Urogenital pathology

Question 1

What is the definition of nodular hyperplasia/benign postatic hyperplasia (BPH)?

Answer 1

overgrowth of the epithelium and tissue of the transition zone and periurethral area

Question 2

What are the symptoms of nodular hyperplasia/benign prostatic hyperplasia (BPH)?

Answer 2

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

Question 3

What region of the prostate does nodular hyperplasia/benign prostatic hyperplasia (BPH) occur?

Answer 3

central zone

Question 4

What are the 3 pathological changes that occur in the development of nodular hyperplasia?

Answer 4

1. Nodule formation
2. Diffuse enlargement of the transition zone and periurethral tissue
3. Enlargement of nodules

Question 5

Why does the hyperplastic process occur?

Answer 5

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

Question 6

What is the most common type of prostatic cancer?

Answer 6

prostatic adenocarcinomas

Question 7

How is prostatic cancer treated?

Answer 7

surgery - radical prostatectomy
radiation therapy
hormonal manipulation - anti-androgens

Question 8

What are the risk factors for prostate cancer?

Answer 8

age
race
inherited polymorphisms (family history)
hormone levels - androgens
environment i.e. increased consumption of fats
germline mutations of the tumour suppressor BRCA2

Question 9

What is the current grading system for prostatic carcinomas?

Answer 9

Gleason scoring system

Question 10

What blood marker can be used for suspected prostatic carcinomas?

Answer 10

Prostate specific antigen (PSA) - not very reliable

Question 11

What is the most common category of testicular tumour?

Answer 11

Germ cell tumours

Question 12

What structures are included in sex cord-gonadal stromal tumors pure form?

Answer 12

not sperm producing structures

Question 13

What medical conditions have been associated with the development of testicular germ cell tumours?

Answer 13

Prior TGCT in the contralateral testicle
Cryptorchidism - undecended testis
Impaired spermatogenesis
Inguinal hernia
Hydrocele
Disorders of sex development
Prior testicular biopsy
Atopy
Testicular atrophy

Question 14

At what age is seminoma’s most common?

Answer 14

35-45 years old
uncommon over 50
rare in children

Question 15

At what age is teratoma’s most common?

Answer 15

1st and 2nd decades of life

Question 16

What is the difference between a teratoma and seminoma?

Answer 16

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

Question 17

What is the clinical presentation of a seminoma?

Answer 17

testicular enlargement (+/- pain)
asymptomatic

Question 18

What is the clinical presentation of a teratoma?

Answer 18

gradual testicular swelling (+/- pain)

almost always benign pre-puberty

Question 19

What blood marker can be seen in seminoma?

Answer 19

elevated serum PLAP and hCG levels

Question 20

What blood marker can be seen in teratomas?

Answer 20

pure teratomaous tissue so not secrete tumour markers

Question 21

What is the appearance of seminomas?

Answer 21

well demarcated
cream colour
coarsely lobulated

Question 22

What is the appearance of teratomas?

Answer 22

well demarcated

solid/multicystic

Question 23

What is the histological appearance of seminomas?

Answer 23

polyhonal cells
clear cytoplasm
central nuclei divided into lobules by stroma

Question 24

What is the histological appearance of teratomas?

Answer 24

mixture of ectoderm, endoderm and mesoderm

Question 25

Name inflammatory conditions of the testis

Answer 25

Acute/chronic epididymoorchitis
Idiopathic granulomatous orchitis
Sarcoidosis of the testis
Malakoplakia of testis
Sperm granuloma
Tuberculous Orchitis

Question 26

What is idiopathic granulomatous orchitis?

Answer 26

older adults
UTI associated symptoms
flu like illness
testis swollen, painful and tender
can form a mass

Question 27

What is sarcoidosis of the testis?

Answer 27

can mimic malignancy, especially with pulmonary abnormalities
non necrotising granulomas

Question 28

What is malakoplakia of the testis?

Answer 28

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

Question 29

What is sperm granulomas?

Answer 29

foreign body giant cell reaction
commonly occurs after vasectomy
pain and swelling of the upper pole of the epididymis, spermatic cord and testis

Question 30

What is tuberculosis orchitis?

Answer 30

rare
painless scrotal swelling
unilateral/bilateral mass
infertility
scrotal fistula
caseating necrosis with fibrous thickening 
enlargement of structures

Question 31

What is primary hypogonadism?

Answer 31

problems with the testis itself secreting hormones

Question 32

What is secondary hypogonadism?

Answer 32

indicates a problem in the hypothalamus or the pituitary gland

Question 33

What are the primary causes of testicular failure?

Answer 33

Undescended testis
Klinefelters syndrome
Haemochromatosis
Mumps
Trauma
CF
Varicocele

Question 34

What are the secondary causes of testicular failure?

Answer 34

Pituitary failure
Drugs
Obesity
Aging