LECTURE - Genitourinary Histology Flashcards
kidney functions
- excretion of wastes/toxins => urine
- balance of fluid volumes/osmolality
- acid-base balance and electrolyte balance
functional unit of the kidney
nephron
renal corpuscle (nephron)
glomerulus and Bowman’s capsule
> filtration
renal tubules (nephron)
absorption
T or F. There are no glomeruli in the medulla
T
Proximal tubules
- abundant eosinophilic cytoplasm (bright pink)
- brush border which increases SA to aid with absorption
Distal tubules
- less cytoplasm, less eosinophilic
- no brush border = smaller role in absorption
most common malignant kidney tumour
clear cell renal carcinoma
- look golden-yellow grossly
- tumour cells have clear cytoplasm,with lots of vessels around them
urothelium lines…
- renal pelvis
- ureters
- bladder
- urethra (except very distal portion = squamous)
big clue to prostate cancer
small, rigid cancerous glands infiltrate within larger benign glands
these produce androgens in the males or testosterone
Leydig cells
vast majority of penile cancers arise from…
glans or foreskin
both the glans and foreskin are lined by this epithelium
stratified squamous
vast majority of penile cancers are …
squamous cell carcinoma
kidney parenchyma is divided into:
renal cortex
- contains all four components
> proxximal tubules => distal tubules
renal medulla
- no glomeruli
- distal tubules/collecting ducts only
glomerulus
- network of small blood vessels in which filtration occurs
- blood enters through afferent arteriole (unfiltered blood)
- blood exits through efferent arteriole (filtered blood)
- filtrate enters Bowman’s capsule => proximal tubule
capillary loops
- in glomerulus
- network of blood vessels
- lined by endothelial cells
podocytes
- in glomerulus
- contain foot processes + filtration slits
- visceral epithelial cells
blood pathway in glomerulus
blood filters through endothelial cell -> glomerular basement membrane -> podocyte
space between capillary loops
mesangium
mesangium
contains mesangial cells
- provide support for glomerulus
disease of kidney vessels
vasculitides
kidney disease is often secondary to a
systemic disease
- diabetes, hypertension, systemic lupus erythematosus
kidney disease due to high BP
hypertensive nephrosclerosis
major cause of end-stage renal disease
hypertensive nephrosclerosis
In this pathology, kidney surfaces are no longer smooth=> granular
hypertensive nephrosclerosis
T or F. there is no mass or tumour in hypertensive nephrosclerosis
T! a non-neoplastic disease
- blood vessels get bigger/hicker
- glomeruli die due to lack of oxygen/blood -> glomerulosclerosis
renal pelvis
- dilated portion of ureter
- renal parenchyma leads into the renal pelvis
ureter
conduit for urine from renal pelvis -> bladder
bladder
storage space for urine until micturition
- facilitated by the detrusor muscle
urethra
- conduit or urine from bladder
- different segments
- pre-prostatic
- prostatic
- membranous
- penile (spongy)
T or F. All of urinary tract is lined by same epithelium
T! urothelium (EXCEPT very distal portions = squamous)
three cell types in the urotheium
- umbrella cells: single layer, large and eosinopilic, can be multinucleated
- intermediate cells: columnar cells
- basal cells: small, cuboidal, flat; overlies basement membrane -> lamina propria
this muscle is in the bladder
detrusor
this muscle is in the bladder
detrusor
layers of bladder ( as well as renal pelvis, ureter, urethra)
- urothelium
- lamina propria
- muscularis mucosa
- muscularis propria (detrusor)
- adventitia/serosal fat
T or F. There is no submucosa in the bladder
T
T or F. deeper invasion in the bladder = higher cancer stage
T
describe the muscularis mucosa of the bladder
thin, wispy, discontinuous bundles of smooth muscle within lamina propria
describe muscularis propria (detrusor muscle)
thick, tightly paccked, continuous bundles of smooth muscle
bladder cancer invading into this layer will mean removing the bladder (cystectomy)
muscularis propria
relaxed urothelium
5-7 cell layers thick
stretched urothelium
2-3 cell layers thick
atypical cells
larger, darker, irregular nuclei, prominent nucleoli
pleomorphic cells
cells/nuclei of varying sizes and shapes amongst each other
cancer
atypical cells
pleomorphic cells
cells are disorganized
most common type of cancer in the renal pelvis, ureter, bladder, and urethra
urotelial carcinoma
- tends to ‘skip’ along the urothelial tract
two patterns of urotheial carcinoma
flat vs. papillary
cancer is forming “finger-like” projections around a fibrovascular core
papillary urothelial carcinoma
parts of the prostate
- base: superiors; sits under the bladder neck
- apex: inferor
- bilateral seminal vesicles: extends superior-posterior to prostate
- prostatic urethra: courses along prostate (base -> apex)
different prostate pathologies can arise from different zones
- cancer = perioheral zone
- benign prostatic hyperplasia = transition zone
where does prostate cancer originate from
peripheral zone
- may be palpable on digital rectal exam
benign prostatic hyperplasia
transition zone; lower urinary tract symptoms
central zone cancer
prostate
area containing ejaculatory ducts
- merges with vas deferens => urethra
prostate gland histology
- prostate glands (acini): secretes postatic fluid which is alkaline and helps neutralize the acidic vaginal cavity
- prostate stroma: collagenous fibrous tissue + smooth muscle
describe benign prostate glands
- undulating contour
- tend to be larger than cancer glands
- consists of two layers
> secretory: small round nuclei, cannot see nucleoli; lots of pale, clear cytoplasm
> basal: flatter cells, can be hard to see on standard H+E, may even need to stain them with specific proteins to highlight them
describe what benign prostate hyperplasia looks like
- large nodules of proliferative flands => benign glands
- compresses on urethra => produces lower urinary tract symptoms (difficulty voiding, dribbling, nocturia)
prostate cancer histology (benign)
- small, rigid cancerous glands infiltrate within larger being glands
- different patterns of prosyaye cancer => Gleason patterns
> corresponds to different grades or aggressiveness of the cancer
malignant prostate cancer histology
- smaller rigid glands
- nuclei are larger and cytoplasm is less
> cancer glands have increased N:C ratio - glands have only one cell layer = basal cell layer is lost; may be hard to appreciate on H+E
- nucleoli are prominent
immunohistochemistry on prostate
- AMACR = red stain that highlights cancer
- brown stain = p40 + HMWK = highlights basal cell layer = not cancer
- all three stains together = PIN cocktail
seminal vesicle histology
- all consits of glands and stroma
> secretes fluid which forms the bulk of semen - fluid is main energy source for sperm
- normal cells look “ugly” = pleomorphic and atypical
> lipofuscin pigment can help distinguish - there are no real pathologies intrinsic to the seminal vesicle
> however, prostate cancer can spread to seminal vesicle
> increases cancer stage
male gonads
testes
function of testes
prodction of sperm and androgens (testosterone)
path that sperm travels
seminiferous tubules -> Rete testes -> ductuli efferentes -> epididymis -> vas deferens -> ejaculatory duct -> urethra
spermatic cord
vas deferens, testicular artery, papmpiniform plexus (veins), nerves, muscle (cremasteric)
each testis is surrounded by …
tunica albuginea (inner layer) tunica vaginalis (outer layer)
where is sperm produced?
semineferous tubules
- process of spermatogenesis
Sertoli cells
provide support during spermatogenesis
epididymis epithelium
PSEUDOSTRATIFIED CILIATED
this helps propel the sperm out
epididymis
path of sperm in epididymis
from ductuli efferentes to head to body to tail to vas deferens
this has thick bundles of smooth muscle which helps squeeze sperm upwards towards ejaculatory duct
vas deferens
Leydig cells
- located in the interstitium (space bw semineferous tubules)
- have bright pink (eosinophilic) cytoplasm
- produces androgens (testosterone)
most common testicular tumor
pure seminoma
- equivalent to dysgerminoma of the ovary
- part of the family of germ cell tumors
- seminoma + embryonal carcinoma + yolk sac tumor + choriocarcinoma + teratoma + fixed GCTs
penile urethra
- involved in voiding of urine and ejaculation of sperm
- surrounded by corpus spongiosum
what is the corpus cavernosum?
- spongy tissue which engorges with blood to initiate erection
- engorged tissue compresses veins to maintain erection
- bundles of smooth muscle + fibrous + network of vessels
vast majority of penile cancers arise fro
glans or foreskin
what epithelium are both the glans and foreskin lined by
stratified squamous epithelium
glans penis
- straitfied squamous epithelium = may have a layer of keratin
- does not have adnexal structures = no sebaceous glands, hair follicles
foreskin
- stratified squamous epithelium (epidermis)
- does have adnexal structures
vast majority of penile cancers are
squamous cell carcinoma
T or F. cancers tend to arise from the type of epithelium that is intrinsic to that organ
T
initiation and maintenance of erection
corpus cavernosum
