Histopathology 4 - Urology

Question 1

Renal stones - are men or women more commonly affected?

Answer 1

Men (3x)

Question 2

What can renal stones be composed of?

Answer 2

Calcium oxalate
Magnesium ammonium phosphate (struvite)
Uric acid

Question 3

Most common renal stone

Answer 3

Calcium oxalate

Question 4

What are “triple stones” and what is the danger of them?

Answer 4

Magnesium ammonium phosphate (Struvite) - can form stag horn calculi

Question 5

Main cause of calcium oxalate stones

Answer 5

Hypercalciuria

Question 6

2 causes of hypercalciuria?

Answer 6

Excessive GI absorption or renal hypercalciuria due to impaired absorption of calcium in renal PCT

Question 7

main cause of triple stones?

Answer 7

UTI with ammonia producing organisms e.g proteus sp.

Question 8

MAin causes of uric acid stones

Answer 8

DUe to hyperuricaemia e.g. gout, rapid turnover of cells from chemo

Question 9

Common points of renal stone impaction

Answer 9

PUJ, VUJ, pelvic brim

Question 10

Name 3 benign renal neoplasms

Answer 10

papillary adenoma, renal oncocytoma, angiomyolipoma

Question 11

Benign kidney tumour associated with tuberous sclerosis

Answer 11

Angiomyolipoma

Question 12

Benign kidney tumour associated with high fat content

Answer 12

Angiomyolipoma

Question 13

Cell type in papillary adenoma and renal oncocytoma?

Answer 13

Renal epithelial cell

Question 14

Cell type in angiomyolipoma?

Answer 14

Mesenchymal cell

Question 15

Size of papillary adenoma by definition

Answer 15

<15mm, if > then malignant PRCC

Question 16

Genetic syndrome associated with RCC

Answer 16

von Hipper Lindau

Question 17

Major RFs for RCC

Answer 17

Smoking, long term dialysis

Question 18

3 main histological subtypes of RCC

Answer 18

Clear cell, papillary rCC, chromophobe

Question 19

Genetic change in clear cell RCC

Answer 19

Loss of chromosome 3p

Question 20

Golden yellow tumours with haemorrhage areas

Answer 20

Clear cell RCC

Question 21

RCC associated with long term dialysis

Answer 21

Papillary RCC

Question 22

Genetic change seen in papillary RCC

Answer 22

Trisomy 7 and trisomy 17

Question 23

Difference in appearance between papillary RCC and chromophobe

Answer 23

Papillary = friable and brown
Chromophobe = solid and brown

Question 24

Small round blue cells

Answer 24

Wilm’s tumour/nephroblastoma

Question 25

Most common presentation of Wilm's tumour

Answer 25

Abdominal mass

Question 26

What is a urothelial carcinoma?

Answer 26

Any neoplasm affecting renal pelvis --> bladder

Question 27

Most common risk factors for urothelial cancers? Most common presenting feature?

Answer 27

Smoking and aromatic amines | Painless haematuria

Question 28

3 main subtypes of urothelial cancer

Answer 28

Non invasive papillary urothelial carcinoma (Ni PUC) Invasive papillary urothelial carcinoma (IPUC) Flat urothelial carcinoma in situ (FUC IT)

Question 29

How does NIPUC present on histology?

Answer 29

Frond-like (lead-like) growths

Question 30

2 main medication options for BPH

Answer 30

5a reductase inhibitors e.g. finasteride and alpha blockers e.g. tamsulosin

Question 31

Surgical mx of BPH

Answer 31

Transurethral resection of the prostate

Question 32

Most common cancer in men

Answer 32

Prostate cancer

Question 33

Prostate cancer associations

Answer 33

Red meat, FHx

Question 34

Prostate adenocarcinoma precursor lesion

Answer 34

prostate intraepithelial neoplasia

Question 35

Common mutations in prostate cancer

Answer 35

PTEN, GST-pi, p27

Question 36

Most powerful prognostic indicator in prostate Ca

Answer 36

Gleason score

Question 37

How is Gleason score calculated?

Answer 37

Adding together the two most common patterns/grades on histological grading

Question 38

Which type of testicular tumours most common?

Answer 38

Germ cell tumours

Question 39

3 types of non-germ cell testicular tumours

Answer 39

Leydig cell tumours Sertoli cell tumours Lymphoma

Question 40

RFs for testicular germ cell tumours

Answer 40

Undescended testis, LBW/SGA

Question 41

Most common testicular germ cell carcinoma

Answer 41

Seminoma

Question 42

Five histological subtypes of germ cell testicular cancers

Answer 42

``` Seminoma Embryonal carcinoma Post-pubertal teratoma Yolk sac tumour Choriocarcinoma ```

Question 43

Best mx for germ cell testicular cancers, good prognosis?

Answer 43

Respond v well to platinum based chemotherapy

Question 44

Testicular lymphoma prognosis

Answer 44

v aggressive, older men, poor survival

Question 45

Leydig cell tumour presentation

Answer 45

Could present with precocious puberty, usually benign

Question 46

Sertoli cell tumours benign or malignant?

Answer 46

90% benign

Question 47

Causative organism of epididymitis <35 and >35

Answer 47

<35: C.trachomatis, N.gonorrhoea | >35 E.coli

Question 48

Where do epidermoid cysts occur?

Answer 48

Scrotum

Question 49

Fournier's gangrene, where? what is it?

Answer 49

Scrotum, necrotising fasciitis

Question 50

Condylomas?

Answer 50

Warts on the penis caused by HPV 6 and 11

Question 51

Inflammatory condition of penis causing phimosis

Answer 51

Lichen sclerosis/ balanitis xerotica obliterans

Question 52

What is Peyronie's disease?

Answer 52

scarring, inflammation and thickening of the corpus cavernosa + upward curvature of penis

Question 53

Scrotal squamous cell carcinoma - importance?

Answer 53

Associated with occupational exposure to carcinogens, classically CHIMMNEY SWEEPERS