Week 3 - E - Pathology 3 - Male benign and carcinoma tumours Flashcards
What is Bowen’s disease and what does it predispose to?
Bowen’s disease is squamous cell carcinoma in-situ and predisposes to SCC
Presents as leukoplakia on penis
What is squamous cell carcinoma in situ of the penis known as?
This is known as erythroplasia of Queryat
In both Bowen’s and Erythroplasia of Queryat there is full thickness dysplasia of epidermis. Is there any invasion deeper?
There is no deeper invasion
What is the aetiology of Erythroplasia of Queryat? (type of penis, type of virus)
It is almost exclusive to men with uncircumcised penises and with poor hygiene
(dirty old men)
Human Papilloma virus infection can predispose - HPV 16
Which part of the penis is affected in the squamous cell carcinoma in-situ?
Usually the glans or prepuce (foreskin) is affected
How does the erythroplasia of queryat present?
Usually with ulceration and bleeding from the penis
Eyrhtroplakia on penis - red patches
What is another condition that can predispose to squamous cell carcinoma?
Actinic keratosis - dry crusty lesions
SCC vs BCC of the skin Which type of sun exposure is each due to?
SCC - chronic long term sun expsoure (eg working outisde)
BCC - intensive short durations
What is used to treat erythroplasia of queryat if confined to the prepuce?
What can be used to treat squamous cell carcinoma in situ in general?
Circumcision if confined to prepuce (foreskin)
Give topical 5flouracil in general (or inquimod)
• Can affect the glans and the foreskin • White patches, fissuring, bleeding, scarring • Tight foreskin that won’t cover the glans What is this?
Balanitis xerotic obliterans (lichen sclerosus of the penis)
Balanitis - inflammation of the glans
Xerotica - dryness
Obliterans- obliteration / obstruction of lumen due to phimosis (foreskin cant be retracted)
What is the main treatment of balanitis xerotica obliterans?
Steroid cream
Common disorder. At least 75% of men over 70 years affected, but only about 5% have significant symptoms. It can cause hesisitancy when going to pee What is this?
Benign prostate hyperplasia
What is the aetiology of benign prostate hyperplasia?
Hormonal imbalance between oestrogen and androgens - normal with age
What type of incontinence do patients with BPH tend to have and why?
Tend to have overflow incontinence as the enlarged prostate obstructs the prostatic urethra preventing urine from passing
Describe when the patient attempts to pee, what may happen in BPH?
When attempting to pee, may have hesistancy (difficulty starting) and finding it difficult to maintain a normal flow of urine
Patient may also complain of terminal dribbling with the urine
How is the fluid in overflow incontinence drained?
Using a catheter
In BPH, what pharmaocological treatment is usually offered first line to try and cause smooth muscle relaxation of the prostate and bladder?
Alpha blockers such as tamsulosin, alfuzosin, doxazosin (Alpha Blockers (α1-Adrenoceptor antagonists))
* Alpha blockade causes relaxation of the neck of the bladder allowing for urine to be emptied
When overflow incontinence continues in BPH, what can the hypertrophy of the detrusor wall cause?
It can cause diverticulum fomration
If untreated what can the backflow of pressure cause from the bladder? Is BPH pre-malignant?
Can lead to hydronephrosis
NOT pre-malignant
What is thought to be the second leading cancer related death in men in scotland?
Prostatic cancer
What age group is usually affected by prostatic cancer? What part of the prostate does the cancer usualy arise?
Usually affects people aged older than 50 and usually arises in the peripheral gland zone
What is latent carcinoma of the prostate most likely found in majority of very elderly men?
This is where there are small but asymptomatic cancer cells
What are the ways in which prostate cancer is spread?
Spread via lymphatics, blood or local metastases
What are the regional lymph nodes of the prostate? Where can they metastasis via haemategnous route?
The sacroiliac nodes
Can metastise to bone
What are (in order) the five most common bone metastasising malignancies?
Breast
Prostate
Lung
Renal
Thyroid
Most type of bone cancers are osteolytic (eg myeloma), how does bone cancer in prostate metastases present?
Is usally osteosclerotic - new (weaker) bone development
Can see the osteosclerotic bone on the lumbar spine
What is the treatment of prostate cancer with metastases? What is the treatment if it is (rarely) localized to the prostate?
Radiotherapy if metastasised
Surgery if localised
What serum marker can be risen in prostatic cancer?
Prostate specific antigen (PSA)
Relatively uncommon although incidence is increasing is testicular tumours
What is a major risk factor for testicular tumours?
Testicular maldescent - increses risk by about 10times
What are the usual presenting complaints of testicular cancer?
Painless testicular enlargement, can be associated with a hydrocele and gynaecomastia
What type of tumour are most testicular tumours classified as?
Most are either teratomas or seminomas
Stromal cells are connective tissue cells of any organ, for example in the uterine mucosa (endometrium), prostate, bone marrow, lymph node and the ovary. They are cells that support the function of the parenchymal cells of that organ.
What are the two stromal cell tumour examples of the testes?
Sertoli Cell
Leydig Cell - the common cause of gynaecomastia
Germ cell tumours account for 90% of testicular tumours Which germ cell tumour is the most common cause?
Seminoma
What does a seminoma tumour look like on histology?
What is the favourable prognostic factor on histology of a seminoma?
The tumour cells are large with a clear cytoplasm on histology
Stromal lymphocytic infiltrate on histology is a good prognostic factor
Seminomas tend to have a haemategnous spread, what organs are usually affected if spread?
What lymph nodes are their regional nodes if spreading via lymphatics?
Spread to lungs or liver
If spreading via lymphatics will spread to the para-aortic lymph nodes as this is where there descent began
(remember lymphatics of abdomen follow arteries, limbs follow veins)
Even in the presence of metastases, prognosis is good in seminoma
What is the treatment that makes this so?
Orchidectomy with Radiotherapy - Radiosensitivity is marked.
>95% cure rate.
Can see the large white pale tumour when chopping into the teste What serum marker is used in seminoma?
PLAP - placental alkaline phosphatase
What is the next most common testicular tumour and when does it occur?
Teratoma
Usually occurs in young adults - around 20 but can occur in childhood
Differentiated Teratoma (TD) Malignant Teratoma Intermediate (MTI). Malignant Teratoma Undifferentiated (MTU). Malignant Teratoma Trophoblastic (MTT). These are the four classifications of teratoma
Which is the most malignant type?
Malignant teratoma trophoblastic
Trophoblastic is tissue found in normal human placenta What may trophoblastic teratomas produce as their serum marker?
bHCG - beta Human Chorionic Gonadotrophin
How does the prognosis of teratoma and seminoma mixed depend on?
Depends on which tumour has the most malignant tissue present
If the teratoma has yolk sac like components, what is measured? It is the same as in hepatocellular carcinoma (most common liver cancer)
Alpha-fetoprotein - AFP
When is bHCG measured in pregnancy?
Human chorionic gonadotropin is used for detecting pregnancy – if not produced by 12 days after ovulation then no pregnancy, usually good to measure if period does not come
