pathology Flashcards
what happens when there is a glomerular blockage?
glomerular sieve stops working
membrane charge is disrupted
can get nephrotic or nephritic syndrome
what 3 modalities are used to assess a renal biopsy?
Light microscopy
Electron microscopy
Immunoflouresence
what antibodies can be seen in IMF?
IgM
IgA
IgG
what cell deposits are seen in electron microscopy
subepithelial (below podocyte)
membranous (on GBM)
subendothelial (below endothelium)
mesangial (around the mesangial cells)
what can be caused by anti-GBM disease?
goodpasture’s
nephritic syndrome
rapidly progressive glomerulonephritis
where does IgG bind to?
IgG binds to alpha-3 unit of type IV collagen found in basement membrane of glomerulus and lung
what causes membranous GN?
infection - hepatitis, malaria, syphilis
Drugs – penicillamine, NSAID, captopril, gold
Malignancy – lung, colon and melanoma
Lupus – 15% of all GMN in lupus
Autoimmune Disease - thyroiditis
what is the histological appearance of membranous GN?
thick membranes, sub-epithelial immune deposits
what is the most common cause of nephropathy worldwide?
IgA nephropathy
who gets IgA nephropathy?
genetic, acquired defect – coeliac
what causes membranoproliferative GN?
idiopathic (type 2- infection, lupus, malignancy)
seen in adults and children
what is the appearance of MPGN?
big lobulated hypercellular glomeruli with thick membranes – tram tracks
does MPGN cause nephrotic or nephritic syndrome?
both
does IgA nephropathy cause nephrotic or nephritic syndrome?
nephritic
what is the treatment of minimal change disease?
steroids - excellent prognosis
what is the most common cause of nephrotic syndrome in children?
minimal change disease
what causes focal segmental glomerulosclerosis (FSGS)?
obesity, HIV, sickle cell, IV drug use
does FSGS cause nephrotic or nephritic syndrome?
nephritic
does FSGS respond to steroids?
sometimes yes, sometimes progresses to renal failure
what do you see on the kidneys in diabetic nephropathy?
Diffuse and Nodular Glomerulosclerosis
Nodules – Kimmel Stiel Wilson Lesion
Also microvascular disease – arterial sclerosis
Infection – pyelonephritis, papillary necrosis
what is the bosniak score?
score to assess the likelihood of a kidney cyst being cancer
what is the main difference in kidneys in ADPKD and ARPKD?
ADPKD - big kidneys, uneven surface with large cysts
ARPKD- normal sized smooth kidneys
what is xanthogranulomatous pyelonephritis?
mass in kidney caused by chronic pyelonephritis so associated with infection and not malignancy
decsribe oncocytoma
Small, oval and well circumscribed tumour
brown with a central stellate (star shaped) scar
describe chromophobe renal cell carcinoma?
rare malignant tumours
look similar to oncocytomas but have shriveled nuclei and perinuclear halos
describe papillary renal cell carcinoma
2nd most common renal cancer
generally low grade
finger like projections
describe collecting duct carcinoma
rare tumour, high grade appearance with very desmoplastic stroma, poor survival
describe clear cell carcinoma
most common renal cancer, when people say renal cancer they usually mean this
common, risk factors- obesity, genetics
presents with haematuria, mass, rarely hypertension
bright yellow tumour surface
where does clear cell carcinoma normally spread to?
renal vein - can then go –> vena cava –> heart
what tumours does VHL cause?
Renal Cell Carcinoma
Cerebellar haemangioblastoma
Pancreatic serous cystadenoma
Tumours of the endolymphatic sac
Epididymal serous cystadenomas
what type of epithelium lines the bladder?
urothelium
what is cystitis?
inflammation of the bladder- usually caused by bacterial infection
what is schistosomiasis?
water borne disease caused by larvae penetrating skin
presents with haematuria
untreated infection can cause hydronephrosis, renal failure and bladder scc
how does schistosomiasis cause bladder scc?
persistent infection –> bladder metaplasia –> malignancy
even though there is no squamous epithelium!
what is the presentation of interstitial cystitis?
middle aged women, persistent symptoms of dysuria but negative cultures
what are risk factors for urothelial cancer?
smoking - almost as high risk as lung cancer
beta-naphthyline - dye industry
describe papillary urothelial carcinoma?
malignant but not invasive, finger like projections
what is the appearance of urothelial carcinoma in situ?
flat lesions
what are rare types of urothelial bladder tumours?
adenocarcinoma - difficult to distinguish from metastasised colon adenocarcinoma
urachal adenocarcinoma
describe the urachus
Remnant of the alantois + urogential sinus
From dome of bladder to the umbilicus
Usually involutes, in some various parts remain patent
Rarely – adenocarcinoma arises within it. Isolated to bladder dome
what is the function of the prostate?
provides passage for urine, some contractile function during ejaculation
describe benign prostatic hyperplasia
prostate gets bigger - hyperplasia in increase in cell number
affects central and transitional zones - obstructing flow of urine
how common is prostate cancer?
At 50 – 30% of all men have it
At 70 – 70% of all men have it
At 90 - 90%
what are the types of prostate cancer?
prostatic acinar carcinoma - most common
small cell carcinoma- most serious
what is PSA?
prostate specific antigen - glycoprotein enzyme - kallikrein 3
what is the problem with PSA?
If normal prostate epithelium makes PSA then very malignant cells won’t - a lot of cancers will though
but can be good in follow ups post tumour removal
what is gleason staging of prostatic cancer?
based on histological appearance
Combination of 2 numbers
Each out of 5
Worst grade and predominant grade
Lowest is usually 3+3 (Score 6)
Highest is 5+5 (Score 10)
1 & 2 not used
what is lichen sclerosus?
same as BXO
chronic inflammatory condition
affects glans, coronal sulcus and/or foreskin
can cause phimosis and paraphimosis
association with non-HPV related scc
what is the clinical presentation of lichen sclerosus?
white patches with petechia, erosion, ulceration, pearly areas
what is a condyloma?
genital wart
papillomatous proliferation of squamous epithelium
can occur in glans, coronal sulcus, foreskin, meatus
caused by HPV - usually 6 & 11 - low risk types
what is PeIN?
penile intraepithelial neoplasia
can be differentiated - non HPV
or dedifferentiated - HPV related
what has an association with penile cancer?
lichen sclerosus
phimosis
smoking
what do male germ cells mature into?
spermatozoa
what stimulates sertoli cells and what is their function?
FSH
function is to control environment within seminiferous tubules to let the sperm mature
what are some common causes of testicular lumps?
Hernia
Cystocoele
Hydrocoele
Spermatocoele
how do hydroceles form?
Accumulation of fluid around the testes
Between the two layers of the tunica vaginalis – mesothelial lining
Unicystic, smooth and fluid filled
when do lesions transilluminate?
when they are fluid filled
solid filled lesions will not
what is a spermatocele?
Cystic change within the vas of the epididymis
Unknown cause and usually asymptomatic
May feel a fullness etc.
Often present after self examination
what is a varicocele?
Varicosities of venous plexus that drains the testis
Usually asymptomatic
May again present having felt a lump
“Bag of worms”
what can cause testicular torsion?
bell clapper deformity
The insertion of the tunica vaginalis is high – the testis can rotate and even sit laterally
what is the most common type of testicular tumour?
germ cell tumour - malignant
several types- seminoma is most common
what are the most common testicular tumours in old people?
lymphoma
spermatic tumour
metastasis
what is a risk factor for seminoma?
undescended testes - contralateral testes share risk
what type of tumour are non-seminomatous tumours?
usually mixed- seminoma still most common subtype on the mix though
what is the prognosis for most testicular cancer?
good - seminoma can be cured even at advanced stage
non-seminomatous still good but need to treat early
what are the features of a mature teratoma?
can be derived from multiple germs layers
all classified as malignant even though might not be
what do yolk sac tumours prdocuce?
alpha feto protein
what is an embyonal tumour non-seminomatous tumour?
aggressive form. Looks high grade and is associated with freq mets
describe trophoblast non-seminomatous tumour
strange looking cells on histology
Positive for beta HCG (human chorionic gonadotrophin)
Positive pregnancy test!
