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Renal > Urology Pathology > Flashcards

Urology Pathology Flashcards

1
Q

Name the parts of the penis

A
  • foreskin
  • glans
  • urethra
  • corpus cavernosum
  • corpus spongiosum
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2
Q

What types of HPV can cause genital warts?

A

HPV6 and 11

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3
Q

Name the two types of penile neoplasia

A

Differentiated (non HPV)

Dedifferentiated (HPV related)

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4
Q

What is the function of the testes?

A

To make sperm

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5
Q

Where is sperm made?

A

Seminiferous tubules from germ cells

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6
Q

Describe the influence of FSH and LH on the testes

A

FSH - stimulates sertoli cells and controls the tubule environment
LH - stimulates leydig cells which produce a precursor that then gets converted into testosterone

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7
Q

Define hydrocele

A

Accumulation of fluid around the testes between the two layers of the tunica vaginalis -mesothelial lining

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8
Q

Describe the clinical features of a hydrocele

A

Unicystic, smooth and fluid filled

Will transluminate

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9
Q

Describe spermatocoele

A

Cystic changes in the vas of the epididymis - asymptomatic felt on examination

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10
Q

What is varicocele?

A

Varicosities of venous plexus that drains the testis usually asymptomatic

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11
Q

Describe a testicular torsion?

A

Emergency twisting of testes and cord around the arterial supply causing ischaemia and cell death

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12
Q

How long after torsion are the testes irretrievable?

A

6 hours

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13
Q

When can torsion occur?

A

Sports but often during sleep

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14
Q

Name a type of deformity that can occur in the testes

A

Bell Clapper Deformity

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15
Q

Describe Bell Clapper deformity

A

Insertion of the tunica vaginalis is high and the testes can rotate and sit laterally

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16
Q

How heavy is the average prostate?

A

20g

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17
Q

Describe the apex of the prostate

A

Inferior and continuous with the striated sphincter

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18
Q

Describe the base of the prostate

A

Superior and continuous with the bladder neck

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19
Q

What kind of cell covers the prostatic urethra?

A

Transitional epithelium

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20
Q

Name the three zones of the prostate

A
  • transitional
  • central
  • peripheral
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21
Q

Where is the transitional zone?

A

Surrounds the prostatic urethra and is proximal to the verumontanum

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22
Q

What pathology arises from the transitional zone?

A

BPH

20% of prostate cancer

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23
Q

Describe the central zone

A

Cone shaped region surrounds the ejaculatory ducts

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24
Q

What percentage of cancers arise from the central zone?

A

1-5%

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25
Q

Where is the peripheral zone?

A

Posterolateral, majority of glandular tissue

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26
Q

What pathology presents in the peripheral zone?

A

70% of prostate adenocarcinoma

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27
Q

What happens in benign prostate hyperplasia?

A

Central and transitional zones get bigger under hormonal influence and can obstruct urine flow

28
Q

At the age of 70 what percentage of men have prostate cancer?

29
Q

State the risk factors for prostate cancer

A
  • age
  • geographic location (western world)
  • race (black)
  • family history (BRCA2 gene)
30
Q

How to people with prostate cancer present?

A 
Most often asymptomatic 
Haematuria 
Haemtospermia 
Bone pain 
Weight loss 
Anorexia
31
Q

What can a DRE of prostate cancer show?

A

Asymmetry, nodule, craggy mass

32
Q

Describe PSA

A

Glycoprotein enzyme in the secretory epithelium of the prostate gland that is involved in the liquefaction of semen

33
Q

In what circumstances does PSA increase?

A 
Prostate cancer 
BPH 
UTI
Urinary retention
Catheterisation 
DRE 
Drugs - spironolactone 
Exercise 
Sex
34
Q

What is the advantage of PSA?

A

It can prevent the need for biopsy

35
Q

What are the indications for a prostate biopsy?

A
  • Men with abnormal DRE and elevated PSA
  • Previous biopsy atypia
  • Previous normal biopsy but rising PSA trends
36
Q

How is a prostate biopsy carried out?

A

USS probe passed through rectum and prostate visualised in transverse and sagittal sections

37
Q

What are the complications associated with prostate biopsy?

A

Sepsis, bleeding, vaso-vagal fainting, haematospermia, haematuria

38
Q

What type of cancer are most prostate cancers?

A

Multifocal adenocarcinoma

39
Q

What is multifocal adenocarcinoma characterised by?

A

Sclerotic lesions

40
Q

Where does prostate cancer spread?

A

Local invasion - urethra, bladder base, seminal vesicles Perineurial invasion - autonomic nerves
Metastases - pelvic lymph nodes and skeleton

41
Q

Name the scoring system for prostate cancer?

A

Gleason - based on architectural appearance

42
Q

Describe the gleason scoring system

A 
Microscopically graded 1-5 
- loss of BM 
- loss of glandular structure 
- replacement by malignant growth 
Two most abundant are added together to give a score out of 10
43
Q

State the TNM classification for prostate cancer

A 
T1 - clinically apparent not palpable 
T2 - confined to prostate 
T3 - extends through prostatic capsule 
T4 - invades adjacent structures 
N0/N1 - no/regional nodes 
M0/M1 - no/distant mets
44
Q

What investigations can be done in addition to prostate biopsy?

A

Bone scan
MRI
CT

45
Q

If the tumour is confined to the prostate what is the treatment?

A

Radical surgery
Radiotherapy
Watch and wait (particularly in elderly)

46
Q

In locally advanced prostate cancer what is the management?

A

Radiotherapy and hormonal therapy

47
Q

What is the management in metastatic prostate cancer?

A

Androgen deprivation therapy
Diethylstilbestrol/steroids
Cytotoxic chemotherapy

48
Q

What is the mechanism of androgen deprivation therapy?

A

If prostate cells are deprived of androgenic stimulation they undergo apoptosis

49
Q

Name two types of androgen deprivation therapy

A
  • LHRH

- Anti-androgens

50
Q

How do LHRH agonists works?

A

Chronic exposure leads to down regulation of LHRH receptors and therefore suppression of LH and FSH.

51
Q

What is the initial risk of LHRH agonists? How is this avoided

A

Initially causes testosterone surge and this can cause spinal cord compression so anti-androgen is given to cover first week and two weeks after treatment

52
Q

What are the side effects of LHRH agonists?

A

Loss of libido, weight gain, hot flushes, anaemia, osteoporosis, gynaecomastia

53
Q

How do anti-androgens work?

A

Compete with testosterone and DHT for binding sites on the receptor in the prostate cell nucleus leading to apoptosis

54
Q

What are the two types of anti-androgen? What are there associated side effects?

A

Steroidal (loss of libido, ED, cardio/hepatotoxic)

Non-steroidal (maintains libido, gynaecomastia, hot flushes, hepatoxic, breast pain)

55
Q

What tumours arise from the bladder?

A

Uroepithelial

56
Q

Name two uroepithelial tumours

A
  • transitional cell

- squamous cell

57
Q

What is the epidemiology of bladder cancer?

A

Usually middle to old aged, strong association with smoking and lung cancer, more common in men

58
Q

What are most transitional cell carcinomas?

A

Papillary (finger like projections)

59
Q

What imaging is done for a suspected transitional cell carcinoma?

A 
Excretory urogram 
Sonography 
Retrograde pyelogram 
CT urography and cystoscopy 
Angiography
60
Q

What are the different variations of transitional cell carcinoma?

A

Single lesion
Multiple discrete
Diffuse and confluent
Tends to be multi centric and bilateral

61
Q

What cancer is bladder carcinoma associated with?

A

Lung
Ureter
Pelvic

62
Q

Signs on imaging

A

halo and calcification?

63
Q

How can adenocarcinoma present?

A

Can occur from background metaplasia but can also be colon cancer invasion

64
Q

Name the bladder remnant and describe the pathology that can arise

A

Urachus - from dome of bladder may remain patent and adenocarcinoma can arise

65
Q

What causes squamous cell carcinoma?

A

Persistent inflammation leading to squamous metaplasia

Renal (20 decks)

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