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Pathology (Guide) > Histopathology - Urological Pathology > Flashcards

Histopathology - Urological Pathology Flashcards

1
Q

Where are renal stones found and formed?

A
  • Formed in renal collecting ducts
  • Can be deposited anywhere in tract
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2
Q

What is the Male:Female prevalence of renal stones?

A

3:1 incidence

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3
Q

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

A

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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4
Q

What are some common points of impacting of renal stones?

A
  • Pelvi-ureteric junction
  • Pelvic brim
  • Vesico-ureteric junction
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5
Q

What is the management for renal stones?

A
  • Small stones = pass spontaneously
  • Large stones = Removal via endoscopic/percutaneous methods / lithotripsy
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6
Q

What is benign prostatic hyperplasia?

A

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

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7
Q

What complication can arise from benign prostatic hyperplasia and why?

A
  • Outflow tract obstruction
  • Nodule formation compresses prostatic urethra
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8
Q

What are som symptoms of benign prostatic hyperplasia?

A
  • Difficulty urinating
  • Retention
  • Frequency
  • Nocturia
  • Overflow dribbling
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9
Q

What is seen on histology for benign prostatic hyperplasia?

A
  • Nodule formation
  • Prostatic epithelial ducts with duct spaces
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10
Q

What is the treatment for benign prostatic hyperplasia?

A
  • TURP
  • 5α reductase inhibitors (e.g. finasteride)
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11
Q

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

A
  • Adenocarcinoma
  • > 50yrs
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12
Q

Where does prostate cancer arise?

A
  • From precursor lesion PIN (prostatic intraepithelial neoplasia) in peripheral area of gland
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13
Q

What are some RFs for developing prostate cancer?

A
  • Age
  • Race
  • FHx
  • Hormonal + environmental influences
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14
Q

Where can prostate cancer spread to?

A
  • Local spread to bladder
  • Haematogenous spread to bone
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15
Q

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

A

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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16
Q

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

A
  • Germ cell tumours (arising from germ cells in testes)
  • Males 20-45yrs
17
Q

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

A
  • 1% of males
  • 90-95% in inguinal canal
  • 10x increase risk
18
Q

Where do testicular cancers arise from

A

Precursor lesion = intratubular germ cell neoplasia

19
Q

What are some features of a seminoma?

A
  • Most common type of germinal tumour
  • Peak age = 30s
  • Radiosensitive
20
Q

What are some features of a teratoma?

A
  • Occur at any age (from infancy to adult life)
  • Malignant IF in post-pubertal male
  • Chemosensitive
21
Q

What are some biological markers for germ cell testicular tumours?

A
  • AFP
  • HCG
  • LDH
22
Q

What are the different types of a germinal testicular tumour?

A
  • Seminoma
  • Spermatocytic seminoma
  • Teratoma
  • Embryonal carcinoma (resembles embryonic tissue)
  • Yolk sac tumour
  • Choriocarcinoma
23
Q

What are some clinical features of a testicular tumour?

A
  • Painless enlargement (lump)
24
Q

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

A

95% = germ cell
5% = non germ cell

25
Q

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

A
  • Leydig cell tumour (derived from stroma)
  • Sertoli cell tumour (derived from sex cord)
26
Q

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

A
  • Cryptorchidism
  • Testicular dysgenesis
  • Genetic factors (e.g. Klinefelter’s)
  • Testicular feminisation
27
Q

What are three types of beningn renal tumours?

A
  • Papillary adenoma
  • Oncocytoma
  • Angiomyolipoma
28
Q

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

A
  • Renal EPITHELIAL tumour, with PAPILLARY architecture
  • Often incidental
  • <15mm

Histo:
- Bland epithelial cells growing in a papillary or tubopapillary pattern
- Well circumscribed cortical nodules

29
Q

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

A
  • Oncocytic renal epithelial neoplasm
  • Often incidental

Histo:
- Macroscopic = mahogany brown
- Microscopic = sheets of oncolytic cells, pink cytoplasm, form nests of cells

30
Q

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

A
  • MESENCHYMAL tumour composed of fat, bloods, vessels + muscle

Histo:
- Fat spaces
- Thick blood vessels
- Spindle cell components

31
Q

What are three types of malignant renal tumours?

A
  • Renal cell carcinoma
  • Nephroblastoma/Wilm’s tumour
  • Transitional cell carcinoma
32
Q

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

A
  • Most common
  • Epithelial tumour
  • Presents with PAINLESS HAEMATURIA

RFs:
- Smoking
- HTN
- Obesity
- Long-term dialysis
- Genetics (Von Hippel Lindau syndrome)

33
Q

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

A
  • Childhood renal neoplasm
  • Presents as abdominal mass
  • 2nd most common childhood malignancy
34
Q

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

A
  • Epithelial neoplasm arising from urothelial tract
  • Most commonly in bladder
  • A/w: Smoking
  • Presents with PAINLESS HAEMATURIA
35
Q

What is seen on histology of a renal cell carcnoma?

A

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

36
Q

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

A

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

37
Q

What is seen on histology of a transitinoal cell carcinoma?

A

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

38
Q

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

A

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

Pathology (Guide) (84 decks)

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