CP4-1 & 2 pathology of the urogenital tract Flashcards
What is a renal cell carcinoma? What are the two most common types?
A cancer of the kidney arising from the renal tubular epithelium.
Clear cell (75% of cases)
Papillary (10% of cases)
Do males or females present more commonly with renal cell carcinoma?
Males
What age group are more likely to get renal cell carcinoma?
Over 60s
What are risk factors for renal cell carcinoma?
Obesity
Smoking
NSAID use
End stage renal failure (+ on dialysis)
What familial disease increases risk of renal cell carcinoma?
Von Hippel-Lindau
What are clinical features of renal cell carcinoma I.e. the how do patients present?
Haematuria
Abdominal pain
Symptoms associated with metastases (e.g. SoB in lung metastases)
Weight loss
Hypertension (due to increased renin secretion as increase in cells)
Polycythaemia (increased red cell count)
What are paraneoplastic syndromes?
Signs and symptoms not related to primary or metastatic tumours which develop due to protein/hormone secretions of tumour cells or immune cross reactivity between tumour cells and normal cells.
What is another name for a Wilms’ tumour?
Nephroblastoma
What is a Wilms’ tumour?
Cancer of the kidney which arises from nephroblasts (embryological cells that develop into the kidney)
What age group are Wilms’ tumours found in?
Under 5 year olds (very rare amongst other age groups)
What genetic syndromes is Wilms’ tumour associated with?
Beckwith-Weidemann syndrome
WAGR syndrome
Denys-Drash syndrome (WT1 mutation)
What is a genetic mutation associated with Wilms’ tumour?
WT1
What % of Wilms’ tumours are bilateral?
10%
How do patients present with a Wilms’ tumour?
Abdominal distension (especially if bilateral) due to abdominal mass
Haematuria
What is the 5 year survival rate of Wilms’ tumour?
90%
What is urolithiasis?
Urinary tract calculi/stones which form anywhere from the renal calyx to the bladder
What are urinary tract stones formed of?
Calcium stones (70%)
Unrated stones
Cystine stones
Struvite stoned (magnesium ammonium phosphate) aka stag horn calculi
What is a risk factor for calcium stones?
Raised serum Ca e.g. due to parathyroid adenoma
What are risk factors for urate stones?
Raised serum urate e.g. due to gout or malignancy
What is a cause of cystine stones?
Raised serum cysteine e.g. due to congenital cystinuria
What is the pathogenesis of urolithiasis caused by calcium, urate or cysteine?
Too high concentration of soluble material causes urine to become saturated. The soluble material precipitates out (+/- stasis) to form stones. This can lead to obstruction and hydronephrosis +/- hydroureter leading to renal impairment, urinary stasis causing infection +/- more stones developing, or local trauma potentially leading to squamous metaplasia and risk of squamous cell carcinoma
What is the pathogenesis of struvite stones?
UTI with urease producing bacteria (e.g. proteus)l the urease converts urea to ammonia which causes a pH rise and precipitation of magnesium ammonium phosphate salts leading to stones forming.
What is the only stones that can be seen in X-ray?
Calcium stones
How do patients with urolithiasis present?
Loin to groin (renal colic) pain/lower abdominal pain - dependent on location of obstruction
Haematuria
Dysuria if obstructed at urethra
+/- Other symptoms of complications
What is vesicoureteral reflux?
When urine flows backwards from the bladder to the ureter rather than into the urethra to be excreted
Who is most likely to get vesicoureteral reflux?
Young people (especially under 2s)
Those with a family history
About 10% of population
What causes vesicoureteral reflux?
Congenital abnormality at the vesicoureteric junction where the ureter enters the bladder at an abnormal angle leading to back flow of urine
How do children with vesicoureteral reflux present?
Usually asymptomatic and most children grow out of it.
Symptomatic if complications
What are potential complications of vesicoureteral reflux?
UTI due to stasis of urine
Renal damage due to back pressure and ascending infection
What is a urothelial carcinoma?
A cancer arising from the urothelium (transitional epithelium in the bladder)
What % of bladder cancers are urothelial carcinomas?
Over 90%
What are risk factors for urothelial carcinomas?
Age >60
Male
Smoking
Exposure to industrial chemicals
Family history
Cancer treatments e.g. pelvic radiotherapy and cyclophosphamide
How do patients with urothelial carcinomas present?
Haematuria
Frequency, urgency and dysuria when urinating
Symptoms associated with lung, bone or liver metastases
Rarely paraneoplastic syndromes
What is the 5 year survival rate of urothelial carcinoma?
Approx 50%
What is a neurogenic bladder?
An inability to properly empty the bladder due to neurological damage
What are the two types of neurogenic bladder?
Spastic (due to damage to brain or spinal cord)
Flaccid (due to damage to peripheral nerves)
What are disease associated with the development of neurogenic bladders?
Spastic = stroke, MS, spinal injury
Flaccid = pregnancy, diabetes, alcohol related B12 deficiency
How do patients with neurogenic bladder present?
Symptoms related to lack of control of bladder emptying e.g. urinary retention +/- abdominal distension, incontinence, urge and frequency of urination
Symptoms related to complications
What are potential complications of neurogenic bladder?
UTI or urinary stones associated with urinary stasis
Renal function impairment due to inability to empty bladder causing bladder distension, hydroureter and hydronephrosis.
What is benign prostate hyperplasia (BPH)?
Increased number of both stromal and glandular cells in the prostate
How do patients refer to BPH?
Enlarged prostate
What is the epidemiology of BPH?
Old men (20% by age 40 and 70% by age 60)
What are risk factors for BPH?
Obesity
Diabetes
Family history
What are complications of BPH?
Compresses the urethra leading to obstruction of bladder outlet. Leads to urinary stasis causing infection +/- stones, acute urinary retention or back pressure causing renal damage.
How do patients present with BPH?
Hesitancy or urgency to pee
Poor/intermittent stream of urine
Straining
Prolonged micturition
Incomplete bladder emptying
Dribbling
Increased frequency of urination
Incontinance
Nocturia
What is prostatic adenocarcinoma?
Cancer of the glandular epithelium in the prostate
What is the epidemiology of prostate adenocarcinoma?
Old men
What are risk factors for prostatic adenocarcinoma?
Black
Male
Family history (BRCA1/2 mutations)
Pesticide exposure
What is the relationship between BPH and prostatic adenocarcinoma?
Often occur concurrently but BPH does NOT cause prostatic adenocarcinoma
How do patients with prostatic adenocarcinoma present?
Lower urinary tract symptoms
Symptoms of bone metastases
Paraneoplastic syndromes are rare
What is the 5 year survival rate of prostatic adenocarcinoma?
90% - most people die with it not of it
What is cryptorchidism?
Undescended testis I.e. the the testes are not in the scrotum
What are the three sub categories of undescended testes?
Abdominal (15%)
Inguinal canal (25%)
Hugh scrotal (60%)
Who is most at risk of undescended testes?
Premature male babies
What causes undescended testes?
No cause identified, unseated multifactorial e.g. family history, environmental factors like maternal smoking or alcohol use
What is the pathogenesis of undescended scrotum?
Embryological failure of descent testis scrotum
How do patients with undescended testes present?
With an empty scrotum (10% bilaterally)
What are complications of undescended testis?
Infertility
Hernias
Increase testicular cancer risk
Testicular torsion
What is a seminoma?
A malignant neoplasm of the testis arising from germ cells in the seminiferous tubules
What are the two types of seminoma?
Classic
Spermatocytic
What type of testicular cancer is the most damaging/has the worst prognosis?
Non-seminomateous germ cell tumours
Who is most at risk of seminoma?
Young men (aged 25-45)
If have family history
Having undescended testis (even if treated with surgical correction)
What mutation is associated with seminomas?
KIT
How do patients with seminomas present?
Testicular lump with swelling and pain
Symptoms associated with lung and lymph node metastases
Gynecomastia (production of HCG)
What testicular cancers have a good prognosis?
Classic and spermatocytic seminomas, leydig cell tumours and Sertoli cell tumours
What is the 5 year survival rate of seminomas?
95%
What causes obstructive lesions of the urinary tract?
Large kidney tumours
Stones in lumen of ureter
Ureter wall abnormalities
External compression of the ureter
Functional abnormality of ureter (VUJ reflux)
Staghorn calculi in the renal pelvis
Bladder stones and tumours
Neurogenic bladder
Anticholinergic drugs
Prostate problems like BPH, tumours, prostatitis
Tumour or phimosis in the penis
Structural abnormalities of the urethra
Foreign bodies in the urethra
A blocked catheter
What does obstruction at the pelviureteric junction do to the kidney?
Caused hydronephrosis
What are symptoms of complete urinary tract obstruction?
Anuria
Pain
What are symptoms of partial obstruction of urinary tract obstruction?
Usually asymptomatic
What are complications of urinary tract obstruction?
Irreversible renal impairment or secondary VUR due to back pressure
Infection or calculi formation due to urinary stasis
What is phimosis?
Tight foreskin that is unable to retract
The kidneys have pain receptors. True or false?
False
Pathology to what part of the renal system causes shooting pains from back to groin?
Ureter
