1
Q
what are the 3 layers of a urinary tract tube (generally)?
A
inner to outer
- transitional epithelium
- lamina propria
- smooth muscle
2
Q
T/F: congenital defects in the ureters are commonly clinically significant
A
FALSE
unless they cause an obstruction
3
Q
what are the 3 congenital defects assoc w/ the bladder?
A
- exstrophy
- diverticula
- vesicoureteral reflux
4
Q
what is bladder inflammation called?
A
cystitis
5
Q
what 4 bugs cause acute & chronic cystitis?
A
- E coli
- Proteus
- Klebsiella
- Enterobacter
6
Q
what are the 4 types of metaplastic lesions in the urinary system?
A
- cystitis cystica et glandularis
- squamous metaplasia
- intestinal metaplasia
- nephrogenic adenoma
7
Q
what are the 5 grades of urothelial tumors (this is long, sorry)
A
- urothelial papilloma
- urothelial neoplasm w/ low malignant potential
- low grade papillary urothelial carcinoma
- high grade papillary urothelial carcinoma
- urothelial carcinoma in-situ
8
Q
what are the 2 sex cord-stromal tumors?
A
- Leydig cell tumor
2. Sertoli cell tumor
9
Q
what type of testicular tumor is more common: germ cell or sex cord/stromal?
A
GERM CELL! makes up 95% of testicular tumors
10
Q
what are the 2 types of germ cell tumors?
A
- seminomatous tumors
2. non
11
Q
what are the 2 types of seminomatous tumors?
A
- seminoma
2. spermatocytic seminoma
12
Q
what are the 4 types of non-seminomatous tumors?
A
- embryonal carcinoma
- yolk sac (endodermal sinus) tumor
- choriocarcinoma
- teratoma
13
Q
what are the 3 main causes of testicular neoplasms?
A
- env
- genetics
- testicular dysgenesis syndrome
14
Q
what are the 3 sx of testicular dysgenesis syndrome?
A
- cryptorchidism
- hypospadias
- Klinefelter
15
Q
what % of germ cell tumors are seminomas?
A
50%
16
Q
what is the most common testicular tumor?
A
seminoma
17
Q
what is a seminoma called if it’s in a woman?
A
dysgerminoma (happens in the ovary)
18
Q
what is unique about the female trigone & urethra?
A
it has squamous epithelium, not transitional
19
Q
here are the questions from her lecture, not her powerpoint, so brace yourself
A
HERE WE GO
20
Q
what is urothelium?
A
transitional epithelium
21
Q
is urothelium simple or stratified?
A
stratified
22
Q
what are umbrella cells?
A
protect the bladder epithelium from osmosis d/t hypertonicity of urine
23
Q
how does urine get from the kidney to the bladder (thru the ureter, but what propels it)?
A
peristalsis via smooth muscle
24
Q
T/F: bladder has the same layers as the ureter
A
true
25
what is the muscular layer in the bladder called?
detrusor muscle
26
what is the majority of the bladder pathology?
neoplasm
27
what is exstrophy?
birth defect where the bladder is outside of the body
28
is interstitial cystitis acute or chronic?
chronic (chronic pain syndrome)
29
what are the sx of cystitis?
urinary urgency, frequency, hematuria
30
what will you see on UA of interstitial cystitis pts?
NO LEUKOCYTE ESTERASE or nitrites on UA (not d/t a pathogen; not an infection)
31
what is malakoplakia d/t?
defect in macrophages
| bacteria overwhelms them and plaques develop
32
what are the sx of malakoplakia?
plaques in the bladder
| hematuria
33
T/F: polypoid & papillary cystitis are both benign
true
| they're just d/t irritation
34
what is the diff btwn a papilla & a polyp?
a papilla has a fibrovascular core
35
what does cystitis cystica form from?
nests of von Brunn
36
what are nests of von Brunn?
urothelial invagination into the lamina propria
37
are nests of von Brunn malignant?
no
38
why does cystitis cystica et glandularis happen?
irritation
39
T/F: the bladder does not undergo squamous metaplasia
FALSE
| yes it does
40
what can cause squamous metaplasia & cancer in the bladder?
schistosomiasis
41
what causes nephrogenic adenoma?
shedding of renal tubular cells from the kidney & then implant into the bladder
42
neoplasms of the bladder are normally (__?__)
papillary
43
what does nephrogenic adenoma mimic?
papillary neoplasm in the bladder
44
is urothelial carcinoma in situ flat or papillary?
flat
45
T/F: urothelial papilloma is the most common urothelial tumor
FALSE
| it's the most RARE
46
T/F: you can have a non-invasive high grade lesion
TRUE
47
how many layers does the urothelium have?
3-6
48
how can you differentiate benign cells from malignant cells?
malignant cells are not uniform, cells are discohesive & diff sizes, hyperchromatic, no umbrella cells on surface
49
which cancer is malignant?
urothelial carcinoma in situ ("in situ" = no invasion, but this can invade)
50
if you see PINK on histology in this section, what should you think?
squamous lesion
51
what is epispadias?
urethral opening on dorsal aspect/top of penis
52
what is phimosis?
foreskin scarring st the foreskin can't be retracted > predisposes to squamous cell carcinoma of penis
53
what does condyloma look like?
cauliflower (it's warts)
54
what is condyloma d/t?
HPV 6 & 11
55
what is the viral cytopathic effect of HPV?
clears the cells out
56
does condyloma acuminatum lead to cancer?
no
57
what is Bowen's dz?
squamous cell carcinoma in situ on the peeenissssss
58
what does Bowen's dz look like on histo?
hyperchromasia
| abn maturation of squamous cells
59
what is Bowen's dz a precursor to?
squamous cell carcinoma
60
what is the testicle mostly made up of?
seminiferous tubules
61
where does spermatogenesis happen?
seminiferous tubules
62
what is the lining of the testicle?
1. tunica vaginalis (parietal & visceral layers)
| 2. tunica albuginea
63
what lines the tunica vaginalis?
mesothelium
64
which layer of the testicle is thicker: vaginalis or albuginea?
albuginea
65
what do Sertoli cells do?
give nourishment to spermatogonia
| Sertoli = Support
66
what do Leydig cells do?
produce hormones
67
when the spermies leave the seminiferous tubule, where do they go?
rete testes > vasa eferentia > epididymis > vas deferens
68
what is cryptochidism?
failure of the testicle to descend, either unilateral or bilateral
69
what is orchiopexy?
surgery to put the testicle in the scrotal sac (treatment for cryptochidism)
70
why does cryptochidism cause infertility?
high temp > testicular atrophy (w/ or w/o RX)
71
what is the point of a testicle?
to make sperm
72
where are Leydig cells found in the testes (generally)?
interstitium
73
what direction does spermatogenesis occur in?
from the base to the lumen
74
what are the spermatogenic cells that undergo mitosis?
spermatogonia type A
75
what are the spermatogenic cells that undergo meiosis?
spermatogonia type B
76
what are the primary spermatocytes?
S1
77
how long does it take a spermatogonia to become a spermatid?
~70 days
78
how long after spermatogonia generation does the first meiotic division occur?
~3 weeks later
79
how soon after the first meiotic division does the second meiotic division occur?
VERY quickly
80
how many spermies do you get from one meiosis event?
4
| none of them degenerate
81
histologically, what does an atrophic testicle look like?
```
no spermatids in lumen
few Sertoli cells
few spermatogonia
reactive hyperplasia of Leydig cells
atrophy of seminiferous tubules
```
82
what does a hydrocele look like grossly?
big and shiny
| they transilluminate
83
where do the -celes occur in the testicle?
btwn the visceral & parietal layers of the tunica vaginalis (i think)
84
what is the ONLY painful testicular mass?
torsion
85
what does testicular torsion look like grossly?
it's BLACK
| d/t hemorrhagic infarction from venous stuff
86
when do most testicular neoplasms occur (what age)?
15-34 yo
87
do you biopsy testicles?
nope
88
what is the genotype of Klinefelter's?
XXY
| Fung says also XYY but that's not true
89
what is intratubular germ cell neoplasia?
like a germ cell carcinoma in situ
90
what is the precursor lesion to testicular tumors?
intratubular germ cell neoplasia (ITGCN)
91
T/F: you can also get seminomas in the mediastinum and in ovaries
TRUE
92
what is a seminoma in the mediastinum called?
germinoma
93
what is a seminoma like grossly?
fleshy
94
what does a seminoma look like microscopically?
nodules of tumor
| lymphocytes that infiltrate btwn tumor
95
what is the most common germ cell tumor?
seminoma
96
T/F: most germ cell tumors occur w/ other tumors (i.e. not alone)
TRUE
97
what does embryonal carcinoma look like grossly?
looks high grade
| hemorrhagic
98
what does embryonal carcinoma usu occur w/i?
mixed germ cell tumors
99
what pt population usu gets yolk sac/endodermal sinus tumors?
children
| i.e. "3 yo w/ a testicular mass"
100
what does a yolk sac tumor produce?
AFP
101
how can you track response to therapy w/ a yolk sac tumor?
measure AFP or hCG (can identify recurrence)
102
what does a yolk sac tumor look like on histo?
SCHILLER-DUVAL BODIES
| microcysts
103
what does a schiller-duval body look like?
an endodermal sinus
104
what do choriocarcinomas make?
hCG
105
what 2 trophoblasts do choriocarcinomas have?
syncytio-
| cyto-
106
T/F: choriocarcinoma is high grade
TRUE
107
how do you differentiate a mature teratoma from an immature teratoma?
teratomas have endoderm, mesoderm, & ectoderm w/ MATURE elements (i.e. cartilage, glands, skin)
108
can a mature teratoma undergo malignant transformation?
yes
109
what kind of tissue does an immature teratoma have?
immature :)
| sometimes neural
110
how do Leydig cell tumor pts present?
sometimes w/ gynecomastia d/t hormone pdtion
111
what do Leydig cell tumors make?
crystals of Reinke
112
what are the zones of the prostate
peripheral
transitional
central
113
which prostate zone is most affected by cancer?
peripheral
114
which prostate zone is affected by BPH?
central
115
does prostate cancer form a mass?
NOT USUALLY
| it's really weird
116
if you're a male and you have bladder cancer, what will they surgically remove?
bladder & prostate
| surely not the WHOLE bladder
117
what is the NORMAL prostatic concretion?
corpora amylacea
118
what are the 2 layers of the prostate?
epithelial
| basal
119
how do you tell the diff btwn seminal vesicle & prostatic glands?
seminal vesicles make pigment
120
do you biopsy prostatitis?
nope
121
what can cause GRANULOMATOUS prostatitis?
BCG
| fungal infxn
122
how is PSA affected by prostatitis?
PSA increases during prostatitis
123
what does nodular hyperplasia look like microscopically?
nodule w/ surrounding fibrous tissue
| stromal proliferation
124
what causes nodular hyperplasia?
testosterone basically
| T > DHT > growth factors > stromal cell growth & epithelial cell survival > nodules
125
what are the 3 treatments for nodular prostatic hyperplasia?
finasteride
flomax
TURP
126
how does finasteride act?
inhibits DHT formation via inhibition of 5α-reductase
127
how does flomax work?
α blocker which affects smooth muscle > reduces tone
128
what is TURP?
transurethral resection of the prostate
| shave down the prostate to reduce nodularity
129
what are the clinical features of nodular hyperplasia?
hesitancy & intermittent stream d/t obstruction
| urgency & frequency d/t bladder irritation
130
what are the clinical features of prostatic adenocarcinoma?
1. palpable or non
2. asymptomatic
3. clinically significant or not
4. PSA
131
what is the major side effect of prostatectomy?
ED
132
why do you use "watchful waiting" with prostate cancers?
some are benign and don't kill the pt, & treatment would cause more issues than the cancer itself
some are malignant and CAN kill the pt
133
what is "elevated PSA"?
PSA >4
134
T/F: adenocarcinoma produces nodules
TRUE
135
aren't Gleason scores interesting
hm oh yes
| scale is 1-5
136
what are the 3 main prostate treatments?
1. watchful waiting
2. androgen deprivation
3. radical prostatectomy
