Renal Pathology Flashcards
1
Q
Nephrotic Syndrome Major Characteristics (4)
A
Proteinuria (>3.5 g/day)
Hypoalbuminemia (Plasma < 3 g/dL)
Generalized Edema
Compensatory Hyperlipidemia
2
Q
Nephritic Syndrome Major Characteristics (3)
A
Hematuria
HTN
Azotemia
3
Q
In Situ Immune Complex Formation
Mechanisms with Microscopy (2) and Examples (4)
A
Abs to intrinsic tissue antigens
Linear immunofluorescence
Goodpasture syndrome
Abs to extrinsic antigens planted in glomerulus Granular immunofluorescence Postinfectious Glomerulonephritis Membranous nephropathy Membranoproliferative Glomerulonephritis
4
Q
Circulating Complex Deposition
Examples (4)
A
Systemic Lupus Erythematosus
IgA Mediated Nephropathy
HBV/HCV Infections
Allergens
5
Q
Acute Proliferative Glomerulonephritis
Pathogenesis, Morphology (4), Causes (3)
A
Immune complex mediated damage most often from deposition of postinfectious antigens
Hypercellularity
Leukocyte Infiltration
IgG/IgM/C3 granular deposits
Subepithelial humps
M protein Streptococcus (kids)
Post-staphylococcus
Some viruses and parasites
6
Q
Acute Proliferative Glomerulonephritis Presentations
Kids (5) and Adults (4)
A
Age 6-10 Post strep pharyngitis/impetigo* Nephritic syndrome Dysmorphic RBCs Periorbital edema
Aggressive and atypical* Sudden HTN Edema Increased BUN Only 60% fully recover
7
Q
RPGN Type I
Etiology (2), HLA Association, Treatment
A
Anti-Basement Membrane Abs
Abs to Type IV collagen (Goodpasture)
HLA-DRB1
Plasmapharesis and immunosuppression
8
Q
Rapidly Progressive Glomerulonephritis
Morphology (4) and Presentation (3)
A
Basement membrane tears (wrinkling)
Crescentic lesions of proliferating epithelial cells
Collapsed glomerular tufts
Macrophage/Leukocyte infiltrates
Rapid progressive renal function loss
Severe oliguria
Nephritic syndrome
9
Q
RPGN Type II
Cause, Microscopy and Treatment
A
Immune complex deposition (SLE, IgA, APG)
Subendothelial Granular immunofluorescence
Treat the underlying condition
10
Q
RPGN Type III
Diagnosis and Examples (2)
A
Cirulating ANCA proteins
Granulomatosis with polyangiitis (PR3 ANCA) Microscopic Polyangiitis (MPO ANCA)
11
Q
Nephrotic Syndrome Causes
Primary (3) and Secondary (5)
A
Membranous Nephropathy
Minimal Change Disease
Focal Segmental Glomerulosclerosis
Diabetes Amyloidosis SLE Drugs (NSAIDS, Heroin) Malignancy
12
Q
Membranous Nephropathy
Pathogenesis (3), Morphology (2) and Presentation (3)
A
Diffuse thickening of glomerular capillary wall
From HLA-DQA1 mutation and PLA2 receptor Abs
Subepithelial IgG4 deposits
Spike formations
Nephrotic syndrome
Non-selective proteinuria
Hematuria
13
Q
Minimal Change Disease
Microscopy, Clinical Features (3), Treatment, Association
A
Foot Process Effacement
Only visible on Electron Microscopy
Most common Primary NS in children
Selective proteinuria
Edema
Very responsive to corticosteroids
Secondary to Non-Hodgkin Lymphoma (adults)
14
Q
Focal Segmental Glomerulosclerosis Causes
Primary (1) and Secondary (3)
A
Primary
Idiopathic: Most common cause of NS in US**
Secondary (glomerular injury)
HIV Associated: collapsing variant possible
Ablation Nephropathy: loss of renal tissue
Genetic Mutation: NPHS, TRPC6, alpha-Actinin
15
Q
Focal Segmental Glomerulosclerosis
Morphology (3), Clinical Features (6), Microscopy (2)
A
Foot Process Effacement (electron microscopy)
Sclerosis
Collapsing Glomerulopathy
Mixed Nephrotic/Nephritic: Hematuria Nonselective proteinuria Decreased GFR HTN Progresses to CKD
Focal IgM and C3 immunofluorescence
Focal Segmental Sclerosis (light microscopy)
16
Q
Type I Membranoproliferative Glomerulonephritis
Pathogenesis (3), Presentation (2) and Microscopy (3)
A
Immune complexes in glomerulus
Activation of classic and alternative complement paths
Mixed GD: hematuria and proteinuria
Mesangial proliferation (Light) Subendothelial deposits (Electron) IgG, C3, C1q, C4 granular immunofluorescence
17
Q
Type I MPGN Primary vs Secondary
Age, Prognosis, Associations (2)
A
Primary Presents younger Nephrotic/Nephritic HTN 50% progress to chronic
Secondary Presents in adults Associated with Chronic Antigenemia Seen in Hep C/SLE/Cancer patients 50% progress to chronic
18
Q
Type II Membranoproliferative Glomerulonephritis
Pathogenesis (2), Presentation (4) and Microscopy (4)
A
C3 Nephritic Factor binds C3 convertase
C3C activates alternative complement pathway
Hematuria
Nephritic Syndrome
Progression to CKD (poorer prognosis)
Primary disease in kids/young adults
Mesangial proliferation (LM) GBM splitting (LM) C3 and IgG deposits (IF) Dense deposits (EM)
19
Q
IgA Nephropathy Clinical Features (5), Microscopy (1)
A
Recurrent Hematuria after mucosal infections**
Most common cause of glomerulonephritis
More common in young adults, whites/asians, males
Familial component
Associated with gluten enteropathy
IgA in mesangium (IF)**
20
Q
Chronic Glomerulonephritis
Description (3), Causes (5), Pathologic Features (3)
A
End stage glomerular disease
From either Acute or Asymptomatic Glomerulonephritis
Resulting in Uremia
Crescentic GN** FSGS MPGN Membranous nephropathy IgA nephropathy
Thinned cortex
Collagenous replacement of Glomeruli
Arterial sclerosis
21
Q
Alport Syndrome Pathologic Features (4), Inheritance (2), Presentation (5)
A
Irregular thickening/thinning of GBM
Lamina densa lamination
Moth eaten or frayed lamina densa appearance
Mutations in Type IV collagen alpha-molecules
X-Linked: males most affected
Autosomal: males/females equally affected
Hematuria RBC casts Proteinuria Neural deafness Vision disturbances
22
Q
Thin Basement Membrane Disease
Clinical Feature, Inheritance (2), Pathologic Feature
A
Familial asymptomatic hematuria**
Most people heterozygous carriers
Homozygous see defective Type IV collagen
Diffuse thinning of GBM
23
Q
Secondary Nephrotic Syndrome Causes (4)
A
Diabetic Nephropathy
SLE (mixed)
Hepatitis C (MPGN Type I)
HIV Nephropathy (FSGS)
24
Q
Secondary Nephritic Syndrome Causes (4)
A
SLE (mixed)
Bacterial Endocarditis (Acute Proliferative)
Goodpasture Syndrome (RPGN)
Henoch-Shonlein Purpura (IgA Nephropathy)
25
Diabetic Mellitus
| Epidemiology (2) and Common Complications (4)
Leading cause of end stage renal failure in US (30%)**
Happens in 40% of diabetics
Nephropathy
Retinopathy
Cataracts
Neuropathy
26
Diabetic Nephropathy Morphologic Changes
| Glomerulus (4), Papilla (2), Vasculature
Thickened GBM
Diffuse mesangial sclerosis
Nodular glomerulosclerosis
Via hyperglycemia and hypertrophy
Necrotizing papillitis (via pyelonephritis)
Arteriolosclerosis
27
Lupus Nephritis
| Pathogenesis and Spectrum (I-VI)
Subendothelial immune complex deposits disrupt glomerulus
```
Minimal mesangial lupus nephritis (class I)
Focal lupus nephritis (class II)
Mesangial proliferative lupus nephritis (class III)
Diffuse lupus nephritis (class IV)
Membranous lupus nephritis (class V)
Advanced sclerosing lupus nephritis (class VI)
```
28
Henoch-Schönlein Purpura
| Description, Presentation (5), Morphology (2)
IgA nephropathy associated with systemic vaculitis
```
Purpuric skin lesions**
Abdominal pain
Intestinal bleeding
Arthralgias
Recurrent Hematuria**
```
```
IgA, IgG and C3 deposition in mesangium (IF)
Mesangial proliferation (LM)
```
29
Bacterial Endocarditis Glomerulonephritis
| Presentation (2) and Microscopy
Hematuria
Proteinuria
Glomerular immune complex deposits
30
Fibrillary Glomerulonephritis
| Presentation (3) and Morphology (2)
Nephrotic syndrome
Hematuria
Progressive renal insufficiency
Fibrillar deposits in mesangium and glomerular capillaries
31
Common Histology of Goodpasture, Granulomatosis with Polyangiitis and Microscopic Polyangiitis (2)
Crescent Lesions
| Foci of Glomerular Necrosis
32
Acute Tubular Injury
| Etiology (2), Pathology (4), Histology (2)
Ischemia
Endogenous/Exogenous Toxic Agents
Tubule cell injury leading to:
Tubuloglomerular feedback
Tubule obstruction (by casts)
Tubular back leak
Focal Tubular epithelial necrosis
Swollen epithelial cells with vacuolization
33
Acute Tubular Injury Clinical Phase Descriptions
| Initiation (1), Maintenance (2), Recovery (3)
Initiation: Oliguria
Maintenance: Uremia, Hyperkalemia*
Recovery: Polyuria, Hypokalemia*, Infection susceptibility
34
Tubulointerstitial Nephritis
Presentation (2), Etiologies (5)
and Features of Acute (3) vs Chronic (2)
Azotemia**
Inability to concentrate urine
Infections, Toxins, Metabolic Diseases, Obstruction, Neoplasms
Acute shows edema, eosinophils and neutrophils
Chronic shows fibrosis and tubular atrophy
35
```
Acute Pyelonephritis
Predisposing Factors (4), Etiologies (5), Morphology (4)
```
Vesicoureteral reflux**
Diabetes
Pregnancy
Males with BPH
Ascending Cystitis from gram negative bacteria
(E. coli, Klebsiella, Proteus, Enterobacter)
Patchy interstitial inflammation
Intratubular neutrophils
Tubulitis
Tubular necrosis
36
Pyelonephritis Complications (3)
Papillary necrosis
Pyonephrosis
Perinephric abscess
37
Chronic Pyelonephritis
| Definition (3), Etiologies (3) and Morphology (3)
Chronic tubulointerstitial inflammation leading to scarring of calyces and pelvis
**Analgesic nephropathy: Vesicoureteral reflux with superimposed UTI
Chronic Obstructive Pyelonephritis: BPH
Xanthogranulomatous: Proteus infections
Polar scarring
Dilated, blunted or deformed calyces
Flattened papillae
38
Papillary Necrosis Etiologies (3)
| Ratios, Time course, Infection and Calcification
Diabetes Mellitus
Mostly female, 10 years, Infectious, no calcification
Analgesic Nephropathy
Mostly female, 7 years, Non-Infectious, calcification
Obstruction
Mostly male, variable time, Infectious, Calcification
39
Myeloma Kidney
| Etiology (2), Morphology (3) and Clinical Features (2)
Bence-Jones proteinuria and cast nephropathy
Pink/Blue masses distending tubular lumens
Interstitial inflammation and fibrosis
Insidious chronic kidney disease
Proteinuria
40
Nephrolithiasis
| Epidemiology (2), Predisposing Factors (4), Minerals (4)
Usually unilateral
Most often in men aged 20-30**
Increased mineral concentration**
pH disturbances
Decreased urine volume
Bacteria
Mostly Calcium**
Also Magnesium, Uric acid, and cystine
41
Benign Nephrosclerosis
| Definition, Etiologies (3) and Morphology (3)
General process of hyaline sclerosis of renal arterioles and small arteries (not a diagnosis)
Increasing age
HTN
Diabetes mellitus
Cortical scarring and shrinking
Hyaline arteriolosclerosis
Patchy ischemic atrophy
42
Malignant Hypertension
| Pathogenesis (5) and Definition
Renal vascular damage causes endothelial injury
Vascular cell death causes focal hemorrhage
Platelets form thrombus, leads to ischemia
Fibrinoid necrosis causes hyperplastic arteriolitis
Decreased renal perfusion causes continuous RAAS
BP over 180/120
43
Malignant Nephrosclerosis
| Morphology (3) and Presentation (5)
"Flea bitten" petechial hemorrhage
Arteriolar fibrinoid necrosis
Interlobular hyperplastic arteriolitis
```
Early on increased intracranial pressure
Retinal hemorrhage
Papilledema
Encephalopathy (emergency)
Renal failure
```
44
Renal Artery Stenosis
| Etiologies (2), Complications (2) and Treatment
Renal A atheromatous occlusion
Fibromuscular dysplasia
HTN (similar to essential)
Shrunken kidney
Surgical stenting
45
Thrombotic Microangiopathies Descriptions
| Typical, Atypical (2) and TTP (2)
Typical Hemolytic-Uremic Syndrome:
Diarrhea from Shiga Toxin exposure
Atypical Hemolytic-Uremic Syndrome:
Inherited mutations in Complement Regulators*
Acquired endothelial injuries
Thrombotic Thrombocytopenic Purpura:
Inherited ADAMTS13 deficiency (von willebrand)
**Neurologic Symptoms**
46
```
Thrombotic Microangiopathies
Common Pathology (2) and Morphology (4)
```
Endothelial damage and activation
Excessive platelet activation and aggregation
Cortical necrosis
Thrombotic glomerular capillary occlusion
Mesangiolysis
Interlobular arteriolar fibrinoid necrosis
47
Atheroembolic Renal Disease
| Morphology (4) and Risk Factors (3)
Atrophy
Fibrosis
Hemorrhage
Necrosis
Atherosclerosis
AAA repair
Intra-aortic cannulization
48
Renal Infarcts
| Pathogenesis, Compounding Risks (2)
Embolism mostly from mural thrombi from left heart
End organ blood supply
Lack of collateral circulation
49
Diffuse Cortical Sclerosis
| Etiologies (2) Complications (2) and Morphology (2)
Obstetric surgery or Septic shock
Causes systemic hypoperfusion and hypoxia
Coagulative necrosis of renal glomeruli and tubules
50
Major Renal Congenital Anomalies (4)
Kidney Agenesis (rare)
Unilateral shows hypertrophy and hypertension
Bilateral is death
Kidney Hypoplasia
Usually unilateral, shows low birth weight
Ectopic Kidney
Kidneys in pelvis, increases bacterial UTIs
```
Horseshoe Kidney (common)
Usually fusion of lower poles, sits across midline vessels
```
51
Autosomal Dominant Polycystic Kidney Disease
| Mutations (2), Pathologic Features (4), Presentation (6) and Prognosis
PKD1 or PKD2 mutations
PKD1 is more common
Always bilateral
Mitral valve prolapse
Liver cysts
Berry aneurysms*
```
Presents in Adults*
Hematuria
Flank pain
UTIs
Nephrolithiasis
HTN
```
Chronic renal failure by age 40-60
(PKD2 better prognosis)
52
Autosomal Recessive Polycystic Kidney Disease
| Mutation, Pathologic Features (2) and Prognosis
PKHD1 gene defect
Enlarged cystic kidneys at birth
Hepatic fibrosis
Death in infancy/childhood
53
Medullary Sponge Kidney
| Pathologic Feature, Presentation (3) and Prognosis
Medullary cysts
Hematuria
UTIs
Recurrent nephrolithiasis
Benign
54
Familial juvenile Nephronophthisis
| Inheritance, Pathologic Features (2), Presentation (4) and Prognosis
Autosomal recessive
Corticomedullary cysts
Shrunken kidneys
Salt wasting
Polyuria
Growth retardation
Anemia
Progressive renal failure in childhood
55
Adult Medullary Cystic Disease
| Inheritance, Pathologic Features (2), Presentation (2) and Prognosis
Autosomal dominant
Corticomedullary cysts
Shrunken kidneys
Salt wasting
Polyuria
Progressive renal failure in adulthood
56
```
Multicystic Renal Dysplasia
Pathologic Features (3) and Prognosis (2)
```
Variable kidney cysts
Ureter agenesis
Ureteropelvic obstruction
Renal failure if bilateral
Surgically curable if unilateral
57
```
Dialysis Associated Cystic Disease
Pathologic Features (2), Presentation (3)
```
Numerous cortical and medullary cysts
Hemorrhage
Erythrocytosis
Renal cell carcinoma
58
```
Simple Renal Cysts
Pathologic Features (2), Presentation
```
Normal sized kidneys
Cortical cyst with clear fluid
Microscopic hematuria
59
Urinary Tract Obstruction
| Main Complication and Clinical Presentations (4)
Hydronephrosis: Dilated renal pelvis/calyces and progressive renal atrophy
Acute: Pain/Bladder issues from underlying cause
Unilateral complete: silent, diagnosed with ultrasound
Bilateral Partial: Polyuria, Nocturia and HTN
Bilateral Complete: Anuria, Postobstructive diuresis
60
Renal Papillary Adenoma
| Classification, Cytogenetics (2) and Morphology (3)
Benign if < 1cm
Most common benign renal neoplasm
Trisomies 7 and 17
Appear cortical, discrete and yellow-gray
61
```
Renal Oncocytoma
Gross Appearance (4), Origin and Histology
```
Mahogany brown
Well circumscribed
Central stellate scar
Large: 10-15 cm**
Type A Intercalated Cells
Eosinophilic cells with numerous mitochondria
62
Renal Angiomyolipoma
| Association, Complication and Morphology (3)
Loss of TSC1/TSC2 tumor suppressor genes
(Tuberous Sclerosis)
Hypovolemic shock via spontaneous hemorrhage
Thick walled vessels
Smooth muscle proliferation
Fat cells
63
Familial Renal Cancer Syndromes
| Examples (4) and Clinical Relevancy
Von Hippel-Lindau: Hereditary and sporadic clear cell renal carcinomas
Hereditary Leiomyomatosis: aggressive papillary carcinoma
Hereditary Papillary Carcinoma: MET oncogene causes Sporadic and Hereditary Papillary carcinoma
Birt-Hogg-Dube: see skin, pulmonary and renal tumors
64
Renal Cell Carcinoma Cytogenetic/Genetic Factors
| Papillary (2) and Familial (1)
Papillary associated with Trisomy 7
Papillary associated with mutated activated MET
Familial Clear cell have Chr 3 VHL translocation/deletion
65
```
Renal Cell Carcinoma Morphology
Clear cell (2), Papillary (2), Chromophobe (2)
```
Clear cell: non-papillary growth and clear cytoplasm
Papillary: papillary growth and multifocal
Chromophobe: pale eosinophilic cytoplasm with nuclear halos
66
Renal Cell Carcinoma
| Presentation (3), Prognoses (4) and Main Danger
Hematuria
Costovertebral pain
Palpable flank mass
Chromophobe is best
Papillary and Clear cell are moderate
Collecting Duct/Sarcomatoid/Medullary are worst
Hematogenous metastasis while remaining subclinical
67
Urothelial (Transitional cell) Carcinoma
| Presentation (3) Complications (2)
Hematuria
Hydronephrosis
Flank pain
Tubulointerstitial nephropathy
Infiltration of renal pelvis/calyx (poor prognosis)
68
Metastatic Disease to the Kidney
| Causes (5) and Description (2)
Metastasis of:
Melanoma or Lung, Breast, GI, Pancreas cancers
Multifocal and bilateral
69
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Neuroblastoma
Unfavorable Factors (5)
```
```
Stage 3 or 4
Older than 18 months
Poor differentiation
Near diploid
NMYC amplification
```
70
Wilms Tumor
| Precursor, Prognostic Factors (6), Genetic Link
Nephrogenic rests are precursor lesion
Favorable: Blastemal, stromal and epithelial cells all present, older age
Unfavorable: Diffuse anaplasia, p53 mutation
WT1 mutation
71
Ureter Congenital Anomalies (3)
Double and Bifid Ureters
Ureteropelvic Junction obstruction
Diverticula
72
Ureter Inflammatory Conditions (2)
Ureteritis Follicularis
| Ureteritis Cystica
73
Ureteral Obstruction Extrinsic Causes (4)
Pregnancy
Periureteral inflammation
Endometriosis
Sclerosing Retroperitoneal Fibrosis (IgG4 related)
74
Urinary Bladder
| Congenital Anomalies with Complications (4)
Diverticulae: bladder infections/calculi
Exstrophy: Adenocarcinoma
Vesicureteral reflux: congenital vesicoureteral fistula
Urachal cysts: Adenocarcinoma
75
Bladder Cystitis - Acute and Chronic
| Presentation (4) and Morphologic Types (3)
Frequency of urination
Lower abdominal pain
Dysuria (burning)
Low grade fever
Hemorrhagic
Follicular
Eosinophilic
76
Bladder Cystitis
| Etiologies (4) and Predisposing Factors (5)
E. coli
Klebsiella
Proteus
Enterobacter
```
Calculi
Obstruction
Diabetes
Immune Deficiency
Radiation
```
77
```
Interstitial Cystitis
Pathologic Features (3) and Presentation (3)
```
Glomerulations
Hunner's Ulcer
Mast cells
Intermittent severe suprapubic pain
Presents in females 30-40
78
```
Malacoplakia
Cause Morphology (2) and Population
```
Defective phagosomes causing chronic E coli infection
Inflammation and plaque formation
Granular macrophages with Michaelis Gutmann bodies
Presents in middle aged women
79
Polypoid cystitis
| Cause and Misdiagnosis
Indwelling catheters
Papillary carcinoma
80
Nephrogenic Adenoma
| Pathology (2)
Renal tubular cells implanted in urothelium
| Urothelium replaced with cuboidal epithelium
81
Cystitis Cystica/Glandularis
| Pathogenesis (3) and Population
Nests of Brunn form
Metaplasia into cuboidal/columnar (glandularis)
Urothelium retracts and flattens (cystica)
Mostly male
82
Papillary Urothelial Carcinoma
| Stages (5)
```
Exophytic papilloma
Inverted papilloma
Carcinoma in situ
PUNLMP (thickened epithelium)
Low/High Grade Papillary Urothelial cancers
```
83
Urothelial Carcinoma
| Presentation (2), Risk Factors (4), Morphology (2)
Painless hematuria
Presents in people over 65 years
Smoking
Cyclophosphamide
Phenacetin
p53 mutation
Hyperchromatic cells
Huge nuclei
84
Mesenchymal Bladder Tumors
| Adult vs Pediatric
Leiomyomas in adults
(intramural, encapsulated)
Embryonal Rhabdomyosarcoma in kids
(Grape-like mass)
85
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Urethritis - Gonococcal and Non-Gonococcal
Main Causes (2) and Male/Female Difference
```
Gonorrhea
Chlamydia
Males are symptomatic and females are not
86
Reactive Arthritis
| Presentation (3) and Description
Arthritis
Conjunctivitis
Urethritis
Non-infectious inflammatory urethritis
87
Primary Carcinoma of the Urethra
| Commonness and Proximal/Distal Differences
Not common
Proximal: urothelial differentiation
Distal: Squamous cell carcinoma
88
Epispadias and Hypospadias
| Description (3) and Complication
Malformation of urethral groove and canal
Ventral if hypospadias
Dorsal if epispadias
Sterility
89
Phimosis
| Description and Complications (2)
Narrowing of the orifice of the prepuce
Increased risk of infections and carcinoma
90
Balanoposthitis
| Description, Causes (2), Complication
Infection of the glans and prepuce
Candida albicans
Gardnerella
Smegma
91
Benign Penile Tumor (Condyloma Acuminatum)
| Cause and Morphology (3)
HPV
Sessile or pedunculated red papillary excrescences
Acanthosis
Koilocytosis
92
Malignant Penile Tumors
| CIS (2) and Squamous Carcinoma (2) Associations
```
Carcinoma in Situ:
Bowen Disease (over 35, solitary lesion)
Bowenoid Papulosis (younger, multiple lesions)
```
Squamous Carcinoma: HPV associated
Verrucous carcinoma is a subtype
93
HPV Complications
| Common Morphology and Examples with HPV Type (4)
Koilocytosis
```
Condyloma Acumunatum (6/11)
Squamous Penile Carcinoma (16/18)
Bowen Disease (16)
Bowenoid Papulosis (16)
```
94
Cryptorchidism
| Description, Histology (2), Timeline (3), Complications (2)
Intra-abdominal testis undescended into scrotal sac
Arrested germ cell development
Hyalinization and thickening of Spermatic Tubule BM
Most will spontaneously descend in first year
Orchiopexy required if not descended by two years
After two years histological deterioration happens
Infertility
Testicular Cancer
95
Testis/Epididymis Pathologic Issues (4) with Causes
Atrophy: Mostly from Klinefelter
Inflammation: Msotly from UTIs
Autoimmune: idiopathic granulomatous orchitis
Specific Infections: Gonorrhea, Mumps, TB, Syphilis
96
Testicular Torsion - Adult and Neonatal
| Causes (2) and Intervention
Adult caused by bell-clapper abnormality
Neonatal lacks anatomic defect
Orchiopexy
97
Testicular Germ Cell Tumors
| Associated Syndrome, Genetics (2) and Precursor Lesion
**Most common tumor in males 15-34
Testicular Dysgenesis Syndrome
KIT and BAK mutations
Intratubular Germ Cell Neoplasia
98
Seminomatous Germ Cell Tumor
| Morphology (5)
**Most common germ cell tumor
```
Large,
Round/polyhedral,
Distinct cell membrane,
Clear cytoplasm,
Central nucleus with nucleoli
```
99
Non-Seminomatous Germ Cell Tumors
| Examples (4)
Embryonal carcinoma
Yolk sac tumor (Schiller duval bodies)
Choriocarcinoma
Teratoma (malignant post puberty)
100
Tunica Vaginalis Lesions (5)
```
Hydrocele
Hematocele
Chylocele
Spermatocele
Varicocele
```
101
Prostate Inflammation Types (4)
Acute Bacterial Prostatitis
Chronic Bacterial Prostatitis
Granulomatous Prostatitis
Chronic Abacterial Prostatitis (most common)
102
Benign Prostatic Hyperplasia
| Age, Pathogenesis (2), Initial Location
Most common over 50 years
Nodular hyperplasia of stromal and epithelial cells
Influenced by DHT related growth factors
Hyperplasia starts in the transition zone
103
Prostate Adenocarcinoma
| Incidence (2), Androgens Role, Genetics (2)
**Most common form of cancer in men**
More common in African Americans
Androgens help cancer grow and survive
(Treat with castration or anti-androgens)
ERG/ETV1 transposed next to TMPRSS2 gene
BRCA2 mutations
104
Prostate Adenocarcinoma Diagnosis
| Gleason Score, Biomarkers (2)
Low score = more differentiated (better prognosis)
*10 is the highest score with worst prognosis
Prostate specific antigen (PSA)
PCA3
