urological pathology Flashcards

Question

features of wilm's tumour

Answer 1

Malignant **triphasic** kidney tumour of childhood * Blastema (small round blue cells) * Epithelial * Stromal *2nd most common tumour of childhood*

Answer 2

abdo mass 2-5yrs

Answer 3

Proportion and appearance of components (blastema, epithelial, stromal) give idea of Px 95% excellent px

Answer 4

transitional cell carcinomas malignant neoplasms arising in urothelial tract - bladder, renal pelvis, ureters Three main subtypes * Non-Invasive Papillary Urothelial Carcinoma * Infiltrating Urothelial Carcinoma * Flat Urothelial Carcinoma in-situ

Answer 5

smoking aromatic amines

Answer 6

haematuria - *do cystoscopy*

Answer 7

**frond like** growths low and high grade based on nuclear atypia low grade have low chance of progression to invasive high = higher risk unstable - genetic aberrations include RB TP53

Answer 8

displays invasive behaviour Treatment based on depth of invasion * Lamina propria – local excision/chemo etc * Muscularis propria – cystectomy = loss bladder, ureter, prostate, +- urethera Can maintain true to appearance, can look like other cancers, can produce and secrete other things – once they start to invade the morphology v diverse – more diverse = worse px

Answer 9

high grade in situ invisible or reddish Flat urothelial lesion with unequivocal high grade features High risk of progression

Answer 10

**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

Answer 11

unclear increased oestrogen levels with age -> may induce androgen receptors -> hyperplasia

Answer 12

alpha blockers and 5a reductase inhibitors transurethral resection - core out centre of prostate to ease flow of urine

Answer 13

“Lower Urinary Tract Symptoms” * Frequency * Nocturia * Urgency * Hesitancy * Poor flow * Terminal Dribbling urinary tract infection - incomplete emptying acute urinary retention renal failure (from poor flow -> bilateral hydronephrosis)

Answer 14

malignant epithelial prostate tumour red meat increased risk if 1st degree relative ethnic differences arise from prostatic intraepithelial neoplasia mutation in *(not traditional oncogenes so we don’t really know why people get them)* * PTEN * AMACR * GST-pi * p27

Answer 15

common Less prominent (but important) cause of cancer-related death

Answer 16

asx dx on biopsy after raised PSA or DRE LUTS - but less than BPH because the cancer is more peripheral so sx are late Rarely present with metastatic disease * Pathological fracture – mets are sclerotic not lytic

Answer 17

**Gleason score** Expressed as x + y = z **Two most common patterns (or most common pattern and worst pattern in biopsy setting** – don’t want to underestimate how bad it could be because only have a small biopsy) Patterns range from 1-5 1 and 2 rarely if ever diagnosed so scores typically range from 6-10 **Higher scores correlate with aggressive behaviour** High volume tumours scoring 8-10 in particular Grade grouping used as well

Answer 18

How distinct the glands are and how much it resembles still Grade 3 – simplified but distinct glands How distinct the glands are and how much it resembles still Grade 3 – simplified but distinct glands

Answer 19

have fusion of glands

Answer 20

Pattern 4 + necrosis Frank sheets of tumour cells

Answer 21

Tumours of the testis arising from germ cells Five histological subtypes Single tumour may be purely one subtype or contain a mixture of multiple subtypes Malignant tumours arise from **Germ Cell Neoplasia in-situ** * Process likely begins in **foetal life** * Amplification of **i12p**

Answer 22

90% of testicular tumours 20-45yrs RF * undescended testes * LBW/SGA

Answer 23

painless lump mets * Back pain – lymphatic drainage is para-aortic * Cough – lung mets * Dyspnoea

Answer 24

germ cell testicular tumour: Clear cells prominent lymphoid infiltrate Fibrous septae Common

Answer 25

High grade Necrotic Nasty

Answer 26

From germinal layers trying to produce different tissues Malignant Each component can develop its own malignancy – ie if tumour trying to become lung, it can then become lung cancer

Answer 27

Try to replicate primitive structures Smaller cells, lace like growth patterns Look different

Answer 28

Cytotrophoblast cells Multinucleated cells – syncitiotrophoblast cells Impacts on Px badly

Answer 29

Highly sensitive to **platinum-based chemotherapy** regimes

Answer 30

**Prognosis excellent** Five year survival is 98% in most countries Poor if have bad types and present with mets

Answer 31

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**

Answer 32

Epididymal cyst – benign Epididymitis * Usually related to C. trachomatis or N. gonnorrhoeae in men under 35; * E. coli in men over 35 Varicocele - Dilated venous plexus Hydrocele - Fluid between layers of tunica vaginalis Adenomatoid Tumour * Small tubules lined by mesothelial cells * Uncommon

Answer 33

Lichen Sclerosus / Balanitis Xerotica Obliterans * Inflammatory condition that causes phimosis * RF for penile ca – rare Zoon’s balanitis * Inflammatory condition that causes red areas Condylomas -HPV 6 and 11 Peyronie’s Disease * Scarring , inflammation, thickening of corpus cavernosa * -> penis curve Penile carcinoma * Rare, elderly men * Smoking, HPV, chronic Lichen Sclerosus are risk factors

Answer 34

Urethritis * Non specific or N. gonorrhoeae (purulent discharge), C. trachomatis Prostatic Urethral Polyp * Papillary lesion in prostatic urethra Urethral Caruncle * Inflammatory mass * common lesion at urethral meatus in women Urethral Carcinoma * Rare, more common in women, usually squamous cell carcinoma Malignant Melanoma - V Rare

Answer 35

Epidermoid Cyst * Common * Invagination of skin – cyst surrounded by skin and filled with keratin when old and contents calcify -> Scrotal Calcinosis * Rare; may be related to old epidermoid cysts Angiokeratomas * Benign vascular lesions * Tumour with vascular network * Keratin and skin on surface has become thickened Fournier’s Gangrene * Necrotising fasciitis; * mortality of 15-20% Important to recognise quickly Scrotal squamous cell carcinoma * Very rare * Historical interest; chimney sweep