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urological Pathology Flashcards

1
Q

what is renal cell carcinoma?

A

cancer of the kidney that arises from the renal tubular epithelium

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2
Q

what are the most common types of renal cell carcinoma?

A

Clear cell 75%

papillary 10%

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3
Q

what is the epidemiology of renal cell carcinoma?

A 
60 years old +
male 
Smoking 
Obesity
NSAID use
ESRF and on dialysis
Family history - von hippel-lindau
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4
Q

what is the aetiology of renal cell carcinoma?

A 
gene mutations causes renal cell carcinoma. this can be 
Environmental factors
- such as smoking 
Inherited genetic mutations 
-VHL
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5
Q

what is the pathogenesis of renal cell carcinoma?

A

the inherited genetic mutations and environmental factors causing mutations accumulate. hallmarks of cancer accumulate which then lead to malignant cell.

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6
Q

why do paraneoplastic syndromes develop?

A

develop as a result of either

  • proteins/hormones secreted by tumour syndromes
  • immune cross reactivity between tumour cells and normal tissues
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7
Q

what are the clinical features of the primary renal cell carcinoma tumour?

A
  • Haematuria

- abdominal pain

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8
Q

what are the effects of renal cell carcinoma distant metastases?

A

lung metastases - SOB

Bone mets - Bone pain

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9
Q

what are the paraneoplastic syndromes of renal cell carcinoma?

A

weight loss
hypertension
polycythemia

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10
Q

what is wilms tumour?

A

nephroblastoma, cancer of the kidney that arises from nephroblasts

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11
Q

what is the epidemiology of wilms tumour?

A 
children under five
5-10% with genetic syndromes will get wilms tumour including 
beckwith-weidemann syndrome 
WAGR syndrome 
Denys-Dash Syndrome
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12
Q

what is the aetiology of wilms tumour?

A

gene mutations causes wilms tumour
this includes
environmental factors causing mutations
and inherited genetic mutations - WT1

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13
Q

what are the clinical features of local primary wilms tumour effects?

A

lots of abdominal distention especially if tumour is bilateral
haematuria

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14
Q

what is urolithiasis

A

they are urinary tract calculi/stones. they form in the lumen of the urinary tract, anywhere from renal calyx to the bladder

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15
Q

what are the different types of urinary tract stones based on composition?

A

calcium stones 70%
urate stones 5%
cystine stones 1%
struvite stones 15%

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16
Q

what is the epidemiology of urolithiasis?

A

it depends on the type of stone and its cause

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17
Q

what is the overall aetiology of urolithiasis

A

too high a concentration of a solute in the urine

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18
Q

what is the aetiology calcium stones?

A

hypercalcemia

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19
Q

what is the aetiology of urate stones?

A

gout

malignancy due to high cell turnover

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20
Q

what is the aetiology of cystine stones?

A

congenital cystinuria i.e. kidneys are unable to reabsorb amino acids.

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21
Q

what is the aetiology of struvite stones?

A

urinary tract infection

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22
Q

what is the pathogenesis for urolithiasis for calcium, urate and cystine stones?

A

there’s too high a concentration of soluble material.
this causes urine to become saturated
soluble material then precipitates out causing stones to form

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23
Q

what is the pathogenesis for urolithiasis, struvite stones?

A

A UTI with urease producing bacteria occurs.

the urease converts urea to ammonia. ammonia causes pH to rise.
this causes precipitation of magnesium ammonium phosphate salts.
then stones form.

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24
Q

what are the clinical features of urolithiasis?

A

pain:
Ureter: loin to groin pain
Bladder: lower abdominal pain
Urethra: dysuria

haematuria

there may also be symptoms of complications

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25
what are some of the signs of complications that can occur in urolithiasis?
Obstruction= may cause hydronephrosis (kidney swelling) +/- hydroureter (dilation of the ureter) may cause renal impairments urinary stasis - infection local trauma - squamous metaplasia may cause SCC risk
26
what is Vesicoureteral reflux (VUR)
it is when urine flows backwards from the bladder to the ureter rather than from the bladder to the urethra
27
What is the epidemiology of VUR?
affects 10% of populations young people especially 2 years old and younger those with a family history of VUR are at a higher risk
28
what causes Vesicoureteral reflux?
congenital abnormality of the vesicoureteric junction
29
what is the pathogenesis of VUR?
the ureter enters the bladder at abnormal angle this causes dysfunction of vesicoureteric junction and therefore when voiding urine flows the wrong way
30
what are the clinical features of Vesicoureteral reflux?
Usually asymptomatic and children usually grow out of it. however there may be symptoms of complications associated with VUR
31
what are the symptoms of complications associated with VUR?
Stasis of Urine may cause UTI. | Back pressure and ascending infection may cause renal damage
32
what is urothelial carcinoma?
its a transitional cell carcinoma. A cancer arising from the urothelium and this accounts for 90% of bladder cancers
33
what is the epidemiology of urothelial carcinomas?
adults aged 60 years+ males smokers those exposed to certain industrial chemicals i.e. dyes family history if they've had treatment for other cancers e.g. pelvic radiotherapy
34
what is the aetiology for urothelial carcinomas?
gene mutations arising from environmental factors such as arylamines from dyes and smoking.
35
what are the clinical features of the local primary tumour in urothelial carcinomas?
- Haematuria - frequency, urgency, dysuria - urinary obstruction
36
what are the effects of distant metastases in urothelial carcinoma?
lung metastases cause SOB Bone metastases cause bone pain Liver metastases cause Jaundice
37
what is neurogenic bladder?
the inability to properly empty the bladder due to neurological damage
38
what are the types of neurogenic bladder?
there are two types spastic: if damage to brain or spinal cord flaccid: if damage to peripheral nerves
39
what is the epidemiology of neurogenic bladder
all genders and ages it depends on the the cause.
40
what is the aetiology for Upper motor neuron damage (spastic) for neurogenic bladder?
Stroke MS Spinal injury
41
what is the aetiology for lower motor damage (flaccid) neurogenic bladder?
Pregnancy Diabetes Alcohol B12 deficiency
42
what are the clinical features of neurogenic bladder?
they usually have symptoms related to lack of control of bladder emptying - urinary retention, abdominal distention, incontinence, urge, frequency they may have symptoms related to complications
43
what are the clinical features of complications that arise due to neurogenic bladder?
stasis of urine may cause UTI which may lead to dysuria. stasis of urine may also lead to urinary stones which may lead to haematuria. inability to empty bladder may lead to bladder distention which can cause hydroureter leading to hydronephrosis which eventually leads to renal function impairment and oedema
44
what is benign prostatic hyperplasia?
it is an increased number of both stroll and glandular cells in the prostate. known as enlarged prostate
45
what is the epidemiology of benign prostatic hyperplasia?
old men 70% by aged 60 obesity diabetes FH
46
what is the aetiology of benign prostatic hyperplasia
hormone mediated, Dihydrotestosterone
47
what urinary complications can occur due to benign prostatic hyperplasia?
``` compression of the urethra causes obstruction of bladder outlet. this may cause Urinary stasis - this leads to infections and stones Acute Urinary - cause retention Back Pressure - causes renal damage ```
48
what are the clinical features of benign prostatic hyperplasia? (9)
``` Lower urinary tract symptoms - hesitancy or urgency - poor/intermittent stream - straining - prolonged micturition \ - incomplete bladder emptying -Dribbling -frequency -incontinence Nocturia ```
49
what is prostatic adenocarcinoma?
cancer of the glandular epithelium in the prostate
50
what is the epidemiology of prostatic adenocarcinoma?
old men black men family history inc BRCA 1/2 pesticide exposure
51
what is the aetiology of Prostatic adenocarcinoma?
accumulation of gene mutations causes prostatic adenocarcinoma. these can be Environmental e.g. obesity, pesticides and inherited genetic mutations e.g. BRCA 1/2
52
what are the clinical features of local primary tumour effects in prostatic adenocarcinomas?
lower urinary tract symptoms (LUTS)
53
what are the clinical effects of distant metastases on prostatic adenocarcinomas?
bone metastases can cause bone pain
54
what is cryptorchidism?
undescended testis, where the testis is not in the scrotum
55
what is the epidemiology for cryptorchidism?
premature babies but still present in 3% of those born full term.
56
what is the aetiology of cryptorchidism?
``` multifactorial often no cause identified. multiple genes indicated - family history - downs syndrome -kleinfelter syndrome multiple environmental factors indicated -low birth weight - maternal smoking - maternal alcohol -prematurity ```
57
what is the pathogenesis of cryptorchidism?
embryological failure of descent testis into scrotum
58
what is the embryological pathway of descent for the testis into the scrotum
at 7 weeks testes begin to form in abdomen at 10-15 weeks transabdominal descent of the testis. at 25-35 weeks: inguinoscrotal descent of the testis
59
what are the clinical features of cryptorchidism
empty scrotum -10% bilateral - may resolve spontaneously - may develop complications
60
what are some clinical features of the complications of cryptorchidism?
infertility hernias testicular cancer risk testicular torsion
61
what is Seminoma?
Its the most common testicular cancer. A malignant neoplasm of the testis arising from germ cells in the seminiferous tubules
62
what is the epidemiology of seminoma
young men 25- 45 year olds Family History cryptochidism - regardless of whether it was surgically corrected
63
what is the aetiology of seminoma?
accumulation of gene mutations environmental and inherited genetic mutations environmental includes cryptorchidism inherited genetic mutations - KIT
64
what is the local primary tumour effects of seminoma?
-testicular lump, swelling and pain
65
what are the clinical feature effects of distant metastases due to seminoma?
lung mets - SOB | LN mets - back pain
66
what are some paraneoplastic syndrome effects due to seminoma?
Gynecomastia - man boobs
67
if there is a complete obstruction in the urinary tract what symptoms are associated with this?
anuria | pain

CP (14 decks)

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