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Renal 2 Test 1 > Renal Pathology Chapter 21 Part 2 > Flashcards

Renal Pathology Chapter 21 Part 2 Flashcards

1
Q

Secondary Tumors of the Bladder

A

most often by direct extension from primary lesions in nearby organs, cervix, uterus, prostate, and rectum
-lymphomas may involve the bladder as a component of systemic disease, but also, rarely, as primary bladder lymphoma

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2
Q

Most common cause of bladder obstruction in males

A

-enlargement of the prostate gland due to nodular hyperplasia

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3
Q

Bladder obstruction in females

A
  • less common

- caused by cystocele of the bladder

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4
Q

Infrequent causes of bladder obstruction

A

-congenital urethral strictures, inflammatory urethral strictures, inflammatory fibrosis and contration fo the bladder, bladder tumors, invasion of the bladder neck by tumors arising in contiguous organ, mechanical obstructions caused by foreign bodies and calculi, and injury of nerves controlling bladder contraction (neurogenic bladder)

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5
Q

Obstruction morphology

A
  • in early stages, only thickening of the bladder wall due to smooth muscle hypertrophy
  • with progressive hypertrophy the individual muscle bundles greatly enlarge and produce trabeculation of the bladder wall
  • in course of time, crypts form and may be converted into diverticula
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6
Q

Gonococcal Urethritis

A

-one of the earliest manifestations of venereal infection

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7
Q

Nongonococcal urethritis

A

can be caused by several different organisms

  • various strains of chlamydia are the cause of 25-60% of nongonococal urethritis in men and about 20% in women
  • Mycoplasma
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8
Q

Urethritis is often accompanied by

A

-cystitis in women and prostatitis in men

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9
Q

Reactive arthritis

A

-associated with the clinical triad of arthritis, conjunctivitis, and urethritis

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10
Q

Urethral caruncle

A
  • inflammatory lesion that presents as a small, red, painful mass about the external urethral meatus, typically in older females
  • inflamed granulation tissue covered by an intact but extremely friable mucosa, which may ulcerate and bleed with the slightest trauma
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11
Q

Benign epithelial tumors of the urethra include

A

-squamous and urothelial papillomas, inverted urothelial papillomas, and condylomas

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12
Q

Hypospadias and epispadias

A
  • malformation of the urethral groove and urethral canal may create an abnormal urethral opening either not he ventral surface of the penis (hypospadias) or on the dorsal surface (epispadias)
  • may be associated with failure of normal descent of the testes and with malformations of the urinary tract
  • may cause abnormal obstruction and increased risk of ascending UTIs
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13
Q

Phimosis

A
  • when the orifice of the prepuce is too small to permit its normal retraction
  • may result from anomalous development but is more frequently the result of repeated attacks of infection that cause scarring of the preputial ring
  • interferes with cleanliness and permits accumulation of secretions and detritus under the prepuce, favoring the development of secondary infections and possibly carcinoma
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14
Q

Inflammations of the penis

A
  • almost invariably involves the glans and prepuce and include a wide variety of specific and nonspecific infections
  • sexually transmitted infections
  • Most cases occur as a consequence of poor local hygiene in uncircumcised males, in some the accumulation of desquamated epithelial cells, sweat, and debris, termed smegma, acts as local irritant
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15
Q

Balanoposthitis

A
  • infection of the glans and prepuce caused by a wide variety of organisms
  • Candida albicans, anaerobic bacteria, Gardnerella, pyogenic bacteria most common
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16
Q

Condyloma Acuminatum

A
  • bening sexually transmitted wart caused by HPV
  • related to common wart and may occur on any moist mucocutaneous surface of the external genitals in either sex
  • HPV type 6 and less frequently 11 are most frequent agents
  • may occur on the external genitalia or perineal ares
  • on the penis the lesions occur most often about the coronal sulcus and inner surface of the prepuce
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17
Q

Condyloma Acuminatum lesions consist of

A
  • single or multiple sessile or pedunculate, red papillary excrescences that may be up to several mm in diameter
  • branching, villous, papillary connective tissue stroma is covered by epithelium that may have considerable superficial hyperkeratosis and thickening of the underlying epidermis (acanthuses)
  • cytoplasmic vacuolization of the squamous cells (koilocytosis) is noted
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18
Q

Condyloma Acuminatum tend to

A

recur, but rarely progress into in situ or invasive cancers

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19
Q

Peyronie Disease

A
  • results in fibrous bands involving the corpus cavernous of the penis
  • lesion results in penile curvature and pain during intercourse
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20
Q

Carcinoma In Situ of the Penis

A
  • Bowen disease and bowenoid populaces

- strong association with infection by high-risk HPV, most commonly type 16

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21
Q

Bowen disease

A
  • occurs in the genital region of both men and women, usually in those older than 35 years old
  • in men tends to involve the skin of the shaft of the penis and scrotum
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22
Q

Bowen disease gross appearance

A
  • solitary, thickened, gray-white, opaque plaque

- can also manifest on the glans and prepuce as single or multiple shiny red, sometimes velvety plaques

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23
Q

Bowen disease histologically

A

epidermis is hyperproliferative, containing numerous mitoses, some atypical
-the cells are markedly dysplastic with large hyper chromatic nuclei and lack of orderly maturation

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24
Q

Bowen disease transforms into

A

-infiltrating squamous cell carcinoma in approximately 10% of patients

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25
Q

Bowenoid papulosis

A
  • occurs in sexually activity adults
  • younger age of affected patients and its presentation is multiple reddish brown papular lesions
  • virtually never develops into an invasive carcinoma and in many cases regresses spontaneously
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26
Q

Squamous cell carcinoma of the penis

A
  • associated with poor genital hygiene and with high-risk HPV infection
  • usually found in patients ages 40-70
  • accounts for less than 1% of cancers in males in the U.S. but may be more in Asia, Africa, and South America
  • circumcision confers protection
  • HPV DNA type 16 more common; but also type 18
  • Cigarette smoking elevates risk
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27
Q

Squamous cell carcinoma of the penis usually begins on

A

-the glans or inner surface of the prepuce near the coronal sulcus

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28
Q

Papillary squamous cell carcinoma of the penis

A

-simulate condylomata acuminata and may produce a cauliflower-like fun gating mass

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29
Q

Flat squamous cell carcinoma of the penis

A
  • appear as areas of epithelial thickening accompanied by graying and fissuring of the mucosal surface
  • with progression, an ulcerated papule develops
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30
Q

Verrucous carcinoma

A

-exophytic well-differentiated variant of squamous cell carcinoma that are locally invasive, but rarely metastasize

31
Q

Invasive squamous cell carcinoma of the penis clinical features

A
  • slow growing, locally invasive
  • nonpainful until secondary ulceration and infection
  • metastasis to inguinal lymph nodes may occur early, but not widspread dissemination until advanced
32
Q

Cryptorchidism

A
  • 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
  • usually occurs as an isolated anomaly but may be accompanied by other malformations
  • most common in inguinal canal
  • asymptomatic; some descend spontaneously into the scrotum during 1st year of life
  • can also have inguinal hernia
33
Q

Testicular descent occurs in 2 morphologically and hormonally distinct phases

A
  • transabdominal phase

- inguinoscrotal phase

34
Q

Transabdominal Phase

A
  • Testis comes to lie within the lower abdomen or brim of the pelvis
  • believe to be controlled by a hormone called Mullerian-inhibiting substance
35
Q

Inguinoscrotal phase

A
  • the testes descends through the inguinal canal into the scrotal sac
  • androgen-induced release of calcitonin gene-related peptide from the genitofemoral nerve
36
Q

Cryptorchidism Morphology

A
  • arrested germ cell development associated with marked hyalinization and thickening of the basement membrane of the spermatic tubules
  • eventually tubules appear as dense cords of hyaline connective tissue outlined by prominent basement membranes
  • concomitant increase in interstitial stroma
37
Q

Testicular Atrophy may be caused by

A
  • progressive atherosclerotic narrowing of the blood supply in old age
  • the end stage of an inflammatory orchitis
  • cryptorchidism
  • hypopituitarism
  • generalized malnutrition or cachexia
  • irradiation
  • prolonged administration of anti androgens
  • exhaustion atrophy
38
Q

Gonorrhea and tuberculosis almost invariably arise in the

A

epididymis

39
Q

Syphilis affectes

A

testes first

40
Q

Epididymitis

A

-possible subsequent orchitis are commonly related to infections in the urinary tract, which reach the epididymis and the testis through either the vas deferens or the lymphatics of the spermatic cord

41
Q

Epididymitis in childhood is usually associated with

A

congenital genitourinary abnormality and infection with gram-negative rods

42
Q

Epididymitis in sexually active men under 35 years old

A

-sexually transmitted pathogens C. trachoma’s and Neisseria gonorrhoeae most frequent culprits

43
Q

Epididymitis in men older than age 35

A

-common urinary tract pathogens, such as E. coli and Pseudomonas, are responsible for most infections

44
Q

Nonspecific Epididymitis and Orchitis

A
  • bacterial invasion induces nonspecific acute inflammation characterized by congestion, edema, and infiltration by neutrophils, macrophages, and lymphocytes
  • in early stage, infection more or less limited to the interstitial connective tissue, but rapidly extends to involve the tubules and may progress to abscess formation or complete suppurative necrosis of the entire epididymis
45
Q

Granulomatous (Autoimmune) Orchitis

A
  • presents in middle age as a moderately tender testicular mass of sudden onset sometimes associated with fever
  • may appear insidiously, however, as a painless testicular mass mimicking a testicular tumor
  • granulomas restricted to spermatic tubules
46
Q

Gonorrhea

A
  • extension of infection from posterior urethra to prostate, seminal vesicles, and then to the epididymis is usual course
  • in severe cases, epididymal abscesses may develop, leading to extensive destruction and scarring
  • infection may also spread to the testis and produce suppurative orchitis
47
Q

Mumps

A
  • systemic viral disease that most commonly affects school-aged children; testicular involvement extremely uncommon in this age group
  • in postpubertal males, orchitis occurs in 20-30% of cases and most often, an acute interstitial orchitis develops about a week after the onset of swelling of the parotid glands
48
Q

Tuberculosis

A
  • when it involves male genital tract, almost invariably begins in the epididymis, from where it may spread to the testis
  • caseating granulomatous inflammation characteristic of tuberculosis
49
Q

Syphilis

A
  • testis and epididymis may be affected in both acquired and congenital syphilis, but almost invariably the testis is involved first
  • morphologic pattern takes 2 forms: production of gummas; a diffuse interstitial inflammation that produces the histologic hallmark of syphilitic infections, obliterative endarteritis associated with perivascular cuffs of lymphocytes and plasma cells
50
Q

Torsion

A
  • twisting of the spermatic cord typically cuts off the venous drainage of the testis
  • if untreated, it frequently leads to testicular infarction and thus represents one of the few true urologic emergencies
  • thick-walled arteries remain patent, producing intense vascular engorgement followed by hemorrhagic infarction
51
Q

Neonatal torsion

A

-occurs either in utero or shortly after birth

52
Q

Adult torsion

A
  • typically seen in adolescence and presents with the sudden onset of testicular pain
  • often occurs without any inciting injury
  • results from a bilateral anatomic defect that leads to increased mobility of the testes (bell-clapper abnormality)
53
Q

In advanced stages of torsion

A

testis is markedly enlarged and consists of soft, necrotic, hemorrhagic tissue

54
Q

Lipomas

A
  • common lesions involving the proximal spermatic cord, identified at the time of inguinal hernia repair
  • many of these lesions actually probably represent retroperitoneal adipose tissue that has been pulled into the inguinal canal along with the hernia sac
55
Q

Adenomatoid tumor

A
  • most common benign paratesticular tumor
  • mesothelial in nature
  • usually small nodules, typically occurring near the upper pole of the epididymis
56
Q

Testicular neoplasms 2 major categories

A
  • germ cell tumors (95%) and sex cord-stromal tumors

- germ cell tumors divided into summons and nonseminomas

57
Q

Germ Cell Tumors

A
  • most common tumor of men in 15-35 year age group
  • more common in whites than in blacks
  • environmental factors play a role
  • testicular germ cell tumors are associated with a spectrum of disorders collectively known as testicular dysgenesis syndrome (TDS)–cryptorchidism, hypospadias, and poor sperm quality
  • strong familial predisposition
  • genetic KIT and BAK associations
58
Q

Seminomatous tumors are composed of

A

cells that resemble primordial germ cells or early gonadocytes

59
Q

Nonseminomatous tumors may be composed of

A

undifferentiated cells that resemble embryonic stem cells, as in the case of embryonal carcinoma, but the malignant cells may also differentiate along other lineages, generating yolk sac tumors, choriocarcinomas and teratomas

60
Q

Intratubular germ cell neoplasm (ITGCN)

A
  • believed to arise in utero and stay dormant until puberty, after which it may progress to seminoma or nonseminomatous tumors
  • lesion costs of atypical primordial germ cells with large nuclei and clear cytoplasm, which are about twice the size of normal germ cells
  • retain expression of transcription factors OCT3/4 and NANOG
  • isochromosome 12p
61
Q

Seminoma

A
  • most common type of germ cell tumors
  • peak incidence is the 3rd decade and they almost never occur in infants
  • OCT3/4 and NANOG and isochromosome 12p
62
Q

Seminoma Morphology

A
  • produce bulky masses
  • homogenous, gray-white, lobulated cut surface, usually devoid of hemorrhage or necrosis
  • occasionally extension to the epididymis, spermatic cord, or scrotal sac
63
Q

Seminoma microscopically

A
  • composed of sheets of uniform cells divided into poorly demarcated lobules by delicate fibrous septa containing a lymphocytic infiltrate
  • classic cell is large and round to polyhedral and has a distinct cell membrane; clear or watery cytoplasm; and large, central nucleus with one or two prominent nucleoli
64
Q

Seminoma immunohistochemistry

A

-positive for KIT, OCT4, and PLAP

65
Q

Spermatocytic Seminoma

A
  • rare, slow-growing germ cell tumor predominantly affecting older men
  • soft, pale gray, cut surface that sometimes reveal mucoid cysts
  • 3 cell populations: (1) nucleus and eosinophilic cytoplasm; (2) smaller cells with a narrow rim of eosinophilic cytoplasm resembling secondary spermatocytes; and (3) scattered giant cells, either uninucleate or multinucleate
  • spireme chromatin
66
Q

Embryonal Carcinoma

A
  • occur mostly in the 20-30 year age group
  • more aggressive than summons
  • primary tumors are smaller than seminoma and do not replace the entire testis, however, extension through the tunica albuginea into the epididymis or cord frequently occurs
  • on cut surface, tumor is often variegated, poorly demarcated at the margins, and punctuated by foci of hemorrhage or necrosis
  • alveolar or tubular growth pattern
  • mitotic figures and tumor giant cells
67
Q

Yolk Sac Tumor

A

most common testicular tumor in infants and children up to 3 years of age

  • good prognosis in infants
  • in adults, pure form is rare; instead yolk sac elements frequently occur in combination with embryonal carcinoma
  • nonencapsulated and have homogeneous, yellow-white, mucinous appearance
  • composed of lace like network of cuboidal or flattened cells
  • other patterns may be found
  • in 50% of tumors, structures resembling endodermal sinuses (Schiller-Duval bodies) may be seen
  • eosinophilic, hyaline-like globules in which AFP and a1-antitrypsin can be demonstrated
68
Q

Choriocarcinoma

A
  • highly malignant form of testicular cancer
  • rare in pure form
  • often cause no testicular enlargement and are detected only as a small palpable nodule
  • typically, these tumors are small, rarely larger than 5 cm in diameter
  • Hemorrhage and necrosis extremely common
  • syncytiotrophoblasts and cytotrophoblasts
69
Q

Teratomas

A
  • testicular tumors having cellular or organoid components reminiscent of the normal derivates of more than one germ layer
  • may occur at any age
  • pure forms family common in infants and children
  • rare in adults
  • usually large tumors that are heterogeneous with solid, sometimes cartilaginous, and cystic areas
  • hemorrhage and necrosis usually indicates admixture with embryonal carcinomas, choriocarcinoma, or both
70
Q

Standard management of a solid testicular mass is

A

-radical orchiectomy based on the presumption of malignancy

71
Q

Testicular tumors have a characteristic mode of spread

A
  • lymphatic spread is common to all forms of testicular tumor
  • in general, retroperitoneal para-aortic nodes are the first to be involved
  • subsequent spread may occur to mediastinal and supraclavicular nodes
  • Hematogenous spread is primarily to the lungs, but liver, brain, and bones may also be involved
72
Q

Seminomas tend to

A
  • remain localized to the testis for a long time, and hence approximately 70% present in clinical stage I.
  • metastases from summons typically involve lymph nodes.
  • Hematogenous spread occurs later in the course of dissemination
73
Q

Approximately 70% of nonseminomatous germ cell tumors (NSGCTs) present with

A
  • advanced clinical stages (II and III)
  • metastasize earlier and use hematogenous route more frequently
  • pure choriocarcinoma is most aggressive form (lungs and liver involved early in virtually every case)
74
Q

In the U.S., 3 clinical stages of testicular tumors are defined

A
  • stage I: tumor confined to testis, epididymis, or spermatic cord
  • Stage II: distant spread confined to retroperitoneal nodes below the diaphragm
  • stage III: metastases outside the retroperitoneal nodes or above the diaphragm

Renal 2 Test 1 (16 decks)

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