Pathology Flashcards
What name is given to an infective cause of nephritis?
Pyelonephritis
What name is given to a non-infective nephritis?
Glomerulonephritis
What structure is most important at holding the glomerulus together?
Mesangial Cells
What other name is given to the podocytes which surround the glomerulus?
Visceral epithelium
Why does immune related inflammation occur in the glomerulus?
- immune response is directed at something in the glomerulus
- circulating complexes get stuck in the sieve
Immune reactions in what neighbouring structures can have glomerulonephritic effect?
Vasculitis in the afferent/efferent arteriole
NOTE - not in glomerulus itself
Give an example of an immune condition which attacks the glomerulus directly?
Good pasture’s syndrome
What is goodpastures syndrome?
IgG antibodies against a subunit of Collagen 4
This type of collagen is found in the glomerular basement membrane
=> attacks the glomerular basement membrane found in kidneys (and also lungs)
What can cause circulating immune complexes to deposit in the kidney?
Infection (Hepatitis, Group A Strep, HIV)
Drugs (Gold, Pencillamine)
Cancer (immune response mounted to “foreign” cancer cells)
What types of vasculitis are most likely to cause glomerulonephritis?
Granulomatosis with Polyangiitis (GPA) - cANCA
Microscopic polyangiitis – pANCA
What is the difference between c-ANCA and p-ANCA?
c-ANCA = cytoplasmic anti-neutrophil cytosplasmic antibody
p-ANCA = perinuclear anti-neutorphil cytoplasmic antibody
What are the main differences between Nephritic and Nephrotic syndrome?
Nephritic – haematuria, hypertension
Nephrotic – heavy proteinuria, oedema, hyperlipideamia
All causes of glomerulonephritis will cause wither a nephrotic or nephritic syndrome. TRUE/FALSE?
TRUE
What investigations can be used to classify glomerulonephritis?
Light microscopy
Electron microscopy (black and white)
Immunoflouresence
Crescents on light microscopy represent a good prognosis. TRUE/FALSE?
FALSE
Indicate rapidly progressive disease which could result in renal failure
What would be seen on Light microscopy in GPA causing glomerulonephritis?
Granulomas
Electron microscopy uses a high magnification to look for deposits in the basement membrane. Where are these usually found?
Subepithelial
Mesangial
Subendothelial
Why is immunofluorescence particularly useful in diagnosis goodpastures syndrome?
Can easily visualise the linear IgG deposition along the basement membrane
Who develops minimal change syndrome?
Kids
Does minimal change syndrome cause nephritic or nephrotic syndrome?
Nephrotic
children present with very puffy, oedematous faces
Is the prognosis for Minimal change good or bad?
Good (due to MINIMAL change)
Resolves after steriods
What is FSGS?
Focal Segmental GlomeruloSclerosis
Who gets FSGS?
Adults
Risks:
- obesity
- HIV
- sickle cell
- IVDUs
Describe what FSGS means?
Focal => not all glomeruli affected
Segmental => of the glomeruli affected, not ALL of one glomerulus is affected
Sclerosis => stiffening
What can cause membranous glomerulonephritis?
– Infection (hepatitis, malaria, syphilis) – Drugs (NSAID, gold, penicillamine) – Malignancy (lung, colon,melanoma) – Lupus – Autoimmune thyroiditis
Lupus can cause any type of glomerulonephritis. TRUE/FALSE?
TRUE
What age group usually develop membranous glomerulonephritis?
Adults
Do patients with membranous glomerulonephritis eventually develop nephrotic or nephritic syndrome?
Nephrotic
How does membranous glomerulonephritis appear under the microscope?
thick membranes (spiky) Sub-epithelial immune deposits
What is the prognosis of membranous glomerulonephritis like?
- variable
- Disease has slow progression
- <40% eventually develop renal failure
What type of stain is used to diagnose membranous glomerulonephritis?
Silver stain
Spiky membrane
White/negative space indicates immune deposits in the basement membrane
What can predispose to IgA glomerulonephritis ?
genetic
acquired defect – coeliac
What group of patients develop an IgA glomerulonephritis?
Post infection
- usually Group A strep. throat
Does IgA glomerulonephritis usually cause a nephrotic or nephritic syndrome?
Nephritic
How does IgA glomerulonephritis look under the microscope?
IgA deposition in mesangium
Prognosis of IgA glomerulonephritis varies. TRUE/FALSE?
TRUE
varies depending on severity
What usually causes Membranoproliferative glomerulonephritis?
idiopathic
OR if Type 2 => infection, lupus, malignancy
Usually only adults develop membranoproliferative glomerulonephritis. TRUE/FALSE?
FALSE
both adults AND kids develop this
In membranoproliferative glomerulonephritis, do you develop nephrotic or nephritic syndrome?
can develop EITHER!
one or the other
How does membranoprliferative glomerulonephritis look under the microscope?
Large lobulated glomeruli
thick DUPLICATED membranes => tram tracks
Diabetes can predispose to what disease processes in the kidney?
Diffuse and Nodular Glomerulosclerosis
Nodules – Kimmel Stiel Wilson Lesion
Microvascular disease – arterial sclerosis
Infection – pyelonephritis, papillary necrosis
Why are the differentials for cystic kidney diseases difficult?
early cancers are cystic or partly cystic
=> more difficult to identify cancer EARLY
What score can be used by radiology to predict the probability of a cyst being cancerous?
Bosniak score
Acquired cysts are so common that they are often seen on autopsy. TRUE/FALSE?
TRUE
What long term treatment can predispose to acquired renal cysts?
Long term dialysis
What are the two main subtypes of Polycystic Kidney Disease?
Autosomal Dominant
Autosomal Recessive
When does Autosomal Dominant Polycystic Kidney Disease usually present?
Adulthood as cysts take a while to develop
What complications can occur in Autosomal dominant polycystic kidney disease?
Kidneys can become HUGE
Cysts can rupture (due to simple epithelium lining)
Cyst can infarct or haemorrhage also
What is the normal presenting complaint in Autosomal dominant polycystic kidney disease?
Mass like lesion (due to growth of kidney)
Pain/haematuria - due to rupture, infarction of cyst
What other parts of the body can become affected in autosomal dominant polycystic kidney disease?
liver cysts and cerebral aneursyms
Who usually presents with Autosomal Recessive Polycystic Kidney Disease?
Children
younger presentation = worse prognosis
What is difference about the appearance of the kindey in Autosomal Recessive Polycystic Kidney Disease?
Kidney is of normal size and has a smooth surface
What disease process is known to create a mass specifically associated with infection?
Xanthogranulomatous pyelonephritis
Name a benign renal tumour
Oncocytoma
Name 4 types of malignant renal tumour.
Chromophobe
Papillary
Collecting duct Carcinoma
Clear cell carcinoma
Name a type of renal tumour which specifically presents in children
Paediatric tumour – Wilm’s tumour
Describe the macroscopic appearance of an oncocytoma
Small, oval and well circumscribed
Mahogany brown with a central scar
Deescribe the microscopic appearance of an oncocytoma
Full of Oncocytes – big pink cells
Fluffy cytoplasm - full of mitochondria
What malignant renal tumour looks similar to oncocytoma on histology?
CHromophobe
Describe the histological appearance of a chromophobe which causes it to differ from a Oncocytoma?
Oncocytic
- raisonoid nuclei
- perinuclear haloes (white around the nuclei)
Papillary renal tumours are typically high grade. TRUE/FALSE?
FALSE
Low grade (1/2)
Low potential for metastases
Describe the microscopic appearance of a Collecting Duct carcinoma and state whether it is High or Low grade.
desmoplastic stroma (new growth of dense CT and unstable blood vessels)
High grade
What cancer do people usually mean when they refer to a “Renal Cell Cancer”?
Clear cell carcinoma
What risk factors can predispose someone to clear cell carcinoma?
obesity
genetics
What is the most common presenting complaint in clear cell carcinoma?
haematuria
noticeable mass
hypertension (RARE)
Describe the macroscopic appearance of a clear cell carcinoma?
- partly cystic
- bright yellow tumour surface
How does a clear cell carcinoma appear microscopically and why is this?
Cells look “clear”
Due to hypoxia in the process of visualisation under the microscope
Where can clear cell carcinoma invade into?
Renal vein
Can track up IVC to heart
What gene is important for many sporadic renal cancers?
VHL - Von Hippel Lindau
How is VHL involved in the development of renal cancers?
- VHL codes for HIF - hypoxia inducible factor
- Usually VHL modifies the proteins on HIF
However, in low O2, they dissociate and HIF acts as a transcription factor for VEGF, EPO etc
=> causing cancers to grow
What links the citric acid cycle to renal cancers?
A mutation in any part of the citric acid cycle can predispose to the development of a renal cancer
What features can be seen in Von Hippel Lindau SYNDROME?
- Renal Cell Carcinoma (KIDNEY)
- Cerebellar haemangioblastoma (BRAIN)
- Pancreatic serous cystadenoma (PANCREAS)
- Tumours of endolymphatic sac (EAR)
- Epididymal serous cystadenomas (TESTES)
What structures are covered by urothelium?
bladder
ureters
collecting system in the kidney
urethra
Cystitis is rarely biopsied. TRUE/FALSE?
TRUE
What parasite is known to cause cystitis?
Schistosomiasis
most likely schistosomiasis haematobium
What causes the inflammation in schistosomiasis cystitis?
the body’s immune response to the parasite
NOT the parasite itself (it does not release any toxins)
What can be left behind after chistosomiasis is cleared?
Eggs (which calcify)
these can then cause a persistent immune response
What can the inflammation in schistosomiasis cause?
Squamous metaplasia (changes from transitional to squamous epithelium to help deal with the inflammation)
Squamous metaplasia can eventually develop into what?
Squamous cell carcinomas
What is the main iatrogenic cause of persistant inflammation, leading to squamous metaplasia?
Indwelling catheters
Why is it a problem if patients with inflammation in their bladder are paraplegic?
They cant feel the symptoms of inflammation
=> wont present to their doctor
=> more likely to present with SCC
What is aseptic/interstitial cystitis?
- Persistent dysuria symptoms
- Persistently negative cultures and urinalysis
- thought to maybe be a hypersensitivity reaction
What can be seen on aseptic/interstitial cystitis pathology?
Variable pathology
sometimes mast cells = visible
What is meant by cystitis cystica?
Infolding of bladder mucosa into cysts
What is the risk with Diverticulae in the bladder?
stagnant urine sits in the out-pouching:
infection
stones
cancer
What changes can occur in the bladder post-obstruction?
Bladder muscle works hard and becomes trabeculated
hyperplasia and hypertrophy occurs
Eventual persistent back pressure
What is the last point affected by back pressure of urine?
Collecting system dilates
Renal parenchyma becomes atrophic
=> This is Hydronephrosis
What is the main cause of transitional cell cancer?
smoking
due to carcinogens/ waste sitting in the bladder
What previous industry predisposed to transitional cell cancer?
Beta-naphthyline – dye industry
What are the main types of transitional cell cancer which are seen in the urinary tract
Papillary – finger like projections
Carcinoma In Situ – flat
When can adenocarcinoma occur in the bladder?
- After glandular metaplasia
- colon cancer that has invaded through
- Urachal Adenocarcinoma (from embryonic remnant)
What are the main functions of the prostate?
- prostatic fluid
- add fluid from seminal vesicles
- contractile function during ejaculation
What is hyperplasia and what is the stimulus for this in the prostate?
Increase in cell number in response to a stimulus
Stimulus = androgens
How is BPH treated and why?
transurethral resection (shaving away part of the prostate from the centre of the prostatic urethra)
- have to get to the centre of the prostate to reach the transitional zone which enlarges in BPH
Some prostatic cancers grow so slowly that they are not given any treatment. TRUE/FALSE?
TRUE
only follow up
What is PSA?
Prostate Specific Antigen
- Glycoprotein enzyme
Some very nasty cancers dont produce PSA. TRUE/FALSE?
TRUE
Give an example of a drug which can increase PSA level?
spironolactone
Why is the urethra located in the corpus spongiosum and not the corpus cavernosum?
So that it is not constricted in the erectile tissue and is patent for sperm to pass through at ejaculation
What parts of penile tissue are covered by squamous epithelium?
Glans
Foreskin
Distal urethra
Who usually gets Balanitis Xerotic Obliterans?
Young males
even neonates, toddlers
What is the difference between Phimosis and paraphimosis?
phimosis - cant retract foreskin
paraphimosis - can retract foreskin but cant restore it to normal position
What is often the cause of penile papillomas?
HPV infection
What strains of HPV can cause genital warts?
HPV 6 and 11
What strains of HPV are particularly high risk?
HPV 16 and 18
What is penile intra-epthelial neoplasia?
dysplastic process related to cervical intra-ep. neoplasia
Can eventually form cancer
What are the two types of penile intra-epithelial neoplasia?
Differentiated – non HPV
Dedifferentiated – HPV related
Penile cancer is relatively uncommon. TRUE/FALSE?
TRUE
Mainly HPV related
Describe the appearance of seminiferous tubules on histology?
Primitive sperm generation from germ cells at edge
sertoli cells maturing sperm
Mature sperm in middle
Pink fluffy cells round outside = leydig cells
What hormones influence sertoli and leydig cells?
Sertoli FSH
Leydig LH
What is the role of leydig cells?
convert testosterone to DHEA (more active)
What is a hydrocoele?
fluid around the testes
Between the two layers of the tunica vaginalis
How do hydrocoeles appear?
Unicystic, smooth and fluid filled can transilluminate (shine light through them)
What is a spermatocoele and when is it ususally found?
Cystic change within the vas of the epididymis
Pts feel a fullness on self-examination
What can be seen on histology of a spermatocoele?
Sperm and some macrophages
What is a varicocoele?
Varicosities of venous plexus that drains the testis
How do patients describe a varicoele as feeling on self-examination?
like a “bag of worms”
If you feel a testicular lump but you cannot palpate above it, it has likely descended from the abdomen. What is it likely to be?
Hernia
What is testicular torsion?
Testis and cord rotate around arterial supply
=> ischaemia
After what point in testicular torsion is the testis thought to no longer be viable?
> 6hrs
What is the prognosis like for testicular cancer?
good prognosis – even at advanced stage
Very responsive to chemo
How does a seminoma appear macroscopically?
looks like a potato
At what age do patients normally develop a seminoma?
40 (older than others)
What it the main risk factor for seminoma?
undescended testes
/ orchidopexy
Seminomas respond to radiotherapy even if they are advanced. TRUE/FALSE?
TRUE
Non seminomatous tumours rarely exist as “pure” tumours, they are often mixed with seminomas or other types. TRUE/FALSE?
TRUE
Who is at risk of developing non-seminomatous tumours?
<30
Are non-seminomatous tumours usually more advanced than seminomas?
Yes = more aggressive and can metastasize
BUT outcome is reasonable – very chemosensitive
What is needed for a diagnosis of Mature teratoma?
three germ layers present on histology
Ecto, endo and mesoderm
Where else can teratomas occur?
OVARIES (except they are usually benign there)
What tumour marker is produced by yolk sac tumours?
alpha feto protein
What tumour marker is secreted by trophoblasts/choriocarcinomas?
beta HCG (human chorionic gonadotrophin) positive pregnancy test
What is the most aggresive form of non-seminomatous tumour?
Embryonal – high grade with freq mets
