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YEAR 5: HISTOPATH > Histo: Urology > Flashcards

Histo: Urology Flashcards

1
Q

What are urinary calculi?

A

Crystal aggregates in the renal collecting ducts.

NOTE: lifetime incidence of 15%

can form ANYWHERE in urinary tract

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2
Q

List the three main types of urinary tract calculi in order of prevalence.

A
  • Calcium oxalate (Weddelite) - 75%
  • Magnesium ammonium phosphate (Struvite) - 15%
  • Urate - 5%
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3
Q

List some underlying conditions that can lead to the formation of calcium oxalate stones.

A
  • Absorptive hypercalciuria - excessive calcium absorption from the gut
  • Renal hypercalciuria - impaired absorption of calcium in the proximal renal tubule
  • Hypercalcaemia (e.g. hyperparathyroidism) - rare
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4
Q

Describe how magensium ammonium phosphate (Struvite) stones are formed.

A
  • Results from infection by a urease-producing organism (e.g. Proteus)
  • Ammonia produced by the bacteria alkalinises the urine leading to precipitation of magnesium ammonium phosphate stones
  • They can become large (e.g. staghorn calculi)
  • NOTE: they are also called triple stones
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5
Q

Which patients are predisposed to the formation of urate stones?

A

Hyperuriciaemia:
* Gout
* Rapid cell turnover (e.g. chemotherapy)

NOTE: however, most patients with urate stones will not have these risk factors

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6
Q

Where do urinary calculi stones tend to get stuck within the urinary tract?

A
  • Pelvic-ureteric junction
  • Pelvic brim
  • Vesico-ureteric junction

if small –> asymptomatic –> just stay in kidney kidney

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7
Q

What are the consequences of large stones within the urinary tract?

A
  • Obstruction
  • Risk of infection
  • CKD
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8
Q

List three types of benign renal neoplasm.

A
  • Papillary adenoma
  • Renal oncocytoma
  • Angiomyolipoma
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9
Q

Define papillary adenoma.

A
  • Benign epithelial kidney tumour composed of papillae and/or tubules
  • They must be <15 mm in size
  • They tend to be well circumscribed
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10
Q

What are the genetic associations of papillary adenomas?

A
  • Trisomy 7 and 17
  • Loss of Y chromosome
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11
Q

What is a renal oncocytoma?

A
  • Benign epithelial kidney tumour composed of oncocytic cells
  • They are usually well-circumscribed and usually sporadic

NOTE: often an incidental finding

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12
Q

Name a syndrome that is associated with renal oncocytoma.

A

Birt-Hogg-Dubé syndrome

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13
Q

Describe the histological appearance of oncocytes.

A

Large cells with pink granular cytoplasm and a prominent nucleolus

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14
Q

What is an angiomyolipoma?

A
  • Benign mesenchymal kidney tumour composed of thick-walled blood vessels, smooth muscle and fat
  • Derived from perivascular epitheloid cells

NOTE: often an incidental finding but may cause flank pain, haemorrhage and shock (if >4cm)

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15
Q

Which hereditary condition is associated with angiomyolipoma?

A

Tuberous sclerosis

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16
Q

list some risk factors for renal cell carcinoma.

A
  • Smoking
  • Hypertension
  • Obesity
  • Long-term dialysis
  • Genetic (e.g. von Hippel Lindau)
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17
Q

How does renal cell carcinoma tend to present?

A
  • Painless haematuria
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18
Q

Name the subtypes of renal cell carcinoma in order of prevalence.

A
  • Clear cell renal carcinoma (70%)
  • Papillary renal cell carcinoma (15%)
  • Chromophobe renal cell carcinoma (5%)
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19
Q

Define clear cell renal carcinoma.

A
  • Epithelial kidney tumour composed of nests of clear cells set in a delicate capillary vascular netwrok
  • Grossly apears golden-yellow with haemorrhagic areas
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20
Q

What is a common genetic finding in clear cell renal carcinoma?

A

Loss of chromosome 3p

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21
Q

Define papillary renal cell carcinoma.

A
  • Epithelial kidney tumour composed of papillae and/or tubules
  • By definition >15mm in size

NOTE: this is the malignant counter part of papillary adenoma. They appear grossly as a fragile, friable brown tumour

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22
Q

Genetic finding in papillary renal cell carcinoma

A

trisomy 7, trisomy 17, loss of Y chromosome

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23
Q

Describe the histological appearance of the two types of papillary renal cell carcinoma.

A
  • Type 1: composed of a single layer of small and flat cells. You see a lot of islands of cells.
  • Type 2: there is stratification (multi-layering) of the cells

NOTE: type 2 tends to have a worse prognosis than type 1

24
Q

Define chromophobe renal cell carcinoma.

A
  • Epithelial kidney tumour composed of sheets of large cells that display distince cell borders, reticular cytoplasm and a thick-walled vascular network

NOTE: grossly appears as a well-circumscribed solid brown tumour

can look similar to oncocytoma

25
Q

Describe the histological appearance of chromophobe renal cell carcinoma.

A

Sharply defined cell borders and a thick vascular network

26
Q

What is the 5-year survival for renal cell carcinoma?

A

60% across all types

27
Q

What grading system is used for clear cell and papillary renal cell carcinoma?

A

ISUP Nuclear Grade

28
Q

What risk progression index is used for clear cell carcinoma?

A

Leibovich risk model

29
Q

What is Nephroblastoma (Wilm’s tumour)?

A

Malignant triphasic kidney tumour of childhood:

  • Blastema (small round blue cells)
  • Epithelial
  • Stromal

Typically present with an abdominal mass in children aged 2-5 years

NOTE: 95% have an excellent prognosis

2nd most common childhood malignancy

30
Q

What are the major risk factors for urothelial carcinoma?

A

Smoking

Aromatic amines

31
Q

What are the three main subtypes of urothelial carcinoma?

A
  • Non-invasive papillary urothelial carcinoma
  • Infiltrating urothelial carcinoma
  • Flat urothelial carcinoma in situ
32
Q

Describe the macroscopic appearance of non-invasive papillary urothelial carcinoma.

A
  • Appears as frond-like growths
  • Can be divided into low or high grade dependent on nuclear atypia

low-grade –> low-risk progression

high-grade –> high-risk progression

NOTE: high grade tumours have many genetic aberrations (e.g. RB, TB53)

33
Q

Describe the histological appearance of invasive urothelial carcinoma.

A
  • This is urothelial tumour that has started showing invasive behaviour
  • Once urothelial cells to invade, the morphology becomes very diverse (e.g. squamous, adenocarcinoma, sarcoma etc.)

NOTE: treatment is based on the depth of invasion: lamina propria, muscularis propria

34
Q

What is flat urothelial carcinoma in situ?

A

High grade lesion in situ (may progress to become invasive)

35
Q

Define benign prostatic hyperplasia.

A

Benign enlargement of the prostate gland as a consequence of increased cell number

36
Q

What is a possible mechanism for the onset of BPH?

A

Increased oestrogen with ageing induces androgen receptors and stimulates hyperplasia

37
Q

List some treatment options for BPH.

A
  • 5alpha-reductase inhibitors
  • Alpha-blockers
  • TURP
38
Q

How can BPH present?

A
  • LUTS (most common) - frequency, urgency, nocturia, hesitance, poor flow, terminal dribbling
  • UTI
  • Acute urinary retention
  • Renal failure
39
Q

What is the most common malignant tumour in men?

A

Prostate cancer

40
Q

What is the precancerous lesion that prostate cancer arises from?

A

Prostatic intraepithelial neoplasia

41
Q

List some mutations that are implicated in prostate cancer.

A
  • PTEN
  • AMACR
  • P27
  • GST-pi
42
Q

What scoring system is used for prostate cancer? Explain how it is calculated.

A

Gleason score

  • Expressed as x + y = z
  • Calculated by adding the top two most common patterns/grades seen on histological grading
  • Higher scores are associated with poorer prognosis
43
Q

List some risk factors for testicular germ cell tumours.

A
  • Undescended testicles
  • Low birth weight
44
Q

What is the pre-malignant lesion associated with testicular germ cell tumours?

A

Germ cell neoplasia in situ

NOTE: this process probably begins in foetal life

testicular germ cell is most common testicular tumour

45
Q

Which genetic factor is associated with testicular germ cell tumours?

A

Amplification of i12p

46
Q

List the five histological subtypes of testicular germ cell tumours.

A
  • Seminoma - most common malignant
  • Embryonal carcinoma
  • Post-pubertal teratoma
  • Yolk sac tumour
  • Choriocarcinoma
47
Q

Describe the histological appearance of:

  1. Seminoma
  2. Embryonal carcinoma
  3. Post-pubertal teratoma
  4. Yolk sac tumour
  5. Choriocarcinoma
A
  1. Seminoma
    • Mostly made up of clear cells with a prominent lymphocytic infiltrate
  2. Embryonal carcinoma
    • High-grade appearance with prominent nucleoli
  3. Post-pubertal teratoma
    • The tumour is trying to produce a variety of tissues (e.g. keratin, cartilage, glands)
    • This is malignant - any component of the tumour can become malignant
  4. Yolk sac tumour
    • Smaller cells
    • Lace-like pattern
    • Some pink inclusions
  5. Choriocarcinoma
    • Made up of two cell types: cytotrophoblasts (clear looking cells) and syncytiotrophoblasts (multinucleated cell)
    • NOTE: both components are needed to define choriocarcinoma
48
Q

How are testicular germ cell tumours treated?

A

They are highly sensitive to platinum-based chemotherapy

5-year survival: 98%

49
Q

Name three types of testicular non-germ cell tumours.

A
  • Lymphoma - more in older men, poor prognosis
  • Leydig cell tumour - may cause precocious puberty (if pre-pubertal)
  • Sertoli cell tumour - 90% benign
50
Q

What are the causes of epididymitis?

A
  • <35 years = N. gonorrhoea and C. trachomatis
  • 35+ years = E. coli
51
Q

List and describe some diseases paratesticular diseases.

A

Epididymal cyst
Epididymitis
Varicocele - Dilated venous plexus
Hydrocele - Fluid between layers of tunica vaginalis
Adenomatoid Tumour - Small tubules lined by mesothelial cells

52
Q

Where is the fluid in hydrocele

A

between layers of tunica vaginalis

53
Q

What is an adenomatoid tumour?

A

Benign tumour consisting of small tubules lined by mesothelial cells

54
Q

List some types of benign penile diseases.

A
  • Lichen sclerosus/balanitis xerotica obliterans - inflammatory condition that causes phimosis
  • Zoon’s balanitis - inflammatory condition that causes red areas
  • Condylomas - HPV6 and 11
  • Peyronie’s disease - scarring, inflammation and thickening of the corpus cavernosa
55
Q

List some risk factors for penile carcinoma.

A
  • HPV
  • Smoking
  • Lichen sclerosus
56
Q

List and describe some benign diseases of the urethra.

A
  • Urethritis - N.gonorrhea, C.trachomatis
  • Prostatic urethral polyp - papillary lesion in the prostatic urethra
  • Urethral caruncle - common lesion at the urethral meatus in women

NOTE: malignant diseases include urethral carcinoma (squamous cell carcinoma) and malignant melanoma

57
Q

List and describe some diseases of the scrotum.

A
  • Epidermoid cyst (common)
  • Scrotal calcinosis
  • Angiokeratomas (benign vascular lesions)
  • Fournier’s gangrene - necrotising fasciitis of the scrotum and perineu,
  • Scrotal squamous cell carcinoma

YEAR 5: HISTOPATH (20 decks)

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