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Y2 Clinical Pathology > Urological Pathology & Male Urogenital Pathology > Flashcards

Urological Pathology & Male Urogenital Pathology Flashcards

1
Q

Label the features of the urogenital syste

A
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2
Q

What is meant by:

  1. Definition
  2. Epidemiology
  3. Aetiology
  4. Pathogenesis
  5. Key clinical features
A

Definition:

  • What is it?

Epidemiology:

  • Who gets it?

Aetiology:

  • What causes it?

Pathogenesis:

  • What is the mechanism causing disease?

Key clinical features:

  • What does it look like?
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3
Q

What is the definition of renal cell carcinoma?

What are the 2 most common types?

A

It is a cancer of the kidney that arises from the renal tubular epithelium

there are several types but the 2 most common are:

  1. Clear cell (75%)
  2. Papillary (10%)
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4
Q

What types of renal cell carcinoma are shown here?

How can you tell?

A

Papillary carcinoma has finger-like architecture

clear cell carcinoma has clear white cells

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5
Q

What is the epidemiology of renal cell carcinoma like?

Who is more likely to get this condition?

A
  • Adults aged 60 and over
  • more common in males
  • those with a past medical history of obesity, smoking, NSAID use and ESFR / on dialysis
  • family history - especially Von Hippel-Lindau
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6
Q

What is the aetiology of renal cell carcinoma?

A

It is caused by gene mutations

these can be inherited genetic mutations (e.g. VHL)

or

environmental factors causing mutations (e.g. smoking)

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7
Q

What is the pathogenesis of renal cell carcinoma?

A
  1. Environmental factors cause mutations and there are inherited genetic mutations
  2. The mutations accumulate
  3. The “hallmarks of cancer” accumulate
  4. This leads to a malignant cell
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8
Q

What are the clinical features of renal cell carcinoma?

What are the 3 categories of effects?

A
  1. Local primary tumour effects
  2. Effects of distant metastases
  3. Paraneoplastic syndromes
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9
Q

What is meant by “paraneoplastic syndromes”?

Why do they develop?

A

Signs and symptoms that are NOT related to local effects of the primary or metastatic tumours

they develop as a result of:

  1. Proteins / hormones secreted by tumour cells
  2. Immune cross-reactivity between tumour cells and normal tissues
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10
Q

What are the local primary tumour effects, effects of distant metastases and paraneoplastic syndromes associated with renal cell carcinoma?

A

Local primary tumour effects:

  • haematuria
  • abdominal pain

Effects of distant metastases:

  • lung mets - shortness of breath
  • bone mets - bone pain

paraneoplastic syndromes:

  • weight loss - “cancer cachexia”
  • hypertension
  • polycythemia
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11
Q

What is meant by a ‘Wilm’s tumour’?

What is an alternative name?

A

Nephroblastoma

it is a cancer of the kidney that arises from nephroblasts

these are cells that develop into the kidney in embryological development

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12
Q

What is the epidemiology of Wilms’ tumour?

A
  • Children under 5
  • 5-10% are associated with genetic syndromes:
  • Beckwith-Weidemann syndrome
  • WAGR syndrome
  • Denys-Drash syndrome
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13
Q

What is the aetiology behind Wilms’ tumour?

A

It is caused by gene mutations

environmental factors may cause mutations

or there may be inherited genetic mutations (e.g. WT1)

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14
Q

What is the pathogenesis of Wilms’ tumour?

A
  • There are inherited genetic mutations (e.g. WT1) and environmental factors causing mutations
  • mutations accumulate
  • “hallmarks of cancer” accumulate
  • this leads to a malignant cell
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15
Q

What are the local primary tumour effects, effects of distant metastases and paraneoplastic syndromes associated with Wilms’ tumour?

A

Local primary tumour effects:

  • extreme abdominal distention - especially in 10% that are bilateral
  • haematuria

metastases and paraneoplastic syndromes are rare

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16
Q

What is shown here?

A

Wilms’ tumour

10% of these are bilateral

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17
Q
A
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18
Q

What is the definition of urolithiasis?

What are the different types?

A

Also known as urinary tract calculi / stones

they are stones forming in the lumen of the urinary tract, anywhere from the renal calyx to the bladder

the types are based on composition:

  1. Calcium stones (70%)
  2. Urate stones (5%)
  3. Cystine stones (1%)
  4. Struvite stones (15%) - magnesium ammonium phosphate
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19
Q

What is the epidemiology of urolithiasis?

A

It depends on the type of stone and its cause

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20
Q

What is the aetiology of urolithiasis?

A

It is caused by too high a concentration of a solute in the urine

calcium stones - hypercalcaemia

urate stones - gout, malignancy

cystine stones - congenital cystinuria (kidneys unable to reabsorb amino acids)

struvite stones - urinary tract infection

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21
Q

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

A
  1. Too high a concentration of soluble material
  2. Urine becomes saturated
  3. Soluble material precipitates out
  4. Stones form
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22
Q

What is the pathogenesis in urolithiasis for struvite stones?

A
  1. UTI with urease producing bacteria
  2. Urease converts urea to ammonia
  3. Ammonia causes pH to rise
  4. Precipitation of magnesium ammonium phosphate salts
  5. Stones form
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23
Q

What are the clinical features of urolithiasis?

A

Pain:

  • ureter - “loin to groin” renal colic pain
  • bladder - lower abdominal pain
  • urethra - dysuria

haematuria

and symptoms of complications

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24
Q

What are the 3 main complications of urolithiasis?

What can they lead to?

A

Obstruction:

  • this leads to hydronephrosis +/- hydroureter
  • this causes renal impairment

Urinary stasis:

  • causes infection

local trauma:

  • causes squamous metaplasia
  • increases squamous cell carcinoma risk
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25
Q

What is the definition of vesicoureteral reflux (VUR)?

A

When urine flows backwards from the bladder to the ureter, rather than from the bladder to the urethra

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26
Q

What is the epidemiology of vesicoureteral reflux (VUR)?

A
  • Affects 10% of the population
  • particularly affects young people, especially those < 2
  • those with a family history of VUR
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27
Q

What is the aetiology of vesicoureteral reflux?

A

A congenital abnormality of the vesicoureteric junction

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28
Q

What is the pathogenesis of vesicoureteral reflux (VUR)?

A

The ureter enters the bladder at an abnormal angle

this causes dysfunction of the vesicoureteric junction

when voiding, urine flows the wrong way

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29
Q

What are the clinical features of vesicoureteral reflux (VUR)?

A

It is usually asymptomatic and most children “grow out of it”

there are only symptoms of complications

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30
Q

What are the complications and symptoms associated with vesicoureteral reflux (VUR)?

A

Stasis can lead to urinary tract infection

back pressure and ascending infection can lead to renal damage

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31
Q

What is the definition of urothelial carcinoma?

A

Also known as transitional cell carcinoma

it is cancer arising from the urothelium (i.e. transitional epithelium)

it accounts for >90% of bladder cancer

32
Q

What is the epidemiology of urothelial carcinoma?

A
  1. Adults aged 60 years and over
  2. More common in males
  3. Exposure to certain industrial chemicals
  4. Family history
  5. Treatment for other cancers - pelvic radiotherapy, cyclophosphamide
33
Q

What causes urothelial carcinoma?

A

Environmental factors causing mutations

e.g. arylamines, smoking

34
Q

What are the local primary tumour effects, effects of distant metastases and paraneoplastic syndromes associated with urothelial cell carcinoma?

A

Local primary tumour effects:

  • haematuria
  • frequency, urgency, dysuria
  • urinary obstruction

effects of distant metastases:

  • lung mets - shortness of breath
  • bone mets - bone pain
  • liver mets - jaundice

Paraneoplastic syndromes are rare

35
Q

What is the definition of neurogenic bladder?

What are the 2 different types?

A

The inability to properly empty the bladder due to neurological damage

spastic:

  • if there is damage to the brain or spinal cord (UMN)

flaccid:

  • if there is damage to peripheral nerves (LMN)
36
Q

What is the epidemiology of neurogenic bladder?

A

It affects all genders and ages - depends on the cause

37
Q

What is the aetiology of neurogenic bladder?

A

Damage to the nervous system:

UMN damage:

  • stroke
  • MS
  • spinal injury

LMN damage:

  • pregnancy
  • diabetes
  • alcohol leading to B12 deficiency
38
Q

Label the following diagram showing neural control of micturition

A
39
Q

What are the clinical features of neurogenic bladder?

A

Symptoms are related to lack of control of bladder emptying

  • urinary retention +/- abdominal distention
  • incontinency
  • urge
  • frequency

there are also symptoms relating to complications

40
Q

What are the symptoms relating to the complications of neurogenic bladder?

A

Stasis:

  • can lead to urinary tract infection
  • can lead to urinary stones

Inability to empty bladder:

  • leads to bladder distention, hydroureter and hydronephrosis
  • this leads to functional impairment and oedema
41
Q

What is the definition of benign prostatic hyperplasia?

A

Increased number of both stromal and glandular cells in the prostate

this is known by patients as an “enlarged prostate”

42
Q

What is the epidemiology of benign prostatic hyperplasia?

A
  • Old men - 20% by age 40 and 70% by age 60
  • obesity
  • diabetes
  • family history
43
Q

What is the aetiology of benign prostatic hyperplasia?

A

It is not entirely known

expected to be hormone-mediated and involve dihydrotestosterone

44
Q

What is the pathogenesis of benign prostatic hyperplasia?

A
  1. Compression of the urethra leads to obstruction of bladder outlet
  2. This leads to urinary stasis, acute urinary problems or back pressure

urinary stasis leads to infection and stones

acute urinary leads to retention

back pressure leads to renal damage

45
Q
A
46
Q

What are the lower urinary tract symptoms (LUTS) associated with benign prostatic hyperplasia?

A
  • Hesitancy or urgency
  • poor/intermittent stream
  • straining
  • prolonged micturition
  • incomplete bladder emptying
  • dribbling
  • frequency
  • incontinence
  • nocturia
47
Q

What is the definition of prostatic adenocarcinoma?

A

Cancer of the glandular epithelium in the prostate

48
Q

What is the epidemiology of prostatic adenocarcinoma?

A
  • Old men
  • black men
  • family history (incl. BRCA1/2)
  • pesticide exposure

as the main risk factor for BPH is also age, the two are often seen in the same patients, but BPH is not a precursor to cancer

49
Q

What is the aetiology of prostatic adenocarcinoma?

A

It is caused by gene mutations

these can be environmental factors causing mutations e.g. obesity, pesticides

or inherited genetic mutations e.g. BRCA 1/2

50
Q

What are the local primary effects, effects of distant metastases and paraneoplastic syndromes associated with prostatic adenocarcinoma?

A

Local primary tumour effects:

  • lower urinary tract symptoms (LUTS)
  • e.g. hesitancy, dribbling, etcc

Effects of distant metastases:

  • bone mets - bone pain

Paraneoplastic syndromes are rare

51
Q

What is the definition of cryptorchidism?

A

Undescended testis

the testis is NOT in the scrotum

there are different types based on the site of the testis

52
Q

What is the epidemiology of cryptorchidism?

A

Premature babies

but it is still present in 3% of those born full term

53
Q

What is the aetiology of cryptorchidism?

A

It is multifactorial and often no cause is identified

environmental factors:

  • low birth weight
  • maternal smoking
  • maternal alcohol
  • prematurity

multiple genes:

  • family history
  • downs syndrome
  • kleinfelter syndrome
54
Q

what is the pathogenesis of cryptorchidism?

A

The embryological failure of the descent of the testis into the scrotum

at 7 weeks the testes begin to form in the abdomen

10-15 weeks - transabdominal descent

25-35 weeks - inguinoscrotal descent

55
Q

What are the clinical features of cryptorchidism?

A

The scrotum is empty (10% bilateral)

it may resolve spontaneously

complications may develop

56
Q

What are the complications associated with cryptorchidism?

A
  • Infertility
  • hernias
  • testicular cancer risk
  • testicualr torsion
57
Q

What is the definition of seminoma?

A

Malignant neoplasm of the testis arising from germ cells in the seminiferous tubules

it is the most common type of testicular cancer

58
Q

Identify the following types of testicular cancer

A
59
Q

Which types of testicular cancers have a bad prognosis and need more aggressive treatment?

A

Non-seminomatous germ cell tumour:

  • teratoma
  • choriocarcinoma
  • yolk sac
  • embryonal

non-germ cell:

  • lymphoma
60
Q
A
61
Q

What types of testicular cancer have a good prognosis and require less aggressive treatment?

A

Seminoma:

  • classis
  • spermatocytic

sex cord stromal tumours:

  • leydig cell tumour
  • sertoli cell tumour
  • these are usually benign
62
Q

What is the epidemiology of seminoma?

A
  • Young men (25 - 45 years old)
  • family history
  • crytporchidism - regardless of whether it was surgically corrected or only affected the other testis
63
Q

What is the aetiology of seminoma?

A

It is caused by gene mutations

environmental factors causing mutations e.g. cryptochidism

or inherited gene mutations e.g. KIT

64
Q

What are the local primary tumours, effects of distant metastases and paraneoplastic syndromes associated with seminoma?

A

Local primary tumour effects:

  • testicular lump
  • swelling, pain, etc.

effects of distant metastases:

  • lung mets - shortness of breath
  • LN mets - back pain

paraneoplastic syndromes:

  • gynecomastia (BHCG)
65
Q
A
66
Q

What are the clinical features of seminoma?

A
  • Dull ache or pain
  • shrinking of testicles
  • increased firmness
  • swelling or enlargement
  • heavy feeling
  • hard lump
  • difference between testicles
  • fluid
67
Q

What are the causes of urinary tract obstruction relating to the kidney?

A

Large tumours

68
Q

What are the causes of urinary tract obstruction relating to the ureter?

A

Material in the lumen:

  • calculi
  • clots
  • sloughed papillae

wall abnormalities:

  • stricture
  • tumour
  • congenital abnormalities

external compression:

  • pregnancy
  • cervical / colon cancer
  • retroperitoneal fibrosis
  • abdominal aortic aneurysm

functional:

  • VUJ reflux - this is not a physical obstruction
69
Q

What are the causes of urinary tract obstruction relating to the renal pelvis?

A
  • Stag horn calculi
  • tumours
70
Q

What are the causes of urinary tract obstruction relating to the bladder?

A
  • Calculi
  • tumours
  • neurogenic bladder
  • anticholinergic drugs
  • constipation
71
Q

What are the causes of urinary tract obstruction relating to the prostate?

A
  • BPH
  • tumours
  • prostatitis
72
Q

What are the causes of urinary tract obstruction relating to the urethra?

A
  • Stricture
  • foreign body
  • posterior urethral valves
  • blocked catheter
73
Q

What is the presentation of urinary tract obstruction?

A

Symptoms of the causative factor plus…

if complete obstruction:

  • anuria
  • pain

if partial obstruction:

  • often asymptomatic
74
Q

What are the complications of urinary tract obstruction relating to back pressures and urinary stasis?

A

Complications due to back pressures:

  • irreversible renal impairment
  • secondary VUR

complications due to urinary stasis:

  • infection
  • calculi formation
75
Q

What is a summary of what happens when the urinary tract becomes blocked?

A

The urinary tract can become physically or functionally blocked

when this happens it leads to infection, stones and renal damage

76
Q

Which malignancies in the urological tract have good and bad prognosis?

A

Renal and bladder carcinoma have bad prognosis

seminoma, prostate carcinoma and Wilms’ tumour have good prognosis

Y2 Clinical Pathology (76 decks)

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