.renal: Bph And Gu Pathologies

Front 1

Most [ carcinomas / hyperplastic lesions (nodular hyperplasia) ] arise in the transitional and central zones whereas most [ carcinomas / hyperplastic lesions (nodular hyperplasia) ] arise in the peripheral zone.

Back 1

Most hyperplastic lesions (nodular hyperplasia) arise in the transitional and central zones whereas most carcinomas arise in the peripheral zone.

Front 2

BPH stands for...

Back 2

benign prostatic HYPERPLASIA (increase int he number of prostatic glandular and stromal cells).

Front 3

True or False:
Only about 50% with microscopic evidence of hyperplasia will have a clinically enlarged prostate, and of those, only about 50% will be symptomatic.

Back 3

True

Front 4

True or False:
If a male is castrated before puberty, he does not develop BPH.

Back 4

True

Front 5

The major hormonal stimulus for BPH is _______, derived from the action of _______ on testosterone.

Back 5

The major hormonal stimulus for BPH is the androgen dihydrotestosterone (DHT), derived from the action of 5-alpha-reductase on testosterone. Androgens and estrogens are involved synergistically in BPH.

Front 6

True or False:
BPH may be the result of age-related increases in estrogen that increase levels of DHT receptor expression in parenchymal cells. T and DHT bind glandular and stromal cell nuclear receptors of prostate resulting in stimulating proliferation of those cells.

Back 6

True

Front 7

So testosterone enters both epithelial and stromal cells. In [ epithelial and stromal ] cell, thru 5 alpha reductase, testosterone is converted into DHT, which is also released and then gets into the other cell too. In both epithelial and stromal cells, DHT binds the androgen receptor in the nucleus and causes transcription of growth factors in an autocrine and paracrine fashion on the stromal and epithelial cells --> increase in cell number and BPH!

Back 7

In the STROMAL cell is where 5 alpha reductase is.

Front 8

What are the clinical manifestations of BPH? (3)

Back 8

- Clinical manifestation is lower urinary tract obstruction, stream hesitancy or interruption.
- Obstruction may completely block urination with painful bladder distention, even hydronephrosis.
- Patients at increased risk of bladder infection.

Front 9

Drugs that inhibit what are used to treat BPH.

Back 9

5-alpha-reductase

Front 10

True or False:
There is no recognized association between prostatic nodular hyperplasia and the subsequent development of prostate adenocarcinoma.

Back 10

TRUE

Front 11

The most common visceral cancer of men is ________.

Back 11

carcinoma of the prostate, an adenocarcinoma of prostate gland origin.

Peak incidence is between 65-75.

Latent carcinomas probably are numerous but 90% of those detected cause no morbidity. At the same time, though, we cannot tell which cancers are in the 10% that will behave badly.

Front 12

By age 70, ____ of men will have benign prostatic hypertrophy to some degree or other.

Back 12

90%

Front 13

What grading system is used for prostate cancer?

Back 13

Gleason scoring system. Stratifies cancers into one of five groups based on glandular patterns and degree of differentiation. A grade is assigned to the two most dominant patterns and they are added together. The higher the score, the worse the prognosis. (2-10)

Front 14

An elevated PSA in a man without a diagnosis of carcinoma may be due to what three things?

Back 14

actual carcinoma of the prostate, nodular hyperplasia or prostatitis (inflammation of the prostate).

Front 15

Renal cell carcinoma are adenocarcinomas derived from renal tubules, usually arises in what part of the cortex?

Back 15

Renal cortex
Occurs 2x more in men, usually in 6th or 7th decades. Strongly linked to tobacco smoking. Most are sporadic but rare autosomal dominant familial forms known.

Front 16

Renal cell carcinoma occurs in _____ of Von Hippel-Lindau syndrome patients.

Back 16

2/3

Front 17

Which type of renal cell carcinoma has the worst prognosis?

A. clear cell carcinoma
B. papillary carcinoma
C. chromophobe renal carcinoma
D. Collecting duct carcinoma

Back 17

A. clear cell carcinoma

7-80% of renal cell carcinomas are this type! :(

Front 18

What is the clinical "triad" that occurs (albeit in only 10% of cases)?

Back 18

hematuria, abdominal mass, dull flank pain

Front 19

True or False:
Renal cell carcinomas are never biopsied.

Back 19

TRUE, they are always removed surgically and biopsied at the SAME TIME.

Front 20

True or False:
Papillary carcinoma is often multifocal.

Back 20

TRUE.

10-15% of Renal cell carcinomas are this type.

Front 21

List the origins to their renal cell cancer.

1. Proximal convoluted tubule epithelium origin
2. Medullary collecting duct origin
3. Collecting duct origin

Back 21

1. Clear cell carcinoma
2. Collecting duct (Bellini duct) carcinoma
3. Chromophobe carcinoma

Front 22

What renal cell carcinoma is pictured?

Back 22

Clear cell carcinoma

Front 23

What renal cell carcinoma is pictuerd?

Back 23

Papillary carcinoma. Is NOT yellow (as clear cell would be), and is bilateral.

Front 24

Match the syndrome that is associated to WIlms tumor with its charcteristics.

1. gonadal dysegenesis, early onset nephropathy
2. 90% risk of WT
3. 33% chance of developing WT
4. Germline mutation of both WT1 alleles necessary for WT development
5. Organomegaly, macroglossia, hemihypertrophy
6. Wilms tumor, aniridia, Genital abnormalities, mental retardation
7. No single gene yet identified but WT2 thought to be important

Back 24

1. gonadal dysegenesis, early onset nephropathy - DenysDrash Syndrome
2. 90% risk of WT - Denys Drash Syndrome
3. 33% chance of developing WT - WAGR
4. Germline mutation of both WT1 alleles necessary for WT development- Denys Drash Syndrome
5. Organomegaly, macroglossia, hemihypertrophy - Beckwith- Wiedmann Syndrome
6. Wilms tumor, aniridia, Genital abnormalities, mental retardation - WAGR
7. No single gene yet identified but WT2 thought to be important- Beckwith Wiedman Syndrome

Front 25

Invasive urothelial carcinoma has two distinct precursors. Which invades less?

Back 25

Non-invasive papillary carcinoma, noninvasive flat urothelial carcinoma. The papillary form tends to invade LESS.

Front 26

Where can invasive urethelium carcinoma arise? What age? What are the risk factors?

Back 26

Can arise anywhere where urithelium is (renal pelvis, thur ureters, thru bladder and upper urethra). Usually occurs 5-80 yrs old. Strongly associated with smoking, bladder infestation with Schistosoma, long term use of oral analgesics, prior radiation to bladder, heave long-term exposure to immunosuppressant cyclophosphamide.

Front 27

Aggressive and invasive urotherilal cancer contain deletions of:
A. portions of chromosome 9
B. chromosome 17p
C. WT1 gene
D. WT2 gene

Back 27

B. chromosome 17p


portions of chromosome 9 are sometimes found in superficial papillary and some non-invasive flat UC. WT1 are in WAGR, DenysDrash, WT2 is thought to influence Bekwith-Wiedmann Syndrome

Front 28

For invasive urethelial carcinomas, reoccurence is common but despite that, prognosis depends upon the histologic grade and the stage at the time of diagnosis. Papillary carcinomas / grad I carcinomas have __% 10year survival. Grade III carcinomas have __ 10 year survival rate.

Back 28

pap/grade I : 98%
grade III: 50%

Front 29

Treatment of invasive urothelial carcinomas depend on the grade. Match low grade localized, low grade multifocal, low grade with high recurrence risk, high grade to their treatment.

1. topical intravesical chemotherapy
2. topical intravesical immunotherapy with attenuated strain of Mycobacterium T-BCG
3. transurethral resection

Back 29

1. low grade multifocal
2. low grade with high recurrence , high grade
3. low grade localized

Radical cystectomies when: tumor is in muscularis propria, tumor is unresponsive to BCG, tumor extends into prostatic urethra or ducts beyond reach of BCG

Front 30

Germ cell tumors are either _____, _____ or a mixture (most are mixtures).

Back 30

seminomas or non-seminomas (embryonal carcinoma, yok sac tumor, teratoma, chriocarcinoma)

Front 31

Regarding the epidemiology of germ cell tumors,
A. what age is this prominent?
B. GCT is 5 times more common in ______ than _____
C. risk factors include (3)

Back 31

A. what age is this prominent? 2nd-4th decades
B. GCT is 5 times more common in Whites than Blacks
C. risk factors include: cryptorchidism, testicular dysgenesis syndromes, sibling with GCT

Front 32

True or False:
Germ cell tumors usually present as painless enlargement of the testis.

Back 32

True

Front 33

True or False:
Germ cell tumors usually present with hematuria and dysuria.

Back 33

FALSE.

Present with painless enlargement of the testis.

Front 34

Where do germ cell tumors have the propensity to spread to if spread hematogenously? (4)

Back 34

lungs, liver, brain and bone.

Front 35

[ Seminomas / non-seminomas ] tend to remain localized in the testis longer than {the other} and usually present at a lower clinical stage and are very radiosensitive.

Back 35

Seminomas


Non-seminomas metastasize earlier, wtih more aggressive behavior and are relatively radioresistant.

Front 36

[ Seminomas / non-seminomas ] metastasize earlier, wtih more aggressive behavior and are relatively radioresistant.

Back 36

non-seminomas

Seminomas tend to remain localized in the testis longer than {the other} and usually present at a lower clinical stage and are very radiosensitive.

Front 37

True or false:
Most germ cell tumors are of one histologic type, i.e., either seminoma or embryonal carcinoma, but not both.

Back 37

False, most are mixed.

Front 38

What are two risk factors for germ cell linked to germ cell tumors? (3)

Back 38

- Cryptorchidism
- Testicular dysgenesis
- Genetic factors, not entirely sorted out

Front 39

What is the most common type of renal cell carcinoma?

Back 39

Clear cell type

Front 40

Most forms of acute pyelonephritis are
A. Hematogenously derived
B. The result of ascending infection

Back 40

B. The result of ascending infection