Week 3 (2) Flashcards
What are the majority of tumours of the penis?
Squamosu carcinoma in situ
What do both bowens disease and erythroplasia of queyrat have in common?
Full thickness dysplasia of epidermis
Who do squamous cell carcinomas of penises almost exclusively occur in?
Uncircumsised men
What are two risk factors for squamous cell carcinoma of penis?
HPV and poor hygeine
What tumour did chimney sweeps used to get?
Squamouc cell carcinoma of the scrotum
Where do squamous cell carcinoma of penis tend to occur?
Glans/prepuce
What condition is common and involves irregular proliferation of both glandular and stromal prostatic tissue?
Benign Nodular Hyperplasia of Prostate - over 70 years of age
What is the aetiology of BNH?
Hormonal imbalance - androgen/oestrogen ratio
What gland tends to be involved in BNH and is oestrogen responsive?
Centrak (peri-urethral)
What are the symtpoms of prostatism in BNH?
Difficulty starting micturition, poor stream and overflow incontinence
What disturbance can BNH cause?
Disturbance of bladder sphincter
How is BNH treated?
Alpha blockers, 5 alpjha reductse inhibitors
Is BNH pre-malignant?
NO
Name two complications of BNH?
Bladder hypertrophy and diverticulum formation
When is peak incidence of carcinoma of prostate?
60-80 years
When is there an increased risk of carcinoma of prostate?
If 1st degree reltive is affected at young age
Is carcinoma of prostate associated with BNH
No
Where do carcinoma of prostate tend to arise?
Peripheral ducts and glands, particularly posterior lobe
Is peri-urethral zone involved in carcinoma of prostate?
Yes at later stage
Can prostaste cancer remain latent?
Yes - prostate biospy with small focus of carcinoma in 85/90 year old male then tend not to treat
Where does lymphatic spread occur in carcinoma of prostate?
Sacral
Iliac
Para aortic nodes
Carcinoma of prostate causes what on radiology in relation to bones?
Osteosclerotic metastases - blood spread to lungs, liver and bone (lumbosacral area)
What biochemical test is done in prostate cancer?
Increased prostate specific antigen (PSA) - but not all prostate cancers have this
How is definitive diagnosis of prostate canacer made?
Biospy. multiple needle core under ultrasound
How are prostate cancers managed?
- hORmonak therapy - anti-androgen, oestrogens, cyproterone
- Radiotherapy - bone metastases
- Surgery - radical prostatectomy
What is the usual presenting symptom of testicular tumours?
Painless testicular enlargement - can be associated with hydrocele, gynaecomastia
If you have a maldescended testicle are you more at risk of testicular tumours?
Yes - 10 times more
What are the commonest type of testicualr tumours?
Germ cell tumours - 90%. Can be seminoma, teratoma or mixed.
Who does leukaemia testicular tumours occur in usually?
Children
Name a paratesticular tumour of the testicle?
Adenomatoid tumour
What is the commonest germ cell tumpur of testicle?
Seminoma - 30-50 years
What tumour is solid, homogenous, pale macroscopic appearance is like a potato?
Seminoma
Where does lymphatic spread occur to in seminomas?
Para-aortic lymph nodes. Blood spread to lungs and liver.
How are seminomas managed?
Radiosensitivity - 95% cure rate!
What is the peak age for teratomas (tumour arising from all three cell lines) appearing?
20-30 - can occur in children
What macroscopic appearance do teratomas have?
Variable - solid areas, cysts, haemorrhage, necrosis
Is a differentiated teratoma benign?
Yes
If there is a malignant teratoma trophoblastic teratoma (tissue resembling human placenta) is it malignant?
Yes - most malignant
What are the three testicular tumour markers?
- bHCG - trophoblastic components
- AFP (alpha feto protein) - yolk sac components
- PLAP - seminoma
Is Glomerulonephritis infective?
NO
Is GN diffuse or focal?
Mainly diffuse
What condition involves glomerular tufts with secondary tubulointerstitial changes?
Glomerulonephritis
What is pyelonephritis usually associated with?
Bacterial infection of renal pelvis, calyces, tubules and interstitium
What is the commonest organism causing pyelonephritis?
E.coli
then pseudomonas, strep. faecalis
Is pyelonephritis commoner in females or males?
Females (shorter, wider urethra)
What is the pathogenesis of pyelonephritis?
Blood-borne - sepsis or post surgery
Ascending infection - cystitis often present
Give some risk factors for pyelonephritis?
- Female
- Pregnancy
- Ureteric dilatation - stasis due to hormonal effects
- Instrumentation
- Urinary tract obstruction (calculus, stricture, neoplasm, duplex system)
- Vesico-ureteric reflux
- Diabetes
What condition involves: hypertension, uraemia, large volume of urine, coarse cortical scarring and distortion of calyces on renal imaging?
Chronic pyelonephritis
What condition comes from tuberculosis in the urinary tract - haematogenous spread from lung?
Tuberculous Pyelonephritis
What condition relates to sterile pyuria?
Tuberculous pyelonephritis
What feature of tuberculus pyelonephritis involves slow growth with progressive renakl destruction, spread to ureters, bladder?
Caseous foci - typical caseatubg granuomatous infection
Name four organissms which cause cystitis?
- E.coli
- Klebsiella
- Proteus
- Pseudomonas
What does cystitis systica result in?
Multiple small fluid filled cysts projecting into lumen. Reactive process but can resemble tumour.
In tropical africa and edgypt what can cause bladder infections?
Schistosomiasis. H. Haematobium - can cause SCC
Give a cause of urinary tract obstruction?
Prolonged bladder outlet obstruction - hypertrophy of detrusor muscle - diverticulum formation
What condition results from dilatation of pelvicalyceal system with parenchymal atrophy?
Hydronephrosis
What are the main causes of hydronephrosis?
- UT obstruction
2. Reflux
What is secondary infection of hydronephrotic kidney called?
Pyonephrosis
What is the prostatic urethra covered with?
Transitional epithelium
What part of the prostate is continuous with the bladder neck and is the superior portion?
Base
What zone of the prostate gives rise to BPH?
Transitional zone
Where do 70% of prostate adenocarcinomas occur?
Peripheral zone
What zone of the prostate surroids the ejaculatory ducts?
Central zone
What is the peak age for prostate cancer?
70-74 years
What do genetic abnormalities on chromosomes 1q, 8p, Xp and mutations on BRCA2 gene lead to?
Prostate cancer
Give some clinical features of prostate cancer presentation?
Lower UTI symtpoms
Haematuria/haematospermia
bone pain, anorexia, weight loss
What does an abnormal digital rectal exam entail?
- Asymmetry
- Nodule
- Fixed craggy mass
What is PSA?
A glycoprotein enzyme produced by the secretory epithelial cells of the prostate gland.
What enzyme is involved in the liquifaction of semen?
PSA - prostate specific antigen
In health - what are the levels of PSA like in semen and serum?
Semen - high
Serum - Low
Name other conditions which elevate PSA?
- BPH
- Prostatitis/UTIs
- Retention
- Catheterisation
- DRE
When would you do trans-Rectal USS guided prostate biospy?
- Men with abnormal DRE, an elevated PSA
- Previous biopsies showing PIN or ASAP
- Previous normal biopsies but rising PSA trends
What are the majority of prostate cancers?
Multifocal adenocarcinomas
What lesions are characterisitc in multifocal adenocarcinomas of prostate?
Sclerotic lesions
Where are adenocarcinomas of prostate most likely to mestastasise to?
Pelvic lymph nodes and the skeleton
What does the Gleason’s score base its score on?
Architectural appearance
Name three imaging modalities for staging?
- Bone scan
- MRI
- CT scan
What therapy can be used to manage locally advanced prostate cancer?
- Radiotherapy with neo-adjuvant hormonal therapy
How is metastatic prostate cancer managed?
1. Androgen deprivation therapy - (hormonal therapy LHRH analogues, anti-androgens) (bilateral subscapular orchidectomy) (maximal androgen blockade) 2. Diethylstilbesterol/steroids 3. Cytotoxic chemotherapy
What is growth of prostate cncer cells under influence of?
- Testosterone
2. Dihydrotestosterone
When treating malignant prostate cancer - what do LHRH agonists suppress?
LH and FSH and so testosterone production
List some side effects of LHRH agonists?
- Loss of libido, ED
- Hot flushes and sweats
- Weight gain
- Gynaecoimastia
- Anaemia
- Cognitive changes
- Osteoporosis
What do anti-androgens promote?
Apoptosis and inhibit CaP growth
Name some side effects of steroidal anti-androgens (cyproterone acetate)
1/ Loss of libido and ED
- Gynaecomastia
- CVS toxicity
- Hepatotoxicity
Name some side effects of non-steroidal anti0androgens (nilutamide, flutamide and bicalutamide)
Sexual interest and libido maintained. Side effects - glynaecomastia, breast pain and hot flushes, hepatotoxicity
What are 90% of uroepithelial tumours?
Transitional cells
What is the malignancy state of nonpapillary type transitional cell carcinomas?
all considered to be malignant
What can excretory urogram, sonography, retrograde pyelogram and CT all image?
Uroepithelial tumours
What appearance do papillary type uroepithelial tumours have?
Stippled appearance
What imaging diagnoses bladder carcinomas?
CT urography or cystoscopy
What sign is prsent in the urinary bladder to suggest cancer?
Halo sign
