What is seen here?
Acute pyelonephritis
What is seen here?
Acute pyelonephritis
What is seen here?
Xanthogranulomatous Pyelonephritis
What is seen here?
Xanthogranulomatous Pyelonephritis
What are some congenital anomalies involving the kidney?
- Agenesis (absence)
- Hypoplasia (small): no scars and fewer lobules
- Ectopic (out of place)
- Horseshoe (abnormal form)
What is seen here?
Horseshoe kidney
What can cause polycystic kidneys?
- Cystic renal dysplasia
- Polycystic kidney
- Medullary cystic kidney
- Acquired (dialysis)
Describe kidney structure with cystic renal dysplasia
Persistence of abnormal structures (cartilage mesenchyme, immature collecting ducts)
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
What is seen specifically in medullary cystic kidney?
Cystic dilation of the collecting ducts
What can cause acquired polycystic kidneys?
Dialysis
What is seen here?
Polycystic kidney disease- AD
What is seen here?
Polycystic kidney disease- AR
What is seen here?
Polycystic kidney disease- AR
What is urolithiasis (broadly)
Stones in urinary tract
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%
What can predispose you to kidney stones?
- Family history
- Male gender
- Dehydration
- Urease positive bacterial infections (struvite)
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
What is seen here?
Nephrolithiasis
What is seen here?
Kidney: staghorn calculus
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
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
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%)
Describe the genetics of Von Hippel Lindau syndrome
- Gene
- Chromosome
- VHL gene
- Chromosome 3
- Caused by deletion/unbalanced translocation or methylation
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
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
What is seen here?
Renal cell carcinoma: clear cell type
- Clear space due to great amounts of fat removed during processing
What is seen here?
Renal cell carcinoma: chromophobe type
What is seen here?
Renal cell carcinoma: papillary type
What is seen here?
Renal oncocytoma
- Mahogany brown appearance
What is seen here?
Renal oncocytoma
- Oncocyte = much eosinophilic cytoplasm containing many mitochondria
What is seen here?
Papillary urothelial CA
What is seen here?
Angiomyolipoma
What is seen here?
Leiomyosarcoma
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
Describe the symptoms and causes of acute cystitis
Symptoms:
- Frequency
- Lower abdominal pain
- Dysuria
Causes:
- E. coli
- Proteus
- Klebsiella
- Enterobacter Radiation?
What are causes of chronic cystitis?
Granulomatous:
- AFB
- Fungi
- Schistosoma
What is seen in interstitial cystitis? What population affected? Caused by what?
- Unknown cause
- Women
- Mast cells
What is seen here?
Acute cystitis
What is seen here?
Acute cystitis
What is seen here?
Granulomatous cystitis
- Epithelioid histiocytes
- Cuff of peripheral lymphocytes
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
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
What is seen here?
Bladder fistula
What is seen here?
Endometriosis
What is seen here?
Endometriosis
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)
What is seen here?
Urothelial carcinoma in situ
- Anaplastic layer of cells up top
- Not very "sticky" to surface
What is seen here?
Papillary urothelial carcinoma (low grade?)
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
What is seen here?
- Symptoms
Urothelial carcinoma in situ
- Loss of urothelium and inflammation
- May present with urgency
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)
What is seen here?
High grade papillary urothelial carcinoma
What is seen here?
Urothelial carcinoma (?)
What is seen here?
Urothelial carcinoma
What is seen here?
Urothelial carcinoma
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
What is seen here?
Prostate cancer (unbeknownst to the pt) seen on the left there
What is seen here?
Normal prostatic gland
What does prostate make?
PSA protein- prevents coagulation of sperm/ejaculate
What else is PSA useful for?
Screening for prostate cancer
What is seen here?
- What causes this
Acute prostatitis
- Typically from BPH causing obstruction and cystitis/prostatitis
What is seen here?
Chronic prostatitis
What is seen here?
Prostate cancer
- Can see nodule on the base there that would be palpable on digital rectal exam
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)
What is seen here?
Prostate cancer (which type??)
- High PIN
How do you grade prostate cancer?
Gleason grading
What is seen here?
Normal testis
What is seen here?
Hydrocele
What is seen here?
Testicular torsion
- May involve infarction
What is seen here?
Granulomatous orchitis
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
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
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
What is seen in seminomas?
- Homogeneous population of cells with large nucleoli and lymphocytes
- Cells are non-cohesive and resemble spermatogonia
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
What is seen in yolk sac tumors?
AFP!
- Delicate lacy architecture with bland nuclei
- Infantile and adult in age distribution
What is seen in choricoracinomas?
HCG!
- Resembles placenta with syncytiotrophoblasts and cytotrophoblasts
- Vascular invasion common
What is seen in teratomas?
- Mature
- Better prognosis but not responsive to tx
- Immature
What is seen here?
Normal testis???
What is seen here?
Cancerous testis
What is seen here?
Seminoma
What is seen here?
Seminoma
What is seen here?
Embryonal carcinoma
What is seen here?
Embryonal carcinoma
What is seen here?
Yolk sac tumor
What is seen here?
Yolk sac tumor
What is seen here?
Choriocarcinoma
What is seen here?
Choriocarcinoma
What is seen here?
Teratoma
What is seen here?
Teratoma
What is seen here?
Penile carcinoma