Penile pathology Flashcards
1
Q
Abnormal urethral opening on the ventral side of the penis
A
Hypospadia
*more common
2
Q
Abnormal urethral opening on the dorsal side of the penis
A
Epispadia
3
Q
Abnormal retraction of prepuce caused by an abnormally small orifice
A
Phimosis
4
Q
Anomalous development
A
Phimosis
5
Q
Repeated attacks of infection that cause scarring of the preputial ring
A
Phimosis
6
Q
Refers to infection of the glans and prepuce caused by a wide variety of organisms
A
Balanoposthitis
7
Q
Poor local hygiene in uncircumcised males
A
Balanoposthitis
8
Q
Accumulation of desquamated epithelial cells, sweat, and debris in balanoposthitis is termed _______ causes local irritation.
A
smegma
9
Q
Condyloma acuminatum is a benign sexually transmitted wart caused by human papillomavirus (HPV) agents like?
A
HPV Type 6
HPV Type 11
10
Q
Single or multiple sessile or pedunculated, red papillary excrescences that may be up to several millimetres in diameter
A
Condyloma Acuminatum
11
Q
Branching, villous, papillary connective tissue stroma covered by squamous epithelium
A
Condyloma Acuminatum
12
Q
Microscopic features of condyloma acuminatum:
A
- Preservation of the normal orderly maturation of the epithelial cells (dysplasia is not evident)
- Hyperkeratosis (thickening of stratum corneum)
- Acanthosis (diffuse epidermal hyperplasia)
- Koilocytosis (cytoplasmic vacuolization of the squamous cells)
13
Q
Cytoplasmic vacuolization of the squamous cells
A
Koilocytes
14
Q
Fibrous bands involving the corpus cavernosum of the penis
A
Peyronie disease
15
Q
The cause of this disease is thought to be due to microvascular trauma and abnormal wound healing
A
Peyronie disease
16
Q
Clinical manifestation of Peyronie disease:
A
- Penile curvature
2. Pain during intercourse
17
Q
Strong association with infection by high-risk HPV type 16
A
Carcinoma in situ (CIS)
18
Q
Two distinct lesions display histologic features of CIS:
A
- Bowen disease
2. Bowenoid papulosis
19
Q
Older than age 35 years
A
Bowen disease
20
Q
Younger Age Group
A
Bowenoid papulosis
21
Q
Solitary plaque
A
Bowen disease
22
Q
Multiple plaque
A
Bowenoid papulosis
23
Q
Transforms into infiltrating squamous cell carcinoma in approximately 10%
A
Bowen disease
24
Q
Never develops into an invasive carcinoma
A
Bowenoid papulosis
25
Regresses spontaneously
Bowenoid papulosis
26
Associated with poor genital hygiene and with high-risk HPV infection
Squamous cell carcinoma
27
More common in populations in which circumcision is not practiced routinely
Squamous cell carcinoma
28
In squamous cell carcinoma, HPV Type _____ is the most frequent culprit, but HPV ____ is also implicated.
16, 18
29
Cauliflower-like fungating mass
Papillary lesions (Squamous cell carcinoma)
30
Epithelial thickening accompanied by graying and fissuring of the mucosal surface.
Flat lesions (Squamous cell carcinoma)
31
An exophytic well-differentiated variant of squamous cell carcinoma that are locally invasive, but rarely metastasize.
Verrucous carcinoma
32
Atypical squamous cells invading the stroma
Squamous cell carcinoma
33
Atypical cells with large pleomorphic nuclei and eosinophilic cytoplasm
Squamous cell carcinoma
34
Complete or partial failure of the intra-abdominal testes to descend into the scrotal sac and is associated with testicular dysfunction and an increased risk of testicular cancer
Cryptorchidism
35
It is found in approximately 1% of 1-year-old boys.
Cryptorchidism
36
Unilateral in most cases, being bilateral in 25% of patients.
Cryptorchidism
37
The most common site of arrest in descent
Inguinal canal
38
Testis comes to lie within the lower abdomen or brim of the pelvis.
Transabdominal phase
39
müllerian-inhibiting substance
Transabdominal phase
40
The testes descend through the inguinal canal into the scrotal sac
Inguinoscrotal phase
41
androgen-dependent
Inguinoscrotal phase
42
Mediated by androgen-induced release of calcitonin gene related peptide from the genitofemoral nerve
Inguinoscrotal phase
43
Marked hyalinization and thickening of the basement membrane of the spermatic tubules
Cryptorchidism
44
Arrest in germ cell development
Cryptorchidism
45
Inguinal cryptorchid testes descend spontaneously into the scrotum.
First year of life
46
Histologic deterioration sets in
2 years of age
47
Commonly related to infections in the urinary tract (cystitis, urethritis
and prostatitis)
Nonspecific Epididymitis and Orchitis
48
Congenital genitourinary abnormality and infection with gram-negative rods
Epididymitis in children
49
Sexually active men younger than 35 years:
C. trachomatis
Neisseria gonorrhoeae
50
Men older than 35 years:
E. coli
| Pseudomonas
51
Neutrophils, macrophages and lymphocytes infiltrating the connective tissue stroma. This will eventually involve the tubules and may progress to abscess formation or complete suppurative necrosis of entire epididymis
Nonspecific Epididymitis and Orchitis
52
Presents in middle age as a moderately tender testicular mass of sudden onset sometimes associated with fever.
Granulomatous (Autoimmune) Orchitis
53
Histologically the orchitis is distinguished by __________________.
granulomas restricted to spermatic tubules
54
The lesions closely resemble tubercles but differ in that the ___________ is present diffusely throughout the testis and is confined to the seminiferous tubules.
granulomatous reaction
55
If untreated, it frequently leads to testicular infarction and thus represents one of the few true urologic emergencies.
Torsion of the spermatic cord
56
Manual untwisting; testis remain viable
Within 6 hours
57
Occurs either in utero or shortly after birth. It lacks any associated anatomic defect to account for its occurrence.
Neonatal torsion
58
Typically seen in adolescence and presents with the sudden onset of testicular pain.
Adult torsion
59
Bilateral anatomic defect that leads to increased mobility of the testis.
Bell clapper abnormality
60
Morphologic changes range from intense congestion to widespread hemorrhage to testicular infarction.
Testicular torsion
61
In testicular torsion advanced stages, the testis is markedly enlarged and consists entirely of _____, ______, ___________.
Soft, necrotic, hemorrhagic tissue
62
Malignant paratesticular tumors in CHILDREN
Rhabdomyosarcoma
63
Malignant paratesticular tumors in ADULT
Liposarcoma
64
Common lesions involving the proximal spermatic cord
Lipomas
65
These lesions probably represent retroperitoneal adipose tissue that has been pulled into the inguinal canal along with the hernia sac, rather than a true neoplasm
Lipomas
66
The most common benign paratesticular tumor.
Adenomatoid tumor
67
Small nodules, typically occurring near the upper/lower pole of the epididymis.
Adenomatoid tumor
68
Adenomatoid tumor is ____________ based on immunohistochemical features and ultrastructural studies.
mesothelial origin
69
Closely packed small tubules and cords of cells
Adenomatoid tumor
70
In the 15- to 34-year age group, ________ constitute the most common tumor of men and cause approximately 10% of all cancer deaths.
testicular germ cell tumors
71
The relative risk is ____ times higher than normal in father and sons of affected patients and ____ times higher in brothers.
4
| 8-10
72
Genetic alteration in germ cell tumors:
Kit and Bak (inducer of apoptic cell death)
73
Characterized by cryptorchidism, hypospadias and poor sperm quality.
Testicular dysgenesis syndrome (TDS)
74
These conditions are increased by in utero exposures to pesticides and nonsteroidal estrogens
Testicular dysgenesis syndrome (TDS)
75
Are composed of cells that resemble primordial germ cells or early gonocytes.
Seminomatous tumors
76
May be composed of undifferentiated cells that resemble embryonic stem cells.
Nonseminomatous tumors
77
Most testicular germ cell tumors originate from a precursor lesion
called ________________.
Intratubular germ cell neoplasia (ITGCN)
78
Reduplication of the short arm of chromosome 12 (12p) in the form of an isochromosome I (12p)
Germ cell tumor
79
Germ cell tumor has activating mutations in the gene encoding the ___________.
KIT receptor tyrosine
| kinase
80
_________ are the most common type of germ cell tumor, making up about 50% of these tumors.
Seminomas
81
Peak incidence
Third decade
82
Identical tumor arises in the ovary.
Dysgerminoma
83
Seminomas contain Isochromosome 12p and express ______ and ______.
OCT3/4
NANOG
84
Approximately 25% of seminoma have ___________.
KIT activating mutations
85
KIT amplification and KIT overexpression through other unknown mechanisms have also been reported.
Seminoma
86
By immunohistochemistry, seminoma cells stain positively for ____, _____, and __________.
KIT
OCT4
placental alkaline phosphatase (PLAP)
87
Produce bulky masses, sometimes ten times the size of the normal testis.
Seminomas
88
The typical _______ has a homogeneous, graywhite, lobulated cut surface,usually devoid of hemorrhage or necrosis.
seminoma
89
Large cells with distinct cell borders, pale nuclei, prominent nucleoli, and a sparse lymphocytic infiltrate
Seminoma
90
Rare, slow-growing germ cell
Spermatocytic seminoma
91
The age of involvement in spermatocytic seminoma are generally older than age _______.
65 years
92
It is a slow-growing tumor that does not produce metastases and the prognosis is excellent.
Spermatocytic seminoma
93
Lack lymphocytes, granulomas, syncytiotrophoblasts, extra-testicular sites of origin, admixture with other germ cell tumors, and association with ITGCN
Spermatocytic seminoma
94
Soft, pale gray, cut surface that sometimes reveal mucoid cysts
Spermatocytic seminoma
95
Most numerous, containing a round nucleus and eosinophilic cytoplasm
Medium sized cells
96
Narrow rim of eosinophilic cytoplasm
Smaller cells
97
Occur mostly in the 20- to 30-year age group. These tumors are more aggressive than seminomas.
Embryonal carcinoma
98
Most primary tumors are smaller than seminoma and do not replace the entire testis.
Embryonal carcinoma
99
Extension through the tunica albuginea into the epididymis or
cord frequently occurs.
Embryonal carcinoma
100
Cut surfaces of the tumor is often variegated, poorly demarcated at
the margins, and punctuated by foci of hemorrhage or necrosis
Embryonal carcinoma
101
Sheets of undifferentiated cells as well as primitive glandular differentiation
Embryonal carcinoma
102
Large and anaplastic, and have hyperchromatic nuclei with prominent nucleoli. Indistinct cell borders. Variation in nuclear size and shape.
Embryonal carcinoma
103
Also known as endodermal sinus tumor
Yolk sac tumor
104
Most common testicular tumor in infants and children up to 3 years of age.
Yolk sac tumor
105
Very good prognosis in children.
Yolk sac tumor
106
In adults the pure form of this tumor is rare
Yolk sac tumor
107
Yolk sac elements frequently occur in combination with _________.
embryonal carcinoma
108
These tumors are nonencapsulated and have a homogeneous, yellow-white, mucinous appearance.
Yolk sac tumor
109
They are composed of a lacelike (reticular) network of medium-sized cuboidal or flattened cells.
Yolk sac tumor
110
Papillary structures and solid cords of cells
Yolk sac tumor
111
Mesodermal core with a central capillary and a visceral and parietal layer of cells resembling primitive glomeruli
Schiller-Duval Bodies
112
ALPHA FETO PROTEIN POSITIVE
Yolk sac tumor
113
Highly malignant form of testicular tumor
Choriocarcinoma
114
In its “pure” form, _________ is rare, constituting less than 1% of all germ cell tumors.
choriocarcinoma
115
Two cell types of choriocarcinoma:
1. Synctiotrophoblasts
| 2. Cytotrophoblasts
116
Regular and tend to be polygonal, with distinct borders and clear cytoplasm. Nuclei are fairly uniform.
Cytotrophoblasts
117
Are large multinucleated cells with abundant eosinophilic vacuolated cytoplasm
Synctiotrophoblasts
118
The designation _______ refers to testicular tumors having various cellular or organoid components reminiscent of the normal derivatives of more than one germ layer.
teratoma
119
Skin and CNS
Ectoderm
120
Mesenchymal tissues (Skeletal muscle, cartilage and bone)
Mesoderm
121
Lining epithelium of GIT
Nedoderm
122
Pure forms of ______ are fairly common in infants and children, second in frequency only to yolk sac tumors.
teratoma
123
In adults, ________ are rare, constituting 2% to 3% of germ cell tumors.
pure teratomas
124
Are usually large, ranging from 5 to 10 cm in diameter.
Teratoma
125
The gross appearance is heterogeneous with solid, sometimes cartilaginous, and cystic areas
Teratoma
126
Disorganized collection of glands, cartilage, smooth muscle, and immature stroma
Teratoma
127
Transformation may take the form of a squamous cell carcinoma, mucin-secreting adenocarcinoma, sarcoma, or other cancers.
“teratoma with malignant transformation”
128
These non–germ cell malignancies retain isochromosome 12p, proving a clonal relationship to the preceding teratoma.
“teratoma with malignant transformation”
129
About 60% of testicular tumors are composed of more than one of the “pure” patterns.
Mixed germ cell tumors
130
Painless enlargement of the testis
Testicular germ cell tumors
131
Solid testicular mass
Testicular germ cell tumors
132
Common mode of spread in testicular germ cell tumors. _________ are the first to be involved.
Lymphatic spread
Retroperitoneal para-aortic nodes
133
__________ is primarily to the lungs, liver, brain, and bones.
Hematogenous spread
134
Localized to the testis for a long time - 70% present in clinical stage I
Seminomas
135
Poor prognosis
Nonseminomatous
136
Metastases from seminomas typically involve lymph nodes. Hematogenous spread occurs later.
Seminomatous
137
60% of males with NSGCTs present with advanced clinical disease (stages II and III).
Nonseminomatous
138
NSGCTs not only metastasize earlier but also use the hematogenous route more frequently.
Nonseminomatous
139
More aggressive
Nonseminomatous
140
Less aggressive
Seminomatous
141
Good prognosis
Seminomatous
142
Tumor confined to the testis, epididymis, or spermatic cord
Stage 1
143
Distant spread confined to retroperitoneal nodes below the diaphragm
Stage 2
144
Metastases outside the retroperitoneal nodes or above the diaphragm
Stage 3
145
___________ correlates with the mass of tumor cells, and provides a tool to assess tumor burden
Lactate dehydrogenase
146
Yolk sac tumor
Alpha feto protein
147
Choriocarcinoma
Human chorionic gonadotropin
148
Seminoma
Placental alkaline phosphatase (Plap)
149
Clinical features of Leydig cell tumors:
1. Testicular swelling
2. Gynecomastia
3. In children - hormonal effects, sexual precocity
150
These neoplasms form circumscribed nodules, usually less than 5 cm in diameter.
Leydig cell tumors
151
They have a distinctive golden brown, homogeneous cut surface
Leydig cell tumors
152
The cytoplasm contains lipid vacuoles and rod-shaped crystalloids of Reinke.
Leydig cell tumors
153
Hormonally silent
Sertoli cell tumors
154
Most Sertoli cell tumors are benign, but approximately 10% pursue a malignant course.
True
155
Present as a testicular mass - firm, small nodules with a homogeneous gray-white to yellow cut surface.
Sertoli Cell Tumors
156
Tumor that arises nearly always in individuals with an underlying gonadal disorder, either pure or mixed gonadal dysgenesis, or male pseudohermaphroditism.
Gonadoblastoma
157
Aggressive non–Hodgkin lymphomas account for 5% of testicular
neoplasms, and are the most common form of testicular neoplasms
in men older than age 60 years.
Testicular Lymphoma
158
The most common testicular lymphomas, in decreasing order of
frequency are:
1. diffuse large B-cell lymphoma
2. Burkitt lymphoma
3. EBV-positive extranodal NK/T cell lymphoma.
159
Have a higher propensity for central nervous system involvement than do similar tumors arising at other sites
Testicular Lymphoma
160
Prostate weighs approximately ______.
20 gm
161
Hyperplasias arise in the _________ whereas most carcinomas originate in the _________.
transitional zone
| peripheral zone
162
Clinical manifestations: fever, chills, and dysuria. On rectal examination the prostate is exquisitely tender and boggy
Acute bacterial prostatitis
163
CLINICAL MANIFESTATION: low back pain, dysuria, and perineal and
suprapubic discomfort
Chronic bacterial prostatitis
164
Patients often have a history of recurrent urinary tract infections (cystitis, urethritis) caused by the same organism.
Chronic bacterial prostatitis
165
most common form of prostatitis
Chronic abacterial prostatitis
166
Expressed prostatic secretions contain more than 10 leukocytes per high-power field, but bacterial cultures are uniformly negative.
Chronic abacterial prostatitis
167
Relatively common and represents a reaction to secretions from ruptured prostatic ducts and acini
Non specific granulomatous prostatitis
168
The most common benign prostatic disease in men older than age 50 years.
Benign Prostatic Hyperplasia or Nodular Hyperplasia
169
It results from nodular hyperplasia of prostatic stromal and epithelial cells and often leads to urinary obstruction.
Benign Prostatic Hyperplasia or Nodular Hyperplasia
170
Large, fairly discrete nodules in the periurethral region of the prostate, which, when sufficiently large, compress and narrow the urethral canal to cause partial, or sometimes virtually complete, obstruction of the urethra.
Benign Prostatic Hyperplasia or Nodular Hyperplasia
171
Paracrine regulators of androgen-stimulated epithelial growth during embryonic prostatic development
FGF
172
Serves as a mitogen for fibroblasts and other mesenchymal cells
TGF B
173
Nodules that contain mostly glands are yellow-pink and soft, and exude a milky white prostatic fluid.
Benign Prostatic Hyperplasia or Nodular Hyperplasia
174
Nodules composed primarily of fibromuscular stroma are pale gray and tough
Benign Prostatic Hyperplasia or Nodular Hyperplasia
175
The most common acquired genetic lesions in prostatic carcinomas are __________ fusion genes and mutations or deletions that activate the PI3K/AKT signalling pathway.
TMPRSS2-ETS
176
Carcinomas of the prostate arise most commonly in the _________ and may be palpable by rectal examination.
outer, peripheral gland
177
The neoplastic tissue is gritty and firm, but when embedded within the prostatic substance it may be extremely difficult to visualize and be more readily apparent on palpation.
Adenocarcinoma
178
The outer basal cell layer typical of benign glands is absent.
Adenocarcinoma
179
PRESENCE OF OUTER BASAL CELL LAYER
BPH
180
Stratifies prostate cancer into five grades on the basis of glandular patterns of differentiation.
Gleason system
Most tumors contain more than one pattern; in such instances, a primary grade is assigned to the dominant pattern and a secondary grade to the second most frequent pattern. The two numeric grades are then added to obtain a combined Gleason grade or score.
181
most well differentiated tumors, in which the neoplastic glands are uniform and round in appearance and are packed into well-circumscribed nodules
Grade 1
182
no glandular differentiation, with tumor cells infiltrating the stroma in the
form of cords, sheets, and nests
Grade 5
183
Back-to-back uniform-sized malignant glands
Low grade
184
Variably sized, more widely dispersed glands
Moderately differentiated
185
Localized prostatic adenocarcinoma
Asymptomatic
186
urinary symptoms occur late
Arise peripherally
187
widely used to assist with the diagnosis and management of prostate cancer.
Prostatic specific antigen
188
is a product of prostatic epithelium and is normally secreted in the semen.
Prostatic specific antigen
189
It is an androgen-regulated serine protease whose function is to cleave and liquefy the seminal coagulum formed after ejaculation.
Prostatic specific antigen
190
is a noncoding RNA which is overexpressed in 95% of prostate cancers
PCA3
191
Elevated urine _____ scores have been shown to be associated with an increased risk of a positive repeat biopsy in this setting.
PCA3
