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Bloc I - Reproduction > Sept11 M3-Pathology - Prostate and Testis > Flashcards

Sept11 M3-Pathology - Prostate and Testis Flashcards

1
Q

most common ovarian cancer

A

epithelial CA (serous and endometrioid types)

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2
Q

most common testes cancer

A

germ cells (in STs)

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3
Q

testicular cancer def

A

germ cell cancer

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4
Q

(IMPORTANT) which testes cancers are malignant

A

ALL are considered malignant bc all have metastatic potential

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5
Q

(IMP) when to bx testicular tumor

A

NEVER bc of high risk of spillage in the sac and complication risk

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6
Q

name of germ cell tumor PRECURSOR lesion

A

intratubular germ cell neoplasia (ITGCN)

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7
Q

2 types of germ cell tumors

A
  • seminoma (peak 35-50) (cells look like ITGCN)

- non-seminoma (peak 20-30)

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8
Q

non seminoma def

A

any tumor with one or a mix of these component

  • embryonal CA
  • teratoma
  • yolk sac tumor
  • chorioCA
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9
Q

ITGCN on histo

A
  • 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
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10
Q

charact of pure classic seminoma

A
  • spread via lymphatics first (paraaortic, mediastinal, supraclavicular lymph nodes)
  • BOTH radio and chemo sensitive
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11
Q

tx for seminoma vs non seminoma

A
  • seminoma = both chemo and radiation

- non seminoma = only chemo (IS NOT radiation sensitive)

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12
Q

(imp) imp investigation modality in seminoma pt

A

CT to rule out metastasis to paraaortic, mediastinal, supraclavicular lymph nodes

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13
Q

seminoma on macro

A
  • no necrosis
  • homogenous
  • multilobulated
  • tan brown
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14
Q

non seminoma on macro

A
  • high rate of necrosis

- lot of hemorrhage

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15
Q

seminoma on micro

A
  • no glands
  • only cell sheets
  • thin fibrous septae
  • T lymphocytes
  • no nuclear overiding
  • monomorphous
  • rare mitosis
  • no hemorrhage
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16
Q

embryonic CA on macro (how differs from seminoma)

A
  • irregular surface
  • paler
  • more colors
  • yellow white
  • necrotic areas
  • hemorrhage
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17
Q

(to know) main histo diff embryonic CA vs seminoma

A

embryonic CA is much more atypical

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18
Q

embryonic CA on histo (how differs from seminoma)

A
  • crowding, overlaping
  • cytoplasm not clear
  • lot of mitosis
  • nuclear polymorphisms
  • so atypia = MORE AGGRESSIVE
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19
Q

yolk sac tumor on histo

A
  • lot of fluid, edema between cords of cells
  • no atypia like embryonic CA
  • secretes AFP (in cyto of cells)
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20
Q

tumor marker for yolk sac tumor

A

AFP (alpha fetoprotein) in serum

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21
Q

(EXAM) typical morphological pattern of yolk sac tumor

A

Schiller Duval body

  • papillary structure with fibrovascular center
  • lining of one layer of cells
  • empty cyst space in the middle
  • whole thing makes AFP
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22
Q

chorioCA sx

A
  • gynecomastia
  • thyrotoxicosis
  • bc high HCG in this tumor and HCG ressembles other hormones like TSH*
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23
Q

chorioCA tumor marker

A

HCG (bc contains cytotrophoblasts and syncytiotrophoblasts)

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24
Q

(important) main features of chorioCA

A
  • syncytiotrophoblasts

- beta HCG

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25
Q

ovarian vs testicular teratoma

A

in testis, considered malignant immediately except in children (but not in ovaries, can be benign there)

26
Q

(imp?) teratoma on histo

A

-DILATED CYSTIC STRUCTURE WITH STROMAL ELEMENTS ** CYSTICALLY DILATED MASS
(other than that, a teratoma can ressemble any tissue)

27
Q

(imp?) clinical feature of teratoma, when to suspect it

A
  • retroperitoneal mass, tumor

- features of teratoma

28
Q

(imp?) typical pres of germ cell tumor

A
  • painless testicular enlargemnet
  • grows with time
  • young male
29
Q

painful testicular enlargement ddx

A

-epididymitis
-testicular torsion
-testicular infarct (vasculitis, thromboembolitic event, etc.)
NOT GCT

30
Q

how to take decision to take out a GCT

A
  1. confirm mass present by echo
  2. rule out hydrocoele
  3. confirm the mass is intratesticular (can be extratesticular. paratesticular is benign)
  4. take out
31
Q

how useful is LDH in GCT

A

is an indicator of how big the mass is

32
Q

how to know a GCT recurred

A
  • tumor serum markers (AFP for yolk sac tumor, HCG for chorioCA) went down to 0
  • now go back up
33
Q

non seminoma vs seminoma

A
  • seminoma = lymphatic spread first, both radio and chemosensitive, less aggressive
  • non seminoma = hematogenous spread early too with lymphatic, only chemosensitive, more aggresive
34
Q

(imp) first line tx of GCT

A
  1. radical orchiectomy
  2. imaging
  3. if see retroperitoneal mass on imaging, chemo OR retroperitoneal lymph node dissection (if lymphovascular invasion)
  4. radiation if seminoma
35
Q

3 reasons for choosing chemo in GCT

A
  1. elevated hormones (LDH, HCG, etc.)
  2. bad imaging
  3. bad pathology
    * so just to make sure*
36
Q

main charact of prostate ca

A
  • 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
37
Q

how prostate ca tx nowadays

A

combo of these androgen (testo) blocking with

  • continuous LHRH agonist or intermittent LHRH antagonist
  • drugs inhibiting androgenR and DHT interaction
38
Q

problem with prostate ca tx

A
  • 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.)
39
Q

name of prostate ca that fails tx after 3-5 years + charact

A

hormone refractory prostate cancer

  • chemo works less
  • radio works less
40
Q

what tx comes in play in hormone refractory prostate cancer (high stage or metastatic)

A

anti-hormone therapy

41
Q

who should be screened for PSA

A
  • men >50

- FHx or black >40

42
Q

PSA values meaning

A

-<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

43
Q

ddx of high PSA

A

anything changing anatomy of prostate

  • prostatitis
  • BPH
  • infarction
44
Q

tests other than PSA for screening and dx of prostate ca

A
  • DRE (firmness + nodule)

- transrectal US with bx (US = hypoechoic area. do a random bx, not target in prostate)

45
Q

(imp?) region of highest likelihood of ca in prostate

A

posterior (peripheral) region

46
Q

(important) 2 main zones in prostate

A
  • transition zone (just around urethra). no cancer. yes BPH = urinary obstruction
  • peripheral region (cancer)
47
Q

normal prostate histo

A
  • irregular luminal contour
  • large in size
  • clear cyto
  • 2 cell types: secretory + basal cells (between stroma and cells)
48
Q

most common result of prostate bx

A

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
49
Q

definition of benign prostate lesion

A

has basal cells

are present in HPGIN and benign

50
Q

meaning of HGPIN

A

high grade prostatic intraepith neoplasia

51
Q

HGPIN on histo

A
  • same architecture as normal prostate
  • several layers of cells
  • prominent nucleoli
  • malignant nuclei
52
Q

(IMPORTANT) 3 most important histo features of prostate cancer (prostatic adenoCA) on histo

A

-small glands
(malignant glands are small) infiltrating in large glands = invasive adenoCA
-prominent nucleoli
-no basal cells

53
Q

most important factor for prognosis and tx of prostate cancer

A

grading using the Gleason grading system that is ONLY BASED ON ARCHITECTURE

54
Q

Gleason score calc how

A

addition of two Gleason grades

55
Q

Gleason score meaning for prognosis

A

2-6 good prognosis
7 interm prognosis
8-10 poor prognosis

56
Q

how to grade a region of prostate ca on histo

A
  • grade 1-2-3 = infiltrative, glands separated, fused stroma
  • grade 4 = fused glands cribiform
  • grade 5 = solid single cells. no glands, no lumen
57
Q

how to make a gleason score for a prostate bx (note take 12 but final score is the worst)

A

sum up the grade of the most common region (grade) first + 2nd most common region (grade) after

58
Q

most common tx for prostate ca grade 6

A

nothing

59
Q

most common tx for prostate ca grade 7

A

either of

  • surgery (radical nerve sparing prostatectomy) = MOST COMMON
  • radiology (radiation pathologist)
60
Q

most common tx for prostate ca grade 8-10 and metastatic dz

A

anti-hormone therapy

61
Q

(imp) most important prognostic factor to report in radical prostatectomy

A
  • TNM (tumor, nodes, margins)

- gleason grade (3 minimum. less than 3 is not reported)

Bloc I - Reproduction (57 decks)

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