Histo: Urology (Phyllis' Version)

Question 1

Common points of urological stones?

Answer 1

Vesico-ureteric junction, pelvic brim, pelvi-ureteric junction

Question 2

3 main types of stones, how common, and pathophysiology?

Answer 2

Calcium oxalate (75%)
- too much calcium absorption from gut

Magnesium Ammonium Phosphate (15%)
- often form staghorn calculi

Uric Acid (5%)
- patients with hyperuricaemia (gout/rapid cell turnover)

Question 3

Method of removal of large stone?

Answer 3

Endoscopic or percut methods or using lithotripsy

Question 4

Histology of BPH & management?

Answer 4

Nodule formation, increased stromal and epithelial cells

Management TURP or 5alpha reductase inhibitors

Question 5

Prostate cancer - type, grading (+ how does it work) and tumour marker

Answer 5

Adenocarcinoma

Grading by gleason system
- 1-5 where 5 is least differentiated and most aggressive
- take 2 biopsies and add the numbers together
- e.g. 5 + 2 = 7

PSA

Question 6

Describe the classification of testicular tumours + prognosis

Answer 6

Germ cell or non-germ cell

GERM CELL (95%) - better prognosis
- Seminoma, yolk sac tumour, choriocarcinoma, teratoma

NON-GERM CELL (5%) - worse prognosis
- leydig cell tumour, sertoli cell tumour

Question 7

Tumour markers for teratoma

Answer 7

AFP, HCG, LDH

Question 8

Predisposing factors to testicular tumours

Answer 8

Cryptorchidism, testicular dysgenesis, Kleinfelters

Question 9

Give me 3 benign renal tumours and how to differentiate between them

Answer 9

Papilliary Adenoma
- most common
- epithelial tumour with papillary architecture

Oncocytoma
- macroscopically mahogany brown
- nests of cells microscopically

Angiomyolipoma
- mesenchymal tumour composed of fat, blood vessels and muscle

Question 10

Tell me the three differentials for malignant renal tumours? What are they associated with/how common are they?

Answer 10

Renal cell carcinoma (most common in general)

Nephroblastoma/Wilm’s tumour (most common in children)

Transitional Cell carcinoma (most commonly associated with smokers)

Question 11

Classify renal cell carcinomas for me and how common each subtype is?
+ what does RCC generally present with

Answer 11

Presents with painless haematuria

Clear cell (70%)
Papillary (15%)
Chromophobe (5%)

Question 12

Histological apperanace of nephroblastoma?

Answer 12

Small round blue cells (very undifferentiated)

+ Primitive renal tubules (Cells trying to differentiate and form new tubules)

Question 13

Classification of bladder tumours and how common are they?

Answer 13

Transitional cell (urothelial) (80%)

Squamous cell carcinoma
- more frequent in endemic schistosomiasis

Adenocarcinoma
- rare

Question 14

What infection predisposes to squamous cell carcinoma of the bladder

Answer 14

schistosomiasis