HISTOPATH Flashcards
softer and paler due to DYSTROPHIC CALCIFICATION
Calcium Phosphate Stones
Gross:
Pus and little microabscesses in the kidney; hyperemia and yellowish discoloration
Acute pyelonephritis
Thin-walled cystic structure; 15-20 cm diameter. Loss of pyramids. Thin cortex.
Far-advanced cases of obstruction; irreversible
VHL is a 1) and encodes protein for 2) complex which normally degrades and controls growth factors such as Hypoxia Inducing Factors (HIF-1)
1) tumor suppressor gene
2) ubiquitin ligase
Macrophage accumulation in cortex
Xanthogranulomatous Pyelonephritis:
Histology:
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placenta-like;
malignant 1) (well-demarcated cell borders,are not multinucleated and have smaller nuclei) and malignant 2) (mutlinucleated large cells)
1) cytotrophoblasts;
2) synctiotrophoblasts;
Choriocarcinoma
1) and 2) can NOT cause obstruction;
3) can as they are sloughed off and this obstruction would NOT be seen on X-ray
All three are complication of pyelonephritis
1) Perinephric abscess
2) pyonephrosis
3) papillary necrosis
Risk of SPONTANEOUS HEMORRHAGE
Angiomyolipoma
Grossly: yellow tumor w/ gelatinous center.
Renal Cell Carcinoma (RCC)
Outlines of tubules WITHOUT nuclei
Necrosis
Histology: clear cytoplasm in cells, arranged in nests.
Clear Cell Carcinoma:
Histology:
Atypical pleomorphic cells that surround a fibrovascular core
Papillary Carcinomas In-Situ:
A Cauliflower-like lesion on a freely movable stalk
Papillar transitional carcinoma; not invasive
Renal Oncoytoma–> Large eosinophilic cells;
Abundant 1) w/o 2)
(compare to Chromophobe RCC)
1) mitochondria
2) perinuclear clearing
Chromophobe has halo around nuclei;
Polysaccharide capsule => 70 serotypes
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Interferes with COMPLEMENT ACTIVATION
Klebsiella
Sclerosis in FSGS: EC collagen deposition in the 1) and 2)
mesangium and capillary loops
Mutation in 1) –>↑HIF-1 (transcription factor) which promotes cell growth (↑PDGF) and angiogenesis (↑VEGF).
VHL
Cystinuria decreased reabsorption of cystine and other dibasic amino acids (?)
lysine, ornithine, and arginine
Glomeruloid-like structures with BV in the center and epithelial cells around it.
Schiller Duval Bodies; seen in yolk sac tumor
Dominant-negative inactivating mutation of WT1 gene
Denys-Drash Syndrome:
Wilms tumor Histology:
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Triphasic combination of 1) + 2) + 3).
1) dense blue cells (blastema);
2) stroma 3) epithelial cell types (abortive tubules or glomeruli)
Papillary necrosis seen in 1) is which type of necrosis:
diabetics; coagulative;
Polyomavirus
H&E–>1)
EM–>2) .
nuclear enlargement and intranuclear inclusions;
2) cystalline-like lattices on EM
Milk-alkali syndrome–>those who take lots of antacids and drink milk
Hypercalcemia (and thus METASTATIC) leading to nephrocalcinosis
Macrophage accumulation surrounding struvite stones
Xanthogranulomatous Pyelonephritis
Easily palpable abdominal mass (visible), can cause intestinal obstruction
Wilms Tumor
Pyonephrosis vs. Perinephric abscess
Both are complications of acute pyelonephritis;
Pyonephrosis has acute inflammation but NOT encapsulated and confined to kidney
Perinephric abscess extends through the renal capsule into perinephric fat and encapsulated
TUBULAR effects first in hydronephrosis–> result 1)
1) impaired concentrating ability; dilute urine; no effect on GFR
ANP 1) sodium reabsorption so the kidney can eliminate sodium and decrease body volume
decreases
Post-obstructive diuresis–> sodium content?
Unilateral Obstruction–>HIGH NaCl in urine;
Histology: papillae lined by epithelial cells.
Papillary Renal Cell Carcinoma
“nodular accumulation of eosinophilic material within glomeruli
KW bodies seen in Diabetic nephropathy
Susceptible locus: chromosomes 1 and 10 (tumor suppressor gene)
Sporadic–>Hypermethylation of Glutathione S-transferase p1 (GSPT1), which is a known GENOME CARETAKER GENE
Men with BRCA2 gene mutation–> higher risk
Prostate Adenocarinoma
Tumor lysis syndrome-> causes what type of stone? is it increased in urine or serum?
Uric acid stone; uric acid increased in URINE;
Grossly:
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Large, tan and fleshy appearance w/ lots of cystic areas and areas of hemorrhage
Wilms Tumor
Neutrophilic microabcesses in renal interstitium
acute pyelonephritis
Hb A1c–>Glucose attached non-enzymatically to 1)
N-terminal amino acid
Beckwith-Wiedmann Syndrome:
Mutation in 1) –> loss 2) in maternal gene leading to 3) of IGF-2.
1) WT2 gene cluster 2) genomic imprinting 3) overexpression
Both are complications of 1);
Pyonephrosis has acute inflammation but NOT 2) and confined to kidney
Perinephric abscess extends through the renal capsule into 3) and encapsulated
1) acute pyelonephritis
2) encapsulated
3) perinephric fat
1) : homogenous and eosinophilic;
EM shows hyaline is EXTRACELLULAR and amorphous; due to plasma proteins insudated from the circulation into glomerular structures, usually a consequence of endothelial or capillary wall injury;
Hyalinosis seen in FSGS
Gram (-) bacillus.
True aerobe; polar flagella for motility;
Widespread in moist environments
Pseudomonas Aeruginosa
a) Sporadic form: Trisomy 7&17; loss of Y in males;
(b) Familial form: Trisomy 7.
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Both forms associated w/ activating mutations in MET.
Papillary Renal Cell Carcinoma (15% of RCC)
Gynecomastia and hyperthyroidism.
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Hemoptysis
Choriocarcinoma
macrophages with abundant pink cytoplasm, usually surrounded by giant cells and a rim of lymphocytes
Granuloma
Bladder cancer:
- Chromosome 9 deletions –> lose p16 (INK4a) or p15.
- P53 mutations;
what is p16? p15?
p16–>encodes inhibitor of a cyclin-dependent kinase
they are both tumor suppressor genes
Chonic pyelo histopath:
1) infiltration of interstitium;
Thyroidization which are 2) within 3);
4)
Lymphocyte;
2) eosinophilic hyaline casts
3) tubules
4) Fibrosis
Gleason Grading system used for 1_
Prostate cancer
Fibrosis surrounding dilated tubules with hyaline casts
Chronic pyelonephritis
Hylaine arteriolosclerosis seen in: 1)
KW bodies seen in:2)
1) afferent and efferent arterioles
2) glomeruli causing glomerusclerosis
Precursor lesion–>PIN
Prostatic Intraepithelial Neoplasia for prostate cancer
Hyperoxaluria—either hereditary (primary oxaluria) or acquired by intestinal overabsorption in pts w/ ___
GI diseases or in vegan diets.
hallmark of prostate CANCER histo
Prominent nucleoli;
Urate Nephropathy: 1) and 2) deposition of crystalline monosodium urate; seen grossly as 3) streaks in the 4)
Tubular and interstitial 3) YELLOW 4) PAPILLAE
Gross: Stones are smooth, hard, yellow and
Uric acid stone
Prostate adenocarcinoma
Susceptible locus: 1)
Sporadic–>2), which is a known GENOME CARETAKER GENE
Men with BRCA2 gene mutation–> higher risk
1) chromosomes 1 and 10 (tumor suppressor gene)
2) Hypermethylation of Glutathione S-transferase p1 (GSPT1)
Sheets/nests of separated by fibrous bands infiltrated by lymphocytes
Clear cytoplasm that contains glycogen.
Can often be stained immunologically by c-kit
Seminoma
Reinke crystals–. rod like cytoplasmic inclusions
Leydig Cell Tumor
Granulomatous Prostatitis–> Rxn following 1)
Transurethral resection (TUR) of prostate for nodular hyperplasia
H&E–>nuclear enlargement and intranuclear inclusions;
EM–>cystalline-like lattices on EM.
Polyoma virus; seen in Immunocompromised such as renal transplants; causes acute pyelonephritis, UTI
Germline deletion of WT1 (tumor suppressor gene) of 11p13—two-hit hypothesis
Wager Syndrome:
Mutation in ____; causes kidney stones due to hypercalciuria, aminoaciduria, and phosphaturia;
Dent’s Syndrome; chloride channels
Grossly
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Abnormal bumpy kidney shape; Scarring at upper and lower poles
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Fibrosis and loss of cortex
Chronic Pyelonephritis:
BPH vs. Prostate cancer histo
BPH has nodules; prostate cancer NO nodules;
Gouty tophus–>a focal accumulation of 1) surrounded by 2)
Urate crystals in the adrenal medulla w/ 3) around them.
4) around the crystals (host response).
urate crystals;
2) inflammatory cells (macrophages)
3) giant cells
4) fibrosis
A 17-year-old woman has a right flank mass which is draining thick yellow fluid.
You examine the fluid microscopically and see white pyramidal crystals
Xanthogranulomatous pyelonephritis; notice fistula; also struvite crystal (white pyramidal crystal)
A 55-year-old man with a long history of diabetes has proteinuria and decreased GFR. A renal biopsy shows pink nodules in his glomerui composed of:
Glycated proteins
Renal pelvis absesses and papillary necrosis caused by hyaline deposition in tubules;
Both complication of ?;
diabetic nephropthy
Angiomyolipoma
Due to loss of:
suppressor function of TSC1 or TSC2 genes
Histology: papillary fronds (can be low or high grade).
Urothelial Carcinoma: Renal Pelvis
EM of ____–>_____ of renal tubular epithelial cells contain abundant calcium deposits.
Nephrocalcinosis; MITOCHONDRIA
Cystoscope: cauliflower-like lesions.
Develops as low grade papillary tumor
Papillary Carcinomas In-Situ:
Hallmark: halos around the nuclei
Chromophobe RCC; remember it is malignant as oppsed to oncocytoma
Hydronephrosis Pathophysiology
the BACK PRESSURE leads to: Renal atrophy (more tubular) Decreased inner medullary blood flow.
Bladder cancer gross:
Gross:
Large fungating mass invading the muscle,
YELLOW amorphous necrosis
Renal atrophy (more tubular) Decreased inner medullary blood flow.
Hydronephrosis Pathophysiology
Calcification of the interstitium
metastatic nephrocalcinosis
Clinical Sign of Invasive Bladder Cancer
1)
Frequency, urgency, and dysuria
PAINLESS hematuria—unless there is obstruction
Wedge-shaped scars mixed w/ relatively normal renal tissue
Nephrocalcinosis
Papillary Renal Cell Carcinoma
a) Sporadic form: 1)
(b) Familial form: 2)
Both forms associated w/ 3) in MET.
Trisomy 7&17; loss of Y in males;
2) Trisomy 7
3) activating mutations
HALLMARK: CENTRAL SCAR; Tan/orange well-circumscribed tumor
Renal Oncoytoma
- Hereditary forms (mutations in podocyte genes) –> podocin, alpha-actinin-4, TRPC6
- Overwork/Stress: *mostly perihalar variant*
- Congenital: unilateral agenesis;
- Acquired: reflux nephropathy
- Obesity (not enough kidney to support the body weight).
- Reduced O2 in blood from Sickle Cell Disease, cyanotic congenital heart disease
FSGS
Hereditary forms (mutations in podocyte genes) podocin, alpha-actinin-4, TRPC6
Sporadic: Overwork/Stress such as obesity or sickle cell
Focal Segmental Glomerulosclerosis
Tubules have eosinophilic hyaline casts called thyroidization.
Chronic Pyelonephritis:
Lesions (hemartomas) composed of fat, smooth muscle and blood vessels.
Angiomyolipoma
unilateral agenesis of kidney can lead to
FSGS
- Chromosome 9 deletions –> lose tumor suppressor gene p16 (INK4a) or tumor suppressor gene p15.
- P53 mutations; normal function is to prevent apoptosis
•Genetic changes (mutations) in bladder cancer:
loss of sequence on short arm of chromosome 3 (where VHL is) and then second allele undergoes 1)
somatic mutation or hypermethylation;
regarding Renal Cell carcinoma
Large gram (-) bacilli
Produce BRICK RED COLONIES
Serratia
Seminoma
Sheets/nests of separated by fibrous bands infiltrated by 1)
2) cytoplasm that contains glycogen.
Can often be stained immunologically by 3)
1) lymphocytes; 2) Clear;
3) c-kit
Lancefield Group D strep, but more ovate than other streptococci
Enterococcus
changes in visceral epithelial cells: effacement of foot processes, vacuolization, retraction, and cell detachment from GBM
Focal Segmental Glomerulosclerosis
Both sporadic and familial RCC associated w/ LOSS of 1) on 2)
1) VHL gene
2) chromosome 3