CP4-1 & 2 pathology of the urogenital tract Flashcards by Grace Whalley

What is a renal cell carcinoma? What are the two most common types?

A cancer of the kidney arising from the renal tubular epithelium.

Clear cell (75% of cases)
Papillary (10% of cases)

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Do males or females present more commonly with renal cell carcinoma?

Males

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What age group are more likely to get renal cell carcinoma?

Over 60s

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What are risk factors for renal cell carcinoma?

Obesity
Smoking
NSAID use
End stage renal failure (+ on dialysis)

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What familial disease increases risk of renal cell carcinoma?

Von Hippel-Lindau

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What are clinical features of renal cell carcinoma I.e. the how do patients present?

Haematuria
Abdominal pain
Symptoms associated with metastases (e.g. SoB in lung metastases)
Weight loss
Hypertension (due to increased renin secretion as increase in cells)
Polycythaemia (increased red cell count)

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What are paraneoplastic syndromes?

Signs and symptoms not related to primary or metastatic tumours which develop due to protein/hormone secretions of tumour cells or immune cross reactivity between tumour cells and normal cells.

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What is another name for a Wilms’ tumour?

Nephroblastoma

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What is a Wilms’ tumour?

Cancer of the kidney which arises from nephroblasts (embryological cells that develop into the kidney)

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What age group are Wilms’ tumours found in?

Under 5 year olds (very rare amongst other age groups)

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What genetic syndromes is Wilms’ tumour associated with?

Beckwith-Weidemann syndrome
WAGR syndrome
Denys-Drash syndrome (WT1 mutation)

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What is a genetic mutation associated with Wilms’ tumour?

WT1

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What % of Wilms’ tumours are bilateral?

10%

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How do patients present with a Wilms’ tumour?

Abdominal distension (especially if bilateral) due to abdominal mass
Haematuria

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What is the 5 year survival rate of Wilms’ tumour?

90%

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What is urolithiasis?

Urinary tract calculi/stones which form anywhere from the renal calyx to the bladder

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What are urinary tract stones formed of?

Calcium stones (70%)
Unrated stones
Cystine stones
Struvite stoned (magnesium ammonium phosphate) aka stag horn calculi

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What is a risk factor for calcium stones?

Raised serum Ca e.g. due to parathyroid adenoma

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What are risk factors for urate stones?

Raised serum urate e.g. due to gout or malignancy

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What is a cause of cystine stones?

Raised serum cysteine e.g. due to congenital cystinuria

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What is the pathogenesis of urolithiasis caused by calcium, urate or cysteine?

Too high concentration of soluble material causes urine to become saturated. The soluble material precipitates out (+/- stasis) to form stones. This can lead to obstruction and hydronephrosis +/- hydroureter leading to renal impairment, urinary stasis causing infection +/- more stones developing, or local trauma potentially leading to squamous metaplasia and risk of squamous cell carcinoma

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What is the pathogenesis of struvite stones?

UTI with urease producing bacteria (e.g. proteus)l the urease converts urea to ammonia which causes a pH rise and precipitation of magnesium ammonium phosphate salts leading to stones forming.

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What is the only stones that can be seen in X-ray?

Calcium stones

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How do patients with urolithiasis present?

Loin to groin (renal colic) pain/lower abdominal pain - dependent on location of obstruction
Haematuria
Dysuria if obstructed at urethra
+/- Other symptoms of complications

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What is vesicoureteral reflux?

When urine flows backwards from the bladder to the ureter rather than into the urethra to be excreted

Who is most likely to get vesicoureteral reflux?

Young people (especially under 2s) Those with a family history About 10% of population

What causes vesicoureteral reflux?

Congenital abnormality at the vesicoureteric junction where the ureter enters the bladder at an abnormal angle leading to back flow of urine

How do children with vesicoureteral reflux present?

Usually asymptomatic and most children grow out of it. Symptomatic if complications

What are potential complications of vesicoureteral reflux?

UTI due to stasis of urine Renal damage due to back pressure and ascending infection

What is a urothelial carcinoma?

A cancer arising from the urothelium (transitional epithelium in the bladder)

What % of bladder cancers are urothelial carcinomas?

Over 90%

What are risk factors for urothelial carcinomas?

Age >60 Male Smoking Exposure to industrial chemicals Family history Cancer treatments e.g. pelvic radiotherapy and cyclophosphamide

How do patients with urothelial carcinomas present?

Haematuria Frequency, urgency and dysuria when urinating Symptoms associated with lung, bone or liver metastases Rarely paraneoplastic syndromes

What is the 5 year survival rate of urothelial carcinoma?

Approx 50%

What is a neurogenic bladder?

An inability to properly empty the bladder due to neurological damage

What are the two types of neurogenic bladder?

Spastic (due to damage to brain or spinal cord) Flaccid (due to damage to peripheral nerves)

What are disease associated with the development of neurogenic bladders?

Spastic = stroke, MS, spinal injury Flaccid = pregnancy, diabetes, alcohol related B12 deficiency

How do patients with neurogenic bladder present?

Symptoms related to lack of control of bladder emptying e.g. urinary retention +/- abdominal distension, incontinence, urge and frequency of urination Symptoms related to complications

What are potential complications of neurogenic bladder?

UTI or urinary stones associated with urinary stasis Renal function impairment due to inability to empty bladder causing bladder distension, hydroureter and hydronephrosis.

What is benign prostate hyperplasia (BPH)?

Increased number of both stromal and glandular cells in the prostate

How do patients refer to BPH?

Enlarged prostate

What is the epidemiology of BPH?

Old men (20% by age 40 and 70% by age 60)

What are risk factors for BPH?

Obesity Diabetes Family history

What are complications of BPH?

Compresses the urethra leading to obstruction of bladder outlet. Leads to urinary stasis causing infection +/- stones, acute urinary retention or back pressure causing renal damage.

How do patients present with BPH?

Hesitancy or urgency to pee Poor/intermittent stream of urine Straining Prolonged micturition Incomplete bladder emptying Dribbling Increased frequency of urination Incontinance Nocturia

What is prostatic adenocarcinoma?

Cancer of the glandular epithelium in the prostate

What is the epidemiology of prostate adenocarcinoma?

Old men

What are risk factors for prostatic adenocarcinoma?

Black Male Family history (BRCA1/2 mutations) Pesticide exposure

What is the relationship between BPH and prostatic adenocarcinoma?

Often occur concurrently but BPH does NOT cause prostatic adenocarcinoma

How do patients with prostatic adenocarcinoma present?

Lower urinary tract symptoms Symptoms of bone metastases Paraneoplastic syndromes are rare

What is the 5 year survival rate of prostatic adenocarcinoma?

90% - most people die with it not of it

What is cryptorchidism?

Undescended testis I.e. the the testes are not in the scrotum

What are the three sub categories of undescended testes?

Abdominal (15%) Inguinal canal (25%) Hugh scrotal (60%)

Who is most at risk of undescended testes?

Premature male babies

What causes undescended testes?

No cause identified, unseated multifactorial e.g. family history, environmental factors like maternal smoking or alcohol use

What is the pathogenesis of undescended scrotum?

Embryological failure of descent testis scrotum

How do patients with undescended testes present?

With an empty scrotum (10% bilaterally)

What are complications of undescended testis?

Infertility Hernias Increase testicular cancer risk Testicular torsion

What is a seminoma?

A malignant neoplasm of the testis arising from germ cells in the seminiferous tubules

What are the two types of seminoma?

Classic Spermatocytic

What type of testicular cancer is the most damaging/has the worst prognosis?

Non-seminomateous germ cell tumours

Who is most at risk of seminoma?

Young men (aged 25-45) If have family history Having undescended testis (even if treated with surgical correction)

What mutation is associated with seminomas?

KIT

How do patients with seminomas present?

Testicular lump with swelling and pain Symptoms associated with lung and lymph node metastases Gynecomastia (production of HCG)

What testicular cancers have a good prognosis?

Classic and spermatocytic seminomas, leydig cell tumours and Sertoli cell tumours

What is the 5 year survival rate of seminomas?

95%

What causes obstructive lesions of the urinary tract?

Large kidney tumours Stones in lumen of ureter Ureter wall abnormalities External compression of the ureter Functional abnormality of ureter (VUJ reflux) Staghorn calculi in the renal pelvis Bladder stones and tumours Neurogenic bladder Anticholinergic drugs Prostate problems like BPH, tumours, prostatitis Tumour or phimosis in the penis Structural abnormalities of the urethra Foreign bodies in the urethra A blocked catheter

What does obstruction at the pelviureteric junction do to the kidney?

Caused hydronephrosis

What are symptoms of complete urinary tract obstruction?

Anuria Pain

What are symptoms of partial obstruction of urinary tract obstruction?

Usually asymptomatic

What are complications of urinary tract obstruction?

Irreversible renal impairment or secondary VUR due to back pressure Infection or calculi formation due to urinary stasis

What is phimosis?

Tight foreskin that is unable to retract

The kidneys have pain receptors. True or false?

False

Pathology to what part of the renal system causes shooting pains from back to groin?

Ureter

CP4-1 & 2 pathology of the urogenital tract Flashcards

(74 cards)