Renal, Genitourinary & Breast Pathology Flashcards

1
Q

Kidney – Function
Structurally complex - —% of body weight, but filters —% of blood through glomeruli

A

0.4
25

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2
Q

Excretes nitrogenous waste products of metabolism - cleans the blood – turns — L into urine

A

1.5

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3
Q

Kidney Function
 Regulates (2)
 Maintains appropriate —- balance
 Endocrine organ – secretes —

A

body water and electrolytes
acid-base
hormones

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4
Q

 Endocrine organ – secretes hormones
 Renin –
 Erythropoietin –

A

blood pressure
proliferative effect on bone marrow to make RBCs

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5
Q

Nephron – Functional Unit
Morphologic Components
(3)

A

 Glomeruli
 Convoluted tubules
 Collecting ducts

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6
Q

Juxtaglomerular cells in wall of afferent arteriole
 Sensor for

A

blood pressure

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7
Q

Macula densa in wall of distal convoluted tubule
 Sensor for

A

sodium

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8
Q

Azotemia – Laboratory Findings
(4)

A

 Elevation of blood urea nitrogen and creatinine levels
 Usually related to reduced glomerular filtration rate (GFR)
 Associated with many primary renal disorders
 May also be associated with extra-renal disorders

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9
Q

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 Pre-renal azotemia –

A

hypoperfusion of the kidneys decreases GFR in the
absence of parenchymal damage

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10
Q

 Post-renal azotemia –

A

urine flow obstructed below the level of the kidney

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11
Q

Uremia – Clinical Findings
(3)

A

 Progression of azotemia to produce clinical manifestations and systemic
biochemical abnormalities
 Failure of renal excretory function
 Metabolic and endocrine alterations

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12
Q

skipped
Uremia
Secondary involvement of organ systems
(4)

A

 Uremic gastroenteritis
 Peripheral neuropathy
 Uremic fibrinous pericarditis
 Uremic stomatitis

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13
Q

 Nephrotic syndrome –

A

(glomerular syndrome) – heavy proteinuria,
hypoalbuminemia, severe edema, hyperlipidemia and lipiduria

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14
Q

 Nephritic syndrome –

A

(glomerular syndrome) – acute onset of grossly-
visible hematuria, mild-to-moderate proteinuria, azotemia, edema and
hypertension (classic presentation of acute post-streptococcal
glomerulonephritis)

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15
Q

 Acute renal failure –

A

oliguria or anuria with recent onset of azotemia. May
result from glomerular injury or acute tubular necrosis

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16
Q

 Chronic renal failure –

A

prolonged symptoms and signs of uremia – the end
result of all renal disease

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17
Q

 Urinary tract infections –

A

bacteriuria and pyuria –
symptomatic or asymptomatic - kidney (pyelonephritis)
or bladder (cystitis)

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18
Q

 Nephrolithiasis –

A

kidney stones - colic, hematuria

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19
Q

Nephrotic Syndrome
(7)

A

 Glomerular syndrome
 A non-specific disorder in which the kidneys are damaged, causing them to leak large
amounts of protein from the blood into the urine.
 Heavy proteinuria
 Hypoalbuminemia
 Severe edema
 Hyperlipidemia
 Lipiduria

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20
Q

Nephritic Syndrome
(8)

A

 Glomerular syndrome
 A non-specific disorder in which the kidneys are damaged, causing them to leak protein and red blood cells from the
blood into the urine.
 Acute onset
 Grossly-visible hematuria
 Mild-to-moderate proteinuria
 Azotemia
 Edema
 Hypertension

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21
Q

 Glomerulonephritis -
def
tx

A

an immune mediated disease of
the renal glomeruli
 Treated with steroids

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22
Q

 Pyelonephritis -
def
tx

A

an infection of the kidney (not the
glomerulus) usually caused by bacteria and of
retrograde origin
 Treated with antibiotics

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23
Q

Post-Streptococcal Glomerulonephritis
(Postinfectious Glomerulonephtitis)
(2)

A

 Acute onset of nephritic syndrome in 9-14 days following
Streptococcal infection
 Type III immune injury (Immune complex-mediated inflammation)

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24
Q

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Pyelonephritis
Pathway of Renal Infection
 Hematogenous dissemination –
 Ascending infection –
 Fecal bacteria from —
 Culture and sensitivity –
 Pyelonephritis is much more common than —

A

least common
most common
perineal area
Bactrim
glomerulonephritis

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25
Q

Kidney Stones (Nephrolithiasis)
Urolithiasis
(7)

A

 Common
 May cause obstruction
 Pain
 Ascending infection
 Hematuria
 Pyuria
 Lithotripsy

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26
Q

Kidney Stones (Nephrolithiasis)
Urolithiasis
 May be associated with

A

hypercalcemia (for example,
hyperparathyroidism, metastatic skeletal disease,
multiple myeloma)

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27
Q

Renal Cell Carcinoma
(3)

A

 Arises from renal tubular epithelium
 Often silent
 May grow into renal vein

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28
Q

Wilm’s Tumor
(Nephroblastoma)
(5)

A

 Children under 5 years
 Abdominal mass
 Chronic low-grade fever
 Histopathology consists of several cell
types, some of which resemble abortive
glomeruli and others that resemble skeletal
muscle
 Better than 90% 5-year survival

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29
Q

Urothelial Carcinoma
 Arises from the
epithelium (transitional epithelium)
 — most common site
 Painless —

A

urinary tract lining
Bladder
hematuria

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30
Q

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Urothelial Carcinoma
 from (5)

A

Cigarette smoking, industrial solvents
(beta-naphthlylamine), chronic cystitis,
schistosomiasis, drugs (cyclophosphamide)

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31
Q

Urothelial Carcinoma
 Clinical significance depends on (2)

A

histologic
grade, differentiation and depth of invasion

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32
Q

Prostate – Three Major Diseases
(3)

A

 Prostatitis
 Benign prostatic hyperplasia
 Adenocarcinoma of prostate

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33
Q

Prostate-Specific Antigen - PSA
(4)

A

 Protein present in the serum at low levels (nl: < 4 ng/mL)
 Increased levels may suggest the presence of prostate cancer
 Elevated in prostatitis
 Velocity of change significant

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34
Q

Prostate-Specific Antigen - PSA
 Physiologic functions
(2)

A

 Liquefy semen, allowing sperm to swim freely
 Dissolution of cervical mucous cap

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35
Q

Prostatitis

A

 Acute bacterial disease treated with antibiotics

36
Q

Nodular (Benign)
Prostatic Hyperplasia - BPH
(6)

A

 Obstruction to flow
 Urinary frequency
 Ascending infections
 Rule-out neoplasia
 Pharmacologic treatment
 Surgical treatment (TURP)

37
Q

Adenocarcinoma of Prostate
(5)

A

 70% of men develop prostate cancer by 70-80 years of age
 Digital prostate examination
 Biopsy – multiple cores
 Wide variation in clinical behavior
 Gleason grading

38
Q

Testes
 Cryptorchidism –
 Seminoma –
 Infections – (4)

A

undescended testes
germ cell tumor (malignant)
tuberculosis, mumps, syphilis, gonorrhea

39
Q

Cryptorchidism
(5)

A

 Absence of one or both testes in the scrotum
 Failure of testis to descend from an abdominal position through the
inguinal canal into the scrotum (“undescended” testes)
 Infertility
 Increased risk for neoplasia
 Orchiopexy

40
Q

Seminoma
(5)

A

 Most common germ cell tumor of testis
 Young adults (15-34 years)
 Surgery plus radiation therapy and chemotherapy
 One of the most treatable and curable cancers
 Over 95% long-term survival in early stages

41
Q

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Infectious Parotitis
(Mumps)
 Complications rare in the young and more common in
older individuals
(8)

A

 Orchitis,
 Oophoritis,
 Mastitis,
 Meningitis,
 Thyroiditis,
 Pancreatitis
 Sterility
 Hearing loss

42
Q

Hypospadias
(3)

A

 Developmental defect of the urethra in the
male
 Abnormally placed urethral meatus
 Urethral meatus opens on the glans penis most
commonly (first degree hypospadias)

43
Q

Phimosis

A

 Foreskin cannot be fully retracted from the head of the penis

44
Q

Priapism
(4)

A

 Erect penis or clitoris does not return to its flaccid state, despite the
absence of both physical and psychological stimulation, within
four hours
 Medical emergency
 Hematologic diseases
 Trauma

45
Q

skipped
 Hematologic diseases
(2)

A

 Sickle cell disease
 Leukemia

46
Q

Uterine Leiomyoma
(4)

A

 Benign smooth muscle neoplasm
 “Fibroids”
 May cause irregular bleeding (metrorrhagia) or
 Painful intercourse (dyspareunia)

47
Q

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Proliferative Lesions:
Endometrial Hyperplasia and Polyps
(2)

A

Glandular epithelium
Bleeding

48
Q

Two Major Diseases of the Endometrium
(2)

A

 Endometriosis
 Adenocarcinoma

49
Q

Endometriosis
(4)

A

 Endometrial tissue outside the uterine cavity
 Ectopic endometrial tissue influenced by hormonal
changes
 Recurring pelvic pain
 Symptoms depend on the site involved and worsen with
the menstrual cycle

50
Q

Risk Factors for
Endometrial Carcinoma
 Age –
 Obesity –
 Infertility –

A

most common in the 55 to 65 age group
greater synthesis of estrogen in body fat
women who are nulliparous are at
increased risk of endometrial carcinoma

51
Q

Cervical
Squamous Cell Carcinoma
(4)

A

 Exfoliative cytologic screening for early detection
(Papanicolau smear)
 Squamo-columnar junction
 High risk HPV sub-types – 16, 18
 Vaccination

52
Q

Cervical Intraepithelial Neoplasia -
Grades I, II, III
(2)

A

 LSIL (low-grade squamous intraepithelial lesion)
 HSIL (high-grade squamous intraepithelial lesion)

53
Q

Teratoma
(5)

A

 A tumor containing tissues from all three germ layers
 Most tumors are derived from one cell layer – ectoderm,
endoderm, mesoderm
 Generally arise in gonadal tissues
 Most commonly seen in the ovary
 “Dermoid cyst” of the ovary – a benign cystic teratoma – may
contain a variety of tissues including hair, teeth, bone, cartillage,
thyroid, etc.

54
Q

Gonorrhea
(5)

A

 Neisseria gonorrhea
 “Mother nature’s birth control”
 Pelvic inflammatory disease
 Tubal scarring
 Ectopic pregnancy

55
Q

Breast
(5)

A

 Glandular epithelium
 Ducts
 Lobules
 Interstitial tissue
 Lymphatics

56
Q

Gynecomastia
(4)

A

 Enlargement of male breast may occur in response to estrogen
 Hyperestrinism in male
 Bilateral – rule-out hormonal
 Unilateral – rule out tumor

57
Q

 Hyperestrinism in male
(4)

A

 Cirrhosis of liver – inability to metabolize estrogens
 Klinefelter syndrome
 Estrogen-secreting tumors
 Estrogen therapy

58
Q

Fibroadenoma
(3)

A

 Most common benign neoplasm of breast
 Discrete, usually solitary, moveable nodule
 Young women (third decade)

59
Q

Lobules - lobular carcinoma
(2)

A

Lobular carcinoma-in-situ
Invasive lobular carcinoma

60
Q

Ducts - ductal carcinoma
(2)

A

Ductal carcinoma-in-situ
Invasive ductal carcinoma

61
Q

Pathogenesis of Breast Cancer
(3)

A

 Genetic changes
 Hormonal influences
 Environmental variables

62
Q

Risk Factors in Breast Cancer
 Well-established risk factors
(6)

A

 Age – uncommon < 30 y
 Genetics and family history - p53, BRCA1/2
genes
 Menstrual history – early menarche (<12y),
late menopause (>55y)
 Length of reproductive life
 Nulliparous – having children is protective
 Geographic variation

63
Q

Risk Factors in Breast Cancer
 Other risk factors
(3)

A

 Exogenous estrogens – postmenopausal
hormone replacement therapy
 Oral contraceptives – newer formulations of
balanced, low doses of estrogen and
progestin safe
 Ionizing radiation during breast development

64
Q

Risk Factors in Breast Cancer
 Less well-established risk factors
(4)

A

 Alcohol consumption
 High fat diet
 Obesity
 Cigarette smoking

65
Q

skipped
Genetic Changes
 Familial syndromes
(4)

A

Li-Fraumeni Syndrome –
Cowden Syndrome –
Ataxia-telangiectasia
gene –
BRCA1/BRCA2 –

66
Q

Li-Fraumeni Syndrome –

A

germ-line mutations in p53

67
Q

Cowden Syndrome –

A

germ-line mutations in
PTEN

68
Q

Ataxia-telangiectasia
gene –

A

DNA repair genes

69
Q

BRCA1/BRCA2 –

A

germ-line
mutations

70
Q

Genetic Changes
HER2/NEU proto-oncogene
(4)

A

Epidermal growth factor
receptor
Amplified in 30% of breast
cancers
Overexpression
associated with poor
prognosis
Therapeutic intervention –
Herceptin (trastuzumab)

71
Q

skipped
Genetic Changes con’t
(5)

A

 Amplification of RAS and MYC
(proto-oncogenes)
 Mutations of Rb and p53 (tumor
suppressor genes)
 Estrogen receptor positivity
Therapeutic intervention -
Tamoxifen
 Progesterone receptor
positivity

72
Q

Hormonal Changes – Risk Factors
 Increased exposure to estrogen
(3)

A

Long duration of reproductive life (More estrogen)
Nulliparity – having children is protective
Late age at birth of first child

73
Q

skipped
Summary of Exposure to Estrogen
and Breast Cancer Risk

A

 Estrogen exposure has a proliferative effect on breast tissue.
Proliferative breast disease found on biopsy indicates an exposure
to increased levels of estrogen. An increased risk of breast cancer
is found in women who have proliferative breast disease.
 The more estrogen the breasts are exposed to over a lifetime, the
higher the risk of breast cancer. During each monthly menstrual
cycle, the breasts are exposed to increased estrogen levels,
especially at the time of ovulation.
 Both early age at the start of menstrual cycles (menarche) and
late menopause increase breast cancer risk through increased
exposure to estrogen during more menstrual cycles.
 Late age for menarche and early age for menopause decrease
breast cancer risk through fewer menstrual cycles.
 Birth control pills and hormone replacement therapy increase
breast cancer risk through increased exposure to estrogen.
 Removal of both ovaries before natural menopause decreases
breast cancer risk by decreasing levels of estrogen.
 Alcohol consumption. The more alcohol consumed, the more
impaired the liver becomes in its ability to metabolize estrogen.
Therefore, alcohol consumption increases breast cancer.
 Obesity. This is because adipose tissue produces small amounts of
estrogen. After menopause, obesity increases breast cancer risk
by increasing the level of estrogen. The more fat, the higher the
estrogen level. Premenopausal obesity does not increase breast
cancer risk. Before menopause, obesity causes hormonal changes
which decrease estrogen production by the ovaries and can even
result in infertility.
 Age at birth of first child. There is a change in structure of breast
lobule at pregnancy. Late age at birth of first child increases breast
cancer risk. With late age at birth of first child, type 1 and type 2
breast lobules persist longer. They are more sensitive to
carcinogens. Therefore, risk increases. During the 3rd trimester of
pregnancy (after 32 weeks), the breast lobules mature into Type 3
lobules. Type 4 lobules are formed after childbirth and produce
milk. Both Type 3 and Type 4 lobules are resistant to carcinogens.

74
Q

Breast Cancer Location
 Upper outer quadrant –
 Central portion –
 Lower outer quadrant –
 Upper inner quadrant –
 Lower inner quadrant –

A

50%
20%
10%
10%
10%

75
Q

Classification of Breast
Cancers (Abridged)
 Noninvasive –
(3)

A

have not penetrated the basement membrane
 Ductal carcinoma in situ (DCIS, intraductal carcinoma)
 Lobular carcinoma in situ (LCIS)

76
Q

Classification of Breast
Cancers (Abridged)
 Invasive –
(3)

A

have penetrated the basement membrane (infiltrating)
 Invasive ductal carcinoma – most common (scirrhous carcinoma)
 Invasive lobular carcinoma

77
Q

Ductal Carcinoma in Situ
(6)

A

 Precursor lesion to invasive carcinoma
 When invasive carcinoma develops in a woman with a previous diagnosis of
DCIS, it is usually in the same breast.
 Treatment – surgery and radiation
 Tamoxifen –
 Aromatase inhibitors –
 Good long-term prognosis

78
Q

 Tamoxifen –

A

antiestrogenic if estrogen receptor + (blocks estrogen receptor)

79
Q

 Aromatase inhibitors –

A

post-menopausal women (blocks estrogen formation)

80
Q

Paget’s Disease of Nipple
(4)

A

 Clinical variant of DCIS
 Extension of DCIS up to the lactiferous ducts and into
the contiguous skin of the nipple
 Crusting exudate over the nipple and areolar skin
 Underlying invasive carcinoma in 50%

81
Q

Lobular Carcinoma in Situ
(4)

A

 One-third of women with LCIS develop invasive
carcinoma
 The invasive carcinoma may arise in either breast
 LCIS is a marker of increased risk for developing breast
cancer in either breast
 Bilateral prophylactic mastectomy may be performed

82
Q

Invasive Ductal Carcinoma
(4)

A

 Most breast carcinomas (70-80%)
 Term used for all carcinomas that cannot be sub-classified into a
specific type (not discussed)
 Does not imply that the tumor specifically arises from the duct
system
 Carcinoma of “no special type” or “not otherwise specified” (NOS)
are synonyms for invasive ductal carcinoma

83
Q

skipped
Clinical Features Common to
all Invasive Carcinomas
(3)

A

 Fixation secondary to adherence to pectoral muscles
or deep fascia of chest wall
 Adherence to overlying skin with retraction or dimpling
of the skin or nipple
 Lymphatic involvement may cause localized
lymphedema with the skin thickened around
exaggerated hair follicles (peau d’orange – orange
peel appearance)

84
Q

TNM Staging of Breast Cancer
- AJCC
 Stage 1 –
metastases
 Stage 2 -
 Stage 3 –
 Stage 4 –

A

tumor <2 cm, without nodal involvement, no
tumor <5 cm with <3 nodes and no distant
metastases (or more than 5 cm without nodes)
* many categories, any cancer infiltration into skin
and chest wall, with nodes, without disseminated metastases
any cancer with disseminated metastases

85
Q

skipped
Prognostic Factors
(9)

A

 Size of primary carcinoma
 Lymph node involvement and
number of nodes
 Distant metastases
 Histologic grade
 Histologic type
 Estrogen or progesterone receptor
expression - Tamoxifen
 Proliferative rate
 Aneuploidy
 HER2/NEU overexpression -
Herceptin

86
Q

Five Year Survival of
Breast Cancer by Stages DCIS or LCIS - 92%
 Stage 1 – –%
 Stage 2 – –%
 Stage 3 – –%
 Stage 4 – –%
 For all stages combined, 10 year survival is about –%
 Natural history is long with metastases sometimes appearing decades after the initial diagnosis

A

87
75
46
13
50