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70 Cards in this Set

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What are the two layers of the urothelium? (male gu)
1. lamina propria = loose connective tissue, and bundles of smooth muscle fibers on tip of muscularis propria

2. Muscularis propria: deep muscle, detrusor muscle, arranged in several layers
What is the function of the urothelium?
To form a tight barrier bwtween urine and blood (umbrella cells form the tight barrier)
VIP
What is the most common cause of hydronephritis is children?
A uretropelvic junction obstruction.
What is cystitis?
Bacterial induced increase in frequency of urination, pain, and dysuria.
Who is more likely to have cystitis?
Women, because of short urethra
What is interstitial cystitis? (aka Hunner's Ulcer"
It is a non-bacterial form of cystitis (90% female) associated with allergies and autoimmune diseases (SLE, RA, thyroiditis)

Causes UTI symptoms
What are the microscopic findings of a Hunner's ulcer:
Fissures and punctate hemorrhages (causing the UTI-like symp and causing diminished bladder capacity)
VIP

What are two unusual causes of bladder CA?
1. Schistosomiasis (parasite endemic in Egypt that causes squamous cell CA of bladder)

2. Chronic irritation of bladder (ie stones)
VIP

What are the two molecular pathways in development of bladder CA?
1. 9p deletion (first event)

2. As deletion progresses others occur: 17p, 5q, 13q, 11p
Compare papillary urothelial carcinoma - low grade to high grade:
Low: orderly appearance (VIP: minimal nuclear atypia), only 10% progression. Can see thin projectins and capillaries inside. Can test patient's chromosomes.

High grade: dyscohesive, large hyperchromatic nuclei, loss of polarity, mitotic figures (80% invasion - VIP)
BLADDER CA
Treatment for:
1. Papillary low grade
2. CIS, papillary high grade
3. T2
4. T4
1. Low grade = resection, follow up
2. Pap high grade = intravesical immunotherapy
3. T2 = cystectomy
4. T4 = chemotherapy
What kind of bladder CA is caused by Mycobacterium TB?
What is the unique treatment?
Bacillius Calmate-Guerin

treatment: intravesical BCG immunotherapy that elicits a local cell-mediated immune reaction that destroys tumor cells.
Describe the normal prostate:
Has a fibrous stroma with lots of acini and ducts, also has secretory and basal cells.

It is chest-nut shaped.
What is the age range effected for benign prostatic hyperplasia?
ages > 50yo
Describe the effects of benign prostatic hyperplasia:
It causes a nodular enlargement of the periurethral (lateral and middle) lobes of the prostate gland.

This compresses the urethra into a vertical slit. So the patient often presents with problems with urination.
In benign prostatic hyperplasia, what tissue is hyperplastic?
Both the prostatic glands and the stroma's muscular component!
What percentage of men with has benign prostatic hyperplasia by the age of 70?
90%
What is the main cause of benign prostatic hyperplasia?
BPH is directly related to the action of DHT, a testosterone metabolite. DHT is synthesized from testosterone by the action of 5-alpha-reductase (reduce in treatment). With the production of DHT = growth-promoting effects.
How does benign prostatic hyperplasia increase the chance of a diverticuli of the bladder?
From the compression of the urethra induced by benign prostatic hyperplasia their is stasis of the bladder --> bladder trys to push it out --> hypertrophy of the wall (increase chance of diverticuli)
What is the most common CA in men and second cause of death?
Adenocarcinoma of the prostate(bladder CA is very common but it doesn't kill)
What are two predisposing factors to adenocarcinoma of the prostate?
1. age, 80% at 80 yo
2. AA > European
VIP
What is PSA?
A serine protease composed of a single-chain glycoprotein that is secreted into the seminal fluid.
It is produced by epithelial cells of normal, hyperplastic, AND cancerous prostate tissue.
VIP

Does high grade adenocarcinoma of the prostate always show a very high PSA?
No, very advanced CA's can stop making PSA!
Do PSA levels increase with age?
Yes
What is an abnormal PSA?

What is the gray area?
Abnormal > 4nm/mL

Gray zone: 4-10nm/mL (not necessarily CA)
How is the ratio of free tobound PSA different in adenocarcinoma of the prostate than it is for BPH?
Free:Bound PSA is lower in adenocarcinoma of the prostate than it is in BPH

CA < BPH (BPH has more free)
VIP
What are the three characterisitic microscopic features of adenocarcinoma of the prostate?
1. prominent nucleoli
2. single cell layer (no more basal cell layer)
3. perineural invasion
VIP
What are Gleason scores and what are they used for?
To predict prognosis of prostate CA.

They look a combination of archetecture of the cells (size, glandular component) and the amount of differentiation (well diff = good). Each are graded on a scale of 1-5 and added together to determine management.
What is a prostatic intraepithelial neoplasm?
A precancerous lesion that affects only the large ducts. However, since they are so closely correlated with prostate CA (33-100% for highgrade PIN), once we see these --> think, "Did I miss a CA?"
What does an increased total PSA and a decreased fraction of free PSA indicate?
Malignancy
What does an increased total PSA and an increased fraction of free PSA indicate?
Benign prostatic hyperplasia
VIP
What is hypospadias?
Urethral opening on the ventral surface of the penis.
VIP
What is epispedias?
Urethral opening on the dorsal side of the penis.
VIP

Phimosis?
Prepuce can not be retracted, caused by poor hygiene. Can cause infections and cancer
VIP

Paraphimosis?
Prepuce becomes trapped behind the glans penis and can't be pulled back --> medical emergency
What effects can Gonorrhea have on the penis?
Can cause urethritis that can lead to urethral strictures causing sterility (in females = ectopic pregnancies)
What effects can Chlamydia trachomatis have on the penis?
C. trachomatis = nongonoreal urethritis
It causes lymphogranulmoa venerum which is when small epidermal vesicles --> ulcer --> inguinal and rectal lyphadenopathy (penile inflammation)
What effect can Tremonena pallidum have on the penus? Describe its progression.
T. Pallidum (syph) has a primary infection of a chancre formation (3 wks), can progress to a palmar/solar rash, lymphadenopathy, headache, fever, and Condyloma latum (2-10wks). If untreated can again progress to neurosyphilis, aortitis, and gummas.
What is a condyloma acuminatum? What causes it?
Veneral wart (red papillary), caused by HPV types 6 and 11.
What characteristic does condyloma acuminatum have microscopically?
Proliferation of squamous cells with KOILOCYTOSIS (clear vacuolization of the cytoplasm)
What causes penile squamous cell carcinoma?
HPV 16 and 18
What are the characteristics of penile squamous cell carcinoma? (3)
1. ulcerative
2. plaque-like
3. keratin pearls
What is cryptorchism?
Undescended testis (one or both). There is often a lack of spermatogenesis due to high body temperature (infertility) and it is associated with an increase in germ cell tumors.
Microscopically what will you see in cryptorchism?
Tubular atrophy from a small testicle
Even if cryptorchism is corrected, is there still a high risk of developing germ cell neoplasia?
Yes
What is the tunical vaginalis?
Serous covering of testis
VIP

Hydrocele testes?
Clear fluid accumulation around testis
VIP

Hematocele testes? Causes (2)
Blood accumulation around testes (trauma, torsion)
VIP

Chylocele testes?
Lymphatic accumlation around testes (elephantitis)
VIP

Spermatocele?
A retention cyst around the testicles that contains semen
VIP

Varicocele?
Dilated vein in the spermatic cord.
VIP

Describe the progression of how the male genitalia is effected (spread) in a:
1. Gonorrhea (or TB) infection
2. Syphilis infection
1. Gonorrhea -- starts in the epididymis and spreads to the testis

2. Syphilis --> starts in the testes and spreads to the epididymis
What infection can both mumps and Coxackie B cause?
Epididymo-orchitis
Male presents to the ER with sudden severe pain of his testicles. Surgeon says he must have surgery on it within 8hrs. What is wrong with the man?
He has torsion of the spermatic cord which supplies blood to the testicle. This can cause the infarction of the testicle (and then fibrosis). Must be corrected within 8 hrs (80% salvage; within 10hrs = 20%)
What are the most common tumors in men aged 15-34?
Testicular tumors
VIP VIP VIP

Three things that predispose the pathogenesis of germ cell testicular tumors?
1. Cryptorchism (even if corrected)
2. Testicular dysgenesis (disorder of testicular development seen in Klinefelters XXY and others)
3. ISOCHROMOSOME of SHORT ARM of CHR 12, i(12p) = 90%!!! VIP
What is the first thing you must know about a testicular germ cell tumor once you've identified it? Why?
Is it semiomatous or nonseminomatous (NSGCT = resistant to radiation therapy)
VIP
What is the most common testicular tumor in elderly men?
Spermatocytic seminoma
(most common primary tumor in elderly men)
Describe the five differences between seminomas and nonseminomatous germ cell tumors?
Seminoma:
1. a "benign" malignancy
2. 70% in stage 1
3. met to LN
4. radiosensitive
5. 95% cured

NSGCT
1. more aggressive
2. 60% in stage II and III
3. hematogenous spread (lungs/liver)
4. radioresistant
5. 90% remission with aggressive chemo
VIP
Describe the microscopic findings of a seminoma:
1. Gray-white cut surface
2. Sheets of large cells
3. Has a FIBROUS SEPTA infiltrated with LYMPHOCYTES
VIP

Explain why Embryonal CA is considered "so different" from a seminoma:
Embryonal:
1. Onset 20-30y (S: 30-40)
2. Gross: poorly demarcated with necrosis and hemorrhage (S: solid gray white surface)
3. Micro: glandular, tubular papillary patterns of large cells (S: large cells with fibrous septa filled with lymphocytes)
Yolk sac tumors have two peaks of age ranges effected - which is better to get?
1. infantile (good prognosis)
2. young adults (mixed tumors)
Describe the microscopic appearance of yolk sac tumors?
Network of cuboidal cellsin a papillary pattern (Schiller-Duval) and hylin-like globules
Is a choriocarcinoma often slow growing or fast?

Age most commonly effected?
Very aggressive - often mets at presentation

(20-30yo)
Are there any benign teratomas in post-pubertal males?
NO!!! (in infancy they are pure but in adulthood they are mixed germ cell tumors)
Is patient at risk for developing metatasis with a teratoma?
Yes
How can we tell if a Leydig tumor is cancer?
The only way is to see if it metastasized.
VIP

Describe the gross and micro appearance of a Leydig tumor:
Gross: homogenous nodule with golden brown cut surface

Micro: large cell with alot of granular cytoplasm around a centrally located nuclei with prominent nucleoli.
VIP!! MOST IMPORTANT

What is a lymphoma of testicles?
The most common testicular neoplasm > 60yo! (first think lymphoma, 2nd-met, 3rd spermatolytic seminoma)

It is usually secondary and its most common form is B-cell lymphoma.
VIP
What are the characteristics of a lymphoma from the testicles?
Gross: fleshy, white to pink, and they usually replace testicular parenchyma!!