Path IV - Finalz Flashcards
Light microscopy: nodular glomerulosclerosis
hyaline deposition in nodules within the glomeruli
Another name for nodular glomerulosclerosis in diabetic patients is __.
Kimmestiel-Wilson disease
Light microscopy: amyloidosis
pink/eosinophilic acellular material deposited in capillary walls -> obliteration of glomerular capillaries
affinity for Congo red dye
diffuse glomerulosclerosis
Light microscopy: post-infectious glomerulonephritis
increased cellularity
poorly defined capillary loops
Light microscopy: rapidly progressive glomerulonephritis
thickened “wire loops” of capillary loops
crescent formation composed of proliferating epithelial cells
What is the MC cause of chronic renal failure in the US?
diabetic nephropathy
Light microscopy: childhood PKD
large cysts lined with flattened cuboidal epithelium and intervening fibrotic parenchyma w/ bluish cartilage
Nephrotic vs Nephritic syndrome
proteinuria (> 3gm/24hrs)
hyperlipidemia
edema
hypoalbuminemia
hematuria RBC casts oliguria azotemia/uremia HTN minimal proteinuria
What is the MC cz of glomerulonephritis worldwide?
IgA nephropathy (Berger’s disease)
What is disease characterized by IgA over-secretion and vasculitis?
Henoch-Schonlein purpura
In patients with acute renal dz and hx of recent infx or new medication, suspect ___.
acute interstitial nephritis
Cystine stones
Assoc. w/ acidic urine
Assoc. w/ multiple stones
Assoc. w/ genetic dz (tf, more likely to be cz of stones in children)
Magnesium ammonium phosphate stones
Assoc. w/ UTIs dt urea-splitting bacteria (proteus)
Assoc. with increased urine pH (less acidic)
Assoc. w/ larger size (staghorn calculi)
What is the MC type of renal stone?
calcium oxalate 75%
triple phosphate 15%
uric acid 5-6%
cystine 1%
Embolization to the kidneys usually comes from ___
cardiac source (enlarged left atrium)
Most important non-cardiac source of renal emboli?
ruptured aortic atheromatous plaques
Histology: HUS
patchy / diffuse microangiopathy
capillary lumens oft. occluded
thickening of capillary walls
MC cz of acute renal failure in children (world)
HUS
Etiology: renal artery stenosis
Atherosclerosis
Fibromuscular dysplasia
Histology: malignant nephrosclerosis
onion-ring appearance of hyperplastic renal arteries
Histology: benign nephrosclerosis
hyaline arteriosclerosis
partial / total hyalinization of glomeruli and tubules
Morphology: benign nephrosclerosis
patchy ischemic atrophy within the kidney (focal loss of parenchyma)
granular appearance
Benign nephrosclerosis is often seen in what patient population?
diabetics w/ HTN (renal complication of HTN)
Histology: Fanconi’s syndrome
atrophic / hyalinized glomeruli, similar to that seen in end-stage kidney dz
Fanconi’s syndrome
dz of proximal renal tubules in which glucose, amino acids, uric acid, phosphate, and bicarbonate are passed into urine
loss of bicarbonate -> metabolic acidosis
loss of phosphate -> rickets
Findings: AIN
Histology: eosinophilia
UA: eosinophils
Acute interstitial nephritis (AIN)
acute renal failure MC dt allergic rxn to drugs or recent infection (2-40 days after exposure)
Histology: ischemic ATN
skip lesions through the tubules
Acute tubular necrosis (ATN)
proximal tubular epithelium necrosis
classified as either toxic or ischemic
common cz of acute renal failure (esp. toxic form)
Histology: Toxic ATN
absence of nuclei in tubular cells
homogenous eosinophilic cytoplasm
normal glomeruli
Labs: Wegener’s granulomatosis
C-ANCA positive serology
Histology: Wegener’s granulomatosis
crescentic glomerulonephritis
Histology: post-strep glomerulonephritis
PMN, mononuclear macrophages infiltration into glomeruli
Endothelial, mesangial proliferation
What is the MC cz of acute nephritic syndrome?
post-streptococcal (GABHS) glomerulonephritis
Renal adenomas are MC found where?
renal papillae
Histology: oncocytoma
Large, eosinophilic polygonal cells
Numerous prominent mitochondria
What is the MC 1˚ renal tumor in children?
Wilm’s tumor
Histology: Wilm’s tumor
nests / sheets of primitive cells
Histology: RCCA
neoplastic cells w/ clear cytoplasm arranged in nests w/ intervening blood vessels
What is the MC cz of hydronephrosis in infants and children?
ureteropelvic junction obstruction
Histology: Graves’ dz
hyperplastic epithelium w/ infoldings lined w/ columnar cells
clear vacuoles next to the epithelium
Toxic nodular goiter (Plummer’s dz)
thyroid gland containing autonomously functioning nodules -> hyperthyroidism
Histology: Non-toxic mutlinodular goiter
irregularly enlarged follicles surrounded by flattened epithelium
Histology: de Quervain’s thyroiditis
granulomas
multi-nucleated giant cells
Hurthle cell
enlarged epithelial cells w/ abundant eosinophilic (pink) granular cytoplasm dt altered mitochondria
seen in Hashimoto’s and thyroid CA
Hashimoto’s thyroiditis
AI dz where the thyroid gland is attacked by antibodies (anti-TPO)
What are the MC hypothalamic suprasellar tumors?
gliomas and craniopharyngiomas
What is the MC initial sx in Sheehan’s syndrome?
agalactorrhea
Ureteritis cystica
fine cysts in mucosa of ureters
Occupational exposure to ___ can also inc. risk for RCC.
cadmium
asbestos
What is the 2nd MC type of cell type seen in renal tumors?
papillary (chromophilic), which arise from the proximal tubule
What is the 2nd MC type of renal tumor?
Metastatic tumor
Oncocytomas are a type of ____
renal adenoma (uncommon), which arise from collecting ducts
What is the MC cz of hypothyroidism in the world?
iodine deficinecy
MC sites for METS to the pituitary
Breast CA
Lung CA
Prostate CA
Histology: craniopharyngiomas
oil-filled cysts, which mb seen grossly
lamellations of “wet” keratin
Histology: pituitary adenoma
small round cells w/ round nuclei
pink-blue cytoplasm
arranged in nests or cords, prominent vascularity
What is the MC type of prostate CA?
adenocarcinoma
Corpora amylacea
benign small laminated pink concretions found within the glandular lumens of the prostate
What are the four MC types of testicular tumors?
Mixed cell types - 40%
Seminoma - 35%
Embryonal carcinoma - 20%
Teratoma - 5%
Histology: embryonal carcinoma
sheets of cells trying to form primitive tubules.
Labs: embryonal carcinoma
mb elev. hCG and AFP
Histology: seminoma
sheets or lobular nests of cells with intervening lymphoid stroma
cells have pale cytoplasm w/ prominent vesicular nuclei
Labs: seminoma tumor
Placental alklaline phosphatase (PLAP) in 50%
elev. Human chorionic gonadotropin (hCG)
Normal serum alpha fetoprotein
Histology: gonococcal urethritis
gram- diplococci
intracellular and extracellular bacteria, PMNs
If bladder CA is related to schistosomiasis, it is more likely what type of CA?
squamous cell carcinoma (70%)
Risks: bladder CA
cigarette smoking (esp. in men) analgesics (long-term) radiation to area exposure to benzenes schistosomiasis
Cystitis as a result of chemotherapy or radiation therapy can result in ___
hemorrhagic cystitis
Histology: malakoplakia
foamy histiocytes w/ round basophilic inclusions (Michaelis-Gutmann bodies)
Malakoplakia
slightly raised mucosal plaques of the bladder lining
Histology: chronic cystitis
chronic inflammatory cells (esp. lymphocytes) in lamnia propria of the bladder
lymphocytes may form germinal centers
Men with prostatic enlargement are at an increased risk for ___
acquired bladder diverticuli
Patients with congenital exstropy of the bladder have an increased risk for ____.
bladder adenocarcinoma
What is the MC type of ureteral malignancies?
transitional cell carcinomas
Morphology: Ureteritis follicularis
fine granular appearance
Ureteritis follicularis
increased lymphocytes in subepithelial region dt chronic localized inflammation
Most islet cell antibodies in DM1 are directed against ___
glutamic acid decarboxylase (GAD) within beta cells
Histology: DM type 1
lymphocytic infiltration in islets of Langerhans
Histology: DM type 2
hyalnization, amyloid deposits in islet cells
What histological feature of DM2 is also seen in normal aging?
amyloid deposits
Male patients with diabetic neuropathy are at an increased risk for ___
impotence
What are the first histological changes that are noted in patients with diabetic nephropathy?
thickened capillary walls within glomerulus
MC location for tumors (MEN1)
parathyroid gland (90%)
pancreas (gastrinoma - 50%, insulinoma - 20%)
pituitary gland (66%)
MC location for tumors (MEN2A)
medullary thyroid carcinoma (100%)
pheochromocytoma (50%)
parathyroid gland (50%)
MC location for tumors (MEN2B)
medullary thyroid carcinoma (85%)
pheochromocytoma (60%)
mucosal neuroma (100%)
marfanoid body habitus (80%)
What is the MC and often initial manifestation and of MEN1?
1˚ hyperparathyroidism
What are the MC ant. pituitary tumors seen in MEN1 patients?
prolactinomas
Histology: medullary thyroid cancer
multiple areas of amyloid deposition
+ staining for calcitonin
Both MEN2A and MEN2B have an increased risk of ___
intestinal aganglionosis and Hirschsprung dz
PTH1 receptors are found in the highest concentration where?
bone, kidney
PTHrP is MC secreted in which types of cancers?
breast, lung CA
What is often the first sign of malignancy in paraneoplastic syndromes?
PTHrP-related hypercalcemia
What is the 2nd MC form of 1˚ hyperparathyroidism?
parathyroid hyperplasia
What is the least common form of 1˚ hyperparathyroidism?
parathyroid carcinoma
What is the MC cz of 2˚ hyperparathyroidism?
renal failure