Pathology of the Male GU I: Prostate

Question 1

What type of cells line the urinary tract?

Answer 1

Urothelium

Question 2

What is the most common cause of hydronephrosis in

children?

Answer 2

Ureteropelvic Junction Obstruction

Question 3

• von Brunn’s nests with degenerated central cells to form small cystic cavities
• Translucent, submucosal, pearly- yellow cysts, usually up to 5mm

Answer 3

Urethritis (AKA Cystitis Cystica)

Question 4

Vesicoureteral Reflux

Answer 4

Valve defect that can lead to the reversal of the

urine - can cause pyelonephritis

Question 5

Exstrophy

Answer 5

Developmental failure in the anterior wall of the abdomen and in the bladder

Question 6

Interstitial Cystitis (Chronic Pelvic Pain Syndrome)

Answer 6

Non-bacterial form of cystitis seen mostly in females and is associated with allergies and autoimmune diseases and mast cells are often a hallmark

Question 7

Malakoplakia

Answer 7

Recurrent fever, bladder irritability and pain, hematuria, pyuria, weight loss.

Question 8

What is seen on cystoscopy with malakoplakia?

Answer 8

Multiple raised soft yellow to brown plaques and nodules

Question 9

Michaelis-Gutmann Bodies

Answer 9

Blue targeted calcospherules seen on histology in malakoplakia

Question 10

What is malakoplakia associated with?

Answer 10

Chronic bacterial infection

Question 11

Leukoplakia

Answer 11

Long-term irritation or chronic infection which appears grossly as gray-white areas and has increased risk of carcinoma of bladder

Question 12

What is a feature of the treatment of bladder cancer?

Answer 12

It has the highest cost per patient from diagnosis to death

Question 13

What gender is more affected by bladder cancer?

Answer 13

Males 3:1 - usually older males

Question 14

What is the clinical presentation of bladder cancer?

Answer 14

• Painless hematuria
• Frequency
• Urgency

Question 15

What are some major risk factors for bladder cancer?

Answer 15

• Cigarette smoking
• Arylamines
• Chronic cystitis

Question 16

What are the two pathways for the development of urothelial carcinoma?

Answer 16

Papillary and Non-papillary

Question 17

What pathway is the most common for the development of urothelial carcinoma?

Answer 17

Papillary Pathway

Question 18

Papillary Pathway

Answer 18

More common and develops with hyperplasia which is genetically stable with FGFR3 mutations. As it develops, it leads to a low grade carcinoma.

Question 19

Non-papillary Pathway

Answer 19

Less common and develops with dysplasia and is genetically unstable with some having p53 mutations. It can develop into high grade carcinoma or carcinoma in situ.

Question 20

What mutation is more likely in a low grade urothelial carcinoma?

Answer 20

FGFR3

Question 21

What mutation is more likely in a high grade urothelial carcinoma?

Answer 21

p53

Question 22

BCG Vaccine

Answer 22

Bacillus Calmette-Guérin - Attenuated strain of Mycobacterium tuberculosis and is used to prevent recurrence of bladder cancer

Question 23

What is the prognosis of low grade bladder cancer?

Answer 23

VERY good

Question 24

What is the prognosis of high grade bladder cancer?

Answer 24

Pretty good - 75% 10 yr survival rate

Question 25

Most common cause of Nongonococcal urethritis...

Answer 25

E. coli

Question 26

What is the most common location for prostate cancer?

Answer 26

Posterior zone

Question 27

What is the most common location for benign prostatic hyperplasia?

Answer 27

Central Zone

Question 28

What cell layers it the prostate comprised of?

Answer 28

- Secretory Cells | - Basal Cells

Question 29

Benign Prostatic Hyperplasia

Answer 29

Hyperplasia of prostatic glands and stroma - extremely common with increasing age

Question 30

What are some complications of BPH?

Answer 30

- Compression of urethra – difficulties with urination | - Retention of urine in the bladder

Question 31

What are the main mediators of prostate growth?

Answer 31

Androgens - mainly DHT

Question 32

How is BPH treated?

Answer 32

Inhibitors of 5-alpha reductase

Question 33

Nodular Hyperplasia of Prostate

Answer 33

Prostatic enlargement due to presence of nodules in the preprostatic region

Question 34

What is the most common cancer in males?

Answer 34

Prostate Cancer

Question 35

Do most men with prostate cancer die from prostate cancer?

Answer 35

No

Question 36

What race is at increased risk of prostate cancer?

Answer 36

African Americans

Question 37

What are some mutations in the androgen receptors that increase prostate cancer risk?

Answer 37

X-linked AR gene contains a polymorphic sequence composed of CAG repeats - patients with shortest CAG repeats have the highest androgen sensitivity

Question 38

What mutation greatly increases prostate cancer risk?

Answer 38

BRCA2 germline mutation on Ch13 - 20 fold increased risk for PCA

Question 39

What is the most common epigenetic alteration in prostate cancer?

Answer 39

Most common epigenetic alteration in PCA hypermethylation of gluthation S-transferase

Question 40

What are some biomarkers of prostate cancer?

Answer 40

- PSA | - AMACR

Question 41

Prostate Specific Antigen (PSA)

Answer 41

Secreted into seminal fluid where dissolves seminal coagulum. Produced by epithelial cells of normal, hyper plastic and cancerous prostatic tissue and is elevated in prostate cancer.

Question 42

Prostatic Intraepithelial Neoplasia

Answer 42

Proliferation of neoplastic cells within large ducts

Question 43

What is the most common morphology of prostate cancer?

Answer 43

Most often - tumor is not grossly visible

Question 44

What is the best marker to predict prognosis of prostate cancer?

Answer 44

Gleason Score

Question 45

What is a common metastasis of prostate cancer?

Answer 45

Osteoblastic Tumor Metastases

Question 46

What is the treatment for localized prostate cancer?

Answer 46

Radical Prostatectomy

Question 47

What is the treatment for metastatic prostate cancer?

Answer 47

Androgen Deprivation