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111 Cards in this Set

  • Front
  • Back
What is epithelium of the Urinary Tract lined by?
Transitional epithelium = Urothelium
Where is the most common Urogenital neoplasm located?
Urinary Bladder
What is the age range for having Urinary Bladder tumors?
50-80 years
What sex is more likely to have Bladder cancer?
Males = 3:1
What are the risk factors for developing Urinary Bladder tumors and which is most important
1. Tobacco ***
2. Aniline dies (naphthylamine) = occupational exposure
3. Schistosoma haematobium (common in Egypt)
Describe the 4 ways in which Bladder Cancers can appear on gross examination
1. Papillary exophytic
2. Flat carcinoma in situ
3. Exophytic cauliflower-like tumors
4. Ulcerated and invading into surrounding structures
This is a very uncommon benign bladder tumor
Transitional bladder papilloma
What is the most common Bladder cancer?
Transitional cell carcinoma
What is Squamous Cell Carcinoma of the Bladder associated with?
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
What are the 2 possible causes of Adenocarcinoma of the Bladder?
1. Urachal remnants ***

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

***most common
Are most urinary bladder tumors benign or malignant?

*but 75% are low grade = not invasive
Vignette: Grape-like masses protruding from the urethral orifice of a boy
Rhabdomyosarcoma of the bladder
What is another name for Bladder Rhabdomyosarcoma?
Sarcoma botryoides
What does prognosis of Urinary Bladder tumors depend on?
Grade and Stage
Describe Low Grade bladder tumors
Noninvasive, papillary
-excellent prognosis, but tend to recur
Describe High Grade bladder tumors
INVASIVE (in muscle layer), papillary or flat
- prognosis varies
Survival rates for TCC bladder cancer
-Stage 1
-Stage 2
-Stage 3
1. 98% (50% recur, 10% progress to grade II or III)
2. 70% (70% recur)
3. 40% (90% recur)
How does Transitional Cell Carcinoma (TCC) of the bladder most often present clinically?
Which has a worse prognosis, Squamous Cell Carcinoma of the bladder or Transitional Cell Carcinoma of the bladder?
Squamous Cell Carcinoma
- only 30% survavial rate for 1 year survival
Testicular Tumors:
1. Common or rare?
2. Are most benign or malignant?
3. What are 90% derived from?
4. Peak age?
1. Rare (5:100,000)
2. Malignant (90%)
3. Germ cell origin
4. 35 years of age
What are the 2 risk factors for Testicular tumors?
1. Cryptorchidism

2. Intersex (pseudohermaphrodites)
What is the prognosis of Testicular Tumors?
Excellent response to Chemotherapy -> greater than 90% five year survival
Why the disparity between the 1% incidence of testicular cancer and 4% incidence of ovarian cancer?
-in testes 90% are from germ cell origin

-in ovary, germ cell tumors accounts for only 15-20%
What are the 2 clinical groups of testicular germ cell tumors?
1. Seminoma

2. Non-seminomatous germ cell tumors = more malignant
What do testicular germ cell tumors originate from?
Intratubular germ cells
-primordial germ cells
What is the preinvasive form of testicular germ cell tumors?
Intratubular germ cell neoplasia (in situ carcinoma) = ITGCN
What are the tumor markers of NSGCT?

What lymph nodes do testicular tumors metastasize to first?
Para-aortic lymph nodes
What tumor markers do Seminomas produce?
NSGCT in which the embryonal carcinoma cells proliferate without differentiating into other cell types
Embyronal carcinoma (undifferentiated)
NSGCT in which the embryonal carcinoma cells differentiate into somatic tissues (neural tissue, cartilage) and extraembryonic tissue (yolk sack, trophoblastic cells)
Terato-Carcinoma (partially differentiated)
NSGCT in which embryonal carcinoma cells differentiate into trophoblastic cells that become the only malignant component
NSGCT in which embryonal cells differentiate into yolk sack cells and the entire tumor is composed of these cells
Yolk Sac tumor
Benign NSGCT in which the embryonal carcinoma cells differentiate into somatic tissues
-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
Intratubular Testicular Germ Cell Neoplasia (ITTGCN)
The most common testicular tumor and it is also composed of a single cell type
What age range do Seminomas occur and what age does it never occur?
25-45 years

Prepubertal boys
Descibe the histology of Seminomas
1. glycogen rich cells resembling ITTN cells or spermatogonia
2. tumor cell nests are surrounded by CT septa with Lymphocytes
What is the gross appearance of Seminomas?
Lobulated, uniform grayish-yellow

No hemorrhage or necrosis
Where are metastases of Seminomas found first?
Para-aortic lymph nodes
1. cure rate
2. treatment
1. 90%

2. radiotherapy, chemo only in advanced cases
What are Seminomas equivalent to in women?
Ovarian Dysgerminoma
Testicular cancer of early childhood (99% are < 4) and has high serum levels of AFP? What else is AFP associated with?
Yolk Sac tumor

Hepatocellular carcinoma

*excellent cure rate (99%)
What are Schiller-Duval bodies?
Glomeruloid structures present in Yolk Sac tumors
What are the 2 Sex Cord / Gonadal Stromal tumors of the testis?
1. Leydig cell tumor

2. Sertoli cell tumor
Which Sex Cord tumor is more frequent?
Are Sexcord tumors usually malignant or benign?
Benign (90%) vs. Malignant (10%)
What is the most common testicular cancer in men >60?
Malignant Testicular Lymphoma
What are the 3 signs of Sex cord tumors?
1. Macrogenitosomia = enlarged genital parts

2. Precocious puberty

3. Gynecomastia (may synthesize estrogen)
What are Reinke crystals?
rod-shaped crystalloids seen in the cytoplasm of Leydig cell tumors
Are carcinomas of the penis common or rare in US?
What places are Penis carcinomas more common?
Africa, Asia, S. America
What is the peak age of having Penis Carcinoma?
60 years old
What are predisposing factors related to Penis Carcinomas?
1. uncircumcision
2. poor hygeine
3. HPV
What type of cancer are Penis Carcinomas?
Squamous Cell carcinoma
How do Penile Carcinomas usually present clinically?
Ulcerations or mucosal indurated plaques
- nonpainful
- may bleed
Where do metastases of the Penis usually go?
Inguinal lymph node
Term used for the squamous carcinoma in situ on the shaft of the penis
Bowen Disease
Term used for squamous carcinoma in situ on the glans of the penis
Erythroplasia of Queyrat
What does prognosis of Carcinoma of the penis depend on?

Depth of invasion
Which part of the Prostate is most sensitive to Estrogen and therefore more likely to undergo Hyperplasia?
Central part (Periurethral)
What is the proposed cause of Benign Prostatic Hyperplasia?
an altered ratio of testosterone:estrogen that develops in the elderly (more estrogen)
What race is BPH more common in?
Black Americans
What part of the prostate does Carcinoma usually develop?
What is the gross appearance of BPH?
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
What is the microscopic appearance of BPH?
1. Hyperplastic glands lined by columnar and cuboidal cells
2. Lined by 2 layers of cells
What are the clinical findings of BPH?
1. increased frequency of urination
2. Nocturia
3. Dysuria
4. Difficulty starting and stopping the stream
5. incomplete evacuation
What is the most common cause of Cystitis in men?
Benign Prostatic Hyperplasia
What are the complications of BPH?
1. Urinary retention
2. Bladder Hypertrophy and Hyperplasia
-thick wall
-trabeculation = strand-like
3. Vesicoureteric reflux
4. Renal dysfunction
What is the most common cancer in males?
Prostate Carcinoma
What is the greatest risk factor for Prostate Cancer?
advancing age (rare before 40)
When does Prostate Carcinoma never occur?
in men castrated before puberty = hormones play a role
What race is more susceptible to having Prostate Cancer?
African americans
What are 2 probable risk factors of Prostate Carcinoma
Dietary factors (fat)
Testosterone levels
What 2 cancers have both grade and stage as important prognostic factors?

What 2 tumor markers are important in Prostate Cancer?

Prostatic Acid Phosphatase (useful in disease progression)
What is the most common distant metastases of Prostate Cancer and what marker may be elevated?

Serum Alkaline Phosphatase
What structures do Prostatic Carcinomas tend to invade?
1. Seminal vesicles
2. Bladder
3. Rectum
What is the histology of Prostate Cancer?
Adenocarcinoma with a desmoplastic stroma
What is the "Gleason Classification"?
used for grading Prostatic Carcinomas

Grade = predominant + second most common
What lymph nodes does Prostate cancer common metastasize to? (2)
1. Pelvic lymph nodes

2. Abdominal Lymph nodes
What bones does Prostate Cancer usually metastasize to and by what method?
Vertebrae and Sacrum

Exophytic Transitional Cell Carcinoma of the Bladder
What is this?
Small Exophytic TCC of Bladder
What is shown here?
High Grade TCC of the bladder
-tumor has crossed the wall of the bladder
-Trabeculae = hypertrophy and hyperplasia of smooth muscle
What is shown here?
Benign Transitional Cell Papilloma
What is shown here?
Exophytic cauliflower-like TCC of low grade
What is shown here?
Low grade Transitional Cell Carcinoma
What is shown here?
High grade
-irregular nuclei
-mitotic figures
Is this tumor High Grade or Low Grade?
High Grade
- invasive
Is this high grade or low grade?
High = invading the muscle
Is this high or low grade?
Intratubular Germ Cell Neoplasia
-precursor of both Seminomatous and Non-seminomatous germ cell tumors
Left is normal, what is shown at the right?
-Gross: lobulated, uniform grayish-yello
-Micro: glycogen-rich cells, tumor cell nests surrounded by CT septa with lymphocytes
What are these showing?
How do you know?
-clear cytoplasm with glycogen
-lobules surrounded by fibrous strand with Lymphocytes
What is this?
Non-seminomatous germ cell tumor
What is this?
What is this?
NSGCT, Embryonal Carcinoma Cells
What is this?
Yolk Sac tumor
Schiller-duval bodies are present
AFP secretion
What is this?
How do you know?
Yolk Sac tumor
-Schiller-duval bodies
What testes tumor is this?
Sertoli Cell tumor
What testicular cancer is this?
Leydig Cell tumor
-Reinke crystalloids (not seen)
What testes tumor is this?

Tumor marker: beta-hCG
Squamous Cell Carcinoma
What kind of cancer?
Normal Prostate
-acini have one layer of cells
What is this?
Prostatic Hyperplasia causing Cystitis and hemorrhaging
Describe this picture?
Prostate Adenocarcinoma
-Desmoplastic stroma
-Dark areas = adenocarcinoma
What is showng here?
What kind of tumor is it?
Prostate Adenocarcinoma