CAM202 Path Pots Flashcards

1
Q
A

Squamous Cell Carcinoma of the Buccal Mucosa

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2
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Pleumorphic Adenoma of the Parotid

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3
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Oesophageal Varices

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4
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Chronic Oseophagitis

(active, with scarring)

Reflux oesophagitis*

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5
Q
A

Squamous Cell Carcinoma of the Oesophagus

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6
Q
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Chronic Gastric Ulcer

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7
Q
A

Leather Bottle Stomach

Strikingly thickened stomach wall - loss of plasticity

(secondary to a plaque-like tumour involving the entire mucosal surface and infiltrating through the muscular layers and into the serosal tissues)

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8
Q
A

Adenocarcinoma of the stomach

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9
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A

Adenocarcinoma of the Stomach

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10
Q

+ microscopically?

A

Perforated Pre-Pyloric Gastric Ulcer

4 zones of chronic gastric ulcer:

  1. Thin Layer of Necrositc Debris
  2. Non-specific Inflammatory Cell Infiltrate
  3. Granulation Tissue
  4. Scar Tissue beneath the granulation tissue
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11
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A

Squamous Cell Carcinoma of the Tongue

The specimen includes: sagitally sliced tongue, epiglottis, larynx, and upper trachea & bit of upper oseophagus

Tumour extends through tongue and into the hyoid bone

Does not invulve the epiglottis

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12
Q
A

Pleumorphic Adenoma of the Parotid

Encapsulated oval shaped tumour mass from the parotid salivary gland

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13
Q
A

Oesophageal Varices

In the lower part of the oesophagus, there are distended, congested venous channels underlying the oesophageal mucosa

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14
Q
A

Squamous Cell Carcinoma of the Oesophagus

Shows a segment of oesophagus encircled with tumour mass 5cm in length that shows ulceration

Grey-white tumour tissue has infiltrated the entire thickness of the oesophagus wall

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15
Q

+ Microscopically?

A

Chronic Gastric Ulcer

Four zones of a chronic ulcer:

  1. Thin layer of Necrotic Cellular Debris
  2. Non-specific Inflammatory Cell Infultrate
  3. Granuluation Tissue
  4. Scar Tissue (lying beneath the granulation tissue)

*Surrounding mucosa exhibits some intestinal metaplasia and inflammatory vhanges - mild atropic gastritis

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16
Q

+ Microscopically

A

Miltiple Perforated Gastric Ulcers

Stomach has been opened to demonstrate the two ulcers which are both adjacent to the Lesser Curvature

Four zones of chronic ulcers:

  1. Thin layer of Necrotic Cellular Debris
  2. Non-specific Inflammatory Cell Infiltrate
  3. Granulation Tissue
  4. Scar Tissue (unerdlying the granulation tissue)
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17
Q
A

Leath Bottle Stomach

Specimen = part of the stomach showing grossly thickened walls. Grey white tumous tissue extends through the muscular layer and into the serosal tissue.

Loss of normal Rugal pattern of the mucosa

This has produced the rigid thickening of ‘leather bottle’

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18
Q
A

Adenocarcinoma of the Stomach

This specimen = posteror wall of the stomach and the pre-pyloric region

Fungating tumour 6cm in diameter situated mostly in the lesser curvature and the upper part of the posterior wall

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19
Q

+ microscopically?

A

Crohn Disease

Specimen = terminal ileum and caecum w/ appendix

Ileal mucosa has irregular polypoid appearance with elongated ulcers in the proximal portaion

Wall of the ileum is grosly thickened and the lumen is narowed

Serosal surface shows marked focal congestion in the area relating to the fistula track

Caecum and appendix are macroscopically normal

Microscopically:

  1. Chronic Mucosal Damage
  2. Transmural Inflammation
  3. Focal Non-Caseating Granulamata
  4. Fibrosis
  5. Knife-like clefts lined with granulation tissue (suggestive of active disease)
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20
Q

+ Histologically

A

Acute Supporative Appendicitis

Enlarged, swollen appendix with a thickened, congested wall

Fibrinous Exudate covers Serosal Surface

Faecal Concretion is Impacted in the Proximal part of the Lumen

Distal Appendix = dilated with pus

Microscopically:

  1. All layers neutrophil infiltration
  2. Fibrinous inflammatory exudate coating the serosa
  3. Oedema
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21
Q
A

Acute Gangrenous Apendicitis

Specimen = appendix with fatty mesoappendix

Serosal surface is partly covered in a grey-rellow fibro-purulent inflammatory exudate

Appendiceal tip shows congestion and dark necrotic tissue

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22
Q

+ Histologically

+ common causative organism

A

Pseudomembranous Colitis

Specimen = two short lengths of opened bowel

Mucosal surface of colon is studded by multiple pale yellow plaques up to 5mm in size

Interventin mucosa appears normal

Muscle and serosal layers are normal

Microscopically:

  1. Multiple foci of ulceration
  2. Gland crypts in foci of ulceration are distended by muco-purulent exudate
  3. Fibrin and neutrophil admix that errupts from the glands forms the ‘pseudomembranes’

Cause

Often post-Abx therapy, and caused by clostridium difficile

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23
Q

+ Microscopically

A

Ulcerative Colitis

Specimen = opened segment of colon

Mucosal surface shows numeroas coalescent areas of ulceration. Between areas of ulceration appear to by islands of regenerating mucosa (appear pale and slightly protuberant) = pseudo polyps.

Microscopically:

  1. Intanct mucosa shows crypt abscess formation
  2. Areas of ulceration show:
  3. loss of mucosa and lamina propria; submucosa partially replaced by acutely inflamed granulation tissue
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24
Q
A

Multiple Colonic Adenomas

Specimen = section of opened bowel

Polyps are long, thin delicate projections

(unusual appearance)

Intervening Mucosa appears normal

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25
Q
A

Adenocarcinoma of Ascending Colon and Caecum

Specimen = terminal ileum, appendix, caecum and ascending colon

Tumour tissue has invaded the entire thickness of the bowel wall and is invading the pericolic adipse tissue

Small abscess is present within the tumour on the lateral side of the bowel*

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26
Q
A

Diverticular Disease of the Colon

Numerous outpouchings alligned with the margins of the Teniae Coli

From the mucosal surface, numerous flask-shaped outpouchings, lined by mucosa, extend into the muscularis propria of the bowel

Diverticulae have thin walls - attenuated or absent muscularis propria

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27
Q
A

Adenocarcinoma of the Rectum

Specimen = Sigmoid Colon, Rectum, Anus and Peri-anal skin

Large, ulcerated and fungating tumour mass with villous sirface is in the rectum

Tumour has extendend through the muscle layer and into the peri-rectal fat at the back of the specimen

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28
Q

+ Histologically

A

Chrons Disease of the Terminal Ileum

Specimen = ~45cm of terminal ileum, the caecum and !20cm of colon

Loops of small bowel are adhered to one another

Ileo-colic fistula is present

Most of the ileal wall is markedly thickened with narrowed lumen

Normal mucosa has been replaced by flattened granular mucosa with longitudinal zones of ulceration

Creeping fat wraps around the bowel surface

Microscopically:

  1. Chronic mucosal damage
  2. Ulceration
  3. Mucosal Atrophy
  4. Heavy plasma cell infiltrate
  5. Non Caseating granulomatas
  6. Transmural inflammation
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29
Q

+ Histologically

A

Acute Obstructive Appendicitis

Appendix containing faecal concretion

Above concretion the appendix appears normal, but below, the lumen is dilated and contained pus

Serosal surface has thin inflammatory exudate, visible at the junction with the mesoappendix

Microscopically:

  1. All layers have neutrophillic infiltration
  2. Fibrinous exudate coats the serosa
30
Q
A

Acute Gangrenous Appendicitis

Specimen = appendix attacked to mesoappendiceal fat

Serosal surface is dull & shows focal areas of vascular congestion and dark discoloration (gangrenous necrosis)

Adherant fibrino-purulent exudate is present, particularly towards the appendiceal tip

31
Q

+ Histologically

A

Pseudomembranous Colitis

Specimen = two segments of large bowel

Mucosa is studded with plaques of fibrino-purulent debris and mucous

Distal segment shows greater involvement

Intervening mucosa appears normal

Microscopically:

  1. Multiple foci of superficial mucosal ulceration
  2. Gland crypts are distended by micro-purulent exudate with fibrin and neutrophils
  3. This exudate errupts out of the glands, forming the ‘pseudomembrane’
32
Q
A

Adenocarcinoma of the Caecum with Metastases to Mesenteric Lymph Nodes

Specimen = Caecum and part of ascending colon

Caecum contains large, circumferential fungating tumour mass

Tumour has infiltrated transmurally, into the para-caecal tissues

Tumour has polypoid surface that is focally ulcerated

There are several enlarged mesenteric lymph nodes on the back of the specimen

*Would be Dukes Grade C*

33
Q
A

Ulcerative Colitis

Specimen= length of ascending colon, including the caecum and terminal ileum (toawrds the top)

(sparing of the proximal caecum and terminal ileum)

Mucosa of the colon is congested and has shaggy, polypoid appearahce

These are pseudopolyps formed by islands of regenerating mucosa

Between these islands, are flat areas of mucosal ulceration (slightly paler in colour)

Bowel wall does not appear thickened

34
Q
A

Diverticular Disease of Sigmoid Colon with Perforation

Specimen = length of sigmoid colon

Fibrous thickening of the wall

Large numbers of flask-shaped diverticulae extend through the bowel wall into the pericolic adipose tissue

Diverticulae are arranged in rows between the teniae coli

A number of the diverticulae appear to have ruptured, and faeces can be seen impacted in one diverticulum

Perforation of the colon with localised paracolic abscess and vesico-colic fistula

35
Q
A

Villous Adenoma of the Sigmoid Colon

Specimen = section of sigmoid wall mucosa

Shows papillary tumour of the bowel mucosa, with a relatively narrow base, projecting into the lumen

Given the size and macroscopic papillary appearance, you would highly suspect that this tumour would show areas of malignancy

(Villous architecture and increasing size correlate with increased risk of malignancy)

36
Q
A

Adenocarcinoma of the Rectum

Specimen= Part of the sigmoid colon, the rectum, anus and peri-anal skin

Just above the recto-anal margin as a rount, raised flattened tumour

Tumour is superficially ulcerated with raised margins

Does not appear to have infiltrated deeply into the bowel wall

37
Q
A

Cirrhosis of the Liver

Specimen = Greater part of the liver

Diffuse nodularity of the liver surface

Cut surface shows variably sized patches of regenerating hepatic parenchyma, separated by bands of pale grey fibrous scar tissue

38
Q

+ Histology

A

Hepatic Steatosis with Early Cirrhosis

Specimen= section of enlarged liver

Liver is yellowy/orange in colour (which would be a result of fixation of a steatoic liver)

No obvious nodularity or fibrosis

Microscopically:

  1. Panlobar steatosis
  2. Increased fibrous connective tissue in the portal tracts
  3. Increased inflammatory infiltrate
  4. Suggestive of early-stage cirrhosis

*Steatosis is reversible, but cirrhosis is not*

39
Q
A

Metastatic Squamous Cell Carcinoma of the Cervix, in the liver

Specimen= Slice of enlarged liver

Most of the normal liver tissue has been replaced by variably shaped and sized masses of pale tumour tissue

Some of the tumour deposits show central pale foci, suggestive of necrosis

Also some facal areas of congestion and necrosis

*Most liver cancers in the western world are metastasies*

40
Q
A

Primary Hepatocellular Carcinoma of the Liver

Specimen = Slice of a massively enlarged liver

Liver shows infiltrative, multinodular tumour mass of yellow-grey tissue, with areas of necrosis and haemorrhage

Portal vein is seen adjacent to the tumour and is completely filled with tumour

*Hepatocellular carcinoma has a propensity to invade in this way*

Uninvolved hepatic parenchyma shows nodular cirrhosis

41
Q

+ Histologically

A

Acute on Chronic Cholecystitis with Cholelithiasis

Specimen = gallbladder containing multiple gallstones

Mucosa is focally congested

Wall is odematous and expanded by grey-white fibrous connective tissue, particularly towards the tip

Serosal surface is focally congested

Microscopically:

  1. Fibrosis
  2. Chronic inflammatory cell infiltrate
  3. Vascular congestion
  4. Acute inflammation and fibrinous exudate indicative of a super-imposed acite inflmammatory process
42
Q
A

Acute on Chronic Cholecystitis with obstruction by a cholsterol gallstone

Specimen = small, thick-walled gallbladder

Mucosal surface is intensely congested - in one place, the congestion involves the full wall thickness

Congestion indicitive of acute inflammation

Obstructing the neck of he gallbladder is a single cholesterol stone ~1cm

43
Q

+ Histologically

A

Cholesterolosis of the gallbladder

(Strawberry Gallbladder)

Specimen = opened gallbladder mucosa

Mucosa shows delicate lace-like pattern of yellow flecks

Flecks are 1-2mm in diameter and are slightly pedunculated

Histologically:

Yellow flecks = collections of cholesterol-laden macrophages within the lamina propria

These collections can form small polyps, recognisable on US

Aetiology: change in gallbladder wall due to excess cholesterol

44
Q

+ its affect on the liver?

A

Gallstone Obstructing the Common BIle Duct (causing Ascending Cholangitis)

Specimen= Thick-walled, scarred gallbladder with several stones trapped in the fundus

The cytis, left and right hepatic ducts are grossly dilated

The common bile duct is also grossly dilated, and it is completely obstructed by a gallston ~3cm superior to the Ampulla of Vater

Affect on the liver:

  1. Bile ducts completely obstructed
  2. Infection ascends the biliary tract and directly invades the liver
  3. Areas of hepatic necrosis
45
Q

+ Histologically

+ Cause of white specks

A

Acute Haemorrhagic Pancreatitis

Specimen= Portion of the pancreas (above) and portion of the omentum (below)

Pancreas is swollen and congested

Areas of necrosis and haemorrhage

Small white chalky deposits are visible in the adipose tissue around the pancreas, and in the omentum - these are areas of fat necrosis

White Specks:

  • Areas of fat necrosis
  • Lipase released from the exodrine pancreas and prematurely activated breaks down the fat
  • The resultant free fatty acids combine with calcium salts, forming these characteristic deposits
  • People with this may have extremely low serum calcium levels due to this process*

Histologically:

  1. Acute inflammatory process
  2. Oedema
  3. Congestion
  4. Neutrophillic Infiltrate
  5. Extensive Tissue Necrosis
  6. Haemorrhage
  7. Characteristic Fat Necrosis
46
Q

+ What is this pathology?

A

Pseudocyst of the pancreas

Specimen = Spleen and a cystic structure 3.5 x 4.5cm

Cystic structure is present within the splenic hilar connective tissue, and intimately related to the tail of the pancreas (seen on the left side)

The cyst has been opened

It would have been filled with blood-stained material and fluid

The wall of the cyst consists of pale grey fibrous connective tissue

**There is no epithelial lining to the pseudocysts - hence the term ‘pseudo’

What are Pancreatic Pseudocysts?

  1. Walled-off collections of necrotic debris rich in pancreatic enzymes
  2. Usually arise in the setting of acute pancreatitis
  3. May also follow trauma to the pancreas
  4. Wall consists of organizing granulation tissue
  5. *Secondary Infection can occur
47
Q

+ Histologically

A

Cirrhosis of the Liver

Specimen = portion of the liver

Diffuse nodularity of the liver surface

Nodules are fairly uniform in size, and are separated out from each other by delicate bands of grey fibrous connective tissue

Cut surface shows similarly diffuse nodularity with intervening bands of fibrous connective tissue

Microscopically:

  1. Regenerating nodules of hepatic parenchya
  2. Between bridging fibrosis between portal tracts and between central veins and portal tracts
  3. Moderate Steatosis also present
48
Q

+ Microscopically

A

Hepatic Steatosis

Specimen = slice of liver

Brighter orange colour now due to fixation. But was originally pale yellow and greasy in appearance

No evidence of nodularity or fibrosis

Microscopically:

  1. Intracytoplasmic accumulation of lipid droplets within hepatocytes
  2. Initially in the centre of lobules, but spreads
  3. *Note steatosis is reversible*
49
Q
A

Metastatic Adenocarcinoma of the Liver

Specimen = Slice of liver

Most of the liver has been replaced by tumour tissue

Liver has numerous, large infiltrative nodules of pale tumour tissue

Areas of central necrosis - the opaque yellow tissue - can be seen

Intervening liver tissue shows congestion

50
Q
A

Primary Hepatocellular Carcinoma of the Liver with Cirrhosis

Specimen = portion of the liver showing diffuse nodularity of the parenchyma (cirrhosis).

The nodules of regenerating hepatic parenchyma measure 0.2-0.5cm and are separated by thin grey fibrous connective tissue ‘bridges’

Several large oval rounded nodues of slightly paler more homogenous looking tumour tissue are present

They have necrotic foci

51
Q

+ Histologically

A

Chronic Cholecystitis with Cholelithiasis and granulomatous Cholecystitis

Specimen = opened thick-walled gallbladder containing 4 gallstones

Microscopically:

  1. Fibrous wall
  2. Chronic inflammatory cell infiltrate
  3. Large numbers of foamy macrophages containing bile
52
Q
A

Acute Cholecystitis with Abscess formation

Specimen = opened gallbladder and separate gallstone

The neck of the gallbladder shows a rounded space where the gallstone was situated, causing obstruction

Wall of the gallbladder is thickened and contains several small abscesses

Serosal surface is congested

53
Q

+ Histologically

A

Cholesterolosis of the Gallbladder

(Strawberry gallbladder)

Specimen = small, opened gallbladder

Mucosa is studden with tiny yellow flecks 1-2mm in size

No gallstones where found in the gallbladder - is assumed these would have passed before the surgery

Microscopically:

  1. Yellow flecks comprise build-up of cholesterol-laden macrophages in the lamina propria
  2. These collections may form multiple small polyps which can be detected on US
54
Q
A

Cholecystitis with Obstruction of the Extra-Hepatic Bile Duct, Resulting in Ascending Cholangitis

Specimen = enlarged, thick-walled gallbladder with focally ulcerated mucosa

The cystic, hepatic and common bile ducts are all markedly dilated

Common bile duct is obstructed by an orange-coloured gallstone, 1cm in diameter, wich has impacted in the ampulla of vater

The gallstone appears to be eroding its way into the duodenum

The ampulla and the gallstone are partially obstructing the duodenum

55
Q

+ Histologically

+ Cause of chalky white flecks

A

Acute Haemorrhagic Pancreatitis

Specimen = Two thin slices of pancreas and a portion of adjacent mesentery with vessels and lymph nodes

Much of the pancreatic tissue is necrotis and haemorrhagic - these areas appear blackish

The included fat shows scattered chalk-white deposits of fat necrosis (best seen on the reverse of the spicimen)

Islands of spared, essentially normal, pancreatic tissue can be seen between areas of necrosis

Histologically:

  1. Acute Inflammation
  2. Oedema
  3. Neutrophillic Infiltrate
  4. Congestion
  5. Widespread necrosis and haemorrhage
  6. Fat Necrosis

Cause of fat necrosis:

  • Release of prematurely activated lipase from pancreatic exocrine acinar
  • Lipase breaks down adipose tissue (fat)
  • The resultant free fatty acids bind with calcium salts
  • Forms the typical fat necrosis deposits
  • *These patients will often have very low serum calcium due to this process*
56
Q
A

Horseshoe Kidney

Congenital abnormality*

The ureters of the fised kidneys pass anteriorly to the kidney parenchyma

This anomaly is quite common - twice as common in males

Fusion of the upper poles accounts for 90% of hoseshoe kidneys

~1/3 of patients are asymptomatic and this will be an incidental finding

However, rates of various diseases are more common in horseshoe kidneys:

  • Hydronephrosis
  • Stone Formation
  • Infection
  • Certain Cancers
57
Q

Cause of that massive thing…?

A

Neohrolithiasis and Pyelonephrosis

Specimen = kidney

Renal parenchyma has been destroyed and replaced by a thin rim of fibrous tissue, stretched over grossly expanded calyces which were filled with pus

Large Staghorn Calculus filling the renal pelvis and obstructing the ureter

Pus can be seen on the surface of the staghorn calculus

Cause of Staghorn Calculi:

  • Almost always a consequence of infection by urea-splitting organisms - e.g. proteus and staphylococci
  • The resultant alkaline urine causes the precipitation of magnesium ammonium phosphate salts
  • These stones account for 15-20% of all renal stones and tend to be some of the largest
58
Q

+ Likely Causes?

A

Hydronephrosis

Specimen = part of the kidney

Opened to show the distended pelvis and calyces

Small remnants of renal parenchyma are present

But most of the kidney has been reduced to thin-walled cystic structure

The hydronephrotic ‘cysts’ are all connected with the hydronephrotic cavity

Cuases:

  • Hydronephrosis may follow an abstruction at any level of the urinary tract
  • Obstruction ultimately leads to reflux and build up of pressure thatn damages the delicate kidney parenchyma
  • This also predisposes to infection, inflammation and stone formation
59
Q

+ Epidemiology of this pathology

+ Diagnosis of this pathology

A

Solitary Cyst of the Kidney

Specimen = A kidney

Kdney displays a large thin-walled cyst of the upper pole, which is compressing surrounding renal parenchyma

This is a solitary simple cyst of the kidney

Renal cysts are present in 50% of people over 50yo

Usually asymptomatic but can sometimes cause symptoms similar to that of a malignant renal lesion:

  • Flank Pain
  • Haematuria
  • Palpable Mass

US and CT scan help in the differentiation of cysts from other renal masses - particularly malignancy

Bosniak system of classification of renal cysts on CT is also a useful method

60
Q

+ Aetiology

+ Incidence and consequences

A

Austosomal Dominant Adult Polycystic Kidney Disease (ADPKD)

Sepcimen = Part of the Right Kidney

Sliced to show numerous cysts

In some, the sero-sanguinous contents are retained

Kidney has retained its classical ‘kidney’ shape, but the renal parenchyma is just about completely destroyed

Aetiology:

  • AD type Polycystic Kidney Disease affects 1 in 400-1000 live births
  • Accounts for 5-10% of chronic renal failure cases
  • Genetic mutations alter mechanical signalling by the tubular epithelium
  • This alters growth and differentiation of the epithelium
  • Resulting in the progressive formation of cysts
  • And destruction of functioning parenchyma
  • By 60yo, 70% of these patients will be in renal failure

*I.e. require transplants

61
Q

+ Histologically

+ Aetiology

A

Clear Cell Carcinoma of the Kidney

Specimen = Right Kidney, Sliced

Sliced edge shows large, expansile tumour of the lower pole

It is infiltrating the renal parenchyma superiorly

Tumour tissue is pale yellow in colour and shows foci of haemorrhage and cystic degeneration

Hilum of the kidney appears unaffected*

Microscopically:

  1. Tumour formed by large polygonal epithelial cells with abundant clear cytoplasm
  2. Show trabecular and tubular growth patterns

*Clear Cell Carcinomas are the most common type of renal cell carcinomas

Aetiology:

  • 98% of these tumours are associated with a loss of sequences on chromosome 3p at the locus of the VHL gene
62
Q

+ Epidemiology

+ Histologically

+ Prognosis

A

Nephroblastoma Kidney - Wilms Tumour

At the upper pole, the small distorded kidney can be seen

Below it, is a large expansile tumour mass

Tumour is lobulated and comprised of pale tan tissue with areas of necrosis, haemhorrage, and cystic degeneration

The tumour has distorted the calyceal system and appears to be encapsulated

Microscopically:

  1. Tumour made up of large sheets of neoplastic cells
  2. Some areas are of embryonic type (blastema)
  3. Other areas show differentiation into primitive tubular and glomerular structures (epithelial)
  4. Loose stroma is also seen
  5. The triphasic histology represents the tumour’s attempt at nephrogenesis
  6. In 5% of cases, cellular anaplasia can be seen - associated with worse prognosis

Epidemiology:

  • Most common primary renal tumour in children
  • Usually diagnosed in children 2-5 years old

Prognosis:

Usually good - 90% at 2 years, even where there has been spread beyond the kidney

63
Q
A

Carcinoma of the Renal Pelvis

Specimen = Right kidney sliced open

Shows massive papillary carcinoma 9 x 5.5 cm

Tumor appears to be arising over most of the surface of the lower half of the renal pelvis

Upper half of the pelvis is dilated and the calyces are blunted

Ureter not involved

*5-10% of renal tumours arise from the renal pelvic urothelium, and they tend to present quite early with haematuria or obstruction

64
Q

+ Histologically

A

Horseshoe Kidney and Renal Hamartoma

Horseshoe kidney

Also present is a small subcapsular tumour-like mass at the upper pole of the left kidney

This tumour appears to have arisen from the cortex of the kidney

The tumout projectes from the capsular surface to form an irregularly shaped mass of pale yellow-grey tissue

Microscopically:

As a hamartoma of the kidney:

  • Tumor composed of thick walled blood vessels
  • Adipose tissue
  • Interlacing bundles of smooth muscle
65
Q

+ Aetiology

A

Staghorn Calculus and Pyelonephrosis

Specimen = Kidney sliced open to reveal a large, fragmented staghor calculus

The calculus filles the dilated renal pelvis and calyceal system

Pus was present in the calyces and renal pelvis

There is thinning of the renal cortex in the areas adjacent to the calculus - especially the upper pole

Aetiology:

  • Staghorn calculi are almost always due to urea-splitting organisms - proteus or staphylococci
  • The result is alkaline urine which causes the precipitation of magnesium ammonium phosphate salts (struvite)
  • These stones are some of the largest renal calculi and account for 15-20% of renal stones
66
Q

+ Histologically

A

Hydronephrosis and Chronic Pyelonephritis

Specimen = Shrunken kidney

Capsular surface shows multiple, deep, irregular scars

Cut surface shown dilated pelvis/calyceal system

Thinning of the overlying cortex and loss of medullary tissue too

Mucosal lining of the renal pelvis shown congestion - consistent with inflammation

Microscopically:

  • Renal parenchyma largely replaced by fibrous tissue
  • Chronic inflammatory cell infiltrate
  • The pelvis/ureteric junction is narrowed and distorted by dense fibrous tissue
67
Q

+ Epidemiology

+ Diagnosis

A

Solitary Cyst Kidney

Specimen = Right Kidney

Kidney has large, thin-walled solitary cyst ~8cm diameter

Cyst is in the mid-zone, overlying the front of the hilar region

Aberrant renal artery and vein also present at the lower pole*

Simple Renal Cysts:

  • Present in over 50% of individuals over 50yo
  • Usually asymptomatic but may produce similar signs and symptoms to malignant lesions: flank pain, haematuria and palpable masses

Diagnosis:

  • US and CT scan help in differentiating cysts from other renal masses
  • Bosniak system of classification also helpful
68
Q

+ Involvement of other organs?

+ Histologically

A

Polycystic Kidney Disease

Specimen = part of the right kidney

Slided to show numerous irregularly sized cysts

Some retain gelatenous material

Other caontain a watery fluid and some contain altered blood

Histologically:

  1. Cysts lined with cuboidal epithelium
  2. Thin rims of renal tissue around the cysts
  3. Tubules filled with proteinaceous casts
  4. Vessels showing hypertensive changes

~40% of patients with ADPKD have liver cysts as well

69
Q

+ Aetiology and incidence

A

Clear Cell Carcinoma of the Kidney

Specimen = Right Kidney

Sliced to reveal a large expansile tumour

Largely of the lower pole of the kidney, and infiltrating the renal parenchyma superiorly

TUmour tissue is pale yellow with areas of haemorrhage, necrosis, and cystic degeneration

Hilar region appears tumour free

Aetiology

  • Loss of sequences on chromosome 3p at the loci of the VHL gene
70
Q

+ Histologically

A

Neohroblastoma Kidney - Wilms Tumour

Specimen = small distorted kidney, at the top of the specimen. The rest is a large expansile tumour

Tumour tissue is pale tan - white

SHows extensive areas or haemorrhage and necrosis centrally, with some areas of cystic degeneration

Tumour appears contained within a delicate fibrovascular capsule

Microscopically:

  1. Small embryonic-type cells
  2. And formation of primitive tubules
  3. Characteristic of a nephroblastoma
  4. This triphasic histology represents the tumour’s attempts at nephrogenesis
  5. Anaplasia only seen in ~5% of cases and is associated with worse prognosis
71
Q
A

Papillary Transitional Cell Carcinoma of the Renal Pelvis

Specimen = Slice shows a papillary tumour mass finning and distorting the calyceal system of the upper pole

No evidence of haemorrhage or necrosis

*Note that 5-10% of renal tumours arise from the pelvic urothelium. These tumours tend to present early with haematuria or obstruction

72
Q
A