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Year 2(B7) - Renal > Week 3 - E - Pathology 3 - Male benign and carcinoma tumours > Flashcards

Week 3 - E - Pathology 3 - Male benign and carcinoma tumours Flashcards

1
Q

What is Bowen’s disease and what does it predispose to?

A

Bowen’s disease is squamous cell carcinoma in-situ and predisposes to SCC

Presents as leukoplakia on penis

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2
Q

What is squamous cell carcinoma in situ of the penis known as?

A

This is known as erythroplasia of Queryat

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3
Q

In both Bowen’s and Erythroplasia of Queryat there is full thickness dysplasia of epidermis. Is there any invasion deeper?

A

There is no deeper invasion

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4
Q

What is the aetiology of Erythroplasia of Queryat? (type of penis, type of virus)

A

It is almost exclusive to men with uncircumcised penises and with poor hygiene

(dirty old men)

Human Papilloma virus infection can predispose - HPV 16

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5
Q

Which part of the penis is affected in the squamous cell carcinoma in-situ?

A

Usually the glans or prepuce (foreskin) is affected

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6
Q

How does the erythroplasia of queryat present?

A

Usually with ulceration and bleeding from the penis

Eyrhtroplakia on penis - red patches

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7
Q

What is another condition that can predispose to squamous cell carcinoma?

A

Actinic keratosis - dry crusty lesions

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8
Q

SCC vs BCC of the skin Which type of sun exposure is each due to?

A

SCC - chronic long term sun expsoure (eg working outisde)

BCC - intensive short durations

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9
Q

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?

A

Circumcision if confined to prepuce (foreskin)

Give topical 5flouracil in general (or inquimod)

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10
Q

• Can affect the glans and the foreskin • White patches, fissuring, bleeding, scarring • Tight foreskin that won’t cover the glans What is this?

A

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)

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11
Q

What is the main treatment of balanitis xerotica obliterans?

A

Steroid cream

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12
Q

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?

A

Benign prostate hyperplasia

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13
Q

What is the aetiology of benign prostate hyperplasia?

A

Hormonal imbalance between oestrogen and androgens - normal with age

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14
Q

What type of incontinence do patients with BPH tend to have and why?

A

Tend to have overflow incontinence as the enlarged prostate obstructs the prostatic urethra preventing urine from passing

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15
Q

Describe when the patient attempts to pee, what may happen in BPH?

A

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

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16
Q

How is the fluid in overflow incontinence drained?

A

Using a catheter

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17
Q

In BPH, what pharmaocological treatment is usually offered first line to try and cause smooth muscle relaxation of the prostate and bladder?

A

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

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18
Q

When overflow incontinence continues in BPH, what can the hypertrophy of the detrusor wall cause?

A

It can cause diverticulum fomration

19
Q

If untreated what can the backflow of pressure cause from the bladder? Is BPH pre-malignant?

A

Can lead to hydronephrosis

NOT pre-malignant

20
Q

What is thought to be the second leading cancer related death in men in scotland?

A

Prostatic cancer

21
Q

What age group is usually affected by prostatic cancer? What part of the prostate does the cancer usualy arise?

A

Usually affects people aged older than 50 and usually arises in the peripheral gland zone

22
Q

What is latent carcinoma of the prostate most likely found in majority of very elderly men?

A

This is where there are small but asymptomatic cancer cells

23
Q

What are the ways in which prostate cancer is spread?

A

Spread via lymphatics, blood or local metastases

24
Q

What are the regional lymph nodes of the prostate? Where can they metastasis via haemategnous route?

A

The sacroiliac nodes

Can metastise to bone

25
Q

What are (in order) the five most common bone metastasising malignancies?

A

Breast

Prostate

Lung

Renal

Thyroid

26
Q

Most type of bone cancers are osteolytic (eg myeloma), how does bone cancer in prostate metastases present?

A

Is usally osteosclerotic - new (weaker) bone development

Can see the osteosclerotic bone on the lumbar spine

27
Q

What is the treatment of prostate cancer with metastases? What is the treatment if it is (rarely) localized to the prostate?

A

Radiotherapy if metastasised

Surgery if localised

28
Q

What serum marker can be risen in prostatic cancer?

A

Prostate specific antigen (PSA)

29
Q

Relatively uncommon although incidence is increasing is testicular tumours
What is a major risk factor for testicular tumours?

A

Testicular maldescent - increses risk by about 10times

30
Q

What are the usual presenting complaints of testicular cancer?

A

Painless testicular enlargement, can be associated with a hydrocele and gynaecomastia

31
Q

What type of tumour are most testicular tumours classified as?

A

Most are either teratomas or seminomas

32
Q

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?

A

Sertoli Cell

Leydig Cell - the common cause of gynaecomastia

33
Q

Germ cell tumours account for 90% of testicular tumours Which germ cell tumour is the most common cause?

A

Seminoma

34
Q

What does a seminoma tumour look like on histology?
What is the favourable prognostic factor on histology of a seminoma?

A

The tumour cells are large with a clear cytoplasm on histology

Stromal lymphocytic infiltrate on histology is a good prognostic factor

35
Q

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?

A

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)

36
Q

Even in the presence of metastases, prognosis is good in seminoma
What is the treatment that makes this so?

A

Orchidectomy with Radiotherapy - Radiosensitivity is marked.
>95% cure rate.

37
Q

Can see the large white pale tumour when chopping into the teste What serum marker is used in seminoma?

A

PLAP - placental alkaline phosphatase

38
Q

What is the next most common testicular tumour and when does it occur?

A

Teratoma

Usually occurs in young adults - around 20 but can occur in childhood

39
Q

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?

A

Malignant teratoma trophoblastic

40
Q

Trophoblastic is tissue found in normal human placenta What may trophoblastic teratomas produce as their serum marker?

A

bHCG - beta Human Chorionic Gonadotrophin

41
Q

How does the prognosis of teratoma and seminoma mixed depend on?

A

Depends on which tumour has the most malignant tissue present

42
Q

If the teratoma has yolk sac like components, what is measured? It is the same as in hepatocellular carcinoma (most common liver cancer)

A

Alpha-fetoprotein - AFP

43
Q

When is bHCG measured in pregnancy?

A

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

Year 2(B7) - Renal (51 decks)

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