Urogenital pathology Flashcards
What is the definition of nodular hyperplasia/benign postatic hyperplasia (BPH)?
overgrowth of the epithelium and tissue of the transition zone and periurethral area
What are the symptoms of nodular hyperplasia/benign prostatic hyperplasia (BPH)?
Symptoms are caused by interference with muscular sphincteric function and obstruction of urine flow through the prostatic urethra
urgency
hesitancy
diminishing stream size and force
increased frequency
incomplete bladder emptying/terminal dribbling
nocturia
What region of the prostate does nodular hyperplasia/benign prostatic hyperplasia (BPH) occur?
central zone
What are the 3 pathological changes that occur in the development of nodular hyperplasia?
- Nodule formation
- Diffuse enlargement of the transition zone and periurethral tissue
- Enlargement of nodules
Why does the hyperplastic process occur?
overall reduction in the rate of cell death
causes the build up of senescent cells (cells that fail to divide)
DHT (androgens) increase celluar proliferation and inhibit cell death
What is the most common type of prostatic cancer?
prostatic adenocarcinomas
How is prostatic cancer treated?
surgery - radical prostatectomy
radiation therapy
hormonal manipulation - anti-androgens
What are the risk factors for prostate cancer?
age
race
inherited polymorphisms (family history)
hormone levels - androgens
environment i.e. increased consumption of fats
germline mutations of the tumour suppressor BRCA2
What is the current grading system for prostatic carcinomas?
Gleason scoring system
What blood marker can be used for suspected prostatic carcinomas?
Prostate specific antigen (PSA) - not very reliable
What is the most common category of testicular tumour?
Germ cell tumours
What structures are included in sex cord-gonadal stromal tumors pure form?
not sperm producing structures
What medical conditions have been associated with the development of testicular germ cell tumours?
Prior TGCT in the contralateral testicle Cryptorchidism - undecended testis Impaired spermatogenesis Inguinal hernia Hydrocele Disorders of sex development Prior testicular biopsy Atopy Testicular atrophy
At what age is seminoma’s most common?
35-45 years old
uncommon over 50
rare in children
At what age is teratoma’s most common?
1st and 2nd decades of life
What is the difference between a teratoma and seminoma?
Teratoma: tumor with tissue or organ components resembling normal derivatives of more than one germ layer e.g. hair, teeth, bones
Seminoma: originates in the germinal epithelium of the seminiferous tubules
What is the clinical presentation of a seminoma?
testicular enlargement (+/- pain) asymptomatic
What is the clinical presentation of a teratoma?
gradual testicular swelling (+/- pain)
almost always benign pre-puberty
What blood marker can be seen in seminoma?
elevated serum PLAP and hCG levels
What blood marker can be seen in teratomas?
pure teratomaous tissue so not secrete tumour markers
What is the appearance of seminomas?
well demarcated
cream colour
coarsely lobulated
What is the appearance of teratomas?
well demarcated
solid/multicystic
What is the histological appearance of seminomas?
polyhonal cells
clear cytoplasm
central nuclei divided into lobules by stroma
What is the histological appearance of teratomas?
mixture of ectoderm, endoderm and mesoderm
Name inflammatory conditions of the testis
Acute/chronic epididymoorchitis Idiopathic granulomatous orchitis Sarcoidosis of the testis Malakoplakia of testis Sperm granuloma Tuberculous Orchitis
What is idiopathic granulomatous orchitis?
older adults UTI associated symptoms flu like illness testis swollen, painful and tender can form a mass
What is sarcoidosis of the testis?
can mimic malignancy, especially with pulmonary abnormalities
non necrotising granulomas
What is malakoplakia of the testis?
commonly affects one testis but can affect both and epididymis
soft yellow/brown nodules
tubules and interstitium are filled with large histiocytes with eosinophilic granular cytoplasms
What is sperm granulomas?
foreign body giant cell reaction
commonly occurs after vasectomy
pain and swelling of the upper pole of the epididymis, spermatic cord and testis
What is tuberculosis orchitis?
rare painless scrotal swelling unilateral/bilateral mass infertility scrotal fistula caseating necrosis with fibrous thickening enlargement of structures
What is primary hypogonadism?
problems with the testis itself secreting hormones
What is secondary hypogonadism?
indicates a problem in the hypothalamus or the pituitary gland
What are the primary causes of testicular failure?
Undescended testis Klinefelters syndrome Haemochromatosis Mumps Trauma CF Varicocele
What are the secondary causes of testicular failure?
Pituitary failure
Drugs
Obesity
Aging
