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Pathology - Handorf Flashcards

1
Q

Congenital Anomalies of the Penis

A
  1. Penile agensis
  2. Duplication - 2 urethral orifices come out
    3 Epispadias
  3. Hypospadias
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2
Q

Penile Epispadias/Hypospadias

A
  • abnormal openings of the urethra on the dorsal or ventral penis from malformations of the urethral canal, can be associated with undescended testes
  • Hypospadias is more common (1 in 300 births)
  • Clinical: urethral obstruction or failure of normal ejaculatory function
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3
Q

Inflammation of Penis

A
  • most commonly related to phimosis (inability to easily retract foreskin) or venereal disease
  • in circumcised/uncircumcised adults, balanoposthitis (glans inflamation = balanitis, foreskin = posthitis) is related to poor hygiene
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4
Q

Circumcision

A

AAP says there is no absolute medical indication for circumcision

  • 60-75% of males in US are circumcised
  • decrease in HIV transmission from females to circumcised males of 57%
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5
Q

Penis - Condyloma acuminata

A
  • “warty,” cauliflower like growths which occur primarily in the anogenital region
  • venerallly transmitted and most often caused by HPV types 6 or 11
  • not premalignat, but tend to recur despite vigorous therapy
  • micro: exuberant exophytic (growing outward) growth pattern of the papillary lesion is seen, few mitosis, no necrosis
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6
Q

Penis - Carcinoma in situ

A

“Bowen disease” - on skin
“erythroplasia or Queyrat” - on glans
-80% related to HPV (type 16)
-10% progress to squamous cell carcinoma if untreated
-red, slightly raised, rough, painless, nonulcerated lesions

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7
Q

Carcinoma in situ: Histology

A

-hyperkeratosis with disordered maturation and elongation of rete ridges and thickening of epidermis

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8
Q

Penis - Squamous Carcinoma

A
  • related to HPV 50% of the time (type 16 & 18)

- other risk factors: poor hygiene & smoking

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9
Q

Testis - Cryptorchidism

A

undescended testes (from abdomen to scrotum)
-1% or one year old boys
-75% unilateral/25% bilateral
-may be related to other anomalies (hypospadias)
Transabdominal phase
-mullerian inhibiting substance
-takes testis to brim of pelvis
-failure here in 5-10% of cases
Inguinoscrotal phase
-androgen induced release of calcitonin-gene related peptide
-takes testis from brim of pelvis into sscrotum
-failure here is 90-95% of cases

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10
Q

Cryptochidism Complications

A
  • inguinal testis susceptible to trauma
  • Sterility
    • decreased spermatogenesis in BOTH testes in unilateral cryptorchidism
    • systemic mechanism, poorly understood (not just “overheated testis”)
    • orchiopexy before age 2 improves (does not guarantee) chances of normal spermatogenesis
  • Neoplasms
    • 5-10 fold increase in risk of malignant neoplasm in cryptorchid testis
    • some increased risk in contra lateral normally descended testis
    • both risks are reduced but not totally eliminated by orchiopexy
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11
Q

Klinefelter Syndrome

A
  • abnormal # or X chromosomes (XXY), primary gonadal insufficiency
  • Frequency: 1/1000-4000 live male births; 1/100 patients in mental institutions and 3.4/100 infertile men
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12
Q

Clinical Appearance of Klinefelter Syndrome

A
  • eunuchoid appearance with increased stature and small to normal-sized, well developed testes (firm)
  • incomplete virilization
  • gyneocomastia
  • mental retardation, speech difficulties

-increased incidence of extragonadal germ cell tumors (mediastinum>pineal gland, CNS, retroperitoneum) as well as hypopituitarism

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13
Q

Histology of Klinefelter Syndrome

A
  • small hyalinized seminiferous tubules

- pseudoadenomatous clusters of Leydig cells (appear to increase in number though b/c of decreased testicular volume)

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14
Q

Testis - Mumps orchitis

A
  • focal atrophy of testicular tubules (most common cause)
  • post puberty complicated by architis on fourth to third of cases
  • unilateral & patchy so that sterility following infection is uncommon
  • echovirus, lymphocytic choriomeningitis virus, influenza virus, Coxsckie virus, arboviruses
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15
Q

Epididymitis

A
  • more frequent cause for scrotal pain and swelling in adult males and is most likely to be the result of a sexually transmissible diseases such as chlamydia trachomatis or Neisseria gonorrheae in younger males or gram negative bacteria from urinary tract infection of older males
  • disseminated tuberculosis may occassionally involved the epididymis
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16
Q

Testis - Syphilis

A

Tertiary: involves testis first, then epididymis

-micrograph shows a silver stain of testis with numerous spirochetes

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17
Q

Testis - Gonorrhea

A

-spreads retrograde from the urethra to the prostate, seminal vesicles, epididymis, and prostate

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18
Q

Testis - Tuberculosis

A
  • spreads retrograde from the prostate to the epididymis, then to the testis
  • granuloma
19
Q

Testis - Granulomatous Orchitis

A
  • uncommon inflammatory testicular lesion that follows a gram negative urinary tract infection in the majority of cases
  • most prevalent in 5th/6th decades
  • testicular involvement is usually diffuse (may be localized nodular lesion & may simulate neoplasm)
  • epididymis & spermatic cord may be involved
20
Q

Inflammatory Process of Granulamatous Orchitis

A
  • predominately intratubular with the cellular infiltrate containing a majority of histiocytes admixed with lymphocytes and plasma cells
  • giant cells
  • predominance of histiocytes imparts a granulomatous appearance but distinct granulomas are not formed
  • non-specific chronic interstitial inflammation
  • intratubular localization of inflammation in granulamatous orchitis aids in its distinction from infectious granulomas and sarcoidosis (interstitial)
  • necrosis is NOT seen
21
Q

Autoimmune orchitis

A
  • rapid onset testicular enlargement in middle aged men
  • may be associated with febrile illness
  • granulomas without organisms
22
Q

Testis - Regression

A

V - Vascular conditions bring to mind varicoceles, which cause atrophy on the side of the dilated veins
I - Inflammation recalls the atrophy following mumps orchitis and other causes of epidydimoorchitis
N - Neoplasms sugest the atrophy that occurs in the estrogen treatment of prostatic carcinoma
D - Degenerative suggests the atrophy resulting from aging
I - Intoxication should remind one of the atrophy resulting from chronic alcholism, Laennec cirrhosis, and hemochromatosis (x-ray exposure may also produce atrophy)
C - Congenital recalls undescended testes and torsion
A - Autoimmune and allergic suggest nothing
T - Trauma reminds one of the atrophy following vasectomy & accidental ligation of the blood supply during hernia repair
E - Endocrine suggests the atrophy of hypopituitarism, Klinefelter syndrome, & other eunuchoidal states

23
Q

Testis - Torsion

A
  • twisting of the spermatic cord, leading to ischemia and venous stasis
  • may be related to trauma, but frequently the inciting event is obscure
  • predisposing anatomic abnormality which allows the testis excess mobility within the scrotum (bell clapper phenomenon), may be bilateral, which is why there is a risk of contra lateral torsion in a patient who has torsion
  • true urologic emergency, since surgery within 4-6 hrs may save testis, after that hemorrhagic infarction with obliteration of the testis is inevitable if reduction of torsion is too late
24
Q

Testicular Neoplasms: Germ Cell Tumors

A
  1. Seminomas
  2. Embryonal Carcinoma
  3. Yolk sac tumor
  4. Choriocarcinoma
  5. Teratoma
25
Seminomas
- 50% of germ cell tumors - most common germ cell tumor to occur in "pure" form - grossly homogeneous, not typically necrotic or hemorrhagic - microscopically has characteristic distinct cell membrane and clear cytoplasm - 15% produce human chorionic gonadotropin (HCG)
26
Embryonal Carcinoma
- occasionally a pure tumor, but much more commonly a component of a mixed germ cell tumor - more aggressive than seminomas - grossly more likely to be hemorrhagic or necrotic - microscopically shows sheets, alveoli, tubules or papillary formations - generally anaplastic looking cells
27
Yolk Sac Tumor
- endodermal sinus tumor - almost exclusively a tumor of infants and children up to 3 years of age - in adults, more commonly seen mixed with other germ cell tumor patterns - main distinguishing features is production of alpha fetoprotein (AFP) which serves as a serum marker - immunohistochemical stain is positive for alpha fetoprotein
28
Choriocarcinoma
- only 1% of germ cell tumors are pure chorio, but chorio is commonly represented in mixed germ cell tumors - highly aggressive - mimics the histology of normal placenta (syncitiotropoblasta & cytotrophoblasts) & produces HCG (tumor marker) - grossly & microscopically very vascular, metastases bleed easily
29
Teratoma
- more common in children, rare in adulats, commonly mixed with other germ cell type tumors in adults - mature types (with adult tissues) and immature types with (fetal tissues) exist - tissue represents more than one germ layer - may be grossly quite large with variegated color and texture (cysts are common)
30
Prostate
- retroperitoneal gland which encircles the neck of the bladder - composed of glandular cells within a supporting stroma; the glands produce secretions which constitute seminal fluid - the gland is divided into peripheral, central, transitional, and periurethral zones (hyperplasia arises in the transitional and periurethral zones whereas carcinoma arises in the peripheral zone)
31
Prostate: Microscope
Prostate glands have two types of epithelium, luminal and basal; these may be distinguished on H and E stain, though they are not always obvious. The luminal cells are responsible for producing seminal fluid and express prostate specific antigen, a serine protease which liquefies the seminal fluid coagulum. An immunoperoxidase stain for PSA (right upper panel) decorates the luminal epithelium. The basal cells do not produce PSA
32
Prostate Inflammation
- acute & chronic bacterial prostatitis and chronic abacterial prostatitis are general categories - also gonorrhea can cause it
33
Acute Bacterial prostate inflammation
-usually urinary tract pathogens such as E. coli (other gram negative rods), Enterococci, Staph
34
Chronic Bacterial Prostate Inflammation
- same organisms as acute bacterial, but more indolent course - common history of UTI
35
Chronic Abacterial Prostate Inflammation
- same course as chronic bacterial but organisms more difficult to identify - ex: mycoplasma, ureaplasma, and chlamydia
36
Prostate Hyperplasia
- nodular hyperplasia (benign) - androgen driven - results from hyperplasia of prostatic glands & stroma - main symptoms relate to bladder obstruction and urinary stasis - 70% of 60 y/o, 90% of 70 y/o, many asymptomatic - >400,000 resections performed annually
37
Prostate Carcinoma
- most common cancer in men - 300,000 new cases yearly, 40,000 deaths - rare under 50, at 70, 70% have at least latent - most tumors never progress, or do so very slowly - Japan 3-4/100,000, white 50-60/100,000 more in black
38
Prostate Carcinoma Etiology
- Androgen related - but there is no correlation of testosterone levels to risk prostate carcinoma - Genetically & ethnically related, but only minority of cases (10%) can be linked to inheritance of germline susceptibility genes - Environmentally related—but low risk ethnic groups (Japanese) who move where high risk groups live (America) only modestly increase their risk
39
Prostate Carcinoma Diagnosis
-physical exam or PSA elevation in blood (both may be done if over 60)
40
PSA
organ (prostate) specific, but not cancer specific - rises in in a number of benign conditions, including BPH and prostatitis - Biopsy is essential to make the diagnosis
41
AUA Screening Recommendation
- no screening under 40 - individualized decisions about screening for men under 55 at higher risk (AA or positive family history) - greatest screening benefit ages 55-69 - every two year screening may be preferred to annual screening - no routine screening after age 70
42
Prostate Carcinoma Microscope
- can be nearly benign glands to highly anaplastic malignant cells - back to back glands in crowded, disorganized pattern - perineural invasion - extracapsular externsion of the tumor
43
Gleason Grading System
- for prostate carcinoma - Grade 1 - best differentiated - Grade 6 - worst - add grade from 2 most prevalent patterns (best score is 2, worst is 10)
44
Prostate Carcinoma Metastases
-bone (almost always osteoblastic rather than osteolytic)

Reproductive (14 decks)

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