Pathology Flashcards
what are the two types of inflammation within the kidney
infective- pyelonephritis
non- infective- glomerulonephritis
what is between the parietal and visceral epithelium in the glomerulus
the
what is glomerulonephritis
inflammation of the glomerulus
what are the two main groups of GMN
immune mediated (immune complexes within the glomerulus- either directed at it or circulating complexes getting stuck in the ‘sieve’)
or GMN relating to vasculitis
what causes immune complexes to be directed at the glomerulus
good pastures syndrome
IgG antibodies
what are the two main features of good pastures (why)
haemoptysis and renal failure
as IgG against alpha 3 subunit of collagen 4 which is in kidneys and lungs
what vasculitis’ are associated with GMN
GPA (cANCA)
MPA (pANCA)
how do immune complexes affect the glomerulus
disrupt membrane charge (also plasma proteins and RBCs to get through), block membranes
what are the features of nephritic syndrome
haematuria and hypertension
what are the features of nephrotic syndrome
heavy proteinuria: non dependent oedema, hyperlipideamia
also loose antibodies, complement and clotting cascade = immunosuppression and renal vein thrombosis
how do you classify GMN
light microscopy
electron microscopy
immunoflouresence
whether they cause nephritic/ nephrotic- are proliferative/ non proliferative
what are cresents
very bad prognostic signs= indicate rapidly progressive GMN
what causes granulomas in GMN
GPA, sarcoid
what is usually seen in light microscopy in all GMN types
hypercellularity (inflammatory cells and reactive proliferations) (= inflammation)
what is usually seen in electron microscopy in GMN
(allows you to see BM)
deposits of immune complexes whether they are subepithelial (in/ around podocytes)/ sub endothelial / mesangial
what does IMF show you
what kind of antibody and what distribution (IgG, IgM, IgA)
what does good pastures look like on IMF
linear IgG deposition
who gets minimal change GMN
children
what are the features of minimal change GMN
nephrotic syndrome
what is the Tx for minimal change GMN
usually resolves with steroids
what causes focal segmental glomerulosclerosis (FSGS)
obesity, HIV, sickle cell, IV drug users (esp heroin)
who gets FSGS GMN
adults with risk factors (can affect children)
what is the presentation of FSGS
nephritic syndrome (can cause nephrotic but less likely)
what is the appearance of FSGS
focal (just in glomeruli)
segmental (not whole glomeruli)
glomerulosclerosis
what is the prognosis for FSGS
v variable
what causes membranous GMN
infection (hepatitis, malaria, syphilis)
drugs (penicillamine, NSAID, captopril, gold)
malignancy (lung, colon, melanoma)
lupus (15% of all GMN in lupus)
autoimmune disease (thyroiditis)
who gets membranous GMN
adults with risk factors
what is the presentation of membranous GMN
nephrotic (can sometimes be nephritic)
what is the appearance of membranous GMN
thick membranes sub-epithelial immune deposits (makes BM look spikey)
what is the prognosis of membranous GMN
variable- slow indolent progression, less than 40% eventually develop renal failure
what is the cause of IgA GMN
genetic/ acquired defect (coeliac)
who gets IgA GMN
people get it after an infection (commonly strep)
how does IgA GMN present
follows an infection (strep throat)
nephritic syndrome
what is the appearance of IgA GMN
IgA deposition in mesangium
what is the test for coeliac disease
anti TTG
what is the prognosis of IgA GMN
variable depending on severity
what causes membranoproliferative GMN
idiopathic (type 2 - infection, lupus, malignancy (hodgkins lymphoma))
what is the presentation of membranoproliferative GMN
either nephritic/ nephrotic
who gets membranoproliferative GMN
adults and children
what is the appearance of membranoproliferative GMN
big lobulated hypercellular glomeruli with thick membranes (look like tram tracks due to the duplication of the BM)
what is the prognosis of membranoproliferative GMN
depends on severity
how does diabetes affect the kidney
diffuse/ nodular glomerulosclerosis
nodules- kimmel stiel wilson lesion
microvascular disease (arterial sclerosis)
infection- pyelonephritis, papillary necrosis
what are the types of cysts in the liver
congenital
inherited (polycystic
acquired
what are a lot of early renal cancers
cystic/ partly cystic
what score predicts renal cancer
bosniak score (5= malignant)
what are the features of an acquired cyst
very common
associated with long term dialysis
simple cysts- attenuated lining
degenrate type of change
(benign)
what are the subtypes of polycystic kidneys
autosomal dominant and recessive PCKD
what are the features of ADPCKD
uncommon
mutation in nephrin
lots of cysts- kidney can be enlarged
secondary changes= haemorrhage, infarction, rupture,
can be bi or uni lateral
what are the cysts like in ADPCKD
lined by a simple epithelium
how does ADPCPKD present
presents as an adult as cysts take while to develop)
mass effect= feel it in flanks- pain, mass like lesion, haematuria (infraction/ rupture)
systemic disease:
- liver cysts
- cerebral aneurysms
- sub arachnoid haemorrhage
what are the features of ARPCKD
several subtypes
all present before 20s
rarer than ADPCKD
kidney is normal size and has a smooth surface
systemic issues= liver cysts
what is the prognosis for ARPCKD
the younger you present the worse your prognosis
neonate subtype fatal
what is xanthogranulomatous pyelonephritis
infection that creates a mass (in kidneys)
what are the benign tumours of the kidney
oncocytoma
what are the malignant tumours of the kidney
chromophobe
clear cell
papillary
collecting duct
what is the paediatric renal tumour
wilms tumour
what are the features of oncocytoma
small, oval and well circumscribed
mahogany brown with a crentral stellate scar
very pink and granular cytoplasma
(benign)
what are the features of chromophobe tumours
v similar to oncocytomas- hard to differentiate
main difference is raisonoid nuclei and perinuclear haloes
(malignant)
what are the features of a papillary tumour
2nd most common renal malignancy
generally low grade
finger like projections
malignant
what are the features of a collecting duct carcinoma
least common c high grade desmoplastic stroma poor survival (malignant)
what are the features of clear cell carcinomas
a.k.a renal cell carcinomas
common
macro- partly cystic, heterogenous surface, bright yellow
micro- clear cells
what are the RF for clear cell carcinomas
obesity +++
genetic influence
what are the presenting complaints of a clear cell carcinoma
haematuria, mass, hypertension (rarely)
how do you stage clear cell cancer
size and invasion of other structures
where does clear cell carcinoma commonly invade
renal vein, extend into vena cava (risk of thromboembolic disease), grow upwards towards the heart
what gene is associates with most sporadic renal cancers
VHL (encodes for HIF- hypoxia inducible factor)
what is the role of VHL anf HIF
Normally VHL ubiquitinates (adds ubiquin) HIF
In low O2 they dissociate and HIF acts as a transcription factor for VEGF, PDGFRB and EPO (erythropoietin)
what cells line the bladder
transitional epithelium (stratified)
this covers all the way from the collecting system of the kidneys to parts of the urethra
what cells are on the surface of the epithelium
umbrella cells
what are common causes of cystitis
infection, aseptic, reactive to catheters
what parasite commonly causes cystitis
schistosomaisis (haematobium)
swims up the urethra
why is schistosomiasis infection so bad
bug not toxic but body cant get rid of it- leaves eggs
causes persistent inflammation
- squamous metaplasia- SCC
how can catheters cause bladder cancer
persistent injury- scarring- squamous metaplasia- SCC
what is aseptic cystitis
persistent symptoms of dysuria (and infection) with consistently negative cultures and urinalysis
what causes aseptic cystitis
unknown- inflammation, congestion, mast cells so maybe hypersensitivity
what is seen pathologically in aseptic cystitis
inflammation, congestion, mast cells
what is cystitis cystica
infolding of the bladder mucosa into cysts (reactive phenomenon- shows inflammation)
(can get it in urethera and ureter aswell)
what is a bladder diverticulae and what can it cause
pouch or sac protruding outwith the bladder wall (can be congenital or acquired)
causes stangant urine- infection, stones and cancer
what happens to the bladder when there is chronic obstruction
become trabeculated (due to working hard) - hypertrophy and hyperplasia
what does a urinary tract obstruction (stone, tumour ect) cause
back pressure:
- collecting system dilates
- renal parenchyma becomes atrophic
- hydronephreisis
when will a urinary tract obstruction affect both kidneys
when blockage is in the bladder or urethera
who gets bladder cancer
relatively common middle age/ elderly no sex predilection smokers +++++++ beta napthyline (dye industry- regulated now)
what cancer do you get in the bladder
transitional cell carcinoma (also adenocarcinoma and squamous)
what are transitional cell carcinomas like
papillary (finger like projections)
can be carcinoma in situ (flat)
what else is at risk in bladder cancer
common to get cancer in whole urinary system as all exposed to the same RF
when do you get adenocarcinomas in the bladder
when there is a background of metaplasia
hard to differentiate from bowel cancer that has invaded through
what is urachal adenocarcinoma
urachus= the remnant of alantosis (what bladders forms from) = from dome of bladder to the umbilicus
adenomas can arise here- confined to dome of bladder
need to resect to umbilicus
why do you get squamous cell cancer in the bladder
persistent inflammation
squamous metaplasia
SCC
what is the role of the prostate
prostatic fluid combines with fluid from seminal vesicles
some contractile function during ejaculation
what is the histology of the prostate
bi layered acinar cells
what is BPH
prostate enlarges due to hormonal effect from androgens, obstructs the flow of urine
(hyperplasia= more cells)
what zone is affected in BPH
central and transitional (why you get transurethral resection as a treatment option)
how common is prostate cancer
@ 50 30% of men
70 70%
90 90%
is prostate cancer aggressive
no
most slow growing and low grade
even when diagnosed only followed up until gets worse
is there a hormonal cause in prostate cancer
less of a link than BPH (so no probably)
where do you get prostate cancer
in the peripheral zones
what biopsy for prostate cancer
transrectal/ rectal core (as most in peripheral gland)
take 10/12 samples - 5/6 from each lobe
what is PSA
glycoprotein enzyme (kallikrein 3) liquidifies semen in ejaculate, allows sperm to swim
why is PSA not an effective marker of prostate cancer
as high grade prostate cancers dont produce PSA
can be increased by prostatits, PR exam, riding a bike, spironolactone or if you have a large prostate
what is PSA useful for
monitoring treatment (decreases as prostate decreases in size)
what score is used to grade prostate cancers
gleason grading system
lowest grade is 6, highest score is ten) (combination of score from both lobes/ beyond the prostate
what is the corpus cavernosum
the erectile tissue of the penis - network of blood vessels
what is the corpus spongiosum
part of penis that contains the urethra (doesnt expand as much during an erection)
why are penile tumours highly associated with mets
as have access to lots of blood vessels
what cells line the foreskin and glans
squamous cells (why can get skin diseases on penis)
what is balanitis xerotic obliterans (BXO)
aka lichen sclerosis
inflammation of the glans penis
who gets BXO
young (neonates, toddlers, primary school children) or elderly
what are the common presentations of BXO
phimosis (unretractable foreskin), paraphimosis (can retract but not replace foreskin)
sore, inflamed and swollen glans/ foreskin
penile ulceration/ plaques
dysuria
what is the histology of BXO
get lichen planus on skin
chronic inflammatory infiltrate
hyalinised scar tissue beneath infiltrate
what virus causes penile papillomas
HPV infection
which HPV causes genital warts
types 6 and 11
what HPV is high risk
types 16 and 18
what neoplasms do you get in the penis
PEin- penile intraspethial neoplasia (same is CIN)
can be differentiate or dedifferentiated
what are the types of penile intraspethial neoplasia associated with
differentiated= non HPV, background of inflammation dedifferentiated= HPV related
what is penile cancer associated with
chronic inflammation
HPV
what is the functional unit of the testes
seminiferous tubules (site of sperm production)
what stimulates sertoli cells
FSH
what does FSH stimulation of sertoli cells cause
produce proteins which bond to testosterone and stimulate spermatogenesis (control the environment within the tubules)
what are germ cells
primitive sperm
what stimulates leydig cells
LH
what do leydig cells do
convert DHEA to testosterone
what is found in the seminferous tubules
germ cells, maturing spematozoa and sertoli cells
what are the common causes of lumps in the testes
hernia
cystocoele
hydrocoele
spermatocoele
adenomatoid tumour
mesothelioma
liposarcoma
what is a hydrocoele
accumulation of fluid around the testes between the tunica vaginalis and the mesothelial lining
what does a hydrocoele look like
unicystic, smooth, fluid filled, well circumscribes, lucent- transilluminable
adjacent to the testes proper
what is a spermatocoele
cystic change within the vas of the epididymis
unknown causes
usually asymptomatic
what is seen in biopsy of spermatocoele
sperm
what is a varicocoele
varicosities of venous plexus that drain the testes
usually asymptomatic
can feel like bag of worms
what should you feel for in a testes exam
if the lump is in the testes or separate
whether in epididymis or separate
can you get above it- if not then likely to be hernia
solid/ unicystic
thin walled, hard, painful etc
what is testicular torsion
emergency
testes and chord rotate around arterial blood supply
causes ischaemia and then cell death
what is the presentation of torsion
extreme pain
no particular precipitant
common in neonates and adolescents
occurring as much in sleep as it does in sport
what is a bell clapper deformity
when the insertion of the tunica vaginalis is high
the testes can rotate and even sit laterally (as not as well encased by TV)
more likely to get torsion
who gets testicular neoplasms
20-50s
what is the prognosis for testicular cancer
generally good
often found in early stages
even when advanced is responsive to chemo/ radio therapy
what are the two main groups of testicular cancer
seminomatous and non semimatous (can get mixed of these in tumours)
what do seminomas look like
potato
white consistent colour
what is the most common type of testicular cancer
seminoma
who gets seminoma
40 y/os
what are the RFs for a seminoma
undescended testes - contralateral testes will also share risk
what is the histology of a seminoma
inflammatory infilrates
arises from germ cells
what is the prognosis for a seminoma
95% cure rate
v responsive to radiotherapy even when advances
usually localised
what is a non seminomatous tumour like
less common than semi
affects younger age group 30s
far more aggressive than semi, can metastasise
what is the histology of a non seminoamtous testicular neoplasm
cystic change and haemorrhage
what is the prognosis for a non seminomatous testicular cancer
reasonable- very chemo sensitive
have to treat v early, can spread in days
what are the four types of non seminomatous testicular tumours
mature teratoma (3 germ layer: endo, meso and ecto) (all classified as malignant)
yolk sac tumour
embryonal (aggressive, high grade, associated with mets)
trophoblastic (choriocarcinoma)
what are the tumour markers for most non seminomatous tumours
LDH
what is the tumour marker for a yolk sac tumour
alpha feto protein
what is the tumour marker for a trophoblastic tumour (choriocarcinoma)
beta HCG (men with positive pregnancy tests)
what is pyelonephritis
infection (bacterial) of the kidneys
what predisposes to pyelonephritis
catheters urinary retention developmental abnormalities (e.g. horseshoe kidney) women (short urethera) renal parenchyma
what organisms usually cause UTIs
gut organisms- coliforms (e. coli)
what vasculitis can cause glomerulonephritis
GPA
HSP
what is the most common renal tumour in children
nephroblastoma
what does clear cell carcinoma arise from
nephron
what staging score system for prostate cancer
gleeson
where does prostate cancer metastasise to
bones
what is a germ cell tumour
the other name for non seminoma testicular cancers
