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Human Reproduction > Week 4: Prostate and Testicular Pathology > Flashcards

Week 4: Prostate and Testicular Pathology Flashcards

1
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Q1 Answer

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3
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BPH AKA

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Benign prostatic hyperplasia

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BPH Histology

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17
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Q8 answer

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A. Carcinoma because cryptorchidism risks for cancer

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18
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21
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22
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Histology of mature teratoma

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23
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Histology of yolk sac tumor

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24
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Features of mature teratoma

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25
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Features of mature teratoma

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26
Q

Types of germ cell tumors

A
  • Teratoma
  • Seminoma
  • Yolk sac tumor
  • embryonal carcinoma
  • Choriocarcinoma
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27
Q

What is choriocarcinoma?

A

Choriocarcinoma is a fast-growing cancer that occurs in a woman’s uterus (womb). The abnormal cells start in the tissue that would normally become the placenta. This is the organ that develops during pregnancy to feed the fetus. Choriocarcinoma is a type of gestational trophoblastic disease

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28
Q

What is Embryonal Carcinoma?

A

Embryonal carcinoma is a germ cell tumor characterized by primitive epithelial cells with marked pleomorphism and various histologic patterns. It may present in pure form but often is part of a mixed germ cell tumor

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29
Q

GCTs AKA

A

Germ Cell Tumors

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30
Q

What is a yolk sac tumor?

A

Yolk sac tumors are those that resembles the yolk sac, allantois, and extraembryonic mesenchyme. They are also known as endodermal sinus tumors.

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31
Q

Epidemiology of yolk sac tumors

A

Yolk sac tumors (YSTs) can be seen in males and females, involving the testis, ovary, and other sites, such as the mediastinum.

Yolk sac tumors (YSTs) of the testis are observed in 2 forms or age groups:

pure YST in young children

and

mixed type in adults.

In children, yolk sac tumors (YSTs) are more common in Asians than in white or black persons. In adults, these tumors are more common in white individuals than in other races.

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32
Q

Clinical presentation of seminoma

A

The typical presentation in testicular seminoma is as follows:

  • A male aged 15-35 years presents with a painless testicular lump that has been noticeable for several days to months
  • Patients commonly have abnormal findings on semen analysis at presentation, and they may be subfertile [3]
  • Patients may present with a hydrocele, and scrotal ultrasonography may identify a nonpalpable testis tumor

Uncommon presentations include the following:

  • Testicular pain, possibly with an acute onset; may be associated with a hydrocele
  • A metastatic testis tumor may manifest as large retroperitoneal and/or chest lesions, while the primary tumor is nonpalpable
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33
Q

Seminoma risk factors

A

The risk of testis cancer is 10-40 times higher in patients with a history of cryptorchidism; 10% of patients with GCTs have a history of cryptorchidism

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34
Q

What is the most common type of GCT?

A

Seminoma (50%)

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35
Q

Seminoma spidemiology

A

peak in 30’s, almost never in infants

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36
Q

Seminoma gender analogous tumor

A

Seminom is morphologically identical tumor to dysgerminoma of the ovary in females

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37
Q

What is a Dysgerminoma?

A

An ovarian tumor that is morphologically identical tumor to seminoma of the testis in males

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38
Q

Describe the histological features of seminoma

A
  • Uniform tumor cells with abundant clear cytoplasm
  • distinct cell border
  • large central nuclei with prominent 1-2 nucleoli
  • separated into nests by fibrous septa
  • Lymphocytic and plasmacytic infiltrates in fibrous septa
  • Multinucleated giant cells (syncytiotrophoblasts) may be seen, especially in patients with elevated hCG
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39
Q

What is the most common site of prostatic carcinoma metastasis?

A

Bone

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40
Q

What is Myelophthisic anemia?

A

is a severe type of anemia found in some people wit diseases that affect bone marrow

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41
Q

What does Myelopthisis mean?

A

Myelopthisis refers to the displacement of hemopoietic bone marrow tissue by fibrosis, tumors or granulomas

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42
Q

Benign Prostatic hyperplasia AKA

A

Nodular prostatic hyperplasia

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43
Q

Nodular prostatic hyperplasia

A

Benign prostatic hyperplasia

44
Q

BPH AKA

A

Benign prostatic hyperplasia

45
Q

Benign prostatic hyperplasia epidemiology

A

common condition in olfer men

46
Q

Benign prostatic hyperplasia pathophysiology

A

The prostate becomes more sensitive to androgenic stimulation with age causing:

proliferation of both prostatic glands and stroma

47
Q

Benign prostatic hypertrophy

A

This often incorrectly refers to benign prostatic hyperplasia or Nodular prostatic hyperplasia but is technically incorrect because the number of glands and stromal cells increase rather than just the size

48
Q

Histological features of Benign Prostatic Hyperplasia

A

Proliferation of prostatic glands and stroma

49
Q

PSA AKA

A

Prostate specific antigen

50
Q

What is PSA?

A

Prostate specific antigen

51
Q

Clinical presentation of nodular prostatic hyperplasia

A
  • difficulty with urination
  • feeling of urgency
  • enlarged to twice the normal size
  • not tender to palpation
  • Slight elevation in PSA level
52
Q

Finasteride MOA

A

5α-reductase inhibitor

Decreases the formation of Dihydrotestosterone (DHT)

53
Q

Finasteride MOA in BPH

A

Decreases the formation of Dihydrotestosterone (DHT) that binds to androgen receptors in prostatic stromal and epithelial cells driving proliferation with prostate gland enlargement

54
Q

α1-adrenergic blockers MOA in BPH

A
  • diminish smooth muscle tone and somewhat more effective in trating nodular hyperplasia
55
Q

Examples of α1-adrenergic blockers

A
  • Doxazosin
  • terazosin
  • alfuzosin
  • tamsulosin
56
Q

BPH pathophysiology

A

Androgens are the major hormonal stimuli of glandular and stromal proliferation resulting in nodular prostatic hyperplasia

Testosterone production decreases with age, prostatic hyperplasia increases probably because of an increased expression of prostatic hormonal receptors that enhance the effect on any DHT that is present

57
Q

BPH Treatment

A
  • 5α-reductase inhibitors (finasteride) - diminish the prostate volume, specifically the glandular component leading to improved urine flow
  • α1-adrenergic receptor blockers (doxazosin, terazosin, alfuzosin, tamsulosin) - cause smooth muscle in the bladder neck and prostate to relax which relieves symptoms and improves urine flow immediately
58
Q

BPH Clinical presentation

A
  • Hesitancy and increased frequency
  • difficulty with urination
  • palpably enlarged prostate to 2x normal size
  • microscope appearance of “chips” nodules of glands with intervening stroma

Medscape

  • Urinary frequency
  • Urinary urgency
  • Nocturia- Needing to get up frequently at night to urinate
  • Hesitancy - Difficulty initiating the urinary stream; interrupted, weak stream
  • Incomplete bladder emptying - The feeling of persistent residual urine, regardless of the frequency of urination
  • Straining - The need strain or push (Valsalva maneuver) to initiate and maintain urination in order to more fully empty the bladder
  • Decreased force of stream - The subjective loss of force of the urinary stream over time
  • Dribbling - The loss of small amounts of urine due to a poor urinary stream as well as weak urinary stream
59
Q

Diagnosis of BPH

A

Clinical symptoms & Digital rectal examination for prostate enlargment not tender to palpation

60
Q

Prostatic carcinoma clinical presentation

A
  • Severe and constant back pain
  • 6-kg weight loss
  • firm and irregular prostate
  • Alkaline phosphatase is elevated
  • PSA is 25

Medscape

  • Urinary complaints or retention
  • Back pain
  • Hematuria
61
Q

Diagnosis of Prostatic Carcinoma

A

PSA levels

  • No PSA level guarantees the absence of prostate cancer.
  • The risk of disease increases as the PSA level increases, from about 8% with PSA levels of ≤1.0 ng/mL to about 25% with PSA levels of 4-10 ng/mL and over 50% for levels over 10 ng/mL
  • The most common site of prostatic carcinoma is bone

Digital rectal exam

  • DRE is examiner-dependent, and serial examinations over time are best
  • Most patients diagnosed with prostate cancer have normal DRE results but abnormal PSA readings

Biopsy

  • Biopsy establishes the diagnosis
  • False-negative results often occur, so multiple biopsies may be needed before prostate cancer is detected
62
Q

When to start prostate cancer screening?

A
  • 50 years of age for men at average risk who have at least a 10-year life expectancy
  • 40 or 45 years of age for African Americans and men who have had a first-degree relative diagnosed with prostate cancer before age 65 years
  • 40 years of age for men with several first-degree relatives who had prostate cancer at an early age
63
Q

Normal PSA levels

A

A normal PSA level is considered to be 4.0 nanograms per milliliter (ng/mL) of blood. For men in their 50s or younger, a PSA level should be below 2.5 in most cases. Older men often have slightly higher PSA levels than younger men.

64
Q

When should you be concerned about PSA levels?

A

The following are some general PSA level guidelines: 0 to 2.5 ng/mL is considered safe. 2.6 to 4 ng/mL is safe in most men but talk with your doctor about other risk factors. 4.0 to 10.0 ng/mL is suspicious and might suggest the possibility of prostate cancer.

65
Q

Clinical presentation of adenocarcinomas of the prostate

A
  • Typically most prostatic carcinomas are adenocarcinomas that form small glands packed back-to-back
  • May adenocarcinomas of the prostate do not produce obstructive symptoms (because mostly the tumors are in the peripheral zone)
66
Q

PSA levels and prostate adenocarcinoma

A
  • PSA is increased in prostatic adenocarcinoma
  • Total PSA is increased while free PSA is decreased
  • PSA can also increase with inflammation and nodular hyperplasias although not to a high level that increases significantly over time
67
Q

What is the Gleason score?

A

The Gleason score is calculated by adding together the two grades of prostate cancer cells that make up the largest areas of the biopsied tissue sample. The Gleason score usually ranges from 6 to 10. The lower the Gleason score, the more the cancer cells look like normal cells and are likely to grow and spread slowly

68
Q

New Prostate cancer grading system

A

ISUP grading (International Society of Urological Pathology)

69
Q

Low risk Prostate cancer to other grading systems

A

ISUP = Grade group 1

Gleason score = ≤6 (3+3)

70
Q

Intermediate favorable risk Prostate cancer to other grading systems

A

ISUP = Grade Group 2

Gleason score = 7 (3+4)

71
Q

Intermediate unfavorable risk Prostate cancer to other grading systems

A

ISUP = Grade Group 3

Gleason Score = 7 (4+3)

72
Q

High risk Prostate cancer to other grading systems

A

ISUP = Grade group 4

Gleason Score = 8

73
Q

Highest risk Prostate cancer to other grading systems

A

ISUP = Grade Group 5

Gleason Score = 9-10

74
Q

Histology of Gleason score of 1-2

A
75
Q

Histological features of Gleason score 3

A

Distinct, discrete glands

76
Q

Histological features of Gleason score 3

A
77
Q

Histological features of Gleason score 4

A
78
Q

Histological features of Gleason score 4

A
79
Q

Histological features of Gleason score 5

A
80
Q

Histological features of Gleason score 5

A
81
Q

Gleason scoring and histological features

A
82
Q

PCA AKA

A

Prostatic Carcinoma

83
Q

PCA Treatment

A
  • Surgery
  • radiation therapy
  • hormonal manipulations
  • active surveillance
  • 90% of patients expected to live 15 years
84
Q

Prostatic carcinoma Prognosis

A

90% of patients expected to live 15 years

85
Q

List of testicular and prostatic pathologies

A
86
Q

Histological features of seminoma

A
  • Morphogenically identical tumor in ovaries are called “dysgerminoma”
  • Uniform tumor cells with abundant clear cytoplasm, distinct cell border and large central nuclei with prominent 1-2 nucleoli
  • Separated into nests by fibrous septa
  • Lymphocytic and plasmacytic infiltrates in fibrous septa
  • Multinucleated giant cells (Syncytiotrophoblasts) may be seen, *especially in patients with elevated HCG*
87
Q

Yolk Sac tumor age of onset

A

2 age peaks

  • 16-18 months (Pure YST)
  • 25-35 years (YST in Mixed germ cell tumor)
88
Q

Lab findings in YST

A

>95% of YST patients have an elevated AFP level (100’s-1000’s of ng/mL)

89
Q

Pure YST associations

A

NOT associated with ITGCN or cryptorchidism

90
Q

What is the most common testicular tumor in infants and yound children?

A

Pure YST

91
Q

Pure YST commonly occurs in?

A

16-18 month old boys

92
Q

Mixed YST commonly occurs in?

A

25-35 year old men

93
Q

Histological features of YST

A
  • Multiple or variable growth patterns (12 patterns)
  • Most common are microcystic, solid and myxomatous
  • PAS+ (periodic-Acid-Schiff stain) Hyaline-like globules
  • Schiller-Duval body
94
Q

Mumps infection and the testicles

A

mumps infection tends to produce patchy bilateral testicular atrophy, usually without infertility

95
Q

Histological features of Choriocarcinoma

A
  • Hemorrhagic mass
  • Early metastases
  • Three cell types: syncytiotrophoblast, cytotrophoblast, intermediate trophoblast
96
Q

Choriocarcinoma gross histology

A
97
Q

Make a table of lab findings and testicular path

A

High AFP - YST, Embryonal Carcinoma, Teratoma

High hCG - Choriocarcinoma, Seminoma *can*, Nonseminomatous germ cell tumors - *seen in tumors that comprise pure or mixed embryonal carcinoma or choriocarcinoma*

98
Q

What is AFP?

A

AFP stands for alpha-fetoprotein. It is a protein made in the liver of a developing baby. AFP levels are usually high when a baby is born, but fall to very low levels by the age of 1. Healthy adults should have very low levels of AFP.

An AFP tumor marker test is a blood test that measures the levels of AFP in adults. Tumor markers are substances made by cancer cells or by normal cells in response to cancer in the body. High levels of AFP can be a sign of liver cancer or cancer of the ovaries or testicles, as well as noncancerous liver diseases such as cirrhosis and hepatitis.

99
Q

Mature teratoma age of onset?

A

2 age peaks:

  • < 4 years old
  • 20’s-40’s
100
Q

Forms of mature teratoma in children < 4 years old

A

Pure mature teratoma

101
Q

Forms of mature teratoma in ages 20-40’s

A

often occur as mixed germ cell tumor (50%)

102
Q

Gross histological features of mature teratoma

A
  • well-circumscribed
  • heterogenous
  • solid and cystic features
  • cysts with flaky or mucoid materials
  • mature tissue with hair, cartilage, bone or teeth
  • fleshy or hemorrhagic foci may indicate primtive elements or non-teratomous components
103
Q

Mature teratoma histological features

A
  • Ectoderm: neuronal tissue or epidermis
  • Endoderm: GI or respiratory mucosa or glands
  • Mesoderm: cartilage, bone or muscles
104
Q

Embryonal carcinoma histological features

A
  • large pleomorphic tumor cells
  • ugly cells
105
Q

Lab values of Embryonal carcinoma

A

serum AFP and hCG may be elevated

106
Q

What is the second most common pure GCT?

A

Embryonal carcinoma

Human Reproduction (40 decks)

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