Genitourinary and renal pathology

Question 1

1. What is the cell of origin for adenomatoid tumors?
   a) Renal tubular epithelial cell
   b) Interstitial cells of Cajal
   c) Mesothelial cell
   d) Hilar cell
   e) Undifferentiated mesenchymal cell

Answer 1

C

Question 2

2. Renal papillary necrosis is seen in the following situations except:
   a. Diabetes mellitus
   b. Urinary tract obstruction
   c. Acute pyelonephritis
   d. Wegener granulomatosis
   e. Analgesic abuse

Answer 2

D

Question 3

3. A prostate needle biopsy specimen contains a conventional prostatic adenocarcinoma, with the following Gleason patterns: pattern 4 about 65%, pattern 3 about 30%, and pattern 5 about 5%. What is the Gleason score?
   a. 8
   b. 7
   c. 7 with a tertiary pattern 5
   d. 9
   e. 12

Answer 3

D

Question 4

4. In the prostate, the basal layer of the epithelium stains for:
   a. Prostate specific antigen (PSA)
   b. p63
   c. Actin
   d. p53
   e. Prostatic acid phosphatase (PAP)

Answer 4

B

Question 5

5. What is the most common malignancy of the spermatic cord of adult males?
   a. Liposarcoma
   b. Leiomyosarcoma
   c. Embryonal rhabdomyosarcoma
   d. Undifferentiated sarcoma
   e. Angiosarcoma

Answer 5

A

Question 6

6. What condition is associated with granular IgA, IgG, IgM, and C3 within glomeruli?
   a. Alport disease
   b. Lupus nephritis
   c. Antineutrophil cytoplasmic antibody (ANCA) associated vasculitis
   d. Postinfectious glomerulonephritis
   e. Membranous nephropathy

Answer 6

B

Question 7

7. Which is not a common histologic finding seen in cyclosporine and FK506 nephrotoxicity?
   a. Tubular isometric vacuolization
   b. Hyaline arteriopathy
   c. Acute thrombotic microangiopathy
   d. Crescentic glomerulonephritis
   e. Normal histology

Answer 7

D

Question 8

8. In myeloma cast nephropathy, what causes renal damage?
   a. Hypercalcemia
   b. Tissue infiltration by neoplastic cells
   c. Immunoglobulin light chains
   d. Infection
   e. Secondary to chemotherapeutic agents

Answer 8

C

Question 9

9. In invasive urothelial carcinoma of the bladder, pT2 disease corresponds to:
   a. Invasion of the lamina propria
   b. Invasion of the muscularis mucosae
   c. Invasion of the submucosa
   d. Invasion of the muscularis propria
   e. Invasion of the prostate

Answer 9

D

Question 10

10. Which is considered a premalignant lesion in the prostate?
    a. High grade prostatic intraepithelial neoplasia
    b. Postatrophic hyperplasia
    c. High grade preinvasive neoplasm
    d. Nephrogenic metaplasia
    e. Columnar change

Answer 10

A

Question 11

11. Which is not a typical morphological feature of balanitis xerotica obliterans?
    a. Orthokeratotic hyperkeratosis
    b. Atrophy of the epidermis
    c. Homogenization of collagen in the upper dermis
    d. Interstitial hemorrhage and hemosiderin deposition
    e. Lymphoplasmacytic lichenoid inflammatory infiltrate

Answer 11

D

Question 12

12. Which stain is typically negative in classic seminoma?
    a. Cytokeratin (AE1/AE3)
    b. Placental alkaline phosphatase (PLAP)
    c. OCT 4
    d. C-kit
    e. Periodic acid-Shiff (PAS)

Answer 12

A

Question 13

13. What is the common genetic alteration seen in testicular germ cell tumors in adulthood?
    a. t(11;22)
    b. Loss of 3p
    c. Isochromosome 12p
    d. t(X;11)
    e. Gain of 13q

Answer 13

C

Question 14

14. Which condition is not associated with renal cell carcinoma?
    a. Birt-Hogg-Dubé syndrome
    b. Autosomal dominant polycystic kidney disease
    c. Tuberous sclerosis
    d. Von-Hippel-Lindau disease
    e. End stage renal disease

Answer 14

B

Question 15

15. What is the T stage of a renal cell carcinoma that shows direct growth into the ipsilateral adrenal gland?
    a. pT2c
    b. pT3a
    c. pT3b
    d. pT3c
    e. pT4

Answer 15

E

Question 16

16. What is the characteristic morphological finding in malakoplakia?
    a. Cytoplasmic lipid
    b. Weibel-Palade bodies
    c. Michaelis-Guttmann bodies
    d. Asteroid bodies
    e. Giant mitochondria

Answer 16

C

Question 17

17. Patients with which variant of urothelial carcinoma listed below have the best prognosis?
    a. Sarcomatoid urothelial carcinoma
    b. Urothelial carcinoma with syncytiotrophoblasts
    c. Micropapillary urothelial carcinoma
    d. Nested urothelial carcinoma
    e. Mixed urothelial and small cell carcinoma

Answer 17

B

Question 18

18. What is the pT stage of a prostatic adenocarcinoma that invades the base of the seminal vesicle?
    a. pT2c
    b. pT3a
    c. pT3b
    d. pT3c
    e. pT4

Answer 18

C

Question 19

19. Which of the following patterns is not a description of Gleason pattern 4?
    a. Cribriform glands with central necrosis
    b. Chains of glands floating in lakes of mucin
    c. Glandular structures showing glomerulations
    d. Chains of fused glandular structures
    e. Poorly formed small glandular structures

Answer 19

A

Question 20

20. Which is not a mimic of invasive prostatic adenocarcinoma?
    a. Glandular atrophy
    b. Atypical adenomatous hyperplasia
    c. Cowper glands
    d. Granulomatous prostatitis
    e. Corpora amylacea

Answer 20

E

Question 21

21. Which entity is not associated with intratubular germ cell neoplasia?
    a. Cryptorchidism
    b. Postpubertal mature teratoma
    c. Embryonal carcinoma
    d. Spermatocytic seminoma
    e. Mixed germ cell tumors

Answer 21

D

Question 22

22. On smear preparations received with male fertility biopsy specimens, which 2 patterns would you expect to show spermatozoa?
    a. Germ cell maturation arrest and hypospermatogenesis
    b. Sertoli cell only and germ cell maturation arrest
    c. Hypospermatogenesis and obstruction of sperm excretory ducts
    d. Testicular atrophy and Sertoli cell only
    e. Obstruction of sperm excretory ducts and Sertoli cell only with immature Sertoli cells

Answer 22

C

Question 23

23. Which is not a pattern seen in urothelial carcinoma in situ?
    a. Clinging/denuding pattern
    b. Small cell pattern
    c. Pagetoid pattern
    d. Undermining pattern
    e. Microcystic pattern

Answer 23

E

Question 24

24. Which is the most common genetic alteration in clear cell renal cell carcinoma?
    a. Loss of 3p
    b. Isochromosome 12p
    c. t(X;11)
    d. Gain of 13q
    e. t(11;22)

Answer 24

A

Question 25

25. Which of the following entities does not typically present with nephrotic syndrome?
    a. Minimal change disease
    b. Focal segmental glomerulosclerosis
    c. Membranous glomerulopathy
    d. Thin basement membrane disease
    e. Membranoproliferative glomerulonephritis

Answer 25

D

Question 26

26. Which of the following is associated with fibrin and platelet thrombi within glomeruli?
    a. Alport syndrome
    b. Hemolytic uremic syndrome
    c. Immunotactoid glomerulopathy
    d. Acute interstitial nephritis
    e. Acute tubular necrosis

Answer 26

B

Question 27

27. Which of the following is true regarding immunostaining patterns in testicular neoplasms?
    a. CD117 stains embryonal carcinoma
    b. OCT 3/4 is positive in teratoma
    c. Glypican 3 highlights yolk sac tumor
    d. EMA stains all types of germ cell tumors
    e. Classic seminoma is positive for CD20

Answer 27

C

Question 28

28. In addition to clear cell renal cell carcinoma, von Hippel-Lindau (VHL) syndrome is also associated with which of the following?
    a. Renal cysts
    b. Adrenal pheochromocytoma
    c. Clear cell pancreatic neuroendocrine neoplasm (PEN)
    d. Papillary cystadenoma of epididymis or broad ligament
    e. All of the above

Answer 28

E

Question 29

29. Which of the following is involved in von Hippel-Lindau syndrome?
    a. Hamartin
    b. Hypoxia inducible factor
    c. Folliculin
    d. Merlin
    e. Tuberin

Answer 29

B

Question 30

30. Inverted urothelial carcinoma of the renal pelvis is associated with which of the following?
    a. Lynch syndrome
    b. Tuberous sclerosis
    c. Birt-Hogg-Dubé syndrome
    d. End stage of renal disease
    e. None of the above

Answer 30

A

Question 31

31. Sickle cell trait is associated with which of the following?
    a. Wilms tumor
    b. Oncocytoma
    c. Clear cell tubulopapillary renal cell carcinoma
    d. Renal medullary carcinoma
    e. None of the above

Answer 31

D

Question 32

32. List the common causes of acute tubular necrosis (ATN).

Answer 32

• Ischemia due to shock or inadequate blood flow.
• Nephrotoxicity due to drugs/medications (e.g., gentamicin, radiographic contrast, heavy metal, organic solvants) or endogenous elements (e.g., myoglobin, hemoglobin, monoclonal light chains, bile/bilirubin).
• Combined causes (e.g., hemolytic crisis with hemoglobinuria or skeletal muscle injury with myoglobinuria).

Question 33

33. Describe characteristic histology of renal toxicity caused by mercuric chloride, carbon tetrachloride, and ethylene glycol.

Answer 33

• Mercuric chloride: severely injured tubular cells containing large acidophilic inclusions.
• Carbon tetrachloride: accumulation of neutral lipids in injured tubular cells.
• Ethylene glycol: hydropic degeneration of proximal convoluted tubular epithelium; ptesence of calcium oxalate crystals.

Question 34

34. Discuss the pathogenesis of nephrogenic adenoma.

Answer 34

• Recent evidence from renal transplant patients suggests that this lesion is derived from renal tubular epithelial cells, and is not a metaplastic lesion.
• It is associated with:
  
  • Calculi.
  • Instrumentation of, or trauma to, the genitourinary tract.
  • Cystitis.

Question 35

35. List the histopathological features of nephrogenic adenoma.

Answer 35

• Tubular (most common), cystic, polypoid, and papillary patterns.
• Cuboidal to low columnar epithelium with scant cytoplasm (occasionally clear cytoplasm); hobnail cells (common).
• Hyalin around tubules in basement membrane (possible).

Question 36

36. Name the anatomic sites where nephrogenic adenoma may be found.

Answer 36

• Urinary bladder.
• Ureter.
• Urethra.
• Renal pelvis.

Question 37

37. List the stains that will help differentiate nephrogenic adenoma from prostatic adenocarcinoma.

Answer 37

Question 38

38. List 3 types of metaplasia seen in the urinary bladder and describe their significance.

Answer 38

• Intestinal metaplasia in cystitis glandularis and cystitis cystica:
  
  • Intestinal metaplasia without dysplasia has no risk of adenocarcinoma.
  • Intestinal metaplasia with dysplasia has increased risk of concurrent or subsequent carcinoma
• Squamous metaplasia:
  
  • Nonkeratinizing squamous metaplasia is usually not associated with increased risk of squamous cell carcinoma. It is commonly seen in the female trigon region.
  • Keratinizing squamous metaplasia is a risk factor for squamous cell carcinoma.
• Nephrogenic metaplasia/adenoma:
  
  • This is a benign lesion. When the tubular component of nephrogenic adenoma involves the superficial muscularis propria, it could be misinterpreted as a malignant process.

Question 39

39. Describe the typical clinical presentation of idiopathic membranous glomerulonephritis.

Answer 39

• Nephrotic syndrome characterized by:
  *