11/19- Pathology of the GU System Flashcards Preview

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Flashcards in 11/19- Pathology of the GU System Deck (92):
1

What is seen here?

Acute pyelonephritis

2

What is seen here?

Acute pyelonephritis

3

What is seen here? 

Xanthogranulomatous Pyelonephritis

4

What is seen here?

Xanthogranulomatous Pyelonephritis

5

What are some congenital anomalies involving the kidney?

- Agenesis (absence)

- Hypoplasia (small): no scars and fewer lobules

- Ectopic (out of place)

- Horseshoe (abnormal form)

6

What is seen here? 

Horseshoe kidney

7

What can cause polycystic kidneys?

- Cystic renal dysplasia

- Polycystic kidney

- Medullary cystic kidney

- Acquired (dialysis)

8

Describe kidney structure with cystic renal dysplasia

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

9

What are the forms of polycystic kidney?

Describe genetics and other features

Autosomal dominant: Adult

- High penetrance

- Bilateral, large homogeneous cysts

- Liver cysts, berry aneurysms

Autosomal Recessive: Infantile

- Longitudinal parallel peripheral cysts

- Hepatic fibrosis

10

What is seen specifically in medullary cystic kidney?

Cystic dilation of the collecting ducts

11

What can cause acquired polycystic kidneys?

Dialysis

12

What is seen here?

Polycystic kidney disease- AD

13

What is seen here? 

Polycystic kidney disease- AR

14

What is seen here?

Polycystic kidney disease- AR

15

What is urolithiasis (broadly)

Stones in urinary tract

16

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

Calcium oxalate/phosphate: 75%

- Hypercalciuria and hypercalcemia

- Hyperuricosuria

- Hypocitraturia

Magnesium ammonium phosphate (struvite): 15%

Uric acid: 6%

- Hyperuricemia/hyperuricosuria

Cystine 1-2%

17

What can predispose you to kidney stones?

- Family history

- Male gender

- Dehydration

- Urease positive bacterial infections (struvite)

18

Are the following stones radiolucent or radioopaque?

- Calcium oxalate/phosphate

- Magnesium ammonium phosphate

- Uric acid

- Calcium oxalate/phosphate: opaque

- Magnesium ammonium phosphate: opaque

- Uric acid: lucent

19

What is seen here? 

Nephrolithiasis

20

What is seen here? 

Kidney: staghorn calculus

21

What are some renal tumors?

- 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

22

Describe the etiology of Renal Cell Carcinoma

- Sporadic risk factors/causes

- Syndromes

Sporadic:

- Tobacco

- Obesity

- Unopposed estrogen

Von Hippel-Lindau Syndrome (VHL gene)

- Hemangioblastoma of cerebellum and retina

- Renal cysts

- Renal cell carcinoma

23

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

- 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%)

24

Describe the genetics of Von Hippel Lindau syndrome

- Gene

- Chromosome

- VHL gene

- Chromosome 3

- Caused by deletion/unbalanced translocation or methylation

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