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Lower Urinary and Male Genital System

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Pathology of Childhood and Adolescence

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Abstract

The urinary tract obstruction is a common problem in pediatrics. When a defect in the urinary tract blocks the normal flow of urine, the urine backs up and causes hydroureters and hydronephrosis. Such abnormalities of the urinary tract may be identified before or after the baby is born. In this chapter some anomalies of the urinary tract as well the pathology of the male genital system are discussed.

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Authors and Affiliations

  1. University of Alberta, Edmonton, AB, Canada

    Consolato M. Sergi

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Multiple Choice Questions and Answers

Multiple Choice Questions and Answers

  • LUS-1 What are the histopathologic features of a testicular torsion after 6 hours of the torsion?

    1. (a)

      Interstitial hemorrhage and apoptosis of germ cells

    2. (b)

      Intratubular hemorrhage, germ cell atypia, and Leydig cell hyperplasia

    3. (c)

      Interstitial hemorrhage and edema, germ cell desquamation, and/or necrosis of germ cells

    4. (d)

      Interstitial hemorrhage and germ cell atypia

  • LUS-2 Which features correspond to the Mikuz score 2 of testicular torsion?

    1. (a)

      Diffuse infarction of testicular parenchyma

    2. (b)

      Diffuse interstitial hemorrhage, focal necrosis of the germ cells

    3. (c)

      Interstitial edema, desquamation of germ cells

    4. (d)

      Interstitial edema, limited blood extravasation, desquamation of germ cells

  • LUS-3 Which one of the following histopathologic features does NOT belong to acute Mumps orchitis?

    1. (a)

      Edema and perivascular lymphocytic exudate

    2. (b)

      Diffuse lymphocytic infiltration of the interstitial tissue with focal hemorrhage

    3. (c)

      Pronounced destruction of the germinal epithelium with plugging of the tubules by epithelial debris, fibrin, polymorphonuclear leukocytes, and giant cells

    4. (d)

      Collagenization

    5. (e)

      Calcification

  • LUS-4 Gonadoblastoma is a rare lesion of that consists of germ cells that resemble those of dysgerminoma and gonadal stroma cells that look like those of a granulosa or Sertoli tumor. These neoplasms usually arise in dysgenetic gonads. Which of the following disorders is associated with the highest risk of gonadal neoplasia?

    1. (a)

      Turner syndrome

    2. (b)

      Pure gonadal dysgenesis

    3. (c)

      Mixed gonadal dysgenesis

    4. (d)

      Klinefelter syndrome

    5. (e)

      WAGR (Wilms’ tumor, aniridia, genital anomalies, mental retardation) syndrome

  • LUS-5 A 21-year-old young man presents at his family doctor with a painless testicular mass. A testicular biopsy is performed. Histologic sections show relatively uniform polyhedral cells in sheets that are divided into poorly demarcated lobules by delicate fibrous septa. Lymphocytes and plasma cells are seen in the septa. Some granulomatous inflammation with Langhans-type multinucleated giant cells is seen at places. An immunohistochemical investigation shows the polyhedral cells to be positive for PLAP, OCT3/OCT4, CD117, D2-40, and SALL4 and negative for EMA, CD30, AFP, hCG, and glypican 3. Which is the most likely diagnosis?

    1. (a)

      Embryonal carcinoma

    2. (b)

      Yolk sac tumor

    3. (c)

      Foreign body orchitis with reactive changes

    4. (d)

      Seminoma, classic

    5. (e)

      Choriocarcinoma

  • LUS-6 Octamer-binding transcription factor 4 (OCT 4) is a critical embryonic stem cell regulating gene regulating self-renewal and differentiation of embryonic stem cells and is encoded by the POU5F1 gene at 6p21.3. Which neoplasm is not expressing OCT 4 by immunohistochemistry?

    1. (a)

      Non-small cell lung carcinoma

    2. (b)

      Neuroblastoma

    3. (c)

      Seminoma/dysgerminoma

    4. (d)

      Embryonal carcinoma

    5. (e)

      Intratubular germ cell neoplasia

    6. (f)

      Teratoma-immature neuroepithelium

    7. (g)

      Spermatocytic seminoma

  • LUS-7 A 15-year-old child presented with dysuria and pyuria for 2 weeks unresponsive to antibiotic treatment. She complained right flank pain and fever accompanied by hematuria for 4 days. Both past medical history and family history were unremarkable. On physical examination, lower abdominal tenderness and mild right costovertebral angle tenderness were noted. An ultrasound of the abdomen showed an ellipsoid mass located in the urinary bladder with inhomogeneous echogenicity. Transurethral resection was performed. The tumor reveals a spindle cell proliferation and an inflammatory infiltrate. There is positive immunohistochemical staining for vimentin, smooth muscle actin, and anaplastic lymphoma kinase (ALK) and negative immunohistochemical staining for desmin, myogenin, myoglobin, CD117, and S100. There is also a polyclonal kappa and lambda light chain Ig staining in plasma cells. Which of the following diagnosis corresponds to the tumor in this question?

    1. (a)

      Angiosarcoma

    2. (b)

      Synovial sarcoma

    3. (c)

      Rhabdomyosarcoma

    4. (d)

      Nodular fasciitis

    5. (e)

      Inflammatory pseudotumor

  • LUS-8 Which genes with germline mutations are associated with an increased risk of developing adenocarcinoma of the prostatic gland?

    1. (a)

      BRCA1, BRCA2, and HOXB13

    2. (b)

      RET, WNT, and RB

    3. (c)

      TP53, WNT, and AAT

    4. (d)

      BRCA1, BRCA2, and HOXB16

    5. (e)

      WNT, BRCA2, and RB

  • LUS-9 Which bacterium is a risk factor to develop adenocarcinoma of the prostate in youth?

    1. (a)

      Moraxella catarrhalis

    2. (b)

      Propionibacterium acnes

    3. (c)

      Mycobacterium avium intracellulare

    4. (d)

      Methicillin-resistant Staphylococcus aureus

    5. (e)

      Fusobacterium nucleatum

  • LUS-10 Which of the following statements does NOT correspond to prostatic intraepithelial neoplasia (PIN)?

    1. (a)

      The intratubular neoplasia shows acinar cells with the presence of prominent nucleoli visible at a 40x magnification or lower.

    2. (b)

      There is complete or partial retention of the basal cell layer.

    3. (c)

      The most common patterns are micropapillary/cribriform, flat, and tufted.

    4. (d)

      Often multicentric in prostatectomy specimens.

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Sergi, C.M. (2020). Lower Urinary and Male Genital System. In: Pathology of Childhood and Adolescence. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-662-59169-7_7

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