Sept11 M3-Pathology - Prostate and Testis Flashcards
most common ovarian cancer
epithelial CA (serous and endometrioid types)
most common testes cancer
germ cells (in STs)
testicular cancer def
germ cell cancer
(IMPORTANT) which testes cancers are malignant
ALL are considered malignant bc all have metastatic potential
(IMP) when to bx testicular tumor
NEVER bc of high risk of spillage in the sac and complication risk
name of germ cell tumor PRECURSOR lesion
intratubular germ cell neoplasia (ITGCN)
2 types of germ cell tumors
- seminoma (peak 35-50) (cells look like ITGCN)
- non-seminoma (peak 20-30)
non seminoma def
any tumor with one or a mix of these component
- embryonal CA
- teratoma
- yolk sac tumor
- chorioCA
ITGCN on histo
- thickened hyalinized BM
- arrest in spermatogenesis (NO SPERMATOZOA)
- neoplastic cells with lot of cyto, big nucleus, prominent nucleolus
- irregular ST contour, not round and smooth
charact of pure classic seminoma
- spread via lymphatics first (paraaortic, mediastinal, supraclavicular lymph nodes)
- BOTH radio and chemo sensitive
tx for seminoma vs non seminoma
- seminoma = both chemo and radiation
- non seminoma = only chemo (IS NOT radiation sensitive)
(imp) imp investigation modality in seminoma pt
CT to rule out metastasis to paraaortic, mediastinal, supraclavicular lymph nodes
seminoma on macro
- no necrosis
- homogenous
- multilobulated
- tan brown
non seminoma on macro
- high rate of necrosis
- lot of hemorrhage
seminoma on micro
- no glands
- only cell sheets
- thin fibrous septae
- T lymphocytes
- no nuclear overiding
- monomorphous
- rare mitosis
- no hemorrhage
embryonic CA on macro (how differs from seminoma)
- irregular surface
- paler
- more colors
- yellow white
- necrotic areas
- hemorrhage
(to know) main histo diff embryonic CA vs seminoma
embryonic CA is much more atypical
embryonic CA on histo (how differs from seminoma)
- crowding, overlaping
- cytoplasm not clear
- lot of mitosis
- nuclear polymorphisms
- so atypia = MORE AGGRESSIVE
yolk sac tumor on histo
- lot of fluid, edema between cords of cells
- no atypia like embryonic CA
- secretes AFP (in cyto of cells)
tumor marker for yolk sac tumor
AFP (alpha fetoprotein) in serum
(EXAM) typical morphological pattern of yolk sac tumor
Schiller Duval body
- papillary structure with fibrovascular center
- lining of one layer of cells
- empty cyst space in the middle
- whole thing makes AFP
chorioCA sx
- gynecomastia
- thyrotoxicosis
- bc high HCG in this tumor and HCG ressembles other hormones like TSH*
chorioCA tumor marker
HCG (bc contains cytotrophoblasts and syncytiotrophoblasts)
(important) main features of chorioCA
- syncytiotrophoblasts
- beta HCG
ovarian vs testicular teratoma
in testis, considered malignant immediately except in children (but not in ovaries, can be benign there)
(imp?) teratoma on histo
-DILATED CYSTIC STRUCTURE WITH STROMAL ELEMENTS ** CYSTICALLY DILATED MASS
(other than that, a teratoma can ressemble any tissue)
(imp?) clinical feature of teratoma, when to suspect it
- retroperitoneal mass, tumor
- features of teratoma
(imp?) typical pres of germ cell tumor
- painless testicular enlargemnet
- grows with time
- young male
painful testicular enlargement ddx
-epididymitis
-testicular torsion
-testicular infarct (vasculitis, thromboembolitic event, etc.)
NOT GCT
how to take decision to take out a GCT
- confirm mass present by echo
- rule out hydrocoele
- confirm the mass is intratesticular (can be extratesticular. paratesticular is benign)
- take out
how useful is LDH in GCT
is an indicator of how big the mass is
how to know a GCT recurred
- tumor serum markers (AFP for yolk sac tumor, HCG for chorioCA) went down to 0
- now go back up
non seminoma vs seminoma
- seminoma = lymphatic spread first, both radio and chemosensitive, less aggressive
- non seminoma = hematogenous spread early too with lymphatic, only chemosensitive, more aggresive
(imp) first line tx of GCT
- radical orchiectomy
- imaging
- if see retroperitoneal mass on imaging, chemo OR retroperitoneal lymph node dissection (if lymphovascular invasion)
- radiation if seminoma
3 reasons for choosing chemo in GCT
- elevated hormones (LDH, HCG, etc.)
- bad imaging
- bad pathology
* so just to make sure*
main charact of prostate ca
- has a hormone influence. is hormone dependent
- influenced by active metab of testo (DHT made by 5 alpha reductase)
- DHT binds androgen R in cyto, R goes in nucleus, activ prolif of cells
how prostate ca tx nowadays
combo of these androgen (testo) blocking with
- continuous LHRH agonist or intermittent LHRH antagonist
- drugs inhibiting androgenR and DHT interaction
problem with prostate ca tx
- works for 3-5 years
- after that, cancer cells bypass the androgen dependency and autostimulate themselves (make new ARs sensitive to DHT, autostimulated ARs, etc.)
name of prostate ca that fails tx after 3-5 years + charact
hormone refractory prostate cancer
- chemo works less
- radio works less
what tx comes in play in hormone refractory prostate cancer (high stage or metastatic)
anti-hormone therapy
who should be screened for PSA
- men >50
- FHx or black >40
PSA values meaning
-<4 ng per mL = normal
-4-10 ng per mL = not sure
-1-+ ng per mL = abnormal
AND NOT ALL PROSTATE CANCERS HAVE HIGH PSA
ddx of high PSA
anything changing anatomy of prostate
- prostatitis
- BPH
- infarction
tests other than PSA for screening and dx of prostate ca
- DRE (firmness + nodule)
- transrectal US with bx (US = hypoechoic area. do a random bx, not target in prostate)
(imp?) region of highest likelihood of ca in prostate
posterior (peripheral) region
(important) 2 main zones in prostate
- transition zone (just around urethra). no cancer. yes BPH = urinary obstruction
- peripheral region (cancer)
normal prostate histo
- irregular luminal contour
- large in size
- clear cyto
- 2 cell types: secretory + basal cells (between stroma and cells)
most common result of prostate bx
one of these
- benign
- HGPIN (precursor lesion of prostate ca
- adenoCA (PCA = prostate ca) = glands infiltrating cells WITHOUT basal cells
- basal cell CA is very rare
definition of benign prostate lesion
has basal cells
are present in HPGIN and benign
meaning of HGPIN
high grade prostatic intraepith neoplasia
HGPIN on histo
- same architecture as normal prostate
- several layers of cells
- prominent nucleoli
- malignant nuclei
(IMPORTANT) 3 most important histo features of prostate cancer (prostatic adenoCA) on histo
-small glands
(malignant glands are small) infiltrating in large glands = invasive adenoCA
-prominent nucleoli
-no basal cells
most important factor for prognosis and tx of prostate cancer
grading using the Gleason grading system that is ONLY BASED ON ARCHITECTURE
Gleason score calc how
addition of two Gleason grades
Gleason score meaning for prognosis
2-6 good prognosis
7 interm prognosis
8-10 poor prognosis
how to grade a region of prostate ca on histo
- grade 1-2-3 = infiltrative, glands separated, fused stroma
- grade 4 = fused glands cribiform
- grade 5 = solid single cells. no glands, no lumen
how to make a gleason score for a prostate bx (note take 12 but final score is the worst)
sum up the grade of the most common region (grade) first + 2nd most common region (grade) after
most common tx for prostate ca grade 6
nothing
most common tx for prostate ca grade 7
either of
- surgery (radical nerve sparing prostatectomy) = MOST COMMON
- radiology (radiation pathologist)
most common tx for prostate ca grade 8-10 and metastatic dz
anti-hormone therapy
(imp) most important prognostic factor to report in radical prostatectomy
- TNM (tumor, nodes, margins)
- gleason grade (3 minimum. less than 3 is not reported)
