MOD Flashcards
ARPKD (AR Polycystic kidney disease)
mutation, appearance, results
Genetically enlarged kidneys with cysts due to PKHD1 mutation on 6p
(gross- holes, histo- large clear spaces)
Causes oligohydramnios (poor kidney fxn so no urine), small lungs bc kidneys enlarged and lack of amniotic fluid, and hepatic fibrosis
ADPKD (AD Polycystic kidney disease)
Mutations in PKD1 (or2), shows at 40-50 yr, assoc w liver cysts and berry aneurysms
- gross- v large kidney with multiple cysts, hemosiderin macros
- HTN and hematuria (due to cyst rupture)
MCDKD (Multicystic Dysplastic kidney disease)
Cystic kidney in children
histo-primitive looking ducts, ltos of blue cells with no glom, gross- dark colored cysts
Chronic polynephritis (leading to Hydronephrosis)
Chronic inflam causing scarred renal cortex, fibrosis, and tubular atrophy, can cause overall sclerosis
-histo: lots of purple dots (chronic inflam), lots of plain pink areas from scarring
Reflux nephropathy
Chronic obstructive polynephritis
Reflux- early childhood due to vesicouretral valve issue causing urine backflow into ureter
Obstructive Polynephritis- adults due to kidneys stones
Acute polynephritis
Hallmark: neutrophils in tubule
Can be from ascending or descending infxn, eg recurring UTI/flank pain/fever
-histo: small black dots that are neutrophils
Ascending vs Descending/hematogenous infxn causes
asc- UTI causing bacteria (E colis, Proteus; affects segments in wedge shape)
Hem-Staph or E coli (small scattered abcesses)
Allergic interstitial nephritis
Xanthogrnulomatous polynephritis
Malakoplakia
- allergic interstitial nephritis- interstitial inflam w eosinophils (from drugs/antibios)
- xantho- chronic pylenonephritis variant with xanthogranulomas made of foamy histiocytes/macros), assoc with nephrolith and obstruction
- malako- chronic gran disorder that affects bladder or kidneys, usu from gram neg orgs (e coli, proteus, kleb) from lysosomal killing, may have cytoplasmic inclusions (michaelis gutnam bodies) that stain positive for Ca (kossa +) and iron
Renal stones types
Calcium oxalate most common in youngish men
Cystine stones (cystinuria)
Struvite stones (women w UTI, aka staghorn calc assoc with proteus)
Uric acid stones-men, from gout or chemo
What can urinary tract obstruction lead to?
infection and inflam of the kidney
Differential Dx of Hematuria chart
RBC- tumor (image kidney then bladder, then urine cytology)
RBC/pain- stones/lithiasis (image)
RBC/WBC- infxn (culture)
RBC/protein- glom disease (renal biopsy) (can have RBC casts or dysmorphic RBCs)
Papillary Urothelial carcinoma (low grade)
thicc urothelial layer, loss of umbrella layer, RBCs (hematuria), this carcinoma could occur in usu bladder/ureter/renal pelvis
-histo: large irreg hyperchrom cells
Bladder carcinoma specifically
- Urothelial carcinoma w detrusor mm invasion (variable px)
- sx are hematuria
- histo: papillary fronds, pleomorphic nuclei/mitotic figures, nests of invading tumor cells
Risk factors for bladder cancers
smoking, exposure to aromatic amines, schistosoma infxn (this infxn can lead to squamous cell tumors)
Clear cell renal cell carcinoma (RCC)
- sx: asymp, hematuria
- mutation: VHL tsg loss of 3p short arm
- gross- tumor has GOLDEN YELLOW APPEARANCE in cortex (hallmark)
- histo- CLEAR CELLS in cluster (w small round nuclei), ARBORIZING vasc, CHICKEN WIRE appearance
- risks: smoking, arsenic exposure, obesity/DM
What main sx do renal and urinary tract tumors produce?
asymptomatic hematuria
Wilm’s tumor (nephroblastoma)
Common kidney tumor in kids with sx of distended abdomen
gross- area of necrosis with soft tan tumor, histo–more blue, cellular, and hyperchromatic
5 prostate zones
1) Peripheral (adenocarcinomas)
2) Transitional (BPH)
3) Peri-urethral (BPH))
4) Central zone
5) Anterior zone
Prostatitis types
Inflammation of prostate
Acute bacterial- mostly E coli (or staph or enterococcus from lower UTI), dysuria/fever, chills/perineal pain, tender boggy prostate, ltos of neutros and WBCs
Chronic bacterial- men with reinfxn of UTIs
Nonbacterial chronic prostatitis- common, all ages, mostly sexually active men, neg bacterial cultures (or diffcult to culture microbes), can mimic prostatic carcinoma
-Granulomatous prostatitis- vague sx, need histo for dx, can be necro or non-necro grans, can be secodnary to prev surgical procedure etc, can mimic prost carcin
BPH (w/ Nodular Hyperplasia)
enlargement of prostate secondary to gland/stromal prolif
- benign, musc hypertrophy occludes urethra
- can cause acute urinary retention–MEDICAL EMERGENCY (need catheter, presents as nocturia, dribbling etc)
- can cause severe chronic urinary obstruction- bladder hypertrophy, cystitis, hydroureter/nephrosis, bladder diverticuli etc
Tx for BPH
Finasterid (a 5-alpha reductase inhib), or alpha blockers, resection etc
Prostatic adenocarcinoma
elderly males, usually in PERIPHERAL zone
- some can be from genetics eg 1q24 or X linked, maybe androgens, NOT smoking
- histo-small lil glands with loss of basal cell layer, ONLY ONE LAYER of epith lining in tumor, eosiniphilic crystalline/blue mucin/prom nucleoli
- usu perineal invasion
- often assoc with PIN (prostatic intraepith neoplasia)
Where are prostatic adenocarcinomas vs BPH located
adeno- PERIPH
BPH- transitional and peri-urethral
Tx for adenocarcinoma of prostate
radiation, srugery, hormone tx
What converts Testosterone to DHT?
5-alpha-reductase in stromal cell cytoplasm
(If absence, have pseudohermaphroditism)
DHT binds to andro receptors in glandular epith, signals GFs to prolif prostate etc
4 types of prostatitis
Acute bacterial
Chronic bacterial
Nonbacterial chronic
Granulmatous
Acute bacterial prostatitis
caused mostly by E COLI (also staph and enterococc from lower UTI)
-sx: dysuria, fever, perineal pain, soft/boggy/tender prostate, w/ lots of neutros and WBCs in secretions
Chronic bacterial prostatitis
- seen in men who get re-infected with lower UTI
- sx: dysuria, pelvic discomfort, low back pain
- histo: infiltrates, lymphos, macros, neutros
Nonbacterial chronic prostatitis
Most common, all ages but mostly sexually active men
-neg bacterial cultures, but could be bacteria that dont culture easily
Granulomatous prostatitis
V vague sx, need histo to dx, can be necro or non necro
- secondary to stromal infiltration of prostatic secr
- can mimic prost carcinoma
- not caused by microbes
BPH (Nodular Hyperplasia)
- what is it
- risks
- gross/histo
- sx
- chronic/acute
- elevations
- tx
- enlargement of prostate from prolif of glands and stroma, age-related, can obstruct urine flow, in transitional and periurethral zone
- DHT binds to andro receptors causing hyperplastic nodules (estros in aging can incr sensitivity to DHT)
- gross: nodular with narrowed urethra, gray-white rubbery tan tissue, may exude fluid, sometimes cna have lithiasis in nodules (calculi), histo: hyperplastic glands sep by hyperplas stroma, papillary hyperplasia of epith, chronic inflam
- sx: urinary hes, nocturia, freq, dribbling, difficulty stopping urination
- acute complete obstruction–acute urinary retention; chronic: bladder hypertrophy/cystitis/bladder diverticuli/hydroureter/neph (swelling), pyelonephritis
- slightly elevated PSA
- tx: 5-a-reductase inhibs
Finesteride
Blocks conversion of Test to DHT
takes months, can be used for baldness, sxe: gynecomastia and ED [Pathoma]
Adenocarcinoma of the Prostate Risks Gross/histo Grading/staging Sx Process Tx
Tumor in peripheral zone of prostate
- risks: AA, andros, (alcs have REDUCED risk bc reduced Test), early sexual with multiple partners, fat, urban, less sunlight, (NOT smoking)
- gross: hard to see bc in periph, firm yellow; histo: tubular complex glands with cribiform patterns, lined by SINGLE layer, prom nucleoli, cystalloids, and blue mucin, with peri neural invasion
- grading: Gleason based on arcitechture, 5 is poorly diff, staging is based on metastases (stage IV is to other organs, stage III is thru prostate capsule)
- sx: often incidental, firm nodule on prostate, bladder obstruction, bone pain/anemia if METASTATIC, (rare may be coagulopathies like thrombosis/endocarditis)
- process: slow, extends thru prostate, then sem vesicles, then to lymph nodes and to bone and lung, spread to lumbar spine/pelvis common (osteoblastic)
- Tx: local-prostatectomy, advanced-hormone suppression
Tumor markers for adenocarcinoma of prostate
Elevated PSA
Decreased free PSA (bc cancer produces BOUND PSA)
Elevated PAP (also other diseases)
PIN
Prostatic INtraepithelial Neoplasia
- Precursor to malignant prostate tumor, elev in cancer
- histo: cell crowding, nuclear enlargement/hyperchromasia/stratification, enlarged nucleoli, intact BM
What (chemicals) can protect vs increase risk of adenocarc
Vitamin A protecc
Cadmium can incr risk
Dx early stage adenocar
rectal exam, ultrasound/biopsy, PSA lvl
What is a paraneoplastic sydnrome?
syndrome that is a consequence of cancer
