

Question 21

What is the cell of origin for most testicular tumours ?

Answer 21

Germ cell

Question 22

What are the main germ cell tumours (hence the main testicular tumours)

Answer 22

• Seminomas (40% of germ cell tumours)
• Teratomas (32% of germ cell tumours)
• Mixed (both semioma and teratoma)

Question 23

What is the difference in age presentation of seminomas and teratomas ?

Answer 23

• 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

Question 24

What is the typical appearance of seminomas ?

Answer 24

Solid, homogenous, pale macroscopic appearance – “potato” tumour.

Question 25

What is the treatment of seminomas and why ?

Answer 25

Radiotherapy as they are very very sensitive to radiotherapy

Question 26

What is the tumour marker associated with seminomas ?

Answer 26

PLAP - placental alkaline phosphatase

Question 27

What is the treatmeant used for teratomas ?

Answer 27

Chemotherapy

Question 28

Where do seminomas tend to spread to ?

Answer 28

Para-aortic lymph nodes

Question 29

What is the typical microscopic appearance of seminomas ?

Answer 29

Large, clear tumour cells with variable stromal lymphocytic infiltrate - this is a good prognostic factor

Question 30

What is the microscopic appearance of teratomas ?

Answer 30

Variable macroscopic appearance – solid areas, cysts, haemorrhage, necrosis

Question 31

Why do teratomas have a worse prognosis ?

Answer 31

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

Question 32

What is the tumour markers associated with teratomas ?

Answer 32

• α-fetoprotein (AFP)
• hCG - beta human chorionic gonadotrophin (this is also tested for in pregnancy tests)

Question 33

What is a mixed seminoma/teratoma?

Answer 33

Seminoma with any variant of teratoma.