Pathology - S2B1 - Male Gu 2

Front 1

What is epithelium of the Urinary Tract lined by?

Back 1

Transitional epithelium = Urothelium

Front 2

Where is the most common Urogenital neoplasm located?

Back 2

Urinary Bladder

Front 3

What is the age range for having Urinary Bladder tumors?

Back 3

50-80 years

Front 4

What sex is more likely to have Bladder cancer?

Back 4

Males = 3:1

Front 5

What are the risk factors for developing Urinary Bladder tumors and which is most important

Back 5

1. Tobacco ***
2. Aniline dies (naphthylamine) = occupational exposure
3. Schistosoma haematobium (common in Egypt)

Front 6

Describe the 4 ways in which Bladder Cancers can appear on gross examination

Back 6

1. Papillary exophytic
2. Flat carcinoma in situ
3. Exophytic cauliflower-like tumors
4. Ulcerated and invading into surrounding structures

Front 7

This is a very uncommon benign bladder tumor

Back 7

Transitional bladder papilloma

Front 8

What is the most common Bladder cancer?

Back 8

Transitional cell carcinoma

Front 9

What is Squamous Cell Carcinoma of the Bladder associated with?

Back 9

Schistosoma hematobium -> eggs are located in the bladder venous plexus
- IgE Ab's attach to eggs
-Eosinophils with Fc receptors activated by IgE -> Major Basic Protein
- Type II HS reaction -> chronic bladder irritation -> Squamous metaplasia

Front 10

What are the 2 possible causes of Adenocarcinoma of the Bladder?

Back 10

1. Urachal remnants ***

2. Glandular metaplasia in patients who have chronic irritation (Cystitis glandularis)

***most common

Front 11

Are most urinary bladder tumors benign or malignant?

Back 11

Malignant

*but 75% are low grade = not invasive

Front 12

Vignette: Grape-like masses protruding from the urethral orifice of a boy

Back 12

Rhabdomyosarcoma of the bladder

Front 13

What is another name for Bladder Rhabdomyosarcoma?

Back 13

Sarcoma botryoides

Front 14

What does prognosis of Urinary Bladder tumors depend on?

Back 14

Grade and Stage

Front 15

Describe Low Grade bladder tumors

Back 15

Noninvasive, papillary
-excellent prognosis, but tend to recur

Front 16

Describe High Grade bladder tumors

Back 16

INVASIVE (in muscle layer), papillary or flat
- prognosis varies

Front 17

Survival rates for TCC bladder cancer
-Stage 1
-Stage 2
-Stage 3

Back 17

1. 98% (50% recur, 10% progress to grade II or III)
2. 70% (70% recur)
3. 40% (90% recur)

Front 18

How does Transitional Cell Carcinoma (TCC) of the bladder most often present clinically?

Back 18

Hematuria

Front 19

Which has a worse prognosis, Squamous Cell Carcinoma of the bladder or Transitional Cell Carcinoma of the bladder?

Back 19

Squamous Cell Carcinoma
- only 30% survavial rate for 1 year survival

Front 20

Testicular Tumors:
1. Common or rare?
2. Are most benign or malignant?
3. What are 90% derived from?
4. Peak age?

Back 20

1. Rare (5:100,000)
2. Malignant (90%)
3. Germ cell origin
4. 35 years of age

Front 21

What are the 2 risk factors for Testicular tumors?

Back 21

1. Cryptorchidism

2. Intersex (pseudohermaphrodites)

Front 22

What is the prognosis of Testicular Tumors?

Back 22

Excellent response to Chemotherapy -> greater than 90% five year survival

Front 23

Why the disparity between the 1% incidence of testicular cancer and 4% incidence of ovarian cancer?

Back 23

-in testes 90% are from germ cell origin

-in ovary, germ cell tumors accounts for only 15-20%

Front 24

What are the 2 clinical groups of testicular germ cell tumors?

Back 24

1. Seminoma

2. Non-seminomatous germ cell tumors = more malignant

Front 25

What do testicular germ cell tumors originate from?

Back 25

Intratubular germ cells
-spermatogonia
-primordial germ cells

Front 26

What is the preinvasive form of testicular germ cell tumors?

Back 26

Intratubular germ cell neoplasia (in situ carcinoma) = ITGCN

Front 27

What are the tumor markers of NSGCT?

Back 27

AFP

hCG

Front 28

What lymph nodes do testicular tumors metastasize to first?

Back 28

Para-aortic lymph nodes

Front 29

What tumor markers do Seminomas produce?

Back 29

NONE

Front 30

NSGCT in which the embryonal carcinoma cells proliferate without differentiating into other cell types

Back 30

Embyronal carcinoma (undifferentiated)

Front 31

NSGCT in which the embryonal carcinoma cells differentiate into somatic tissues (neural tissue, cartilage) and extraembryonic tissue (yolk sack, trophoblastic cells)

Back 31

Terato-Carcinoma (partially differentiated)

Front 32

NSGCT in which embryonal carcinoma cells differentiate into trophoblastic cells that become the only malignant component

Back 32

Choriocarcinoma

Front 33

NSGCT in which embryonal cells differentiate into yolk sack cells and the entire tumor is composed of these cells

Back 33

Yolk Sac tumor

Front 34

Benign NSGCT in which the embryonal carcinoma cells differentiate into somatic tissues

Back 34

Teratoma

Front 35

-Malignant germ cells that have enlarged, hyperchromatic nuclei and well developed cytoplasm filled with glycogen
-cells remain inside the tubules for variable periods of time and then give rise to invasive tumor cells that spread outside the Seminiferous Tubules

Back 35

Intratubular Testicular Germ Cell Neoplasia (ITTGCN)

Front 36

The most common testicular tumor and it is also composed of a single cell type

Back 36

Seminoma

Front 37

What age range do Seminomas occur and what age does it never occur?

Back 37

25-45 years

Prepubertal boys

Front 38

Descibe the histology of Seminomas

Back 38

1. glycogen rich cells resembling ITTN cells or spermatogonia
2. tumor cell nests are surrounded by CT septa with Lymphocytes

Front 39

What is the gross appearance of Seminomas?

Back 39

Lobulated, uniform grayish-yellow

No hemorrhage or necrosis

Front 40

Where are metastases of Seminomas found first?

Back 40

Para-aortic lymph nodes

Front 41

Seminoma:
1. cure rate
2. treatment

Back 41

1. 90%

2. radiotherapy, chemo only in advanced cases

Front 42

What are Seminomas equivalent to in women?

Back 42

Ovarian Dysgerminoma

Front 43

Testicular cancer of early childhood (99% are < 4) and has high serum levels of AFP? What else is AFP associated with?

Back 43

Yolk Sac tumor

Hepatocellular carcinoma

*excellent cure rate (99%)

Front 44

What are Schiller-Duval bodies?

Back 44

Glomeruloid structures present in Yolk Sac tumors

Front 45

What are the 2 Sex Cord / Gonadal Stromal tumors of the testis?

Back 45

1. Leydig cell tumor

2. Sertoli cell tumor

Front 46

Which Sex Cord tumor is more frequent?

Back 46

Leydig

Front 47

Are Sexcord tumors usually malignant or benign?

Back 47

Benign (90%) vs. Malignant (10%)

Front 48

What is the most common testicular cancer in men >60?

Back 48

Malignant Testicular Lymphoma

Front 49

What are the 3 signs of Sex cord tumors?

Back 49

1. Macrogenitosomia = enlarged genital parts

2. Precocious puberty

3. Gynecomastia (may synthesize estrogen)

Front 50

What are Reinke crystals?

Back 50

rod-shaped crystalloids seen in the cytoplasm of Leydig cell tumors

Front 51

Are carcinomas of the penis common or rare in US?

Back 51

Rare

Front 52

What places are Penis carcinomas more common?

Back 52

Africa, Asia, S. America

Front 53

What is the peak age of having Penis Carcinoma?

Back 53

60 years old

Front 54

What are predisposing factors related to Penis Carcinomas?

Back 54

1. uncircumcision
2. poor hygeine
3. HPV

Front 55

What type of cancer are Penis Carcinomas?

Back 55

Squamous Cell carcinoma

Front 56

How do Penile Carcinomas usually present clinically?

Back 56

Ulcerations or mucosal indurated plaques
- nonpainful
- may bleed

Front 57

Where do metastases of the Penis usually go?

Back 57

Inguinal lymph node

Front 58

Term used for the squamous carcinoma in situ on the shaft of the penis

Back 58

Bowen Disease

Front 59

Term used for squamous carcinoma in situ on the glans of the penis

Back 59

Erythroplasia of Queyrat

Front 60

What does prognosis of Carcinoma of the penis depend on?

Back 60

Staging

Depth of invasion

Front 61

Which part of the Prostate is most sensitive to Estrogen and therefore more likely to undergo Hyperplasia?

Back 61

Central part (Periurethral)

Front 62

What is the proposed cause of Benign Prostatic Hyperplasia?

Back 62

an altered ratio of testosterone:estrogen that develops in the elderly (more estrogen)

Front 63

What race is BPH more common in?

Back 63

Black Americans

Front 64

What part of the prostate does Carcinoma usually develop?

Back 64

Peripheral

Front 65

What is the gross appearance of BPH?

Back 65

1. central portion is expanded by nodules that compress the peripheral part

2. peripheral portion is compressed into a "surgical capsule"

3. Urethra is compressed and tortuous or deformed

Front 66

What is the microscopic appearance of BPH?

Back 66

1. Hyperplastic glands lined by columnar and cuboidal cells
2. Lined by 2 layers of cells

Front 67

What are the clinical findings of BPH?

Back 67

1. increased frequency of urination
2. Nocturia
3. Dysuria
4. Difficulty starting and stopping the stream
5. incomplete evacuation

Front 68

What is the most common cause of Cystitis in men?

Back 68

Benign Prostatic Hyperplasia

Front 69

What are the complications of BPH?

Back 69

1. Urinary retention
-cystitis
-urolithiasis
2. Bladder Hypertrophy and Hyperplasia
-thick wall
-trabeculation = strand-like
3. Vesicoureteric reflux
-hydroureter/hydronephrosis
-pyelonephritis
4. Renal dysfunction

Front 70

What is the most common cancer in males?

Back 70

Prostate Carcinoma

Front 71

What is the greatest risk factor for Prostate Cancer?

Back 71

advancing age (rare before 40)

Front 72

When does Prostate Carcinoma never occur?

Back 72

in men castrated before puberty = hormones play a role

Front 73

What race is more susceptible to having Prostate Cancer?

Back 73

African americans

Front 74

What are 2 probable risk factors of Prostate Carcinoma

Back 74

Dietary factors (fat)
Testosterone levels

Front 75

What 2 cancers have both grade and stage as important prognostic factors?

Back 75

Prostate

Bladder

Front 76

What 2 tumor markers are important in Prostate Cancer?

Back 76

PSA

Prostatic Acid Phosphatase (useful in disease progression)

Front 77

What is the most common distant metastases of Prostate Cancer and what marker may be elevated?

Back 77

Bone

Serum Alkaline Phosphatase

Front 78

What structures do Prostatic Carcinomas tend to invade?

Back 78

1. Seminal vesicles
2. Bladder
3. Rectum

Front 79

What is the histology of Prostate Cancer?

Back 79

Adenocarcinoma with a desmoplastic stroma

Front 80

What is the "Gleason Classification"?

Back 80

used for grading Prostatic Carcinomas

Grade = predominant + second most common

Front 81

What lymph nodes does Prostate cancer common metastasize to? (2)

Back 81

1. Pelvic lymph nodes

2. Abdominal Lymph nodes

Front 82

What bones does Prostate Cancer usually metastasize to and by what method?

Back 82

Vertebrae and Sacrum

Hematogenous

Front 83

Exophytic Transitional Cell Carcinoma of the Bladder

Back 83

What is this?

Front 84

Small Exophytic TCC of Bladder

Back 84

What is shown here?

Front 85

High Grade TCC of the bladder
-tumor has crossed the wall of the bladder
-Trabeculae = hypertrophy and hyperplasia of smooth muscle

Back 85

What is shown here?

Front 86

Benign Transitional Cell Papilloma

Back 86

What is shown here?

Front 87

Exophytic cauliflower-like TCC of low grade

Back 87

What is shown here?

Front 88

Low grade Transitional Cell Carcinoma

Back 88

What is shown here?

Front 89

High grade
-irregular nuclei
-mitotic figures

Back 89

Is this tumor High Grade or Low Grade?

Front 90

High Grade
- invasive

Back 90

Is this high grade or low grade?

Front 91

High = invading the muscle

Back 91

Is this high or low grade?

Front 92

Intratubular Germ Cell Neoplasia
-precursor of both Seminomatous and Non-seminomatous germ cell tumors

Back 92

Left is normal, what is shown at the right?

Front 93

Seminoma
-Gross: lobulated, uniform grayish-yello
-Micro: glycogen-rich cells, tumor cell nests surrounded by CT septa with lymphocytes

Back 93

What are these showing?
How do you know?

Front 94

Seminoma
-clear cytoplasm with glycogen
-lobules surrounded by fibrous strand with Lymphocytes

Back 94

What is this?

Front 95

Non-seminomatous germ cell tumor
-non-homogenous

Back 95

What is this?

Front 96

NSGCT

Back 96

What is this?

Front 97

NSGCT, Embryonal Carcinoma Cells

Back 97

What is this?

Front 98

Yolk Sac tumor
Schiller-duval bodies are present
AFP secretion

Back 98

What is this?
How do you know?

Front 99

Yolk Sac tumor
-Schiller-duval bodies

Back 99

What testes tumor is this?

Front 100

Sertoli Cell tumor

Back 100

What testicular cancer is this?

Front 101

Leydig Cell tumor
-Reinke crystalloids (not seen)

Back 101

What testes tumor is this?

Front 102

-

Back 102

-

Tumor marker: beta-hCG

Front 103

-

Back 103

-

Front 104

-

Back 104

-

Front 105

Squamous Cell Carcinoma

Back 105

What kind of cancer?

Front 106

Normal Prostate
-acini have one layer of cells

Back 106

What is this?

Front 107

Prostatic Hyperplasia causing Cystitis and hemorrhaging

Back 107

Describe this picture?

Front 108

Prostate Adenocarcinoma
-Desmoplastic stroma
-Dark areas = adenocarcinoma

Back 108

What is showng here?

Front 109

-

Back 109

-

Front 110

-

Back 110

-

Front 111

What kind of tumor is it?

Back 111

Prostate Adenocarcinoma