Urogenital pathology Flashcards
What is nodular hyperplasia?
Enlargement of the prostate or benign prostatic hyperplasia (BPH), consists of overgrowth of the epithelium and fibromuscular tissue of the transition zone and periurethral area.
What are the symptoms of nodular hyperplasia and what is their aetiology?
Lower urinary tract symptoms (LUTS)
- urgency
- difficulty in starting urination
- diminished stream size and force
- increased frequency
- incomplete bladder emptying
- nocturia
Caused by interference with muscular sphincteric function and by obstruction of urine flow through the prostatic urethra.
What are the names given to the different zones of the prostate gland?
- Central zone
- Peripheral zone
- Transitional zone
- Periurethral zone
In which zone do most carcinomas of the prostate arise which makes them easily palpable in the rectum?
Peripheral zone
In which zone does nodular hyperplasia usually arise which makes it more likely to produce urinary obstruction early than carcinoma?
Central zone
What are the three pathological changes seen in nodular hyperplasia?
- Nodule formation
- Diffuse enlargement of the transition zone and periurethral tissue
- Enlargement of nodules
What is the aetiology of prostatic hyperplasia?
- It is believed that the main component of the “hyperplastic” process is impaired cell death.
- It has been proposed that there is an overall reduction of the rate of cell death, resulting in the accumulation of senescent cells in the prostate.
- In keeping with this androgens (mainly DHT) which are required for the development of BPH, can not only increase cellular proliferation, but also inhibit cell death.
What is the incidence of carcinoma of the prostate?
- 95% of prostatic malignancies
- rare in 40s incidence rises sharply
- PMs of men show very high level of latent cancer
- incidence much higher in men of African ancestry
How is carcinoma of the prostate treated?
- Surgery
- Radiotherapy
- hormonal manipulations
- most common treatment for localised is radical prostatectomy
Also: brachytheraphy, external beam radiotherapy
What are the risk factors for prostate cancer?
- Age
- Race
- FHx
- Hormone levels
- Environmental influences
What is the role of androgens in prostate cancer?
The importance of androgens in maintaining the growth and survival of prostate cancer cells can be seen in the therapeutic effect of castration or treatment with anti-androgens, which usually induce disease regression.
What are the risk factors for carcinoma of the prostate?
- Inherited polymorphisms
- FHx
- Germline mutations of BRCA2
What is the name of the grading system used for carcinoma of the prostate?
Gleason
Why is there currently no screening programme in the UK for prostate cancer?
- PSA test can produce false positives and negatives
- Limited benefits
- Reduced mortality vs risks of overtreatment
What is the epidemiology of testicular cancer?
Globally, testicular cancer incidence is highest among men of northern European ancestry and lowest among men of Asian and African descent.
What pre-existing conditions have been associated with the development of testicular germ cell tumours?
- Prior TGCT in the contralateral testicle
- Cryptorchidism
- Impaired spermatogenesis
- Inguinal hernia
- Hydrocele
- Disorders of sex development
- Prior testicular biopsy
- Atopy
- Testicular atrophy
What is the clinical presentation of a seminoma?
Testicular enlargement, with or without pain (>70%) and metastases (10%). Some patients with seminoma have no symptoms. Rare symptoms: gynecomastia, exophthalmos, and infertility
What identifying markers are secreted by seminomas?
Elevated serum PLAP and hCG seen in 40% and 10% of patients, respectively; the latter is the cause of gynecomastia.
What is the macroscopic appearance of seminomas?
Well-demarcated, cream-colored, homogeneous, and coarsely lobulated.
What is the microscopic appearance of seminomas?
Monotonous polygonal cells with mostly clear cytoplasm and central nuclei divided into lobules by thin bands of fibrovascular stroma.
What is the epidemiology of seminomas?
Most commonly in 35-45 years old, uncommon in men over 50 years of age, and rare in children.
What is the clinical presentation of teratomas?
Gradual testicular swelling with or without pain. Although mature teratoma is almost always benign in prepubertal patients, it can pursue an aggressive clinical course after puberty (e.g. metastasis). Immature teratoma is a common component of NSGCTs but its pure form is very rare.
What identifying markers are secreted by teratomas?
Pure teratomatous tissues do not secrete tumour markers.
What is the macroscopic appearance of teratomas?
Well-demarcated solid or multicystic.
