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Pathology Flashcards

1
Q

what is meant by agenesis?

A

complete absence of an organ

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2
Q

what do duplex system congenital abnormalities of the renal system give an increased risk of?

A

infection

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3
Q

do simple cysts of the kidney usually cause any problems?

A

no they are very common, usually no functional disturbance

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4
Q

what is the more rare form of polycystic disease and how is it inherited?

A

infantile type, autosomal recessive polycystic kidney disease

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5
Q

what does the infantile polycystic kidney disease cause? what is the prognosis?

A

uniform bilateral renal enlargement- elongated cysts- dilation of medullary collecting ducts. causes terminal renal failure, baby usually dies in neonatal period but less severe cases can survive a few months

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6
Q

what does infantile polycystic disease have an association with?

A

congenital hepatic fibrosis

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7
Q

what is the more common form of congenital cystic disease and how is it inherited?

A

adult polycystic disease- autosomal dominant polycystic kidney diease

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8
Q

what is the gene defect in ADPKD 1?

A

defect on chromosome 16

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9
Q

what is the gene defect in ADPKD 2?

A

defect on chromosome 4

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10
Q

what percentage of ADPKD is type 1?

A

90%

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11
Q

when does ADPKD usually present?

A

usually middle adult life

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12
Q

how does ADPKD usually present?

A

abdo mass, haematuria, hypertension, chronic renal failure

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13
Q

how many times is the enlargement of a kidney in ADPKD compared to normal?

A

10 times larger

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14
Q

what can be seen on the kidney in ADPKD?

A

multiple cysts of varying sizes, distortion of reniform shape of kidney.

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15
Q

where can cysts arise in the nephron ADPKD?

A

at any part of the nephron

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16
Q

what do 1/3rd of patients with ADPKD also have?

A

cysts in liver, pancreas and lung - usually no functional effect

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17
Q

what is ADPKD associated with?

A

berry anuerysms in circle of willis - subarachnoid haemorrhage

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18
Q

what are the cysts in ADPKD filled with?

A

most filled with clear fluid but some can be filled with blood

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19
Q

what are the 2 types of brain haemorrage someone with ADPKD is at risk of getting and why?

A

ADPKD associated with subarachnoid haemorrhage. Also at more risk if intracellular haemorrhage due to hypertension caused by ADPKD

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20
Q

what are the 4 most common benign renal tumours?

A
  • fibroma
  • adenoma
  • angiomyolipoma
  • JGCT
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21
Q

what is the origin and appearance of a renal fibroma?

A

medullary origin, white nodules

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22
Q

what is the appearance a renal adenoma and what size would you expect it to be?

A

yellowish nodules, often less than 2cm

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23
Q

where in the kidney would you find an adenoma?

A

cortex

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24
Q

what makes up the contents of an angiomyolipoma on the kidney?

A

mixture of fat, muscle and blood vessels

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25
Q

is an angiomyolipoma solitary or diffuse?

A

can be solitary but often multiple and bilateral

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26
Q

what condition is renal angiomyolipomas associated with?

A

Tuberous Sclerosis

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27
Q

how does a JGCT of the kidney cause secondary hypertension?

A

stimulates production of rennin

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28
Q

what is the commenest intra-abdominal tumour in children and what is it?

A

a nephroblastoma (Wilm’s tumour). Arises from residual primitive renal tissue

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29
Q

where in the renal system do you most commonly find uroethelial carcinomas?

A

renal pelvis and calyces

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30
Q

what is the commonest primary renal tumour in adults?

A

renal cell carcinoma

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31
Q

what is presenting age group and M:F ratio in renal cell carcinoma?

A

55-60 years. M:F - 2:1

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32
Q

how does a renal cell carcinoma usually present?

A

abdo mass, haematuria, flank pain, general features of malignant disease

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33
Q

what are the paraneoplastic manifestations of a renal cell carcinoma?

A

polycythaemia, hypercalcaemia

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34
Q

what causes polycythaemia in renal cell carcinoma?

A

erythropoietic stimulating substance

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35
Q

what is the macroscopic appearance of a renal cell carcinoma?

A

large, apparently well circumscribed mass centred on cortex. yellow colour with solid, cystic, necrotic and haemorrhagic areas

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36
Q

where does a renal cell carcinoma commonly extend in to?

A

into the renal vein

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37
Q

once a renal cell carcinoma is extended into the renal vein, where can it spread to?

A

into vena cava and up to right atrium

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38
Q

does a renal cell carcinoma usually spread by blood or lymph?

A

initially by blood- lymphatic spread later

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39
Q

what is the commonest type of renal cell carcinoma?

A

clear cell type

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40
Q

what are clear cell type tumour cells rich in?

A

glycogen and lipid

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41
Q

what is the name of the grading system in renal cell carcinoma?

A

Fuhrman staging

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42
Q

where does a transional cell carcinoma arrise from?

A

from transitional epithelium from pelvicalyceal system to urethra

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43
Q

transitional cell carcinomas make up what percentage of bladder tumours?

A

90%

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44
Q

risk factors for developing a transitional cell carcinoma?

A

-aniline dyes
-rubber industry
-benzidine
-cyclophophamide
-analgesics
- schistosomiasis
smoking

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45
Q

commenest symptom in transitional cell carcinoma?

A

haematuria

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46
Q

where do transitional cell carcinomas caused by analgesics most commonly occur?

A

renal pelvis

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47
Q

where do 75% of transitional cell carcinomas occur?

A

in region of trigone

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48
Q

what happens to the papillae in a transitional cell carcinoma?

A

has a thicker lining than normal urothelium

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49
Q

what does a stage of pTa mean?

A

superficial and non-invasive

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50
Q

what does a stage of pT1 mean?

A

stromal invasion

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51
Q

what does a stage of pT2 mean?

A

invasion of muscle

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52
Q

what lymph nodes would a transitional cell carcinoma spread to?

A

obturator nodes in the pelvis

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53
Q

why do patients with a treated transitional cell carcinoma have to be closely followed up?

A

recurrence is frequent and tumours often progress to higher grade/stage

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54
Q

what is the commonest malignant bladder tumour in children?

A

embryonal Rhabdomyosarcoma

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55
Q

what predisposes to a squamous carcinoma in the renal tract?

A

calculi, schistosomiasis

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56
Q

what predisposes to a adenocarcinoma of the renal tract?

A
  • extroversion of the bladder
  • urachal remnants
  • long standing cystitis cystica
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57
Q

where do you find erythroplasia of Queyrat and what is its appearance?

A

mostly on glans of penis, has red velvety raised area

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58
Q

what is seen in bowens disease and erythroplasia of Queyrat?

A

full thickness dysplasia of epidermis

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59
Q

who does squamous carcinoma of the penis almost exclusively occur in?

A

in uncircumcised men

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60
Q

what things can predispose to a squamous cell carcinoma of the penis?

A

poor hygiene, HPV infection

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61
Q

what does a SCC of penis look like?

A

ulcerated indurated tumour or exophytic mass

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62
Q

what percentage of men over 70 have benign nodular hyperplasia of prostate? what % ahve significant symptoms?

A

atleast 75%. only 5% have significant symptoms

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63
Q

what is benign nodular hyperplasia of prostate?

A

irregular proliferation of both glandular and stromal prostatic tissue

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64
Q

what is BNH due to?

A

hormonal imbalance - androgens diminish and oestrogen stays level

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65
Q

what area of the prostate is involved in BNH?

A

central (peri-urethral)

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66
Q

in which 2 ways can BNH cause disturbance of bladder sphincter?

A
  1. physical obstruction

2. physiological inference - peri-urethral glands at internal urethral meatus

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67
Q

what is meant by prostatism?

A
  • difficulty in starting micturition
  • poor stream
  • overlfow incontinence
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68
Q

what can BNH lead to in the bladder?

A

bladder hypertrophy and diverticulum formation

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69
Q

if BNH causes bladder obstruction what can this lead to?

A

hydroureter, hydronephrosis, infection

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70
Q

what drugs are used to treat BNH?

A

alpha blockers, 5 alpha reductase inhibitors

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71
Q

is BNH pre-malignant?

A

no

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72
Q

what is the second leading cause of cancer deaths in males?

A

carcinoma of prostate

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73
Q

peak age incidence for carcinoma of the prostate?

A

60-80 years

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74
Q

what gives an increased risk of carcinoma of prostate?

A

if 1st degree relative is affected at young age

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75
Q

where does a carcinoma of the prostate mainly arise?

A

in peripheral ducts and glands

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76
Q

why can it take symptoms of prostanism a long time to arise in carcinoma of the prostate?

A

since it is found in peripheral ducts and glands and peri-urethral zone is not involved until later stage

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77
Q

what is meant by “latent” carcinoma?

A

microscopic cancer foci found incidentally in surgical specimens or at atopsy. but they have no clinical affect. die with them not of them

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78
Q

where can a carcinoma of the prostate spread to locally?

A

urethral obstruction, capsular penetration, seminal vesicles, bladder, rectum

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79
Q

what lymphatics could a carcinoma of the prostate spread to?

A

-sacral, iliac, para-aortic nodes

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80
Q

what is the characteristic appearance of a bone met from a carcinoma of the prostate?

A

osteosclerotic mets

81
Q

what hormonal therapies are used in treatment of carcinoma of the prostate?

A
  • anti- androgen

- oestrogens, crproterone

82
Q

when is radiotherapy used in the treatment of carcinoma of the prostate?

A

in bone mets

83
Q

when is radical prostatectomy not as effective?

A

when there is mets

84
Q

what gives a 10 times increase in risk for a testicular tumours?

A

testicular maldescent - failure of testes to descend

85
Q

what is the normal presenting symptoms in a testicular tumour?

A

painless testicular enlargement

86
Q

what makes up 90% of testicular tumours?

A

germ cells tumours

87
Q

what are the types of germ cell tumours?

A

seminoma, teratoma and mixed

88
Q

what makes up 10% of testicular tumours?

A

lymphoma/leukaemia. stromal tumours

89
Q

what are the two stromal tumours of the testical?

A

sertoli and leydig cell

90
Q

in what age group do primary testicular lymphomas mostly happen in?

A

elderly

91
Q

what type of testicular cancer commonly affects young males?

A

leukaemia relapse to testicles

92
Q

what testicular tumour often presents with gynaecomastia?

A

a leydig cell tumour - type of stromal tumour

93
Q

what is the commonent germ cell tumour?

A

seminoma

94
Q

age peak for seminoma of testes?

A

30-50 years

95
Q

what is the macroscopic appearance of a seminoma of the testes?

A

solid, homogenous, pale macroscopic appearance - potato tumour

96
Q

what is the histological appearance of a seminoma?

A

large, clear tumour cells with variable stromal lymphocytic infiltrate

97
Q

what are 2 variants of seminoma?

A

spermatocytic and anaplastic types

98
Q

how is a seminoma treated?

A

radiotherapy

99
Q

peak incidence of testicular teratoma?

A

20-30 years

100
Q

what do teratomas arise from?

A

all three 3 cells lines - endoderm, mesoderm and ectoderm

101
Q

macrocopic appearance of a teratoma?

A

solid areas, cysts, haemorrhage and necrosis

102
Q

microscopic appearance of a testicular teratoma?

A

wide variery of tissue types eg primitive brain tissue, pancreastic tissue, smooth muscle, cartilage etc

103
Q

4 types of teratoma in the classification?

A
  • differentiated teratoma
  • malignant teratoma intermediate
  • malignant teratoma undifferentiated
  • malignant teratoma trophoblastic
104
Q

what type of tumour releases bHCG?

A

trophoblastic tumours

105
Q

what component of a tumour releases AFP?

A

yolk sac components

106
Q

what testicular tumours releases placental alkaline phosphatase (PLAP)?

A

seminoma

107
Q

what are the 2 types of nephritis?

A
  • glomerulonephritis

- pyelonephritis

108
Q

what is often the cause of glomerulonephritis?

A
  • immunological mechanism often implicated- but no single cause
109
Q

what is affected in glomerulonephritis in the early and then later stage?

A

glomerular tufts involved initially, then secondary tubulointerstial changes can occur

110
Q

in what type of pattern does glomerulonephritis usually affect the kidney?

A

usually it is diffuse- every glomerulus is affected. but some forms can cause focal involvement

111
Q

what is pyelonephritis?

A

bacterial infection of renal pelvis, calyces, tubules and interstitium

112
Q

what are the 2 forms of pyelonephritis?

A

acute and chronic

113
Q

what type of distribution does pyelonephritis follow?

A

patchy

114
Q

what is the commonest organism in pyelonephritis? what are the other less common organism?

A

E.coli most common, also pseudomonas, strep. faecalis

115
Q

what sex is pyelonephritis most common in?

A

females

116
Q

what are the 2 ways in which bacteria can enter the kidney causing pyelonephrititis?

A
  • blood -borne in septicaemia, post surgery

- ascending infection.

117
Q

what mode of getting pyelonephritis is much more common? and what is often present?

A
  • ascending infection

- cystitis often present

118
Q

why are females at higher risk of developing pyelonephritis?

A

shorter, wider urethra

119
Q

how many organisms/ml in urine need to present to be classed as a UTI?

A

> 100,000 organisms/ml

120
Q

how can pregnancy increase risk of developing a UTI?

A

causes ureteric dilation

121
Q

risk factors for developing pyelonephritis?

A
  • urinary tract obstruction
  • vesico-ureteric reflux
  • diabetes
122
Q

what things can cause a urinary tract obstruction?

A
  • calculus, stricture, neoplasm, congenital anomaly, prostatic and urethral pathology
123
Q

what is vesico-ureteric reflux?

A

incompetence of valves where the ureters enter the bladder. urine can move back up the ureter

124
Q

what is chronic pyelonephritis associated with?

A

hypertension and/or uraemia

125
Q

why do people with chronic pyelonephritis pass large amounts of urine?

A

kidney not functioning properly so cant concentrate urine effectively

126
Q

what can be seen on renal imaging in chronic pyelonephritis?

A

course cortical scarring, distortion of calyces

127
Q

what can be seen histologically in chronic pyelonephritis?

A

lymphocytes and plasma cells. destruction of glomeruli in later stages

128
Q

how is tuberculous usually spread to the kidney and what does it cause?

A

haematogenous spread usually from lung. causing tuberculous pyelonephritis

129
Q

symptoms of tuberculous pyelonephritis?

A

vague symptoms- weight loss, fever, loin pain, dysuria

130
Q

what is meant by sterile pyuria in relation to TB pyelonephritis?

A

puss in the urine but in the initial stage of culture it appears sterile as TB bacterium can take weeks to grow

131
Q

what techniques are used now to detect tuberculous pyelonephritis?

A

PCR

132
Q

how does TB pyelonephritis affect the kidney?

A

caseous foci- slow growth with progressive renal destruction

133
Q

where can TB pyelonephritis spread to?

A

to ureters, bladder and other viscera

134
Q

most common bacteria causing cystitis?

A
  • e.coli
  • Klebsiella
  • proteus
  • psuedomonas
135
Q

what forms in ureteritis and cystitis cystica?

A

multiple small fluid filled cysts projecting into the lumen - reactive process

136
Q

what infection of the bladder predisposes to SCC of the bladder?

A

schistosomiasis

137
Q

what happens to the bladder muscle (detrusor) in prolonged bladder outlet obstruction?

A

hypertrophy and diverticulum formation

138
Q

what is hydronephrosis ?

A

dilatation of pelvicalyceal system with paranchymal atrophy

139
Q

what are the main causes of hydronephrosis?

A

urinary tract obstruction and reflex

140
Q

possible causes of bilateral hydronephritis?

A
  • urethral obstruction
  • neurogenic disturbance
  • vesico-ureteric reflux
  • bilateral ureteric obstruction
141
Q

what is a possible cause of bilateral ureteric obstruction?

A

tumour eg advanced carcinoma of cervix

142
Q

possible causes for unilateral hydronephrosis?

A
  • calculi
  • neoplasm
  • pelvi-ureteric obstruction
  • strictures
143
Q

why is there little pelvicalyceal dilation in a sudden and complete obstruction?

A

urine production quickly ceases

144
Q

in severe hydronephrosis what can been seen macroscopically on the kidney?

A

marked cortical thinning, atrophy and fibrosis

145
Q

what is a kidney that is hydronephrosed at higher risk of?

A

secondary infection

146
Q

what is pyonephrosis?

A

infection (pus) in the kidney secondary to hydronephrosis

147
Q

what does bladder muscle look like when it has undergone hypertrophy?

A

criss-cross appearance

148
Q

in a young adult, what does the prostate weigh?

A

around 20g

149
Q

what is the apex of prostate (posterior portion) continuous with?

A

striated sphincter

150
Q

what is the base (superior portion) of prostate continuous with?

A

bladder neck

151
Q

what lines the prostatic urethra?

A

transitional epithelium

152
Q

where is the verumontanum on the urethra?

A

just distal to uretheal angulation

153
Q

what joins to form the ejaculatory duct?

A

seminal vesicles and each vas deferens

154
Q

where do they ejaculatory ducts drain to?

A

each side of prostatic urethra

155
Q

what are the 3 different zones of the prostate?

A
  • transitional zone
  • central zone
  • peripheral zone
156
Q

what does the transitional zone of prostate surround?

A

the prostatic urethra proximal to the verumontanum

157
Q

in young men, the transitional zone of prostate accounts for what % of prostatic glandular tissue?

A

only 10%

158
Q

what shape is the central zone of prostate and what does it surround?

A
  • cone shaped region that surround the ejaculatory ducts
159
Q

what percentage of glandular tissue of the prostate is made up by the central zone?

A

25%

160
Q

what percentage of prostate cancers arise in the transitional zone of prostate?

A

only about 20%

161
Q

what percentage of prostate cancers arise in the central zone of prostate?

A

only 1-5%

162
Q

what zone of prostate makes up most of the glandular tissue?

A

the peripheral zone

163
Q

where is the peripheral zone of the prostate?

A

posteriolateral prostate

164
Q

what percentage of prostate adenocarcinoas arise from the peripheral zone?

A

up to 70%

165
Q

what zone of the prostate gives rise to BPH?

A

the transitional zone

166
Q

peak age incidence for prostate cancer?

A

70-74 years

167
Q

what race are more at risk of prostate cancer?

A

black men are at a greater risk than caucasians. asians rarely develop it unless they move to the West

168
Q

what doubles the risk of developing prostate cancer?

A

one first degree relative

169
Q

how much is the risk increased if you have 2 first degree relatives affected by prostate cancer?

A

by 4 folds

170
Q

what can be felt in a digital rectal exam in prostate cancer?

A

asymetry of prostate, nodule, fixed craggy mass

171
Q

what produces PSA?

A

secretory epithelial cells of the prostate gland

172
Q

in health, what should the PSA levels be in semen and in serum?

A

high in semen and low in serum

173
Q

other conditions (not cancer) that elevate PSA?

A
  • BPH
  • Prostatitis / UTIs
  • retention
  • catheterization
  • digital rectal exam
174
Q

what is the sensitivity of PSA in detecting prostate cancer?

A

90%

175
Q

what is the specificty of PSA in detecting prostate cancer?

A

40%

176
Q

indications for a trans-rectal USS guided prostate biopsy?

A
  • men with an abnormal rectal exam, an elevated PSA
  • previous biopsies showing prostatic intraepithelial neoplasia or atypical small acinar proliferation
  • previous normal biopsies but rising PSA trends
177
Q

how many biopsies are taken from the prostate in a trans-rectal USS guided prostate biopsy?

A

10 - 5 from each lobe

178
Q

what are the majority (>95%) of prostate cancers?

A

multifocal adenocarcinomas

179
Q

what scoring system is used in grading prostate cancer?

A

Grading- Gleason’s scoring

180
Q

what is meant by T3 in prostate cancer?

A

tumour extends through the prostatic capsule

181
Q

what is meant by T4 in prostate cancer?

A

tumour fixed or invades adjacent structures other than seminal vesicles: bladder neck, external sphincter, rectum, levator muscles or pelvic wall

182
Q

complications of radical surgery on the prostate?

A
  • erectile dysfunction
  • incontinence
  • bladder neck stenosis
183
Q

what is the curative approach in locally advanced prostatic cancer?

A

radiotherapy with neo-adjuvant hormonal therapy

184
Q

what therapy is used in the management of metastatic disease prostatic cancer?

A

androgen deprivation therapy

185
Q

what hormones is growth of prostate cancer cells influenced by?

A

testosterone and dihydrotestosterone

186
Q

what happens to prostate cells if they are deprived of androgenic stimulation?

A

they undergo apotosis

187
Q

what affect does LHRH agonists have on LH, FSH and testosterone?

A

chronic exposure to LHRH agonists results in down-regulation of LHRH-receptors, with subsquent suppression of pituitary LH and FSH secretion and testosterone production

188
Q

what is the testosterone surge in the hormonal therapy, LHRH agonists?

A

they initially stimulate pituitary LHRH receptors, causing a transient rise in LH and RSH and testosterone production.

189
Q

how do 20% of patients with testosterone surge due to LHRH agonists present?

A

with catastrophic spinal cord compression

190
Q

in hormonal therapy using LHRH agonists, how is testosterone surge prevented?

A

anti-androgens are given 1 week before starting therapy and 2 weeks after the first dose of LHRH injection

191
Q

side effects of LHRH agonists for prostate cancer?

A
  • loss of libido
  • hot flushes and sweats
  • weight gain
  • gynaecomastia
  • anaemia
  • cognitive changes
  • osteoporosis
192
Q

how do anti-androgens work in treatment of prostatic cancer?

A
  • compete with testosterone and DHT for binding sites on their receptor in the prostate cell nucleus, thus promoting apoptosis and inhibiting cancer cell growth
193
Q

what are the 2 types of anti-androgens?

A

steroidal and non-steroidal

194
Q

an example of a steroidal anti-androgen?

A

cyproterone acetate

195
Q

side effects of steroidal anti-androgens?

A

loss of libido, ED, cardiovascular toxicity and hepatotoxicity

196
Q

examples of non-steroidal anti-androgens?

A
  • nilutamide, flutamide, bicalutamide
197
Q

side effects of non-steroidal anti-androgens?

A

gynaecomastia, breast pain and hot flushes, hepatotoxicity

198
Q

classification of transitional cell carcinoma?

A

papillary and non-papillary

199
Q

what percent of transitional cell carcinomas are papillary type?

A

80%

Renal (10 decks)

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