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Path 21 Male Repro

LECOM Path Ch 21 The Lower Urinary Tract and Male Genital System

Lymphocyte aggregates forming germinal centers in subepithelium of ureters Dx? ureteritis follicularis
Fine cysts lined by flattened urothelium in ureters Dx? ureteritis cystica
Fibrous proliferative inflammatory process encasing retroperitoneal stuctures and can cause hydronephrosis. Dx? 2 Drug causes, name of idiopathic Dx? Sclerosisng Retroperitoneal Fibrosis; ergot derivatives, Beta blockers; Ormond disease
MC type of bladder diverticula acquired
MCC of acquired bladder diverticula prostate enlargement
Developmental defect in anterior wall of abdomen and bladder. Dx and predisposes to? Exstrophy and adenocarcinoma
20-40% of bladder adenocarcinomas arise from these urachal cysts
4 MCC of infectious cystitis E.coli; Proteus; Klebsiella; Enterobacter
Common cause of cystitis in Egypt and what it predisposes to? Schistosomiasis; squamous cell carcinoma
2 common causes of hemorrhagic cystitis cyclophosphamide and adenovirus
Aggregates of lymphocytes into follicles in bladder mucosa Dx? Follicular cystitis
Persistant, painful form of chronic cystitis usually in women, no sign of infection, fissures and punctate hemorrhages in bladder mucosa Dx? Interstitial cystitis/ Chronic Pelvic Pain Syndrome
Yellow/white plaque, with large, foamy macrophages with multinucleated giant cells Dx? malacoplakia
BUZZ: Michaelis-Gutmann bodies Dx? And description malacoplakia; laminated mineral concretions of calcium in lysosomes in macrophages
2 MC infections associated with malacoplakia? E.coli and Proteus
Nests of urothelium growing downward into lamina propria with epithemial transformation into cuboidal or columnar epithelium Dx? Cystiitis glandularis
Nests of urothelium growing downward into lamina propria with epithemial transformation into cystic spaces filled with clear fluid lined by flattened urothelium Dx? Cystiitis cystica
Lesions in bladder that resemble renal tubules with cuboidal epithelium Nephrogenic Adenoma
MC origin of bladder tumors epithelium
2 precurson lesions of invasive urothelial cancer; in order MC non-invasive papillary tumor; CIS/flat non-invasive urothelial carcinoma
Epithelial lesion with cytologic malignant changes, confined to epithelium without BM invasion. Dx? CIS
With invasive bladder cancer, the major decrease in survival is associated with what? invasion of the muscularis propria
4 levels of WHO/ISUP Grades of urothelial tumors urothelial papilloma; urothelial neoplasm of low malignant potential; Papillary carcinoma, low grade; “”, high grade
2 Differences in Papilloma and PUNLMP thicker urothelium or diffuse nuclear enlargement
Mass of orderly, evenly spaced cells, with scattered hyperchromic muclei and infrequent mitotic figures; in bladder. Dx? Low-Grade papillary urothelial carcinomas
Mass of disordered cells in bladder; large hyperchromatic nuclei, frequent mitotic figures Dx? Hig-grade papillary urothelial cancer
Likelihood of Low and High grade bladder cancers to invade 10% and 80%
MC metastatic spread of invasive bladder CA regional lymph nodes
Untreated CIS progresses to what? And how often? muscularly invasive cancer 50-75%
Most important factor at determining outlook for invasive urothelial cancer ? extent of spread/staging
7 Staging of bladder carcinoma goes from what to what ? Ta;Tis;T1;T2;T3a;T3b;T4
7 Levels of invasion for staging of bladder cancer non-invasive/papillary; CIS; Lamina Propria; Muscularis propria; microscopic extra-vesicular invasion; grow exra-vesicular invasion; Invades adjacent structures
Most important influence/ risk factor for urothelial bladder cancer cigarette smoking
2 genetic implications in bladder cancer chromosome 9: p16(INK4a); 17p: p53
Can be the only symptom is bladder tumors painless hematuria
Do urothelial tumors tend to come back / show new growths after excision? yes
10 yr survival for Papillomas, PUNLMP, and low grade papillary carcinomas 98%
Likelihood of death in High grade Papillary urothhelial carcinoma 25%
MCC of bladder obstruction in men prostatic enlargement
MCC of bladder obstruction in women cystocele
Signs of early bladder obstruction smooth muscle hypertrophy
Progressive bladder smooth muscle hypertrophy secondary to obstruction leads to ? trabeculation of the bladder wall
Acute or terminal bladder obstruction can cause gross dilation of the bladder
2 classifications of urethritis gonococcal and non-gonococcal
25-60% of non-gonococcal urethritis in men is caused by Chlamydia
Other common cause of non-gonococcal urethritis (not chlamydia) mycoplasma (ureaplasma)
MC congenital abnormality of urethral malformation hypospades
HPV type most associated with condyloma acuminatum type 11
Solitary, thickened gray-white opaque plaque on the shaft of a 50yo man. Dysplastic cells, numerous mitosis, hyperchromatic nuclei, intact BM. Dx? Bowen disease
Multiple reddish brown popular lesions on a 20yo sexually active males shaft, dysplastic cells, intact BM. Dx? Bowenoid papulosis
HPV type associated with bowen disease HPV type 16
Squamous cell carcinoma of the penis is more common where… people aren’t circumcised
HPV associated with squamous cell carcinoma (2) HPV type 16 and 18
1st phase of testicular descent is mediated by what? mullerion-inhibiting substance
2nd phase of testicular descent is mediated by what? androgen induced releace of calcitonin gene-related peptide
Cells spared in testicular wasting in cryptorchidism Leydig cells (interstitial cells)
Findings of testicular atrophy in cryptorchidism thickened BM, tubules appear as dense cords of hyaline connective tissue
Syphilis affects what area in the scrotum first? testis
Gonorrhea and tuberculosis affect what area in the scrotum first? epididymis
MCC of epididymitis in children gram negative rods
MCC of epididymitis in sexually active men under 35 c. trachomatic and N. gonorrhea
MCC of epididymitis in men over 35? E.coli and pseudomonas
Diffuse granulomatous reaction throughout testis and confined to the seminiferous tubules Dx? Granulomatous/Autoimmune Orchitis
Frank abscess in the epididymis is characteristic of gonorrhea
1 week after parotid glands start to well in 20yo male he has pain in his testicles Dx? mumps
Caseating granulomas throughout testicle, in all tissue, but started in the epididymis Dx? tuberculosis
Testicular pain with edema, obliterative endarteritis with perivascular cuffing of lymphocytes and plasma cells Dx? Syphilis
95% of testicular tumors arise from germ cells
MC tumor of men from 15-34 germ cell tumors of the testicles
Most important risk factor for Germ cell tumors of the testicle cryptorchidism
MC testicular tumor seminoma
Invasive tumors of the testicles all have this chromosomal change additional copies of 12p
Seminomas and precursor ITGCN lesions retain expression of what 2 proteins OCT3/4 and NANOG
Large testicular mass; homogenous, grey-white, lobulated with no hemorrhage or necrosis Dx? classical seminoma
Seminoma cells are usually positive for what 3 markers c-KIT, OCT3/4, PLAP
Testicular mass, cells are large, round, distinct cell membrane, clear cytoplasm, large central nuclei w/ nucleoli. No hemorrhage or necrosis Dx? seminoma
Other histologic finding in seminomas ill-formed granulomas, lymphocytes, synciotrophoblasts
Difference in seminoma vs spermatocytic seminoma older age, doesn’t mets, no lymphs, granulomas or synciotrophoblasts, also have 3 different types of cells
Age group of embryonal carcinoma 20-30
Seminoma and embryonal carcinoma share and differ in what markers share OCT3/4 and PLAP; Differ: Embryonal carcinoma is c-KIT negative and cytokeratin and CD30 positive
Poorly demarked testicular mass, with foci of hemorrhage and necrosis, cells large, indistinct borders, anaplastic with epithelial appearance, mitotic figures and giant cells present. Locally invasive. Dx? embryonal carcinoma
MC testicular tumor in infants and children up to 3yo yolk sac tumor
Tumor cells positive for AFP and alpha 1 antitrypsin are yolk sac tumors
Spread of testicular tumors lymph to retroperitoneal para-aortic nodes and hematogenous spread to lungs
Seminomas present in what clinical stage Stage 1, local
NSGCT presents in what stage Stage 2 or 3 in 60% of cases
These tumors metastasize earlier and use hematogenous spread more often NSGCT
Elevation of this in the blood relates to the size of a testicular tumor lactate dehydrogenase
Gynecomastia is a presenting symptom in what tumor Leydig cell tumor
Golden-brown cut surface of 5mm nodules in testicle. Large round cells, abundant eosinophilic granular cytoplasm with rod shaped crystaloids of Reinke Dx? Leydig cell tumor
Firm small nodules in testicle, grey-white/yellow cut surface, with corlike structures and tubules Dx? Sertoli Cell tumors
MC testicular neoplasm in men over 60yo aggressive Non-Hodgkin lymphoma
Most hyperplasias arise in what zone of the prostate? transitional zone
Carcinomas usually arise in what zone of the prostate? peripheral
The main component of the hyperplastic process in BPH is impaired cell death
Main androgen in the prostate DHT
Enzyme that converts testosterone to DHT and where it is found type II 5alpha reductase; stromal cells
Most important factor mediating paracrine regulation of androgen timulated prostatic growth FGF-7
Hallmark of BPH grossly is nodularity
MC used and effective medical treatment of BPH is alpha blockers
MC form of cancer in men in the US is adenocarcinoma of the prostate
2 MC causes of cancer mortality in men in the US colorectal and prostatic
Someone with the shortest CAG repeats in X-linked AR gene are more or less likely to have prostate cancer? more likely black and whites have short CAG repeats
Overexpression of this transcription factor makes prostate cells more invasive ETS
How does prostate cancer mets? lymph first to obturator nodes then para-aortic. Blood to the bones of the axial skeleton
Created by: csheck