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CPR III > Renal Pathology 9: Male GU (Dobson) > Flashcards

Renal Pathology 9: Male GU (Dobson) Flashcards

1
Q

How are bladder cancers staged?

A

Staged on the basis of invasion of the detrusor muscle

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2
Q

The three points of slight narrowing of the ureter?

A
  1. uteropelvic junction
  2. where the ureter enters the bladder
  3. where the ureter crosses the iliac vessels
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3
Q

Ureteropelvic junction (UPJ)

A

most common cause of hydronephrosis in infants and children

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4
Q

Retroperitoneal fibrosis

A

(AKA Ormond disease) fibrotic proliferative inflammatory process encasing the retroperitoneal structures (SAD PUCKERS) and causing hydronephrosis; tx is steroids, but will need stents and surgery

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5
Q

Cystitis infectious agents

A

E. coli (most common)
Chlamydia, Mycoplasma, Proteus, Klebsiella

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6
Q

Predisposition to cystitis

A

Bladder stones (calculi)
Urinary obstruction
DM
Instrumentation
Immune deficiency
Irradiation of the bladder

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7
Q

Triad of symptoms in cystitis?

A
  1. increased frequency (need to go every 20 mins)
  2. lower abd pain (localized to suprapubic region)
  3. dysuria
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8
Q

Malakoplakia

A

chronic bacterial cystitis (E. coli or Proteus)
Michaelis-Gutmann bodies

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9
Q

Michaelis-Gutmann bodies

A

macrophages with intra-lysosomal laminated calcified concentrations seen in malakoplakia (chronic bacterial cystitis)

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10
Q

Polypoid cystitis

A

inflammatory lesion from irritation of bladder mucosa; most commonly due to indwelling catheters; marked submucosal edema that can lead to bulbous polypoid projections; confused with papillary urothelial carcinoma

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11
Q

Squamous cell carcinoma of the bladder

A

PAINLESS hematuria; response to chronic inflammation; urothelium replaced by non keratinizing squamous epithelium (more resilient cells); Schistosoma haematobium infections, smoking and chronic UTIs

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12
Q

Urothelium tumors (2 main type)

A
  1. Noninvasive papillary tumors (most common)
  2. Flat noninvasive urothelial carcinoma
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13
Q

Noninvasive papillary tumors

A

most common precursor lesion to urothelial tumors; orginates from papillary urothelial hyperplasia

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14
Q

Urothelial carcinoma risk factors

A

predominantly males; age 50-80 yrs; cigarette smoking (the most important) and cyclophosphamide (drug used cancer tx) is another risk

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15
Q

50-80% of all bladder cancers are associated with what?

A

Cigarette smoking

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16
Q

Papillary Urothelial Neoplasms of Low Malignant Potential (PUNLMP)

A

slightly larger than papillomas; THICKER urothelium; rarely progress to higher grade

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17
Q

High Grade Papillary Urothelial Cancer

A

dis-cohesive cells with anaplastic features; loss of polarity; high risk of invasion into the muscular layer, higher risk of progression and significant metastatic potential

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18
Q

Invasive urothelial cancer

A

Invasive of muscularis mucosae (detrusor muscle) is prognostically important; staging at the initial diagnosis is the most important factor in determining the outlook for the patient

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19
Q

Adenocarcinoma of the bladder

A

PAINLESS hematuria; rare; some arise from urachal remnants or in the setting of intestinal metaplasia; histologically identical to adenocarcinomas of the GI tract

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20
Q

Bladder Cancer Clinically

A

PAINLESS hematuria; tend to recur after excision at a higher grade in different sites; treatment responds to chemo but if not then surgery is curative

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21
Q

Prostate enlargement

A

most common cause of obstruction of the bladder outlet in males due to nodular hyperplasia

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22
Q

Cystocele of the bladder

A

most common cause of obstruction of the bladder in females

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23
Q

Urethral Caruncle

A

PAINFUL, small, red inflammatory lesion of the external urethral meatus in older females, bleed easily due to ulceration; excision is curative

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24
Q

Hypospadias

A

more common than epispadias; congenital anomaly of the penis; urethral opening on the VENTRAL aspect of the penis; incomplete fusion of urogenital folds; can lead to urinary obstruction (severe cases - post renal AKI and hydronephrosis)

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25
Epispadias
congenital anomaly of the penis; urethral opening on the DORSAL aspect of the penis; due to abnormal positioning of the genital tubercle during development; present with exstrophy of the bladder
26
Balanoposthitis
infection of the glans and prepuce by non specific organisms (not STD); due to poor local hygiene in uncircumcised males
27
Common infection in uncircumcised males
Balanoposthitis; infection of the glans and prepuce by non specific organisms (not STD); due to poor local hygiene
28
Condyloma Acuminata
Penile tumor; benign sexually transmitted wart, HPV 6>11, recurs after excision, but rarely transforms to malignancy, may display Kolicytosis- cytoplasmic vacuolization of the squamous cells; characteristic of HPV
29
Kolicytosis
cytoplasmic vacuolization of the squamous cells; characteristic of HPV seen in Condyloma Acuminata; Penile tumor; benign sexually transmitted wart
30
Peyronie Disease
benign proliferation of fibroblasts of tunica albuginea; results in fibrous bands involving the penile corpus cavernosum; causes penile curvature and pain during intercourse
31
Disease that causes penile curvature and pain during intercourse
Peyronie Disease; benign proliferation of fibroblasts of tunica albuginea; results in fibrous bands involving the penile corpus cavernosum
32
Bowenoid Papulosis
multiple, pigmented papular lesions on external genitalia (penis); histologically indistinguishable from Bowens disease; so use age and number of lesions; younger patients and multiple (compared to older and solitary lesion); also rarely progresses to carcinoma
33
Cryptorchidism
the most common congenital anomaly of the testes; failure of testes to descent; can lead to tubular atrophy and sterility; 75% unilateral; found in 1% of 1 yr old boys; decreased germ cell development; fibrosis with sparing prominent Leydig cells; completely asymptomatic
34
most common congenital anomaly of the testes
Cryptorchidism; found in 1% of 1 yr old boys; failure of testes to descent
35
Inflammation of the epididymis and testis
more common in epididymis, epididymis is first then testis (gonorrhea/TB) if testis first then epididymis (syphilis - but epididymis is commonly spared altogether)
36
Granulomatous (autoimmune) Orchitis
moderately tender testicular mass of sudden onset; sometimes associated with fever; granulomas are restricted to spermatic tubules
37
Gonorrhea
from neglected gonococcal infection; RETROGRADE expansion of infection from posterior urethra to prostate, seminal vesicles and epididymis
38
Gonorrhea left untreated
testis suppurative orchitis
39
Severe complication of gonorrhea
epididymal abscesses = destruction and scarring
40
Mumps
systemic viral infection; commonly affects children; testicular involvement is rare; 20-30% of post-pubertal men who are infected present with orchitis 1 week after inflammation of parotid glands
41
Post-pubertal men who have inflammation of parotid glands and one week later present with orchitis, should make you think what?
Mumps; systemic viral infection; testicular involvement is rare
42
Syphilis
testes are involved FIRST and the epididymis is commonly spared; nodular gummas; histological hallmark: obliterative endarteritis associated with perivascular cuffs of lymphocytes and plasma cells.
43
obliterative endarteritis associated with perivascular cuffs of lymphocytes and plasma cells.
Syphilis
44
STI in men were testes are involved first and then the epididymis is commonly spared
Syphilis
45
Nodular gummas
Syphilis
46
Testicular torsion
twisting of the spermatic cord cuts off testicular venous drainage; arterial supply remains patent; occludes venous outflow; true urologic emergency (testis can become enlarged and hemorrhagic); surgery < 6 hours
47
Adenomatoid tumor
most benign paratesticular neoplasm; small nodules of mesothelial cells near the upper epididymal pole
48
Rhabdomyosarcoma
most common paratesticular tumor in children
49
Most common paratesticular tumor in children?
Rhabdomyosarcoma
50
Liposarcoma
Most common paratesticular tumor in adults
51
Most common paratesticular tumor in adults?
Liposarcoma
52
Classification of testicular germ cell tumors
1. Seminomatous tumors: cells that look like primordial germ cells 2. Nonseminomatous tumors: undifferentiated cells that look like embryonic stem cells
53
Seminomatous tumors
testicular germ cell tumor were the cells that look like primordial germ cells; remain localized to testis for long time; radiosensitive; good prognosis
54
Nonseminomatous tumors
testicular germ cell tumors were undifferentiated cells that look like embryonic stem cells; more aggressive; radioresistant; metastasize early
55
Intratubular germ cell neoplasia (ITGCN)
occurs in utero, dormant until puberty; commonly has a duplication of the short arm of 12 which is always found in all invasive germ cell tumors
56
Seminoma
most common type of germ cell tumor, 20-30 yrs; almost never in infants; express isochromosome 12p and OC3/4 and NANOG
57
Most common type of germ cell tumor?
Seminoma; 20-30 yrs; almost never in infants; express isochromosome 12p and OC3/4 and NANOG
58
Spermatocytic Seminoma
rare and slow growing testicular germ cell tumor; patient > 65 yrs old; excellent prognosis; no associated with ITGCN
59
Embryonal carcinoma
more aggressive than seminomas; poorly demarcated, small, gray-white mass, positive for OCT3/4, PLAP, CD30, cytokeratin and negative for cKIT
60
Yolk sac tumor
Endodermal sinus tumor; most common testicular tumor in children <3 years and comes with a very good prognosisl Schiller-Duval bodies (primitive glomeruli)
61
Choriocarcinoma
highly malignant neoplasm, small palpable nodule without testicular enlargement; derived from chorionic villi in placenta; contains syncytiotrophoblasts - hCG reaches very high levels in the serum; can lead to signs of hyperthyroidism
62
If hCG reaches very high levels in the serum what should be on you differential?
Choriocarcinoma; highly malignant neoplasm, small palpable nodule without testicular enlargement; contains syncytiotrophoblasts - hCG reaches very high levels in the serum
63
Teratoma
differentiation in all three germ layers; all embedded in a fibrous or myxoid stroma; post-pubertal = all teratoma s are regarded as malignant
64
What is the most aggressive nonseminomatous germ cell tumor (NSGCT)?
Pure Choriocarcinoma; rapid hematogenous spread; lungs and liver are involved early; no testicular enlargement
65
Pure Choriocarcinoma
most aggressive nonseminomatous germ cell tumor (NSGCT); rapid hematogenous spread; lungs and liver are involved early; no testicular enlargement
66
Stage II of testicular tumor staging
persistent elevation of hCG or AFP concentrations following orchiectomy, even if lymph nodes appear normal
67
Persistent elevation of hCG or AFP concentrations following orchiectomy, even if lymph nodes appear normal indicates what?
Stage II of testicular tumor staging
68
AFP biomarker
biomarker markedly elevated in yolk sac tumor (nonseminous tumor)
69
biomarker markedly elevated in yolk sac tumor
AFP biomarker
70
hCG biomarker
biomarker markedly elevated in choriocarcinoma; 15% of seminomas have elevated hCG
71
Leydig cell tumors
2% of all testicular tumors; most are benign; tumor produces androgens, estrogens and corticoidsteroids; present with testicular swelling
72
Eosinophilic Reinke crystalloids
Leydig cell tumors
73
Testicular lymphoma
most common form of testicular tumors in >60 yrs; disseminate widely; high incidence of CNS involvement
74
Lymphoma with high incidence of CNS involvement?
Testicular lymphoma; most common form of testicular tumors in >60 yrs; disseminate widely
75
Hydrocele
accumulation of serous fluid within the tunica vaginalis; leads to enlargement of scrotal sac that contains clear fluid; will transilluminate (a beam of light can pass through)
76
Hematocele
accumulation of blood secondary to trauma, torsion or generalized bleeding diathesis; will not transilluminate
77
Chylocele
accumulation of lymphatic fluid secondary to lymphatic obstruction
78
Spermatocele
local cystic accumulation of semen in dilated efferent ducts or ducts of the rete testis
79
Variococele
dilated veins in the spermatic cord; may be asymptomatic; will not transilluminate
80
Peripheral zone of the prostate
where most carcinomas arise; classically in a posterior location
81
Transitional zone of the prostate
where most hyperplasia occurs (much more common than tumors)
82
Nonbacterial Chronic Prostatitis
most common prostatitis; cultures are uniformly negative; no history of recurrent UTI
83
Chronic Bacterial Prostatitis
frequent bouts of UTI, hx of recurrent UTI; leukocytosis in the expressed prostatic secretions
84
Granulomatous Prostatitis
the most common cause in the US is from instillation of BCG into the bladder for treatment of superficial bladder cancer
85
Benign Prostatic Hyperplasia (BPH)
Nodular hyperplasia; most common prostatic disorder; stromal proliferation; can be thought of as a sign as aging; large nodules in the peri-urethral region of the prostate
86
BPH pathogensis
increased number of epithelial cells and stromal components in the peri-urethral area of the prostate; believe the hyperplasia is because of impaired cell death; DHT-induced growth factors act by increasing proliferation of stromal cells and decrease death of epithelial cells
87
Diagnosis of BPH
need DRE (palpate a firm rubbery mass); cannot be made on needle biopsy; too small to appreciate nodularity and do not biopsy transition zone where BPH occurs
88
Clinical presentation of BPH
Nocturia, urgency, hesitancy, difficulty starting and stopping the stream of urine; inability to completely void bladder
89
BPH are at increased risk for what?
bacterial infections of the bladder and kidney; inability to completely void bladder, reservoir of residual urine, common source of infection; is NOT a precursor for malignancy.
90
Adenocarcinoma of the prostate
most common cancer in men; uncommon in Asians, more common in Blacks; Rearrangement of ETS family transcription factor gene (ERG or ETV1); most important risk factor is increasing age (60-70 yrs); PSA screenings; develops in the posterior lobe of peripheral zone AWAY from urethra so no urinary symptoms (symptoms think BPH)
91
Kennedy disease
long trinucleotide expansions of CAGs in x-linked andreogen receptor gene; disease is characterized by muscle cramping and fatigue; shortest expansion = more sensitive= Blacks; intermediate = Whites; Longer = Asians
92
Prostatic intraepithelial neoplasia (PIN)
obstruction of the urinary tract presenting like BPH; finding of osteoblastic metastases by skeletal surveys or the much more sensitive radionuclide bone scanning is virtually diagnostic of prostate cancer in men, bony metastases are typically osteoblastic and this feature in men strongly points to prostatic origin; is a precursor for malignancy
93
Benign prostate glands
contain Basal cells
94
Malignant prostate glands
absent basal cells
95
Histology shows perineural invasion
specific for prostate cancer
96
Gleason score of 2-6
grading of prostate cancers; 2-6 have excellent prognosis; 2 = minimum Gleason score and most well differentiated
97
If tested are not palpable in the scrotum of a child under 1 yr?
Cryptorchidism; did not fully descend from the abdomen; external inguinal ring is the most common location; visible mass in the groin, most spontaneously descend by 6 month
98
Bilateral cryptochidism is commonly associated with what?
a genetic disorder; commonly Klinefelter syndrome (47 XXY) this syndrome commonly causes hypogonadism
99
Treatment for cryptochidism
Orchiopexy- surgery
100
What reflect is absent in testicular torsion?
Cremasteric reflex; normally - pinch skin of upper thigh and see elevation of i/l testis
101
How does testicular torsion present?
Acute scrotal pain; this is a true testicular emergency!
102
Diagnosis of hydrocele
with an ultrasound; will transilluminate (a beam of light will pass through; differs in varicocele and trauma)
103
Bowen disease
penile carcinoma presents with crusting and oozing erythematosis plaques on shaft of penis
104
Phimosis
fibrosed foreskin that cannot be retracted from the glans
105
Patent urachus
failure of allantois to completely involute/obliterate; abnormal connection between bladder and umbilicus; leakage of urine from the umbilicus in newborns

CPR III (20 decks)

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