Pathology 4: Summary From Tutorial 1

Question 1

Which lesion is almost pathognomonic for nodular glomerulosclerosis as a result of diabetic nephropathy?

Answer 1

Kimmelstiel-Wilson lesion

Question 2

How can diabetic nephropathy damage the kidney?

Answer 2

Atherosclerosis of larger renal arteries

Pyelonephritis

Renal papillary necrosis

Question 3

Renal paillary necrosis is often seen in conjunction with which other condition?

Answer 3

Acute pyelonephritis

Question 4

What causes renal papillary necrosis?

Answer 4

Combination of vasuclar damage and inflammation

This causes ischaemia of the renal papillae which often slough off into the distal urinary tract

Question 5

What is a highly important factor which dtermines the degree of renal impairment in diabetes?

Answer 5

Age of onset of diabetes

(it becomes more severe the earlier diabetes occur in life)

Question 6

Amyloidosis is due to what?

Answer 6

Abnormal protein produced by plasma cells of the bone marrow

Question 7

How does deposition of amyloid affect the kidneys?

Answer 7

Deposition in the glomeruli particularly around basement membrane increases permeability for protein loss

This can progress to nephrotic syndrome

Question 8

Which conditions are commonly associated with amyloidosis?

Answer 8

RA/SLE

Bonchiestasis

Myeloma

Question 9

Which stain is used for amyloid and what is the appearance under polarised light?

Answer 9

Congo red stain

Apple green birefringence under polarised light

Question 10

Why is there an associated with renal calculi and myeloma?

Answer 10

Myeloma causes bone destruction and hypercalcaemia

Question 11

Why do myeloma patients have increased risk of UTIs and pyelonephritis?

Answer 11

Immunodeficiency

Question 12

What is the typical appearance of a seminoma?

Answer 12

Solid, white homogenous macroscopic appearance

Like a potato

Question 13

What is the commonest primary germ cell tumour of young men?

Answer 13

Seminoma

(very rare in older men)

Question 14

What is the lymphatic drainage of the testes?

Answer 14

Para-aortic nodes

Question 15

How does seminoma spread?

Answer 15

Lymphatioc mainly (to para-aortic nodes)

Also haematogenous to liver and lungs

Question 16

What is the prognosis of seminoma and what is the treatment?

Answer 16

Very good (>95%)

Radiotherapy and also chemotherapy

Question 17

Which tumour marker is associated with seminoma?

Answer 17

PLAP

(placental alkaline phosphatase)

Question 18

Which tumour marker is associated with teratoma?

Answer 18

AFP

(alpha-fetoprotein)

Produced by teratomas with yolk sac elements

Question 19

If a teratoma contains trophoblastic it is very malignant. What tumour marker will it possess?

Answer 19

bHCG

(human chorionic gonadotrophin)

Question 20

There is overgrowth of which tissues in benign prostatic hyperplasia?

Answer 20

Glandular and stromal elements of the prostate

Question 21

How does BPH differ from prostate cancer in terms of which location of the gland is affected?

Answer 21

Centreaffected in BPH

Question 22

How can prostatic carcinoma be diagnosed?

Answer 22

PSA (showing a gradual increase)

Immunohistochemical techniques

Question 23

What is peculiar about skeletal metastases of prostatic carcinoma?

Answer 23

Typically osteosclerotic (more dense than surrounding bone)

(most metastatic tumours are lytic)

Question 24

In malignant hypertension, which changes can be seen in the kidneys?

Answer 24

Fibrinoid necrosis in arterioles and glomerular tufts

Question 25

Name causes of secondary hypertension

Answer 25

Renal artery stenosis

Any renal parenchymal disease

Renin secreting tumours (rare) - e.g. juxtaglomerular cell tumour

Pheaochromocytoma

Cushing’s syndrome

Question 26

Which condition is involved with hypertension, subarachnoid haemorrhage and bilateral renal enlargement?

Answer 26

ADPKD

Question 27

Why can subarachnoidal haemorrhage occur with ADPKD?

Answer 27

Associated with Berry aneurysm formation in circle of Willis

Question 28

Why is LVH a feature of ADPKD?

Answer 28

Hypertension