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Pathology > Genitourinary > Flashcards

Genitourinary Flashcards

1
Q

What are 3 benign tumours of the kidney

A

Benign papillary adenoma
Angiomyolipoma
Oncocytoma

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2
Q

What are the two most common invasive malignancies of the kidney

A

Renal cell carcinoma
Wilms tumour

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3
Q

How common are benign papillary adenomas of the kidney at autopsy

A

Found in 7-22%

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4
Q

How do renal papillary adenomas differ from low grade papillary renal cell carcinoma histologically

A

No difference
Often size criteria used; >3cm much greater risk of spread

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5
Q

What is the most common subtype of renal cell carcinoma. What are it’s histological features

A

Clear cell
-non papillary
-clear or granular cytoplasm
-mutation of VHL/ chromosome 3 short arm deletions

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6
Q

What are the most common variants of renal cell carcinoma

A

Clear cell
Papillary

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7
Q

What is the gross presentation of the two most common types of renal cell carcinoma

A

Most commonly affect poles of kidneys
Clear cell: solitary tumour
Papillary: multifocal

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8
Q

What are the most common sites of metastasis of renal cell carcinoma. What are the rates of metastasis at diagnosis

A

Present in 15% at diagnosis
Lungs and bone most common site

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9
Q

What is the most common malignancy of the renal pelvis

A

Urothelial (transitional) carcinoma

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10
Q

What are the two precursor lesions to invasive urothelial carcinoma

A

Papilloma
Flat carcinoma in situ

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11
Q

Invasion of what layer of the bladder wall defines a T1 urothelial carcinoma. What layer defines T2a/b

A

T1: lamina propria (deep to basement membrane)
T2a: invasion of muscular is propria (less that half of thickness)
T2b: invasion of muscular is propria (more than half of thickness)

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12
Q

What 2 genetic mutations are frequently implicated in flat cis of the bladder

A

P53, Rb

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13
Q

What percentage of urothelial CIS proceeds to invasive cancer if left untreated

A

50-75%

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14
Q

What is the most common type of malignancy of the testis

A

Germ cell tumour

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15
Q

What are the two categories of germ cell tumour of the testis

A

Seminomatous
Non-seminomatous

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16
Q

What tumour markers should be checked in testicular cancer that for part of staging

A

B-hcg (choriocarcinoma)
AFP (embryonal carcinoma, yolk sac, +/-teratoma)
LDH (seminoma)

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17
Q

What are the main histological types of non seminomatous germ cell tumour

A

Mixed germ cell tumour (with components of multiple types below, and also seminomatous)

Embryonal carcinoma
Yolk sac (post pubertal type)
Choriocarcinoma
Teratoma (post pubertal type)

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18
Q

What is the usual CK7/CK20 profile for prostate cancer

A

Both negative

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19
Q

What are the two IHC markers most useful for RCC

A

PAX8 (uniformly positive in RCC)
CAIX (strong positivity in clear cell RCC (increased expression as a result of VHL mutation), most other variants of RCC negative)

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20
Q

What IHC tests can be used to distinguish RCC from adrenocortical neoplasms and pheochromocytoma

A

RCC: positive: PAX8, broad spectrum CK (AE1/AE3, cam 5.2). EMA (usually positive whereas CKs are variable)
Adrenocortical: positive: SF1, melan-A (other melanoma markers negative), inhibin, synaptophysis frequently positive. Negative: S100, chromogranin, cytokeratins
Pheo: neuroendocrine markers (synaptophysin, chromogranin, CD56), S100, SOX10, GATA3. Negative: SF1, CKs

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21
Q

What are the microscopic features of prostate adenocarcinoma

A

Loss of basal layer of glands
Invasion through basement membrane
Prominent nucleoli enlarged nuclei. Round nuclei.
Loss of gland formation with higher grade
Mitoses
Stromal desmoplasia
Glomerularions (glands that look like glomeruli)
Various intraluminal contents

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22
Q

What are the microscopic differences between benign and malignant prostate gland appearances

A

Benign: large, regularly spaced glands. No nucleoli, small nuclei. Abundant apical clear cytoplasm
Malignant: small glands with haphazard spacing. Large nuclei with prominent nucleoli.

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23
Q

What are the rules for Gleason grading

A

Primary pattern: always the most common pattern
Secondary pattern: must be present >5% if primary pattern is higher grade. If primary grade is lower then report any presence of highest grade
Tertiary: only reported for prostatectomy specimens. Other rules still apply

24
Q

Epidemiology of bladder cancer

A

Common (4th male, 8th female)
Median age 70
M>F 3:1

25
Q

Risk factors for bladder cancer

A

Smoking
Chemical exposure (industrial, hair dyes)
Medications: some analgesics, cyclophosphamide
Schistosomiasis (associated with SqCC)
Chronic inflammation
Radiation exposure
Lynch syndrome

26
Q

What are the two hypothesis of the development of multi focal bladder cancer

A

1) clonogenic: arises from a single transformed cell, but malignant cells spread through urothelial tract via intraepithelial migration or seeding

2) Field change: multiple areas of urothelial mucosa exposed to same (chronic) carcinogen and independent malignant cells arise resulting in multiple tumours

27
Q

Deletion of what chromosome is strongly associated with urothelial carcinoma

A

Chromosome 9

28
Q

What are the two main pathways of development of urothelial carcinoma and their associated gene abnormalities.

A

1. Hyperplasia (most common pathway, 70-80%): chromosome 9 loss results in hyperplasia and superficial (non muscle invasive tumours). Associated with HRAS/FGFR3. 70% recurrence rate, 15% will progress to muscle invasive

2. Dysplasia (20-30%) chromosome 9 loss results in dysplasia then progression to muscle invasive tumour. Associated with p53 and Rb abnormalities. Invasive urothelial cancer associated with loss of e-cadherin

29
Q

How is bladder CiS distinguished from dysplasia

A

HMWCK stains full thickness in CiS, but only the basal layer will stain in dysplasia

30
Q

What is the importance of grading in non-invasive papillary carcinoma (Ta) bladder.

A

Low grade: CSS 98%
High grade: CSS 40%

31
Q

What IHC stains are positive in urothelial carcinoma

A

CK7, CK20, HMWCK, GATA3, p63

32
Q

What features of cytological atypia are used to distinguish low from high grade urothelial carcinoma

A

Mitotic rate
Nuclear size/pleomorphism, hyperchromatism

33
Q

What is the most common precipitant of SqCC of the bladder

A

Chronic inflammation. (Eg recurrent uti, schistosomiasis, recurrent bladder calculi)

34
Q

What is the macro and micro appearance of bladder SqCC

A

Whitish appearance, necrosis
Keratin pearls, intercellular bridges, CK5/6+. Adjacent squamous meta plasma/dysplasia

35
Q

What are the differentials for a bladder mass

A

Pre-invasive
Cis
Ta

Malignant:
Urothelial carcinoma
SqCC
Adenocarcinoma
Small cell carcinoma
Sarcoma
Lymphoma
Melanoma
Metastasis

36
Q

What are the epidemiological patterns of prostate cancer

A

Male gender
Increasing age
Family history
African American race

37
Q

What are the microscopic features of each Gleason grade of prostate cancer

A

Grade 1- closely packed glands, larger than grade 3 glands. Abundant cytoplasm
Grade 2- some irregularity of glands, but still large, abundant cytoplasm
Grade 3- abundant small glands, variable in size and shape
Grade 4- fused glands, cribriform glands, glomerulations
Grade 5- sheets of cells, loss of glands. Comedo necrosis

38
Q

IHC staining prostate adeno vs urothelial cancer

A

Opposite patterns
Urothelial: (positive) p63, HMWCK, GATA3, CK7/20
Prostate: AMACR, NKX3.1, PSA, PSMA. (In benign prostate tissue p63, HMWCK both positive)

39
Q

What is the significance of the presence of intraductal carcinoma of the prostate in biopsies of adenocarcinoma

A

Associated with high grade, high volume disease. Early biochemical recurrence and metastatic disease.

40
Q

What are the microscopic features of intraductal carcinoma of the prostate

A

Large calibre glands
Preservation of basal cell layer (p63 and HMWCK positive in basal layer of glands
Significant nuclear atypia
Comedo necrosis often present

41
Q

What IHC stains would be useful in a general panel for testicular tumours

A

AE1/AE3 (neg lymphoma, spermatocytic)
SALL4 (non specific, but positive most germ cell tumours)
OCT3/4 (seminoma and embryonal carcinoma only)
B-hcg (choriocarcinoma)
CD45 (lymphoma)
CD30 (embryonal carcinoma)
CD117/ckit (multiple)
AFP
Glypican 3
Sox 2

42
Q

What is the most aggressive germ cell tumour

A

Choriocarcinoma. Frequent hemorrhagic Mets

43
Q

What chromosomal abnormality is commonly associated with testicular seminoma and embryonal carcinoma

A

Isochrome 12p
Ie, loss of the q arm of chromosome 12, and the 12p arm gets mirrored.

44
Q

What is the microscopic appearance of seminoma

A

Large polygonal cell with clear cytoplasm
Distinct cell membranes
Prominent nucleoli
Nested architecture
Lymphocyte infiltrate

45
Q

What is the difference in behaviour of post pubertal testicular teratoma and ovarian teratoma

A

Testicular usually malignant, ovarian usually benign

46
Q

What are the two main types of sex cord stromal tumours

A

Leydig cell tumour - may secrete testosterone and cause precocious puberty
Sertoli cell tumour

47
Q

What are the subtypes of seminomatous germ cell tumour

A

Classical
Anaplastic
Spermatocytic

48
Q

Aside from germ cell tumours and sex cord stromal tumours, what other tumours are associated with the testis

A

Lymphoma
Mesothelioma (of tunica vaginalis)
Sarcomas (eg liposarcoma, rhabdomyosarcoma)

49
Q

What are the 3 WHO categories of testicular tumours (not including lymphoma, sarcomas)

A

Type 1: Germ cell tumours derived from GCNIS (most of the common types including postpubertal teratoma). Associated with isochrome 12p
Type 2: Germ cell tumours unrelated to GCNIS (spermatocytic, pre-pubertal yolk sac and teratoma)
Type 3: Sex cord stromal tumours (serotonin cell, leydig cell + others)

50
Q

What is the S component of staging for testicular germ cell tumours

A

Serum tumour marker levels (AFP, bHCG, LDH)
S0= all not elevated.
S1-3 depending on exact levels they are raised to

51
Q

At a basic level what is represented by the different stages of testicular germ cell tumour

A

Stage 1a: T1
Stage 1b: T2-4
Stage 2a-c: N1-3
Stage 3: M+

52
Q

How are is the primary staged for testicular cancer (ie T1-4)

A

T1: not invading tunica vaginalis
T2: invading tunica vaginalis
T3: invading spermatic cord
T4: invading scrotum (risk of node spread to inguinal/ext iliac)

53
Q

What is the microscopic appearance of testicular embryonal carcinoma

A

Large crowded pleomorphic cells (giving purple appearance to slide)
Vesicular nuclei, prominent nucleoli
Variable architecture (nests, sheets, papillae, glands)

54
Q

What is the microscopic appearance of testicular choriocarcinoma

A

Cytotrophoblasts and trophoblasts (mononuclear with light cytoplasm)
Syncytiotrophoblasts (multinucleated with deeply eosinophilic cytoplasm- giving red colour to slide)
Abundant haemorrhage
Associated with haemorrhagic metastasis

55
Q

What is the typical microscopic appearance of testicular post pubertal yolk sac tumours

A

Usually part of a mixed germ cell tumour

Most commonly reticular/microcytic architecture (honeycomb mesh work)
Hypocellular myxoid areas
Other distinctive features (see Kurt’s notes)

Pathology (16 decks)

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