Urological Pathology

Question 1

State the male to female ratio of renal stones

Answer 1

3:1

Question 2

State the 3 main types of renal stones and their %

Answer 2

Calcium oxalate (75%), magnesium ammonia phosphate (struvite, 15%), uric acid (5%)

Question 3

Which type of renal stone forms staghorn calculi?

Answer 3

Magnesium ammonia phosphate (struvite)

Question 4

State the 3 main points of renal stone impaction

Answer 4

Pelvi-ureteric junction, pelvic brim, vesico-ureteric junction

Question 5

State the main cause of magnesium ammonia phosphate renal stones

Answer 5

Urease-producing organisms which alkalinise urine, promoting precipitation of magnesium ammonium phosphate salts

Question 6

State the main cause of calcium oxalate renal stones

Answer 6

Intrinsic renal pathology impairing calcium absorption from the proximal tubule

Question 7

Describe the management of renal stones

Answer 7

Small stones may pass spontaneously. Larger stones can be removed using lithotripsy or endoscopic or percutaneous intervention

Question 8

What is benign prostatic hyperplasia (BPH)?

Answer 8

Dihydrotestosterone-mediated hyperplasia of prostatic stromal and epithelial cells, causing the formation of large nodules which compress the prostatic urethra

Question 9

Describe the clinical features of benign prostatic hyperplasia

Answer 9

Difficulty urinating, urinary retention, frequency, nocturia, overflow dribbling

Question 10

Describe the histological features of benign prostatic hyperplasia

Answer 10

Nodule formation, prostatic epithelial ducts with duct spaces

Question 11

Describe the management of benign prostatic hyperplasia

Answer 11

TURP, 5alpha reductase inhibitors

Question 12

Name a 5-alpha reductase inhibitor

Answer 12

Finasteride

Question 13

State the most common form of prostate cancer in men >50

Answer 13

Adenocarcinoma

Question 14

Name the precursor of prostate adenocarcinoma

Answer 14

Prostatic intraepithelial neoplasia

Question 15

Where does prostate adenocarcinoma classically arise?

Answer 15

Peripheral zone of gland

Question 16

Where does prostate adenocarcinoma typically spread?

Answer 16

Locally to bladder, haematogenously to bone

Question 17

Name the grading system for prostate adenocarcinoma

Answer 17

Gleason system

Question 18

State the main age range for testicular cancer

Answer 18

20-45

Question 19

State the most common type of testicular cancer

Answer 19

Germ cell tumours

Question 20

How much do undescended testes increase the rest of testicular cancer?

Answer 20

10x

Question 21

Name the main precursor lesion to testicular cancer

Answer 21

Intratubular germ cell neoplasia

Question 22

Name the most common type of germinal tumour

Answer 22

Seminoma

Question 23

State at least two biological markers for germ cell tumours

Answer 23

Alpha-fetoprotein (AFP), human chorionic gonadotrophin (HCG), lactate dehydrogenase (LDH)

Question 24

Name at least four types of germ cell tumour

Answer 24

Seminoma, teratoma, embryonal carcinoma, yolk sac tumour, choriocarcinoma

Question 25

What % of testicular tumours are non-germ cell?

Answer 25

5%

Question 26

Name two types of non-germ cell testicular tumours

Answer 26

Leydig cell tumour, Sertoli cell tumour

Question 27

Name at least two benign renal tumours

Answer 27

Papillary adenoma, oncocytoma, angiomyolipoma

Question 28

What is a renal angiomyolipoma?

Answer 28

Benign mesenchymal tumour composed of fat, blood vessels, and muscle

Question 29

Name at least two malignant renal tumours

Answer 29

Renal cell carcinoma, nephroblastoma (Wilm’s tumour), transitional cell carcinoma

Question 30

What is an oncocytoma?

Answer 30

Benign oncocytic renal epithelial neoplasm

Question 31

Describe the histology of renal papillary adenoma

Answer 31

Bland epithelial cells growing in a papillary or tubopapillary pattern, well circumscribed cortical nodules <5mm

Question 32

Describe the histology of oncocytoma

Answer 32

Macroscopic: mahogany brown
Microscopic: sheets of cells with pink cytoplasm, forming a nest of cells

Question 33

Describe the histology of angiomyolipoma

Answer 33

Fat spaces, thick blood vessels, spindle cell components

Question 34

State at least three risk factors for renal cell carcinoma

Answer 34

Smoking, hypertension, obesity, long-term dialysis

Question 35

Name three types of renal cell carcinoma

Answer 35

Clear cell, papillary, chromophobe

Question 36

Describe the histological appearance of clear cell carcinoma

Answer 36

Macroscopic: golden yellow with haemorrhagic areas
Microscopic: nests of epithelium with clear cytoplasm

Question 37

Describe the histological appearance of papillary renal cell carcinoma

Answer 37

Macroscopic: friable brown tumour
Microscopic: papillary or tubopapillary growth pattern >5mm

Question 38

Describe the histological appearance of chromophobe renal cell carcinoma

Answer 38

Macroscopic: solid brown tumour
Microscopic: sheets of large cells with distinct cell borders

Question 39

Describe the histological appearance of nephroblastoma

Answer 39

Small round blue very undifferentiated cells. Epithelial component with cells trying to differentiate and form primitive renal tubules

Question 40

Describe the histological appearance of non-invasive transitional cell carcinoma

Answer 40

Macroscopic: Growths projecting from the bladder wall, often multifocal
Microscopic: papillary fronds lined by urothelium

Question 41

State the male to female ratio of transitional cell tumours

Answer 41

3:1

Question 42

What is the main risk factor for squamous cell bladder carcinoma?

Answer 42

Urinary schistosomiasis