T11 - L3/4 Pathology of Urogenital Tract Flashcards
1
Q
what is renal cell carcinoma?
A
Cancer of the kidney that arises from the renal tubular epithelium
2
Q
what are the two most common types of renal cell carcinoma?
A
Clear cell (75%)
Papillary (10%)
3
Q
what is the epidemiology of renal cell carcinoma?
A
- 60 + YO
- Male > female
• Those with a PMH of: – Obesity – Smoking – NSAID use – ESRF and on dialysis
• Family history (especially Von Hippel-
Lindau)
4
Q
Von Hippel- Lindau syndrome (VHL) is associated with which renal cell carcinoma?
A
clear cell
5
Q
what 3 different ways can a tumour cause disease/present clinical features?
A
local primary tumour effects
effects of distant metastases
paraneoplastic
6
Q
what are paraneopastic clinical features?
A
Signs and symptoms that are NOT related to local effects of the primary or metastatic tumours
Develop as a result of either: - Proteins/ hormones secreted by tumour cells - Immune cross reactivity between tumour cells and normal tissues
7
Q
what are local primary tumour effects of renal cell carcinoma?
A
- Haematuria
tumour effects - Abdominal pain
8
Q
what are effects of distant metastases of renal cell carcinoma?
A
- lung mets (SOB)
- bone mets (bone pain)
9
Q
what are paraneoplastic syndromes of renal cell carcinoma?
A
PNS are common in RCC and include:
- Weight loss “cancer
cachexia”* - Hypertension (renin) - Polycythemia (EPO)
10
Q
what is Wilms’ tumour?
A
nephroblastoma
Cancer of the kidney that arises from nephroblasts (cells that develop into the kidney in embryological development)
11
Q
what is epidemiology of film’s tumour?
A
• Children under
5
• 5% a/w genetic syndromes: – Beckwith- Weidemann Syndrome – WAGR Syndrome – Denys-Drash Syndrome
WT1 syndrome
12
Q
which gene mutation can result in a wilms tumour?
A
WT1
13
Q
what is Beckwith-
Weidemann
Syndrome?
A
an overgrowth disorder usually present at birth, characterized by an increased risk of childhood cancer
- big babies
14
Q
what do local primary tumour effects of a wilm’s tumour present?
A
- +++ Abdominal distention (especially if bilateral (10% are))
- Haematuria
15
Q
what is a physical characteristic of a child with a wilms’ tumour
A
distended abdomen
16
Q
how do effects of distant metastases of a wilm’s tumour present?
A
mets are rare
17
Q
how do paraneoplastic effects of a wilm’s tumour present?
A
PNS are rare
18
Q
which cancer of the kidney commonly occurs in children?
A
wilms
19
Q
which cancer of the kidney commonly occurs in adults?
A
renal cell carcinoma
old people
20
Q
what are clinical features of renal cell carcinoma?
A
haematuria
paraneoplastic syndrome
21
Q
what is Urolithiasis?
A
aka urinary tract calculi/ stones
Stones forming in the lumen of the urinary tract, anywhere from renal calyx bladder
22
Q
what are the different types of Urolithiasis?
A
Types (based on composition):
- Calcium stones (70%)
- Urate stones (5%)
- Cystine stones (1%)
- Struvite stones (15%) (
magnesium ammonium
phosphate)
23
Q
what is the most common type of Urolithiasis?
A
calcium stones
24
Q
what type of Urolithiasis is characteristically one big stone?
A
Staghorn calculi refer to branched stones that fill all or part of the renal pelvis and branch into several or all of the calyces. They are most often composed of struvite (magnesium ammonium phosphate) and/or calcium carbonate apatite.
25
what causes Urolithiasis?
Too high a concentration of a solute in the urine
26
what causes Urolithiasis?
Too high a concentration of a solute in the urine
– Calcium stones hypercalcemia
– Urate stones gout, malignancy (high cell turnover)
– Cystine stones congenital cystinuria (kidneys unable
to reabsorb amino acids)
– Struvite stones UTI
27
what is the pathogenesis of Urolithiasis?
calcium, rate and cystine (NOT struvite):
- too high concentration of soluble material
- urine is saturated
- soluble material precipitates out
- stones form
- precipitation of magnesium ammonium phosphate salts
28
what is the pathogenesis of struvite Urolithiasis?
- UTI with. urease producing bacteria e.g. proteus
- urease converts urea to ammonia
- ammonia causes a pH rise
- - precipitation of magnesium ammonium phosphate salts
29
what are complications of Urolithiasis?
- Obstruction =
Hydronephrosis +/-
hydroureter = renal
impairment
- Urinary stasis =
infection
- Local trauma=
squamous metaplasia =
SCC risk
30
what is Hydronephrosis?
swelling of a kidney due to a build-up of urine
31
what is hydroureter?
dilation of the ureter.
32
what is Vesicoureteral reflux (VUR)?
When urine flows backwards from the bladder to the ureter, rather than from the bladder to the urethra
33
what is the epidemiology of Vesicoureteral reflux (VUR)?
* Affects 10% of population
* Young people, especially those <2 YO
* Those with a family history of VUR
34
why will urate stones not show up on an X-ray?
no metal in them e.g. calcium or magnesium
- would need a CT
35
what causes Vesicoureteral reflux (VUR)?
Caused by dysfunction of vesicoureteric
junction when ureter enters bladder at
abnormal angle
36
what condition is caused by a dysfunction of vesicoureteric
junction?
VUR
37
what condition is caused by a dysfunction of vesicoureteric
junction?
VUR
38
what is the pathogenesis of Vesicoureteral reflux (VUR)?
- stasis = UTI (can lead to infection in the kidney also)
| - Back pressure and ascending infection = renal damage
39
what are clinical features of Vesicoureteral reflux (VUR)?
* Usually asymptomatic
* +/- symptoms of UTI or renal impairment
* Most children “grow out of it”
40
what ureter condition is usually asymptomatic?
VUR
41
which ureter condition commonly affects children
VUR
42
what condition is caused in children due to the ureter entering the bladder at an abnormal angle?
VUR
43
pain and haematuria are clinical features of which disease?
urolithiasis
44
what does urease do?
converts urea to ammonia
45
what is Urothelial Carcinoma?
aka transitional cell carcinoma
Cancer arising from urothelium (aka transitional epithelium)
Accounts for >90% of bladder Ca
46
what is the epidemiology of Urothelial Carcinoma?
- Adults aged >60YO
- M>F
- Smokers
- Exposure to certain industrial chemicals (most commonly dyes and rubber)
- Family history
- Treatment for other Ca (pelvic radiotherapy, cyclophosphamide)
47
what is the biggest environmental factor causing Urothelial Carcinoma?
arylamines
smoking
48
what are local primary tumour effects/clinical features of Urothelial Carcinoma?
- haematuria
- frequency, urgency, dysuria
- urinary obstruction
49
what are effects of distant metastases/clinical features of Urothelial Carcinoma?
- lung mets (SOB)
- bone mets (Bone pain)
- liver mets (jaundice etc)
50
what are effects of paraneoplastic syndromes/clinical features of Urothelial Carcinoma?
PNS are rare
51
what is haematuria?
the presence of blood in urine.
52
what is dysuria?
painful or difficult urination
53
with reference to the bladder, what are umbrella cells?
The umbrella cells form the urine-contacting layer of the stratified uroepithelium that lines the mucosal surface of the urinary bladder, ureters, and renal pelvis. Critically, these cells must maintain a high-resistance barrier in the face of cyclical changes in stretch as the bladder fills and empties.
54
where does transitional cell carcinoma most commonly arise?
bladder (92%)
ureters (2%)
renal pelvis (5%)
urethra (1%)
55
what is Neurogenic Bladder?
Inability to properly empty the bladder due to neurological damage
- massive distended bladder
56
what are the two types of neurogenic bladder?
Spastic: if damage to brain or spinal cord (UMN)
Flaccid: if damage to peripheral nerves (LMN)
57
what is spastic neurogenic bladder due to?
damage to brain or spinal cord (UMN)
58
what is flaccid neurogenic bladder due to?
damage to peripheral nerves (LMN)
59
what is the epidemiology of a neurogenic bladder?
All genders and ages- depends on cause
60
what sort o damage to the nervous system would cause a spastic neurogenic bladder?
UMN damage:
- stroke
- MS
- spinal injury
61
what sort o damage to the nervous system would cause a flaccid neurogenic bladder?
LMN damage:
- pregnancy
- diabetes
- alcohol (B12 deficiency)
62
what is the pathogenesis of a neurogenic bladder?
- bladder is full sensed by stretch receptors in bladder wall
- tells the brain
- detrusor contracts
- sphincters reflex = urination
any loss to this nerve pathway leads to neurogenic bladder
63
what are clinical features of neurogenic bladder?
Symptoms related to lack of control of bladder emptying Urinary retention +/- abdominal distention, incontinence, urge, frequency
or symptoms related to complications
64
what are complications of neurogenic bladder?
Stasis - Urinary tract infection - dysuria etc
Stasis - urinary stones - hameaturia etc
Inability to empty bladder - bladder distention - hydroureter - hydronephrosis - renal function impairment - oedema etc
65
what is Benign Prostatic Hyperplasia (BPH)?
Increased number of both stromal and glandular cells in the prostate.
Known by patients as an ‘enlarged prostate’.
nondularity of prostate
NB: not hypertrophy, hyperplasia
66
what is the epidemiology of Benign Prostatic Hyperplasia (BPH)?
Old men (20% by age 40 vs 70% by age 60)
Obesity
Diabetes
Family History
67
what causes Benign Prostatic Hyperplasia (BPH)?
?Hormone mediated ?Dihydrotestosterone (DHT)
68
what is the pathogenesis of Benign Prostatic Hyperplasia (BPH)?
- compression of the urthera
- obstruction of bladder outlet
results in:
1) urinary stasis = infection and stones
2) acute urinary retention
3) back pressure = renal damage
69
what are clinical features of Benign Prostatic Hyperplasia (BPH)?
Lower urinary tract symptoms (LUTS):
- Hesitancy or urgency
- Poor/ intermittent stream
- Straining
- Prolonged micturition
- incommplete bladder emptying
- Dribbling
- Frequency
- Incontinence
- Nocturia
70
what is Prostatic Adenocarcinoma?
Cancer of the glandular epithelium in the prostate
71
what is the epidemiology of Prostatic Adenocarcinoma?
- Old men
- Black men
- Obesity
- Family history (inc BRCA1/2)
- Pesticide exposure
NB: As the main risk factor for BPH is also age, the two are often seen in the same patients, but BPH is NOT a precursor to Ca
72
what gene mutation can lead to Prostatic Adenocarcinoma?
BRCA 1/2
73
what are local primary tumour effects/clinical features of Prostatic Adenocarcinoma?
lower urinary tract symptoms (LUTS) - hesitancy, dribbling etc
74
what are effects of distant metastases/clinical features of Prostatic Adenocarcinoma?
bone mets = bone pain
75
what are paraneoplastic effects/clinical features of Prostatic Adenocarcinoma?
PNS are rare
76
what is Cryptorchidism?
Aka undescended testis. Where the testis is NOT in the scrotum.
77
what is epidemiology of Cryptorchidism?
Premature babies
| but still present in 3% of those born full term
78
what is the pathogenesis of Cryptorchidism?
Failure of descent testis into scrotum
79
what is the aetiology of of Cryptorchidism?
Multifactorial
Often no cause identified
environmental factors:
- low birth weight
- maternal smoking
- maternal alcohol
- prematurity
genetic:
- family history
- Down syndrome
- kleinfelter syndrome
80
what are clinical features of Cryptorchidism?
Empty scrotum (10% bilateral)
- infertility
- hernias
- testicular cancer risk
- testicular torsion
81
what is seminoma?
Malignant neoplasm of the testis arising from germ cells in the seminiferous tubules
82
where does the malignancy of seminoma arise from?
germ cells in the seminiferous tubules
83
what is the most common type of testicular cancer?
seminoma
84
what are the different types of Cryptorchidism?
based on site of testis
- abdominal (15%)
- inguinal canal (25%)
- high scrotal (60%)
- normal
85
what is the most common testis site of Cryptorchidism?
high scrotal (60%)
86
list some aggressive testicular tumours
- teratoma
- choriocarcinoma
- yolk sac
- embryonal
- lymphoma
87
list some less aggressive testicular tumours that have a good prognosis
- classic seminoma
- spermatohytic seminoma
- leydig cell tumour
- sertoli cel tumour
88
what is the epidemiology of a seminoma?
- Young men (25-45 YO)
- Family history
- Cryptorchidism (REGARDLESS OF WHETHER IT WAS SURGICALLY CORRECTED OR ONLY AFFECTED THE OTHER TESTIS)
89
what gene can lead to seminoma?
KIT
90
what are local primary tumour effects/clinical features of seminoma?
- testicular lump
- swelling
- pain
91
what are effects of distant metastases/clinical features of seminoma?
- lung mets (SOB)
| - LN mets (back pain)
92
what are effects of paraneoplastic syndromes/clinical features of seminoma?
Gynecomastia (βHCG)
93
what is Gynecomastia?
Gynecomastia is a condition that makes breast tissue swell in boys and men. It can happen when the balance of two hormones in your body is thrown off. Although breasts don't develop in men the way they do in women, all boys are born with a small amount of breast tissue。
94
what kidney factors could cause Urinary Tract Obstruction?
tumours if. large
95
what ureter factors could cause Urinary Tract Obstruction?
```
MATERIAL IN LUMEN
- Calculi
- Clots
- Sloughed
papillae
```
WALL ABNORMALITIES
- Stricture
- Tumour
- Congenital abnormalities
EXTERNAL COMPRESSION
- Pregnancy
- Cervical/ colon Ca
- Retroperitoneal fibrosis
- AAA
FUNCTIONAL
- VUJ reflux*
96
what penis factors could cause Urinary Tract Obstruction?
tumour
phimosis
97
what renal pelvis factors could cause Urinary Tract Obstruction?
staghorn calculi
tumours
98
what bladder factors could cause Urinary Tract Obstruction?
- Calculi
- Tumours
- Neurogenic bladder*
- Anticholinergic drugs*
- Constipation
99
what prostate factors could cause Urinary Tract Obstruction?
- BPH
- tumours
- Prostatitis
100
what urethra factors could cause Urinary Tract Obstruction?
- Stricture
- Foreign body
- Posterior urethral valves
- Blocked catheter
101
what are clinical features of complete Urinary Tract Obstruction?
anuria
pain
102
what are clinical features of partial Urinary Tract Obstruction?
often asymptomatic
103
which type of Urinary Tract Obstruction is often asymptomatic?
partial
104
what are complications of urinary tract obstructions?
due to back pressures:
- Irreversible renal impairment
- Secondary VUR
due to urinary stasis:
- Infection
- Calculi formation
105
what are some complications of urinary tract obstructions due to back pressures?
- Irreversible renal impairment
| - Secondary VUR
106
what are some complications of urinary tract obstructions due to urinary stasis?
- Infection
| - Calculi formation
107
what cancer of the urinary tract is associated with the BRCA gene?
prostate cancer
108
renal and bladder carcinoma generally have what prognosis?
bad
109
seminoma, prostate carcinoma and Wilms’ tumour generally have what prognosis?
good prognosis
