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Path 21 Male Repro
LECOM Path Ch 21 The Lower Urinary Tract and Male Genital System
| Question | Answer |
|---|---|
| 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
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