Urological histopathology Flashcards

Question

1. Describe non-invasive papillary urothelial carcinoma

Answer 1

* Appear as frond-like growths * Divided into low grade and high grade (WHO 2004) based on nuclear atypia * Low grade tumours have a low risk of progression to invasive disease (\<5%) * High grade tumours carry a higher risk of progression to invasive disease * Unstable, carry a number of genetic aberrations including in RB and TP53

Answer 2

Non-invasive Papillary Urothelial carcinoma

Answer 3

1. Urothelial tumor displaying invasive behavior 2. Treatment based on depth of invasion * Lamina propria * Muscularis propria

Answer 4

1. May be invisible or appear as a reddish area 2. Flat urothelial lesion with unequivocal high grade features - high risk of progression

Answer 5

1. Benign enlargement of prostate as a consequence of increase in cell number 2. * Very common – symptomatic in 25% of men by age 80 * Histologically present in 90% of men by age 80 3. Aetiology is not clear * Increased oestrogen levels in blood, which rises with age, may induce androgen receptors and stimulate hyperplasia * Treatment based on alpha blockers and 5⍺-reductase inhibitors as well as transurethral resection

Answer 6

Presents with “Lower Urinary Tract Symptoms” * Frequency * Nocturia * Urgency * Hesitancy * Poor flow * Terminal Dribbling May also present with urinary tract infectionl acute urinary retention or renal failure

Answer 7

1. Malignant epithelial prostate tumour 2. Epideiology * Most common malignant tumour in men * 25% of all male cancers * 1 in 8 men will develop it in their lifetime * Less prominent (but important) cause of cancer-related death * Association with red meat consumption * 5-10x risk increase if first degree relative is also affected 3. Arises from Prostatic Intraepithelial Neoplasia 4. Mutations in PTEN, AMACR, GST-pi, p27 and more…

Answer 8

* Usually asymptomatic; usually diagnosed on biopsy following raised serum prostate-specific antigen or digital rectal examination * May have lower urinary tract symptoms * Rarely may present with metastatic disease * Pathological fracture

Answer 9

* Most powerful prognositic indicator is the Gleason score * Higher scores correlate with more aggressive behavior * Expressed as x + y = z * Two most common patterns (or most common pattern and worst pattern in biopsy setting) * Patterns range from 1-5 * 1 and 2 rarely if ever diagnosed so scores typically range from 6-10

Answer 10

Gleason grade 1, 2 and 3

Answer 11

Gleason grade 5

Answer 12

1. Tumours of the testis arising from germ cells 2 * Account for 90% of testicular tumours * Typically arise in men aged 20-45 3.Risk factors include * Undescended testis (3-5x increased risk) * Low birth weight / small for gestational age 4. Malignant tumours arise from Germ Cell Neoplasia in-situ * Process likely begins in foetal life * Amplification of i12p

Answer 13

1. * Present as painless lump * 10% present with symptoms related to metastasis * Back pain * Cough * Dyspnoea * Five histological subtypes * Single tumour may be purely one subtype or contain a mixture of multiple subtypes

Answer 14

* Seminoma * Embryonal carcinoma * Post-Pubertal teratoma * Yolk sac tumor * Choriocarcinoma

Answer 15

* Highly sensitive to platinum-based chemotherapy regimes * Prognosis excellent * Five year survival is 98% in most countries

Answer 16

* Much less common than germ cell tumours * Lymphoma * Older men, 5% of all testicular tumours * Highly aggressive; poor survival rates •Leydig Cell Tumour * 3% of all testicular tumours * May present with precocious puberty if pre-pubertal * Usually benign •Sertoli Cell Tumour * 1% of testicular tumours * 90% are benign

Answer 17

1. Epididymal cyst * Benign fluid filled lump that forms in the epididymis 2Epididymitis * Usually related to C. trachomatis or N. gonnorrhoeae in men under 35; E. coli in men over 35 3. Varicocele * Dilated venous plexus 4. Hydrocele * Fluid between layers of tunica vaginalis 5. Adenomatoid Tumour * Small tubules lined by mesothelial cells

Answer 18

1.Lichen Sclerosus / Balanitis Xerotica Obliterans * Inflammatory condition that causes phimosis * Chronic, often progressive disease, which can lead to phimosis and urethral stenosis, affecting both urinary and sexual function 2.Zoon’s balanitis * Inflammatory condition that causes red areas * inflammation of the glans penis. 3.Condylomas * HPV 6 and 11 * Refers to an infection of the genitals. The two subtypes are: Condyloma acuminata, or genital warts, caused by human papilloma virus subtypes 6, 11, and others. Condylomata lata, white lesions associated with secondary syphilis. 4.Peyronie’s Disease * Scarring , inflammation, thickening of corpus cavernosa * Peyronie's disease is penis problem caused by scar tissue, called plaque, that forms inside the penis. It can result in a bent, rather than straight, erect penis. Most men with Peyronie's disease can still have sex. But for some, it can be painful and cause erectile dysfunction 5.Penile carcinoma * Rare, elderly men * Smoking, HPV, chronic Lichen Sclerosus are risk factors

Answer 19

1. Urethritis * Common causes: N. gonorrhoeae, C. trachomatis 2. Prostatic Urethral Polyp * Papillary lesion in prostatic urethra 3. Urethral Caruncle * Common lesion at urethral meatus in women 4. Urethral Carcinoma * Rare, more common in women, usually squamous cell carcinoma 5. Malignant Melanoma * Rare

Answer 20

1. Epidermoid Cyst * Common * An epidermoid cyst or epidermal inclusion cyst is a benign cyst usually found on the skin. The cyst develops out of ectodermal tissue. Histologically, it is made of a thin layer of squamous epithelium 2. Scrotal Calcinosis * Rare; may be related to old epidermoid cysts 3. Angiokeratomas * Benign vascular lesions 4. Fournier’s Gangrene * Necrotising fasciitis; mortality of 15-20% 5. Scrotal squamous cell carcinoma * Very rare * Historical interest; chimney sweep