Urology/Gynae

Question 1

How are testicular tumours classified?

Answer 1

Germ cell tumours (95%)

• Seminomas GCTs
  
  • ~50%
  • Lymphatic spread
  • Usually localised at presentation
  • Extremely radiosensitive; good prognosis
• Non-seminomatous GCTs
  
  • Embryonal, yolk-sac, chorio, and teratomas
  • More aggressive and worse prognosis
  • Haematogenous spread
  • Highly sensitive to platinum based chemo

Stromal tumours

• Sertoli cell, Leydig cell, and Granulosa cell tumours

Lymphomas

• Older patients with scrotal or testicular masses.

Question 2

How are testicular tumours staged?

Answer 2

USS for cT stage, CT for N and M stage.

MRI adds little except for brain lesions and PET scan for GCTs has a high false negative rate.

AFP, b-hCG, and LDH should be assessed in all patients with testicular tumours.

In the TNM system for testicular tumours, the TNM findings are combined with serum tumor marker values (S) for the beta-hCG, AFP, and LDH to define prognostic stage groups from I to III.

Question 3

Classify renal calculi and their attendant risk factors or causes.

Answer 3

1. Calcium (oxylate, phosphate)
   
   • Hypercalcaemia, hyperoxaliuria (diet, meds)
   • Hyperparathyroidism
2. Struvite (magnesium, ammonium, phosphate)
   
   • Recurrent (Proteus/Klebsiella) UTIs
   • Persistently alkaline urine favours stone formation
3. Uric acid stones
   
   • Hyperuricaemia (gout)
   • Not seen well on x-ray (radioluscent)

Question 4

What are the risk factors for RCC?

What are the different histological sub-types?

Answer 4

Risk factors include obesity, smoking, hypertension, asbestos, and unopposed oestrogen therapy.

vHL syndrome predisposes to RCC (angiogenic tumours).

• 70-80% - Clear cell
• 10-15% - Papillary cell
• 5% - Chromophobe

Question 5

What are the risk factors for bladder cancer?

What are the different histological sub-types?

Answer 5

Bladder TCC and SCC are diseases due to field cancerization; chronic dysplastic conditions pre-dispose to cancer. Occupational exposure with aromatic amines in dyes and rubber, artifical sweeteners, schistosomiasis, long term IDC and bladder stones all predispose to cancer formation.

90% - TCC

5% - SCC

<2% - AdenoCa

Question 6

How are ovarian tumours classified?

Answer 6

Classified using the WHO classification. Overall 80% are benign, in young (<40) women most are benign, in older women most are malignant.

Epithelial

• Serous
• Mucinous
• Endometrioid

Sex cord-stromal

• Granulosa cell
• Sertoli-cell

Germ Cell Tumour

• Teratoma
• Dysgerminoma
• Yolk-sac tumour
• Mixed

Metastases to ovary