Histopathology - Urological Pathology Flashcards by Annie Rees

Where are renal stones found and formed?

Formed in renal collecting ducts
Can be deposited anywhere in tract

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What is the Male:Female prevalence of renal stones?

3:1 incidence

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What are the 3 main types of stones and their features?

CALCIUM OXALATE (75%)
- Too much calcium absorbed from gut
- Intrinsic renal probems: imapired calcium absorption from proximal tubule

Magnesium Ammonium Phosphate (15%)
- Triple stones
- Commonly due to urease producing organisms which alkanise urine promoting precipitation of magnesium ammonium phosphate salts
- Often form “STAGHORN CALCULI” = large + painful

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

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What are some common points of impacting of renal stones?

Pelvi-ureteric junction
Pelvic brim
Vesico-ureteric junction

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What is the management for renal stones?

Small stones = pass spontaneously
Large stones = Removal via endoscopic/percutaneous methods / lithotripsy

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What is benign prostatic hyperplasia?

Dihydrotestosterone-mediated hyperplasia of prostatic stromal + epithelial cells, resulting in formation of large nodules

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What complication can arise from benign prostatic hyperplasia and why?

Outflow tract obstruction
Nodule formation compresses prostatic urethra

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What are som symptoms of benign prostatic hyperplasia?

Difficulty urinating
Retention
Frequency
Nocturia
Overflow dribbling

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What is seen on histology for benign prostatic hyperplasia?

Nodule formation
Prostatic epithelial ducts with duct spaces

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What is the treatment for benign prostatic hyperplasia?

TURP
5α reductase inhibitors (e.g. finasteride)

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What is the most common type of prostate cancer and which age group is it most prominent in?

Adenocarcinoma
> 50yrs

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Where does prostate cancer arise?

From precursor lesion PIN (prostatic intraepithelial neoplasia) in peripheral area of gland

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What are some RFs for developing prostate cancer?

Age
Race
FHx
Hormonal + environmental influences

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Where can prostate cancer spread to?

Local spread to bladder
Haematogenous spread to bone

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What is the grading system used for prostate cancer and how does it work?

Gleason System
- Based on degree of differentiation + glandular patterns
- 1-5 based on differentiation (5 = worst least differentiated + most aggressive)
- 1-5 based on classification of most common pattern seen + worst pattern seen
- Add numbers together = /10

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What are the most common types of testicular tumours and which age group are they predominantly seen in?

Germ cell tumours (arising from germ cells in testes)
Males 20-45yrs

What is the prevalence of mldescent of testis, where is it seen and what is the increased risk of testicular cancer as a result?

1% of males
90-95% in inguinal canal
10x increase risk

Where do testicular cancers arise from

Precursor lesion = intratubular germ cell neoplasia

What are some features of a seminoma?

Most common type of germinal tumour
Peak age = 30s
Radiosensitive

What are some features of a teratoma?

Occur at any age (from infancy to adult life)
Malignant IF in post-pubertal male
Chemosensitive

What are some biological markers for germ cell testicular tumours?

What are the different types of a germinal testicular tumour?

Seminoma
Spermatocytic seminoma
Teratoma
Embryonal carcinoma (resembles embryonic tissue)
Yolk sac tumour
Choriocarcinoma

What are some clinical features of a testicular tumour?

Painless enlargement (lump)

What percentage of testicular tumours are of germ cell origin, and what are non-germ cell?

95% = germ cell
5% = non germ cell

What are some types of non-germ cell testicular tumours?

- Leydig cell tumour (derived from stroma) - Sertoli cell tumour (derived from sex cord)

What are some predisposing factors to a germ cell testicular tumour?

- Cryptorchidism - Testicular dysgenesis - Genetic factors (e.g. Klinefelter's) - Testicular feminisation

What are three types of beningn renal tumours?

- Papillary adenoma - Oncocytoma - Angiomyolipoma

What are some features of a papillary adenoma (benign renal tumour) + what is seen on its histology?

- Renal EPITHELIAL tumour, with PAPILLARY architecture - Often incidental - <15mm Histo: - Bland epithelial cells growing in a papillary or tubopapillary pattern - Well circumscribed cortical nodules

What are some features of an oncocytoma (benign renal tumour) + what is seen on its histology?

- Oncocytic renal epithelial neoplasm - Often incidental Histo: - Macroscopic = mahogany brown - Microscopic = sheets of oncolytic cells, pink cytoplasm, form nests of cells

What are some features of an angiomyolipoma (benign renal tumour) + what is seen on its histology?

- MESENCHYMAL tumour composed of fat, bloods, vessels + muscle Histo: - Fat spaces - Thick blood vessels - Spindle cell components

What are three types of malignant renal tumours?

- Renal cell carcinoma - Nephroblastoma/Wilm's tumour - Transitional cell carcinoma

What are some features and RFs of a renal cell carcinoma?

- Most common - Epithelial tumour - Presents with PAINLESS HAEMATURIA RFs: - Smoking - HTN - Obesity - Long-term dialysis - Genetics (Von Hippel Lindau syndrome)

What are some features of a nephroblastoma (Wilm's tumour)?

- Childhood renal neoplasm - Presents as abdominal mass - 2nd most common childhood malignancy

What are some features of a transitional cell carcinoma (malignant renal tumour)?

- Epithelial neoplasm arising from urothelial tract - Most commonly in bladder - A/w: Smoking - Presents with PAINLESS HAEMATURIA

What is seen on histology of a renal cell carcnoma?

Clear Cell (70%): - Macroscopic = golden yellow with haemorrhagic areas - Microscopic = nests of epithelium with clear cytoplasm Papillary (15%): - Macroscopic = fragile, friable brown tumour - Microscopic = Papillary/tubopapillary growth pattern (>15mm) Chromophobe (5%): - Macroscopic = well circumscribed, solid brown tumour - Microscopic = sheets of large cells, distinct cell borders

What is seen on histology of a nephroblastoma (Wilm's tumour)?

Microscopic: - Small round blue cells (very undifferentiated) - Epithelial component - cells trying to differentiate + form primitive renal tubules

What is seen on histology of a transitinoal cell carcinoma?

Non-invasive papillary: - Urothelial carcinoma - Frond like growths projecting from bladder wall, often multifocal - Microscopic: papillary fronds lined by urothelium - Can be low grade or high grade Invasive urothelial carcinoma: - Tumour with invasive behaviour - Usually grow as solid masses - Fixed to tissue

What are the three types of bladder tumours and their features?

Transitional Celll (Urothelial) Tumours: - 90% of all bladder tumours - M:F = 3:1 - 80% occur between 50-80yrs Squamous Cell Carcinoma: - More frequent in countries with endemic urinary schistosomiasis Adenocarcinoma: - Rare - Arising from extensive intestinal metaplasia or from urachal remnant