uroological pathology

Question 1

where do renal calculi typically form?

Answer 1

collecting duct

Question 2

what are kidney Stones typically made of?

Answer 2

Calcium Oxalate (Weddellite) – 75%
Magnesium Ammonium Phosphate (Struvite) – 15%
Uric Acid – 5%

Question 3

list the MOA for hypercalcicuria?

Answer 3

Absorptive hypercalciuria – excessive calcium absorption from gut

Renal hypercalciuria – impaired absorption of calcium in proximal renal tubule

Question 4

what are triple stones? why do they form? give examples

Answer 4

Magnesium ammonium phosphate stones

eg staghorn calculi - when they become really large

Form as a consequence of infection with urease-producing organisms Proteus sp. ‘infection stones’

Question 5

which organisms are implicated in ‘infection stones’? most common?

Answer 5

most common - Proteus mirabilis

otehr proteus sp.
Klebsiella
Staph sap
Staph A
H. Pylori

and many more!!

Question 6

what is the aetiology of uric acid stones?

Answer 6

Majority - because they produce slightly acidic urine

Hyperuricaemia: Gout, Rapid cell turnover

Question 7

How do urinary calculi present depending on character?

Answer 7

Small stones:

1. Asymptomatic:
   - stay in kidney
   - detected when haematuria, or recurrent UTIs
2. Colic
   - if leaves kidney

Large stones:

1. Obstruction, Chronic renal failure, Infection
   - As remain in kidney

Question 8

list the areas where small kidney stones can become lodged?

Answer 8

Pelvi-ureteric junction,

Pelvic brim,

Vesico-ureteric junction

Question 9

list the beningn renal tumours?

Answer 9

Papillary Adenoma
Renal Oncocytoma
Angiomyolipoma

Question 10

A patient with a hx of T2DM and HTN passes away. On autopsy, a tumour is found in his kidney. which tumour is it most likely to be?

Answer 10

Papillary Adenoma
- usually incidental find when ivx kidney + associated
with other kidney disease eg CKD

Question 11

A patient presents with flank pain and haemorrhage. Obs show: BP 108/50, HR 120.

He has a PMH of tuberous sclerosis. What is the likely diagnosis and what are thee characteristics?

Answer 11

Angiomyolipoma

this is the typical presentation + shock

Can be seen in tuberous sclerosis

Question 12

which malignancy has larger tumours (> 4cm) ?

Answer 12

Angiomyolipoma

Question 13

Which tumour is by definition, 15mm (1.5cm) or less in size?

Answer 13

Papillary Adenoma

size is a key defining feature

Question 14

name a benign epithelial kidney tumour

Answer 14

Papillary Adenoma

Renal Oncocytoma

Question 15

name a benign mesenchymal kidney tumour

Answer 15

Angiomyolipoma

Question 16

Which tumours are associated with the following:

Trisomy 7, Trisomy 17, Loss of Y chromosome

Answer 16

Papillary Adenoma

Papillary Renal Cell Carcinoma

Question 17

list some malignant renal neoplasms - most common?

Answer 17

Renal Cell Carcinoma:

   - Clear Cell RCC - 70%
   - Papillary RCC
    - Chromophobe RCC

Nephroblastoma - aka Wilm’s Tumour

          note: most end with carcinoma

Question 18

Renal Cell Carcinoma is a malignancy of ___?

Answer 18

Of the DCTubules

Question 19

a patient presents with haematuria what could be the cause?

Answer 19

1. KIDNEY:
   Calculi - lodged in kidney

Benign tumour - Angiomyolipoma

Malignant tumour - RCC (painless)

2. Urothelial carcinomas/TCCs

Question 20

Histology and genetic testing for a tumour on kidney reveals:

Appears grossly as a golden yellow tumour with haemorrhagic areas
Genetically shows loss of chromosome 3p

which is it most likely to be?

Answer 20

Clear Cell Renal Cell Carcinoma

Question 21

what is the difference between

Papillary Renal Cell Carcinoma &
Papillary adenoma

Answer 21

Size!!

Papillary Renal Cell Carcinoma: above 15mm (1.5cm)

P Adenoma: below 15mm (1.5cm)

Question 22

which kidney tumour is composed of

sheets of large cells that display distinct cell borders, reticular cytoplasm and a thick-walled vascular network

Answer 22

Chromophobe Renal Cell Carcinoma

Question 23

which kidney tumour presents in childhood?

characteristics?

Answer 23

Blastema (small round blue cells)

presents as an abdominal mass in children aged 2-5 years old

excellent prognosis

Question 24

Group of malignant epithelial neoplasms arising in urothelial tract (Bladder, Renal Pelvis, Ureters) are known as?

associations?

Answer 24

Transitional Cell Carcinomas or Urothelial Carcinomas

Associations: Aromatic amines, smoking

Question 25

how do Urothelial Carcinomas present?

Answer 25

haematuria

Question 26

what is the aetiology of BPH - Benign Prostatic Hyperplasia?

Answer 26

Increased oestrogen levels in blood, which rises with age, may induce androgen receptors and stimulate hyperplasia - note, on histology, the architecture is the same but there are now MORE CELLS

Question 27

how does BPH present?

Answer 27

Lower Urinary Tract Symptoms” LUTZ
Frequency
Urgency
Nocturia

Hesitancy
Poor flow
Terminal Dribbling

May also present with urinary tract infection, acute urinary retention or renal failure - due to obstruction

Question 28

What is the Most common malignant tumour in men?

Answer 28

Prostatic Adenocarcinoma

Question 29

what is the aetiology of Prostatic Adenocarcinoma?

Answer 29

Arises from Prostatic Intraepithelial Neoplasia - PIN

Mutations in PTEN, AMACR, GST-pi, p27 and more… BRCA

Question 30

how does Prostatic Adenocarcinoma present?

Answer 30

Usually asymptomatic; usually diagnosed on biopsy following raised serum PSA prostate-specific antigen or digital rectal examination

May have lower urinary tract symptoms

Rarely may present with metastatic disease
-Pathological fracture

Question 31

what is the Most powerful prognostic indicator in Prostatic Adenocarcinoma?

Answer 31

The Gleason score - grading system - g for grade

Question 32

how is the Gleason score calculated?

Answer 32

2 most common areas/ worst areas on biopsy are number 1-5 then the 2 numbers are added x+y=z

Higher scores correlate with aggressive behaviour
High volume tumours scoring 8-10 in particular

Question 33

What are the most important prognostic factors in Renal Cell Carcinoma?

Answer 33

Staging and Grading :

1. ISUP Nuclear Grade (1-4) - clear cell & papillary RCC
2. TNM 8th Ed
3. Risk progression index - clear cell