Urological Pathology

Question 1

Where does cancer of the kidney arise from

Answer 1

Epithelial lining of the tubular system

Question 2

Where does cancer of the kidney not arise from

Answer 2

Glomerulus
Proximal tubule
Collecting duct

Question 3

What are the symptoms of renal cancer

Answer 3

Haematuria
Low back pain 
Mass/lump in the abdomen
Fatigue 
Weight loss
Chronic fever
Paraneoplastic syndromes

Question 4

What is the treatment for renal cancer

Answer 4

Surgery
Radiation
Chemotherapy
Biologic therapy

Question 5

What are the types of surgery that can occur

Answer 5

1. Radical nephrectomy

2. Partial nephrectomy

Question 6

What is radical nephrectomy

Answer 6

Removal of the kidney, adrenal gland and surrounding tissue

Question 7

What is partial nephrectomy

Answer 7

Removal of the cancer and some tissue

Question 8

What are the classification of renal epithelial tumours in adults

Answer 8

Clear cell carcinoma 
Papillary carcinoma 
Chromophobe cell carcinoma 
Unclassified 
Oncocytoma

Question 9

What type of cells are clear cell carcinima

Answer 9

Clear cells

Question 10

What 2 factors are important in the prognois of clear cell carcinoma

Answer 10

Grading

Staging

Question 11

How do we grade clear cell carcinoma

Answer 11

Fuhrmann system

Question 12

If a tumour shows a variety of grade which is used to grade it

Answer 12

The highest one

Question 13

What is staging for clear cell carcinoma

Answer 13

TNM staging

Question 14

What are other tumours that you can get in the kidney

Answer 14

Angiomyolipoma 
Lymphoma 
Sarcoma
Metastasis 
Inflammatory pseudo tumour

Question 15

What are the 3 components of angiomyolipoma

Answer 15

Fat
Muscle cells
Thick vessel

Question 16

What are the most common types of renal cancer seen in children

Answer 16

Wilms tumour

Question 17

What does cancer of the urinary tract arise from

Answer 17

Epithelium

Question 18

Where can cancer of the urinary tract be seen in

Answer 18

Pelvis
Kidney 
Ureter
Bladder
Urethra

Question 19

What type of epithelium does cancer of the urinary tract arise from

Answer 19

Transitional epithelium

Question 20

What are the risk factors for cancer of the urinary tract

Answer 20

Smoking
Repeated exposure to chemicals e.g dyes, leather, rubber and paint
Infection
Chronic bladder inflammation

Question 21

What are the symptoms of cancer of the urinary tract

Answer 21

Same as symptoms of UTI
Haematuria
Dysuria
Frequency and urgency

Question 22

How is cancer of the urinary tract diagnosed

Answer 22

Cystoscopy with biopy or transurethral resection
Urine cytology
Imaging: ct scan and ultrasound

Question 23

How is urinary tract tumours classified

Answer 23

Non invasive

Invasive

Question 24

What is a invasive tumour

Answer 24

Grows into the wall of the bladder (high grade tumour)

Question 25

Whatdoes papillary tumour mean

Answer 25

They grow into the lumen of the bladder

Question 26

What gene deletion is usually seen in low grade urinary tract tumour

Answer 26

NQ gene

Question 27

What type of mutation is usually seen in high grade urinary tract tumours

Answer 27

P53 gene mutation

Question 28

What is carcinoma in situ

Answer 28

When the malignant cells replace urothelium

Question 29

What is staging based on

Answer 29

TNM staging and depth of invasion

Question 30

What is T1

Answer 30

Tumour at the subeptihelial connecitve tissue

Question 31

What is t2

Answer 31

Tumour that invasde the muscular wall/destrusor muscle

Question 32

What is t3

Answer 32

Tumour that invades anything outside the bladder wall e.g fat

Question 33

What is t4

Answer 33

Tumour that invades the adjacent organs e.g prostate or rectum

Question 34

What are the zone of prostate

Answer 34

Peripheral zone Central zone Transition zone

Question 35

What structure is at the transition zone

Answer 35

Urethra

Question 36

What are the 2 main lesions that can occur in the prostate

Answer 36

Benign prostatic hyperplasia (BPH) | Adenocarcinoma

Question 37

Which prostate zone does BPH arise from

Answer 37

Transitional zone

Question 38

Which zone does the adenocarcinoma arise from

Answer 38

Peripheral zone

Question 39

What are the symptoms of BPH

Answer 39

UTI | Urinary retention

Question 40

What is the treatment of BPH

Answer 40

Alpha blockers | Transurethral resection of prostate

Question 41

What are the symptoms of prostatic adenocarcinoma

Answer 41

Usually do not show symptoms

Question 42

How is prostate adenocarcinoma diagnosed

Answer 42

Psa levels Digital rectal examination Biopsy via transrectal needle core biopsy with USS guidance

Question 43

What is prostate adenocarcinoma graded with

Answer 43

Gleason grading system

Question 44

What is the grade range of the gleason grading system

Answer 44

``` Grade 1 (low): well defined glands Grade 5 (high): no glandular differentiation and there are blocks ```

Question 45

What is the treatment of prostatic adenocarcinoma

Answer 45

Surgery: radical prostatectomy Hormone therapy: gherelin- reduces the size before surgery Radiotherapy