Urological Pathology Flashcards
State the male to female ratio of renal stones
3:1
State the 3 main types of renal stones and their %
Calcium oxalate (75%), magnesium ammonia phosphate (struvite, 15%), uric acid (5%)
Which type of renal stone forms staghorn calculi?
Magnesium ammonia phosphate (struvite)
State the 3 main points of renal stone impaction
Pelvi-ureteric junction, pelvic brim, vesico-ureteric junction
State the main cause of magnesium ammonia phosphate renal stones
Urease-producing organisms which alkalinise urine, promoting precipitation of magnesium ammonium phosphate salts
State the main cause of calcium oxalate renal stones
Intrinsic renal pathology impairing calcium absorption from the proximal tubule
Describe the management of renal stones
Small stones may pass spontaneously. Larger stones can be removed using lithotripsy or endoscopic or percutaneous intervention
What is benign prostatic hyperplasia (BPH)?
Dihydrotestosterone-mediated hyperplasia of prostatic stromal and epithelial cells, causing the formation of large nodules which compress the prostatic urethra
Describe the clinical features of benign prostatic hyperplasia
Difficulty urinating, urinary retention, frequency, nocturia, overflow dribbling
Describe the histological features of benign prostatic hyperplasia
Nodule formation, prostatic epithelial ducts with duct spaces
Describe the management of benign prostatic hyperplasia
TURP, 5alpha reductase inhibitors
Name a 5-alpha reductase inhibitor
Finasteride
State the most common form of prostate cancer in men >50
Adenocarcinoma
Name the precursor of prostate adenocarcinoma
Prostatic intraepithelial neoplasia
Where does prostate adenocarcinoma classically arise?
Peripheral zone of gland
Where does prostate adenocarcinoma typically spread?
Locally to bladder, haematogenously to bone
Name the grading system for prostate adenocarcinoma
Gleason system
State the main age range for testicular cancer
20-45
State the most common type of testicular cancer
Germ cell tumours
How much do undescended testes increase the rest of testicular cancer?
10x
Name the main precursor lesion to testicular cancer
Intratubular germ cell neoplasia
Name the most common type of germinal tumour
Seminoma
State at least two biological markers for germ cell tumours
Alpha-fetoprotein (AFP), human chorionic gonadotrophin (HCG), lactate dehydrogenase (LDH)
Name at least four types of germ cell tumour
Seminoma, teratoma, embryonal carcinoma, yolk sac tumour, choriocarcinoma
What % of testicular tumours are non-germ cell?
5%
Name two types of non-germ cell testicular tumours
Leydig cell tumour, Sertoli cell tumour
Name at least two benign renal tumours
Papillary adenoma, oncocytoma, angiomyolipoma
What is a renal angiomyolipoma?
Benign mesenchymal tumour composed of fat, blood vessels, and muscle
Name at least two malignant renal tumours
Renal cell carcinoma, nephroblastoma (Wilm’s tumour), transitional cell carcinoma
What is an oncocytoma?
Benign oncocytic renal epithelial neoplasm
Describe the histology of renal papillary adenoma
Bland epithelial cells growing in a papillary or tubopapillary pattern, well circumscribed cortical nodules <5mm
Describe the histology of oncocytoma
Macroscopic: mahogany brown
Microscopic: sheets of cells with pink cytoplasm, forming a nest of cells
Describe the histology of angiomyolipoma
Fat spaces, thick blood vessels, spindle cell components
State at least three risk factors for renal cell carcinoma
Smoking, hypertension, obesity, long-term dialysis
Name three types of renal cell carcinoma
Clear cell, papillary, chromophobe
Describe the histological appearance of clear cell carcinoma
Macroscopic: golden yellow with haemorrhagic areas
Microscopic: nests of epithelium with clear cytoplasm
Describe the histological appearance of papillary renal cell carcinoma
Macroscopic: friable brown tumour
Microscopic: papillary or tubopapillary growth pattern >5mm
Describe the histological appearance of chromophobe renal cell carcinoma
Macroscopic: solid brown tumour
Microscopic: sheets of large cells with distinct cell borders
Describe the histological appearance of nephroblastoma
Small round blue very undifferentiated cells. Epithelial component with cells trying to differentiate and form primitive renal tubules
Describe the histological appearance of non-invasive transitional cell carcinoma
Macroscopic: Growths projecting from the bladder wall, often multifocal
Microscopic: papillary fronds lined by urothelium
State the male to female ratio of transitional cell tumours
3:1
What is the main risk factor for squamous cell bladder carcinoma?
Urinary schistosomiasis