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Histopathology - Path > Urological histopathology > Flashcards

Urological histopathology Flashcards

1
Q
  1. What are urinary calculi?
  2. What is the epidemiology?
  3. What can urinary calculi be made from?
A
  1. Crystal aggregates that form in the renal collecting ducts

•May be deposited anywhere in the urinary tract

2.

  • Lifetime incidence 15%
  • Males three times more likely to be affected than females
  1. Stones can be made of:
  • Calcium Oxalate (Weddellite) – 75%
  • Magnesium Ammonium Phosphate (Struvite) – 15%
  • Uric Acid – 5%
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2
Q

Describe the common causes of calcium oxalate kidney stones

A
  • Calcium oxalate stones are related to hypercalciuria
  • Absorptive hypercalciuria – excessive calcium absorption from gut
  • Renal hypercalciuria – impaired absorption of calcium in proximal renal tubule
  • Hypercalcaemia – primary hyperparathyroidism
  • Rare
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3
Q
  1. What are triple stones?
  2. What are they caused by?
A
  1. Magnesium ammonium phosphate stones are also known as ”triple stones”

2.

  • Form as a consequence of infection with urease-producing organisms
  • Proteus sp.
  • Ammonia alkalinises urine – precipitation of magnesium ammonium phosphate salts follows
  • Triple stones can become very large indeed
  • “Staghorn Calculi”
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4
Q

What does this image show?

A

Triple stones

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5
Q

Describe the causes of uric acid urinary calculi

A

•Uric acid stones may form in patients with hyperuricaemia

  • Gout
  • Rapid cell turnover
  • Most patients do not actually have hyperuricaemia or increased uric acid excretion in urine
  • Believed to be due to tendency to produce slightly acidic urine
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6
Q

What are the complications of urinay calculi? For both large and small stones

A

•Small stones that stay in the kidney may be largely asymptomatic

  • Otherwise detected during investigation of haematuria or recurrent urinary tract infection

•Small stones that drift out of the kidney may become impacted and cause colic

  • Pelvi-ureteric junction, pelvic brim, vesico-ureteric junction

•Large stones tend to stay in the kidney

  • Obstruction, risk of infection, chronic renal failure
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7
Q
  1. What is a papillary adenoma?
  2. What are the common genetic abnormalities?
A
  1. Benign epithelial kidney tumour composed of papillae and / or tubules
  • By definition, 15mm or less in size
  • Well-circumscribed
  1. Trisomy 7, Trisomy 17, Loss of Y chromosome

Frequent incidental finding in the nephrectomies on autopsy of CKD and acquired cystic renal disease patients

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8
Q

What does this image show?

A

Papillary adenoma

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9
Q
  1. What is a renal onocytoma?
  2. With what condition is it most commonly associated with?
A
  1. Benign epithelial kidney tumour composed of oncocytic cells
  • Well-circumscribed
  • Usually sporadic
  1. Birt-Hogg-Dube syndrome
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10
Q

What does this image show?

A

Renal oncocytoma

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11
Q
  1. What is an angiomyolipoma?
  2. With what condition is it seen?
A
  1. Benign mesenchymal kidney tumour composed of thick-walled blood vessels, smooth muscle and fat
  • Derived from perivascular epithelioid cells
  • Mostly sporadic
  1. Can be seen in tuberous sclerosis

Large tumors of bigger than 4cm present with flank pain, haemorrhage and shock

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12
Q

What does the image show?

A

Angiomyolipoma

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13
Q
  1. What is renal cell carcinoma?
  2. Epidemiology
  3. Risk factors
A
  1. Malignant epithelial kidney tumour

2.

  • Accounts for 2% of cancers worldwide
  • More common in developed countries
  • 10 per 100,000 men, 3 per 100,000 women
  1. Risk factors include:
  • Smoking
  • Hypertension
  • Obesity
  • Long-Term Dialysis
  • Genetic Syndromes – von Hippel Lindau
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14
Q
  1. What do half of cases of RCC present with?
  2. How else is RCC picked up?
  3. What are the various sub-types?
A
  1. Half of cases present with painless haematuria

2.

  • Most of the remaining cases are detected incidentally on imaging
  • Small proportion present with metastatic disease
  1. Various subtypes are recognised
  • Clear Cell Renal Cell Carcinoma (70%)
  • Papillary Renal Cell Carcinoma (15%)
  • Chromophobe Renal Cell Carcinoma (5%)
  • Remaining 10% are various rare subtypes
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15
Q
  1. What is clear cell renal carcinoma?
  2. How does it appear?
  3. What are the underlying genetics?
A
  1. Epithelial kidney tumour composed of nests of clear cells set in a delicate capillary vascular network
  2. Appears grossly as a golden yellow tumour with haemorrhagic areas
  3. Genetically shows loss of chromosome 3p
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16
Q

What does this image show?

A

Clear cell renal cell carcinoma

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17
Q
  1. What is papillary renal cell carcinoma?
  2. Underlying genetics
  3. How does it appear?
A
  1. Epithelial kidney tumour composed of papillae and / or tubules
    * By definition, more than 15mm in size
  2. Genetically shows trisomy 7, trisomy 17 and loss of Y chromosome
    * Subdivided into two types based on morphology
  3. Grossly appears as a fragile, friable brown tumour
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18
Q

What does this image show?

A

Papillary renal cell carcinoma

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19
Q
  1. What is Chromophobe renal cell carcinoma
  2. How does it appear?
A
  1. Epithelial kidney tumour composed of sheets of large cells that display distinct cell borders, reticular cytoplasm and a thick-walled vascular network
    * Shows variable genetic aberrations
  2. Grossly appears as a well-circumscribed solid brown tumour
20
Q

What does this image show?

A

Chromophobe renal cell carcinoma

21
Q

What are the staging and grading for Renal cell carcinoma?

A
  • ISUP nuclear grade (1-4) applies to clear cell and papillary renal cell carcinoma
  • TNM 8th Ed
  • For clear cell renal cell carcinoma there is also a risk progression index
    • Leibovich risk model (low risk, intermediate risk, high risk)
22
Q
  1. What is a nephroblastoma?
  2. How does it present?
A

1.

  • Also known as Wilm’s Tumour
  • Malignant triphasic kidney tumour of childhood
    • Blastema (small round blue cells)
    • Epithelial
    • Stromal
  1. Typically presents as an abdominal mass in children aged 2-5 years old
    * 1 in 8,000 – second most common childhood malignancy
23
Q
  1. What is a urothelial carcinoma?
  2. What are the risk factors?
A

1.

  • Also known as Transitional Cell Carcinomas
  • Group of malignant epithelial neoplasms arising in urothelial tract
    • Bladder
    • Renal Pelvis
    • Ureters
  1. Very common:
  • Smoking
  • Aromatic amines
24
Q
  1. What is the most common presentation of urothelial carcinoma?
  2. What are the three main subtypes?
A
  1. Haematuria
  2. Three main subtypes:
  • Non-Invasive Papillary Urothelial Carcinoma
  • Infiltrating Urothelial Carcinoma
  • Flat Urothelial Carcinoma in-situ
25
Q
  1. Describe non-invasive papillary urothelial carcinoma
A
  • Appear as frond-like growths
  • Divided into low grade and high grade (WHO 2004) based on nuclear atypia
  • Low grade tumours have a low risk of progression to invasive disease (<5%)
  • High grade tumours carry a higher risk of progression to invasive disease
    • Unstable, carry a number of genetic aberrations including in RB and TP53
26
Q

What does this image show?

A

Non-invasive Papillary Urothelial carcinoma

27
Q
  1. What is infiltrating Urothelial carcinoma?
  2. What is treatment based on?
A
  1. Urothelial tumor displaying invasive behavior
  2. Treatment based on depth of invasion
  • Lamina propria
  • Muscularis propria
28
Q

What does flat urothelial caricinoma in situ

A
  1. May be invisible or appear as a reddish area
  2. Flat urothelial lesion with unequivocal high grade features - high risk of progression
29
Q
  1. What is benign prostatic hyperplasia?
  2. Epideimiology
  3. Aetiology
A
  1. Benign enlargement of prostate as a consequence of increase in cell number

2.

  • Very common – symptomatic in 25% of men by age 80
  • Histologically present in 90% of men by age 80
  1. Aetiology is not clear
  • Increased oestrogen levels in blood, which rises with age, may induce androgen receptors and stimulate hyperplasia
  • Treatment based on alpha blockers and 5⍺-reductase inhibitors as well as transurethral resection
30
Q

How does BPH present?

A

Presents with “Lower Urinary Tract Symptoms”

  • Frequency
  • Nocturia
  • Urgency
  • Hesitancy
  • Poor flow
  • Terminal Dribbling

May also present with urinary tract infectionl acute urinary retention or renal failure

31
Q

What does this image show?

A

BPH

32
Q
  1. Describe Prostatic adenocarcinoma
  2. Epidemiology
  3. Where does it arise from?
  4. Where are the mutations?
A
  1. Malignant epithelial prostate tumour
  2. Epideiology
  • Most common malignant tumour in men
  • 25% of all male cancers
  • 1 in 8 men will develop it in their lifetime
  • Less prominent (but important) cause of cancer-related death
  • Association with red meat consumption
  • 5-10x risk increase if first degree relative is also affected
  1. Arises from Prostatic Intraepithelial Neoplasia
  2. Mutations in PTEN, AMACR, GST-pi, p27 and more…
33
Q

How does prostatic adenoma present?

A
  • Usually asymptomatic; usually diagnosed on biopsy following raised serum prostate-specific antigen or digital rectal examination
  • May have lower urinary tract symptoms
  • Rarely may present with metastatic disease
  • Pathological fracture
34
Q

What is the prognostic indicator for prostatic adenocarcinoma?

A
  • Most powerful prognositic indicator is the Gleason score
  • Higher scores correlate with more aggressive behavior
  • Expressed as x + y = z
  • Two most common patterns (or most common pattern and worst pattern in biopsy setting)
  • Patterns range from 1-5
  • 1 and 2 rarely if ever diagnosed so scores typically range from 6-10
35
Q

What does this image show?

A

Gleason grade 1, 2 and 3

36
Q

What does this image show?

A
37
Q

What does this image show?

A

Gleason grade 5

38
Q
  1. What are testicular germ cell tumors?
  2. Epidemiology
  3. Risk factors
  4. When do they arise?
A
  1. Tumours of the testis arising from germ cells

2

  • Account for 90% of testicular tumours
  • Typically arise in men aged 20-45

3.Risk factors include

  • Undescended testis (3-5x increased risk)
  • Low birth weight / small for gestational age

4.

Malignant tumours arise from Germ Cell Neoplasia in-situ

  • Process likely begins in foetal life
  • Amplification of i12p
39
Q

How do testicular germ cell tumors present?

A

1.

  • Present as painless lump
  • 10% present with symptoms related to metastasis
    • Back pain
    • Cough
    • Dyspnoea
  • Five histological subtypes
  • Single tumour may be purely one subtype or contain a mixture of multiple subtypes
40
Q

Name 5 germ cell tumors (each histologically different)

A
  • Seminoma
  • Embryonal carcinoma
  • Post-Pubertal teratoma
  • Yolk sac tumor
  • Choriocarcinoma
41
Q

What is the treatment for testicular germ cell tumors?

A
  • Highly sensitive to platinum-based chemotherapy regimes
  • Prognosis excellent
  • Five year survival is 98% in most countries
42
Q

Describe the 3 types of Non-germ cell tumors

A
  • Much less common than germ cell tumours
  • Lymphoma
  • Older men, 5% of all testicular tumours
  • Highly aggressive; poor survival rates

•Leydig Cell Tumour

  • 3% of all testicular tumours
  • May present with precocious puberty if pre-pubertal
  • Usually benign

•Sertoli Cell Tumour

  • 1% of testicular tumours
  • 90% are benign
43
Q

Describe the following paratesticular diseases

  1. Epididymal cyst
  2. Epidymitis
  3. Varicocele
  4. Hydrocele
  5. Adenomatoid tumor
A
  1. Epididymal cyst
    * Benign fluid filled lump that forms in the epididymis

2Epididymitis

  • Usually related to C. trachomatis or N. gonnorrhoeae in men under 35; E. coli in men over 35
    3. Varicocele
  • Dilated venous plexus
    4. Hydrocele
  • Fluid between layers of tunica vaginalis
    5. Adenomatoid Tumour
  • Small tubules lined by mesothelial cells
44
Q

Describe the following penile diseases

  1. Lichen sclerosus/Balanitis Xerotica Obliterans
  2. Zoon’s balanitis
  3. Condylomas
  4. Peyronie’s disease
  5. Penile carcinoma
A

1.Lichen Sclerosus / Balanitis Xerotica Obliterans

  • Inflammatory condition that causes phimosis
  • Chronic, often progressive disease, which can lead to phimosis and urethral stenosis, affecting both urinary and sexual function

2.Zoon’s balanitis

  • Inflammatory condition that causes red areas
  • inflammation of the glans penis.

3.Condylomas

  • HPV 6 and 11
  • Refers to an infection of the genitals. The two subtypes are: Condyloma acuminata, or genital warts, caused by human papilloma virus subtypes 6, 11, and others. Condylomata lata, white lesions associated with secondary syphilis.

4.Peyronie’s Disease

  • Scarring , inflammation, thickening of corpus cavernosa
  • Peyronie’s disease is penis problem caused by scar tissue, called plaque, that forms inside the penis. It can result in a bent, rather than straight, erect penis. Most men with Peyronie’s disease can still have sex. But for some, it can be painful and cause erectile dysfunction

5.Penile carcinoma

  • Rare, elderly men
  • Smoking, HPV, chronic Lichen Sclerosus are risk factors
45
Q

Describe the following urethral diseases

  1. Urethritis
  2. Prostatic urethral polyp
  3. Urethral carnuncle
  4. Urethral carcinoma
  5. Malignant melanoma
A
  1. Urethritis
    * Common causes: N. gonorrhoeae, C. trachomatis
  2. Prostatic Urethral Polyp
    * Papillary lesion in prostatic urethra
  3. Urethral Caruncle
    * Common lesion at urethral meatus in women
  4. Urethral Carcinoma
    * Rare, more common in women, usually squamous cell carcinoma
  5. Malignant Melanoma
    * Rare
46
Q

Describe the following scrotal diseases

  1. Epidermoid cyst
  2. Scrotal calcinosis
  3. Angiokeratomas
  4. Fournier’s gangrene
  5. Scrotal squamous cell carcinoma
A
  1. Epidermoid Cyst
  • Common
  • An epidermoid cyst or epidermal inclusion cyst is a benign cyst usually found on the skin. The cyst develops out of ectodermal tissue. Histologically, it is made of a thin layer of squamous epithelium
  1. Scrotal Calcinosis
    * Rare; may be related to old epidermoid cysts
  2. Angiokeratomas
    * Benign vascular lesions
  3. Fournier’s Gangrene
    * Necrotising fasciitis; mortality of 15-20%
  4. Scrotal squamous cell carcinoma
  • Very rare
  • Historical interest; chimney sweep

Histopathology - Path (14 decks)

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