1. Incomplete LES Relaxation 2. Increased LES Tone 3. Esophageal Peistalsis

Pathology (Sections 16-20) Flashcards by Carl Uy

Most common form of intestinal atresia

Imperforate anus

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Most common type of tracheoesophageal fistula

Distal TEF with proximal esophageal atresia

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Posterolateral diaphragmatic hernia

Bochdalek

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Anteromedial diaphragmatic hernia

Morgagni

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Pathophysiology: Omphalocoele

Failure of bowel to return during physiologic herniation (6th to 10th week AOG)

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Pathophysiology: Gastroschisis

Abnormal closure of the abdominal wall, usually to the right of the umbilicus

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True diverticulum, antimesenteric
Failed involution of vitelline/omphalomesenteric duct

Rule of 2's:
2% of population
2ft from ileocecal valve
2x in males
Symptomatic by 2 years of ages

Meckel’s Diverticulum

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Teratogens associated with pyloric stenosis

Erythromycin, Azithromycin

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Types of Esophageal Diverticula

Zenker (Pharyngoesophageal)
(Above the UES)

Epiphrenic
(Above the LES)

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Iron deficiency Anemia
Glossitis
Cheilosis
Esophageal Webs

Plummer-Vinson Syndrome

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Circumferential narrowng of the esophagus brought about by thickening of mucosa and muscle

Schatzki Ring

Type A:
Above Gastroesophageal Junction

Type B:
Squamocolumnar Junction of lower esophagus

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Triad of Achalasia

Incomplete LES Relaxation
Increased LES Tone
Esophageal Peistalsis

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Longitudinal tears near GEJ from retching

Mallory-Weiss

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Vascular anastomosis involved in esophageal varices

Esophageal branch of Left Gastric Vein

And

Azygos Vein

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Intestinal metaplasia of the squamous esophageal epithelium

Complication of chronic GERD

Barrett Esophagus

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Common site of SCCA in the esophagus

Middle third

versus AdenoCA: Distal Third

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Proximal duodenal ulcers associated with severe burns and trauma

Curling Ulcers

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Esophageal, gastric, or duodenal ulcers in patients with elevated ICP (direct vagal stimulation and increased acid secretion)

Cushing Ulcers

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Most common cause of diffuse, acute chronic gastritis

Autoimmune gastritis

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H. Pylori virulence factors

Lophotrichus flagella
Adhesins
Urease
CagA Toxin

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Type 4 HSR causing destruction of gastric parietal cells directed against the H/K ATPase Pump

Spares the Antrum

Autoimmune Gastritis

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Histologic change associated with autoimmune gastritis

Endocrine Cell Hyperplasia

versus Intestinal Metaplasia in H. pylori

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Most common complication of PUD

Bleeding

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Most common form of PUD

Antral/Duodenal

H. pylori associated

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``` Mucosal atrophy Corpus-predominant Decreased gastric acid secretion Pain with meals No nocturnal awakening ```

Gastric Ulcer

Triad of Zollinger-Ellison Syndrome

1. Pancreatic Cell Tumor 2. Gastric Hypersecretion 3. Peptic Ulcer Disease

Hypertrophic gastropathy with resulting hypoproteinemia due to protein-losing enteropathy

Menetrier Disease

Type of gastric polyp Lined with flattened chief/parietal cells Absent a nflammation No dysplasia

Fundic gland polyp

Most common type of gastric polyp

Inflammatory/Hyperplastic (85%)

Most common malignancy of the stomach

Adenocarcinoma

Most common site of extranodal lymphomas

Stomach

Most common abdominal mesenchymal tumor

Gastrointestinal stromal tumor

Most common site of gastric adenocarcinoma

Antral, Lesser Curvature

Gastric adenocarcinoma Abnormality in WNT signalling Exophytic, ulcerative lesions

Intestinal Type

``` Gastric adenocarcnoma Loss of E-Cadherin Infiltrative lesions with desmoplasia Leather bottle appearance (lintis plastica) Poorly cohesive cells ```

Diffuse Infiltrative

Most common inducer of MALT lymphoma

H. pylori Infection

Most important prognosticating factor for GI Carcinoids

Location *Midgut tumors often multiple and aggressive

Most common site of GI Carcinoids

Small Intestine (40%)

``` Arise from Cajal Cells cKIT Mutation (75-80%) ```

Gastrointestinal Stromal Tumor

Most common cause of intestinal obstruction

Hernias *in less than 2 years: intussusception

Most common sites of ischemic bowel disease

Splenic Flexure Sigmoid Rectum

Hallmark of malabsorptive syndromes

Steatorrhea

Cell-mdiated immune reponse to gliadins CD8+ T-Cells in villi Diagnostic: Transglutaminase antibodies Increased risk of Enteropathy-associated T-Cell Lymphoma

Celiac Disease

Most common bacterial enteric pathogen

Campylobacter jejuni

Associated with Whipple Disease | Ssx of GITB, but AFB (-)

Trophyrema whippeli

Common cause of severe childhood diarrhea; associated with diarrheal mortalities worldwide

Rotavirus

Causes almost half of gastroenteritis outbreaks worldwide

Norwalk Virus

Inflammatory bowel disease Transmural involvement Any part of the GIT Hallmark: Non-caseating granuloma

Crohn's Disease

Inflammatory bowel disease Mural Involvement Involves colon and rectum

Ulcerative Colitis

Most common site of diverticular disease

Sigmoid

Absent in False Diverticula

Muscularis propria

Single most important factor that relates to malignancy risk in GIT adenomas

Size | > 4cm

Elephant-feet Glands

Sessile serrated adnoma | high malignant potential

Multiple hamartomatous polyps, mucocutaneous hyperpigmentation along GIT Arborizing networks of smooth muscle Autosomal Dominant

Peutz-Jegher Polyps

Multiple (at least 100) colorectal adenomas during teenage years APC Mutation Pathgenesis: Hyperactive WNT signalling

Familial Adenomatous Polyposis

``` Familial clustering of the following tumors: Colorectal Endometrial Ovarian GIT, HBT Neurologic Skin ``` Pathogenesis: Defective DNA Repair

Hereditary nonpolyposis colon cancer

Diagnostic criteria used for HNPCC

Amsterdam Criteria

Drug considered protective against GIT adenocarcinoma

NSAID | decreased PGE2

Most common site of metastases for GIT malignancies

Liver

Gross description of colon cancers

Proximal: Exophytic, Bulky Distal: Annular

Vascular plexuses involved in hemorrhoid formation

Internal: Superior Hemorrhoidal Plexus External: Inferior Hemorrhoidal Plexus

Most common cause of appendiceal obstruction

Children: Lymphoid Hyperplasia Adults: Fecalith

Mucinous ascites due to peritoneal seeding of mucinous tumors

Pseudomyxoma Peritonei

Most common appendiceal tumor

Carcinoid

Pathophysiology: Ormond Disease

IgG mediated retroperitoneal sclerosis

Functions of hepatic stellate cells

Vitamin A Storage | Scar formation in hepatic injury

Etiology of rapid hepatic necrosis in ALF without evidence of repair

Drug-induced

Pathophysiology: Hepatorenal Syndrome

Decreased GFR due to afferent arteriole vasoconstriction (c/o RAAS) from renal hypoperfusion Initiating Event: Systemic Vasodilation

Most common cause of portal hypertension

Cirrhosis

Pathologic derangements of portal hypertension

Sinusoidal remodelling and intrahepatic shunting Hyperdynamic pulmonary circulation

Councilman Bodies

Eosinophilic inclusions in viral hepatitis

Autoimmune hepaitis Middle aged and older ANA, Anti-SMA autoantibodies Better prognosis

Type 1

Autoimmune hepatitis Children and teenagers Anti-LKM-1 autoantibody Less favorable prognosis

Type 2

Drugs that trigger an immune response via binding of large molecules

Hapten

Alcohol consumption associated with ALD

80g/day

Morphologic patterns of ALD

Hepatocellular steatosis (Lipid droplets; reversible) Alcoholic steatohepatitis (Swelling and necrosis) Steatofibrosis (Chicken-wire Fibrosis)

Mallory-Denk Bodies

Amorphous, eosinophilic material seen in ALD

Most common metabolic liver disease

Non-alcoholic fatty liver disease

Triad of Hemochromatosis

1. Micronodular cirrhosis (mediated by activation of stellate cells by iron) 2. DM (pancreatic fibrosis) 3. Skin pigmentation (Slate gray skin)

Impaired copper excretion in bile ATP7B mutation Putaminal atrophy (movement disorders) Kayser-Fleisher Ring (corneal limbus)

Wilson Disease

``` Autosomal ecessive PiZZ genotype Panlobular emphysema (elevated elastase) Liver damage (misfolded CHON accumulation) ```

Alpha-1-antitrypsin Deficiency

Conditions associated with impaired uridine diphosphate glucoronyltransferase

Criggler-Najar Type 1 (AR, absent activity) Criggler-Najar Type 2 (AD, decreased activity) Gilbert (AR, decreased activity)

Conjugated hyperbilirubinemia MRP2 Mutation Impaired biliary excretion

Dublin-Johnson Syndrome

``` Conjugated hyperbilirubinemia Mechanism unknown #PinoyPride ```

Rotor Syndrome

Most common cause of bilde duct obstructions

Adults: Gallstones Children: Biliary Atresia

Charcot Triad

1. Fever 2. Jaundice 3. RUQ Pain

Complete or partial obstruction of the extrahepatic BT within first 3 months of life Single most common cause of hepatic mortality in early childhood

Extrahepatic biliary atresia

Types of Biliary Atresia

Fetal (Malformation) Perinatal (Postnatal destruction)

``` Median age 50 Female Associated with Sjogren Syndrome (70%) AMA positive (95%) Loss of small ducts ``` Florid duct lesion Mallory-Denk Bodies

Primary Biliary Cirrhosis

``` Median Age 30 Male Associated with IBD (70%) ANCA positive(65%) Involvement of all sizes of hepatic ducts ```

Primary Sclerosing Cholangitis

Triad of Choledochal Cysts

1. Pain 2. Jaundice 3. Abdominal Mass

Congenital cystic dilatation of intrahepatic bile ducts Associated with choledochal cysts

Caroli disease

Congenital bile duct hamartomas Associated with polycystic kidney disease

Von Meyenbrg Complex

Infarct of Zahn

Intrahepatic thrombosis

Sinusoidal dilatation due to impediment in hepatic blood outflow

Peliosis hepatis

Thrombotic obstruction of more than 2 hepatic veins Hemorrhagic centrilobular necrosis

Budd-Chiari Syndrome

Sinusoidal remodelling secondary to toxic endothelial injury

Sinusoidal Obstruction Syndrome

Components of Nutmeg Liver

Centrilobular Congestion (RSHF) Centrilobular Ischemic Coagulative Necrosis (LSHF)

Centrilobular fibrosis in long-standing congestion

Cardiac sclerosis

Most common benign hepatic tumor

Cavernous Hemangioma

Most common liver tumor in early childhood

Hepatoblastoma

Most common tumor of the liver

Metastasis

Most common primary malignant tumor pf the liver

Hepatocellular Carcinoma

Second most common primary malignancy of the liver

Cholangiocarcinoma

Tumor marker for HCC

Alpha-fetoprotein

Pattern and site of metastasis for HCC

Hematogenous to the Lungs

HCC Variant Oncocytes in clusters Parallel lamellae of dense connective fiber

Fibrolamellar HCC

Common location of Cholangiocarcinoma

Perihilar (Klatskin Tumor)

Most common congenital anomaly of the gallbladder

Folded fundus | Phrygian Cap

Most common biliary tract disease

Cholelithiasis

Types of acute cholecystitis

Acute calculous (90%) Acute acalculous (ischemic)

Rochitansky-Aschoff Sinuses

Mucosal outpouching of the gallbladder

Extensive, dystrophic calcification of the gallbladder

Porcelain Gallbladder

Atrophic, dilated GB with clear secretions

Hydrops

Failure of fusion of fetal pancreatic duct systems Most common congenital anomaly of the pancreas

Pancreatic divisum

Most common site of ectopic pancreatic tissue

Stomach, Duodenum

Mutation involved in pancreatic agenesis

PDX1

Most frequntly mutated oncogene in pancreatic cancer

KRAS

Most common location of pancreatic cancer

Head

Tumor marker for pancreatic cancer

CA 19-9

Common site of metastasis for pancreatic cancer

Liver, Lungs

Acute Kidney Injury

1. Increase in SCr by 0.3 in 48 hrs 2. Increase in SCr by 1.5x baseline within 7 days 3. Urine < 0.5mL/kg/hr for 6 hrs

Nephritic Syndrome Type 3 HSR EM: Subepithelial bumps IF: IgG, C3 positve Most common cause of nephritic syndrome in children

PSGN

Histologic hallmark of RPGN

Crescent formation

Electron Microscopy and Immunofluorescence in RPGN

Type I EM: Ruptured GBM IF: Linear deposits Type II EM: Lumpy-Bumpy deposits IF: Granular deposits Type III EM, IF: No deposits

Males in their 20's Smokers Hemoptysis and Renal Failure Antibodies against Collagen type 4

Goodpasture Syndrome

Nephrotic Syndrome EM: Effaced foot processes Responsive to steroids Most common cause in children

Minimal Change Disease

Nephrotic Syndrome EM:"Spike and Dome" subepithelial deposits IF: Granular deposits Second most common cause in adults

Membranous Nephropathy

``` Nephrotic Syndrome Associated with HIV, Heroin LM: Mesangial proliferation, hyalinosis EM: Effacement of foot processes IF: Non-specific trapping in hyalinosis ``` Most common cause in adults

Focal Segmental Glomerulonephritis

Difference between MPGN Type 1 and 2

Type 1 Classical and alternative complement activation WITH Immune Complex Deposition Type 2 Also known as Dense Deposit Disease Alternative complement activation WITHOUT Immune Complex Deposition

Nephrotic Syndrome IgA deposition localized to kidneys (mesangial) Gross hematuria post-infection (GI, Pulmo) IF: Mesangial deposit of IgA Most common GN worldwide

IgA Nephropathy | Berger Disease

Nephrotic Syndrome Systemic IgA Deposition Purpuric skin lesions, GI Bleed, Arthralgias IF: Mesangial deposit of IgA

Henoch-Schonlein Purpura

Defective assembly of Type 4 Collagen Isolated Hematuria EM: Diffuse thinning of GBM

Thin Basement Membrane Lesion

``` Defective assembly of Type IV collagen Posterior Lens dislocation Hearling Loss Hematuria EM: Basket-Weave Appearance ```

Alport Syndrome

Top causes of AKI

1. Pyelonephritis | 2. Drug-induced TIN

Pathophysiology: Adult Polycystic Kidney Disease

PKD1 (85%, more severe) and PKD2 (15%) Mutations

Pathophysiology: Childhood Polycystic Kidney Disease

PKHD1 Mutation

Most commn stones in urolithiasis

Calcium Oxalate, Calcium Phosphate (70%)

Types of Renal Stones

Calcium Oxalate (Acidic, Opaque) Struvite (Basic, Opaque) Uric Acid (Acidic, Lucent) Cystine (Acidic, Opaque)

Renal tumor associated with Tuberous Sclerosis

Angiomyolipoma

Benign renal tumor arising from the intercalated cells of the collecting duct

Oncocytoma

Benign renal tumor arising fr, tubular epithelial cells in a palm frond configuration

Renal Papillary Adenoma

Most common renal malignancy

Renal Cell Carcinoma

Second most common renal malignancy

Wilms Tumor

Third most common renal malignancy

Urothelial carcinoma of the pelvocalyceal system

Common in: Males 60's-70's Smoker Most common renal malignancy

Renal Cell Carcinoma

Sites of predisposition: Renal Cell Carcinoma

Renal Cell: Proximal Tubule Papillary: Distal Tubule Chromophobe: Intercalated cells of the Collecting Ducts

Triad of Renal Cell Carcinoma

1. Hematuria 2. Flank Pain 3. Palpable Mass

Renal malignancy associated with Lynch Syndrome and Analgesic Nephropathy

Urothelial Carcinoma of the Renal Pelvis

Metastatic spread by Renal Cell Carcinoma

Hematologic to the Lungs, Bones

Most common cause of hydronephrosis in children

Ureteropelvic Junction Obstruction

Most common primary malignancy in the Ureters

Urothelial Carcinoma

Most common and serious congenital anomaly of the ureters

Vesicoureteral Refux

Consequences of a patent Urachus

Fistula between umbilicus and urinary bladder (total patency) Urachal Cyst (partial patency)

Most common bacterial pathogens of acute cystitis

Escherichia coli Klebsiella Proteus Enterobacter

Viral cause of hemorrhagic cystitis

Adenovirus

Cytotoxic drug associated with hemorrhagic cystitis

Cyclophosphamide

Triad of Acute Cystitis

1. Frequency 2. Lower abdominal pain' 3. Dysuria

Common in women Intermittent, severe suprapubic pain Frequency, urgency, hematuria, dysuria Cystoscopy: Punctate hemorrhages, fissures, Hunner Ulcers May mimic carcinoma-in-situ

Chronic Pelvic Pain Syndrome | Interstitial Cystitis

Hunner Ulcers

Chronic mucosal ulcers found in patients with Interstitial Cystitis

Seen in cases of chronic E. coli and Proteus infections Defect of phagocyte function Michaelis-Guttman Bodies

Malakoplakia

Michaelis-Guttman Bodies

Macrophages with abundant lysosomal calcium deposits Seen in Malakoplakia

Form of cystitis that mimics Urothelial carcinoma both clinically and histologically Arises from irritation secondary to catheterization

Polypoid Cystitis

Brunn nests (urothelial cells) grow downward into lamina propria; presents as glandular metaplasia or cyst formation

Cystitis Cystica et Glandularis

Implantation of renal tubular cells at sites of injured urothelium

Nephrogenic Adenoma

``` Males Smokers 5th to 8th decade of life Mediated by 9p and 9q deletions/monosomy Presents as painless hematuria, frequency, urgency ``` Most common histologic type: Urothelial

Bladder Cancer

Infectious cause of SCCA in the bladder

Schistosoma haematobium

Denuding Cystitis

Few malignant cells on a largely denuded basement membrane with inflamed stroma. Seen in carcinoma-in-situ of the urinary bladder

Intravesically administered vaccine used as treatment for non-invasive urothelial carcinomas Attenuated strain of Mycobacterium bovis

Bacille-Calmette-Guerin

Most important prognostic factor in invasive urothelial carcinoma of the bladder

Staging

Most common benign tumor of the bladder

Leiomyoma

Most common sarcoma in children

``` Embryonal Rhabdomyosarcoma (Sarcoma Botryoides) ```

Most common sarcoma in adults

Leiomyosarcoma

Most common cause of urinary bladder obstruction in males

Nodular prostatic hyperplasia

Most common cause of urinary bladder obstruction in females

Cystocoele of the bladder

Non-infectious cause of urethritis

Reiter Syndrome

Inflamed granulation tissue in the urethra, covered by a friable mucosa

Urethral Caruncle

Distribution of Urethral Malignancies

Proximal: Urothelial Carcinoma Distal: Squamous Cell Carcinoma

Pathophysiology: | Hypospadias, Epispadias

Malformation of the urethral groove

Most common cause of phimosis

Scarring from infection

Infection of the glans and the prepuce

Balanoposthitis

Pathogen responsible for Condyloma Acuminatum

HPV 6, HPV 11

HPV 16 Infection Solitary gray-white, opaque plaque Progresses to SCCA in 10% of cases

Bowen Disease

HPV 16 infection | Solitary, shiny, red, velvety plaque

Erythroplasia of Queyrat

HPV 16 Infection Multiple reddish-brown papules Does not progress to SCCA

Bowenoid Papulosis

Locally invasive, but rarely metastatic verrucous tumor of the penis

Buschke-Lowenstein Tumor | Giant Condyloma Acuminatum

Most important prognostic factor in penile malignancy

Staging

Most common site of cryptorchidism

Inguinal Canal

Most common phase of arrest in Cryptorchidism

Inguinoscrotal | 4th to 7th month AOG

Anatomic predisposition of the various patholog processes in male gonads

Epididymis: Inflammation, Gonorrhea (initially), EPTB (initially) Testes: Tumors, Syphilis (initially)

Pathogenesis of orchitis and epidydimitis

Ascending or lymphatic spread of UTI

Testicular mass with or without fever | Non-caseating granulomas in spermatic tubules

Granulomatous / Autoimmune Orchitis

Acute interstitial orchitis following a previous PAROTITIS Unilateral testicular involvement Not associated with infertility

Mumps Orchitis

Urologic emergency Hemorrhagic infarction from twisting of the spermatic cord Golden period: 6 hours

Testicular Torsion

Adult-type testicular torsion results from this bilateral anatomic defect in adolescents

Bell-clapper Deformity | increased mobility of testes

Most common cause of painless testicular enlargement

Testicular neoplasia

Histologic types of Testicular Tumors

Germ Cell (95%, aggressive) Sex cord-stromal (5%, less aggressive)

Prescursor lesion of most Testicular Germ Cell Tumors

Intratubular germ cell neoplasia

Most common route of lymphatic spread by Germ Cell Tumors

Retroperitoneal para-aortic lymph nodes

Most common route of hematogenous spread by Germ Cell Tumors

Lungs Liver Brain Bones

``` Clinical division of GCT Diagnosed at Stage I (70%) Lymphatic Spread Radiosensitive Cells resemble primordial germ cells ```

Seminomatous

``` Clinical division of GCT Diagnosed at Stage II or III (60%) Hematogenous spread Radioresistant Undifferentiated Cells ```

Non-seminomatous

Staging of GCT

Stage I Confined to testes, epididymis, or spermatic cord Stage II Spread to subdiaphragmatic LN Stage III Spread to retroperitoneal LN or those above diaphragm

``` Seminomatous GCT Occurs after puberty Precursor lesion: ITGCN Ovarian equivalent: Dysgerminoma Gray-white, lobulated mass ``` Most common GCT

Seminoma

``` Seminomatous GCT Occurs at 6th decade of life and beyond No precursor lesion No ovarian equivalent Well-circumscribed, pale-gray, multinodular mass ```

Spermatocytic Seminoma

Types of Seminoma

Typical/Classic (Large polyhedral cells, clear cytoplasm, central nucleus) Anaplastic (Same as typical, with atypia)

``` 20's to 30's Precursor lesion: ITCGN Common component of Mixed GCT's (80%) More aggressive than Seminomas Small, poorly demarcated masses with foci of hemorrhage ```

Embryonal Carcinoma

<3 years old No precursor lesions Excellent prognosis Non-encapsulated, solid, homegnous, yellow-white mass Schiller-Duval Bodies, Hyaline-like Globules (+) AFP is highly characteristic Most common testicular tumor in children less than 3 years

Yolk Sac Tumor | Infantile Embryonal Carcinoma, Endodermal Sinus Tumor

Highly malignant Hematogenous Spread with Brain metastases Clinically, normal sized testes and/or small nodule Tumor Marker: HCG Histology: Cytotrophoblasts and Syncytiotrophoblasts

Choriocarcinoma

Complex tumor with various components derived from more than 1 germ cell layer Second most common testicular tumor in infants and children

Teratoma

Best prognostic factor for Teratomas

Age | Post-puberty: All considered malignant

Differentiates Immature from Mature Teratomas

Degree of Differentiation | Less in Immature

Malignant transformation of a Teratoma

Non-germ cell malignancy arising from within a teratoma Usually chemoresistant Retains i(12p) Mutation from Teratoma precursors

Schiller-Duval Bodies

Central blood vessels enveloped by tumor cells within a space lined by tumor cells Seen in Yolk Sac Tumors

Second most common GCT in adults (60%)

Mixed GCT

``` Sex Cord-Stromal Tumor 2nd to 6th decade of life Gynecomastia, Precocious Puberty Benign Well-differentiated polygonal cells with abundant granular cytoplasm; with Crystalloids of Reinke (rod-shaped) ```

Leydig Cell Tumor

``` Sex Cord-Stromal Tumor First 4 decades of life Hormonally silent Most are benign Trabeculae and cords recemble seminiferous tubules ```

Sertoli Cell Tumor

Most common form of testicular neoplasm in males greater than 60 years of age

Testicular Lymphoma

``` Fever, chills, and dysuria Tender, boggy prostate on DRE Caused by E. coli, Enterococci, Staphylococci Chronic: History of recurrent UTI Prostatic secretions: >15 WBC/hpf ```

Bacterial Prostatitis

Painful ejaculation Caused by Chlamydia, Trichomonas, Ureaplasma, and Mycoplasma Prostatic secretions: >10 WBC/hpf (-) Bacterial Cultures

Abacterial Prostatitis

Most common site of prostatic intraepithelial neoplasia (PIN), and prostatic malignancy

Peripheral Zone

Most common site of nodular prostatic hyperplasia (NPH)

Transitional Zone

Prostatic neoplasia Mediated by Dihydroxytestosterone (DHT) Fibromuscular and glandular hyperplasia leading to nodule formation NOT a premalignant lesion

Nodular Prostatic Hyperplasia

``` > 50 years High fat diet, Obesity, Alcoholism Adenocarcionoma without basal layer Presents as dysuria (most common) Direct local extension to seminal vesicles and bladder Hematogenous spread to Lumbar Spine ``` Diagnostics: PSA (Non-specific)

Prostatic Adenocarcinoma

PTEN Mutation in Prostatic CA

Gives resistance to anti-androgen therapy

ERG-ETV1-TMPRSS2 Mutation in Prostatic CA

Associated with invasiveness; very common mutation

Diagnostic used in the context of elevated PSA given a normal prostate biopsy

PCA3

Prostate CA scoring system based on the two most dominant glandular patterns on histology

Gleason Scoring System

Best prognostic factor for Prostate CA

Stage and Grade

Most common cause of renal artery stenosis

Atherosclerosis