Urogenital Pathology Flashcards
What is nodular hyperplasia?
- Benign prostatic hyperplasia
- Enlargement of the prostate
- Overgrowth of epithelium & fibromuscular tissue of the transition zone & periurethral area
What are the symptoms of benign prostatic hyperplasia?
- Caused by interference with muscular sphincter function
- Obstruction of urine flow through prostatic urethra
- LUTs
- Urgency & inc frequency
- Difficulty starting urination
- Diminished stream size
What is the pathogenesis of nodular hyperplasia?
- Most carcinomas arise from peripheral glands
- Nodular hyperplasia arises more centrally situated glands
- More likely to produce urinary obstruction earlier than carcinoma
What are the zones in the normal prostate?
- Central zone
- Peripheral zone
- Transitional zone
What are the 3 pathological changes in nodular hyperplasia?
- Nodule formation
- Enlargement of nodules
- Diffuse enlargement of the transitional zone & periurethral tissue
What is the aetiology of nodular hyperplasia?
- Impaired cell death
- Overall reduction of the rate of cell death resulting in accumulation of senescent cells in prostate
- Androgens(DHT) needed for development of BPH=inc cell proliferation & inhibit cell death
What are risk factors of carcinoma of the prostate?
- Age
- Race
- Family history
- Hormone levels
- Environmental influences
- Inherited polymorphisms
What pre-existing conditions can be linked to testicular tumours?
- Inguinal hernias
- (testicular) Atrophy
- Hydrocele
- Cryptorchidism
- Impaired spermatogenesis
- Disorders of sex development
What are the 2 main types of testicular tumours?
- Teratoma=young, gradual testicular swelling, benign before puberty, complete resection, chemoresistant, poor prognosis, AFP elevated, painless testicular mass
- Seminoma=common(50%), middle aged, testicular enlargement w/metastasis, painless mass, abdo discomfort, b-HCG&PLAP elevated, AFP normal, yellow nodules uniform/lobulated, testicular removal &chemo, good prognosis
- TNM staging
What are acute inflammatory conditions of the testes?
- Acute & chronic epididymoorchitis
- Idiopathic granulomatous orchitis
- Sarcoidosis
- Malakoplakia
- Myofibroblastic pseudotumor
- Sperm granuloma
- Tuberculous Orchitis
What is Myofibroblastic pseudotumor?
Atypical inflammation & myofibroblastic reaction with fasciitis like large cells, benign
What is Malakoplakia?
soft yellow nodules replacing normal parenchyma, tubules & interstitium infiltrated by large histiocytes
What is Sarcoidosis?
mimic malignancy, non-necrotizing granulomas involving testicular parenchyma
What is acute & chronic epididymoorchitis?
- Bacterial infection causing inflammation of the epididymis +/- testis
- Infarct seminiferous tubules surrounded by purulent exudate
What is Idiopathic granulomatous orchitis?
Older adults, swollen/painful/tender testis, mass formation
What is sperm granuloma?
Foreign body giant cell reaction to extravasated sperm, pain& swelling upper pole of epididymis/spermatic cord, sometimes after vasectomy
What is tuberculous Orchitis?
In epididymis, secondary testicular involvement, painless scrotal swelling, scrotal fistula, caseating granulomatous inflammation w/fibrous thickening & enlarged epididymis
What is Cryptorchidism?
- Empty scrotum (usually in inguinal canal or upper scrotum)
- Congenital
- Acquired=post-op, inability of spermatic vessels to grow adequately
- Complications= testicular atrophy, infertility, carcinomas
What is testicular failure? What are the symptoms?
Primary= undescended testis, mumps, klinefelter syndrome, orchitis, CF, varicocele, testicular torsion
Secondary= drugs, obesity, ageing, pituitary failure
-Dec height, gynecomastia, infertility, lack of muscle mass/libido, loss of armpit & pubic hair, voice changes
Why/why not screen for prostate cancer?
- Reduces mortality-caught early before symptoms develop
- PSA not tumour specific inc naturally in older age
- Overtreat/diagnose
Describe prostatic carcinoma
- Prognosis=Potentially curable
- Staging=TNM staging
- Pathology=95%-adenocarcinoma developing fom acini of prostatic ducts
- Mortality= no.1 for male cancer mortality
