6/ Haematuria

Question 1

What are the most common causes of haematuria?

Answer 1

• renal or bladder calculi
• urinary tract infections
• bladder tumours
• renal tumours
• urinary obstruction
• drugs

Question 2

What does normal urine cytology show?

Answer 2

• single urothelial cells
• abundant cytoplasm
• low nuclear cytoplasmic ratio
• bland nuclei
• regular nuclear outline
• no nucleolio
• also multinulceate umbrella cells

Question 3

What are the features of malignancy on cytology?

Answer 3

• hyperexfoliation in papillary sheets, single pleomorphic cells with increasd nuclear cytoplasmic ratio, irregualr, hyperchromatic nuclei, prominent nucleoli

Question 4

What are the types of bladder tumours?

Answer 4

Benign
- papilloma
Malignant
- transitiional cell carcinoma which can be papillary or solid invasive
- other carcinomas - SCC, adenocarcinoma (rare), rhabdomyosarcomas in children

Question 5

What is normal bladder histology?

Answer 5

• 4/5 layers with superficial umbrella cell layer, polarised, small nuclei

Question 6

What are the histological features of a papillary TCC?

Answer 6

• exophytic, fibrovascular cores, multilayering, loss of polarity, cytonuclear atypia and mitosis

Question 7

What modalities of treatment are available for bladder cancer?

Answer 7

• intravesical BCG
• intravesical chemotherapy (mitomycin)
• endoscopic transurethral resection
• cystectomy
• radiotherapy
• chemotherapy

Question 8

What pathological parameters influence management?

Answer 8

• number of tumours
• grade
• stage
• presence of in situ carcinoma in remaining bladder

Question 9

What is the ideal treatment for the following:

1. low grade, superfical tumuor
2. high grad with/without lamina propria invasion

Answer 9

1. TURBT and follow up with urine cytology and cystoscopy

2. intravesical BCG, mitomycin

Question 10

What are the commonest tumours of the kidneys in adults?

Answer 10

Benign
- oncocytoma, adenoma, angiomyolipoma
Malignant
- renal cell carcinoma

Question 11

What are the gross features of a renal cell tumour>?

Answer 11

yellow brown cut surface

haemorrhage and cystic change

Question 12

What are the gross features of an oncocytoma?

Answer 12

well-cirucumscribed homgenous, tan-brown tumour with a central scar

Question 13

What is the histology of an oncocytoma?

Answer 13

• composed of uniform large cells with pink cytoplasm. The nuclei are large containing prominent nucleoli

Question 14

What is the histology of a clear cell carcinoma?

Answer 14

• large cvells wiht clear cytoplasm arranged in alveoli

- with sinusoids containing red blood cells

Question 15

What is the hisotlogy of a papillary renal cell carcinoma?

Answer 15

• this tumour is composed of papillae lined by medium eosinophilic cells algon with foci of calcification

Question 16

What is the histology of chromophobe type renal cell carcinoma?

Answer 16

-sheets of cells with thick cell membranes (plant like cells), winkled nuclei with perinuclear folds

Question 17

What pathological features determine the prognosis of renal cell carcinoma?

Answer 17

type 
tumour size
nuclear grade
tumour necrosis 
vascular invasion 
tumour stage

Question 18

Which has a better prognosis, chromophobe carcinoma or clear cell?

Answer 18

• chromophobe