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Pathology Amber > Histopathology > Flashcards

Histopathology Flashcards

1
Q

What are the main pathologies affecting the renal tubules and interstitium?

A

Acute tubular necrosis
Tubulointerstitial nephritis

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2
Q

What triad is associated with nephrotic syndrome?

A

1) Hypoalbuminaemia
2) Proteinuria (frothy urine)
3) Oedema

Also note hyperlipidaemia and hypercholesterolaemia

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3
Q

What are the different types of nephrotic syndromes?

A

1) Minimal change disease
2) Membranous glomerular disease - phospholipase A2
3) Focal segmental glomerulosclerosis
4) Membranoproliferative glomerulonephritis

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4
Q

What are the characteristics of nephritic syndrome?

A

P - Proteinuria
H - Haematuria
A - Azootemia (high urea and creatinine)
R - Red cell casts
O - Oliguria
H - Hypertension

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5
Q

What are the different types of nephritic syndrome?

A

1) Acute post infectious glomerulonephritis
2) IgA nephropathy (Berger disease)
3) Rapidly progressive (Crescentic) glomerulonephritis
4) Alport’s syndrome (hereditary nephritis)
5) Thin basement membrane disease (benign familial haematuria)

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6
Q

What is the main sign/symptom of Ig A nephropathy (Berger disease)?

A

Frank haematuria

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7
Q

What are the 3 different types of rapidly progressive glomerulonephritis?

A

T1: Anti-GBM antibody
T2: Immune complex mediated
T3: Pauci immune

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8
Q

Antibodies to phospholipase A2 receptor are associated with what form of glomerulonephritis?

A

Membranous glomerular disease

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9
Q

What are the most common causes of PID?

A

chlamydia and gonorrhoea

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10
Q

What are the symptoms and signs associated with PID?

A

Dyspareunia, adnexal tenderness, cervical excitation

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11
Q

How is PID treated?

A

Metronidazole, Ceftriaxone, Doxycyline

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12
Q

What are the complications of PID?

A

Fitz-Hugh Curtis syndrome (Violin strings around the liver)
Sub fertility
Ectopic pregnancy
Tubo - ovarian abscess
Peritonitis

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13
Q

What is endomestriosis?

A

Endometrium growing outside the uterus

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14
Q

What is adenomyosis?

A

Endometrium growing within the myometrium

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15
Q

What is the typical sign and symptom of endometrial cancer?

A

Post-menopausal bleeding

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16
Q

What are the RF of endometrial cancer?

A

Anything increasing excess oestrogen exposure

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17
Q

How do you diagnose vulval cancer?

A

Biopsy

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18
Q

What is the main type of ovarian tumour?

A

Epithelial - 70% of ovarian cancers

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19
Q

What cancer is associated with psammoma bodies?

A

Serous cystadenoma

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20
Q

What cancer is associated with tubular glands and a history of endometriosis?

A

Endometrioid carcinoma

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21
Q

What cancer is associated with ‘clear cells’ and a hobnail appearance (bulbous nucleus and nuclear projections into the cytoplasm)?

A

Clear cell carcinoma????

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22
Q

What is the most common ovarian cancer in younger women?

A

Dysgerminoma

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23
Q

What is a cystic teratoma also known as?

A

Dermoid cyst

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24
Q

What is a tumour that has cells that have differentiated into mature tissues called?

A

Teratoma

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25
Q

What are the 3 sex cord tumours?

A

1) Granulosa/ Theca cell tumours
2) Sertoli-Leydig cell tumours
3) Fibromas - these don’t release hormones

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26
Q

What is Fibroma associated with?

A

Meig’s syndrome

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27
Q

How does HPV lead to cervical cancer?

A

HPV 16 and 18 are high risk. These produce proteins E6 and E7. E6 inactivates p53 and E7 inactivates retinoblatoma (Rb). These are both TSGs - so it inactivates TSGs.

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28
Q

During a self examination, a 44 year old detects a mass in her left breast. A biopsy subsequently confirms an invasive ductal carcinoma. A CT scan is performed to stage her mass. On the CT scan, it is noted she has a mass in her left ovary also. Blood results show an elevated level of oestrogen in the blood? Which is most likely?

A

1) Pathological endometrial hyperplasia
2) Pathological endometrial hypertrophy
3) Physiological endometrial hyperplasia
4) Physiological endometrial hypertrophy

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29
Q

What are the 3 inflammatory breast conditions?

A

Acute mastitis
Duct ectasia
Fat necrosis

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30
Q

What are the 2 types of carcinoma in situ?

A

1) Lobular
2) Ductal

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31
Q

What type of carcinoma in situ is more common?

A

Ductal carcinoma

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32
Q

What are the indications of invasive carcinoma?

A

Peau d’orange, tethering, Paget’s disease, nipple retraction, lymphadenopathy, ulceration, bloody nipple discharge

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33
Q

What is the most important prognostic factor for invasive breast carcinoma?

A

Axillary lymph node involvement

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34
Q

What is the commonest type of pancreatic neoplasm?

A

Ductal adenocarcinoma

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35
Q

All of the following are causes of chronic pancreatitis except:
Alcohol
Gall stones
Cystic fibrosis
None of the above

A

None of the above

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36
Q

The following are all complications of gall stones except:
Acute cholecystitis
Gall bladder cancer
Haemolytic anaemia
Obstructive jaundice

A

Haemolytic anaemia

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37
Q

What inflammatory process is associated with:

  • Neutrophils
  • Lymphocytes
  • Plasma cells
  • Eosinophils
  • Mast cells
  • Macrophages
A
  • Neutrophils
  • Lymphocytes
  • Plasma cells
  • Eosinophils
  • Mast cells
  • Macrophages
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38
Q

What are the histological features of squamous cell carcinomas?

A

Keratin producing

Intercellular bridges

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39
Q

What are the cytological features of neutrophils and what inflammatory process are they associated with?

A

They are polymorphs - their nucleus is polylobate.

They are associated with ACUTE INFLAMMATION.

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40
Q

What are the cytological features of lymphocytes and what inflammatory process are they associated with?

A

Single round nucleus that fills the cytoplasm (high nucleus:cytoplasm ratio)

Associated with CHRONIC INFLAMMATION

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41
Q

If we see a lot of lymphocytes on microscopy what are 2 pathologies we should keep in mind?

A

1) Chronic inflammation (this will be polyclonal)
2) Lymphoma (this will be monoclonal)

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42
Q

What are the histological features of a lymphoma?

A

Dense tumour

Monoclonal

Monomorphic

Starry sky appearance for Burkitt’s lymphoma (Macrophages scattered throughout housing necrotic debris)

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43
Q

What are the cytological features of eosinophils?

A

Bilobed nucleus

Pink granules

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44
Q

What are the cytological features of mast cells?

A

Big cell

Packed full of dark blue-purple granules

Cannot clearly see nucleus

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45
Q

What are the cytological features of macrophages?

A

Large cell

Lots of cytoplasm

Contains medium sized nucleus

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46
Q

What inflammatory processes are associated with macrophages?

A

Late acute inflammation (clear up)

Chronic inflammation (priming)

Granuloma formulation

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47
Q

What is a granuloma?

A

An organised collection of activated macrophages (epithelioid cells) - very secretory in function.

Also will show fusion giant cells centrally.

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48
Q

Where do squamous cell carcinomas originate?

A

Anywhere in the body where squamoud epithelium is found.

Skin

Oesophagus

Head and neck

Anus

Cervix

Vagina

Exception: the lung (smoking induces metaplasia to squamous epithelium)

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49
Q

What are the congo-red stains and congo-red+ fluorescent light/polarised light used for?

A

Amyloid (RED with just congo-red and Apple green birefringence under polarised light)

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50
Q

How could we differentiate a carcinoma and lymphoma?

A

We can stain with pan- cytokeratin which is an epithelial marker. Brown would be a +ve result. If the result is negative, then it cannot be a carcinoma.

We can stain for CD45 - a lymphoid marker - if this is positive, we know it is a lymphoma.

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51
Q

How can we identify the location of a primary from a metastases?

A

We can stain to identify the cytokeratins the biopsy is positive for. There are many different types of cytokeratin and they are produced by many different cell types.

For example a liver metastases that displayed CK20 +ve but CK7 -ve, would indicate it was from the colon.

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52
Q

The characteristic inflammatory cell seen in asthma is?

A

Eosinophil

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53
Q

The defining features of a squamous cell carcinoma are:

a) Keratin production and glands present
b) Mucin production and keratin production
c) Kertain production and intercellular bridges

A

c) Keratin production and intercellular bridges

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54
Q

What is the site of origin of melanoma?

A

Skin

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55
Q

What is the site of origin of lymphoma?

A

Bone marrow

Lymph nodes

Spleen

Thymus

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56
Q

What is the site of origin of transitional cell carcinoma?

A

Urinary system transitional cells:

Renal pelvis

Pelvis

Ureters

Bladder

Urethra

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57
Q

What is this cancer and what are the features seen?

A

Transitional cell carcinoma

Dysplastic change

Hyperplasia

Everted papillomas (finger like protusions of epithelium)

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58
Q

What is this cancer and what are the histological features?

A

Squamous cell carcinoma

Keratin production (deposits centrally)

Intercellular bridges

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59
Q

What is this cancer and what are the histological features?

A

Lymphoma

Dense

Monomorphic/clonal cells

High proportion of lymphoctyes

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60
Q

What are the sites of origin of adenocarcinoma?

A

Any glandular organs

Breast

Lung

Stomach

Colon

Prostate

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61
Q

What are the histological features of adenocarcinoma?

A

Presence of glands

Nests of cells

Mucin production (stains blue with mucicarmine stain)

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62
Q

What is shown by these pictures?

A

1st picture shows an oesophageal ulcer caused by CMV infecting a HIV patient taken during endoscopy

2nd picture shows the histology of the lesion including big cell with intranuclear inclusion, classical of CMV

3rd picture shows immunohistochemistry for CMV (brown stain is positive)

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63
Q

What is shown by these pictures?

A

Kaposi’s sarcoma (HHV-8 and HIV associated)

a) Dermis is expanded by a solid tumour
b) Monomorphic spindled cells + slit like vascular channels
c) Nuclei of tumour cells demonstrating immunoreactivity for HHV-8

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64
Q

What do these pictures show?

A

B cell lymphoma in HIV patient (Also assoc with EBV)

a) Tumour mass

B) Perivascular lymphomatous infiltrate

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65
Q

What do these pictures show?

A

1) Cavitating TB
2) Granuloma with caseous necrosis

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66
Q

What do these pictures show?

A

Sarcoid granuloma: organised collection of activated macrophages

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67
Q

What are giant cells?

A

Large fused-together macrophages

Multinucleate cells

May be present in sarcoid granuloma

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68
Q

What cell type is characteristic of granuloma?

A

Epithelioid macrophages

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69
Q

What do these pictures show?

A

IgG4 related disease

a) Plasma cell rich inflammatory infiltrate
b) Immunohistochemistry for IgG4 - IgG4 +ve

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70
Q

What are the steps of alcohol-induced liver disease?

A

1) Steatosis
2) Steatohepatitis
3) Fibrosis
4) Cirrhosis
5) Hepatocellular carcinoma

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71
Q

Causes of granulomatous inflammation in the liver include…

A

Infectious - Mycobacterium tuberculosis

Non-infectious inflammatory disease - Sarcoidosis

Others:

Primary biliary cholangitis

Drug induced disease

Schistomasiasis

Malignancy

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72
Q

The different types of liver damage include…

A

Fatty change/Steatosis

Fatty liver hepatitis/Steatohepatitis

Liver cirrhosis

Hepatocellular carcinoma

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73
Q

What type of amyloid is associated with multiple myeloma and B cell lymphoma?

A

AL amyloid

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74
Q

What does GORD stand for?

A

Gastro-Oesophageal Reflux Disease

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75
Q

What are the complications of reflux oesophagitis?

A

Ulceration

Haemorrhage

Perforation

Stricture

Barrett’s oesophagus

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76
Q

What are the 2 different types of Barrett’s oesophagus?

A

1) Without goblet cells - gastric metaplasia
2) With goblet cells - intestinal types metaplasia (more likely to lead to dysplasia and cancer)

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77
Q

What are the causes of acute gastritis?

A

Chemical - aspirin/NSAIDs

Alcohol

Corrosives - any physical drugs i.e. tablets taken without enough water

Infection - Helicobacter pylori

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78
Q

What happens if a patient has a gastric ulcer that bleeds slowly?

A

Anaemia

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79
Q

What happens if a patient has a gastric ulcer that bleeds rapidly and massively?

A

Shock - hypovolaemic

80
Q

What happens if a patient has a gastric ulcer that perforates?

A

Peritonitis - urgent surgical repair needed

81
Q

What is the most common type of malignant gastric cancer?

A

Adenocarcinomas (>95%)

82
Q

What cancers are patients with coeliac disease at risk of?

A

Duodenal MALToma (lymphoma of the mucosal associated lymphoid tissue)

This is within the duodenum and originates in T-cells (Enteropathy Associated T-Cell Lymphoma)

Histologically, we will see T-cells present.

83
Q

Most oesophageal and gastric cancers arise from pre-existing adenomas…

True or False

A

False

They arise from the flat dysplasia pathway (chronic inflammation, metaplasia, low grade dysplasia, high grade dysplasia, cancer)

84
Q

In a patient with coeliac disease, on a diet containing gluten, the following is the most likely histological change in the duodenum?

a) Normal villous architecture, no increase in intraepithelial lymphocytes
b) Villous atrophy, no increase in intra-epthelial lymphocytes
c) Villous atrophy, increased intra-epithelial lymphocytes
d) Normal villous architecture, increased intra-epithelial lymphocytes

A

c) Villous atrophy, increased intra-epithelial lymphocytes (this is what causes damage to the villi)

85
Q

Which of the following is not a cause of chronic gastritis?

a) Auto-immunity
b) Infection
c) Drugs
d) Metabolic disease

A

d) Metabolic disease - the others are all causes of chronic gastritis

86
Q

Describe the main ducts within the pancreas

A

Main pancreatic duct (formed from all of the intralobular ducts) joins to the common bile duct to drain into the duodenum at the Ampulla of Vater

87
Q

What does this picture show?

A

The pancreas

88
Q

What does this picture show?

A

Islets of langerhans in the pancreas (endocrine component of pancreas)

89
Q

What would you see in the histological sample of acute pancreatitis?

A

Yellow-white fatty foci (soaps formed from precipitation of calcium ions and necrosed fat)

90
Q

What mutation is most associated with Pancreatic ductal carcinoma?

A

K-Ras mutation

91
Q

What does this picture show?

A

An invasive pancreatic ductal carcinoma

92
Q

What is the commonest type of pancreatic neoplasm?

A

Ductal adenocarcinoma

93
Q

All the following are causes of chronic pancreatitis except…

Alcohol

Gall stones

Cystic Fibrosis - “mucoviscoidosis”

Haemochromatosis

Trick question

A

Trick question - all the answers are causes of chronic pancreatitis

94
Q

The following are all complications of gall stones except…

a) acute cholecystitis
b) gall bladder cancer
c) haemolytic anaemia
d) obstructive jaundice

A

c) haemolytic anaemia

95
Q

What demographic are primary malignant bone tumours most common in?

A

Children and young adults

96
Q

What are RF in older patients that may point towards a bone malignancy?

A

Previous radiotherapy

Paget’s disease

97
Q

What is the histology of an osteochondroma?

A

Fibrous surface overlying the cortical or trabecular bone

98
Q

What is the commonest malignant tumour in bone?

A

Metastases (but metastases are uncommon below the elbow and knee)

99
Q

What age group does osteosarcoma most commonly affect?

A

<20s (75%)

100
Q

Where are osteosarcomas most commonly found?

A

Around the knee - lower femur/upper tibia (60%), hip, shoulder

101
Q

How can osteosarcomas and chondrosarcomas be differentiated?

A

Osteosarcomas are more haemorrhagic, chondrosarcomas are white in colour.

102
Q

What is the most common age group experiencing chondrosarcoma?

A

30-60s (60%)

103
Q

What is Ewing’s sarcoma (PPNET) and who does it usually affect?

A

A highly malignant small round cell tumour

<20 years (80%)

104
Q

What is the chromosomal translocation associated with Ewing’s sarcoma?

A

11;22 EWS/Fli1

105
Q

What is the definition of soft tissue tumour (sarcoma)

A

Mesenchymal proliferations which occur in the extraskeletal, non-epithelial tissues of the body - excluding the meninges and lymphoreticular system

106
Q

What age do soft tissue tumours usually affect?

A

Older patients 50%>55 yrs

107
Q

What are the most common pituitary adenoma cells?

A

Prolactin secreting cells - lactotrophs (20-30%)

108
Q

Out of all the intracranial tumours that come to clinical attention, how many would you expect are pituitary adenomas?

A

10%

109
Q

What are the clinical features associated with prolactinomas?

A

Amenorrhoea

Galactorrhoea

Loss of libido

Infertility

110
Q

What are the clinical features of a growth hormone adenoma?

A

Pre-pubertal children -> Gigantism

Adults -> Acromegaly

Diabetes mellitus, congestive cardiac failure, muscle weakness, HTN

111
Q

What are the clinical features of hypopituitarism?

A
112
Q

What is hypopituitarism associated with ischaemic necrosis of the pituitary after giving birth?

A

Sheehan’s syndrome

113
Q

What are the signs and sx of local mass effects of pituitary tumours?

A

Bitemporal hemianopia

Headache

Papilloedema (Raised ICP)

Obstructive hydrocephalus

114
Q

What are the causes of non-toxic thyroid goitre?

A

Iodine deficiency

Low iodine water and soil content (endemic)

Impaired thyroid hormone synthesis

Puberty (especially in females)

Substance interaction (brassica cabbage)

Hereditary enzyme defects

115
Q

What can happen when a thyroid goitre becomes too large?

A

May lead to mechanical defects i.e. dysphagia and airway obstruction

116
Q

What is the triad of clinical features associated with Grave’s disease?

A

1) Thyrotoxicosis
2) Infiltrative ophthalmopathy with exophthalmos in upto 40%
3) Infiltrative dermopathy (pretibial myxoedema) in a minority of cases

117
Q

What are the different types of thyroid neoplasm?

A

Adenomas

Carcinomas

118
Q

What are the subtypes of thyroid carcinoma and what proportion of thyroid carcinomas do they make up?

A

Papillary (75-85%)

Follicular (10-20%)

Medullary (5%)

Anaplastic (<5%)

119
Q

What are the actions of PTH?

A

1) Activates osteoclasts
2) Increases renal tubular absorption of calcium
3) Increases conversion of vit D to active form
4) Increases urinary phosphate excretion
5) Increases intestinal calcium absorption

120
Q

How can parathyroid adenoma be distinguished from normal parathyroid tissue histologically?

A

Normal parathyroid tissue is 50% fat

121
Q

What is secondary hyperparathyroidism caused by?

A

Caused by any chronic depression of serum Ca2+. The parathyroid glands are then consistently stimulated and produce PTH. They may be enlarged and asymmetrical.

122
Q

What is tertiary hyperparathyroidism?

A

When your parathyroid glands keep making too much PTH after your calcium levels return to normal. This type usually occurs in people with kidney problems.

123
Q

What is the most common cause of secondary hyperparathyroidism?

A

Renal failure/ chronic kidney failure

124
Q

What are the causes of hypoparathyroidism?

A

Surgical ablation

Congenital absence

Autoimmune disease

125
Q

What are the clinical features of hypoparathyroidism?

A

Neuromuscular irritability - tingling, muscle spasms, tetany

Cardiac arrhythmias

Fits

Cataracts

126
Q

What are the clinical features of hyperaldosteronism?

A

Hypertension

Hypokalaemia

127
Q

What are the rules of 10 associated with phaeochromocytoma?

A

10% arise in association with a familial genetic syndrome i.e. MEN2a/2b, von HL, Sturge Weber

10% are bilateral

10% are malignant

10% of the catecholamine secreting tumours arise outside of the adrenals (paragangliomas)

128
Q

What are the features of tumours in multiple endocrine neoplasia syndrome?

A

Younger age than sporadic tumours

Arise in multiple endocrine organs

Multifocal

Preceded by hyperplasia

Usually more agressive than sporadic tumours

129
Q

What is the most comon type of thyroid cancer?

A

Papillary thyroid carcinoma

130
Q

What type of thyroid carcinoma arises from the parafollicular or c cells of the thyroid?

A

Medullary carcinoma

131
Q

What syndrome is caused by an adrenal adenoma that secretes aldosterone?

A

Conn’s syndrome

132
Q

What are the clinical features of SLE?

A

Skin - malar rash/ discoid lesions

Oral ulcers

Joint pain/swelling

Neurological - psychosis, depression

Serositis - recurrent pleuritic chest pain

Renal - renal failure

Haematological - pancytopenia

Immunological

133
Q

What is libman sacks?

A

It is a non-infective endocarditis caused by SLE. Clinical presentations include peripheral emboli and stroke.

134
Q

What is the alternative name for scleroderma?

A

Systemic sclerosis

135
Q

What antibodies are the diffuse form and limited form of scleroderma/systemic scerosis associated with?

A

Diffuse form - Anti DNA topoisomerase Ab (Scl70)

Limited form - Anti centromere Ab

136
Q

What is the pathological hallmark of sarcoidosis?

A

Non-caseating granulomatous inflammation

137
Q

What is the hallmark triad for granulomatosis with polyangiitis?

A

ENT

Lungs

Kidney

138
Q

What is the hallmark triad for eosinophilic granulomatosis with polyangiitis?

A

Asthma

Eosinophilia

Vasculitis

139
Q

What are some secondary causes of nephrotic syndrome?

A

Diabetes

Systemic Lupus Erythematosus

Amyloidosis

140
Q

What is the main pathophysiology behind nephrotic syndrome?

A

Breakdown in the selectivity of filtration barrier i.e. integrity of the glomerular basement membrane

141
Q

How does the pathophysiology of nephrotic and nephritic syndrome differ?

A

Nephrotic - Damage to the selectivity of the filtration barrier i.e. glomerular basement membrane

Nephritic - However, is due to glomerular inflammation

142
Q

What glomerular renal pathologies are nost likely to occur in children?

A

1) Minimal change disease
2) Acute post infectious glomerulonephritis (after streptococcal throat infection Group A B-haemolytic strep pyogenes or impetigo)

143
Q

What nephritic syndrome is associated with the deposition of IgA immune complexes in the glomeruli?

a) Acute glomerunephritis
b) Berger disease
c) Rapidly progressive / crescentic glomerulonephritis
d) Alport’s syndrome

A

b) Berger disease (AKA: IgA nephropathy) is associated with the deposition of IgA-C3 complexes in the golmeruli mesangium (visualised using immunofluorescence on biopsy)

144
Q

What is the anti-GBM Ab in goodpasture’s disease directed against?

A

COL4-A3

145
Q

What mutation causes hereditary nephritis (Alport’s syndrome) and what is the inheritance pattern?

A

Mutation in type 4 collagen alpha 5 chain
X-linked inheritance pattern

146
Q

When and how does Alport’s syndrome pregress?

A

Nephritic syndrome (progresses to ESRF) + sensorineural deafness + eye disorders

Presents at 5-20 years

147
Q

What is the mutation associated with Thin Basement Membrane disease and what is the inheritance pattern?

A

Mutation in Type 4 collagen alpha 4 chain

Autosomal dominant inheritance pattern

148
Q

How does thin basement membrane disease commonly present?

A

Asymptomatic haematuria

149
Q

What is the definition of vasculitis?

A

Inflammation of the blood vessels

150
Q

What are urinary calculi made out of?

A

Most commonly they are calcium oxalate (Weddelite) stones (75% of them)

The next most common substance is Magnesium Ammonium Phosphate (Struvite/Triple stones) stones (15% of them)

Uric acid makes up 5% of the stones

151
Q

What are calcium oxalate urinary calculi often associated with?

A

Hypercalciuria

152
Q

What are Magnesium Ammonium Phosphate stones also known as?

A

Triple stones

153
Q

What precedes the formation of Magnesium Ammonium Phosphate stones?

A

Infection with a urease-producing organism i.e. Proteus spp.

154
Q

What are the complications of urinary calculi?

A

Small stones -> Impaction and colic

Large stones -> Obstruction to urine flow and blood flow, infection, chronic renal failre

155
Q

Define renal cell carcinoma

A

Malignant epithelial kidney tumour

156
Q

What are the risk factors of renal cell carcinoma?

A

Smoking

Obesity

Hypertension

Long-term dialysis

Genetic syndromes - von Hippel Lindau

157
Q

How does renal cell carcinoma present?

A

Half of cases present with painless haematuria - but most are asymptomatic and are picked up on incidental imaging

158
Q

What is this?

A

Papilary renal cell carcinoma type 1

159
Q

What is Wilm’s tumour (nephroblastoma)?

A

Malignant triphasic kidney tumour of childhood

2nd most common malignancy in children

160
Q

What are the 3 phases of Wilm’s tumour?

A

Triphasic tumour:

1) blastema - small round blue cells
2) Epithelial component
3) Stromal component

161
Q

How does Wilm’s tumour usually present?

A

Abdominal mass in childern 2-5 years old

162
Q

What is the epidemiology of benign prostatic hyperplasia?

A

Very common - 25% of men are symptomatic by age 80

It is histologically present in 90% of men by age 80!!!

163
Q

What is the aetiology of benign prostatic hyperplasia?

A

Aetiology is not clear

IT is thought that perhaps increased oestrogen levels in the blood may induce androgen receptors and stimulate hyperplasia (oestrogen levels increase with age)

164
Q

How is benign prostatic hyperplasia treated?

A

Alpha blockers

5-a reductase inhibitors

Transurethral resection

165
Q

Define prostatic adenocarcinoma

A

Malignant epithelial prostate tumour

166
Q

What does prostatic adenocarcinoma arise from?

A

Prostatic Intraepithelial Neoplasia

167
Q

What mutations are associated with prostatic adenocarcinoma?

A

PTEN, AMACR, GST-pi, p27

168
Q

How does the gleason score and grade work?

A

Score = x + y = z (z score ranges from 6-10)

X= most common pattern grade from histology sample

Y = worst pattern grade possible i.e. 5

Grade = Most common pattern from the histology sample (grade ranges from 1-5)

169
Q

How does a testicular germ cell tumour present?

A

Usually as a painless lump

10% of patients present with metastasis signs:

Back pain

Cough

Dyspnoea

170
Q

What testicular tumour is associated with a lace like growth pattern?

A

Yolk sac tumour

171
Q

What is the maximum size permissible for a papillary adenoma of the kidney?

A

15mm

172
Q

What is the most common renal cell carcinoma?

A

Clear cell renal cell carcinoma

173
Q

What is the gleason score used for?

A

To score and grade prostate histology samples to determine prognosis i.e. for Prostatic cancers

174
Q

What are the major functions of the kidney?

A

1) Excretion of metabolic waste products and foreign chemicals (including drugs)
2) Regulation of fluid, electrolyte and acid/base balance (HOMEOSTATIC)
3) Regulation of blood pressure (renin)
4) Regulation of calcium and bone metabolism (1,25 dihydroxycholecalciferol)
5) Regulation of haematocrit (erythropoietin)

175
Q

How much blood is filtered through the glomerulus per minute?

A

125 ml

176
Q

Which parts of the nephron regulate pH?

A

Distal convoluted tubule and collecting duct

177
Q

What is the thickness of the glomerular basement membrane?

A

350nm

178
Q

As well as agenesis, renal fusion (horseshoe), ectopic kidney, renal dysplasia and pelvi-ureteric Junction Obstruction what are 3 other genitourinary malformations?

A

Ureteral duplication

Vesicoureteral Reflux

Posterior urethral valves

179
Q

What is the inheritance pattern of Adult Polycystic Kidney Disease?

A

Autosomal dominant

180
Q

How does polycystic kidney disease present?

A

Usually in adulthood

Hypertension

Flank pain

Haematuria

181
Q

What is there a propensity to form in adult polycystic kidney disease?

A

Berry aneurysms (PKD1,2,3 increase risk)

182
Q

What brain bleed is associated with berry aneurysms?

A

Subarachnoid haemorrhage

183
Q

What cystic disease gives a 7% risk of developing papillary renal cell carcinoma?

a) Serous cystadenoma
b) Mucinous cystadenoma
c) Clear cell renal carcinoma
d) Acquired cystic disease of the kidney

A

d) Acquired cystic disease of the kidney

184
Q

Define acute renal failure

A

Rapid deterioration in renal function - ocurring in hours - days

185
Q

Define tubulo-interstitial nephritis

A

Immune injury to tubules and interstitium

186
Q

What are some secondary causes of nephrotic syndrome?

A

Diabetes mellitus

Amyloidosis

Systemic lupus erythematosus

187
Q

What are the 2 different types of primary glomerular nephrotic syndrome?

A

Immune complex related and non-immune complex related

188
Q

How does diabetic nephropathy progress?

A

Starts as a microalbuminuria before progression to proteinuria and nephrotic syndrome

189
Q

Define chronic kidney disease

A

A Progressive, irreversible loss of renal function characteriused by prolonged symptoms and signs of uraemia (fatigue, itching, anorexia, confusion, bleeding)

190
Q

What is the commonest cause of chronic kidney disease in the UK?

A

Diabetes (19.5%)

191
Q

The basic unit of the kidney function is the

A

Nephron

192
Q

Anti-GBM disease is caused by Ab directed against…

A

C-terminal of type 4 collagen

193
Q

An accepted definition of nephrotic syndrome includes proteinuria of more than…

A

3.5g/24hr

194
Q

Which histological stain us used to detect amyloid…

A

Congo red

195
Q

IgA renal disease is scored using the…

A

Oxford classification MEST-C

196
Q

When a cause is identifies, the commonest cause of kidney failure requiring renal replacement therapy is…

A

Diabetes

197
Q
A

Pathology Amber (6 decks)

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