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YR5 Histopathology > Urological Pathology > Flashcards

Urological Pathology Flashcards

1
Q

What are urinary calculi? What is the epidemiology of urinary calculi?

A

Crystal aggregates that form in the renal collecting ducts.

May be deposited anywhere in the urinary tract.

Lifetime incidence 15%.

M 3x more likely to be affected than F.

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2
Q

What are stones in urinary calculi made of?

A

Calcium Oxalate (Weddellite): 75%

Magnesium Ammonium Phosphate (Struvite): 15%

Uric Acid: 5%

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3
Q

What are calcium oxalate stones related to?

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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4
Q

What are triple stones?

A

Magnesium ammonium phosphate stones are AKA ”triple stones”.

Form as consequence of infection with urease-producing organisms (Proteus sp.).

Ammonia alkalinises urine: precipitation of magnesium ammonium phosphate salts follows.

Can become very large

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5
Q

What are Staghorn Calculi made of?

A

Magnesium ammonium phosphate

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6
Q

What is this?

A

Triple stones

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7
Q

What are uric acid stones?

A

Uric acid stones may form in patients with hyperuricaemia: Gout or Rapid cell turnover (Chemo)

Most patients DONT 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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8
Q

What are complications associated with urinary calculi?

A

Small stones that stay in the kidney may be largely asymptomatic: Otherwise detected during Ix of haematuria or recurrent UTI

Small stones that drift out of kidney may become impacted + cause colic: Pelvi-ureteric junction, pelvic brim, vesico-ureteric junction.

Large stones tend to stay in kidney: Obstruction, risk of infection, chronic renal failure.

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9
Q

What are papillary adenomas?

A

Benign epithelial kidney tumour composed of papillae and/or tubules.

  • 15mm or less in size.
  • Well-circumscribed.
  • Trisomy 7, Trisomy 17, Loss of Y chromosome.

Frequent incidental finding in nephrectomies + at autopsy, esp. in CKD, acquired cystic renal disease.

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10
Q

What is this?

A

Papillary adenoma

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11
Q

What are renal oncocytomas?

A

Benign epithelial kidney tumour composed of oncocytic cells:

  • Well-circumscribed
  • Usually sporadic
  • Can be seen in Birt-Hogg-Dubé syndrome

Usually an incidental finding.

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12
Q

What is this?

A

Renal oncocytoma

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13
Q

What is this?

A

Renal oncocytoma

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14
Q

What are angiomyolipomas?

A

Benign mesenchymal kidney tumour composed of thick-walled blood vessels, smooth muscle + fat:

  • Derived from perivascular epithelioid cells
  • Mostly sporadic
  • Can be seen in tuberous sclerosis
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15
Q

What are the signs and symptoms of angiomyolipomas?

A

Usually an incidental finding.

Larger tumours (> 4cm) may present with flank pain, haemorrhage, shock.

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16
Q

What is this?

A

Angiomyolipoma

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17
Q

What are renal cell carcinomas?

A

Malignant epithelial kidney tumour.

Accounts for 2% of cancers worldwide.

More common in developed countries.

10 per 100,000 M
3 per 100,000 F

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18
Q

What are 5 risk factors for renal cell carcinomas?

A

Smoking

HTN

Obesity

Long-Term Dialysis

Genetic Syndromes: von Hippel Lindau

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19
Q

What are signs and symptoms of renal cell carcinoma?

A

Half of cases present with painless haematuria.

Most remaining cases are detected incidentally on imaging.

Small proportion present with metastatic disease.

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20
Q

What are 4 subtypes of renal cell carcinoma?

A

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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21
Q

What are clear cell renal cell carcinomas?

A

Epithelial kidney tumour composed of nests of clear cells set in a delicate capillary vascular network.

Appears grossly as a golden yellow tumour with haemorrhagic areas.

Genetically shows loss of chromosome 3p.

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22
Q

What is this?

A

Clear Cell Renal Cell Carcinoma

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23
Q

What are papillary renal cell carcinoma?

A

Epithelial kidney tumour composed of papillae and / or tubules.

  • By definition, more than 15mm in size.
  • Genetically shows trisomy 7, trisomy 17 and loss of Y chromosome.
  • Subdivided into two types based on morphology.

Grossly appears as a fragile, friable brown tumour.

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24
Q

What is this?

A

Papillary renal cell carcinoma

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25
Q

What is this?

A

Papillary renal cell carcinoma

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26
Q

What are chromophobe renal cell carcinoma?

A

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.

Grossly appears as a well-circumscribed solid brown tumour.

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27
Q

What is this?

A

Chromophobe renal cell carcinoma

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28
Q

What is the prognosis of renal cell carcinomas?

A

Five year survival across all tumour types is 60%.

Staging and Grading are most important prognostic factors.

ISUP Nuclear Grade (1-4) applies to clear cell and papillary renal cell carcinoma.

For clear cell renal cell carcinoma there is also a risk progression index.

Leibovich Risk Model (low risk, intermediate risk, high risk).

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29
Q

What is a nephroblastoma?

A

Also known as Wilm’s Tumour.

Malignant triphasic kidney tumour of childhood.

  • Blastema (small round blue cells)
  • Epithelial
  • Stromal

Typically presents as an abdominal mass in children aged 2-5 years old.

1 in 8,000 – second most common childhood malignancy.

95% of cases show favourable histological features with excellent prognosis.

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30
Q

What are urothelial carcinoma?

A

Also known as Transitional Cell Carcinomas.

Group of malignant epithelial neoplasms arising in urothelial tract.

  • Bladder
  • Renal Pelvis
  • Ureters

Very common.

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31
Q

What are risk factors for urothelial carcinomas?

A

Smoking

Aromatic amines

32
Q

What are the signs and symptoms of urothelial carcinomas?

A

Most present with haematuria.

33
Q

What are the three main subtypes of urothelial carcinomas?

A

Non-Invasive Papillary Urothelial Carcinoma

Infiltrating Urothelial Carcinoma

Flat Urothelial Carcinoma in-situ

34
Q

What are non-invasive papillary urothelial carcinomas?

A

Appear as frond-like growths. Divided into low grade and high grade 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.

35
Q

What is this?

A

Non-invasive papillary urothelial carcinoma

36
Q

What is this?

A

Non-Invasive Papillary Urothelial Carcinoma

37
Q

What is this?

A

Non-Invasive Papillary Urothelial Carcinoma

38
Q

What are infiltrating urothelial carcinomas and what is treatment dependent on?

A

Urothelial tumour displaying invasive behaviour.

Wide range of subtypes.

Treatment based on depth of invasion:

  • Lamina propria
  • Muscularis propria
39
Q

What are flat urothelial carcinoma in-situ and how do they appear?

A

May be invisible or appear as a reddish area.

Flat urothelial lesion with unequivocal high grade features.

High risk of progression.

40
Q

What is benign prostatic hyperplasia?

A

Benign enlargement of prostate as a consequence of increase in cell number.

Very common – symptomatic in 25% of men by age 80.

Histologically present in 90% of men by age 80.

41
Q

What is the aetiology of benign prostatic hyperplasia?

A

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.

42
Q

What are signs and symptoms of BPH?

A

Presents with “Lower Urinary Tract Symptoms”.

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

May also present with urinary tract infection, acute urinary retention or renal failure.

43
Q

What is this?

A

BPH

44
Q

What are prostatic adenocarcinomas?

A

Malignant epithelial prostate tumour. 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

Arises from Prostatic Intraepithelial Neoplasia.

Mutations in PTEN, AMACR, GST-pi, p27 and more.

45
Q

What are signs and symptoms of prostatic adenocarcinomas?

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.

46
Q

What is the Gleason score?

A

Most powerful prognostic indicator.

A total score is calculated based on how cells look under a microscope, with the first half of the score based on the dominant, or most common cell morphology (scored 1—5), and the second half based on the non-dominant cell pattern with the highest grade (scored 1—5). These two numbers are then combined to produce a total score for the cancer.

47
Q

What are testicular germ cell tumours?

A

Tumours of the testis arising from germ cells.

Account for 90% of testicular tumours.

Typically arise in men aged 20-45.

48
Q

What are risk factors for testicular germ cell tumours?

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

Malignant tumours arise from Germ Cell Neoplasia in-situ:

  • Process likely begins in foetal life
  • Amplification of i12p
49
Q

What are signs and symptoms of testicular germ cell tumours?

A

Present as painless lump.

10% present with symptoms related to metastasis:

  • Back pain
  • Cough
  • Dyspnoea
50
Q

How are testicular germ cell tumours classified?

A

Five histological subtypes.

Single tumour may be purely one subtype or contain a mixture of multiple subtypes.

51
Q

What is this?

A

Seminoma

52
Q

What is this?

A

Embryonal Carcinoma

53
Q

What is this?

A

Post-Pubertal Teratoma

54
Q

What is this?

A

Yolk Sac Tumour

55
Q

What is this?

A

Choriocarcinoma

56
Q

What is the management and prognosis of testicular germ cell tumours?

A

Highly sensitive to platinum-based chemotherapy regimes.

Prognosis excellent.

Five year survival is 98% in most countries.

57
Q

What are testicular non-germ cell tumours?

A

Much less common than germ cell tumours:

  • Lymphoma
  • Leydig Cell Tumour
  • Sertoli Cell Tumour
58
Q

What is lymphoma?

A

Older men, 5% of all testicular tumours

Highly aggressive; poor survival rates

59
Q

What are leydig cell tumours?

A

3% of all testicular tumours.

May present with precocious puberty if pre-pubertal.

Usually benign.

60
Q

What are sertoli cell tumours?

A

1% of testicular tumours

90% are benign

61
Q

What are paratesticular diseases?

A

Epididymal cyst

Epididymitis

Varicocele

Hydrocele

Adenomatoid Tumour

62
Q

What is epididymitis?

A

Usually related to C. trachomatis or N. gonnorrhoeae in men under 35; E. coli in men over 35.

63
Q

What is a variocele?

A

Dilated venous plexus.

64
Q

What is a hydrocele?

A

Fluid between layers of tunica vaginalis

65
Q

What is a adenomatoid tumour?

A

Small tubules lined by mesothelial cells

66
Q

What are penile diseases?

A

Lichen Sclerosus/Balanitis Xerotica Obliterans

Zoon’s balanitis

Condylomas: HPV 6 and 11

Peyronie’s Disease

Penile carcinoma

67
Q

What is Lichen Sclerosus/Balanitis Xerotica Obliterans?

A

Inflammatory condition that causes phimosis

68
Q

What is Zoon’s balanitis?

A

Inflammatory condition that causes red areas.

69
Q

What is Peyronie’s Disease?

A

Scarring, inflammation, thickening of corpus cavernosa.

70
Q

What is penile carcinoma?

A

Rare, elderly men

Smoking, HPV, chronic Lichen Sclerosus are risk factors.

71
Q

What are urethral diseases?

A

Urethritis: N. gonorrhoeae, C. trachomatis

Prostatic Urethral Polyp

Urethral Caruncle

Urethral Carcinoma

Malignant Melanoma: Rare

72
Q

What are Prostatic Urethral Polyps?

A

Papillary lesion in prostatic urethra

73
Q

What are urethral caruncle?

A

Common lesion at urethral meatus in women.

74
Q

What are urethral carcinomas?

A

Rare, more common in women, usually squamous cell carcinoma.

75
Q

What are scrotal diseases?

A

Epidermoid Cyst: Common

Scrotal Calcinosis: Rare; may be related to old epidermoid cysts.

Angiokeratomas: Benign vascular lesions

Fournier’s Gangrene: Necrotising fasciitis; mortality of 15-20%.

Scrotal squamous cell carcinoma: Very rare. Historical interest; chimney sweep.

YR5 Histopathology (27 decks)

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