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PATHOLOGY > urological pathology > Flashcards

urological pathology Flashcards

1
Q

what are urinary calculi

A

Crystal aggregates that form in the renal collecting ducts
May be deposited anywhere in the urinary tract

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2
Q

epi of urinary calculi

A

common

men 3x mor e

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3
Q

composition of renal stones

A
  • Calcium Oxalate (Weddellite) – 75%
  • Magnesium Ammonium Phosphate (Struvite) – 15%
  • Uric Acid – 5%
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4
Q

what are ca oxalate stones and potential mechanisms for them

A

related to hyperca
* absorptive hyperca - excessive ca absorption from the gut
* renal hyperca - impaired absorption of ca in the prox renal tuble
* hyperca - primary hyperpareathyroidism - rare !

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5
Q

what are triple stones

A

Magnesium ammonium phosphate stones

can become very big - staghorn calculi

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6
Q

mech of triple stones

A

Form as a consequence of infection with urease-producing organisms

eg Proteus sp.

-> Ammonia alkalinises urine
-> precipitation of magnesium ammonium phosphate salts follows

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7
Q

mech of uric acid calculi

A

hyperuricaemia - but many that have these stones dont have hyperuricaemia
* gout
* rapid turnover

tendency for some people to produce slightly acidic urine

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8
Q

complications of urinary calculi

A

depends on size

small and stay in kidney:
* asx
* haematuria
* recurrent UTI

out of kidney and small
* intense pain/colic - kidney impacted as stone gets stuck at Pelvi-ureteric junction, pelvic brim, vesico-ureteric junction

large and in kidney
* obstruction
* risk of infection - stagnant urine
* CKD - increased pressure
* kidney atrophy around stone

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9
Q

what are the benign renal neoplasms

A

papillary adenoma
renal oncocytoma
angiomyolipoma

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10
Q

what is papillary adenoma and features

A

benign renal neoplasm

made of papillae and/or tubules

by definition 15mm or less

well circumscribed

chr:
* trisomy 7
* trisomy 17
* loss of Y chr

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11
Q

presention of papillary adenoma

A

incidental finding at nephrectomies and autopsy

esp in CKD/acquired cystic disease

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12
Q

what is renal oncocytoma and features

A

Benign epithelial kidney tumour composed of oncocytic cells

Well-circumscribed

Usually sporadic

Can be seen in Birt-Hogg-Dubé syndrome

Made of pink oncocytic cells - Pink because mitochondria
Mohogony brown with central scar

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13
Q

presentation of renal oncocytoma

A

incidental

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14
Q

what are angiomyolipomas

A

benign mesenchymal kidney tumour

made of
* thick walled bv
* sm
* fat

Derived from perivascular epithelioid cells
Mostly sporadic
Can be seen in tuberous sclerosis – most people that have it don’t have tuberous sclerosis

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15
Q

presentation of angiomyolipoma

A

incidental

> 4cm
* flank pain
* haemorrhage -> shock

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16
Q

epidemiology of renal cell ca

A

common
more in developed
more men

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17
Q

RF for RCC

A

Smoking
Hypertension
Obesity
Long-Term Dialysis
Genetic Syndromes – von Hippel Lindau

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18
Q

what is RCC

A

malignant epithelial kidney tumour

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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19
Q

presentation of RCC

A

painless haematuria

incidental

small proportion - mets

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20
Q

what are clear renal cell ca

A

epithelial tumour

nests of clear cells set in delicate capillary vascular network

macro = golden yellow tumour, haemorrhagic areas

loss of chr 3p

Squished normal kidney inc glomerulus On R – clear cells pushing way in
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21
Q

what is papillary renal cell ca

A

epithelial

composed of papillae and/or tubules

>15 mm (counterpart is papillary ademoma)
macro = fragile, friable brown tumour

chr:
* trisomy 7
* trisomy 17
* loss of Y chr

subdivided:
* Type 1 = well defined and show consistent genetic loss
* Type 2 – more heterogenous - tend to have worse Px but because heterogenous cant tell which ones will be

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22
Q

what are chromophobe RCC

A

epithelial
sheets of large cells that display
* distinct cell borders
* reticular cytoplasm
thick walled vascular network

heterogenous

macro - well circumscribed solid brown tumour
plant like - because of well defined borders

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23
Q

px of RCC

A

5yr survival 60%
staging and grading are important
grade 1-4

for clear cell there is also risk of progression index - leibovich risk model (low, intermediate, high)

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24
Q

what is Wilm’s tumour

A

nephroblastoma

25
Q

features of wilm’s tumour

A

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

2nd most common tumour of childhood

26
Q

presentation of Wilm’s tumour

A

abdo mass
2-5yrs

27
Q

px of Wilm’s

A

Proportion and appearance of components (blastema, epithelial, stromal) give idea of Px

95% excellent px

28
Q

what are urothelial carcinomas

A

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

29
Q

epi and RF for urothelial carcinoma

A

smoking
aromatic amines

30
Q

presentation of urothelial tumours

A

haematuria - do cystoscopy

31
Q

summarise non-invasive papillary urothelial carcinoma

A

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

Frond like lumps mid = low grade R = high grade
32
Q

summarise infiltrating urothelial carcinoma

A

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

33
Q

what are flat urothelial carcinoma in situ

A

high grade
in situ

invisible or reddish

Flat urothelial lesion with unequivocal high grade features
High risk of progression

34
Q

what is BPH

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

Nodule of normal glandular and stromal part of the prostate
35
Q

aetiology of BPH

A

unclear

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

36
Q

rx of BPH

A

alpha blockers and 5a reductase inhibitors

transurethral resection - core out centre of prostate to ease flow of urine

37
Q

presentation of BPH

A

“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)

38
Q

what is prostatic adenocarcinoma and the aetiology

A

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

39
Q

epi of prostatic adenocarcinoma

A

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

40
Q

presentation of prostatic adenocarcinoma

A

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

41
Q

px indicator for prostatic cancer

A

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

42
Q
A

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

43
Q

gleason grade 4

A

have fusion of glands

44
Q

gleason grade 5

A

Pattern 4 + necrosis
Frank sheets of tumour cells

45
Q

what are testicular germ cell tumours

A

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

46
Q

epi and RFs for testicular germ cell tumours

A

90% of testicular tumours

20-45yrs

RF
* undescended testes
* LBW/SGA

47
Q

presentation of testicular germ cell tumours

A

painless lump

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

48
Q

seminoma

A

germ cell testicular tumour:

Clear cells prominent lymphoid infiltrate
Fibrous septae

Common

49
Q

embryonal germ cell testicular ca

A

High grade

Necrotic

Nasty

50
Q

post pubertal teratoma - germ cell testicular tumour

A

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

Tumour trying to produce keratin
51
Q

yolk sac tumour - testicular germ cell tumour

A

Try to replicate primitive structures

Smaller cells, lace like growth patterns

Look different

52
Q

testicular choriocarcinoma - germ cell tumour

A

Cytotrophoblast cells
Multinucleated cells – syncitiotrophoblast cells

Impacts on Px badly

53
Q

mx of germ cell tumour

A

Highly sensitive to platinum-based chemotherapy regimes

54
Q

Px of germ cell tumour

A

Prognosis excellent
Five year survival is 98% in most countries

Poor if have bad types and present with mets

55
Q

summarise the testicular non-germ cell tumours

A

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

56
Q

list some paratesticular diseases

A

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

57
Q

what are the penile diseases

A

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

58
Q

urethral diseases

A

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

59
Q

scrotal diseases

A

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

PATHOLOGY (94 decks)

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