Urogenital Pathology Flashcards
What is enlargement of the prostate? (nodular hyperplasia, or benign prostatic hyperplasia)
Overgrowth of the epithelium & fibromuscular tissue of the transition zone & periurethral area.
Androgens which are required for this development of BPH can not only increase cell development but also inhibit cell death.
Risk factor for prostate cancer?
Men with germline mutations of the tumour suppressor BRCA2 have a 20-fold increased risk of developing prostate cancer.
What are 6 risk factors of testicular cancer?
- Cryptorchidism (absense of testes from scrotum)
- Metachronous Testes cancer
- Positive family history
- Diethylstilbestrol exposure (synthetic, non-steroidal estrogen)
- Gonadal dysgenesis
- Androgen insensitivity syndrome
Features of TERATOMA? (testicular tumour)
- Most common in 1st/2nd decades of life. (prepubertal)
- Pure teratomatous tissues don’t secrete tumour markers
- Well-demarcated solic or multicystic.
Features of SEMINOMA? (testicular tumour)
- Most common in 35-45 years old
- Elevated serum PLAP and hCG seen in some
- Well-demarcated, cream-coloured, homogenous, & coarsely lobulated.
(inflammatory conditions of the testes)
Acute and chronic Epididymoorchitis?
Pain, swelling & inflammation of epididymis.
Due to infections spreading from urethra (STIs) or bladder. Mumps also risk factor.
(inflammatory conditions of the testes)
Idiopathic granulomatous orchitis?
Later may form a residual mass indistinguishable from a neoplasm.
No granulomas are present (but histologically appears granulomatous)
(inflammatory conditions of the testes)
Sarcoidosis of the testes?
Non-necrotizing granulomas involving testicular parenchyma. Causes occlusion & fibrosis of the ductus epididymis, so fertility may be effected.
(note= sarcoidosis is a systemic disease of unknown aetiology, that results in the formation of non-caseating granulomas in multiple organs)
(inflammatory conditions of the testes)
Malakoplakia of testes?
The tubules and interstitium are extensively infiltrated by large histiocytes that have abundant eosinophilic granular cytoplasm (von Hansemann histiocytes)- intracellular & extracellular round structures containing iron and calcium.
(inflammatory conditions of the testes)
Sperm Granuloma?
An exuberant foreign body giant cell reaction to extravasated sperm.
(inflammatory conditions of the testes)
Tuberculous Orchitis?
Caseating granulomatous inflammation is prominent, with fibrous thickening & enlargement of the epididymis etc.
Examples of Primary and Secondary Testicular Failure?
Primary= undescended testis, Klinefelter syndrome, hemochromatosis, mumps, orchitis, CF, testicular torsion. Secondary= pituitary failure, obesity & aging, drugs (glucocorticoids, chemotherapy, opioids).
What are some causes of Urinary Tract Obstruction?
Pelvis) (Ureter- intrinsic and extrinsic) (Bladder) (Prostate
Pelvis: Calculi, tumours
Ureter, Intrinsic: Calculi, tumours, clots, inflammation
Ureter, Extrinsic: Pregnancy, tumours
Bladder: Calculi, tumours
Prostate: Hyperplasia, carcinoma, prostatitis
Urethra: Stricture
What are some sequelae of urinary tract obstruction?
- Infection (cystitis, ureteritis, pyelitis)
- Stone/ calculi formation
- Kidney damage (acute or chronic)
Pathogenesis of Renal Calculi/ urolithiasis?
Excess of substances that may precipitate out (eg, Ca2+)
A change in the urine constituents causing precipitation of substances (eg change in pH)
Poor urine output (supersaturation)
Decreased citrate levels
Classification of Renal calculi?
- Calcium stones (70%): common cause is hypercalcaemia, or inability to reabsorb tubular Ca2+
- Struvite stones (15%): magnesium ammonium phosphate. Large ‘staghorn’ calculi. Urease producing bacterial infection.
- Urate stones (5%): uric acid. Hyperuricaemia (Gout, patients with high cell turnover eg. leukaemia)
- Cystine stones (1%): when an inability of kidneys to reabsorb amino acids
What are some sequelae of renal calculi?
Haematuria, infection, squamous metaplasia… carcinoma.
Features of Renal Cell Carcinoma?
3% of cancers, peak age 65-80.
Vast majority of renal cell carcinomas are clear cell.
What is the comst common of renal cell carcinomas?
Von Hippel-Lindau Syndrome (common in clear cell RCC)
VHL gene required for breakdown of Hypoxia-Inducible Factor-1 (HIF1) oncogene, so loss of gene function causes cell growth & increased cell survival.
Tumours develop in kidneys, blood vessels, pancreas.
What are paraneoplastic syndromes? What ones are associated with RCC?
Clinical syndromes due to substances produced by tumours.
Associated with RCC= Cushing’s disease, hypercalcaemia, polycythaemia
Urethelial Cell Carcinoma and presentation?
95% bladder tumours. Arise from the specialised multilayered epithelium.
Presentation: haematuria, urinary frequency & pain, urinary tract obstruction.
