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The Lower Urinary Tract and Male Genital System > Robbins > Flashcards

Robbins Flashcards

1
Q

Normal number of layers of urothelium

A

5-6

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2
Q

surface layer of urothelium

A

umbrella cells

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3
Q

T/F The lamina propria in the bladder has smooth muscle

A

T

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4
Q

T/F Bladder muscularis mucosa is composed of a single continuous layer of smooth muscle

A

False, it is composed of discontinuous wisps of smooth muscle from the lamina propria

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5
Q

In females, relaxation of pelvic support leads to prolapse (descent) of the uterus, pulling with it the floor of the bladder. Thus the bladder is protruded into the vagina, creating a pouch called

A

cystocele

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6
Q

most common cause of hydronephrosis in infants and children

A

Ureteropelvic junction (UPJ) obstruction

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7
Q

benign ureter tumor-like lesion often occurring in children, is composed of loose, vascularized connective tissue overlaid by urothelium

A

Fibroepithelial polyp

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8
Q

Unilateral ureteral obstruction typically results from

A

proximal intrinsic or extrinsic causes (e.g., stones, neoplasms etc.

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9
Q

bilateral ureteral obstruction arises from distal causes, such as

A

nodular hyperplasia of the prostate

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10
Q

most common and serious congenital anomaly where incompetence of the vesicoureteral valve allows bacteria to ascend the ureter into the renal pelvis

A

Vesicoureteral reflux

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11
Q

why are carcinoma that arise in bladder diverticula are on average more advanced in stage?

A

thin or absent musclularis propria

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12
Q

is a developmental failure in the anterior wall of the abdomen and the bladder and is associated with an increased risk of adenocarcinoma in the bladder remnant

A

Exstrophy of the bladder

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13
Q

T/F Urachal cysts are at increased risk for neoplastic transformation, mostly presenting as squamous carcinomas

A

False mostly present as adenocarcinomas

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14
Q

Predisposing factors for cystitis (5)

A

bladder calculi, urinary obstruction, diabetes mellitus, instrumentation, and immune deficiency

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15
Q

most common etiologic agents of cystitis

A

Escherichia coli, followed by Proteus, Klebsiella, and Enterobacter

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16
Q

result in emphysematous cystitis (gas-filled vesicles in the bladder wall)

A

Gas-forming bacteria (such as Clostridium perfringens)

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17
Q

Patients receiving systemic chemotherapy or pelvic irradiation may develop this type of cystitis

A

iatrogenic cystitis

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18
Q

Cytotoxic agents, such as cyclophosphamide, may cause this type of cystistis

A

hemorrhagic cystitis

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19
Q

this type of cystitis may occur following the irradiation of the bladder region

A

radiation cystitis

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20
Q

this type of cystitis is characterized by the presence of lymphoid follicles within the bladder mucosa and underlying wall

A

Follicular cystitis

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21
Q

this cystitis is manifested by infiltration of the submucosa by eosinophils, typically is a nonspecific subacute inflammation but may also be a manifestation of a systemic allergic disorder

A

Eosinophilic cystitis

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22
Q

All forms of cystitis are characterized by a triad of symptoms namely

A

frequency
lower abdominal, bladder region, or suprapubic pain
dysuria

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23
Q

an unpleasant sensation (pain, pressure, discomfort) perceived to be related to the urinary bladder, associated with urinary tract symptoms of more than six weeks duration, in the absence of infection or other identifiable causes.

A

Interstitial Cystitis (Chronic Pelvic Pain Syndrome)

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24
Q

Typical cystoscopic findings include mucosal fissures and punctate hemorrhages (glomerulations). Microscopically, the pathologic findings are nonspecific; mast cells are often increased in the submucosa

A

Interstitial Cystitis (Chronic Pelvic Pain Syndrome)

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25
Q

main role of biopsy of interstitial cystitis

A

r/o carcinoma in situ

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26
Q

a distinctive chronic inflammatory reaction that appears to stem from acquired defects in phagocyte function that takes the form of soft yellow, slightly raised mucosal plaques, 3 to 4 cm in diameter

A

malakoplakia

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27
Q

common etiologic cause of cystisits including malakoplakia

A

E.coli

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28
Q

Characteristic feature of Malakoplakia which shows laminated mineralized concretions resulting from deposition of calcium in enlarged lysosomes

A

Michaelis-Gutmann bodies

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29
Q

an inflammatory lesion where the urothelium is thrown into broad bulbous polypoid projections as a result of marked submucosal edema

A

polypoid cystitis

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30
Q

lesions of the urinary bladder in which nests of urothelium (von Brunn nests) grow downward into the lamina propria. Here, epithelial cells in the center of the nest undergo metaplasia and take on a cuboidal or columnar appearance and are called ______ or retract to produce cystic spaces lined by flattened urothelium called and are called ______.

A

Cystitis glandularis, cystitis cystica

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31
Q

Cystitis glandularis and cystitis cystica often coexist, the condition is typically referred to as

A

cystitis cystica et glandularis

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32
Q

_____ is a precursor to bladder dysplastic lesions and in situ and invasive squamous cell carcinoma. Classically, this is seen in ______, a precursor to dysplastic lesions and in situ and invasive squamous cell carcinoma.

A

Extensive multifocal keratinizing squamous metaplasia, bladder schistosomiasis

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33
Q

Lesion where the overlying urothelium is focally replaced by cuboidal epithelium, which can assume a papillary growth pattern. Although the lesions are typically less than 1 cm in size, larger lesions have been reported that can produce signs and symptoms that raise a suspicion of cancer

A

nephrogenic adenoma

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34
Q

two distinct precursor lesions to invasive urothelial carcinoma

A

noninvasive papillary tumors

flat noninvasive urothelial carcinoma in situ

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35
Q

_______ is the most common precursor lesions of urothelial carcinoma and it originates from ______

A

noninvasive papillary tumors, papillary urothelial hyperplasia

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36
Q

major decrease in survival in bladder cancer is associated with

A

invasion of the muscularis propria

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37
Q

the most important risk factor for urothelial carcinoma, increasing the risk threefold to sevenfold,

A

Cigarette smoking

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38
Q

exposure to this industrial compound is a risk factor for urothelial carcinoma appearing 15-40 years after first exposure

A

aryl amines like 2-napthylamine

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39
Q

parasite infection in endemic areas that have an established risk for urothelial carcinoma

A

Schistosoma haematobium

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40
Q

T/F Long-term use of analgesics is implicated as a risk for urothelial CA

A

True

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41
Q

these are mutated in the pathway for tumor progression for non-invasive papillary utothelial cancer (3)

A

FGFR3, RAS, and PI3K

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42
Q

these mutations appear earlier in the pathway for flat urothelial CIS than in non-invasive papillary lesions

A

p53 and RB

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43
Q

These bladder tumors typically arise singly as small (0.5 to 2 cm), delicate structures superficially attached to the mucosa by a stalk and their individual finger-like papillae have a central core of loose fibrovascular tissue covered by epithelium that is histologically identical to normal urothelium and are referred to as

A

exophytic papillomas

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44
Q

are completely benign lesions consisting of inter-anastomosing cords of cytologically bland urothelium that extend down into the lamina propria; they simulate an invasive process

A

inverted papillomas

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45
Q

share many histologic features with papillomas, differing only in having thicker urothelium with greater density of cells

A

Papillary urothelial neoplasms of low malignant potential (PUNLMP)

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46
Q

invasive urothelial papillary tumor with an orderly architectural appearance and low-grade cytologic atypia.The cells are evenly spaced (i.e., maintain polarity) and cohesive.There are scattered hyperchromatic nuclei, infrequent mitotic figures predominantly toward the base, and slight variation in nuclear size and shape

A

Low-grade papillary urothelial carcinomas

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47
Q

invasive urothelial tumor with papillary architecture that contain dyscohesive cells with large hyperchromatic nuclei, irregular nuclear chromatin, and prominent nucleoli. Some of the tumor cells are highly anaplastic. Mitotic figures, including atypical ones, are frequent. Architecturally, there is disarray and loss of polarity

A

High-grade papillary urothelial carcinomas

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48
Q

is defined by the presence of cytologically malignant cells within a flat urothelium. It may range from full-thickness cytologic atypia to scattered malignant cells in an otherwise normal urothelium

A

CIS (or flat urothelial carcinoma)

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49
Q

most important prognostic factor in Invasive urothelial carcinoma

A

extent of spread (stage)

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50
Q

indication for radical cystectomy or radiation therapy with neoadjuvant or adjuvant chemotherapy

A

invasion of the muscularis propria layer

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51
Q

most common symptom of bladder cancer

A

painless hematuria

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52
Q

together referred to as non–muscle-invasive bladder tumors (2)

A

Noninvasive papillary urothelial tumors and those that solely invade the lamina propria

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53
Q

these tumors are treated with intravesical instillation of an attenuated strain of Mycobacterium bovis called bacillus Calmette-Guérin (BCG) (7)

A

CIS and papillary tumors that are large, hg, multifocal, hx of recurrence, or invade the lamina propria

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54
Q

CAP T staging
Ta
Tis
T1
T2a
T2b
T3a
T3b
T4a
T4b

A

Ta - noninvasive papillary ca
Tis - urothelial CIS, flat tumor
T1 - invades lamina propria
T2a - invade superfical muscularis propria (MP)
T2b - invades deep MP
T3a - inade perivesicular soft tissue microscopically
T3b - grossly
T4a - invades, protate, seminal v, uterus or vagina
T4b - pelvic or abdominal wall

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55
Q

In addition to muscle-invasive cancers, radical cystectomy is also indicated in cases of (3)

A
  1. CIS or hg pap CA refractory to BCG and other intravesical therapies
  2. CIS extending to prostatic urethra and ducts, sites where BCG can’t reach
  3. too large
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56
Q

T/F Mixed urothelial carcinoma with areas of squamous carcinoma is more frequent than pure squamous cell carcinoma.

A

True

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57
Q

most common benign mesenchymal tumor in the bladder

A

leiomyoma

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58
Q

The most common bladder sarcoma in adults is

A

leiomyosarcoma

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59
Q

The most common bladder sarcoma in infancy or childhood is

A

embryonal rhabdomyosarcoma (sarcoma botryoides)

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60
Q

most common cause of obstruction of the bladder outlet in males is

A

benign prostatic hyperplasia (BPH)

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61
Q

Urethritis is classically divided into

A

gonococcal and non-gonococcal causes

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62
Q

triad of arthritis, conjunctivitis, and urethritis

A

reactive arthritis (formerly Reiter syndrome)

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63
Q

cause of 25% to 60% of nongonococcal urethritis in men and about 20% in women

A

Various strains of Chlamydia (e.g., Chlamydia trachomatis)

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64
Q

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

A

Urethral caruncle

65
Q

cancerous lesions originating within the distal urethra are more often

A

squamous cell carcinomas and HPV-related

66
Q

Malformation of the urethral groove and canal may create an abnormal opening either on the ventral surface of the penis (____) or on the dorsal surface (____)

A

hypospadias, epispadias

67
Q

When the orifice of the prepuce is too small to permit its normal retraction, the condition is designated____

A

phimosis

68
Q

most frequent penile neoplasms (2)

A

squamous cell carcinoma and benign genital warts

69
Q

characterized by hard penile plaques that result from the deposition of collagen in the connective tissue between the corpora cavernosa and the tunica albuginea

A

Peyronie Disease

70
Q

non–HPV-related (differentiated) penile intraepithelial noeplasia (PeIN) is associated with

A

balanitis xerotica obliterans

71
Q

Undifferentiated PeIN is composed of more overtly malignant cells and may manifest clinically as two distinct lesions

A

Bowen disease and bowenoid papulosis

72
Q

most commonly affects the penile shaft and scrotum of older men. At these sites, it appears as a solitary, thickened, gray-white, opaque plaque. In less common cases when it affects the glans, the lesion acquires a velvety red appearance. Histologically, the lesion consists of dysplastic squamous cells containing large hyperchromatic irregular nuclei and lacking orderly maturation. Mitoses, some atypical, are numerous

A

Bowen disease

73
Q

Undiff PeIN that occurs in sexually active younger adults. It presentation as multiple (rather than solitary) reddish brown papular lesions. It is etiologically related to HPV 16

A

Bowenoid papulosis

74
Q

Undiff PeIN that virtually never develops into invasive carcinoma and usually regresses spontaneously

A

Bowenoid papulosis

75
Q

T/F Circumcision confers protection from penile invasive squamous cell carcinoma

A

true

76
Q

Squamous cell carcinoma of the penis usually originates in

A

glans or inner surface of the prepuce near the coronal sulcus

77
Q

is 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

A

Cryptorchidism

78
Q

Testicular descent occurs in two phases namely

A

transabdominal phase
inguinoscrotal phase

79
Q

transabdominal phase is controlled by what hormone?

A

müllerian-inhibiting substance

80
Q

inguinoscrotal phase is dependent on what hormone

A

androgen

81
Q

most common site of arrest in cryptorchidism

A

inguinal canal

82
Q

earliest histologic change in cryptorchidism

A

thickening of the basement membrane

83
Q

T/F repositioning of testis in cryptorchidism has been proven to completely eliminate the risk of cancer

A

false

84
Q

The cryptorchid testis carries a ______fold higher risk for testicular cancer

A

3-5

85
Q

tuberculosis and gonorrhea, arise first in the epididymis and only involve the testis secondarily, while others, such as _____, involve the testis first

A

syphilis

86
Q

epididymitis in childhood is usually associated with______ and infection with ________.

A

a congenital genitourinary abnormality, gram-negative rods.

87
Q

In sexually active men younger than age 35 years most common causes of epididymitis are (2)

A

C. trachomatis and Neisseria gonorrhoeae

88
Q

In men older than age 35 the more commone causes of epididymitis are

A

E. coli and Pseudomonas

89
Q

Histologically, this type of orchitis is distinguished by granulomas restricted to spermatic tubules

A

granulomatous autoimmune orchitis

90
Q

T/F testicular involvement in mumps is more common in school-age children rather than post pubertal males

A

false, more common in postpubertal

91
Q

The morphologic pattern of the reaction in testicular syphilis takes two forms

A

1) obliterative endarteritis associated with perivascular cuffs of lymphocytes and plasma cells (2) granulomatous inflammation, a lesion known as a gumma.

92
Q

histologic hallmark of testicular syphilis

A

obliterative endarteritis associated with perivascular cuffs of lymphocytes and plasma cells

93
Q

In (children/adults?) torsion results from a bilateral anatomic defect that leads to increased mobility of the testes called _____

A

adults, bell-clapper abnormality

94
Q

The most common benign paratesticular tumor is

A

adenomatoid tumor

95
Q

The most common malignant paratesticular tumors are ____ in children and ____ in adults.

A

rhabdomyosarcoma, lipsarcoma

96
Q

most common cancer in the 15-45 age group

A

germ cell tumors

97
Q

Components of this syndrome include cryptorchidism, hypospadias, and poor sperm quality

A

testicular dysgenesis syndrome

98
Q

this syndrome is associated with a greatly increased risk (50 times normal) for development of mediastinal GCTs, but these patients do not develop testicular tumors

A

Klinefelter syndrome

99
Q

genetic loci linked to familial GCT risk (2)

A

KIT and BAK

100
Q

___ mutation is involved in the genesis of precursor lesion germ cell neoplasia in situ (GCNIS)

A

KIT

101
Q

Progression to full-blown GCTs is strongly associated with ______ a cytogenetic alteration that is invariably found in invasive GCTs regardless of histologic type

A

isochromosome 12p, a reduplication of the short arm of chromosome 12

102
Q

is the most common type of GCT

A

seminoma

103
Q

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

A

seminoma

104
Q

affected individuals are generally older

seminoma or spermatocytic tumor?

A

spermatocytic tumor

105
Q

seminoma and other GCNIS tumors are associated with this cytogenetic alteration _______, while spermatocytic tumors are associated with ____

A

isochromosome 12p, chromosome 9q

106
Q

________ are notably lacking in the morphology of spermatocytic tumor vs seminoma and is also OCT3/4____

A

inflammatory infiltrates, negative

107
Q

Germ cell tumor with neoplastic cells that have an epithelial appearance, are large and anaplastic, and have hyperchromatic nuclei with prominent nucleoli. The cell borders are usually indistinct, and there is considerable variation in cell and nuclear size and shape (pleomorphism). Mitotic figures and tumor giant cells are frequently seen.Vascular-lymphatic invasion is common

A

embryonal carcinoma

108
Q

ihc for embryonal carcinoma

A

oct3/4+, cd30+, cd117-

109
Q

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

A

prepubertal yolk sac tumors

110
Q

germ cell tumor composed of a lace-like (reticular) network of medium-sized cuboidal, flattened, or spindled cells. Eosinophilic, hyaline-like globules containing α-fetoprotein (AFP) and α1-antitrypsin are also typically seen

A

yolk sac tumor

111
Q

Yolk Sac Tumor is also known as ___ and in approximately 50% of tumors, structures resembling endodermal sinuses called ____ may be seen

A

endodermal sinus tumor, Schiller-Duval bodies

112
Q

ihc for yolk sac tumor

A

sall4+ oct3/4- cd30- glypican3+

113
Q

most aggresive GCT

A

choriocarcinoma

114
Q

malignant non–germ cell (somatic) tumors arise in postpubertal teratomas, a phenomenon referred to as ___. tumor.These non–germ cell malignancies retain isochromosome ___

A

teratoma with somatic-type malignant transformation, 12p

115
Q

the standard management of a solid testicular mass is

A

radical orchiectomy

116
Q

characteristic mode of spread of testicular tumors

A

Lymphatic spread

117
Q

serum biomoarker in germ cell tumors which correlates with the mass of tumor cells and provides a tool to assess tumor burden

A

LDH

118
Q

Both of these markers are elevated in more than 80% of individuals with nonseminomatous GCTs at the time of diagnosis

A

AFP and hCG

119
Q

Pure choriocarcinoma and mixed GCT with predominantly choriocarcinoma. prognosis?

A

poor

120
Q

is radiosensitive and chemosensitive, has the best prognosis among testicular gcts

A

seminoma

121
Q

Cells of this sex cord stromal tumor elaborate androgens and in some cases estrogens and corticosteroids as well. They may arise in children or adults. As with other testicular tumors, the most common presenting feature is testicular swelling, but in some patients gynecomastia brings them to clinical attention.

A

Leydig cell tumor

122
Q

The cytoplasm of leydig tumors frequently contains lipid droplets, vacuoles, or lipofuscin pigment and, most characteristically, rod-shaped _____

A

crystalloids of Reinke

123
Q

hormonically silent sex cord-gonadal tumor

A

sertoli cell tumors

124
Q

Histologically, the tumor cells of this sex cord tumor are arranged in distinctive trabeculae that tend to form cord-like structures and tubules

A

sertoli-cell tumors

125
Q

most common form of testicular neoplasm in men older than 60 years of age

A

Primary testicular lymphomas

126
Q

The most common testicular lymphomas, in decreasing order of frequency (3)

A

dlbcl

burkitt lymphoma

Epstein-Barr virus–positive extranodal NK/T-cell lymphoma

127
Q

a mesothelial-lined surface exterior to the testis

A

tunica vaginalis

128
Q

accumulation of serous fluid ni the tunica vaginalis

A

hydrocele

129
Q

a collection of blood in the tunica vaginalis. It is an uncommon condition usually encountered following testicular trauma or torsion, or in individuals with systemic bleeding disorders

A

hematocele

130
Q

refers to the accumulation of lymph in the tunica and is almost always found in patients with elephantiasis who have widespread, severe lymphatic obstruction caused, for example, by filariasis

A

Chylocele

131
Q

refers to a small cystic accumulation of semen in dilated efferent ducts or ducts of the rete testis

A

Spermatocele

132
Q

a dilated vein in the spermatic cord

A

Varicocele

133
Q

In a normal adult, the prostate weighs approximately ___ grams

A

20

134
Q

the prostate can be divided into four biologically and anatomically distinct regions

A

peripheral, central, transition, and periurethral zones

135
Q

Most prostatic carcinomas arise from the ____ zone

A

peripheral

136
Q

BPH arises from _____ zone

A

transitional

137
Q

most cases of acute prostatitis are caused by various strains of

A

E. coli

138
Q

Biopsy of a gland in which acute prostatitis is suspected is contraindicated, as this may lead to

A

sepsis

139
Q

Diagnosis of chronic bacterial prostatitis depends on

A

demonstration of leukocytosis in expressed prostatic secretions and positive bacterial cultures

140
Q

most common form of prostatitis

A

Chronic abacterial prostatitis

141
Q

in chronic abacterial prostatitis, e xpressed prostatic secretions contain _____ leukocytes per high-power field, and bacterial cultures are uniformly ____

A

> 10, negative

142
Q

the most common cause of Granulomatous prostatitis in the US

A

instillation of BCG for treatment of bladder cancer

143
Q

the most common benign prostatic disease in men older than age 50 years

A

bph

144
Q

activates androgen receptors (AR) in BPH

A

dihydrotestosterone (DHT)

145
Q

androgen receptors (AR) translocate from the cytoplasm to the nucleus and activate the transcription of androgen-dependent genes, which encode several growth factors and their receptors. Most important among the upregulated factors are members of the (2)

A

fibroblast growth factor (FGF) and trasforming growth factor B (TGFB)

146
Q

____ serves as a mitogen for fibroblasts and other mesenchymal cells but inhibits epithelial proliferatio, while ____, produced by stromal cells, are paracrine regulators of androgen-stimulated epithelial growth

A

TGF B and FGF

147
Q

besides androgens, ______ contribute to BPH pathogenesis by tipping the balance toward proliferation

A

estrogens

148
Q

In treatment of symptomatic bph, the ______ decrease prostate smooth muscle tone, while the _______ physically shrink the prostate by decreasing DHT synthesis

A

α-adrenergic blockers and 5α-reductase inhibitors

149
Q

second cause of cancer-related death in men

A

prostate cancer

150
Q

polymorphisms in _______, an enzyme involved in detoxification of polycyclic aromatic hydrocarbons, are linked to prostate cancer risk

A

glutathione-S-transferase (GSTP1)

151
Q

modest increase in risk of prostate CA are variants in regulatory regions that influence the expression of (4)

A

MYC
BRCA2
MMR
HOXB13

152
Q

the growth and survival of prostate cancer cells depend on

A

androgens

153
Q

The most common genetic alteration in the prostate is

A

chromosomal rearrangement of ETS family transcription factor gene (most commonly ERG or ETV1) next to the androgen-regulated TMPRSS2 promoter

154
Q

One particularly frequent early event in prostate cancer is epigenetic silencing by DNA methylation of the

A

GSTP1

155
Q

pathognomonic features of prostate cancer

A

PNI
glomerulation
mucinous fibroplasia

156
Q

are the most important prognostic factors in prostate cancer

A

Grade and stage

157
Q

Prostate cancers that reveal abundant mucinous secretions in greater than 25% of the tumor are termed

A

colloid carcinoma of the prostate

158
Q

The most aggressive variant of prostate cancer

A

small-cell carcinoma (also known as neuroendocrine carcinoma)

159
Q

The most common tumor to secondarily involve the prostate is

A

urothelial cancer

The Lower Urinary Tract and Male Genital System (1 decks)

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