Pathology Flashcards
what is agenesis
absence of one or both kidneys
what is the name given to small kidneys but normal development
hypoplasia
what is a ‘horseshoe’ kidney
fusion of the kidneys at either ple
what is duplex system
two kidneys (one on top of the other) on one or both sides of your body
what is a very common cystic disease of the kidney
simple cysts
can be multiple and large
usually clear fluid filled
often incidental finding
what conditions is simple cysts often secondary to
native kidneys in long term dialysis
what are the two subtypes of genetic polycystic disease
infantile type (ARPKD) adult polycystic disease (ADPKD)
features of infantile polycystic disease
rare
causes terminal renal failure
less severe cases can survive for some months
why is infantile polycystic disease terminal
perinatal - not suitable for renal transplant or dialysis
what are pathological features of infantile polycystic disease
Uniform bilateral renal enlargement.
Elongated cysts – dilatation of medullary collecting ducts.
what type of genetic inheritance is infantile polycystic disease
autosomal recessive
what is infantile polycystic disease associated with
congenital hepatic fibrosis
how is infantile polycystic disease diagnosed
prenatal ultrasound
what congenital cystic disease is more common
Adult Polycystic Disease
what type of inheritance is Adult Polycystic Disease
autosomal dominant
what are the two possible chromosomes that can be affect to cause Adult Polycystic Disease
Chromosome 16
Chromosome 4
what chromosome defect is 90% of the cases of Adult Polycystic Disease
Chromosome 16 defect
typical presentation of adult polycystic disease
middle adult life abdominal mass haematuria hypertension chronic renal failure renal stone
pathology of Adult Polycystic Disease
massive bilateral renal enlargement
multiple cysts of varying size arising in any part of nephron
what is seen in 1/3rd of patients with Adult Polycystic Disease
cysts in liver, pancreas, lung but with no functional effect
what is Adult Polycystic Disease associated with
Berry aneurysms in Circle of Willis
what does Berry aneurysms predisposed patients to
subarachnoid haemorrhage.
what other haemorrhage are patients with adult polycystic disease are at risk at and why
intra-cerebral haemorrhage
due to hypertension
most common benign renal tumour and its features
fibroma
Medullary origin, white nodules. No clinical consequence.
typical features of a benign renal adenoma
yellowish nodules
what is an Angiomyolipoma
benign renal tumour
mixture of fat, muscle and blood vessels
can be multiple and bilateral so can affect renal function
what are angiomyolipoma associated with
tuberous sclerosis
what is a JGCT and what can they cause
tumour of the cells that make renin
secondary hypertension»_space; due to over production of renin
what is the commonest renal tumour of childhood
Wilms’ Nephroblastoma
what is the pathology of a Wilms tumour
undifferentiated mesodermal tumour of the intermediate cell mass
Sx of Wilms’ tumour
fever
flank pain
abdo mass
where are Urothelial Carcinomas found
in renal pelvis and calcyes
what is the commonest renal tumour of adulthood
Renal Cell Carcinoma
what is a Renal Cell Carcinoma also known as
Clear Cell Ca,
hypernephroma
Grawitz tumour
what does a RCC arise from
renal tubular epithelium
typical presentation of RCC
55-60 y/o
M > F
Sx of RCC
Abdominal mass
haematuria
flank pain
weight loss, malaise
what do RCC often cause
polycythaemia - increased concentration of haemoglobin in the blood, either through reduction of plasma volume or increase in red cell numbers
why does RCC cause polycythaemia
erythropoietic stimulating substance
what other disorder can RCC cause
hypercalcaemia
pathology of RCC
Large, well circumscribed mass centred on cortex.
Yellow - due to tumour being rich in glycogen and lipid
Renal vein extension common
Can extend into vena cava
where does RCC tend to spread
via blood
lung, bone
where can a Transitional Cell Carcinoma arise
bladder, ureter or renal pelvis
how common are TCC’s
are 90% of bladder tumours
Risk factors for TCCs
Smoking
schistosomiasis (parasitic infection caught in tropical countries)
Dye and Rubber industry occupation
Sx of TCCs
Painless Haematuria - v common Frequency Urgency Dysuria Urinary tract obstruction
Ix of TCC
Cystoscopy w/ biopsy - diagnostic
CT urogram - 2nd line
pathology of TCC
75% occur in region of trigone
Papillary or solid.
Papillae have thicker lining than normal urothelium.
main tumour seen on the penis and prognosis
squamous carcinoma arising from the skin
only 5% become invasive
what is Bowen disease of the penis called and what does it indicate
Erythroplasia of Queyrat.
pre-malignancy
histology of squamous carcinoma in the penis
full thickness dysplasia of epidermis
aetiology of penis tumours
uncircumcised men
poor hygiene
HPV infection
what was a common tumour in chimney sweeps
SCC of scrotum
Benign Nodular Hyperplasia of Prostate (BNH) is an uncommon and always troublesome disease - true or false
false
75% of men over 70 have it
only 5% have significant symptoms
what causes BNH
Irregular proliferation of both glandular and stromal prostatic tissue.
how can BNH obstruct the bladder sphincter mechanism
by physical obstruction
or
physiological interference
where does BNH often affect physiological interference in the bladder
peri-urethral glands at internal urethral meatus.
where internal opening are
what is prostatism (symptoms of bladder obstruction)
difficulty in starting micturition (i.e. starting to pee)
poor stream
overflow incontinence
what is complication of BNH
chronic urinary retention
bladder hypertrophy
diverticulum formation in bladder wall
If untreated > hydroureter, hydronephrosis, infection
Mx of BNH
Surgery - transurethral resection
Drugs - alpha blockers, 5 alpha reductase inhibitors
is BNH pre-malignant
No
Ix for BNH
Midstream urine sample
Ultrasound
Rule out Cancer - PSA, transrectal USS +/- biopsy
prostate cancer is linked with BNH - true or false
false
there is no link
however they can before occur in the same gland
where does prostate cancer most often arise
peripheral ducts and glands
particularly posterior lobe
when does prostate cancer become symptomatic
when it reaches the peri-urethral zone in later stages
where does prostate cancer often spread to
local - bladder, rectum
lymphatic - sacral, iliac, para-aortic
blood - bone, lungs, liver
what is the relationship of prostate cancer and bone spread
makes new bone
very dense
mets termed osteosclerotic
should always x-ray w/ prostate cancer
Ix of prostate cancer
1st - Rectal Examination + PSA levels (increased levels but not all prostate cancers do)
2nd - transrectal US and biopsy
3rd - x-ray and bone scan
what can greatly increase the risk of getting testicular cancer
undescended testicles
features of testicular cancer
commonest solid organ malignancy in males aged 15-44
only 1% cancer deaths
what does testicular cancer present w/ and what can it be associated with
painless testicular enlargement
associated with hydrocele, gynaecomastia, general effects of malignant disease.
classifications of testicular tumours
Germ cell tumours (90% of tumours)
Others (10%) - primary lymphoma, metastatic leukaemia
what are the types of germ cell tumours
Seminoma, Teratoma, mixed.
what do patients with Leygid cell tumours present with
gynaecomastia
what is the commonest GCT
seminoma
pathology of seminoma
Solid, homogenous, pale macroscopic appearance – “potato” tumour.
Large, clear tumour cells with variable stromal lymphocytic infiltrate.
tumour markers of seminoma
PLAP - placental alkaline phosphatase
Tx for seminoma
very Radiosensitivity
sensitive to radiotherapy and chemotherapy
what is the second commonest GCT
teratoma - tumour of all 3 cell lines
tumour markers of teratoma
AFP - seen in teratomas with yolk sac elements
bhCG - seen in highly malignant teratomas containing trophoblastic tissue
what is the classifications of teratoma
Differentiated Teratoma (TD) - benign
Malignant Teratoma Intermediate (MTI).
Malignant Teratoma Undifferentiated (MTU).
Malignant Teratoma Trophoblastic (MTT).
3rd commonest GCT
Mixed seminoma/teratoma
features of glomerulonephritis
non-infective
immunological mechanisms
usually diffuse, can be focal
definition of Pyelonephritis
Bacterial infection of renal pelvis, calyces, tubules and interstitium.
features of Pyelonephritis
acute or chronic
pathy distribution
commoner in females
what organisms are common to cause Pyelonephritis
E. Coli - most common
Pseudomonas - seen in immunocompromised
pathogenesis of Pyelonephritis
can be due to septicaemia, post-surgery - blood borne
ascending infection from distal urinary tract, cystitis often present (infection in the bladder) - more common pathogenesis
risk factors for pyelonephritis
Age
Female - shorter, wider urethra
Pregnancy; can cause Ureteric dilatation
Instrumentation/Surgery
Urinary Tract obstruction e.g. calculus, stricture, prostatic pathology
Vesico-ureteric reflux (VUR)
Diabetes
symptoms of Chronic pyelonephritis
often no previous Hx of UTI
Vague symptoms
Hypertension and/or uraemia
Large volume of urine
what would renal imaging of Chronic pyelonephritis show
coarse cortical scarring
distortion of calyces
how can TB be spread to the urinary tracy
causes pyelonephritis via haematogenous spread from lung
Sx of TB pyelonephritis
Vague symptoms Weight loss Fever esp at night Loin pain Dysuria - pain on passing urine Sterile pyuria - pus in the urine, but in the initial stage of culture does not grow anything
what is the typical form of necrosis seen in TB
Caseous foci
- slow growth with progressive renal destruction
What stained is used to diagnose TB
Zeehl-Neilsen
what is cystitis
inflammation of the bladder normally caused by an infection
what bacteria commonly cause cystitis
E. Coli. - most common
Klebsiella, Proteus, Pseudomonas.
what can chronic cystitis cause
ureteritis
cystitis cystica
what is Ureteritis and Cystitis Cystica
multiple small fluid filled cysts projecting into lumen
what can cause urethral obstruction
stricture
posterior urethral valves
prostatic disease
consequences of prolonged bladder outlet obstruction
hypertrophy of detrusor muscle
diverticulum formation.
what is hydronephrosis
water in the kidney -
happens to kidney that is exposed to prolonged urinary obstruction
what happens is hydronephrosis
Dilatation of pelvicalyceal system with parenchymal atrophy
when is hydronephrosis bilateral
urethral obstruction
neurogenic disturbance
VUR
bilateral ureteric obstruction e.g. advanced carcinoma of cervix
when is hydronephrosis unilateral
calculi
neoplasms
pelvi-ureteric obstruction
strictures
what happens when hydronephrosis is sudden and quick
urine production quickly ceases > little pelvicalyceal dilatation
what happens when hydronephrosis is gradual and partial
dilatation
what happens when hydronephrosis is severe
Marked cortical thinning, atrophy and fibrosis.
Secondary infection often follows
what is infection of a hydronephrotic kidney called
Pyonephrosis
