Histopathology - Urological Pathology Flashcards
Where are renal stones found and formed?
- Formed in renal collecting ducts
- Can be deposited anywhere in tract
What is the Male:Female prevalence of renal stones?
3:1 incidence
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)
What are some common points of impacting of renal stones?
- Pelvi-ureteric junction
- Pelvic brim
- Vesico-ureteric junction
What is the management for renal stones?
- Small stones = pass spontaneously
- Large stones = Removal via endoscopic/percutaneous methods / lithotripsy
What is benign prostatic hyperplasia?
Dihydrotestosterone-mediated hyperplasia of prostatic stromal + epithelial cells, resulting in formation of large nodules
What complication can arise from benign prostatic hyperplasia and why?
- Outflow tract obstruction
- Nodule formation compresses prostatic urethra
What are som symptoms of benign prostatic hyperplasia?
- Difficulty urinating
- Retention
- Frequency
- Nocturia
- Overflow dribbling
What is seen on histology for benign prostatic hyperplasia?
- Nodule formation
- Prostatic epithelial ducts with duct spaces
What is the treatment for benign prostatic hyperplasia?
- TURP
- 5α reductase inhibitors (e.g. finasteride)
What is the most common type of prostate cancer and which age group is it most prominent in?
- Adenocarcinoma
- > 50yrs
Where does prostate cancer arise?
- From precursor lesion PIN (prostatic intraepithelial neoplasia) in peripheral area of gland
What are some RFs for developing prostate cancer?
- Age
- Race
- FHx
- Hormonal + environmental influences
Where can prostate cancer spread to?
- Local spread to bladder
- Haematogenous spread to bone
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
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?
- AFP
- HCG
- LDH
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
