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a_GYNGU > 11/19- Pathology of the GU System > Flashcards

11/19- Pathology of the GU System Flashcards

1
Q

What is seen here?

A

Acute pyelonephritis

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2
Q

What is seen here?

A

Acute pyelonephritis

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3
Q

What is seen here?

A

Xanthogranulomatous Pyelonephritis

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4
Q

What is seen here?

A

Xanthogranulomatous Pyelonephritis

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5
Q

What are some congenital anomalies involving the kidney?

A
  • Agenesis (absence)
  • Hypoplasia (small): no scars and fewer lobules
  • Ectopic (out of place)
  • Horseshoe (abnormal form)
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6
Q

What is seen here?

A

Horseshoe kidney

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7
Q

What can cause polycystic kidneys?

A
  • Cystic renal dysplasia
  • Polycystic kidney
  • Medullary cystic kidney
  • Acquired (dialysis)
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8
Q

Describe kidney structure with cystic renal dysplasia

A

Persistence of abnormal structures (cartilage mesenchyme, immature collecting ducts)

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9
Q

What are the forms of polycystic kidney?

Describe genetics and other features

A

Autosomal dominant: Adult

  • High penetrance
  • Bilateral, large homogeneous cysts
  • Liver cysts, berry aneurysms

Autosomal Recessive: Infantile

  • Longitudinal parallel peripheral cysts
  • Hepatic fibrosis
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10
Q

What is seen specifically in medullary cystic kidney?

A

Cystic dilation of the collecting ducts

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11
Q

What can cause acquired polycystic kidneys?

A

Dialysis

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12
Q

What is seen here?

A

Polycystic kidney disease- AD

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13
Q

What is seen here?

A

Polycystic kidney disease- AR

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14
Q

What is seen here?

A

Polycystic kidney disease- AR

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15
Q

What is urolithiasis (broadly)

A

Stones in urinary tract

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16
Q

Describe the common stone types, the preidsposing conditions, and their prevalence

A

Calcium oxalate/phosphate: 75%

  • Hypercalciuria and hypercalcemia
  • Hyperuricosuria
  • Hypocitraturia

Magnesium ammonium phosphate (struvite): 15%

Uric acid: 6%

  • Hyperuricemia/hyperuricosuria

Cystine 1-2%

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17
Q

What can predispose you to kidney stones?

A
  • Family history
  • Male gender
  • Dehydration
  • Urease positive bacterial infections (struvite)
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18
Q

Are the following stones radiolucent or radioopaque?

  • Calcium oxalate/phosphate
  • Magnesium ammonium phosphate
  • Uric acid
A
  • Calcium oxalate/phosphate: opaque
  • Magnesium ammonium phosphate: opaque
  • Uric acid: lucent
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19
Q

What is seen here?

A

Nephrolithiasis

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20
Q

What is seen here?

A

Kidney: staghorn calculus

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21
Q

What are some renal tumors?

A
  • Renal cell carcinoma
  • (Renal oncocytoma?)
  • Urothelial carcinoma of renal pelvis
  • Angiomyolipoma (benign)
  • Can get fairly large; if rupture, the hemorrhage may be life threatening
  • Soft tissue tumors of renal capsule
  • Leiomyosarcoma
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22
Q

Describe the etiology of Renal Cell Carcinoma

  • Sporadic risk factors/causes
  • Syndromes
A

Sporadic:

  • Tobacco
  • Obesity
  • Unopposed estrogen

Von Hippel-Lindau Syndrome (VHL gene)

  • Hemangioblastoma of cerebellum and retina
  • Renal cysts
  • Renal cell carcinoma
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23
Q

What are the different types (and percentages) of renal cell carcinoma?

A
  • Clear Cell Carcinoma: 80%
  • Deletion or unbalanced translocation of chromosome 3 (VHL gene) or methylation. The “internist’s tumor”.
  • Chromophobe: 5%
  • Papillary: 10-15%
  • Collecting Duct Carcinoma (1%)
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24
Q

Describe the genetics of Von Hippel Lindau syndrome

  • Gene
  • Chromosome
A
  • VHL gene
  • Chromosome 3
  • Caused by deletion/unbalanced translocation or methylation
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25
Q

Describe renal cancer staging

A

- Stage I: limited to kidney (under 7 cm)

- Stage II: limited to kidney (> 7cm)

- Stage III: beyond capsule into perinephric tissue (not beyond Gerota’s fascia), major veins, adrenal gland

- Stage IV: tumor beyond Gerota’s fascia, > 1 LN involved, and/or 1+ distant met

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26
Q

What is seen here?

A

Renal cell carcinoma: clear cell type

  • Left: multilobulated tumor with hemorrhagic cut surface
  • Right: yellow appearance; this yellow color is pretty diagnostic
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27
Q

What is seen here?

A

Renal cell carcinoma: clear cell type

  • Clear space due to great amounts of fat removed during processing
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28
Q

What is seen here?

A

Renal cell carcinoma: chromophobe type

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29
Q

What is seen here?

A

Renal cell carcinoma: papillary type

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30
Q

What is seen here?

A

Renal oncocytoma

  • Mahogany brown appearance
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31
Q

What is seen here?

A

Renal oncocytoma

  • Oncocyte = much eosinophilic cytoplasm containing many mitochondria
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32
Q

What is seen here?

A

Papillary urothelial CA

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33
Q

What is seen here?

A

Angiomyolipoma

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34
Q

What is seen here?

A

Leiomyosarcoma

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35
Q

What is seen here?

A

Urothelial histology

  • 8ish layers of endometrial urothelial cells (line surfaces storing water/urine)
  • Upper surface are specialized “umbrella” cells
  • Normal with round/oval nuclei
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36
Q

Describe the symptoms and causes of acute cystitis

A

Symptoms:

  • Frequency
  • Lower abdominal pain
  • Dysuria

Causes:

  • E. coli
  • Proteus
  • Klebsiella
  • Enterobacter Radiation?
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37
Q

What are causes of chronic cystitis?

A

Granulomatous:

  • AFB
  • Fungi
  • Schistosoma
38
Q

What is seen in interstitial cystitis? What population affected? Caused by what?

A
  • Unknown cause
  • Women
  • Mast cells
39
Q

What is seen here?

A

Acute cystitis

40
Q

What is seen here?

A

Acute cystitis

41
Q

What is seen here?

A

Granulomatous cystitis

  • Epithelioid histiocytes
  • Cuff of peripheral lymphocytes
42
Q

What is seen here?

A

Schistosomiasis

  • Worm present in perivesicular veins
  • Migrate through layers of bladder into the urine
  • Causes squamous metaplasia of urothelium; predisposes to squamous cell carcinoma (rather than urothelial) in areas of high prevalence
43
Q

What is seen here?

Describe the process of formation

A

Bladder fistula

  • Can see diverticulum going past muscular propria into peri-colonic fat
  • Inflammation causes compromise of blood circulation; loss of colon epithelium
  • Can track along colon and reach bladder where it causes a fistula
44
Q

What is seen here?

A

Bladder fistula

45
Q

What is seen here?

A

Endometriosis

46
Q

What is seen here?

A

Endometriosis

47
Q

What are types of urothelial neoplasms?

A

- Urothelial carcinoma in situ (high grade lesion; 50% become invasive)

- Urothelial papilloma

- Papillary urothelial carcinoma (low and high grade)

48
Q

What is seen here?

A

Urothelial carcinoma in situ

  • Anaplastic layer of cells up top
  • Not very “sticky” to surface
49
Q

What is seen here?

A

Papillary urothelial carcinoma (low grade?)

50
Q

Describe the staging of bladder cancer?

A
  • TIS: in situ
  • TIA: not invasive at all
  • T1: just into lamina propria
  • T2: touches superficial muscle
  • T3a: through muscle into fat
  • T3b: farther
  • T4: adjacent organs in pelvis
51
Q

What is seen here?

  • Symptoms
A

Urothelial carcinoma in situ

  • Loss of urothelium and inflammation
  • May present with urgency
52
Q

What is seen here?

  • Symptoms
A

Low grade papillary urothelial carcinoma

  • Don’t invade (low grade), but proliferation throws them up into folds/papillary stalks
  • Common presentation of hematuria (micro or gross)
53
Q

What is seen here?

A

High grade papillary urothelial carcinoma

54
Q

What is seen here?

A

Urothelial carcinoma (?)

55
Q

What is seen here?

A

Urothelial carcinoma

56
Q

What is seen here?

A

Urothelial carcinoma

57
Q

Describe the anatomy of the prostate

A
  • Triangular-shaped with base (top with groove) and apex (pointing down)
  • Vas deferens (2) enter superiorly
  • Seminal vesicles (2) enter as well
58
Q

What is seen here?

A

Prostate cancer (unbeknownst to the pt) seen on the left there

59
Q

What is seen here?

A

Normal prostatic gland

60
Q

What does prostate make?

A

PSA protein- prevents coagulation of sperm/ejaculate

61
Q

What else is PSA useful for?

A

Screening for prostate cancer

62
Q

What is seen here?

  • What causes this
A

Acute prostatitis

  • Typically from BPH causing obstruction and cystitis/prostatitis
63
Q

What is seen here?

A

Chronic prostatitis

64
Q

What is seen here?

A

Prostate cancer

  • Can see nodule on the base there that would be palpable on digital rectal exam
65
Q

Why are PSA levels high in prostate cancer?

A

The cells are not connected to ducts and leaves the prostate (in BPH, most cells do still connect to ducts)

66
Q

What is seen here?

A

Prostate cancer (which type??)

  • High PIN
67
Q

How do you grade prostate cancer?

A

Gleason grading

68
Q

What is seen here?

A

Normal testis

69
Q

What is seen here?

70
Q

What is seen here?

A

Testicular torsion

  • May involve infarction
71
Q

What is seen here?

A

Granulomatous orchitis

72
Q

What are the different types of testicular tumors?

A

Germ cell tumors

  • Seminoma
  • Yolk sac
  • Teratoma
  • Embryonal carcinoma

Sex cord-stromal tumors

  • Leydig cell
  • Sertoli cell
  • Rare variants…

Seminoma vs. non-seminoma based on historical treatment considerations

  • Currently tx for non-seminoma is almost as good
73
Q

What is the treatment for germ cell tumors?

A

Stage I

  • High risk: orchiectomy + lymphadenectomy or chemo
  • Low risk: orchiectomy + watchful waiting if pt is compliant

Stage II+ get full treatment

74
Q

What are germ cell tumor markers for:

  • Seminoma
  • Embryonal carcinoma
  • Yolk sac tumor
  • Choriocarcinoma
  • Teratoma

IMPORTANT SLIDE

A
  • Seminoma: LDH
  • Embryonal carcinoma
  • Yolk sac tumor: AFP
  • Choriocarcinoma: HCG
  • Teratoma

IMPORTANT SLIDE

75
Q

What is seen in seminomas?

A
  • Homogeneous population of cells with large nucleoli and lymphocytes
  • Cells are non-cohesive and resemble spermatogonia
76
Q

What is seen in embryonal carcinoma?

A
  • Sheets of malignant cells sometimes forming secondary structures such as tubules
  • Very anaplastic nuclei with abundant mitoses and apoptotic bodies
  • Vascular invasion common
77
Q

What is seen in yolk sac tumors?

A

AFP!

  • Delicate lacy architecture with bland nuclei
  • Infantile and adult in age distribution
78
Q

What is seen in choricoracinomas?

A

HCG!

  • Resembles placenta with syncytiotrophoblasts and cytotrophoblasts
  • Vascular invasion common
79
Q

What is seen in teratomas?

A
  • Mature
  • Better prognosis but not responsive to tx
  • Immature
80
Q

What is seen here?

A

Normal testis???

81
Q

What is seen here?

A

Cancerous testis

82
Q

What is seen here?

83
Q

What is seen here?

84
Q

What is seen here?

A

Embryonal carcinoma

85
Q

What is seen here?

A

Embryonal carcinoma

86
Q

What is seen here?

A

Yolk sac tumor

87
Q

What is seen here?

A

Yolk sac tumor

88
Q

What is seen here?

A

Choriocarcinoma

89
Q

What is seen here?

A

Choriocarcinoma

90
Q

What is seen here?

91
Q

What is seen here?

92
Q

What is seen here?

A

Penile carcinoma

a_GYNGU (17 decks)

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