Histopathology 9 - Urological pathology Flashcards
What is the most common composition of urinary calculi?
Calcium oxalate
What is the most likely cause of calcium oxalate urinary calculi?
Hypercalciuria
Either due to excessive Ca absorption from gut or impaired absorption in nephron (intrinsic renal problems)
What are magnesium ammonium phosphate urinary calculi also known as?
Triple stones
What is the cause of triple stones?
A consequence of infection with urease-producing organisms
Urease –> ammonia increase
Ammonia makes urine alkaline –> triple stone precipitation
Why might a small urinary stone become symptomatic?
If it gets out of kidney and gets into the ureter - it will cause colic at any point where the ureter bends
What type of urinary calculi are caused by gout?
Uric acid stones
What is papillary adenoma of the kidney?
Benign epithelial kidney tumour composed of papillae and/or tubules
ALWAYS 15MM OR LESS IN SIZE
What is a renal oncocytoma?
Benign epithelial kidney tumour composed of oncocytic cells
What syndrome should be considered in a patient with many renal oncocytomas?
Birt-Hogg-Dubé syndrome
What is an angiomyolipoma?
Benign mesenchymal kidney tumour composed of thick-walled blood vessels, smooth muscle and fat
In what condition are angiomyolipomas most likely to appear?
Tuberous sclerosis
What is a renal cell carcinoma?
Malignancy of epithelial cells of proximal convuluted tubule
What is the main symptom of renal cell carcinoma?
Painless haematuria
What is the most common subtype of renal cell carcinoma?
Clear cell renal cell carcinoma
(other types = papillary cell + chromophone)
What is the genetic association of clear cell carcinoma?
Loss of chromosome 3p
What is Nephroblastoma also known as?
Wilm’s tumour
What is nephroblastoma?
Triphasic kidney tumour of childhood
How does nephroblastoma typically present?
Abdominal mass in children aged 2-5
What is the new name for transitional cell carcinoma?
Urothelial carcinoma
What are the 2 main treatments of BPH?
5 alpha reductase inhibitors
Alpha blockers
What score is used for prostatic adenocarcinoma?
Gleason score
What is the most common type of testicular tumour?
90% = germ cell
Recall 2 risk factors for testicular germ cell tumours
Undescended testes
Low birth weight
What are the histological subtypes of germ cell testicular tumour?
Seminoma
Embryonal carcinoma
Post-pubertal teratoma
Yolk Sac Tumour
What is the most useful form of chemo in germ cell testicular tumours?
Platinum based
What are the 3 subtypes of non-germ cell testicular tumours?
Lymphoma
Leydig cell
Sertoli cell
Which type of testicular tumour can present with precocious puberty?
Leydig cell
What is flat urothelial carcinoma in situ?
Very high grade lesion with high risk of progression
Which testicular germ cell tumour has clear polygonal cells and a lymohcytic inflitrate?
Seminoma
**equivalent of dysgerminoma in females**
Which type of urinary stone is most likely to develop into a massive “staghorn calculus”?
Triple stone
What is the typical histological appearance of non-invasive papillary urothelial carcinoma?
Frond-like growths
What is the typical histological appearance of a seminoma?
Clear polygonal cells and lymphocytic infiltrate
Where in the kidneys do renal stones form?
Collecting ducts
What type of stone does magneisum ammonium phosphate stone form?
Staghorn calculus - large and painful
Common points of impaction of renal stones
PUJ
Histology of BPH
Treatment of BPH
Most common cause of prostate cancer in men over 50y
Adenocarcinoma
Precursor lesion of prostate cancer
Prostatic intraepithelial neoplasia
Which zone of the gland does prostate cancer arise in?
Peripheral zone
PSA that diagnoses prostate cancer
>4ng/ml
Most common tumour of the testes
Germ cell tumours
Examples of germ cell tumours of testes
Seminoma
Spermatocytic seminoma
Embryonal carcinoma
Yolk sac tumour
Choriocarcinoma
Teratoma
Predisposing factors of germ cell tummours
Cryptorchidism, testicular dysgenesis,
genetic factors e.g. Kleinfelters, testicular feminisation
Example of non germ cell tumour
Leydig cell tumour
Sertoli cell tumour
Examples of benign renal tumours
Papillary adneoma
Oncocytoma
Angiomyolipoma
What is papillary adenoma
Renal epithelial tumour with papillary architecture
<5mm
Renal papillary adenoma
Compare the benign renal tumours
3 types of malignant renal tumours
Renal cell carcinoma
Nephroblastoma
Transitional cell carcinoma
Most common malignant epithelial tumour
RF for renal cell carcinoma
Smoking, HTN, obesity, long-term dialysis
what’s the 2nd most common childhood malignancy?
Nephroblastoma
Most common location of transitional cell carcinoma
Bladder
3 types of renal cell carcinoma
Clear cell (70%)
Papillary (15%)
Chromophobe (5%)
Histology of clear cell renal cell carcinoma
Macro- Golden yellow iwth haemorrhagic areas
Micro- nests of epithelium with clear cytoplasm
Papillary: histology
Macroscopic: friable brown tumour
Micro- paipllary/tubulopaipllary growth pattern >5mm
Chromophobe tumour: histological appearance
Macro- solid brown tumour
Micro- sheets of large cells, distinct cell borders
Nephroblastoma histology
Micro- small round blue cells, epithelial component - cells trying to differentiate and form primitive renal tubules
Two types of transitional cell carcinoma
a) non-invasive papillary
Frond like growths
projecting from bladder
wall, often multifocal
Microscopic – papilliary
fronds lined by urothelium
Can either be low grade
or high grade
b) invasive urothelial carcinoma
Tumour with invasive
behaviour. Usually grow
as solid masses, fixed to
tissue
Most common bladder tumour
Urothelial (transitional cell)
RF for squamous cell carcinoma of bladder
Schistosomiasis
