Year 2008-09 A) Give short account on : a. Testicular biopsy in infertility 1.

Normal spermatogenesis all tubules are normally undergoing spermatogenesis may occur in patients with excurrent duct obsruction, patients in normal sperm counts and low motility, patients with normal sperm counts and immotile-cilia syndrome 2. Hypospermatogenesis tubules with reduced degree of spermatogenesis, but not one that stops at a particular point in spermatogenesis. may occur in a variety of circumstances : exposure to toxins or excess heat, varicocele, hypothyroidism 3. Maturation arrest Complete maturation arrest : when the germ cells in the tubules mature only to a certain point usually at the stage of primary spermatocytes . maybe due to : gonadotropin deficiency, radiation therapy, alkylating agent therapy 4. Germinal cell aplasia (Sertoli cell-only syndrome) Tubules with reduced diameter lined by sertoli cells only may be due to alkylating agents and irradiation. 5. Germinal cell anaplasia and and focal spermatogenesis Testicular biopsies contain two populations of tubules, the smaller tubules exhibit GCA and tubules of increased diameter show spermatogenesis that is usually reduced. due to loss of germ cells during intrauterine development or post-natally resulting in tubules with and with out germinal cells. 6. Karyotypic and chromosomal abnormalities Kleinefelter syndrome characterized by a karyotype of 47XXY. characterized by reduced body and pubic hair, gynecomastia, small testes, increase of serum FSH and sometimes LH. The testes after puberty shows fibrosis of tubules. 7. Tubular sclerosis and interstitial fibrosis Sclerotic tubules may be found in biopsies with hypospermatogenesis, in cryptorchid testes and karyotypic If present bilaterally and involving the entire testicular parenchyma, it is end stage testis. 8. Excurrent duct obstruction Azospermia, normal sized testes, active spermatogenesis ( not necessarily normal )

b. Risk factors of cervical carcinoma 1. 2. 3. 4. 5. 6. 7. Early age at first intercouse Multiple sexual partners A male partner with multiple previous sexual partner Low social economic state Chronic cervicitis and multiple pregnancy Genetic factor (altered immunity, smoking) Sexually transmitted agent (HPV,HSV II, Smegma bacilli)

B) Tabulate the difference between: a. Complete and partial mole Feature Foetal part Karyotype Villous edema Trophoblast proliferation Atypia Serum HCG HCG in tissue Behaviour Complete Mole Absent Diploid 46XX/46XY All villi Diffuse circumferential Present Elevated ++++ 2% progress to choriocarcinoma Partial Mole Present Triploid 69XXY Some villi Focal and slight Absent Less elevated + Rare to give choriocarcinoma

b. Renal cell carcinoma and Wilms tumor Feature Occurence Origin Cut section Renal cell carcinoma Adult Tubular epithelium Variegated appearance with areas of necrosis and hemorrhage - Formed of clear cells/granular cells - Scanty stroma but highly vascularized Triad : - Painless profuse hematuria - Pain at costovertebral angle - Palpable mass Wilms tumor Children Primitive renal blastema cells Fish fleash sarcomatous appearance, homogenous - Sheets and nests of primitive blastema cells - Abortive tubules and glomeruli - Spindle cell stroma - large abdominal mass in a child - fever, abdominal pain or intestinal obstruction

Microscopic

Clinical feature

C) Discuss the pathogenesis : a. Prostatic carcinoma 1. Hormonal factor : evidence by absence of prostatic carcinomain males castrated before puberty. Also its growth inhibition by orchiectomy and by administration of estrogen. 2. Role of genetic influence : increase incidence of prostatic cancer in first degree relatives. 3. Environmental factors : occurrence in certain industrial setting and by the significance geographic difference in incidence of disease. b. Chronic pyelonephritis 1. Chronic obstructive pyelonephritis : recurrent infection superimpose on obstructive lesion.It causes recurrent bouts of inflammation and scarring. Unilateral obstruction is due to obstructive anomalies in ureter or stones. Bilateral obstructionis due to posterior urethral valve and bladder neck obstruction. 2. Chronic reflux-associated pyelonephritis : repeated infection from a congenital vesicoureteric relux or intrarenal reflux or incompetent renal papillae. D) Enumerate : a. Types of urinary stones 1. 2. 3. 4. 5. Calcium oxalate stone Calcium magnesium, ammonium phosphate (Triple) stone Calcium phosphate stone Uric acid and urate stone Cystine stone

c. Histological feature of fibrocystic changes of breast 1. 2. 3. 4. Cyst formation Fibrosis Adenosis Apocrine metaplasia

d. Skin changes in breast cancer 1. Peau dorange 2. Retraction of the skin/nipple E) Problem solving : 1. a) Papillary carcinoma of thyroid gland b) Ground glass nuclei Hyperchromatic nuclei with mitotic figure Prominent nucleoli c) Graves disease

2. a) Nephrotic syndrome of the kidney b) Lipid in blood (hyperlipidemia) Lipid in urine (lipiduria) Hypoalbuminemia