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Histopathology > Urologoical Pathology > Flashcards

Urologoical Pathology Flashcards

1
Q

How common are urinary calculi?

A

Incidence is up to 15%

M:F 3:1

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2
Q

How many main types of urniary stones are there?

A

3

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3
Q

What is the most common type of renal stone?

A

75% calcium oxalate
Most related to absorptive hypercalciuria (gut)
Some have renal calciuria, where calcium absorption from proximal tubule is impaired

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4
Q

What is the second most common renal stone?

A

15% magnesium ammonium phosphate aka triple stones

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5
Q

What are triple stones formed as a result of?

A

Infections with urease-producing organisms e.g Proteus
Ammonia alkalises the urine and promotes precipitation of stones
Can form staghorn calculi.

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6
Q

What is urease?

A

An enzyme that catalyses urea into carbon dioxide and ammonia, the ammonia is alkaline.

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7
Q

What is the 3rd most common type of renal stone we see?

A

Uric acid 5%
Forms with rapid cell turnover, eg gout.
Most patients don’t have hyperuricaeima/ increased urinary excretion of uric acid.
They may have a tendency to form slightly acidic urine

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8
Q

How do small stones present?

A

If confined to the kidney, they are asymptomatic, or picked up after ix of haematuria or recurrent UTI

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9
Q

What can larger stones in the kidney cause?

A

Obstruction and gradual loss of renal function

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10
Q

What can small stones or stone fragments do in the ureter?

A

They impact and cause ureteric colic.

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11
Q

What are the common points of impaction?

A

PUJ
Pelvic brim
VUJ

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12
Q

What may be the outcome of small stones?

A

Pass of their own accord, give analgesia

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13
Q

What can happen to larger stones?

A

May be removed by endoscopic or percutaneous methods or shattered using acoustic pulses (shock wave lithotripsy)

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14
Q

What will happen to very large renal stones?

A

If they are obstructing the kidney with infection, it may require removal of the entire kidney

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15
Q

What leads to hydronephrosis?

A

Staghorn calculi. Kidney becomes atrophied.

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16
Q

What are the benign renal neoplasms?

A

Papillary adenoma,
Oncocytoma
Angiomyolipoma

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17
Q

What is a papillary adenoma?

A

Benign renal epithelial tumour with a papillary or tubular architecture
size of 5mm or less
Well circumscribed cortical nodules

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18
Q

When are papillary adenoma found?

A

Found incidentally in nephrectomy specimens

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19
Q

What is the histology of papillary adenoma?

A

Bland epithelial cells growing in a papillary or tubulopapillary pattern

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20
Q

What is an oncocytoma?

A 
Benign renal epithelial neoplasm, lots of cytoplasm 
Discovered incidentally 
Some associated with genetic syndromes 
No capacity for spread 
Mahogany brown
Central area of scarring
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21
Q

What is an angiomyolipoma?

A

Benign mesenchymal tumour of the kidney
Variable amounts of fat, smooth muscle, thick walled blood vessels
Small proportion assoc. with tuberous sclerosis in younger patients

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22
Q

How can angiomyolipoma present?

A

With flank pain, due to haemorrhage into the tumour

Fat is diagnostic radiologically

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23
Q

What are the malignant renal neoplasms?

A

RCC x 3

Nephroblastoma

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24
Q

What is renal cell carcinoma?

A

Malignant epithelial tumour arising in the kidney
2% cancers worldwide
10/10000 or 3/10000 women

25
Q

What are the recognised risk factors for RCC?

A 
Smoking
Hypertension 
Obesity
Environmental chemical 
Long term dialysis 
Genetic syndromes- von Hippel Lindau
26
Q

What is von Hippel Lindau syndrome?

A

X

27
Q

How does RCC present?

A

Half present with painless haematuria
Remainder is incidental
Small proportion present with met spread

28
Q

What are 3 main histological types of RCC?

A

Clear cell
Papillary
Chromophobe

29
Q

What is the histology of clear cell renal cell carcinoma?

A

70% of all RCC
Grossly appear as golden yellow tumours with haemorrhagic areas
Nests of epithelial cells with clear cytoplasm set in delicate capillary vascular network
Loss of chromosome 3p

30
Q

What is the second most common RCC?

A 
15% of RCC
Friable brown tumours 
Epithelial with a papillary or tubulopapillary growth pattern, less than 5mm in size 
Trisomy of chromosome 7 and 17 
Often filled with foamy macrophages
31
Q

What is the least common RCC?

A

Chromophobe 5% of RCC
Macroscopically appear as solid brown tumours, paler than oncocytoma
Sheets of large cells, distinct borders, thick walled vasculature
Extensive chromosomal loss

32
Q

What the general outcomes for RCC?

A

Overall 5 year survival rate, 60%
Stage and grade most important prognostic factors
Fuhrman grading system based on degree of nuclear atypia

33
Q

What is a nephroblastoma? (Wilm’s tumour)

A

Malignant childhood renal neoplasm

1 in 8000 (second most common childhood malignancy)

34
Q

How does Wilm’s present?

A

2-5 years with abdo mass
Undifferentiated small round blue cells, with areas of more differentiated epithelial stromal components
Excellent prognosis with tx

35
Q

What are urothelial carcinomas?

A

Transitional cell carcinoma
Epithelial neoplasms, arise in urothelial tract
Most arise in bladder, anywhere from pelvis onwards
Smoking increases risk, carcinogens dwell longest in the bladder

36
Q

What can urothelial carcinomas be divided into?

A

Non-invasive papillary urothelial carcinomas

Invasive urothelial carcinomas

37
Q

How do non invasive papillary urothelial carcinomas present?

A

Present with haematuria
Appear as frond like growths projecting from the surface of the bladder mucosa
Multi focal in bladder

38
Q

What is the grading prognosis for non invasive papillary urothelial carcinoma?

A

Low or high grade tumours

Low grade- low grade nuclear atypia, low risk of progression into invasion (

39
Q

What are the non invasive papillary urothelial carcinomas treatment?

A

Complete resection +/- intravesical chemo

Regular cystoscopies, due to high incidence of multifocality and recurrence

40
Q

How does infiltrating urothelial carcinoma present?

A

Haematuria
Solid mass, invading carcinoma nests
Capacity for metastic spread

41
Q

What is the tx and prognosis of infiltrating urothelial carcinoma?

A

Depends on stage of disease
Lamina propria- resection and intravesical chemo
Detrussor muscle- radical treatment with cystectomy +/- radiotherapy +/- systemic chemo

42
Q

What is the most common problem of the prostate?

A

BPH

43
Q

What is BPH?

A

Enlargement of the prostate gland due to an increase in cell number
Common
Affect 3% aged 45-49, rise to 25% by 80
Increased androgens critical to pathogenesis

44
Q

How does BPH present?

A 
Lots of nodules form on prostate,
Lower UTI symptom 
UTI, acute urinary retention 
Renal failure 
Smooth muscle of detrussor becomes hyper plastic too
45
Q

What are treatment options for BPH?

A

Alpha blockers eg doxazosin
5 alpha reductase inhibitors eg finasteride
If medical treatment fails then TURP Is treatment of choice

46
Q

What is the next most common problem with the prostate?

A

Malignant epithelial neoplasm arising in the prostate
Most common malignancy in men
Many behave indolently

47
Q

What are the risk factors for prostate cancer?

A

Race
genetic- GST-pi, PTEN, AMACR, p27, E-cadherin.
Red meat
Arises from precursor lesion prostatic intraepithelial neoplasia

48
Q

How does prostatic carcinoma present?

A

Majority are asymptomatic, diagnosed when needle biopsy is performed for raised PSA
LUTS
Symptoms of mets

49
Q

What is the prognosis like for prostate cancer?

A

Gleason score indicator, calculated by adding 2 most common gleason patterns present in the tumour
Can range form 6-10

50
Q

What is pattern 3-5 Gleason?

A 
3- individual glandular units
4- fusing glands. Poor gland formation
5- solid sheets of tumour. 
Score 6- small volume, will die with disease not from it
8-10- high volume, mets and death
51
Q

What are the treatment options for prostate cancer?

A

Active surveillance
Radical prostatectomy
Radical radiotherapy

52
Q

What are testicular germ cell tumours?

A

Malignant tumours of testis arising from germ cells
Account for more than 90% of all testicular tumours
Aged 20-45

53
Q

What is the risk factors for testicualr germ cell tumour?

A

Cryptorchidsim- increase risk 3-5 fold
Low birth weight
Small gestational age
Most arise from intratubular germ cell neoplasia
Likely that disease process begins in fetal life, then further genetic aberrations lead to malignant transformation

54
Q

How does testicular germ cell tumours?

A

Most present with painless testicular lump
10% present with met symptoms
Embryonic/fetal and or adult tissues

55
Q

What are the types of germ cell tumours?

A 
Seminoma- resembles germ cells
Embryonal carcinoma- embryonic tissue 
Yolk sac
Immature teratoma- fetal tissue 
Mature teratoma- adult tissue 
Choriocarcinoma
56
Q

What is the prognosis for testicular germ cell tumours?

A

Excellent- 5 year survival rates of 98%

High sensitivity of germ cell tumours to modern platinum based chemo

57
Q

Paratesticular disease

A

X

58
Q

Penile disease

A

X

59
Q

What are urinary calculi?

A

Crystal deposits that precipitate in the renal collecting ducts but can be deposited anywhere in urinary tract.

Histopathology (4 decks)

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