Practice questions answers Male reproductive system II

Practice questions answers

Male reproductive system II

© Jun Wang, MD, PhD

1. C. Large atypical cells with clear cytoplasm limited within the tubules without spermatogenesis is most consistent intratubular germ cell neoplasia. Embryonal carcinoma is characterized by primitive epithelial cells with minimal differentiation and positive reactivity to CD30 and cytokeratin.  Hairy cell leukemia has “fried egg” appearance, but usually are seen in marrow, in a background for pancytopenia. Seminoma cells have same morphology as intratubular germ cell neoplasia, but the tumor is not limited to tubules. Teratoma has differentiated tissue, such as skin and adnexa, etc. None of these will be limited to tubules.

2. D. Sheets of large testicular tumors with round nuclei and clear cytoplasm is highly suggestive of seminoma, unless a secondary neoplastic components are identified. These tumor cells are positive for PLAP, KIT and OCT3/4. Diffuse large B cell lymphoma is the most common testicle tumor in people older than 60. It is sheets of markedly atypical cells expressing B cell markers, including CD20. Mixed germ cell tumor need two or more different components, such choriocarcinoma, yolk sac tumor, etc. Teratoma has differentiated tissue, such as skin and adnexa, etc.

3. D. Seminoma usually has elevate PLAP. AFP is elevated in yolk sac tumor, hCG in choriocarcinoma, PSA in prostate adenocarcinoma. Elevated serum CD30 can be seen in a few lymphomas, including Hodgkin lymphoma.

4. C. Seminoma is considered as the counterpart of ovarian dysgerminoma, and is extremely sensitive to radiation and chemotherapy. This patient has signs of metastasis (enlarged periaortic lymph nodes), and radiation therapy be more appropriate. Bone marrow biopsy and flow cytometry studies are more commonly used for diagnostic and staging purpose of hematopoietic disorders.

5. E. Diffuse infiltrate of tumor with three populations, all have round nuclei, in the testis of an old patient is most likely spermatocytic seminoma. Diffuse large B cell lymphoma has markedly atypical cells expressing B cell markers, including CD20. Embryonal carcinoma is characterized by primitive epithelial cells with minimal differentiation and positive reactivity to CD30 and cytokeratin. Mixed germ cell tumor need two or more different components, such choriocarcinoma, yolk sac tumor, etc. Seminoma cells are positive for PLAP, KIT and OCT3/4.

6. B. Primitive epithelial cells with minimal differentiation that express CD30 and cytokeratin are seen in embryonal carcinoma. Choriocarcinoma has multinucleated syncytiotrophoblast and elevated serum hCG. Hodgkin lymphoma has Reed Sternberg cells and is negative for cytokeratin. Seminoma cells are large with clear cytoplasm, and positive for PLAP. Spermatocytic seminoma has diffuse infiltrate of tumor with three populations, all have round nuclei.

7. E. Schiller-Duval body (central blood vessel enveloped by germ cells within a space similarly lined by germ cells, resembles glomerulus) is diagnostic for yolk sac tumor, a tumor usually has elevated AFP. Choriocarcinoma has multinucleated syncytiotrophoblast and elevated serum hCG. Embryonal carcinoma is characterized by primitive epithelial cells with minimal differentiation and positive reactivity to CD30 and cytokeratin. Teratoma has differentiated tissue, such as skin and adnexa, etc.

8. A. See discussion of question 3.

9. D. See discussion of question 7.

10. E. Mixed germ cell tumor are defined as at least two types of germ cell neoplasia. This patients has embryonal carcinoma, as characterized by primitive epithelial cells with minimal differentiation, in a background of teratoma, as characterized by differentiated tissue, such as skin and adnexa, etc. In addition, elevated AFP and hCG is highly suggestive of additional components of the tumor, since these two usually are not elevated in a pure teratoma.

11. A. Diffuse large B cell lymphoma is the most common testicle tumor in people older than 60. It is sheets of markedly atypical cells expressing B cell markers, including CD20. Embryonal carcinoma is characterized by primitive epithelial cells with minimal differentiation and positive reactivity to CD30 and cytokeratin. Mixed germ cell tumor are defined as at least two types of germ cell neoplasia. Seminoma cells are large with clear cytoplasm, and positive for PLAP. Spermatocytic seminoma has diffuse infiltrate of tumor with three populations, all have round nuclei. Germ cell neoplasia are negative for CD20.

12. B. A patient with urinary symptoms and enlarged prostate most likely has prostatitis. If the symptom is acute, with leukocytosis, then it is most likely acute prostatitis, a condition commonly diagnosed clinically, provided PSA is not markedly elevated. Acute cystitis usually will not cause prostate enlargement. Diabetic nephropathy is associated with increased glomerular extracellular matrix, resulted from hyperglycemia, and presents with proteinuria, but not fever, leukocytosis and prostate enlargement. Prostate adenocarcinoma commonly has elevated PSA. Prostate hyperplasia usually have chronic symptoms of urinary bladder outlet obstruction.

13. E. Acute prostatitis is usually bacterial infection with positive urine microbiology tests. Cystoscopy is for bladder lesions. Biopsy and image studies are used for prostate adenocarcinoma and prostate hyperplasia, both usually have chronic symptoms, or elevated PSA.

14. D. Diffusely enlarged painful prostate with a chronic process and positive microbiology work up is most compatible with chronic bacterial prostatitis. Acute prostatitis has a sudden onset. Chronic abacterial prostatitis has same clinical presentation as chronic bacterial prostatitis, but NEGATIVE microbiology work up. Chronic cystitis usually does not cause prostate enlargement. Prostate adenocarcinoma usually has elevated PSA.

15. C. See discussion of question 14.

16. D. Chronic urinary bladder outlet obstruction with prostate enlargement and normal PSA is most likely caused by prostate hyperplasia, as confirmed by proliferation of glands with intact basal layers. Adenocarcinoma of bladder, as adenocarcinoma in any other sites, has irregular gland and cytological atypia. Prostate adenocarcinoma usually has elevated PSA and absence of basal layers. This patient has trabeculation of bladder, a result of smooth muscle hypertrophy associated with chronic outlet obstruction, not papillary growth of urothelium, as seen in urothelial papilloma. Bladder urothelial carcinoma does not have glandular differentiation.

17. E. Prostate hyperplasia is associated with elevated androgen activity due to activation of type II 5-a-reductase in stroma. Amplification or gain-of-function mutation of androgen receptor are seen in prostate adenocarcinoma. Aneuploidy of urothelial cells are seen in high grade urothelial carcinoma, including urothelial carcinoma in situ. FGFR3 mutation is seen in urothelial papilloma.

18. B. See discussion of question 16 and 17.

19. D. Small glands, lack of basal layers identified by either routine histology or immunohistochemistry studies for p63 and 34betaE12, and positive reactivity to racemase are consistent with prostate adenocarcinoma. Benign conditions including prostate hyperplasia and prostatitis have intact basal layers, negative racemase reactivity and normal serum PSA. Adenocarcinoma of lung is usually positive for TTF1.

20. A. See discussion of question 17. BCG treatment is associated with granulomatous cystitis and prostatitis.

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