Histopathology 9 - Urological pathology

Question 1

What is the most common composition of urinary calculi?

Answer 1

Calcium oxalate

Question 2

What is the most likely cause of calcium oxalate urinary calculi?

Answer 2

Hypercalciuria
Either due to excessive Ca absorption from gut or impaired absorption in nephron (intrinsic renal problems)

Question 3

What are magnesium ammonium phosphate urinary calculi also known as?

Answer 3

Triple stones

Question 4

What is the cause of triple stones?

Answer 4

A consequence of infection with urease-producing organisms
Urease –> ammonia increase
Ammonia makes urine alkaline –> triple stone precipitation

Question 5

Why might a small urinary stone become symptomatic?

Answer 5

If it gets out of kidney and gets into the ureter - it will cause colic at any point where the ureter bends

Question 6

What type of urinary calculi are caused by gout?

Answer 6

Uric acid stones

Question 7

What is papillary adenoma of the kidney?

Answer 7

Benign epithelial kidney tumour composed of papillae and/or tubules
ALWAYS 15MM OR LESS IN SIZE

Question 8

What is a renal oncocytoma?

Answer 8

Benign epithelial kidney tumour composed of oncocytic cells

Question 9

What syndrome should be considered in a patient with many renal oncocytomas?

Answer 9

Birt-Hogg-Dubé syndrome

Question 10

What is an angiomyolipoma?

Answer 10

Benign mesenchymal kidney tumour composed of thick-walled blood vessels, smooth muscle and fat

Question 11

In what condition are angiomyolipomas most likely to appear?

Answer 11

Tuberous sclerosis

Question 12

What is a renal cell carcinoma?

Answer 12

Malignancy of epithelial cells of proximal convuluted tubule

Question 13

What is the main symptom of renal cell carcinoma?

Answer 13

Painless haematuria

Question 14

What is the most common subtype of renal cell carcinoma?

Answer 14

Clear cell renal cell carcinoma

(other types = papillary cell + chromophone)

Question 15

What is the genetic association of clear cell carcinoma?

Answer 15

Loss of chromosome 3p

Question 16

What is Nephroblastoma also known as?

Answer 16

Wilm’s tumour

Question 17

What is nephroblastoma?

Answer 17

Triphasic kidney tumour of childhood

Question 18

How does nephroblastoma typically present?

Answer 18

Abdominal mass in children aged 2-5

Question 19

What is the new name for transitional cell carcinoma?

Answer 19

Urothelial carcinoma

Question 20

What are the 2 main treatments of BPH?

Answer 20

5 alpha reductase inhibitors
Alpha blockers

Question 21

What score is used for prostatic adenocarcinoma?

Answer 21

Gleason score

Question 22

What is the most common type of testicular tumour?

Answer 22

90% = germ cell

Question 23

Recall 2 risk factors for testicular germ cell tumours

Answer 23

Undescended testes
Low birth weight

Question 24

What are the histological subtypes of germ cell testicular tumour?

Answer 24

Seminoma
Embryonal carcinoma
Post-pubertal teratoma
Yolk Sac Tumour

Question 25

What is the most useful form of chemo in germ cell testicular tumours?

Answer 25

Platinum based

Question 26

What are the 3 subtypes of non-germ cell testicular tumours?

Answer 26

Lymphoma Leydig cell Sertoli cell

Question 27

Which type of testicular tumour can present with precocious puberty?

Answer 27

Leydig cell

Question 28

What is flat urothelial carcinoma in situ?

Answer 28

Very high grade lesion with high risk of progression

Question 29

Which testicular germ cell tumour has clear polygonal cells and a lymohcytic inflitrate?

Answer 29

Seminoma \*\*equivalent of dysgerminoma in females\*\*

Question 30

Which type of urinary stone is most likely to develop into a massive "staghorn calculus"?

Answer 30

Triple stone

Question 31

What is the typical histological appearance of non-invasive papillary urothelial carcinoma?

Answer 31

Frond-like growths

Question 32

What is the typical histological appearance of a seminoma?

Answer 32

Clear polygonal cells and lymphocytic infiltrate

Question 33

Where in the kidneys do renal stones form?

Answer 33

Collecting ducts

Question 35

What type of stone does magneisum ammonium phosphate stone form?

Answer 35

Staghorn calculus - large and painful

Question 36

Common points of impaction of renal stones

Answer 36

PUJ

Question 38

Histology of BPH

Question 39

Treatment of BPH

Question 40

Most common cause of prostate cancer in men over 50y

Answer 40

Adenocarcinoma

Question 41

Precursor lesion of prostate cancer

Answer 41

Prostatic intraepithelial neoplasia

Question 43

Which zone of the gland does prostate cancer arise in?

Answer 43

Peripheral zone

Question 44

PSA that diagnoses prostate cancer

Answer 44

\>4ng/ml

Question 45

Most common tumour of the testes

Answer 45

Germ cell tumours

Question 46

Examples of germ cell tumours of testes

Answer 46

Seminoma Spermatocytic seminoma Embryonal carcinoma Yolk sac tumour Choriocarcinoma Teratoma

Question 47

Predisposing factors of germ cell tummours

Answer 47

Cryptorchidism, testicular dysgenesis, genetic factors e.g. Kleinfelters, testicular feminisation

Question 48

Example of non germ cell tumour

Answer 48

Leydig cell tumour Sertoli cell tumour

Question 49

Examples of benign renal tumours

Answer 49

Papillary adneoma Oncocytoma Angiomyolipoma

Question 50

What is papillary adenoma

Answer 50

Renal epithelial tumour with papillary architecture \<5mm

Question 51

Answer 51

Renal papillary adenoma

Question 52

Compare the benign renal tumours

Answer 52

Question 53

3 types of malignant renal tumours

Answer 53

Renal cell carcinoma Nephroblastoma Transitional cell carcinoma

Question 54

Most common malignant epithelial tumour

Question 55

RF for renal cell carcinoma

Answer 55

Smoking, HTN, obesity, long-term dialysis

Question 56

what's the 2nd most common childhood malignancy?

Answer 56

Nephroblastoma

Question 57

Most common location of transitional cell carcinoma

Answer 57

Bladder

Question 58

3 types of renal cell carcinoma

Answer 58

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

Question 59

Histology of clear cell renal cell carcinoma

Answer 59

Macro- Golden yellow iwth haemorrhagic areas Micro- nests of epithelium with clear cytoplasm

Question 60

Papillary: histology

Answer 60

Macroscopic: friable brown tumour Micro- paipllary/tubulopaipllary growth pattern \>5mm

Question 61

Chromophobe tumour: histological appearance

Answer 61

Macro- solid brown tumour Micro- sheets of large cells, distinct cell borders

Question 62

Nephroblastoma histology

Answer 62

Micro- small round blue cells, epithelial component - cells trying to differentiate and form primitive renal tubules

Question 63

Two types of transitional cell carcinoma

Answer 63

**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

Question 64

Most common bladder tumour

Answer 64

Urothelial (transitional cell)

Question 65

RF for squamous cell carcinoma of bladder

Answer 65

Schistosomiasis