Lut - Male Genital System Pathology - Kort

Front 1

Part of the LOWER URINARY TRACT that are lined by special form of transitional epithelium - UROTHELIUM

Back 1

1. Renal pelvis

2. Ureters

3. Bladder

4. Urethra ( except *terminal portion)

Front 2

composed of five to six layers of cells with oval nuclei, often with linear nuclear grooves, and a surface layer consisting of large, flattened "___________" with abundant cytoplasm and uroplakins(proteins)

Back 2

Urothelium

- umbrella cells

Front 3

Urothelium rests on a well-developed __________ beneath which is a __________

Back 3

1. Basement membrane

2. Lamina propria

Front 4

The lamina propria in the urinary bladder contains wisps of smooth muscle that form discontinuous _________________

Back 4

Muscularis mucosae

Front 5

T or F

Muscularis mucosae is different with detrussor muscle ( muscularis propria )

Back 5

True

Front 6

T or F

Bladder cancers are staged on the basis of invasion of muscularis mucosae

Back 6

False - detrussor muscle

Front 7

The tumor cells do not normally cross the basement membrane. The presence of an intact BM connotes that more likely, the involvement is only in the epithelium. You call this___________

Once, it reaches the underlying epithelium layer, this is what you call _________

Back 7

Tumor in Situ

Invasive

Front 8

There are three points of slight narrowing in the ureter:

Back 8

- Ureteropelvic junction - Entry into the bladder - Where they cross the iliac veins

Front 9

These are where renal calculi may become impacted/trapped when they pass from the kidney to the bladder.

Back 9

- Ureteropelvic junction - Entry into the bladder - Where they cross the iliac veins

Front 10

Ureteral narrowings can also lead to vesicoureteral reflux, particularly at the ________________

Back 10

Uteropelvic junction

Front 11

Abnormal angulations at the point of narrowing allow backflow of the urine from the bladder to the kidneys, and this can lead to ______________

Back 11

Pyelonephritis

Front 12

___________ is the incompetence of the vesicoureteral valve allows bacteria to ascend the ureter into the renal pelvis]

Back 12

Vesicoureteral reflux (VUR)

Front 13

Found in about 2% or 3% of all autopsies

Back 13

Congenital Anomalies

Front 14

Congenital anomaly with Four, instead of two, ureters

Back 14

Double and bifid ureter

Front 15

Double or bifid ureter are Almost invariably associated with ____________or with the _____________ having a partially bifid pelvis terminating in separate ureters.

Back 15

1. totally distinct double renal pelves

2. anomalous development of a large kidney

Front 16

Double and Bifid ureters May pursue separate courses to the bladder but commonly are (joined/not joined) within the bladder wall and drain through a (single/double) ureteral orifice.

Back 16

1. Joined

2. Single

Front 17

T of F

Double / bifid ulcers - Most are bilateral and of no clinical significance.

Back 17

False

Front 18

Most common cause of hydronephrosis in infants and children.

Back 18

URETEROPELVIC JUNCTION (UPJ) OBSTRUCTION

Front 19

________________is the dilation of the renal pelvis and calyces associated with progressive atrophy of the kidney due to obstruction to the outflow of urine.

Back 19

Hydronephrosis

Front 20

UPJ obstruction may be caused by:

Back 20

- Abnormal angulation of the ureter - Abnormal organization of smooth muscle bundles at the UPJ - Excess stromal deposition of collagen between smooth muscle bundles - Rarely to congenitally extrinsic compression of the UPJ by renal vessels

Front 21

Saccular outpouchings of the ureteral wall

Back 21

Divertucula

Front 22

Urinary stasis within diverticula sometimes leads to recurrent infections and/or inflammation. This is called __________

Back 22

Diverticulitis

Front 23

Treatment of diverticulitis can be in the form of?

Back 23

1. Antibiotics

2. Diverticulectomy

Front 24

may occur as congenital anomalies or as acquired defects, and these may lead to hydronephrosis.

Back 24

1. Hydorureter ( dilation)

2. Elongation

3. Tortuosity

Of ureters

Front 25

Accumulation or aggregation of lymphocytes forming germinal centers in the ____________ may cause slight elevations of the mucosa and produce a __________€€ mucosal surface.

Back 25

URETERITIS FOLLICULARIS

1. Germinal centers

2. Fine granular mucosa surface

Front 26

At other times, the mucosa may become sprinkled with fine cysts varying in diameter from 1 to 5 mm lined by flattened urothelium

Back 26

URETERITIS CYSTICA

Front 27

What lines the fine cysts of ureteristis cystica

Back 27

Flattened urothelium

Front 28

T o F

When you pop the cysts- ureteristis cystica- along the ureteral wall, you expect water to come out

Back 28

F - pus

Front 29

Diagnosis of ureteristis cystica is thru:

Back 29

1. Urinalysis

2. Radiograph

Front 30

What is the expected result of ureteristis cystica in

1. Urinalysis

1. Urinalysis2. Radiograph

2. Radiograph

Back 30

1. >WBC2. cystic lesions

Front 31

T or F

Primary tumors of ureter are common

Back 31

False - rare

Front 32

Small benign tumors of the ureter are generally of ___________ origin

Back 32

Mesenchymal

Front 33

__________ is a tumor-like lesion that presents as a small mass projecting into the lumen, often in children, and is composed of loose, vascularized connective tissue over- laid by urothelium.

Back 33

Fibroepithelial polyp

Front 34

Fibroepithelial polyp is common in ______ and is composed of _________ overlaid by ________

Back 34

1. Children

2. Loose vascularize connective tissue

3. Urothelium

Front 35

These are smooth muscle tumors

Back 35

Leiomyomas

Front 36

Benign tumors of ureters

Back 36

1. Fibroepithelial polyps

2. Leiomyoma

Front 37

Primary malignant tumors of the LUT

Back 37

1. Urothelial or Transitional Cell Carcinoma

Front 38

This is the majority of primary malignant tumor of LUT

Back 38

Urothelial or Transitional Cell Carcinoma

Front 39

Urothelial or Transitional Cell Carcinoma is most frequently during the ________ decades________ or life

Back 39

1. 6th and 7th

Front 40

T or F

Urothelial or Transitional Cell Carcinoma

- these are multiple masses with nodules and are unifocal

Back 40

False - multifocal

Front 41

because of loss of __________, cells are less cohesive. As a result, they are sloughed and can now be detected in the urine.

Back 41

1. E- cadherin

Front 42

Diagnosis for Urothelial or Transitional Cell Carcinoma

Back 42

1. Urine cytology

2. Cell block

3. Radiography

4. Ultrasound

Front 43

Intrinsic causes of obstructive lesions

Back 43

1. Calculi

2. Strictures

3. Tumors

4. Blood clots

5. Nerurogenic

Front 44

Extrinsic causes of obstructive lesions

Back 44

1. Prenancy

2. Periureteral inflammation

3. Endometriosis

4. Tumor

Front 45

All causes of obstructive lesions leads to

Back 45

1. Hydroureter

2. Hydronephrosis

3. Pyelonephritis

Front 46

Characterized by a fibrotic proliferative inflammatory process encasing the retroperitoneal structures and causing hydronephrosis.

*fibrosis brings about sclerosis

Back 46

SCLEROSING RETROPERITONEAL FIBROSIS

Front 47

What is the onset and sex predominance of SCLEROSING RETROPERITONEAL FIBROSIS

Back 47

1. Mid to late age

2. Male > female

Front 48

SCLEROSING RETROPERITONEAL FIBROSIS may be related to ___________ dse

Back 48

IgG4- related dse

Front 49

Drug exposure cases associated with sclerosis retroperitoneal fibrosis

Back 49

1. Ergot derivatives

2. B- blockers

Front 50

Adjacent inflammatory conditions associated with sclerosing retroperitoneal fibrosis

Back 50

1. Vasculitis

2. Diverticulitis

3. Crohn'n dse

Front 51

Malignant dse associated with sclerosisng retroperitoneal fibrosis

Back 51

1. Lymphoma

2. Urinary tract carcinoma

Front 52

Sclerosing retroperitoneal fibrosis

Most, however, have no obvious cause and are considered primary or idiopathic -

Called:____________

Back 52

Ormond disease

Front 53

Congenital anomalies of urinary bladder

Back 53

1. Diverticula

2. Exstrophy of the bladder

3. Vesicoureteral reflux

4. Urachal anomalies

5. Congenital fistula

6. Peristent urachus

7. Urachal cyst

Front 54

Pouchlike evaginations of the bladder wall that vary from less than ___ cm to __ to __ cm in diameter (most are small and asymptomatic)

Back 54

1, 5, 10

(most are small and asymptomatic)

Front 55

T or F

Diverticula may be clinically significant

Back 55

True

Front 56

This type of diverticulitis May be due to a focal failure of development of the normal musculature or to some urinary tract obstruction during fetal development

Back 56

Congenital

Front 57

Type of urinary diverticulitis Most often seen with prostatic enlargement (hyperplasia or neoplasia), producing obstruction to urine outflow and marked muscle thickening of the bladder wall.

Back 57

Acquired

Front 58

Acquired type of urinary bladder diverticulitis is most often seen in _________

Back 58

Prostatic enlargement (hyperplasia/neoplasia)

Front 59

Mechanism in which urinary stasis causes diverticulitis and bladder calculi

Back 59

1. Urinary stasis > infection > bladder calculi

2. Urinary stasis > inflammation > diverticulitis

Front 60

T or F

Diverticulitis or urinary bladder may not predispose to vesicoureteral reflux as a result of impingement on the ureter.

Back 60

False - not

Front 61

Developmental failure in the anterior wall of the abdomen and the bladder, so that the bladder either communicates directly through a large defect with the surface of the body or lies as an opened sac.

Back 61

EXSTROPHY OF THE BLADDER

Front 62

T of F

Exstrophy of the bladder - May undergo colonic glandular neoplasia

Back 62

False - metaplasia

Front 63

What is colonic glandular metaplasia in u- bladder

Back 63

The normal urothelium may change into glandular epithelium

Front 64

T or F

Patients have an increased risk of adenoma arising in the bladder remnant in exsotrophy of the bladder

Back 64

False - adenocarcinoma

Front 65

Most common and serious congenital anomaly

Back 65

Vesicoureteral reflux

Front 66

Abnormal connections between the bladder and the vagina, rectum, or uterus may create

Back 66

congenital vesicouterine fistulae

Front 67

the canal that connects the fetal bladder with the allantois

is normally obliterated after birth, but it sometimes remains patent in part or in whole.

Back 67

Urachus

Front 68

Most common anomaly or urachus

Back 68

Abnormal communication

Front 69

What is the treatment for urachal anomalies

Back 69

Surgical resection and correction

Front 70

T or F

Urachus anomalies are always malignant

Back 70

False - benign

Front 71

When totally patent, a fistulous urinary tract connects the bladder with the umbilicus

Back 71

Congenital Fistula

Front 72

Urachus does not close (lifted from the Internet)

Back 72

PERSISTENT URACHUS

Front 73

Only the central region of the urachus persists, giving rise to urachal cysts, lined by either urothelium or metaplastic glandular epithelium

Back 73

Urachal cysts

Front 74

Inflammation of the urinary bladder is termed as

Back 74

Cystitis

Front 75

Diagnosis regarding the type of organism that grows is through

Back 75

Urine culture

Front 76

The common etiologic agents of cystitis are the:

Back 76

1. Coliform - E. coli

2. Proteus

3. Klebsiella

4. Enterobacter

Front 77

T or F

Women are more likely to develop cystitis as a result of their shorter urethras.

Back 77

True

Front 78

__________is almost always a sequel to renal tuberculosis.

Back 78

Tuberculous cystitis

Front 79

cause cystitis, particularly in immunosuppressed patients or those receiving long-term antibiotics.

Back 79

1. Candida albicans - less often

2. Cryptococcal agents

Front 80

____________ is rare in the United States but is common in certain Middle Eastern countries, notably Egypt. - cause of cystitis

Back 80

Schistosoma haematobium

Front 81

Other causes of cystitis -

Back 81

1. Viruses

2. Chlamydia

3. Mycoplasma

Front 82

Predisposing factor of cystitis

Back 82

1. Bladder calculi

2. Urinary obstruction

3. DM

4. Instrumentation

5. Immune deficiency

Front 83

Irradiation of the bladder region gives rise to---

Back 83

Irradiation of the bladder

Front 84

If you are not after the process of identification (through urine culture), you can do ______________, which counts the actual number of bacteria and WBC in the specimen.

Back 84

Automated urine analysis

Front 85

Patients receiving cytotoxic antitumor drugs, such as cyclophosphamide, may develop____

Back 85

Hemorrhagic cystitis

Front 86

This virus can also cause hemorrhagic cystitis

Back 86

Adenovirus

Front 87

Persistence of the bacterial infection leads to chronic cystitis associated with________

Back 87

Mononuclear inflammatory infiltrates

Front 88

_____________is characterized by the presence of lymphoid follicles within the bladder mucosa and underlying wall.

Back 88

Follicular cystitis

Front 89

____________ is manifested by infiltration with submucosal eosinophils

Back 89

Eosinophilic cystitis

Front 90

Triad of symptoms of acute and chronic cystitis

Back 90

1. urination every 15 to 20 minutes; or dribbling of urine; acute cystitis

suprapubic region

2. Lower abdominal pain - suprapubic region

3. Dysuria - pain/burning on urination

Front 91

T or F

“The ubiquitous presence of mild chronic inflammation in the bladder accompanied by clinical symptoms should not be given the diagnosis of chronic cystitis.”

Back 91

False - unaccompanied

Front 92

T or F

The local symptoms of cystitis may be merely disturbing

Back 92

True

Front 93

T or F

Infections of chronic cystitis may not also be antecedents to pyelonephritis

Back 93

False - may

Front 94

Cystitis is sometimes a secondary complication of an underlying disorder associated with urinary stasis, such as______

Back 94

1. Prostatic enlargement

2. Cytocele of the bladder

3. Calculi

4. Tumors

Front 95

T or F

The primary diseases must be corrected before the cystitis can be relieved

Back 95

True

Front 96

Special forms of cystitis

Back 96

1. Interstitial cystitis - chronic pelvic pain syndrome

2. Malakoplakia

3. Polyploid cystitis

Front 97

Interstitial cystitis is also called

Back 97

Chronic pelvic pain syndrome

Front 98

Special cystitis most frequently in women

Characterized by?_____

Back 98

Chronic pelvic pain syndrome

1. Intermittent, severe SUPRAPUBIC PAIN

2. Urinary frequency, urgency

3. Hematuria

4. Dysuria

Front 99

Interstitial cystitis - chronic pelvic pain syndrome is associated with _________

Back 99

Chronic mucosal ulcers - hunner ulcer

Front 100

T or F

Etiology of INTERSTITIAL CYSTITIS (CHRONIC PELVIC PAIN SYNDROME) is known

Back 100

False

Front 101

Chronic mucosal ulcer is also called ___

Back 101

Hunner ulcer

Front 102

How does chronic mucosal ulcer causes interstitial cystitis

Back 102

[this is termed the late (classic, ulcerative) phase] → Transmural Fibrosis →Contracted bladder

Front 103

Arises in the setting of chronic bacterial infection, mostly by E. coli or occasionally Proteus species.

Back 103

Malakoplakia

Front 104

Bacteria responsible for malakoplakia

Back 104

1. E. coli

2. Proteus spp

Front 105

These are - Soft, yellow, slightly raised mucosal plaques, 3 to 4 cm in diameter.

Back 105

Malakoplakia

Front 106

Malakoplakia is filled with-

Back 106

1. large, foamy macrophages

mixed with occasional

2. multinucleated giant cells and lymphocytes (mononuclear cells).

Front 107

MALAKOPLAKIA

Laminated mineralized concretions resulting from deposition of calcium in enlarged lysosomes, known as __________________, are typically present within the macrophages

Back 107

Michaelis-Gutmann bodies

Front 108

Malakoplakia point to defect in the__________ of macrophages

Back 108

Phagocytic function

Front 109

---Results from irritation of the bladder mucosa.

----Indwelling catheters are the most commonly cited culprits

Back 109

Polypoid cystitis

Front 110

Most common cited culprits of polypoid cystitis

Back 110

Indwelling catheters

Front 111

Polypoid cystitis may be confused with__

Back 111

Papillary urothelial carcinoma

Front 112

Broad bulvous polypoid projetions is due to

Back 112

Markee submiucosal edme

Front 113

What are the metaplastic lesions involving urothelium

Back 113

1. CYSTITIS GLANDULARIS

2. CYSTITIS CYSTICA

3. CYSTITIS CYSTICA ET GLANDULARIS

4. SQUAMOUS METAPLASIA

5. NEPHROGENIC ADENOMA

Front 114

Metaplastic lesion wherein Nests of urothelium (Brunn nests) grow downward into the lamina propria.

Back 114

Cystitis glandularis

Front 115

In cystitis glandularis - Epithelial cells in the center of the nest undergo metaplasia and take on a _________ or ________

Back 115

1. Cuboidal

2. Columnar

Front 116

Nests of urothelium is called?

Back 116

Brunn nests

Front 117

In a variant of cystitis glandularis goblet cells are present, and the epithelium resembles________

Back 117

intestinal mucosa (intestinal or colonic metaplasia).

Front 118

Metaplastic lesion of urothelium wherein Epithelial cells retract to produce cystic spaces lined by flattened urothelium

Back 118

Cystitis cystica

Front 119

Cystic spaces is cystitis cystica is lined by________

Back 119

Flattened urothelium

Front 120

Metaplastic lesion of urothelium wherein there is coexistence of 2 process

Back 120

CYSTITIS CYSTICA ET GLANDULARIS

Front 121

Metaplastic lesion

----Urothelium is often replaced by nonkeratinizing squamous epithelium. ---- Response to injury

Back 121

Squamous metaplasia

Front 122

Results from implantation of shed renal tubular cells at sites of injured urothelium. ,--- Response to injury

Back 122

NEPHROGENIC ADENOMA

Front 123

What are responses of urothelium to injury

Back 123

1. Squamous metaplasi

2. Nephrogenic carcinoma

Front 124

What is the bottomline of metaplasia

Back 124

Malignancy

Front 125

Cystitis glandularis → Squamous metaplasia →

Back 125

1. Adenocarcinoma

2. Squamous Cell Carcinoma

Front 126

About 95% of bladder tumors are of _______ origin (mostly _________), the remainder (5%) being _________ tumors.

Back 126

1. Epithelial

2. Urothelial

3. Mesenchymal

Front 127

Represent about 90% of all bladder tumors.

Back 127

UROTHELIAL (TRANSITIONAL) TUMORS

Front 128

There are two distinct precursor lesions to invasive urothelial carcinoma:

Back 128

1. Non-invasive papillary tumors (most common),

2. Flat noninvasive urothelial carcinoma (carcinoma in situ).

Front 129

Most common precursor lesion to invasive urothelial carcinoma

Carcinoma in situ precursor of urothelial carcinoma

Back 129

1. Non-invasive papillary tumors

2. Flat non- invasive urothelial carcinoma

Front 130

Gross patterns of urothelial carcinoma

Back 130

1. Papillary to nodular

2. Flat

Front 131

Gross patter of urothelial carcinoma wherein there are projections into the lumen

Back 131

1. Papillary to nodular

Front 132

Gross pattern of urothelial carcinoma wherein there is thickening of the wall, without necessary projection into the cavity

Back 132

Flat

Front 133

Significance of gross appearance in cytoscopy

Back 133

for visualization of the mass--Polypoid or Flat

Front 134

T or F

Urothelial carcinoma can be invasive only

Back 134

False

Invasive and non invasive

Front 135

Generalizations in urothelial carcinoma

Back 135

If it is papillary, it is usually

1. low-grade,

2. laterally- or posteriorly-positioned

Front 136

---1% or less of bladder tumors, usually seen in younger patients.

--- Typically arise singly as small (0.5 to 2 cm), delicate, structures

Back 136

Papillomas

Front 137

Lining epithelium of papilloma is supposed to be

Back 137

1. reminiscent of normal

Front 138

Superficially attached to the mucosa by a stalk and are referred to as _____

Back 138

exophytic papillomas.

Front 139

are completely benign lesions consisting of inter-anastomosing cords of cytologically bland urothelium that extend down into the lamina propria.

Back 139

Inverted papilloma

Front 140

Papilloma Have a central core of loose ___________ covered by epithelium.

Back 140

fibrovascular tissue (fibrovascular core)

Front 141

Share many histologic features with papilloma, differing only in having thicker urothelium and with diffuse nuclear enlargement (atypia).

Back 141

PAPILLARY UROTHELIAL NEOPLASMS OF LOW MALIGNANT POTENTIAL (PUNLMP)

Front 142

Diffences of PUNLMP With papilloma

Back 142

1. Thick urothelium

2. Diffuse nuclear enlargement - atypia

Front 143

T of F

PUNLMP is smaller that papilloma

90% 10-year survival

Back 143

False - larger - 98%

Front 144

--Have an orderly architectural and cytologic appearance.

--The cells are evenly spaced (i.e., maintain polarity) and cohesive, with thicker lining epithelium.

--Mild degree of nuclear atypia

Back 144

LOW-GRADE PAPILLARY UROTHELIAL CARCINOMAS

Front 145

LOW-GRADE PAPILLARY UROTHELIAL CARCINOMAS- Mild degree of nuclear atypia consisting of______

Back 145

1. scattered hyperchromatic nuclei,

2. infrequent mitotic figures predominantly toward the base, and

3. slight variation in nuclear size and shape.

Front 146

Contain dyscohesive cells with large hyperchromatic nuclei.

Back 146

HIGH-GRADE PAPILLARY UROTHELIAL CARCINOMAS

Front 147

T or F

In HIGH-GRADE PAPILLARY UROTHELIAL CARCINOMAS

1. Mitotic figures, including atypical ones, are rare

2. There is no disarray and loss of polarity

3. Low incidence of invasion into the muscular layer.

4. Aggressive, multinodular.

Back 147

1. F -frequent

2. F - there is

3. F - higher

4. T

Front 148

T or false

Low grade and hight grade urothelial carcinoma both have atypia

Back 148

True

Front 149

Diffrentiate low grade and high grade carcinoma

Back 149

Front 150

High grade urothelial carcinoma has _______ cytologic atypia

Back 150

Marked

Front 151

- Flat Urothelial Carcinoma

- Defined by the presence of cytologically malignant cells within a flat urothelium.

Back 151

Carcinoma in situ

Front 152

Carcinoma in situ May range from___________

Back 152

1. full-thickness cytologic atypia to

2. scattered malignant cells in an otherwise normal urothelium

Front 153

scattered malignant cells in an otherwise normal urothelium

Back 153

Pagetoid spread

Front 154

A common feature of carcinoma in situ shared with high-grade papillary urothelial carcinoma is a _______________ which leads to the shedding of malignant cells into the urine.

Back 154

lack of cohesiveness

Front 155

What is of prognostic significance to invasive urothelial cancer

Back 155

The extent of the invasion into the muscularis mucosaa

Front 156

is the most important factor in determining the outlook for a patient of invasive urothelial cancer

Back 156

Staging at initial diagnosis

Front 157

T or F

Almost all infiltrating urothelial carcinomas are high grade, with 50% mortality rate

Back 157

False - 30%

Front 158

Carcinoma in Situ vs. Invasive Urothelial CA

-Look at the basement membrane

------If BM is intact and you only see the atypical cells with no stromal invasion _______

------If you see infiltration in the stroma, that is _______

Back 158

1. Carcinoma in situ

2. Invasive urothelial CA

Front 159

Pure squamous cell carcinomas are nearly always associated with ___________

Back 159

1. chronic bladder irritation and infection.

Front 160

- More frequent than pure squamous cell carcinomas.

- Most are invasive, fungating tumors or are infiltrative and ulcerative.

Back 160

Mixed Urothelial Carcinoma with areas of Squamous Carcinoma

Front 161

- Recall that this may come from cystitis glandularis.

- Some arise from urachal remnants or in association with extensive intestinal metaplasia.

Back 161

Adenocarcinoma

Front 162

Arise in the bladder often in association with urothelial, squamous, or adenocarcinoma.

Back 162

Small-Cell Carcinomas

Front 163

Sall-Cell Carcinomas Arise in the bladder often in association with______

Back 163

1. Urothelial

2. Squamous

3. Adenocarcinoma

Front 164

is clearly the most important influence, increasing the risk threefold to sevenfold,

depending on the ________ and _______use.

Back 164

Cigarette smoking

Front 165

Factor that causes - 70% SCCA, some urothelial or glandular.

Back 165

Schistosoma heamatobium infx

Front 166

Chemical factor that causes urothelial carcinoma

Back 166

Aryl amines

2-naphthylamine and related compounds.

Front 167

T of F

Long term use of analsegic can cause urothelial carcinoma

Back 167

True

Front 168

Heavy long-term exposure to _____ can cause urothelial carcinoma

Back 168

cyclophosphamide

Front 169

T or F

Irradiation, often administered for other pelvic malignancies can cause urothelial carcinoma

Back 169

True

Front 170

These abnormalities are often the only chromosomal changes present in superficial noninvasive papillary tumors and occasionally in noninvasive flat tumors

Back 170

losses of genetic material on chromosome 9 (including monosomy or deletions of 9p and 9q)

Front 171

losses of genetic material on chromosome 9 (including monosomy or deletions of 9p and 9q) are the only abnomalities seen in _____

Back 171

1. Superficial noninvasive papillary tumor

2. Non invasive flat tumor

Front 172

Seen in many invasive urothelial CAs

Back 172

17p deletion and p53 mutation

Front 173

Found predominantly in non-invasive low-grade papillary carcinomas and result in constitutive activation of the FGFR3 receptor tyrosine kinase.

Back 173

Gain- of-function mutations in FGFR3

Front 174

Gain- of-function mutations in FGFR3 is found predominantly in

Back 174

Non invasive low grade papillary carcinoma

Front 175

Almost always seen in high-grade and, frequently, muscle invasive tumors.

Back 175

Loss-of-function mutations in the TP53 and RB tumor suppressor genes

Front 176

Clinical course of urothelial carcinoma

Back 176

1. Painless hematuria

2. Frequency, urgency, and dysuria occasionally accompany the hematuria.

Front 177

Tumor that Can arise from anything with muscles

Back 177

Mesenchymal tumors

Front 178

is the most common origin of mesenchymal tumors

Back 178

Detrussor muscle

Front 179

-- is the most common benign tumor

--Grow as isolated, intramural, encapsulated, oval-to-spherical masses, varying in diameter up to several centimeters.

Back 179

Leiomyoma

Front 180

The most common sarcoma in infancy or childhood is_________

Back 180

embryonal rhabdomyosarcoma.

Front 181

The most common sarcoma in the bladder in adults is ________

Back 181

leiomyosarcoma (malignant counterpart of leiomyoma).

Front 182

In males, the most common cause of obstruction is

Back 182

1. enlargement of the prostate gland due to nodular hyperplasia

Front 183

T or F

Bladder obstruction is common in females

Back 183

False - less common

Front 184

Bladder obstruction is less common in females and is most often caused by_________

Back 184

Cystocele of the bladder

Front 185

Strictures associated with urethral obstruction

Back 185

1. Congenital urethral strictures 2. Inflammatory urethral strictures

Front 186

T or F

Inflammatory fibrosis and contraction of the bladder can cause obstruction

Back 186

True

Front 187

Injury of nerves controlling bladder contraction that causes obstruction

Back 187

Neurogenic bladder

Front 188

Other causes of urethral obstruction

Back 188

1. Bladder tumors, either benign or malignant

2. Invasion of the bladder neck by tumors arising in contiguous organs

3. Mechanical obstructions caused by foreign bodies and calculi

Front 189

In urinary bladder hypertrophy/hyperplasia trabeculations of the bladder becomes______ and wall becomes________

Back 189

1. Prominent

2. Thickened

Front 190

is the inflammation of the urethra.

Back 190

Urethritis

Front 191

one of the earliest manifestations of this venereal infection.

Back 191

Gonococcal urethritis

Front 192

Diagnosis of gonococcal infxn is thru

Back 192

Gram staining

Front 193

What can cause non- gonococcal infxn

Back 193

1. E. Coli

2. C. Trachomatis

3. U. Urealyticum ( mycoplasma)

Front 194

Reactive arthritis is associated with the clinical triad of____

Back 194

1. Arthritis

2. Conjunctivitis

3. Urethritis

Front 195

Reactive arthritis is associated with the clinical triad of arthritis, conjunctivitis, and urethritis - this is called______

Back 195

REITER syndrome

Front 196

is an inflammatory lesion that presents as a small, red, painful mass about the external urethral meatus, typically in older females.

Back 196

Urethral caruncle

Front 197

This is typical in older women

Back 197

Urethral caruncle

Front 198

What are benign epithelial tumors of urethra

Back 198

1. Squamous and urothelial papilloma

2. Inverted urothelial carcinoma

3. Condyloma

Front 199

Papilloma are related to what virus

Back 199

HPV

Front 200

results in fibrous bands involving the corpus cavernosum of the penis, with penile curvature and pain during intercourse.

Back 200

Peyronie dse

Front 201

T or F

Primary carcinoma of the urethra is an common lesion.

Back 201

False - uncommon

Front 202

Diagnosis of tumors and tumorlike lesions

Back 202

1. Urine cytology

2. Urine cell block

3. Radiographs

Front 203

Abnormal urethral opening on the ventral surface of the penis

Abnormal urethral opening on the dorsal surface—

Back 203

1. Hypospadias

2. epispadias

Front 204

Hypospadias and epispadias are associated with failure of_____

Back 204

1. Normal descent of testes

2. Malformations of the urinary tract

Front 205

Condition wherein The orifice of the prepuce is too small to permit its normal retraction

Back 205

PHIMOSIS

Front 206

What are the causes of phimosis

Back 206

1. Abnormal development

2. Infection - repeated- scarring of preputial ring

Front 207

T or F

Phimosis does not Interferes with cleanliness and permits the accumulation of secretions and detritus under the prepuce.

Back 207

False - does

Front 208

Location of accumulation of secretions and detritus caused by phimosis

Back 208

1. Under the prepuce

Front 209

Refers to infection of the glans and prepuce caused by a wide variety of organisms.

Back 209

Balanophosthitis

Front 210

What can cause balanoposthistis

Back 210

1. Candida albicans

2. Anaerobic bacteria

3. Gardneralla

4. Pyogenic bacteria

Front 211

Most cases of balanoposthistis occur as a consequence of poor local hygiene in ____________ in whom the accumulation of desquamated epithelial cells, sweat, and debris, termed ________ acts as local irritant.

Back 211

1. Uncircumcised male

2. Smegma

Front 212

Gonorrhea and chancroid

Back 212

Front 213

Gonorrhea and chancroid is diagnosed with

Back 213

1. Gram staining

Front 214

What causes granuloma inguinale

Back 214

Klebsiella granulomatis/calymmatobacterium donovani

Front 215

Characteristic feature of granuloma inguinale

Back 215

Protruberant, soft, painless mass

Front 216

Benign sexually transmitted wart caused by human papillomavirus (HPV).

Back 216

Condylomata acuminatum

Front 217

Condylomata accuminatum is related to ______

Back 217

Common warts

Front 218

HPV type ___, and less frequently type __, are the most frequent agents.

Back 218

1. 6

2. 11

Front 219

Condylomata acuminatum consists of________

Back 219

1. single or multiple sessile or

2. pedunculated, red papillary excrescences

Front 220

Characteristic of condylomata acuminata wherein there is Branching, villous, papillary connective tissue stroma is covered by epithelium that may have considerable superficial hyperkeratosis and thickening of the underlying epidermis

Back 220

Acanthosis

Front 221

Cytoplasmic vacuolization of the squamous cells ____________

____________ is characteristic of HPV infection.

Back 221

koilocytosis

Front 222

---Confined to the epithelium

---These lesions have a strong association with infection by high-risk HPV, most commonly type _____

Back 222

1. Carcinoma in situ

2. Type 16

Front 223

Erythroplasia of Queyrat

Back 223

Bowen Disease

Front 224

---Appears as a solitary, thickened, gray-white, opaque plaque.

---The epidermis is hyperproliferative, containing numerous mitoses, some atypical.

Back 224

Bowen dse

Front 225

In bowen dse The dermal-epidermal border is sharply delineated by an _____

_____

Back 225

intact basement membrane.

Front 226

Malignant tumor that occurs in sexually active adults

Back 226

Bowenoid papulosis

Front 227

Presentation of bowenoid papulosis

Back 227

1. Multiple (rather than solitary)2. Reddish brown papular lesion

Front 228

T or F

Bowenoid papulosis Virtually always develops into an invasive carcinoma and in many cases dont regresses spontaneously.

Back 228

False - never, regress

Front 229

Squamous cell carcinoma of the penis is associated with __________ and with __________.

Back 229

1. Poor genital hygiene

2. high-risk HPV infection

Front 230

What confers protection form invasive CA (SCC)

Back 230

Circumcision

Front 231

Most common culprit of invasive CA(SCC) in penis

Back 231

HPV type 16

HPV type 18- also implicated

Front 232

T or F

Cigarette smoking also elevates the risk of developing penile cancer.

Back 232

True

Front 233

Two macroscopic patterns seen in SCC

Back 233

1. Papillary

2. Flat

Front 234

is an exophytic well-differentiated variant of squamous cell carcinoma that is slow-growing, locally invasive, but rarely metastasize.

Back 234

Verrucous carcinoma

Front 235

T or F

If malignancy is found, the penis is not cut.

Free margin is 5 cm away from the line of resection

Back 235

False - it is cut

2-3 cm

Front 236

Complete or partial failure of the intra-abdominal testes to descend into the scrotal sac.

Back 236

CRYPTORCHIDISM

Front 237

T or F

Crytochidism is bilateral in most cases

Back 237

False - unilateral - 75%

Front 238

Cyptochidism is associated with

1. Bilateral

2. Unilaretal

Back 238

1. Sterility

2. Infertility

Front 239

T or F

Cryptochidism is Associated with increased risk of testicular cancer.

Back 239

True

Front 240

Two morphologically and hormonally distinct phases of cryptochidism

Back 240

1. Transabdominal phase

2. Inguinoscrotal phase

Front 241

Phase of cryptochisdism wherein Testis comes to lie within the lower abdomen or brim of the pelvis, and is believed to be controlled by a hormone called ___________

Back 241

müllerian-inhibiting substance

Front 242

What controls the transabdominal phase of cryptochidism

Back 242

Mullerian inhibiting substance

Front 243

Phase of cryptochisdism wherein Testes descend through the inguinal canal into the scrotal sac, and is androgen-dependent.

Back 243

Inguinoscrotal phase

Front 244

Inguinoscrotal phase is dependent on

Back 244

Androgen

Front 245

Histologic changes in the malpositioned testis begin as early as ______ years of age

Back 245

2

Front 246

Histologic feature of Cryptochidism

Back 246

1. Arrested germ cell development

2. Marked hyalinization and thickening of basement membrane of SPERMATIC TUBULES

3. Prominent leydig cells

Front 247

Why is leydig cells prominent in histology of cyptochidism

Back 247

1. They are spared

Front 248

These three are characteristics of testicular atrophy.

Back 248

1. Sperm number is markedly decreased.

2. Thickening of the basement membrane.

3. More prominent Leydig cells

Front 249

Testicular atrophy may be caused by:

Back 249

1. Blood supply narrowing - athersclerotic- old age

2. End stage of inflammatory orchitis

3. Cryptochidism

4 Hypopituitarism

5. Generalized malnutrition or cachexia

6. Irradiation

7. Prolonged administration of antiandrogens - prostate CA tx- advanced stage

8. Exhaustion atrophy

Front 250

What causes exhaustrion atrophy

Back 250

persistent stimulation by high levels of follicle-stimulating pituitary hormone.

Front 251

Genetic in origin that can cause testicular atrophy and decreased fertility

Back 251

Klinefelter syndrom

Front 252

How does mumps causes atrophy and decreased fertility

Back 252

Causes fibrosis 2ndary to orchitis

Front 253

Atrophy is =

Back 253

1. Fibrosis

2. <sperm count

3. Leydig cells

4. Small testis

Front 254

What arevthe inflammations of the testis

Back 254

1. Nonspecific Epididymitis and Orchitis

2. Granulomatous (Autoimmune) Orchitis

3. Specific inflammations:

Front 255

Specific inflammations of the testis

Back 255

1. Gonorrhea

2. Mumps

3. Tuberculosis

4. Syphilis

Front 256

Twisting of the spermatic cord which typically cuts off the venous drainage of the testis.

Back 256

Torsion

Front 257

Torsion frequently leads to ___________and thus represents one of the few true urologic emergencies.

Back 257

Testicular infarction

Front 258

There are two settings in which testicular torsion occurs:

Back 258

1. Neonatal

2. Adult

Front 259

Torsion that occurs either in utero or shortly after birth, and it lacks any associated anatomic defect to account for its occurrence.

Back 259

Neonatal torsion

Front 260

torsion that is typically seen in adolescence and presents with the sudden onset of testicular pain; it results from a bilateral anatomic defect that leads to increased mobility of the testes

Back 260

Adult torsion

Front 261

abnormality wherein there is bilateral anatomic defect that leads to increased mobility of the testes

Back 261

BELL CLAPPER ABNORMALITY

Front 262

Morphologic changes cause by torsion of testicular vessels

Back 262

Intense congestion> widespread hemorrhage> testicular infarction

Front 263

In advanced stages of testicular torsion the testis is markedly

Back 263

1. Enlarged

2. Consist of soft, necrotic, hemorrhagic tissue

Front 264

Physical exam in testicular torsion

Back 264

Front 265

SPERMATIC CORD AND PARATESTICULAR TUMORS

Back 265

1. Lipoma

2. Adenomatoid tumor

3. Rhabdomyosarcoma

4. Liposarcoma

Front 266

Common lesions involving the proximal spermatic cord, identified at the time of inguinal hernia repair.

Back 266

Lipoma

Front 267

When does lipoma in testis is identified

Back 267

Time of inguinal hernia repair

Front 268

What is involved in paratesticular lipoma

Back 268

Proximal spermatic cord

Front 269

Paratesticular lipoma Represent ____________ that has been pulled into the inguinal canal along with the hernia sac, rather than a true neoplasm

Back 269

retroperitoneal adipose tissue

Front 270

T or F

Paratesticular lipoma is a true neoplasm

Back 270

False

Front 271

The most common benign paratesticular tumor.

Back 271

Adenimatoid tumor

Front 272

The most common malignant paratesticular tumors in children.

Back 272

Rhabdomyosarcoma

Front 273

The most common malignant paratesticular tumors in adults.

Back 273

Liposarcoma

Front 274

What do you look for in testicular tumors

Back 274

Enlarged balls

Front 275

T or F

Testicular tumor is always painful

Back 275

False- not always

Front 276

Two major catergories of testicular tumor

Back 276

1. Germ cell tumor

2. Tumors of sex cord gonadal stroma

Front 277

Classification of germ cell tumor

Back 277

1. Seminomatous tumor

2. Nonseminimatous tumor

Front 278

This is the most common tumor of men in 15-34yr age group

Back 278

Testicular germ cell tumor

Front 279

Testicular germcell tumors is Associated with a spectrum of disorders collectively known as

Back 279

testicular dysgenesis syndrome (TDS).

Front 280

Components of testicular dysgenesis syndrome (TDS).

Back 280

1. cryptorchidism,

2. hypospadias,

3. poor sperm quality.

Front 281

a strong familial predisposition associated with the development of testicular germ cell tumors.

Back 281

Xq27 genetic polymorphisms

Front 282

Classificiation of germcell tumor that are composed of cells that resemble primordial germ cells or early gonocytes.

Back 282

Seminomatous tumors

Front 283

Classificiation of germcell tumor that may be composed of undifferentiated cells that resemble embryonic stem cells, as in the case of embryonal carcinoma, but the malignant cells may also differentiate along other lineages, generating yolk sac tumors, choriocarcinomas and teratomas.

Back 283

Nonseminomatous tumors

Front 284

In embryonal carcinoma what is the appearance of cells.

Back 284

undifferentiated cells that resemble embryonic stem cells,

Front 285

Malignant cells of nonsemonomatous tumor can diffrentiate along othe lineages generating:

Back 285

1. Yolk sac tumor

2. Choriocarcinoma

3. Teratoma

Front 286

Most testicular germ cell tumors originate from a precursor lesion called

Back 286

intratubular germ cell neoplasia (ITGCN).

Front 287

The exceptions to this rule (ITTGCN rule) are: ____________all of which are of uncertain origin.

Back 287

1. pediatric yolk sac tumors

2. Teratoma

3. Adult spermatocytic seminomas,

Front 288

T or F

ITGN is believed to arise in utero and donot stay dormant until puberty

Back 288

False - stay dormant

Front 289

ITGCN cells retain the expression of the transcription factors _____________, which are important in maintenance of pluripotent stem cells.

Back 289

OCT3/4 and NANOG

Front 290

In ITGCN Reduplication of the short arm of chromosome _______ in the form of an _______

Back 290

1. 12p

2. Isochrome i(12p)

Front 291

In ITGCN Activating mutations in the gene encoding the ____________ are also frequently present.

Back 291

KIT receptor tyrosine kinase

Front 292

About ___% of individuals with ITGCN develop _______ within five years after diagnosis

Back 292

1. 50

2. Invasive germ cell tumors

Front 293

T or F

it may be that practically all patients with ITGCN will eventually develop invasive tumors.

Back 293

True

Front 294

If not otherwise specified, “seminoma” refers to

Back 294

1. Classic or typical seminoma

Front 295

Most common type of germ cell tumor, making up about 50% of these tumors.

Back 295

Classical seminoma

Front 296

The peak incidence of seminoma is

Back 296

3rd decade

Front 297

T or F

Seminoma occurs in infants

Back 297

False- almost never occur

Front 298

An identical tumor of seminoma arises in the ovary, where it is called

Back 298

Dysgerminoma

Front 299

Seminoma contains these mutations

Back 299

1. Isochrome 12 p

2. OCT3/OCT4

3. NANOG

Front 300

Approximately 25% of seminoma tumors have

Back 300

KIT activating mutations.

Front 301

Produce bulky masses and has a homogeneous, gray-white, lobulated cut surface, usually devoid of hemorrhage or necrosis

Back 301

Seminoma

Front 302

The classic seminoma cell is _________ and ____________ ___________ appearing cytoplasm; and a ______ nucleus with _________ prominent nucleoli.

Back 302

1. large and round to polyhedral

2. has a distinct cell membrane;

3. clear or watery-

4. large, central

5. one or two

Front 303

Three things to remember for Classic Seminoma:

Back 303

1. Clear, watery cytoplasm

2. Fibrosis

3. Lymphocytes

Front 304

T or F

Anaplastic seminom has less cellular and nuclear irregularity (atypia)

Back 304

False - greater

Front 305

T or F

Anaplastic seminoma and seminoma has different behaviour

Back 305

False - same

Front 306

Who has greater mitotic activity and frequent tumor giant cells

Anaplastic seminoma/seminoma

Back 306

Anaplastic seminoma

Front 307

Uncommon, representing 1% to 2% of all testicular germ cell neoplasms.

----Affected individuals are generally men older than age _____years.

Back 307

Spermatocytic seminoma

Front 308

T or F

Spermatocytic seminoma has bad prognosis because it metastasize and it is fast growing

Back 308

False. - good prognosis- do not metastasize- slow growing

Front 309

T or F

Classic seminoma is larger than spermatocytic seminoma

Back 309

False. - SS is lager than CS

Front 310

Spermatocytic seminoma lacks-

Back 310

1. Lymphocyte

2. Granuloma

3. Syncytiotrophoblast

4. Extra- testicular site of origin

5. Admixture with other germ cell tumors

6. Association with ITGCN

Front 311

Spermatocytic seminoma containe 3 cell population these are:

Back 311

1. Medium sized cells

2. Smaller cells

3. Scattered giant cells (uninucleate/multinucleate

Front 312

Cell population ng spermatocytic seminoma w/c is most numerous, containing a round nucleus and eosinophilic cytoplasm

Back 312

Medium sized cells

Front 313

Cell population of spermatocytic seminoma that has a narrow rim of eosinophilic cytoplasm resembling secondary spermatocytes

Back 313

Small cells

Front 314

Cell population of spermatocytic seminoma that can be uninucleate or multinuceate

Back 314

Scattered giant cells

Front 315

Differentiate spermatocytic and classic seminoma

Back 315

1. No lymphocytes

2. Clear, water cytoplasm, fibrosis, lymphocytes

Front 316

Spermatocytic vs anaplastic

Back 316

*anaplastic has atypia

Front 317

What is the general gross characteristic of seminomas

Back 317

1. Yellow

2. Lobulated

3. Variegated

Front 318

--Occur mostly in the 20- to 30-year age group.

--These tumors are more aggressive than seminomas.

Back 318

Embryonal carcinoma

Front 319

T or F

Most primary tumors (e.g. embryonal carcinoma) are larger than seminoma.

Back 319

False - smaller

Front 320

Embryonal CA

On cut surfaces, the tumor is often variegated, poorly demarcated at the margins, and punctuated by foci of __________ or ________

Back 320

1. Hemorrhage

2. Necrosis

Front 321

Histologically, the cells of embryonal CA grown in what pattern

Back 321

1. alveolar or tubular patterns,

2. sometimes with papillary convolutions.

Front 322

T or F

More undifferentiated lesions may no display sheets of cells.

Back 322

False - may

Front 323

Neoplastic cells of embryonal CA Has

______

Back 323

1. Epithelial appearance

2. Large and anaplatic

3. Hyprochromatic nuclei + prominent nucloeli

Front 324

T or F

In embryonal CA The cell borders are usually distinct, and there is inconsiderable variation in cell and nuclear size and shape

Back 324

False - distinct, considerable

Front 325

T or F

In embryonal CA Mitotic figures and tumor giant cells are frequently seen

Back 325

True

Front 326

T or F

Embronal CA never occurs with another tumor (like teratoma)

Back 326

False - almost always

Front 327

Differentiate seminoma from embryonal CA

Back 327

1. Yellow.

2. Hemorrhagic

Front 328

Refers to complex testicular tumors having various cellular or organoid components reminiscent of the normal derivatives of more than one germ layer (three germ layers).

Back 328

TERATOMA

Front 329

Peak age of teratoma

Back 329

Any age from infancy to adult

Front 330

T or F

Pure teratoma in adult is common

Back 330

False - rare

Front 331

Pure forms of teratoma are fairly common in ___

Back 331

infants and children

Front 332

The frequency of teratomas mixed with other germ cell tumors is approximately ____%.

Back 332

45

Front 333

In the postpubertal male all teratomas are regarded as__________

Back 333

Malignant

Front 334

T or F

Teratoma in postpubertal male are not capable of metastatic behavior whether the elements are mature or immature.

Back 334

False - capable

Front 335

Gross appearance of teratoma

Back 335

heterogeneous with solid, sometimes cartilaginous, and cystic areas.

Front 336

Hemorrhage and necrosis in teratoma usually indicate admixture with ___

Back 336

1. embryonal carcinoma,

2. choriocarcinoma,

3. or both.

Front 337

Teratoma is Composed of a heterogeneous, helter-skelter collection of differentiated cells or organoid structures, such as _______

Back 337

1. neural tissue

2. muscle bundles,

3. islands of cartilage,

4. clusters of squamous epithelium,

5. structures reminiscent of thyroid gland,

6. bronchial or bronchiolar epithelium, and

7. bits of intestinal wall or

8. brain substance,

Front 338

Diffrentiated cells and organoid structures of teratoma are all embeded in ______

Back 338

1. Fibrous / myxoid stroma

Front 339

What are the forms of elements of teratoma

Back 339

1. Mature

2. Immature

Front 340

A phenomenon wherein there are malignant non–germ cell tumors that arise in teratomas.

Back 340

Teratoma with malignant Transformation

Front 341

T or F

Teratoma with malignant Transformation are chemosensitive

Back 341

False - chemoresistant

Front 342

The only hope for cure in Teratoma with malignant Transformation

Back 342

Resectability of the tumor

Front 343

Yolk sac tumor is also known as

Back 343

Endodermal sinus tumor

Front 344

It is the most common testicular tumor in infants and children up to 3 years of age, wherein it has a very good prognosis.

Back 344

Yolk sac tumor(endodermal sinus tumor)

Front 345

T or F

Yolk sac tumor in adults, the pure form of this tumor is common

Back 345

Rare

Front 346

In adults, yolk sac tumor frequently occurs in combination with ________

Back 346

Embryonal CA

Front 347

Yolk sac tumor is composed of _____

Back 347

lacelike (reticular) network of medium- sized cuboidal or flattened cell

Front 348

In approximately 50% of tumors, structures resembling endodermal sinuses (_______)may be seen;

Back 348

Schiller duval bodies

Front 349

Components of schiller duval bodies

Back 349

1. Mesodermal core - visceral and pareital layer of cell - resembling primitive glomerumi - GLOMERULOID

Front 350

This is demonstrated in immunocytochem staining of yolk sac tumor

Back 350

1. Alpha feto protein

2. Alpa 1- antitrypsin

Front 351

-- Highly malignant

-- Often cause no testicular enlargement and are detected only as a small palpable nodule, rarely larger than 5 cm in diameter

Back 351

CHORIOCARCINOMA

Front 352

These are common manifestation of choriocarcinoma

Back 352

1. Hemorrhage

2. Necrosis

Front 353

Histologically the choriocarcinoma tumors contain two cell types,

Back 353

1. Syncytiotrophoblast

2. Cytotrophoblast

Front 354

are large multinucleated cells with abundant eosinophilic vacuolated cytoplasm containing HCG (marker), which is readily detected by immunohistochemistry.

Back 354

Syncytiotrophoblast

Front 355

Cell marker for syncytiotophoblast

Back 355

HCG

Front 356

About 60% of testicular tumors are composed of more than one of the “pure” patterns.

Back 356

MIXED TUMORS

Front 357

Common mixtures of mixed tumor

Back 357

1. Teratoma + embryonal CA + yolksac tumor ---- YET

2. Seminoma + embryonal CA --- ES

3. Embryonal CA + teratoma --- TE - terotocarcinoma

Front 358

T or F

Germ cell tumors causes painful enlargement of testis

Back 358

1. False - painless

Front 359

This spread is common to all forms of testicular tumors

Back 359

Lymphatic spread

Front 360

What the primary node involved in lymphatic spread

Back 360

1. Retroperitoneal para-aortic nodes

Front 361

Hematogenous spread of germ cell tumor is primarily to the

Back 361

1. Lungs -1st

2. Liver

3. Brain

4. Bones

Front 362

Stage of testicular tumor wherein tumor confined to the testis, epididymis, or spermatic cord

Back 362

Stage 1

Front 363

Stage of testicular tumor wherein distant spread confined to retroperitoneal nodes below the diaphragm

Back 363

Stage 2

Front 364

Germ cell tumor stage where in there is metastases outside the retroperitoneal nodes or above the diaphragm

Back 364

Stage 3

Front 365

What are the bio markers of germcell tumor

Back 365

1. Lactate dehydrogenas

2. AFP

3. HCG

4. AFP AND HCG

Front 366

elevation correlates with tumor cell mass; provides a tool to assess tumor burden

Back 366

Lactate Dehydrogenase:

Front 367

Markes produced by yolk sac tumors

Back 367

AFP

Front 368

Marker produced by choriocarcinoma elements

Back 368

HCG

Front 369

elevated in more than 80% of individuals with NSGCT

Back 369

AFP + HCG

Front 370

In the context of testicular tumors, the value of serum markers is fourfold:

Back 370

- In the evaluation of testicular masses

- In the staging of testicular germ cell tumors.

- In assessing tumor burden

- In monitoring the response to therapy

Front 371

T or F

After eradication of tumors there is a slow fall in serum AFP and HCG).

Back 371

False - rapid

Front 372

TUMORS OF SEX CORD-GONADAL STROMA

Back 372

1. LEYDIG CELL TUMORS

2. SERTOLI CELL TUMORS

Front 373

Leydig cell tumor May elaborate _______ and in some cases both ________and _______€, and even _________

Back 373

1. Androgen

2. Androgen and estrogen

3. Corticosteroids

Front 374

T or F

Leydig cell tumors may arise at any age, although most cases occur between 20 and 60 years of age.

Back 374

True

Front 375

The most common presenting feature in leydig cell tumor is_________ but in some patients, ___________ may be the first symptom.

Back 375

1. Testicular swelling

2. Gynecomastia

Front 376

In children, hormonal effects, manifested primarily as ,____________ are the dominant feature

Back 376

sexual precocity

Front 377

T or F

LC tumor Have a distinctive golden brown, homogenous cut surface.

Back 377

True

Front 378

Leydig cells are large in size and have ___________cell outlines, abundant granular eosinophilic cytoplasm, and a round central nucleus.

Back 378

round or polygonal

Front 379

Most characteristically, rod-shaped _________are seen in about 25% of the LC tumors.

Back 379

crystalloids of Reinke

Front 380

Appear as firm, small nodules with a homogeneous gray-white to yellow cut surface.

Back 380

Sertoli cell tumor

Front 381

Cells are arranged in distinctive trabeculae that tend to form _______structures and tubules.

Back 381

Cordlike

Front 382

T or F

Most Sertoli cell tumors are malignant

Back 382

False - benign

Front 383

Rare neoplasms comprised of a mixture of germ cells and gonadal stromal elements that almost always arise in gonads with some form of testicular dysgenesis.

Back 383

Gonadoblastoma

Front 384

Most common form of testicular neoplasms in men older than age 60 years.

Back 384

Testicular lymphoma

Front 385

account for 5% of testicular neoplasms.

Back 385

Aggressive non-Hodgkin lymphomas

Front 386

MISCELLANEOUS LESIONS OF TUNICA VAGINALIS

1. accumulation of serous fluid

2. presence of blood

3. Accumulation of lymph

4. Accumulation of semen

5. dilated vein in the spermatic cord

Back 386

1. Hydrocele

2. Hematocele

3. Chylocele

4. Spermatocele

5. Varicocele

Front 387

Approximat weight of prostate

Back 387

20gm

Front 388

It is a retroperitoneal organ encircling the neck of the bladder and urethra, and is devoid of distinct capsule.

Back 388

Prostate

Front 389

Four biologically and anatomically distinct zones or regions of prostate:

Back 389

1. peripheral,

2. central,

3. transitional

4. periurethral zones

Front 390

Most hyperplasias arise in the _______ whereas most carcinomas originate in the _______

Back 390

1. transitional zone

2. peripheral zone.

Front 391

When you do rectal examinations, you will be able to palpate for the ___________ where the most common site of malignancy is located.

Back 391

peripheral zone,

Front 392

Two layer of cells that lines the prostatr gland

Back 392

1. Low cuboidal epith

2. Low columnar secretory

Front 393

Procedure used in the diagnosis if prostate cancer

Back 393

Core needle biopsy

Front 394

In core needle biopsy of the prostate the pathologist looks for____

Back 394

Gland and/or stroma

Front 395

If prostate cancer is benign you can see_____

Back 395

1. Two cell layers

2. fibrocollagenous stroma with inflammatory cells

Front 396

What do you see in maglignant prostate cancer

Back 396

Single linging

Front 397

Inflammation of prostate

Back 397

Prostatitis

Front 398

Acute bacterial prostatitis is mostly caused by

Back 398

1. E. Coli

2. G(-) rods

3. Enterococci

4. Staphylococci

Front 399

How are organisms implanted on the prostate

Back 399

1. Intraprostatic reflux

2. Lymphohematogenous route

Front 400

Prostatitis is clinically associated with

Back 400

1. Fever

2. Chills

3. Dysuria

Front 401

In acute bacterial prostatitis On rectal examination, the prostate is exquisitely ______

Back 401

1. tender and boggy.

Front 402

In ACUTE BACTERIAL PROSTATITIS Diagnosis can be established by ____

Back 402

1. urine culture and

2. clinical features.

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CHRONIC BACTERIAL PROSTATITIS is presented with ________

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1. low back pain

2. dysuria

3. perineal and suprapubic discomfort

**it can be assymptomatic

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Patients of chronic bacterial prostatitis has a history of ______

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1. Cystitis

2. Urethritis

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Diagnosis of chronic bacterial prostatitis depends on the demonstration of________

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1. Leukocytosis - >10/hpf

2. Prostatic secretions

3. + bacterial culture

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--Most common prostatitis

--no history of recurrent UTI

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CHRONIC ABACTERIAL PROSTATITIS

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Diagnosis result of CHRONIC ABACTERIAL PROSTATITIS

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1. >10/hpf

2. - urine culture

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Most common cause is instillation of BCG within the bladder for treatment of superficial bladder cancer.

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Granulomatous prostatitis

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Granulomatous prostatis that is typically seen only in immunocompromised hosts.

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Fungal granulomatous prostatitis

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-------- presence of neutrophils, culture- positive

--------lymphocytes and macrophages, culture-positive

-------- lymphocytes and macrophages, culture-negative

-------- macrophages with giant cells, culture-positive

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1. Acute bacterial

2. Chronic bacterial

3. Chronic abacterial

4. Granulomatous

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Most common benign prostatic disease in men older than age 50 years.

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BENIGN PROSTATIC HYPERPLASIA OR NODULAR HYPERPLASIA

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BPH results from nodular hyperplasia of prostatic _________and ______ cells (or glands) and often leads to urinary obstruction.

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1. Stromal

2. Epithelial

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Characterized by the formation of large, fairly discrete nodules in the periurethral region of the prostate, which, when sufficiently large, compress and narrow the urethral canal to cause partial, or sometimes virtually complete, obstruction of the urethra

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BPH

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Characteristic feature of BPH during urination

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1. Dysuria

2. Dribbling of urine 15-20×

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Hormone associated with BPH

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Androgen

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The main androgen in the prostate, constituting 90% of total prostatic androgens, is

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dihydrotestosterone (DHT).

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What is responsible for androgen-dependent prostatic growth

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Stromal cells

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A metabolite of circulating testosterone thru the action of type 2 5alpha-reductase located in the stromal cells

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DHT

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are paracrine regulators of androgen-stimulated epithelial growth during embryonic prostatic development

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Fibroblast growth factors (FGFs), produced by stromal cells,

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Weight of prostate in BPH

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60- 100 gm

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Nodules that contain mostly glands in BPH .

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1. yellow-pink and soft,

3. exude a milky white prostatic fluid

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The major clinical problem in those with BPH is

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urinary obstruction

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---Putative precursor lesion

---Benign-looking glands with intra-acinar proliferation

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Prostatic intraepithelial neoplasia - PIN

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What makes PIN intraepitheliap

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Anaplasia within basement membrane

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T or F

PIN Typically predominate in the peripheral zone

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True

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*Most common form of cancer in men *Second leading cause of cancer death

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PROSTATIC ADENOCARCINOMA

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T or F

Environment plays a role in prostatic adenocarcinoma

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True

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Etiology and pathogenesis of prostatic adenocarcinoma

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1. Androgens play an important role in prostate cancer.

2.bHypermethylation of glutathione S-transferase (GSTP1) gene located at 11q13

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Arises in the __________ of the gland, classically in a________ location, where it may be palpable on rectal examination

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1. peripheral zone

2. posterior

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In prostatic adenomcarcinoma Characteristically, on cross-section of the prostate, the neoplastic tissue is

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gritty and firm.

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Local extension of prostatic adenocsrcinima most commonly involves

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1. periprostatic tissue

2. seminal vesicles,

3. base of the urinary bladder.

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Metastases of prostatic adenovarcinoma spread via _______ to the ________ and eventually to the para-aortic nodes.

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1. lymphatics.

2. obturator nodes > paraortic nodes

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Hematogenous spread of prostatic adenocarcinoma occurs chiefly to the _____.

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1. bones,

2. particularly the axial skeleton

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Commonly involved bone in hematogenous spread of Prostatic adenocarcinoma

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1. Lumbar spine

2. Proximal femur

3. Pelvis

4. Thoracic spine

5. Ribs

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What layer of prostate is absent in prostatic adenocarmcino

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Outer basal dmc ater

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A histologic finding on biopsy that is specific for prostate cancer is

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perineural invasion.