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a_GYNGU > 11/19- Pathology of the GU System > Flashcards

11/19- Pathology of the GU System Flashcards

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1
Q

What is seen here?

A

Acute pyelonephritis

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2
Q

What is seen here?

A

Acute pyelonephritis

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3
Q

What is seen here?

A

Xanthogranulomatous Pyelonephritis

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4
Q

What is seen here?

A

Xanthogranulomatous Pyelonephritis

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5
Q

What are some congenital anomalies involving the kidney?

A
  • Agenesis (absence)
  • Hypoplasia (small): no scars and fewer lobules
  • Ectopic (out of place)
  • Horseshoe (abnormal form)
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6
Q

What is seen here?

A

Horseshoe kidney

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7
Q

What can cause polycystic kidneys?

A
  • Cystic renal dysplasia
  • Polycystic kidney
  • Medullary cystic kidney
  • Acquired (dialysis)
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8
Q

Describe kidney structure with cystic renal dysplasia

A

Persistence of abnormal structures (cartilage mesenchyme, immature collecting ducts)

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9
Q

What are the forms of polycystic kidney?

Describe genetics and other features

A

Autosomal dominant: Adult

  • High penetrance
  • Bilateral, large homogeneous cysts
  • Liver cysts, berry aneurysms

Autosomal Recessive: Infantile

  • Longitudinal parallel peripheral cysts
  • Hepatic fibrosis
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10
Q

What is seen specifically in medullary cystic kidney?

A

Cystic dilation of the collecting ducts

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11
Q

What can cause acquired polycystic kidneys?

A

Dialysis

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12
Q

What is seen here?

A

Polycystic kidney disease- AD

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13
Q

What is seen here?

A

Polycystic kidney disease- AR

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14
Q

What is seen here?

A

Polycystic kidney disease- AR

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15
Q

What is urolithiasis (broadly)

A

Stones in urinary tract

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16
Q

Describe the common stone types, the preidsposing conditions, and their prevalence

A

Calcium oxalate/phosphate: 75%

  • Hypercalciuria and hypercalcemia
  • Hyperuricosuria
  • Hypocitraturia

Magnesium ammonium phosphate (struvite): 15%

Uric acid: 6%

  • Hyperuricemia/hyperuricosuria

Cystine 1-2%

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17
Q

What can predispose you to kidney stones?

A
  • Family history
  • Male gender
  • Dehydration
  • Urease positive bacterial infections (struvite)
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18
Q

Are the following stones radiolucent or radioopaque?

  • Calcium oxalate/phosphate
  • Magnesium ammonium phosphate
  • Uric acid
A
  • Calcium oxalate/phosphate: opaque
  • Magnesium ammonium phosphate: opaque
  • Uric acid: lucent
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19
Q

What is seen here?

A

Nephrolithiasis

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20
Q

What is seen here?

A

Kidney: staghorn calculus

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21
Q

What are some renal tumors?

A
  • Renal cell carcinoma
  • (Renal oncocytoma?)
  • Urothelial carcinoma of renal pelvis
  • Angiomyolipoma (benign)
  • Can get fairly large; if rupture, the hemorrhage may be life threatening
  • Soft tissue tumors of renal capsule
  • Leiomyosarcoma
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22
Q

Describe the etiology of Renal Cell Carcinoma

  • Sporadic risk factors/causes
  • Syndromes
A

Sporadic:

  • Tobacco
  • Obesity
  • Unopposed estrogen

Von Hippel-Lindau Syndrome (VHL gene)

  • Hemangioblastoma of cerebellum and retina
  • Renal cysts
  • Renal cell carcinoma
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23
Q

What are the different types (and percentages) of renal cell carcinoma?

A
  • Clear Cell Carcinoma: 80%
  • Deletion or unbalanced translocation of chromosome 3 (VHL gene) or methylation. The “internist’s tumor”.
  • Chromophobe: 5%
  • Papillary: 10-15%
  • Collecting Duct Carcinoma (1%)
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24
Q

Describe the genetics of Von Hippel Lindau syndrome

  • Gene
  • Chromosome
A
  • VHL gene
  • Chromosome 3
  • Caused by deletion/unbalanced translocation or methylation
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25
Describe renal cancer staging
**- Stage I**: limited to kidney (under 7 cm) **- Stage II**: limited to kidney (\> 7cm) **- Stage III**: beyond capsule into perinephric tissue (not beyond Gerota's fascia), major veins, adrenal gland **- Stage IV**: tumor beyond Gerota's fascia, \> 1 LN involved, and/or 1+ distant met
26
What is seen here?
Renal cell carcinoma: clear cell type - **Left**: multilobulated tumor with hemorrhagic cut surface - **Right**: yellow appearance; this yellow color is pretty diagnostic
27
What is seen here?
Renal cell carcinoma: **clear cell type** - Clear space due to great amounts of fat removed during processing
28
What is seen here?
Renal cell carcinoma: **chromophobe** type
29
What is seen here?
Renal cell carcinoma: **papillary** type
30
What is seen here?
**Renal oncocytoma** - Mahogany brown appearance
31
What is seen here?
**Renal oncocytoma** - Oncocyte = much eosinophilic cytoplasm containing many mitochondria
32
What is seen here?
Papillary urothelial CA
33
What is seen here?
Angiomyolipoma
34
What is seen here?
Leiomyosarcoma
35
What is seen here?
**Urothelial histology** - 8ish layers of endometrial urothelial cells (line surfaces storing water/urine) - Upper surface are specialized "umbrella" cells - Normal with round/oval nuclei
36
Describe the symptoms and causes of acute cystitis
_Symptoms:_ - Frequency - Lower abdominal pain - Dysuria _Causes:_ - E. coli - Proteus - Klebsiella - Enterobacter Radiation?
37
What are causes of chronic cystitis?
Granulomatous: - AFB - Fungi - Schistosoma
38
What is seen in interstitial cystitis? What population affected? Caused by what?
- Unknown cause - Women - Mast cells
39
What is seen here?
Acute cystitis
40
What is seen here?
Acute cystitis
41
What is seen here?
**Granulomatous cystitis** - Epithelioid histiocytes - Cuff of peripheral lymphocytes
42
What is seen here?
**Schistosomiasis** - Worm present in perivesicular veins - Migrate through layers of bladder into the urine - Causes squamous metaplasia of urothelium; predisposes to squamous cell carcinoma (rather than urothelial) in areas of high prevalence
43
What is seen here? Describe the process of formation
**Bladder fistula** - Can see diverticulum going past muscular propria into peri-colonic fat - Inflammation causes compromise of blood circulation; loss of colon epithelium - Can track along colon and reach bladder where it causes a fistula
44
What is seen here?
Bladder fistula
45
What is seen here?
Endometriosis
46
What is seen here?
Endometriosis
47
What are types of urothelial neoplasms?
**- Urothelial carcinoma in situ** (high grade lesion; 50% become invasive) **- Urothelial papilloma** **- Papillary urothelial carcinoma** (low and high grade)
48
What is seen here?
**Urothelial carcinoma in situ** - Anaplastic layer of cells up top - Not very "sticky" to surface
49
What is seen here?
Papillary urothelial carcinoma (low grade?)
50
Describe the staging of bladder cancer?
- TIS: in situ - TIA: not invasive at all - T1: just into lamina propria - T2: touches superficial muscle - T3a: through muscle into fat - T3b: farther - T4: adjacent organs in pelvis
51
What is seen here? - Symptoms
**Urothelial carcinoma in situ** - Loss of urothelium and inflammation - May present with urgency
52
What is seen here? - Symptoms
**Low grade papillary urothelial carcinoma** - Don't invade (low grade), but proliferation throws them up into folds/papillary stalks - Common presentation of hematuria (micro or gross)
53
What is seen here?
High grade papillary urothelial carcinoma
54
What is seen here?
Urothelial carcinoma (?)
55
What is seen here?
Urothelial carcinoma
56
What is seen here?
Urothelial carcinoma
57
Describe the anatomy of the prostate
- Triangular-shaped with base (top with groove) and apex (pointing down) - Vas deferens (2) enter superiorly - Seminal vesicles (2) enter as well
58
What is seen here?
Prostate cancer (unbeknownst to the pt) seen on the left there
59
What is seen here?
Normal prostatic gland
60
What does prostate make?
**PSA protein**- prevents coagulation of sperm/ejaculate
61
What else is PSA useful for?
Screening for prostate cancer
62
What is seen here? - What causes this
**Acute prostatitis** - Typically from BPH causing obstruction and cystitis/prostatitis
63
What is seen here?
Chronic prostatitis
64
What is seen here?
**Prostate cancer** - Can see nodule on the base there that would be palpable on digital rectal exam
65
Why are PSA levels high in prostate cancer?
The cells are not connected to ducts and leaves the prostate (in BPH, most cells do still connect to ducts)
66
What is seen here?
Prostate cancer (which type??) - High PIN
67
How do you grade prostate cancer?
Gleason grading
68
What is seen here?
Normal testis
69
What is seen here?
Hydrocele
70
What is seen here?
**Testicular torsion** - May involve infarction
71
What is seen here?
Granulomatous orchitis
72
What are the different types of testicular tumors?
**Germ cell tumors** - Seminoma - Yolk sac - Teratoma - Embryonal carcinoma **Sex cord-stromal tumors** - Leydig cell - Sertoli cell - Rare variants... Seminoma vs. non-seminoma based on historical treatment considerations - Currently tx for non-seminoma is almost as good
73
What is the treatment for germ cell tumors?
**Stage I** - High risk: orchiectomy + lymphadenectomy or chemo - Low risk: orchiectomy + watchful waiting if pt is compliant **Stage II+** get full treatment
74
What are germ cell tumor markers for: - Seminoma - Embryonal carcinoma - Yolk sac tumor - Choriocarcinoma - Teratoma IMPORTANT SLIDE
- Seminoma: **LDH** - Embryonal carcinoma - Yolk sac tumor: **AFP** - Choriocarcinoma: **HCG** - Teratoma IMPORTANT SLIDE
75
What is seen in seminomas?
- Homogeneous population of cells with large nucleoli and lymphocytes - Cells are non-cohesive and resemble spermatogonia
76
What is seen in embryonal carcinoma?
- Sheets of malignant cells sometimes forming secondary structures such as tubules - Very anaplastic nuclei with abundant mitoses and apoptotic bodies - Vascular invasion common
77
What is seen in yolk sac tumors?
AFP! - Delicate lacy architecture with bland nuclei - Infantile and adult in age distribution
78
What is seen in choricoracinomas?
HCG! - Resembles placenta with syncytiotrophoblasts and cytotrophoblasts - Vascular invasion common
79
What is seen in teratomas?
- Mature * Better prognosis but not responsive to tx - Immature
80
What is seen here?
Normal testis???
81
What is seen here?
Cancerous testis
82
What is seen here?
Seminoma
83
What is seen here?
Seminoma
84
What is seen here?
Embryonal carcinoma
85
What is seen here?
Embryonal carcinoma
86
What is seen here?
Yolk sac tumor
87
What is seen here?
Yolk sac tumor
88
What is seen here?
Choriocarcinoma
89
What is seen here?
Choriocarcinoma
90
What is seen here?
Teratoma
91
What is seen here?
Teratoma
92
What is seen here?
Penile carcinoma

a_GYNGU (17 decks)

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