Urogenital Pathology

Question 1

What is BPH?

Answer 1

Benign prostatic hyperplasia - enlargement of epithelial and fibromuscular tissue in prostate

Question 2

Where does BPH usually occur?

Answer 2

TRANSITION ZONE and PERIURETHRAL ZONE - more central so compresses urethra

Question 3

What are the symptoms of BPH? (LOWER URINARY TRACT SYMPTOMS)

Answer 3

• Increased urgency/frequency
• Problems starting urination/emptying bladder
• Nocturia
• Diminished stream size and force (‘not hitting wall’)

Question 4

Where do most carcinomas of the prostate arise?

Answer 4

Peripheral zone - symptoms of BPH do not arise until very advanced

Question 5

What is the pathogenesis of BPH? What is predominant in older men? (*)

Answer 5

Nodule formation*

Enlargement of transitional and periurethral zone

Enlargement of nodules*

Question 6

What is the cause of BPH?

Answer 6

Impaired cell death resulting accumulation of senescent (old) cells in prostate

Hormone imbalance e,g, testosterone (DHT)

Question 7

What is the main type of prostate cancer?

Answer 7

Prostatic adenocarcinoma

Question 8

What is the treat for prostatic adenocarcinoma?

Answer 8

• Surgery - radical prostatectomy
• Radiotherapy
• Hormonal manipulations

Question 9

What are the risk factors for prostatic cancer?

Answer 9

Age, race, family history, environmental (increased consumption of fats)

Androgen exposure - reduced androgen exposure (with castration/anti-androgens) is associated with disease regression

BRCA2

Question 10

What grading system is used for prostatic carcinoma?

Answer 10

Gleason grade

TMN stage

Question 11

Why is there no screening programme for prostatic cancer?

Answer 11

Prostatic specific antigen - associated with false negatives/positives

Complications of treatment e.g. importance, incontinence

Unnecessary treatments/limited benefits

Question 12

What are the two functions of the testes?

Answer 12

Sperm production

Androgen production

Question 13

What are the major aetiological causes of germ cell tumours?

Answer 13

• Prior germ cell tumour in contralateral testicle
• Cryptochordism (absence of testicle(s) in scrotum - e.g undescended)
• Inguinal hernia/hydrocele (anything impairing blood flow to testicle)
• Disorder spermatogenesis
• Testicular atrophy

Question 14

What age group do seminomas most likely effect?

Answer 14

35-45 yr olds (rare >50 yrs)

Question 15

What are the clinical presentations of seminomas?

Answer 15

Pain
Testicular enlargement
Asymptomatic
Metastases
Infertility
Gynecomastia - male breasts

Question 16

What serum markers are associated with seminoma?

Answer 16

PLAP

hCG - cause of gynecomastia

Question 17

When do teratomas most commonly arise?

Answer 17

10-20yrs old

Question 18

If the patient is pre-pubescent, what is a mature teratoma considered?

Answer 18

Benign

Question 19

If the patient is post-pubescent, what is a mature teratoma considered

Answer 19

Malignant

Question 20

What serum tumour markers do teratomas secrete?

Answer 20

none

Question 21

What is the definition of orchitis?

Answer 21

Any inflammatory condition of the testes

Question 22

What are the clinical features and causes for epididymoorchitis?

Answer 22

Infective inflammation of epididymus

Fever, malaise, pain, warm, enlarged

Neutrophil invasion and inflammation

UTI (non-specific)/gonococcal infection

Question 23

What are the clinical features of an idiopathic granulomatous orchitis?

Answer 23

Older people (idiopathic = unknown cause)

Symptoms of UTI, trauma or flu-like lines

Testis = swollen painful and tender

Question 24

What is sarcoidosis of the tests?

Answer 24

Granulomas in the testes

Question 25

What is the pathogenesis and clinical characteristics of a sperm granuloma?

Answer 25

Extraversion of sperm into interstitium, resulting in inflammatory reaction (histiocytes/polymorphs) and fibrosis

Results in swelling in epididymis. Can result from result vasectomy

Question 26

What presents with bilateral/unilateral painless scrotal swelling, infertility and scrotal fistula. Prominent caseating granulomatous inflammation fibrous thickening and enlargement of epididymis and other structures?

Answer 26

TB orchitis

Question 27

What is cryptorchordisn? What is its complications?

Answer 27

Failure of testes to defend into scrotum - acquired or congenital causes

Results in testicular ischaemia and hypoxia -> testicular atrophy -> infertility/testicular cancer

Question 28

Name some primary causes of testicular failure (hypogonadism)

Answer 28

Cryptochoridism
Klinefelter syndrome
Mumps 
Orchitis
CF
testicular torsion

Question 29

Name some secondary causes of gonadal failure (hypogonadism)

Answer 29

Pituitary failure
Acing
Obesity
Steroids