Pathology Lab-Male GU System Flashcards
A 25-year-old sexually active woman presented to her primary care physician for evaluation of post-coital suprapubic pain and dysuria with urgency, frequency and associated with bladder fullness. She used a diaphragm with a spermicide prior to initiation of coitus. She had experienced two episodes of urinary tract infection (UTI) within the previous six months. She also gave a history of occasional episodes of Candida vulvo-vaginitis with an associated discharge, which was treated with cotrimazole. Her maternal grandfather had died of urothelial carcinoma. She was otherwise well but suffered regularly from mid-cycle mittelschmerz. T = 99.6°F. Pulse rate = 78/min. RR = 18/min. Vaginal examination disclosed the presence of bilateral tenderness in the adnexal regions. If labs show bacteria in the urine and increased WBCs. Does this mean that she has acute cystitis?
No. You may not have had a clean catch or have cystitis not due to infection (with normal bacterial colonization).
A 65-year-old white male complains of nocturia and difficulty starting and stopping his urinary stream. 7 pack year smoking history; quit 3 years ago. No incontinence, history of STDs, or pain on urination. Abnormal nodularity on digital rectal examination. PSA is 2.0 ng/mL (nl: < 4.0 ng/mL). Is there anything you want to know about this patient before analyzing his PSA?
Recent ejaculation? Recent prostatitis? Recent DRE? Recent bicycle ride? All of these things can elevate your PSA.
A 68-year-old AA male has a screening physical examination, which reveals an abnormal DRE. Nocturia, retention, and dribbling noted. Back pain for the past three months. A firm prostatic nodule of about 1 cm diameter is palpated. There is tenderness upon palpitation of the lower spine. Prostate specific antigen (PSA) level= 12 ng/mL. What are two reasons this patient might have bone pain?
Metastasis of prostatic adenocarcinoma or a chronic prostatitis.
A 58-year-old male with presents with a three-month history of intermittent painless hematuria. 18 year hx of HTN, well controlled with medication. A 40-year history of smoking one-and-a-half packs a day. No urethral discharge or palpable regional lymph nodes. What are some possible etiologies of his condition?
Urothelial carcinoma can be caused by smoking (50-80% of cases), 2-naphthylamine, schistosomiasis, long term analgesic use, cyclophosphamide and irradiation.
A 32-year-old man presents with painless enlargement of his left testicle. Non-tender, nodular left testicle that is twice the size of his right testicle. Testicular ultrasound shows parenchymal mass. What are some things that present as a testicular mass?
Germ cell tumors, sex-cord stromal tumors, hydrocele, torsion, mumps. Someone of this patient’s age is at risk for testicular cancer.
What is responsible for a low PSA in patients with highly malignant prostatic adenocarcinoma?
The cells are so poorly differentiated that they cannot even produce PSA.
What types of pathogens are causes of chronic prostatitis that does not present as a bacteria prostatitis?
Obligate intracellular organisms like mycoplasm or chlamydia.
Why is cystitis more common in females?
Shorter urethra
Common infective agents responsible for acute cystitis?
E. coli, Proteus, Klebsiella, Enterobacter
Lab tests to do in patients with cystitis?
Urinalysis (>10 WBCs phf), dipstick (leukocyte esterase/nitrites) and culture.
Cystitis presentation w/schistosomiasis
Eggs in urine and granulomatous inflammation of bladder w/risk of squamous cell carcinoma of the urinary bladder.
What would you expect to see on histology of this image and what is causing this condition?
Malacoplakia. Note the flat, yellowish plaques throughout the mucosa. On histology you see foamy macrophages, vesicular inflammation and Michaelis-Gutmann bodies (bacterial concretions) due to macrophage dysfunction. The macrophages are able to phagocytose the pathogen but not able to degrade them.
What is your diagnosis of the image shown below from a urinary biopsy?
Chronic cystitis. Note the lymphocytic infiltrate (chronic inflammation), hemorrhage, fibrosis and edema.
What is your diagnosis of the image shown below from a urinary biopsy? What might give you this condition?
Granulomatous cystitis. Note the nodules of inflammation and pink aggregates. This can be caused by schistosomiasis, Tb and BCG immunotherapy.
What is your diagnosis of the image shown below from a urinary biopsy? What is responsible for the granulomas seen below?
Note the granulomatous inflammation surrounding the schistosomal eggs. This is schistosomiasis. IF-gamma and IL-4 play a role in activation of granulomas.
What is your diagnosis of the image shown below from a urinary biopsy?
Radiation cystitis. Radiation induces endothelial damage causing narrowing of blood vessels, fibrosis and ischemia weeks and months after exposure. This explains the inflammatory and fibrotic condition seen in the biopsy. Finally note the large atypical nuclei that can mimic cancer.
What causes the histology of the prostate shown below?
BPH is a result of DHT-induced hyperplasia of stromal cells and inhibition of epithelial cell death. Note the glandular proliferation (saw tooth appearance) within nodules.
How do you know you are looking at BPH and not prostatic carcinoma?
In prostatic carcinoma there are not basal columnar cells. Note the basal columnar cells and lumenal cuboidal cells characteristic of BPH. Also note that there are NO PROMINENT NUCLEOLI.
Is this prostatic cancer or BPH?
Note that there is the papillary infolding with 2 layers, indicating BPH in the lower right part of the image. Also note that there are small round glands with a prominent nucleolus with a vesicular nucleus.
What do prostatic adenocarcinomas have in common with salivary and pancreatic tumors?
They all invade the perineural sheath
What about this biopsy makes you think it is metastatic prostate cancer?
The bone spicula are dense and alkaline phosphatase should be high, indicating osteoblastic activity which is induced by metastatic prostate cancer. Note that breast cancer will present with osteolytic lesions and hypercalcemia.
If you had a mass in the kidney, how do you know if it is a renal cell carcinoma or a urothelial carcinoma?
Urothelial carcinomas present in the pelvis. Renal cell carcinomas have clear cells due to lipid accumulation and will be yellow. Urothelial cell carcinomas are reddish brown.
What is your diagnosis in this biopsy from a patient’s bladder?
Normal urothelium
5 categories of urothelial carcinoma from best prognosis to worst prognosis. What is the one that is not papillary?
Exophytic papillomas, inverted papillomas, PNLMP (papillary growth w/increase # of cell layers w/o cytologic atypia), low grade carcinoma, high grade carcinoma. The non-papillary lesion is carcinoma in situ (flat).
What type of bladder cancer is alway high grade?
Carcinoma insitue. Note the marked disorganization, nuclear atypia, pleomorphisms, mitotic figures and discohesion.
What do seminomas cells look like?
Homogenous lobulated, no hemorrhage. Cells look like normal germ cells you find in the seminiferous tubules (clear cytoplasm, polyhedral, vesicular nuclei) with lymphocytes around surrounding CT.
What cell is indicated below?
Sertoli cell
What type of tumor is indicated below?
Note the squamous cells, keratin, cartilage and intestinal gland development…indicating a terratoma.
Why type of testicular tumor is indicated below?
Note large masses of atypical cells characteristic of embryonal carcinoma
What type of testicular tumor is indicated below?
Note the central lumen, cells surrounding the central lumen and cells surrounding the clear space…a Schiller-Duval body characteristic of a yolk sac tumor.
What type of testicular tumor is indicated below?
Note the syncytiotrophoblasts and cytotrophoblasts characteristic of choriocarcinoma.
