Urogenital Pathology

Question 1

What is enlargement of the prostate? (nodular hyperplasia, or benign prostatic hyperplasia)

Answer 1

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.

Question 2

Risk factor for prostate cancer?

Answer 2

Men with germline mutations of the tumour suppressor BRCA2 have a 20-fold increased risk of developing prostate cancer.

Question 3

What are 6 risk factors of testicular cancer?

Answer 3

• Cryptorchidism (absense of testes from scrotum)
• Metachronous Testes cancer
• Positive family history
• Diethylstilbestrol exposure (synthetic, non-steroidal estrogen)
• Gonadal dysgenesis
• Androgen insensitivity syndrome

Question 4

Features of TERATOMA? (testicular tumour)

Answer 4

• Most common in 1st/2nd decades of life. (prepubertal)
• Pure teratomatous tissues don’t secrete tumour markers
• Well-demarcated solic or multicystic.

Question 5

Features of SEMINOMA? (testicular tumour)

Answer 5

• Most common in 35-45 years old
• Elevated serum PLAP and hCG seen in some
• Well-demarcated, cream-coloured, homogenous, & coarsely lobulated.

Question 6

(inflammatory conditions of the testes)

Acute and chronic Epididymoorchitis?

Answer 6

Pain, swelling & inflammation of epididymis.

Due to infections spreading from urethra (STIs) or bladder. Mumps also risk factor.

Question 7

(inflammatory conditions of the testes)

Idiopathic granulomatous orchitis?

Answer 7

Later may form a residual mass indistinguishable from a neoplasm.
No granulomas are present (but histologically appears granulomatous)

Question 8

(inflammatory conditions of the testes)

Sarcoidosis of the testes?

Answer 8

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)

Question 9

(inflammatory conditions of the testes)

Malakoplakia of testes?

Answer 9

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.

Question 10

(inflammatory conditions of the testes)

Sperm Granuloma?

Answer 10

An exuberant foreign body giant cell reaction to extravasated sperm.

Question 11

(inflammatory conditions of the testes)

Tuberculous Orchitis?

Answer 11

Caseating granulomatous inflammation is prominent, with fibrous thickening & enlargement of the epididymis etc.

Question 12

Examples of Primary and Secondary Testicular Failure?

Answer 12

Primary= undescended testis, Klinefelter syndrome, hemochromatosis, mumps, orchitis, CF, testicular torsion.
Secondary= pituitary failure, obesity & aging, drugs (glucocorticoids, chemotherapy, opioids).

Question 13

What are some causes of Urinary Tract Obstruction?

Pelvis) (Ureter- intrinsic and extrinsic) (Bladder) (Prostate

Answer 13

Pelvis: Calculi, tumours
Ureter, Intrinsic: Calculi, tumours, clots, inflammation
Ureter, Extrinsic: Pregnancy, tumours
Bladder: Calculi, tumours
Prostate: Hyperplasia, carcinoma, prostatitis
Urethra: Stricture

Question 14

What are some sequelae of urinary tract obstruction?

Answer 14

• Infection (cystitis, ureteritis, pyelitis)
• Stone/ calculi formation
• Kidney damage (acute or chronic)

Question 15

Pathogenesis of Renal Calculi/ urolithiasis?

Answer 15

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

Question 16

Classification of Renal calculi?

Answer 16

• 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

Question 17

What are some sequelae of renal calculi?

Answer 17

Haematuria, infection, squamous metaplasia… carcinoma.

Question 18

Features of Renal Cell Carcinoma?

Answer 18

3% of cancers, peak age 65-80.

Vast majority of renal cell carcinomas are clear cell.

Question 19

What is the comst common of renal cell carcinomas?

Answer 19

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.

Question 20

What are paraneoplastic syndromes? What ones are associated with RCC?

Answer 20

Clinical syndromes due to substances produced by tumours.

Associated with RCC= Cushing’s disease, hypercalcaemia, polycythaemia

Question 21

Urethelial Cell Carcinoma and presentation?

Answer 21

95% bladder tumours. Arise from the specialised multilayered epithelium.
Presentation: haematuria, urinary frequency & pain, urinary tract obstruction.