Pathology 5: Summary from Tutorial 2

Question 1

What are the main causes of renal papillary necrosis?

Answer 1

• Pyelonephritis
• Obstruction
• Sickle cell disease
• Tuberculosis
• Cirrhosis
• Analgesic and alcohol abuse (phenacetin, long continual paracetamol)
• Renal vein thrombosis
• Diabetes
• Systemic vasculitis

Remember POSTCARDS

Question 2

What happens to the necrosed papillae in renal papillary necrosis?

Answer 2

They can slough off and be passed in the urine

Question 3

What is the most common type of necrosis in the kidney?

Answer 3

Cortical necrosis

Question 4

What causes cortical necrosis?

Answer 4

Hypovolaemic states

This leads to hypoperfusion and necrosis of the renal cortex

Question 5

How does pyelonephritis present?

Answer 5

Loin pain

Fever

Dysuria

Question 6

What are the key causative organisms in pyelonephritis?

Answer 6

E. coli

Enterobacter

Proteus

Pseudomonas aeruginosa

Question 7

In the glomeruli, what is the purpose of the mesangial cells?

Answer 7

Provide support to capillaries

Regulate blood flow by altering contractile status

Question 8

Nephritic syndrome involves damage to which aspects of the glomeruli?

Answer 8

Endothelium

Mesangial cells

Question 9

How does nephritic syndrome typically present?

Answer 9

Haematuria

Hypertension

Oedema

Question 10

Nephrotic syndrome typically involves damage to which aspects of the glomeruli?

Answer 10

Capillaries

Podocytes

Question 11

How does nephrotic syndrome typically present?

Answer 11

Proteinuria

Hypoalbuminaemia

Peripheral oedema

Question 12

What is rapidly progressive glomerulonephritis?

Answer 12

Acute deterioration of kidney function associated with crescent formation around the glomerulus

Question 13

What is Goodpasture’s syndrome?

Answer 13

Autoimmune condition where anti-GBM antibodies attack type IV collagen affecting the kidneys and lungs

Question 14

How does Goodpasture’s syndrome present?

Answer 14

AKI

Haematuria

Haemoptysis

Question 15

How does Goodpasture’s syndrome present on immunofluorescence?

Answer 15

Linear IgG deposition along basement membrane

Question 16

Which conditions can be associated withe rapidly progressive glomerulonephritis?

Answer 16

Immune complex mediated type of glomerulonephritis e.g. minimal change, focal segmented

Vasculitis

Immunological (SLE, HSP, Goodpasture’s)

Question 17

What is renal cell carcinoma?

Answer 17

Cancer of the kiney arising from the epithelium in the proximal tubule

Question 18

What is the most common type of renal cell carcinoma?

Answer 18

Clear cell

(cytoplasm rich in lipids and glycogen)

Question 19

What is the second most common type of renal cell carcinoma?

Answer 19

Papillary

(elongated papillae with foamy cells)

Question 20

What is the most aggressive for of renal cell carcinoma?

Answer 20

Collecting duct

Question 21

What is the classic feature of renal cell carcinoma on CXR?

Answer 21

Cannonball metastases

Question 22

Involvement of what in renal cell carcinoma indicates a poor prognosis?

Answer 22

Renal vein

Question 23

Who generally gets renal cell carcinoma?

Answer 23

Older men (>60)

Question 24

Why is renal cell carcinoma potentially a particularly dangerous type of cancer?

Answer 24

It often goes unnoticed

It is known as a “silent cancer”

Question 25

Which symptoms are associated with renal cell carcinoma?

Answer 25

Haematuria

Palpable mass

Loin pain

Fever/weight loss

Question 26

Which genetic condition is associtaed with renal cell carcinoma?

Answer 26

von Hippel Lindau syndrome

(RCC can be caused by a mutation in the vHL tumour suppressor protein)

Question 27

How are renal cell carcinomas usually treated?

Answer 27

Nephrectomy or surgical resection

(resistant to chemotherapy and radiotherpy)

New treatments such as anti-VEGF receptor therapies are effective

Question 28

Which area in the prostate is typically affected by prostate cancer?

Answer 28

Peripheral zone

(posterior aspect (felt on PR) is most common)

Question 29

Which type of cancer affects the prostate?

Answer 29

Adenocarcinoma

(since the prostate is a gland)

Question 30

How can prostate cancer be treated best?

Answer 30

Chemotherapy and radiotherapy

Androgen deprivation therapy

Question 31

How is the prostate biopsied in suspected prostate cancer?

Answer 31

Areas from the entire gland are biopsied

This allows the localisation of cancer and allows mnay zones to be examined

Question 32

How is the staging of prostate cancer undertaken?

Answer 32

Gleason staging

(cancer is graded 1-5 depending on severity. The most common grade is added to the highest sampled grade. The overall number gives a risk score)

• Low risk < 6
• Intermediate risk = 7
• High risk = 8-10

Question 33

Whta is the most malignant type of testicular cancer?

Answer 33

Trophoblastic tumours

Question 34

In which age group do trophoblastic testicualr cancers occur?

Answer 34

20-40

Question 35

How are trophoblastic tetsicular cancers treated?

Answer 35

Chemotherapy

Question 36

What are the serum markers for

a) Testicular tumours derived from yolk-sac components
b) Testicular tumours derived from trophoblastic components

Answer 36

a) Yolk-sac components - Alpha-feta protein
b) Trophoblastic components - bHCG

Question 37

Which serum marker is associated with seminoma?

Answer 37

PLAP

(placental alkaline phosphatase)

Question 38

If any cancer is non-specific and undifferentiated what 3 things is it likely to be?

Answer 38

Metastatic carcinoma

Primary malignant lymphoma

Melanoma