Uro Path Flashcards
these specialized epithelial cells allow the urothelium to expand and contract while staying water tight
umbrella cells
name 5 renal cystic diseases
multicystic renal dysplasia, adult polycystic kidney disease, infantile polycistic kidney disease, simple renal cysts, acquired cystic kidney disease
pathologic hallmark of renal dysplasia
undifferentiated tubules and ducts surrounded by mesenchyme (may contain muscle or cartilage)
renal dysplasia is almost always associated with?
other urinary tract abnormalities and obstruction to urine flow in utero
most common cause of abdominal mass in newborn
multicystic renal dysplasia
differences between adult and infantile polycystic disease
AD vs AR, midlife vs birth (75% die in utero), distorted vs smooth kidneys, bunch of cysts + normal kidney vs dilated collecting system (big blown up kidney)
simple renal cysts are usually found in the?
renal cortex
microscopy of simple renal cyst shows?
lined by single layer of flattened epithelium (internal septations can mimic cancer)
acquired cystic kidney disease occurs in?
pts with long-term dialysis hx
acquired cysts are bad because?
they may turn into RCC
intrinsic causes of kidney obstruction
stones, blood clots, tumors of urinary tract, posterior urethral valves, strictures
renal cell carcinoma is cancer of what cell type?
adenocarcinoma (clear cell or papillary) that arises from renal tubular epithelium
abnormalities in which chromosome are associated with clear cell vs. papillary RCC?
chr 3 with clear cell; 7 and 17 with papillary
late stage signs of RCC (tho usually detected before this)
hematuria, flank pain, abdominal mass
if you see a solid renal mass, what should you do next?
straight to surgery usually (rather than biopsy)
infectous causes of cystitis
coliform bacteria, TB, schistosomiasis
non-infectious causes of cystitis
radiation and/or chemo
these patients can have severe intractable cystitis from chronic use of indwelling catheter
paraplegics
bladder obstruction usually occurs in (men/women) secondary to?
men; BPH
90% of bladder cancers are?
urothelial (transitional cell) carcinoma
paraplegic’s and people with schistosomiasis infection get this type of bladder cancer
squamous cell carcinoma
risk factors for urothelial neoplasms
industrial exposure to carcinogens, tobacco use (big one!), cyclophophamide
usual clinical presentation of bladder cancer
hematuria or dysuria
diagnosis of bladder cancer is made by?
urine cytology and/or cytoscopy + biopsy
adenocarcinoma of the bladder may be associated with?
congenital anomalies or metaplasias
the bladder may be home to mets from what primary tumors?
local invasion by tumors of the cervix, prostate, colon; mets from melanoma, stomach, breast, and lung cancer
major risk factors for germ cell neoplasms of the testis
cryptorchidism, fam hx, gonadal dysgenesis
etiologic agents of orchitis
gram neg bacteria, syphilis, mumps
testicle torsion is due to twisting of the?
spermatic cord
what happens when a testicle is twisted?
hemorrhagic infarct +/- necrosis with time
most primary testicular germ cell tumors present as?
painless, solid masses within the testis
this tumor marker is suggestive of yolk sac differentiation
alpha-fetoprotein (AFP)
this tumor marker is suggestive of chorionic/trophoblastic differentiation
beta HCG
this is a non-specific marker seen of bulky tumors of many types
lactic dehydrogenase
this is the most common pure germ cell tumor (40-50%) of the testis
seminoma
gross appearance of seminoma
solid, grayish-white mass without necrosis or hemorrhage (mets common)
microscopic appearance of seminoma + tumor markers
uniform, large tumor cells and lymphocytes; elevated LDH ONLY
peak age for seminoma
4th decade (30-40 years)
peak age for embryonal carcinoma
3rd decade (20s)
gross appearance of embryonal carcinoma
gray-white solid mass WITH necrosis and hemorrhage (often)
tumor markers for embryonal carcinoma of the testis
may be AFP+, usually BHCG – (also show sheet-like pattern on histo)
yolk sac tumors are often characterized by a ____ appearance microscopically
microcystic
_____ are pathognomonic for yolk sac tumors
Schiller-Duval bodies
classic presentation of choriocarcinoms
tiny hemorrhagic and necrotic primary tumor in testis with widespread mets
microscopic appearance of choriocarcinoma + tumor markers
must have both syncytiotrophoblasts and cytotrophoblasts, greatly elevated serum BHCG
this testicular tumor has tissues from all 3 germ layers and is more aggressive in adults
teratoma
management of mixed germ cell tumors of the testis
based on individual components
what is Peyronie disease?
focal asymmetric fibrosis of the shaft of the penis, results in a bent penis when erect
cancer of the penis is generally ______ and only occurs in?
squamous cell carcinoma; uncircumcized males
