Renal Pathology 9 Flashcards
what is the most common primary tumor of the ureter?
papillary transitional cell carcinoma
how is retroperitoneal fibrosis characterized?
by the development of extensive fibrosis throughout the retroperitoneum
what demographic of people are most likely to get retroperitoneal fibrosis?
middle to late age males
what are the predisposing factors for cystitis?
bladder calculi, urinary obstruction, diabetes mellitus, instrumentation, and immune deficiency
what are the most common etiologic agents of cystitis?
e. coli, p. klebsiella, enterobacter
what is interstitial cystitis?
UTI symptoms of more than 6 weeks duration in the absence of infection or other identifiable causes
what are the typical cystoscopic findings of interstitial cystitis?
mucosal fissures and punctate hemorrhages
what is malakoplakia?
distinctive chronic inflammatory reaction that appears to stem from acquired defects in phagocyte function; it arises in the setting of chronic bacterial infection
who is most likely to get malakoplakia?
people who are immunosuppressed, such as in renal transplant recipients
what are michaelis-gutmann bodies?
they are laminated mineralized concentration resulting from deposition of calcium in enlarged lysosomes of macrophages
what is polypoid cystitis?
an inflammatory lesion resulting from irritation of the bladder mucosa, most commonly as a result of instrumentation
what are 3 examples of metaplastic lesions of the bladder?
cystitis glandularis and cystitis cystica, squamous metaplasia, nephrogenic adenoma
cystitis glandularis and cystitis cystica both arise in what setting?
inflammation and metaplasia
squamous metaplasia of the bladder is a consequence of what?
it is a response to chronic injury
what occurs in nephrogenic adenoma of the bladder?
the overlying urothelium is focally replaced by cuboidal epithelium
the overwhelming majority of bladder tumors are of what origin?
epithelial, with urothelial neoplasms being by far the most common
how is staging of bladder cancer done?
based on the depth- the major decrease in survival is associated with the invasion of the muscularis propria (detrusor muscle)
what are the factors that have been implicated to be the causation of urothelial carcinoma?
smoking, aryl amines, analgesic use long term, cyclophosphamide, irradiation
mutations that disrupt the function of what genes are present in all muscle-invasive cancers, but occur early in the development of CIS?
TP53 and RB mutations
what does the treatment of urothelial carcinoma of the bladder depend on?
it depends on the presence of detrusor muscle invasion
how do you treat non-muscle invasion of urothelial carcinoma of the bladder?
transurethral resection/intravesicle chemo. life long follow up
how do you treat muscle invasive urothelial cancers?
cystectomy/cystoprostatectomy or radiation with chemo
where do urothelial carcinoma of the bladder mets usually go?
locoregional nodes; distant sitesL peritoneum, lung, liver, and bone
true sarcomas of the bladder are very uncommon. What is more common that true sarcomas?
inflammatory myofibroblastic tumors and various carcinomas that assume sarcomatoid growth patterns
what is the most common bladder sarcoma in infancy or childhood?
embryonal rhabdomyosarcoma
what is the most common bladder sarcoma in adults?
leiomyosarcoma
how does embryonal rhabdomyosarcoma manifest?
polypoid grape-like mass (sarcoma botryoides)
how is urethritis classically divided?
gonococcal and nongonococcal causes
what is one of the earliest manifestations of urethritis?
gonococcal urethritis
what are the 2 most common cause of nongonococcal urethritis?
various strains of chlamydia and mycoplasma
urethritis is also accompanied by what in women and what in men?
cystitis in women and prostatitis in men
what is a urethral caruncle?
an inflammatory lesion that presents as a small red painful mass about the external urethral meatus, typically in older females
primary carcinoma of the urethra is an uncommon lesion. What types of carcinoma?
proximal: urethral differentiation
distal: squamous cells carcinoma and HPV related
what is condyloma acuminatum?
a benign sexually transmitted wart caused by HPV 6 and 11
what does high magnification of condyloma acuminatum show on histology?
the epithelium shows perinuclear vacuolization (koilocytosis)
what is peyronie disease?
reactive rather than neoplastic disorder; hard penile plaques that result from microvascular trauma and subsequent organizing sclerosing chronic inflammation
what is the treatment for peyronie disease?
surgery and injection of collagenase to lyse the fibrous plaques
What are the precursor lesions associated with HPV related squamous neoplasia of the penis?
bowen disease and bowenoid papulosis
how does bowen disease present?
penile shaft and scrotum of older men, thickened gray-white opaque plaque
how does bowenoid papulosis present?
usually in sexually active adults (younger age) multiple reddish brown papular lesions; virtually never develops into invasive carcinoms
which HPV strain is associated with bowen and bowenoid lesions?
HPV 16
what is non HPV related squamous carcinoma in situ/ neoplasia of the penis associated with?
balanitis xerotica obliterans
Invasive squamous cell carcinoma of the penis is associated with what?
high risk HPV infection, smoking, and chronic inflammatory conditions such as lichen sclerosis et atrophicus
what confers protection against invasive squamous cell carcinoma of the penis?
circumcision
what is the contribution of high-risk HPV to penile carcinoma?
HPV that encodes for E6 and E7
how does invasive squamous cell carcinoma present?
it has often been present for a year or more before it is brought to medical attention
epididymitis in childhood (uncommon) is usually associated with what?
a congenital genitourinary abnormality and infection with gram negative rods such as e. coli, klebsiella, and pseudomonas
in sexually active men younger than age 35 years, what is the most common cause of epididymitis?
sexually transmitted pathogens like c. trachomatis and neisseria gonorrhoeae
in men older than 35 what is the most common cause of epididymitis?
common urinary tract pathogens like e. coli and pseudomonas
what is orchitis? and what are the most common causes?
testicular infections; neisseria gonorrheae, mumps, mycobacterium, treponema pallidum
what are the clinical features of a testicular torsion?
affected testicle lies horizontally, high riding testicle due to spermatic cord shortening
what are the key physical exam maneuvers associated with testicular torsion?
absent cremasteric reflex and prehn sign (lifting scrotum relieves pain in epididymitis and increases pain in torsion)
what is the most common benign paratesticular tumor?
adenomatoid tumor
germ cell tu,ors of the testicles most often affect what age group?
15-45 white males
what contributes to the development of germ cell neoplasia of the testicles?
both environmental exposures and inherited and acquired genetic abnormalities
progression to full-blow GCTs of the testicles is strongly associated with what?
reduplication of the short arm of chromosome 12
what are the risk factors for GCTs of the testicles?
cryptorchidism and Klinefelter syndrome
when is the peak incidence of seminoma?
4th decade of life
what is the histopathology of a seminoma?
clear or watery appearing cytoplasm and large central nucleus with one or two prominent nuclei
what are the tumor markers that may be elevated in seminomas?
hCG
what is the treatment for seminomas?
they are radiosensitive and chemosensitive- best prognosis
when is the peak incidence for embryonal carcinoma?
20-30 year olds
what is the histopathology of an embryonal carcinoma?
the neoplastic cells have an epithelial appearance, are large and anaplastic, and have hyperchromatic nuclei with prominent nucleoi- gland formation
what are the special stains for seminoma tumors?
postive for KIT, OCT3/4, and podoplanin; negative for cytokeratin
what are the special stains for embryonal GCTs of the testicle?
positive for OCT3/4 and cytokeratin; negative for KIT and podoplanin
what is the most common testicular tumor in infants and children?
yolk sac tumor
what is seen in about 50% of yolk sac tumors?
schiller-duyal bodies- mesodermal core with central capillary and visceral and parietal layer of cells
what are the special stains/tumor markers for yolk sac tumors?
AFP and cytokeratin
what is a highly malignant type of GCTs of the testicles?
choriocarcinoma
what two cell types are seen in choriocarcinomas?
syncytiotrophoblasts and cytotrophoblasts
what are the tumor markers associated with choriocarcinomas?
hCG
what are teratoma GCTs of the testicles?
organoid structures–> differentiated cells
what is the standard management of a solid testicular mass?
radical orchiectomy; biopsy of a testicular neoplasm is contraindicated as it is associated with risk of tumor spillage into scrotal skin
testicular tumors have a characteristic mode of spread. What is it?
lymphatic to nodes (usually retroperitoneal para-aortic nodes then mediastinal and supraclavicular, and hematogenous, which primarily involves the lung)
what does elevated LDH in testicular tumors correlate with?
with the mass of the tumor cells and it provides a tool to asses tumor burden
what are the two most important members of the sex-cord gonadal stromal tumors?
leydig cell tumors and sertoli cell tumors
what are the features associated with leydig cell tumors?
they elaborate androgens, testicular swelling, gynecomastia, large cells, ROD SHAPED CRYSTALLOIDS OF REINKE
what are sertoli cell tumors associated with?
carney complex (caused by germline mutations in the gene PRKAR1A), peutz-jeghers syndrome, and FAP syndrome
what is the histopathology of sertoli cell tumors?
they are arranged in distinctive trabeculae that tend to form cord-like structures and tubules
what is the most common form of testicular neoplasm in men older than 60 years of age?
primary testicular lymphomas
what is the most common testicular lymphoma and what are the tumor cells positive for?
diffuse large B cell lymphoma; tumor cells are positive for CD45 and CD20
what are 4 examples of cystic testicular masses?
hematocele, chylocele, spermatocele, varicocele
what is a chylocele?
accumulation of lymph in the tunica vaginalis
what is spermatocele?
small cystic accumulation of semen in dilated efferent ducts or ducts of the rete testis
what is a varicocele?
a dilated vein in the spermatic cord, usually left sided; BAG OF WORMS; infertility
what are the 4 biological/anatomical distinct regions of the prostate gland?
peripheral, central, transition, and periurethral zones
how does acute bacterial prostatitis present?
fever, chills, dysuria. tender and boggy
how does chronic bacterial prostatitis present?
low back pain, dysuria, and perineal and suprapubic discomfort; patients often have a history of recurrent UTIs
what is the most common form of prostatitis, what is is caused by, and how do you diagnose it?
chronic abacterial prostatitis; symptoms similar to chronic bacterial prostatitis, but there is not history of recurrent UTI; expressed prostatic secretions contain more than 10 leukocytes, but bacterial cultures are uniformly negative
what is the most common cause of granulomatous prostatitis?
instillation of BCG for treatment of bladder cancer
who is at risk for fungal granulomatous prostatitis?
immunocompromised hosts
what zone of the prostate does BPH affect?
the transition zone, and thus may encroach the urethra
what are some of the factors that contribute to the pathogenesis of prostatic adenocarcinoma?
charred red meats, adrogen dependence, inherited genetic factors, epigenetic events
what is the most common genetic alteration in the prostate?
chromosomal rearrangement that juxtaposes the coding sequence of an ETS family transcription factor gene next to the androgen regulated TMPRSS2 promoter
carcinoma of the prostate most commonly arises in what zone?
the peripheral zone, classically in the posterior location
what biopsy findings are specific to prostate cancer?
perineural invasion, absence of basal cells, upregulation of AMACR
what can be said about PSA?
it is organ specific but not cancer specific
how is grading of prostatic cancer done?
gleason system
hematogenous spread of prostate cancer occurs chiefly to where?
the bones, particularly the axial skeleton–> lumbar spine; osteoblastic metastases: increased alk phos
what is the most common treatment of prostate cancer?
radical prostatectomy
