Pathology Flashcards
1
Q
What name is given to an infective cause of nephritis?
A
Pyelonephritis
2
Q
What name is given to a non-infective nephritis?
A
Glomerulonephritis
3
Q
What structure is most important at holding the glomerulus together?
A
Mesangial Cells
4
Q
What other name is given to the podocytes which surround the glomerulus?
A
Visceral epithelium
5
Q
Why does immune related inflammation occur in the glomerulus?
A
- immune response is directed at something in the glomerulus
- circulating complexes get stuck in the sieve
6
Q
Immune reactions in what neighbouring structures can have glomerulonephritic effect?
A
Vasculitis in the afferent/efferent arteriole
NOTE - not in glomerulus itself
7
Q
Give an example of an immune condition which attacks the glomerulus directly?
A
Good pasture’s syndrome
8
Q
What is goodpastures syndrome?
A
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)
9
Q
What can cause circulating immune complexes to deposit in the kidney?
A
Infection (Hepatitis, Group A Strep, HIV)
Drugs (Gold, Pencillamine)
Cancer (immune response mounted to “foreign” cancer cells)
10
Q
What types of vasculitis are most likely to cause glomerulonephritis?
A
Granulomatosis with Polyangiitis (GPA) - cANCA
Microscopic polyangiitis – pANCA
11
Q
What is the difference between c-ANCA and p-ANCA?
A
c-ANCA = cytoplasmic anti-neutrophil cytosplasmic antibody
p-ANCA = perinuclear anti-neutorphil cytoplasmic antibody
12
Q
What are the main differences between Nephritic and Nephrotic syndrome?
A
Nephritic – haematuria, hypertension
Nephrotic – heavy proteinuria, oedema, hyperlipideamia
13
Q
All causes of glomerulonephritis will cause wither a nephrotic or nephritic syndrome. TRUE/FALSE?
A
TRUE
14
Q
What investigations can be used to classify glomerulonephritis?
A
Light microscopy
Electron microscopy (black and white)
Immunoflouresence
15
Q
Crescents on light microscopy represent a good prognosis. TRUE/FALSE?
A
FALSE
Indicate rapidly progressive disease which could result in renal failure
16
Q
What would be seen on Light microscopy in GPA causing glomerulonephritis?
A
Granulomas
17
Q
Electron microscopy uses a high magnification to look for deposits in the basement membrane. Where are these usually found?
A
Subepithelial
Mesangial
Subendothelial
18
Q
Why is immunofluorescence particularly useful in diagnosis goodpastures syndrome?
A
Can easily visualise the linear IgG deposition along the basement membrane
19
Q
Who develops minimal change syndrome?
A
Kids
20
Q
Does minimal change syndrome cause nephritic or nephrotic syndrome?
A
Nephrotic
children present with very puffy, oedematous faces
21
Q
Is the prognosis for Minimal change good or bad?
A
Good (due to MINIMAL change)
Resolves after steriods
22
Q
What is FSGS?
A
Focal Segmental GlomeruloSclerosis
23
Q
Who gets FSGS?
A
Adults
Risks:
- obesity
- HIV
- sickle cell
- IVDUs
24
Q
Describe what FSGS means?
A
Focal => not all glomeruli affected
Segmental => of the glomeruli affected, not ALL of one glomerulus is affected
Sclerosis => stiffening
25
What can cause membranous glomerulonephritis?
```
– Infection (hepatitis, malaria, syphilis)
– Drugs (NSAID, gold, penicillamine)
– Malignancy (lung, colon,melanoma)
– Lupus
– Autoimmune thyroiditis
```
26
Lupus can cause any type of glomerulonephritis. TRUE/FALSE?
TRUE
27
What age group usually develop membranous glomerulonephritis?
Adults
28
Do patients with membranous glomerulonephritis eventually develop nephrotic or nephritic syndrome?
Nephrotic
29
How does membranous glomerulonephritis appear under the microscope?
```
thick membranes (spiky)
Sub-epithelial immune deposits
```
30
What is the prognosis of membranous glomerulonephritis like?
- variable
- Disease has slow progression
- <40% eventually develop renal failure
31
What type of stain is used to diagnose membranous glomerulonephritis?
Silver stain
Spiky membrane
White/negative space indicates immune deposits in the basement membrane
32
What can predispose to IgA glomerulonephritis ?
genetic
| acquired defect – coeliac
33
What group of patients develop an IgA glomerulonephritis?
Post infection
| - usually Group A strep. throat
34
Does IgA glomerulonephritis usually cause a nephrotic or nephritic syndrome?
Nephritic
35
How does IgA glomerulonephritis look under the microscope?
IgA deposition in mesangium
36
Prognosis of IgA glomerulonephritis varies. TRUE/FALSE?
TRUE
| varies depending on severity
37
What usually causes Membranoproliferative glomerulonephritis?
idiopathic
| OR if Type 2 => infection, lupus, malignancy
38
Usually only adults develop membranoproliferative glomerulonephritis. TRUE/FALSE?
FALSE
| both adults AND kids develop this
39
In membranoproliferative glomerulonephritis, do you develop nephrotic or nephritic syndrome?
can develop EITHER!
| one or the other
40
How does membranoprliferative glomerulonephritis look under the microscope?
Large lobulated glomeruli
| thick DUPLICATED membranes => tram tracks
41
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
42
Why are the differentials for cystic kidney diseases difficult?
early cancers are cystic or partly cystic
| => more difficult to identify cancer EARLY
43
What score can be used by radiology to predict the probability of a cyst being cancerous?
Bosniak score
44
Acquired cysts are so common that they are often seen on autopsy. TRUE/FALSE?
TRUE
45
What long term treatment can predispose to acquired renal cysts?
Long term dialysis
46
What are the two main subtypes of Polycystic Kidney Disease?
Autosomal Dominant
| Autosomal Recessive
47
When does Autosomal Dominant Polycystic Kidney Disease usually present?
Adulthood as cysts take a while to develop
48
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
49
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
50
What other parts of the body can become affected in autosomal dominant polycystic kidney disease?
liver cysts and cerebral aneursyms
51
Who usually presents with Autosomal Recessive Polycystic Kidney Disease?
Children
| younger presentation = worse prognosis
52
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
53
What disease process is known to create a mass specifically associated with infection?
Xanthogranulomatous pyelonephritis
54
Name a benign renal tumour
Oncocytoma
55
Name 4 types of malignant renal tumour.
Chromophobe
Papillary
Collecting duct Carcinoma
Clear cell carcinoma
56
Name a type of renal tumour which specifically presents in children
Paediatric tumour – Wilm’s tumour
57
Describe the macroscopic appearance of an oncocytoma
Small, oval and well circumscribed
| Mahogany brown with a central scar
58
Deescribe the microscopic appearance of an oncocytoma
Full of Oncocytes – big pink cells
| Fluffy cytoplasm - full of mitochondria
59
What malignant renal tumour looks similar to oncocytoma on histology?
CHromophobe
60
Describe the histological appearance of a chromophobe which causes it to differ from a Oncocytoma?
Oncocytic
- raisonoid nuclei
- perinuclear haloes (white around the nuclei)
61
Papillary renal tumours are typically high grade. TRUE/FALSE?
FALSE
Low grade (1/2)
Low potential for metastases
62
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
63
What cancer do people usually mean when they refer to a "Renal Cell Cancer"?
Clear cell carcinoma
64
What risk factors can predispose someone to clear cell carcinoma?
obesity
| genetics
65
What is the most common presenting complaint in clear cell carcinoma?
haematuria
noticeable mass
hypertension (RARE)
66
Describe the macroscopic appearance of a clear cell carcinoma?
- partly cystic
| - bright yellow tumour surface
67
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
68
Where can clear cell carcinoma invade into?
Renal vein
| Can track up IVC to heart
69
What gene is important for many sporadic renal cancers?
VHL - Von Hippel Lindau
70
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
71
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
72
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)
73
What structures are covered by urothelium?
bladder
ureters
collecting system in the kidney
urethra
74
Cystitis is rarely biopsied. TRUE/FALSE?
TRUE
75
What parasite is known to cause cystitis?
Schistosomiasis
| most likely schistosomiasis haematobium
76
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)
77
What can be left behind after chistosomiasis is cleared?
Eggs (which calcify)
| **these can then cause a persistent immune response**
78
What can the inflammation in schistosomiasis cause?
```
Squamous metaplasia
(changes from transitional to squamous epithelium to help deal with the inflammation)
```
79
Squamous metaplasia can eventually develop into what?
Squamous cell carcinomas
80
What is the main iatrogenic cause of persistant inflammation, leading to squamous metaplasia?
Indwelling catheters
81
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
82
What is aseptic/interstitial cystitis?
- Persistent dysuria symptoms
- Persistently negative cultures and urinalysis
- thought to maybe be a hypersensitivity reaction
83
What can be seen on aseptic/interstitial cystitis pathology?
Variable pathology
| sometimes mast cells = visible
84
What is meant by cystitis cystica?
Infolding of bladder mucosa into cysts
85
What is the risk with Diverticulae in the bladder?
stagnant urine sits in the out-pouching:
infection
stones
cancer
86
What changes can occur in the bladder post-obstruction?
Bladder muscle works hard and becomes trabeculated
hyperplasia and hypertrophy occurs
Eventual persistent back pressure
87
What is the last point affected by back pressure of urine?
Collecting system dilates
Renal parenchyma becomes atrophic
=> This is Hydronephrosis
88
What is the main cause of transitional cell cancer?
smoking
| due to carcinogens/ waste sitting in the bladder
89
What previous industry predisposed to transitional cell cancer?
Beta-naphthyline – dye industry
90
What are the main types of transitional cell cancer which are seen in the urinary tract
Papillary – finger like projections
| Carcinoma In Situ – flat
91
When can adenocarcinoma occur in the bladder?
- After glandular metaplasia
- colon cancer that has invaded through
- Urachal Adenocarcinoma (from embryonic remnant)
92
What are the main functions of the prostate?
- prostatic fluid
- add fluid from seminal vesicles
- contractile function during ejaculation
93
What is hyperplasia and what is the stimulus for this in the prostate?
Increase in cell number in response to a stimulus
| Stimulus = androgens
94
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
95
Some prostatic cancers grow so slowly that they are not given any treatment. TRUE/FALSE?
TRUE
| only follow up
96
What is PSA?
Prostate Specific Antigen
| - Glycoprotein enzyme
97
Some very nasty cancers dont produce PSA. TRUE/FALSE?
TRUE
98
Give an example of a drug which can increase PSA level?
spironolactone
99
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
100
What parts of penile tissue are covered by squamous epithelium?
Glans
Foreskin
Distal urethra
101
Who usually gets Balanitis Xerotic Obliterans?
Young males
| even neonates, toddlers
102
What is the difference between Phimosis and paraphimosis?
phimosis - cant retract foreskin
| paraphimosis - can retract foreskin but cant restore it to normal position
103
What is often the cause of penile papillomas?
HPV infection
104
What strains of HPV can cause genital warts?
HPV 6 and 11
105
What strains of HPV are particularly high risk?
HPV 16 and 18
106
What is penile intra-epthelial neoplasia?
dysplastic process related to cervical intra-ep. neoplasia
| Can eventually form cancer
107
What are the two types of penile intra-epithelial neoplasia?
Differentiated – non HPV
| Dedifferentiated – HPV related
108
Penile cancer is relatively uncommon. TRUE/FALSE?
TRUE
| Mainly HPV related
109
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
110
What hormones influence sertoli and leydig cells?
Sertoli FSH
| Leydig LH
111
What is the role of leydig cells?
convert testosterone to DHEA (more active)
112
What is a hydrocoele?
fluid around the testes
| Between the two layers of the tunica vaginalis
113
How do hydrocoeles appear?
```
Unicystic, smooth and fluid filled
can transilluminate (shine light through them)
```
114
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
115
What can be seen on histology of a spermatocoele?
Sperm and some macrophages
116
What is a varicocoele?
Varicosities of venous plexus that drains the testis
117
How do patients describe a varicoele as feeling on self-examination?
like a "bag of worms"
118
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
119
What is testicular torsion?
Testis and cord rotate around arterial supply
| => ischaemia
120
After what point in testicular torsion is the testis thought to no longer be viable?
>6hrs
121
What is the prognosis like for testicular cancer?
good prognosis – even at advanced stage
Very responsive to chemo
122
How does a seminoma appear macroscopically?
looks like a potato
123
At what age do patients normally develop a seminoma?
40 (older than others)
124
What it the main risk factor for seminoma?
undescended testes
| / orchidopexy
125
Seminomas respond to radiotherapy even if they are advanced. TRUE/FALSE?
TRUE
126
Non seminomatous tumours rarely exist as “pure” tumours, they are often mixed with seminomas or other types. TRUE/FALSE?
TRUE
127
Who is at risk of developing non-seminomatous tumours?
<30
128
Are non-seminomatous tumours usually more advanced than seminomas?
Yes = more aggressive and can metastasize
| BUT outcome is reasonable – very chemosensitive
129
What is needed for a diagnosis of Mature teratoma?
three germ layers present on histology
| Ecto, endo and mesoderm
130
Where else can teratomas occur?
OVARIES (except they are usually benign there)
131
What tumour marker is produced by yolk sac tumours?
alpha feto protein
132
What tumour marker is secreted by trophoblasts/choriocarcinomas?
```
beta HCG (human chorionic gonadotrophin)
positive pregnancy test
```
133
What is the most aggresive form of non-seminomatous tumour?
Embryonal – high grade with freq mets
