Pathology-Male Genitourinary System Flashcards
Common causes of acute cystitis?
Bacteria: E. coli + other coliforms. Fungi: Candida
Common causes of chronic cystitis?
Bacteria, schistosoma haematobium
Common causes of subacute cystitis?
Eosinophils
Common causes of hemorrhagic cystitis?
Cyclophosphamide and adenovirus
Common causes of interstitial cystitis (presenting as frequency and urgency in women)?
Chronic cystitis w/ulceration -> transmural fibrosis (typically in females)
Common causes of malacoplakia (a form of chronic cystitis)? What would this look like histologically?
Note the soft, yellow, raised plaques along the bladder mucosa typical of malacoplakia. Histologically you would see foamy macrophages with Michaelis-Gutmann bodies (undigested bacterial concretions).
6 common etiologies of bladder cancer
1) Smoking. Drugs (analgesics, cyclophosphamide), pelvic irradiation, chronic cystitis, schistosomiasis (squamous cell carcinoma of bladder) and aromatic amines (2-napthylamine 15-40 years later)
A 40 year old woman presents with painless hematuria. Cystoscopy reveals a papillary mass arising from the bladder mucosa. Why might this patient be at risk for hydronephrosis and pyelonephritis?
Blockade of the urethral orifice and obstruct and cause urine back up and stasis.
What are the two major growth patterns of bladder neoplasms and how often are they seen? What type of growth patterns are seen less often?
75% are superficial and 20% are invasive. The other 5% are metastatic. Flat invasive (carcinoma) and noninvasive (carcinoma in situ) lesions are more rare.
Why do you have to do further studies of the urinary tract (from urethra up to renal pelvis) if you find bladder cancer?
40% of bladder cancers occur at multiple sites.
What must you increase surveillance if someone has a superficial papillary bladder tumor removed
50-70% recur at 5 years and 5-20% come back at a higher stage.
What is the most common type of tumor found in the bladder?
90% are urothelial (transitional cell).
Bladder tumors with best prognosis?
Papillomas, PUNLMP and low grade carcinomas.
Histological presentation of urothelial papillomas (benign)?
Umbrella cell layer + fibrovascular core.
Histological presentation of low grade urothelial carcinoma?
Mitotic figures, even spacing, loss of umbrella cells and usually no invasion.
Histological presentation of high grade papillary urothelial carcinoma?
Loss of polarity, nuclear atypia, pleomorphisms, mitosis, loss of umbrella cells.
Why do we do urine cytology in people who have a history of urothelial carcinoma?
The tumor cells tend to be discohesive and slough off into the urine so you can measure them.
Histological presentation of urothelial carcinoma in situ?
Cytoscopy will show mucosal reddening, cells are still discohesive and have atypia, pleomorphisms and are confined to the mucosa.
How do genetics affect bladder cancers?
Superficial papillary tumors: chromosome 9 monosomy/deletion involving tumor suppressor p16. Invasive papillary tumors and carcinoma in situ: 17p deletion involving p53 gene.
Common causes of urinary tract obstruction
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A 70 year old man presents with frequency, nocturne, difficulty starting and stopping his stream, dribbling and dysuria. Prostate biopsy is shown below. What is the pathogenesis of his condition?
Note the variably-sized and dilated glands in the periurethral zone. BPH is caused by testosterone conversion to DHT in prostate stromal cells by 5-alpha-reductase. This results in proliferation of prostatic stromal cells and decreased death of prostatic epithelial cells.
A 70 year old man presents with frequency, nocturne, difficulty starting and stopping his stream, dribbling and dysuria. Prostate biopsy is shown below. What will help you differentiate this from a benign vs a malignant process?
Note the hyper plastic glands and stroma w/nodular architecture. In benign processes there are two cell layers: outer cuboidal basal cells and inner columnar secretory cells (shown below).
A 55 year old man presents with dysuria, frequency, hesitancy, hematuria, fatigue and low back pain. Physical exam reveals a nodule on DRE. X-ray shows osteoblastic lesions in the lower lumbar spine. Where do these types of tumors most often arise?
Posterior periphery. This is why it would be rare for a patient with early prostate cancer to present with urinary symptoms.
Where is the cancer and where is the BPH in this image?
Green = BPH (large, irregular, branching glands). Red = adenocarcinoma (small, round, regular glands, only one cell layer).
What would lower the prognosis of this tumor?
If it spread through the thin prostate capsule or invaded the seminal vesicles
Why does prostate cancer have such a predilection to cause pain?
It likes perineural invasion.
What does a well-differentiated prostate adenocarcinoma look like?
Forms lots of small glands.
A 12 year old boy presents with a painless enlarging mass of the testis. It cannot be transilluminated. Biopsy is shown below. What is your diagnosis? What is a risk for this condition?
Note that there are atypical clear cells with hyperchromatic nuclei WITHIN the seminiferous tubules. This is likely pre-neoplastic intra-tubular germ cell neoplasia (ITGCN). Increased copies of chromosome 12 p is associated with this, this is thought to occur in utero but remain dormant until puberty.
A 30 year old man presents with a painless enlarging mass of the testis. It cannot be transilluminated. Biopsy is shown below. What is likely causing his condition? How would you confirm this?
This is a seminoma. Note the fleshy mass replacing the majority of the testis. Note the poorly demarcated lobules, large homogenous cells, clear cell borders and large nuclei and scattered lymphocytes. You can confirm your diagnosis by staining the biopsy and the cells will be PLAP and CD 117 (c-kit) positive.
A 30 year old man presents with a painless enlarging mass of the testis. It cannot be transilluminated. Biopsy is shown below. What is likely causing his condition?
This is a non-seminoma: embryonal carcinoma. Note the hemorrhage in the gross specimen. Note the pleomorphic cells in cords, glands and sheet w/embryoid bodies.
Most common presentation of testicular tumor in children < 3 years old?
Yolk Sac Tumors. All will have elevated AFP. Histology will show anastomosing glandular networks and endodermal sinuses (Schiller-Duval bodies that look like primitive glomeruli). Teratomas also occur in young kids.
Diagnostic feature in the biopsy of choriocarcinoma?
Cytotrophoblast AND syncytiotrophoblast sheets
What are the different tissues you may see on analysis of a teratoma?
Glandular formations, cartilage, squamous epithelium or immature tissue.
