6/ Haematuria Flashcards
What are the most common causes of haematuria?
- renal or bladder calculi
- urinary tract infections
- bladder tumours
- renal tumours
- urinary obstruction
- drugs
What does normal urine cytology show?
- single urothelial cells
- abundant cytoplasm
- low nuclear cytoplasmic ratio
- bland nuclei
- regular nuclear outline
- no nucleolio
- also multinulceate umbrella cells
What are the features of malignancy on cytology?
- hyperexfoliation in papillary sheets, single pleomorphic cells with increasd nuclear cytoplasmic ratio, irregualr, hyperchromatic nuclei, prominent nucleoli
What are the types of bladder tumours?
Benign
- papilloma
Malignant
- transitiional cell carcinoma which can be papillary or solid invasive
- other carcinomas - SCC, adenocarcinoma (rare), rhabdomyosarcomas in children
What is normal bladder histology?
- 4/5 layers with superficial umbrella cell layer, polarised, small nuclei
What are the histological features of a papillary TCC?
- exophytic, fibrovascular cores, multilayering, loss of polarity, cytonuclear atypia and mitosis
What modalities of treatment are available for bladder cancer?
- intravesical BCG
- intravesical chemotherapy (mitomycin)
- endoscopic transurethral resection
- cystectomy
- radiotherapy
- chemotherapy
What pathological parameters influence management?
- number of tumours
- grade
- stage
- presence of in situ carcinoma in remaining bladder
What is the ideal treatment for the following:
- low grade, superfical tumuor
- high grad with/without lamina propria invasion
- TURBT and follow up with urine cytology and cystoscopy
2. intravesical BCG, mitomycin
What are the commonest tumours of the kidneys in adults?
Benign
- oncocytoma, adenoma, angiomyolipoma
Malignant
- renal cell carcinoma
What are the gross features of a renal cell tumour>?
yellow brown cut surface
haemorrhage and cystic change
What are the gross features of an oncocytoma?
well-cirucumscribed homgenous, tan-brown tumour with a central scar
What is the histology of an oncocytoma?
- composed of uniform large cells with pink cytoplasm. The nuclei are large containing prominent nucleoli
What is the histology of a clear cell carcinoma?
- large cvells wiht clear cytoplasm arranged in alveoli
- with sinusoids containing red blood cells
What is the hisotlogy of a papillary renal cell carcinoma?
- this tumour is composed of papillae lined by medium eosinophilic cells algon with foci of calcification
What is the histology of chromophobe type renal cell carcinoma?
-sheets of cells with thick cell membranes (plant like cells), winkled nuclei with perinuclear folds
What pathological features determine the prognosis of renal cell carcinoma?
type tumour size nuclear grade tumour necrosis vascular invasion tumour stage
Which has a better prognosis, chromophobe carcinoma or clear cell?
- chromophobe
