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60 Cards in this Set

  • Front
  • Back
Does tamsulosin increase risk of cataract surgery?
Yes, 2.33 OR of adverse event within 14 days of cataract surgery.

Coffman et al. Ontario Health Insurance Plan database of 96,128 men undergoing cataract surgery (JAMA 2009). Theorized due to unopposed parasympathetic action in iris
most common parasite seen in urine in US
trichomonas
what virus:
enlarged nucleus with single, irregular blue-ish "bird eye's" inclusion
CMV
what virus:

multinucleated cells with "ground glass" nuclei and large eosinophilic intranuclear inclusions surrounded by halo
HSV
what cancer is long term phenacetin and acetaminophen exposure associated with?
kidney cancer
What GU cancer associated with "hypochromic anemia"?
Kidney cancer from BM invasion
What is Stauffer's syndrome?
Hepatic dysfunction (elevated AP, ALT/AST, coagulopathy) from RCC
What is associated with VHL syndrome?
3p25
CNS/retinal heminagioblastoma
Epididymal cystadenomas
Pheochromocytomas
Pancreatic cysts
RCC (30-50% pts)
What is associated with tuberous sclerosis?
hamartomas of brain, retina, skin, kidney, heart, bone and lung
Renal cysts
AML
RCC
On path slide, how can you differentiate clear cell RCC from XGP kidney?
XGP- foam cells

RCC- look for "chicken wire" pattern
What are signs of Malakoplakia?
(path stuff)
Michaelis-Gutmann bodies (spherical blue things in cytoplasm)

Van Hansemann cells (large eosinophilic histiocytes)
What are genetics of clear cell RCC?
Loss 3p
Gain 5q
c-myc

(3p and 5q not seen in Papillary/Chromophil or chromophobe)
What are genetics of papillary (chromophil) RCC?
trisomy of 7 and 17, loss Y chromosome

(NO loss of 3p or gain 5q)
What is importance of Hale's Colloidal Iron Stain
Distinct for chromophobe (STAIN POSITIVE)

Allows differentiation from CLEAR and ONCOCYTOMA which are NEGATIVE
What kidney cancer stains
vimentin positive and is described with "hobnail" appearance?
Collecting Duct Carcinoma (Belli's duct carcinoma)
-bad prognosis

(UTUCC is vimentin negative)
What do you look at to determine the Fuhrman grading system?
Nuclear size, shape, chromatin and nucleoli.

Mitotic figures are NOT part of system
G1->86% 5 year CSS, G4->24%
Can you see areas of hemorrhage/necrosis with oncytoma?
You shouldn't. This almost always mitigates dx of oncytoma

NO mitotic figures, papillary architecture, no clear cells or iron staining (later is chromophobe), no vascular invasion, no fat invasion
What RCC has mean survival of 15 weeks after resection?
Medullary Carcinoma
-may be variant of collecting duct ca.
-Seen in young pts with sickle cell
-ill-define mass in medulla w/hemorrhage + necrosis
What renal tumor is HMB positive?
This is typically melanoma marker:
-angiomyolipoma (AML)

Intervene when > 4cm
what's most common enzyme defect with CAH?
90% - 21-hydroxylase deficiency (virilization + salt wasting)

5% 11-beta hydroxylase (virilization + HTN from increase cortisol products)
What are pathologic features of adrenocortical carcinoma?
-Giant cells with bizarre nuclei
-Nuclear grade III or IV
-mitosis > 5/50HPF
-Diffuse architecture
-Necrosis
-capsular/vascular invasion
BUT NOTHING short of metastases can 100% differentiate benign from malignant
What pathologic characteristics are important with neuroblastoma?
-Shimada FAVORABLE or UNFAVORABLE
-N-myc amplification (bad)
-loss of chr 1p (bad)
-extra 17q (bad)
Where is a pheo located if it's secreting high norepinephrine?
Extra-adrenal
-methylation of NOR->Epi requires high glucocorticoid environment of adrenal cortex
What is Waterhouse-Friedrichsen syndrome?
acute bilateral adrenal hemorrhage in infants, usually from memingococcal or pseudomonal septicemia (from DIC)
What are two theories for the cause of renal dysplasia?
-urinary obstruction in utero
-Inability of the ureteric bud to induce tissue; or failure of metanephric blastema to respond
Large red moist patch on glans of uncirc'd patient.

Bx->plasma cells. what is this?
Zoon's Balanitis.

Benign. Need bx to rule out SCC
STD
gram negative "biscuit shaped" diplococci
Neisseria gonorrhea
what are the names for penile CIS?
Erythroplasia of Queyrat->on glans

Bowen's disease-> on shaft
what cancer did chimney sweets get
Pott's cancer
scrotal squamous cell carcinoma
from 3,4'-benzpyrene
Most common cause of emphysematous cystitis
E. coli or aerobacter aerogenes

female diabetics
What is cyclophosphamide use associated with?
bladder cancer
-accumulation of metabolite acrolein
-10.7% increased risk at 12 years
What is most common genetic abnormality in bladder cancer
-Loss of chromosome 9q (in up to 50% cases)
-Also trisomy 7 and loss of Y
what is prognosis of TCC CIS?
up to 1/3 already have microinvasive disease at time of dx

32-83% will progressive to invasive disease
who gets bladder SCC?
-schitosomiasis (middle east)
-chronic irritation (SCI with foleys/stones)
-bladder diverticula
which cells in the prostate stain positive for PSA?
the columnar secretary epithelial cells.
also PAP+

Basal cells: PSA(-)
What should you look for to dx HGPIN?
intact basal cells,
+nucleoli
-basophilic glands due to increase N:C
-glands intact
Where in prostate is cancer most commonly located?
80% peripheral
20% TZ
Syndromes associated with UDT's
prune belly
Klinefelt's
Noonan's
Kallman's
Prader-Willi
Trisomy 13,18, 21
GU anomalies associated with UDT
(10%)
hypospadias
Duplication GU tract
Kidney malrotation
Valves
Sperm excretory duct anomalies (ie poor fusion of epi to testis)
What clinical findings are associated with Klinefelters?
47XXY karotype (80%)
Eunuchoid phenotype (long extremities)
Incomplete virilization
Gynecomastia
Mental retardation
Small, hyalinized testes
Increased extragonadal germ cell tumors
Hypogonadism
Obesity
Hypotonia
Mental + Physical Retardation
Chr 15p11-12
Prader-Willi
Genetic syndrome associated with psychopathic personalities
47 XYY syndrome
-tall
3% men in mental institutions + prison
Nl ext genitalia but decreased fertility
Mixed tubular atrophy on bx
NL T and LH levels
Peak age incidence of testicular cancer
30
(except spermatocytic seminoma which is in older men ~50)
What is risk of contralateral primary testicular cancer?
2-5% in other testes
(esp. if bx proven IGCNU)
50% within 3-5 years of 1st tumor
Is family hx important in testicular cancer?
Yes. 5.5x incidence if first degree relative
Also greater incidence b/l tumors (8-14%)
Does prior vasectomy increase risk of testicular cancer?
NO.
Neither does EtOH or XRT
What percentage of pt with androgen insensitivity syndrome develop testes cancer?
5-10%
Perform prophylactic orchiectomy
Why do men with seminoma sometimes have gynecomastia?
HCG stimulating T secretion
(10-20% stage I pt with elevated HCG)

HCG > 40/L poor px indicator
What type of seminoma do you see three different cell sizes?
Spermatocytic
Peak age 52-58
whites > AA
AFP, HCG, LDH negative
what tumor markers elevated with embryonal ca.?
HCG in 60%

(AFP signifies non-pure; embryonal may transform into yolk sac)
+LDH + PLAP elevated
What is rate of relapse after orchiectomy for stage I pure embryonal testicular ca?
40% relapse
Most can be salvaged with chemoRx
Most common testicular tumor of prepubertal children
yolk sac
average age = 18 months
What testicular tumor has Schiller Duval bodies?
Yolk Sac
(also known as glomeruloid bodies)

H&E: Yolk has honeycomb or vacuolated appearance
Do most children with yolk sac testicular tumor need RPLND?
No. 80% are stage I and can be followed with surveillance.
What is second most common testicular germ cell tumor in prepubertal children?
Teratoma (14-18% cases)
Mean age = 20 months
> 4 years is unusual
How do pts with pure choriocarcinoma present?
Present with symptoms of metastatic dz (to lung, brain, and GI tract)
Pt 2nd to 3rd decades
Rare, 0.3% of testicular tumors
What secondary hormone manifestations can pt with choriocarcinoma present with?
High HCG->cross react with TSH and LH
-Can have gynecomastia or thyrotoxicosis
What markers do choriocarcinoma stain for?
100% stain for HCG
-50% can have aFP
What testicular tumor has Reinke Crystals?
Leydig Cell
(Assoc. with Klinefelter's and UDT)
3% bilateral
What paraneoplastic syndrome can Sertoli cells tumors be associated with?
Gynecomastia
30% cases

10% malignant->orch + chemo/XRT