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MHD II Test 3 > Pathology of the Lower Urinary Tract and Male Genital System II > Flashcards

Pathology of the Lower Urinary Tract and Male Genital System II Flashcards

1
Q

Define

  1. Hypospadias
  2. Epispadias
  3. What can happen if the testes fail to descend?
  4. What can a urinary tract obstruction cause?
  5. What can problems with ejaculation and insemination cause?
A
  1. urethral opening on the ventral surface
  2. urethral opening on the dorsal surface
  3. malformation of urinary tract, predisposes to tumors
  4. ascending urinary tract infections
  5. sterility
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2
Q

Define

  1. Phimosis
  2. What can happen as a result?
  3. Paraphimosis
  4. What can happen as a result?
A
  1. prepuce cannot be retracted
  2. poor hygiene –> infections –> phimosis –> infections –>?carcinoma
  3. phimotic prepuce is forcibly retracted
  4. constriction and swelling –> pain –> acute urinary retention
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3
Q

Penis Infections: Gonorrhea

  1. Gonorrhea Sequelae
  2. Who gets Chlamydia?
  3. Other name for chlamydia? what does it describe?
  4. What is Reiter syndrome (3)?
A
  1. urethritis –> urethral strictures –> sterility and ectopic pregnancies
  2. M>F
  3. lymphogranuloma venereum, small epidermal vesicle –> ulcer –> inguinal and rectal lymphadenopathy; trachoma: chronic keratonconjunctivitis
  4. conjunctivitis, polyarthritis, genital infection
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4
Q

Penis Infection: Syphilis

  1. Primary
  2. Secondary
  3. Tertiary
A
  1. 3 weeks: chancre
  2. 2-10 weeks: palmar, solar rash, lymphadenopathy, arthritis, headache, fever, condyloma latum
  3. years: neurosyphilis, aortitis, gummas
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5
Q

Penis Infection: Molluscum Contagiosum

  1. What causes it?
  2. What does it infect?
  3. What does it look like?
A
  1. DNA virus,
  2. squamous epithelium
  3. pearly papules w/ central umbilication
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6
Q

Penis Tumors:Condyloma Acuminatum

  1. Etiology
  2. Gross look
  3. Micro look
A
  1. HPV types 6 and 11
  2. single or multiple sessile or pedunculated, red papillary excrescencies, one-several mm
  3. papillary proliferation of squamous cells; Koilocytosis- clear vacuolization of the cytoplasm
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7
Q

Penis Tumors:Squamous Cell Carcinoma

  1. Risk Factors
  2. What lowers risk?
  3. Etiology?
  4. Gross look
  5. Micro look
A
  1. poor hygiene, phimosis- accumulation of smegma, hx of genital warts
  2. circumcision
  3. HPV 16 and 18
  4. ulcerative, fungating, plaque-like, papillary lesions
  5. resembling squamous epithelium, intercellular bridges, and keratin pearls
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8
Q

Cryptorchidism

  1. Define
  2. Causes (2)
  3. Complications
  4. Gross look
  5. Histo look
A
  1. undescended testis
  2. trisomy 13, majority idiopathic
  3. infertility, germ cell neoplasia
  4. usually unilater (25% bilateral), small, firm testicle
  5. tubular atrophy: sertoli cells are present, no spermatogonia, Leydig cell hyperplasia
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9
Q

Tunica Vaginalis

  1. Define
  2. Define Hydrocele
  3. Hematocele
  4. Chylocele
  5. Spermatocele
  6. Varicocele
A
  1. serous cavity: mesothelial lined sac immediately proximal to the testis and epididymis
  2. clear fluid in serous cavity (transillumination)
  3. blood in serous cavity (trauma, torsion)
  4. lymph in serous cavity (elephantiasis)
  5. Semen in serous cavity
  6. dilated veins in the spermatic cord; may feel like a “bag of worms”
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10
Q

Epididymitis and Orchitis: Causes

  1. Viral
  2. Bacterial
  3. Granulomatous
  4. What do Gonorrhea and TB infect?
  5. What does syphilis infect?
A
  1. Mumps, Coxsackie B
  2. E coli, Neisseria, Gonorrhea
  3. TB, Syphilis, Leprosy, Brucellosis, Sarcoidosis
  4. epididymis
  5. testis
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11
Q

Testicular Torsion

  1. What happens?
  2. When does it occur?
  3. Symptoms
  4. What happens if not treated?
  5. How is it treated?
  6. Success rate?
A
  1. twisting of cord –> thick-walled arteries patent–> vascular engorgement –> infarction
  2. neonate (in utero/right after birth), Adolescence (often w/o inciting injury, could be due to anatomic defect), doesn’t require severy injury
  3. sudden, severe pain
  4. congestion, edema, hemorrhage –> hemorrhagic infarct –> fibrosis
  5. surgery; UROLOGIC EMERGENCY
  6. surgery w/in 8 hrs = 80% salvage
    surgery after 10 hrs = 20% salvage
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12
Q

Testicular Tumors:

  1. What age group gets it?
  2. What ethnic group gets it?
A
  1. 15-34: most common tumor in men

2. Whites more than african americans (5:1)

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13
Q

Testicular Tumors: Classification

  1. 2 Types
  2. Which type lacks malignant potential?
A
  1. Germ Cell Tumors and Sex Cord-Stromal Tumors

2. Sex Cord-Stromal Tumors

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14
Q

Germ Cell Tumors

  1. One histologic Pattern (40%) (6)
  2. Mixed germ cell tumors (60%) (1)
A
  1. Seminoma, Spermatocytic seminoma, Embryonal Carcinoma, Yolk Sac Tumor, Choriocarcinoma, Teratomas
  2. Teratocarcinoma (Teratoma + embryonal)
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15
Q

Seminoma

  1. Stage at presentation
  2. Where does it metastasize to?
  3. Radiosensitive?
  4. Cure rate?
A
  1. 70% stage I, localized to testis for long time
  2. lymph nodes
  3. yes, also chemosensitive
  4. 95%
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16
Q

Nonseminomatous germ cell tumors

  1. Stage at presentation
  2. Where does it metastasize to?
  3. Radiosensitive?
  4. Cure rate?
A
  1. 60% stage II or III
  2. lungs and liver via blood
  3. radioresistant
  4. 90% complete remission and cure with aggressive chemo
17
Q

Testicular Tumors: Risk Factors (5)

6. What is NOT a risk factor?

A
  1. cryptorchidism (higher the testis, higher risk of cancer; R>L)
  2. gonadal dysgenesis with Y chromosome
  3. Testicular feminization
  4. Presence of ITGCN (intratubular germ cell neoplasia)
  5. HIV infection
  6. Trauma
18
Q

Testicular Tumors: Genetics

1. What cytologic abnormality is found in 90% of invasive tumors regardless of histological type?

A
  1. Isochromosome of the short arm of chromosome 12, i(12p)
19
Q

Germ Cell Tumors: Clinical Features

  1. Two types
  2. What happens to testis?
  3. Where does it spread?
  4. Effectiveness of radiotherapy
A
  1. Seminoma and Nonseminomatous Germ Cell Tumors (NSGCT)
  2. painless enlargement
  3. lymphatics (retroperitoneal, paraaortic, mediastinal, supraclavicular LN); Hematogenous spread (lungs, liver, brain);
  4. Seminoma- radiosensitive; NSGCT- relatively radioresistant
20
Q

ITGCN

  1. often associated with what?
  2. Intratubular proliferation of what?
  3. Micro look
  4. Positive Markers
  5. Negative markers
A
  1. malignant germ cell tumors
  2. malignant germ cells
  3. large atypical cells, abundant clear cytoplasm, central nucleus, prominent nucleoli (fried egg appearance)
  4. CD 117, D-240
  5. AFP, Cytokeratin, CD 30
21
Q

Seminoma

  1. What age group gets it?
  2. How common is it?
  3. Gross look
  4. Micro Look (4)
  5. Positive Markers
  6. Negative Markers
A
  1. 30-40 y/o
  2. most common germ cell tumor
  3. homogenous, gray-white cut surface
  4. sheets of univorm, large cells w/ distinct membrane; clear cytoplasm; large central nucleolus; fibrous septate infiltrated w/ lymphocytes
  5. bHCG (10%), CD 117, D-240
  6. Cytokeratin, AFP, CD-30, PAS-D
22
Q

Embryonal Carcinoma

  1. What age group gets it?
  2. Gross Look
  3. Micro look
A
  1. 20-30 years old
  2. variegated, poorly demarcated, foci of necrosis (yellowish) and hemorrhage
  3. large anaplastic cells w/ prominent nucleoli with indistinct cell borders arranged in solid, glandular, tubular, papillary patterns
23
Q

Yolk Sac Tumor

  1. What age groups get it?
  2. Most common testicular tumor in whom?
  3. Micro look?
  4. Serum Marker
A
  1. infacts (good prognosis) and young adults (mixed tumors)
  2. infants up to 3 y/o
  3. reticular network of cuboidal cells, papillary and solid patterns (Schiller-Duval or glomeruloid bodies), and hyaline-like globules (AFP and alpha-1 antitrypsin)
  4. AFP
24
Q

Choriocarcinoma

  1. What age group gets it? Prognosis?
  2. Gross look
  3. Micro look (2 cell types)
  4. Serum marker
A
  1. 2nd and 3rd decade; metastasis at presentation, highly aggressive
  2. small, hemorrhage, and necrosis
  3. synctiotrophoblast- large, vacuolated and multinucleated cell w/ dark eosinophilic cytoplasm,positive HCG
  4. Cytotrophoblast- uniform, polygonal cell with clear cytoplasm, single nucleus, and distinct cell borders
  5. b-HCG
25
Q

Teratoma

  1. Define
  2. When do these tumors occur?
  3. Benign or Malignant?
A
  1. random admixture of tissue derived from ectoderm, endoderm, and mesoderm
  2. from infancy (pure) to adulthood (mixed germ cell tumors)
  3. malignant transformation, there are no benign teratomas in post-pubertal males
26
Q

Leydig Cell Tumor

  1. How common?
  2. What age groups?
  3. Location
  4. Symptoms
A
  1. most common sex cord- stromal tumor
  2. any age, most common from 2nd-6th decade
  3. usually unilateral
  4. testicular enlargement, endocrine manifestations
27
Q

Leydig Cell Tumor

  1. Gross look
  2. Micro look
  3. What is pathognomic for the disease?
A
  1. well circumscribed, 3-4 cm nodule with homogenous, golden-brown cut surface
  2. solid growth of large, polygonal cells w/ abundant granular cytoplasm and single, round, centrally located nuclei with prominent nucleoli
  3. Crystalloids of Reinke
28
Q

Lymphoma

  1. Primary or Secondary?
  2. For what age range is it the most common testicular neoplasm?
  3. Prognosis
  4. Gross look?
A
  1. usually secondary- large B cell lymphoma
  2. > 60
  3. poor
  4. fleshy, white gray to pink, usually replaces testicular parenchyma
29
Q
  1. What is the most common testicular tumor in adults?
  2. What is the most common primary testicular tumor?
  3. What is the most common bilateral testicualr tumor?
  4. What is the most common testicular cancer in infants and children?
  5. What is the most common nongerm cell tumor of the testis?
  6. Which are more common, mixed tumors or primary tumors?
A
  1. seminoma
  2. seminoma
  3. Lymphoma
  4. Yolk sac tumor
  5. Leydig cell tumor
  6. Mixed (60%)

MHD II Test 3 (14 decks)

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