Genitourinary Flashcards
(470 cards)
1
Q
In a non-functioning kidney which is secondary to ureteric obstruction what macroscopic changes can be seen?
A
Dilation of pelvicalaceal system due to back pressure of the obstrustion
Cortex will be thinner
Scarring and granularity on the outer surface if previous infections have occurred
2
Q
In a non-functioning kidney which is secondary to ureteric obstruction what microscopic features would you expect to see?
A
Sclerosed glomeruli
Interstitial inflammation
Fibrosis
Tubular atrophy and dilation
3
Q
What are the possible causes for uteric obstruction?
A
Intrinsic
Stones
Injury leading to scarring
Tumour
Congenital PUJ obstruction
Extrinsic
Compression by lymph nodes, vessels or tumour
4
Q
What blocks would you take for a non-functioning kidney which is secondary to ureteric obstruction?
A
Resection margin of the ureter, in case of an unexpected tumour
Obstructed segment of ureter
Representative sections of the kidney demonstratingcortx and medullary.
Make serial slices to check for unexpected pathologies and sample accordingly
5
Q
What clinical findings could alert a clinician to prostatic disease?
A
Obstructive symptoms =
Irritative symptoms =
6
Q
How would you describe and handle prostate needle core biopsies in the lab?
A
Count cores
Measure
Lie cores flat
Wrap to prevent loss
Process all
Embed flat
Section with care
Levels
Check IDs at all stages
7
Q
What is BNH?
A
Benign nodular hyperplasia
8
Q
What is BPH?
A
Benign prostatic hyperplasia
9
Q
What is TURP?
A
Trams-urethral resection of the prostate
10
Q
What is LUTS?
A
Lower urinary tract symptoms
11
Q
How are TURPs described and handled in the lab?
A
Weigh specimen
Often a non-description tissue - may be pale, yellow, microcystic areas
Process first 12g then 2g for every additional 5g sent
If under 50 embed all
12
Q
What does cryptorchid mean?
A
A testis that has failed to descend from the abdomen into the scrotum
13
Q
How might a cryptorchid testis differ macroscopically from a normal testis?
A
Smaller in size
14
Q
What possible histological changes might be seen in a cryptorchid testis?
A
Less tubules
Thick basement membrane
Lack of spermogenesis or hypospermatogenesis
Sertoli cells only
Microcalcification
15
Q
Why are cryptorchid testis removed?
A
They are at risk of developing cancer
(germ cell neoplasia)
16
Q
What is the anatomical location of the renal calyx?
A
At the renal hilum
Extension of the renal pelvis into the kidney
Upper, middle and lower calyx
17
Q
What is the normal histological appearance of the renal calyx?
A
Lined by urothelium
18
Q
Give 2 pathological lesions that may occur in the renal calyx?
A
Stones
Tumours
19
Q
What is the anatomical location of the pelviureteric junction?
A
Where are you the ureter dilate to become the pelvis at the hilum?
20
Q
What is the normal histological appearance of the pelviureteric junction?
A
Funnel-like
Lined by urothelium
21
Q
Give 2 examples of pathological lesions that can occur in the pelviureteric junction
A
Stones
Tumours
22
Q
What is the anatomical location of the trigone?
A
A triangular area at the base of the urinary bladder that joins the ureteric and urethral orifices
23
Q
What is the normal histological appearance of the trigone?
A
Lined by urothelium in males and non-keratinising squamous epithelium in females
Looks paler than the rest of the bladder, especially in women
24
Q
What can cause the trigone to become keratinised?
A
Irritation
25
Give 2 examples of pathological lesions that may be found in the trigone?
Stones
Catheters can irritate the trigone. Leading to keratinisation of the non-keratinising squamous epithelium and the risk of squamous carcinoma
26
What is the anatomical location of the epididymis?
Along the lateral edge of the testis
27
What is the normal histological appearance of the epididymis?
Coiled tubules
Lined by ciliated epithelium
Secrete glycoprotein which provide the necessary environment for the viability of sperm
28
Give 2 examples of pathological lesions that may occur in the epididymis?
Infections (epididymisitis)
Sperm granuloma
Cysts
Abscess
29
What is the anatomical location of the prepuce?
Foreskin covering the glans
30
What is the normal histological appearance of the prepuce?
Squamous lining
Partly keratinised
31
Give 2 examples of pathological lesions that may occur in prepuce?
Balanitis (including lichen sclerosis)
Tumour
32
Define hydronephrosis?
Dilation of the renal pelvis and calyces
33
What is the underlying cause of hydronephrosis?
Distal obstruction of the ureter
34
Give 4 lesions that may lead to hydronephrosis?
Stones
Tumours
Pelviuteric junction obstruction
Extrinsic compression
35
What is PUJ?
Pelviuteric junction
36
What is a Sperm granuloma and what is it's microscopic appearance?
Sperm escapes into following a rupture of epithelium/wall
Reactive process with inflammation and fibrosis
37
What is cystitis cystic a and how does it appear microscopically?
Distended subepithelial cysts under bladder epithelium
Lined by urothelium containing secretions.
Normal reactive process
Can undergo columnar metaplasis
38
What is Torsion of the testis and how can it occur?
Twisting of the spermatic cord
May be due to a long cord, trauma, tumour
39
What are the clinical implications of not treating a specimen with the clinical information"tortion of the testis"?
May lead to ischaemia
Necrosis
40
How is a specimen with the clinical information "Torsion of the testis" treated?
Excision
41
What would you see macroscopically, on a specimen sent with the clinical information "Torsion of the testis"
Haemorrhage
Complete necrosis
42
Whare are the collecting ducts found?
Kidney
43
Where is the trigone found?
The bladder
44
Where are Sertoli cells found?
Testis, within the seminiferous tubules
45
Where is the urachal remnant found?
The dome of the bladder
46
What is a bladder diverticulum and how might it arise?
Outpouching of the bladder mucosa through a defect in the wall.
Congenital or acquired
47
What are the clinical implications of a long standing bladder diverticulum?
Stagnant urine can cause infection, stones and tumour
48
What is the macroscopic appearance of a kidney with the clinical data adult Polycystic kidney disease?
Diffuse enlargement of the kidney
Loss of reniform shape
Multiple cysts
No normal renal parenchyma
+/- tumour
49
Contrast the macroscopic appearance of kidney with adult Polycystic kidney disease with that of a hydronephrotic kidney
**APKD**
Enlarged
Loss of reniform shape
No normal parenchyma
Cysts
**hydronephrotic**
Dilation of pelvicalaceal system
Compressed thin cortex
No cysts
50
How can handling of a TURP and a TURBT differ in the cut up room, and why?
**TURP**
Used for benign conditions
Don't process all unless under 50y
Process first 12g plus 2g for every additional 5g
**TURBT**
Remival of malignant tissue
Process all
Taken for staging, no levels required
51
How can BPH present clinically?
Hyperplasia of gland, stroma or muscle leads to constriction of the urethra
Obstructive symptoms =
Irritative symptoms =
52
What are the potential complications of untreated BPH?
UTIs
Stones
Complete urinary obstruction
Kidney backpressure changes
53
What is the typical macroscopic appearance of TURP specimens?
Non-descript chips
Pale and yellow areas
Burnt diathermy areas
54
What is the typical microscopic appearance of TURP specimens?
Glandular and stroma hyperplasia
Incidental cancer
55
How would you assess, handle and dissect a cryptorchid testis?
Always assume an incidental tumoir
Measure testis and cord
Take cord resection margin
Bivalve plus additional parallel slices to check for tumours
If not identified take sections of testis, epididymis and hilum
If tumour identified, call pathologist and sample under their guidance or pass to them for dissection
56
A slide is returned to the lab from a consultant containing a small amount of high grade urothelial carcinoma in an otherwise benign prostate chippings sample. How might this have occured?
It may be from that patient in their prostatic urethra or the base of their bladder and has been sampled in the TURP procedure
It could be carryover during theatre (2 specimens 1 pot), tissue transfer (not cleaned Forceps, board) , processor (loose tissue floating around) , embedding (Forcepts or floating in the wax) or cutting of the sections on the microtome (equipment or water bath)
Need to check block to see if introduced before or softer embedding
May need DNA analysis to see if same patient or patient to be reexamined but this may not solve the issue
Clinical incident need filling in, clinician need informing do the patient can be informed
57
What is a stag horn calculus?
Calculi that fills the entire pelvis
Shaped like the pelvic and calyces
58
What are the clinical implications of leaving a stag horn calculus untreated?
Obstruction
Infection
Needs removal
59
Explain the difference between a true diverticula and a false one?
**True diverticula**
Includes all three layers of the wall in the outpouching
**False diverticula**
Only the mucosa outpuches through the defect
60
How do you dissect a vas deferens?
Identify that there is a tubular structure
Measure the length and diameter
At least 2 transverse sections
61
Why is it important to handle vas deferens correctly in the lab?
Important the patient is aware a complete section has been removed
If not danger of pregnancy
If not embedded correctly full cross section of tube and lumen cannot be seen and patient cannot be reassured
62
What is a hydrocoele?
Accumulation of fluid between 2 layers of the tunica vaginalis and albuginea (outer layers of the testis)
63
What are the causes of a hydrocoele?
Inflammation
Trauma
Lymphatic obstruction
Tumour
64
What is a spermatocoele?
A cyst in the epididymis filled with fluid including sperm
65
Testis removed for painful testis removed at time of hernia repair. How would you handle, dissect and select blocks for this specimen?
Always assume an incidental tumoir
Measure testis and cord
Take cord resection margin
Bivalve plus additional parallel slices to check for tumours
If not identified take sections of testis, epididymis and hilum
If tumour identified, call pathologist and sample under their guidance or pass to them for dissection
66
Where are the testis and epididymis found?
Within the scrotum
67
Where are the testis and epididymis found?
Within the scrotum
68
What is the function of the testis?
Site of sperm production
Hormone synthesis
69
What is the function of the epididymis?
Sperm storage
70
Where is the epididymis located?
Posterolateral aspect of each testis
71
What can be found within the spaghmatic cord?
Vessels
Nerves
Vast deferens
72
Where are the testes located during embryonic development?
Located on the posterior abdominal wall
Desend down through the abdomen
Through the inguinal canal to the scrotum
73
What components make up a testis
Seminiferous tubules
Rete testes
Tunica albuginiea
Tunica vaginalis
Testicular vein
Testicular artery
Ductus deferens
74
How are the testes arranged anatomically?
Ellipsoid in shape
Series of lobules containing seminiferous tubules
Supported by interstitial tissue
Seminiferous tubules are lined by sertoli cells which aid in the maturation of spermatazoa
Interstitial tissue contains leydig cells which produced testosterone
Spermatazoa is produced in the seminiferous tubules and moves to the rete testes before going onto the epididymis for storage and maturation
75
What are the testes covered by?
Tunica vaginalis
76
What is the tunica vaginalis composed of?
Peritoneal origin and has serous fluid between its layers
77
What protects the Testicular parenchyma?
Tunica albuginea
78
What is the tunica albuginea composed of?
Fibrous
79
What is the function of the vas deferens?
Move sperm from the epididymis to the prostatic portion of the urethra for ejaculation
80
What is the appendix epididymis?
A remnant of the mesonephric duct
81
What is the appendix testis?
Historically called hydatid of morghani
Remnant of the mullarian duct
Attached to the tunica albuginea at the upper testicular Pole
82
What is the general presentation of testicular and epididymis pathologies?
Testicular tumour can be painless - rare
Mass with diffuse/chronic/sharp pain
Tenderness
Urinary symptoms
Swelling
Bowel symptoms
Redness
Hardness
Patients with disminated disease have haemoptysis or can be asymptomatic
Torsion of an undescended testis can be a warning sign of testicular cancer
83
What tests can be used to investigate testicular and epididymal pathologies?
Infections are more common than tumors
Blood tests
Urinanalysis
Palpitation
Imaging ultrasound can show solid/cystic areas
Chest x-ray rules out pulmonary involvement for cough
CT scan/MRI shows masses
PET helps with staging
Trauma can confuse the diagnosis
84
What is a general description and dissection for vas deferens?
Specimen taken following a vasectomy
Tubular structure
Measure in two dimensions
Describe appearance
Sample at least two transverse sections
Embed en bloc
85
What would be the typical description and dissection for a spaghmatic cord lipoma?
Benign lobulated pseudoencapsulated fatty mass
Describe
Measure in three dimensions
Serially slice
Embed all if small or representative sections if large
86
What is a typical description and dissection for an orchidectomy?
Requires opening through the lateral border so that the epididymis and rete testes are bisected (common tumor site)
Measures spermatic cord two dimensions
Testis in three-dimensions
Weigh
Describe outer surface
Cut surface (hemorrhage/lesion/fluid filled cavities)
Blocks - spermatic chord resection margin plus adjacent, 2-3 blocks of interest demonstrating background testes, epididymis, hilum and any lymph nodes to present
87
What can cause infertility in the testes?
Pre-testicular - endocrine disorders (hyperthalmic, pituitary or adrenal)
Post testicular - duct obstruction (congenital, inflammatory, post surgical)
88
What tests can be carried out to investigate testicular or epididymal pathologies?
History
Physical examination
Semen analysis
White blood cell count in semen
Detection of anti-sperm antibodies
Sperm function tests (cervical mucus interaction, ova penetration and hemizonal assay)
89
What is hypospermatogenesis?
All stages of spermatogenesis are present but reduced to varying degrees
90
In sperm production what is maturation arrest?
Complete maturation arrest germ cell maturity ceases at a specific point
91
What is a testicular granulomatous lesion?
Rare, benign granulomatous inflammation of the testes
92
Who is at most at risk as testicular granulomatous lesions?
40 to 59-year-olds
93
What is the clinical presentation of testicular granulomatous lesions?
Sudden onset of tender testicular mass
Variable fever
94
What tests can be used to investigate to testicular granulomatous lesions ?
Culture to rule out infectious agents and inflammatory response
95
Where would a granulomatous ischemic lesion affect within the testis?
Usually the head of the epididymis
96
What is the macroscopic appearance of a testicular granulomatous lesion?
Solid, unilateral, nodular enlargement of the testes resembles lymphoma
97
What is the microscopic appearance of testicular granulomatous lesion?
Lymphocyte and plasma cell infiltrate
In interstitium and surrounding seminiferous tubules
Giant cells and histiocytes
Zonal necrosis involving ducts and interstitial tissue
98
What are the causes of a testicular granulomatous lesion?
AIDS
E coli
Gonorrhea
Leprosy
Mumps
Syphilis
Tuberculosis
99
What is the differential diagnosis of testicular granulomatous lesion?
Inflammation
Lymphomas
100
What is orchitis?
Inflammation of the testicle
101
What are the causes of orchitis?
Infections such as mumps
102
Who is most at risk of orchitis?
Prepubescent boys
103
What is the clinical presentation of orchitis?
Mild to severe testicular pain
Tenderness
Swelling
Redness
Fever
Chills
Headache
Body aches
Nausea
Fatigue
If mumps there is also parotted gland inflammation
104
What is epididymitis?
Usually related to cystitis, prostatitis or urethritis
Primary cause of epididymal obstruction
Acute disease
105
What is the macroscopic appearance of epidemisitis?
Epididymis is enlarged
Covered in fibrin
+/- pus and rupture
106
What are the causes of epididymisitis?
Brucellosis - affects testis and epididymis has granulomatous appearance
Gonorrhea - affects epididymis then testis
Tuberculosis - causes confluenct caseation that spreads to the testis
In children gram negative rods and congenital abnormalities
If younger than 35 years old chlamydia, gonorrhea
35 plus year olds E coli, pseudomonas, UTI organisms
107
What is the clinical presentation of epididymisitis?
Comes on gradually
Testicular pain
Nausea
Vomiting
Tenderness
Swelling
Redness
Abdominal pain
Fever
Urethral discharge
Urinary symptoms (frequency, urgency burning)
108
What is testicular torsion?
Twisting of the spermatic cord and it contents
Surgical emergency
109
Who is at most risk of testicular torsion?
Two peaks of incidence
Perinatal and puberty
Can occur in adults
110
What are the clinical implications of leaving testicular torsion untreated?
Twisting of the testicle along the spermatic cord leads to a decrease in venous outflow and vascular congestion
If prolonged leads to decreased arterial flow and ischaemia which can then lead to necrosis
111
What is the clinical presentation of testicular torsion?
Intravaginal
Twisting inside the tunica vaginalis
Sudden onset of pain
Nausea
Vomiting
Swelling
History of trauma
Extravaginal
Tunica vaginalis also twists
Can be asymptomatic
Mass in inguinal region or superior aspect of scrotum
112
How is testicular torsion diagnosed?
Ultrasound
113
What is the macroscopic appearance of testicular torsion?
Depends on degree of torsion and duration
Dark red testes with smooth external surface and solid consistency
114
What is the microscopic appearance of testicular torsion?
Oedema
Congestion
Haemorrhage
Dilation of seminiforous tubules leading to necrosis and infarction
115
What is the differential diagnoses of testicular torsion?
Germ cell neoplasia in situ (GCNIS)
Lymphoma
116
What is cryptorchidism?
Absence of one or both testes in the scrotum
Most common congenital abnormality in the genitourinary tract
Commonly due to failure to desend
117
What is the clinical presentation of cryptorchidism?
Maybe palpated in the inguinal area or upper scrotum
Some may be abdominal
Associated with increased risk of testicular germ cell tumor, torsion and inguinal hernia
118
How is cryptorchidism diagnosed?
Laproscopy is the gold standard
119
What is the microscopic appearance of cryptorchidism?
Smaller atrophic testis
120
What is the microscopic appearance of cryptorchidism?
Peritubular fibrosis
Semniferous tubular atrophy
Decreased or absent spermatogenesis
121
What is the differential diagnoses of cryptorchidism?
Germ cell neoplasia in situ (GCNIS)
122
What is anorchia?
Vanishing testis syndrome
Absence of one or both testes
123
What is an orchiopexy or orchidopexy?
Procedure that tethers the testicle to the scrotum (treatment if under 2y)
124
What is GCNIS?
Germ cell neoplasia in situ
Common precursor of type II germ cell tumours (seminomas and postpubertal nonseminomatous germ cell tumours)
125
Who is at most risk of GCNIS?
Higher ratio found in patients with uncorrected cryptorchidism
126
How does GCNIS present clinically?
Microlithiasis can be detected by ultrasound
127
How is GCNIS diagnosed?
Ultrasound
Confirmation via histology
128
How is GCNIS treated?
Orchidectomy
+/- low dose radiation
129
What is the microscopic appearance of GCNIS?
Neoplastic cells located along the basement membrane of the seminiferous tubules
Cells are large with clear cytoplasm
Hyperchromatic nuclei
Coarse chromatin
130
What additional tests can be used to help diagnose GCNIS?
Oct 3/4, PLAP positive
WT1, CD30 negative
131
What is the differential diagnoses of GCNIS?
Infantile testis
Seminoma
132
What is a hydrocoele?
Accumulation of fluid between the two layers of the tunica vaginalis
133
Who is most at risk of hydrocoele?
Any age
Children > men
Can extend into the abdominal via the inguinal canal, forming a varient
134
What are the varients of hydrocoele?
Encysted
Funicular
135
How does the encysted varients of a hydrocoele appear?
No communication with the abdominal cavity
Defective closure at both the Proximal and distal ends of the process us vaginalis
136
What is the differential diagnoses of a hydrocoele?
Inguinal lymphadenopathy
Hernia
Tumour of the spermatic cord
137
How does the funicular varients of a hydrocoele appear?
Communication with the peritoneal cavity
Defective closure of the distal end of the tunica vaginalis
138
What is the clinical presentation of a hydrocoele?
Painless scrotal swelling
Feeling of heaviness
139
How is a hydrocoele diagnosed?
Physical examination
140
How is a hydrocoele treated?
Spontaneous regression
Surgery occasionally
Follow up for reoccurance
141
What is the macroscopic appearance of a hydrocoele?
Uniloccular swelling
142
What is the microscopic appearance of a hydrocoele?
Loose connective tissue lined by single layer of cuboidal/flattened mesothelial cells
+/- hyperplay (solid/papillary, squamous metaplasia or atypia)
143
What is a spermatic granuloma?
Inflammation or trauma to epithelium or basement membrane that causes spillage of spermatazoa into the interstitum of the testes
Forms a nodule at the head of the epididymis
144
How does a spermatic granuloma present?
A nodule up to 3 cm at the head of the epididymis
Non-caseating granuloma forms around the spermatazoa
145
What are the causes of a spermatic granuloma?
40% due to previous vasectomy
Trauma
Infections
Surgery
146
In the testes what is a vasitis nodosa?
Granulomatous condition of vas deferens that resembles spermatic granuloma of epididymis
Usually post vasectomy
147
What is the microscopic appearance of vasitis nodosa?
Proliferating ductules and dilated tubules containing spermatazoa in a wall of vast deference
Small bundles of hyperplastic smooth muscle
Vas deferens may show irregular thickening
148
What is the differential diagnosis of vasitis nodosa?
Adenocarcinoma of the epididymis
149
What are cysts in the testes and epidemis?
Benign cystic lesions
Mesothelial cysts and hydrocele are true cysts
150
Who is most at risk of true cysts within the testis and epididymis?
Hydrocoele - more common in children
Mesothelial cyst - >40yo. Can be associated with PCKD
151
How do you cysts and cystic dilations appear within the testes and epididymis?
In the epididymis and rete testes
Arise from tubal epithelium
Frequently secondary to obstruction
152
What is the clinical presentation of a testicular or epididymal cyst?
Painful or painless
Cystic swelling of scrutum
Maybe incidental finding
153
How are testicular or epididymal cysts diagnosed?
Ultrasound
154
What is the macroscopic appearance of a testicular or epididymal cyst?
Fluid filled cyst
Clear fluid
+/- haemorrhage or infection
155
What is the microscopic appearance of a testicular or epididymal cyst?
Single layer of cuboidal or flattened mesothelial cells
Prominent atypia, squamous metaplasia or inflammation
156
What is the differential diagnosis of a testicular or epidemal cyst?
Neoplastic cystic lesions
157
What is a spermatocoele?
Benign dilation of efferent ductals in the rete testes or head of epididymis
158
Who is most at risk of a spermatocoele?
All ages, typically 20 to 50 year olds
159
What is the clinical presentation of a spermatocoele?
Painless bulging mass
Separate from the testicle
160
How is the spermatocoele diagnosed?
Ultrasound
Occasionally MRI
Histology of resection specimen
161
How are spermatocoele treated?
Resection
162
What is the macroscopic appearance of spermatocoele?
Collapsed thin walled membrane
Round or ovid
Uniloccular or multiloccular
Translucent
163
What is the microscopic appearance of sperm?
Lined by single layer cuboidal to ciliated columnar epithelial which becomes flattened as the fluid accumulates
Thin wall of fibromuscular soft tissue
Proteinaceous fluid and spermatazoa maybe present
164
What additional tests can aid in the diagnosis of spermatocoele?
AE1/AE3, EMA positive
Calretinin, D2-40 negative
165
What is the differential diagnosis of spermatocoele?
Hydrocele
Mesothelial cyst
Simple cyst
Dermoid cyst (Teratoma)
166
What are the three parts of the penis?
Root
Body
Glans
167
Where is the root of the penis?
Located in the superficial perineal pouch of the pelvic floor
Is not visible externally
168
What is the body of the penis?
Free part of the Penis suspended from the pubic synthesis composed of three cylinders of a rectile tissue two corpora cavernosa and a corpus spongiosum (ventral)
169
What is the glans of the penis?
Distal part
Conical shape
Formed by expansion of the corpus spongiosum
170
What is the internal structure of a penis?
2 corpus cavernosa
1 corpus spongiosum on the ventral aspect
Urethra runs through the corpus spongiosum
171
What is the prepuce of the penis?
The foreskin
172
How is the prepuce formed?
A double layer of skin and fascia located at the neck of the glands it is connected to the glands by the frenulum on the ventral aspect
173
How does penile pathology present clinically?
Infectious diseases - induration, erythema of the glans, pain, puritus
Penile cancer - painless nodule, warty growth or ulceration, especially on the glans or prepuce
174
What tests can be carried out to investigate penile pathologies?
Blood tests
Biochemistry - increased calcium in bone metastases
Swabs - infections
MRI/CT - staging, inguinal lymph node involvement
175
What histological specimens can be received from the penis?
Skin lesions - arrive as punch or ellipse excessions and treated as such
Circumcision - removed due to benign conditions eg phimosis, BXO
Glansectomy - glans plus foreskin, not commonly used for T2 lesions
Partial penectomy - common for T2/3 lesions invading the corpus spongiosum or corpus cavernosum. Legion plus tumour free margin
Radical penectomy - penis, scrotum, testis, spermmatic cord and inguinal lymph nodes
176
What is a general description for a circumcision specimen?
Measure
Inspect
Orientate
If received in cylindrical form will need opening on the dorsal surface this cut is not a resection margin
Resection margins need inking
If suspected cancer process all
If not block pathology and representatives sections
177
What is penile condoloma accumulatum?
HPV associated non-neoplastic tumour-like growths considered benign
178
Where can be affected by penile condaloma accumulatum?
Penis, scrotum, perineum and anus
On the penis it is generally on the glans
179
Who is most at risk of penile condyloma accumulatum?
25 to 29-year-olds
Spread by skin to skin contact
Sexually transmitted
HPV 6 and 11 linked
HPV 16 and 18 leads to squamous cell carcinoma
180
What is the clinical presentation of penile condyloma accumulatum?
Soft friable papillomatous growth can be single or clustered
181
How is penile condyloma accumulatum diagnosed?
History
Physical examination
Biopsy
182
How is penile condyloma accumulatum treated?
Medical management
Cryosurgery
Ablation
183
What is the macroscopic appearance of penile condyloma acuminatum?
Soft
Flesh coloured lesions
Can be flat
Delicately papillary or warty and cauliflower-like
184
What is the microscopic appearance of penile condyloma acuminatum?
Papillomatous
Acanthosis with well demarcated bulbous base
Prominent central fibrovascular core with branching pattern t
Koilocytic atypia is the hallmark
185
What is the differential diagnosis of penile condyloma acuminatum?
Pearly penile papules
Seb K
Papillary squamous cell carcinoma
186
What is balantis/phimosis?
Phimosis - inability to retract the foreskin
Can be congenital or acquired
Balanoposthitis - non-specific information of the glans (balanitis) and prepuce (posthitis)
Often secondary to phimosis
187
Who is most at risk of phimosis/Balanoposthitis?
Phimosis - uncircumcised men, any age
Balanoposthitis - uncircumcised men, any age. Can be linked to diabetes
188
What are the common causes of phimosis?
Infectious agents - bacterial, viral, parasites
189
What is the clinical presentation of phimosis/Balanoposthitis?
Phimosis - irritation and pain if prolonged
Balanoposthitis - erythematous rash, puritis, tenderness, pain +/- ulceration
190
How is phimosis/Balanoposthitis diagnosed?
Physical examination
Plus biopsy for balanoposthitis
191
How is phimosis/Balanoposthitis treated?
Routine cleaning or circumcision if severe
192
What is the microscopic appearance of phimosis/Balanoposthitis?
Phimosis - often normal lymphocytes and plasma cells, fibrosis, oedema, congestion
Balanoposthitis - non-specific inflammatory infiltrate, lymphocytes, plasma cells
193
What is the differential diagnoses of phimosis/Balanoposthitis ?
Syphilis
Squamous cell carcinoma insitu
194
What is penile lichen sclerosis (Balanitis xerotica obliterans)
Chronic inflammation
Mucocutaneous condition
Benign
195
What is BXO?
Balanitis xerotica obliterans
196
Where does lichen sclerosis of the penis affect?
Inner prepuce
Coronal sulcus
Glans mucosae
197
Who is most at risk of lichens sclerosis of the penis?
Middle aged men common cause of phimosis
198
What is the clinical presentation of lichens sclerosis of the penis?
Phimosis
Narrowing of urethral meatus and paraphimosis
Associated with low grade keratinizing squamous cell carcinoma
199
How is lichen sclerosis of the penis diagnosed?
Physical examination and biopsy of suspected cases
200
How is penile lichen sclerosis treated?
Corticosteroids
Circumcision if it involves the foreskin
201
What is the macroscopic appearance of penile lichen sclerosis?
Greyish, bluish-white irregular geographic foci of atrophy
Erosion
Ulceration
Raised pearly white areas
202
What is the microscopic appearance of penile lichen sclerosis?
Squamous epithelium - normal/atrophic/hyperplastic with hyperkeratosis
Sclerotic globules
Variable lymphatic infiltration
203
What is the differential diagnosis of penile lichen sclerosis?
Lichen planis
204
Give five examples of penile skin lesions?
Cellulitis
Melanosis
Lentigenosis
Scrotal calcinosis
Squamous hyperplasia
Bowenoid papulosis
Extra mammary Paget's disease
Penile intraapithelial neoplasia (PeIN)
Squamous cell carcinoma
Basal cell carcinoma
205
What is PeIN and what different types can occur?
Penile intraepithelial neoplasia
precursor for penile invasive carcinoma
Undifferentiated - HPV linked
Differentiated - lichen sclerosis linked
206
Give a benign, premalignant and malignant example of pathologies that affect the bladder?
Benign - cystitis
Premalignment - urothelial carcinoma insitu
Malignant - urothelial carcinoma
207
Give examples of benign, premalignant and malignant pathologies that affect the prostate?
Benign - hyperplasia
Premalignment - high grade prostatic intra-epithelial neoplasia (Pin)
Malignant - adenocarcinoma of the prostate
208
Give examples of benign, premalignment and malignant pathologies that affect the kidney?
Benign - cysts
Premalignant - urothelial cell carcinoma insitu
Malignant - renal cell carcinoma
209
Give examples of benign, premalignant and malignant pathologies that affect the ureter?
Benign - stricture
Premalignant - urothelial carcinoma insitu
Malignant - urothelial carcinoma
210
Give examples of benign, premalignant and malignant pathologies affect the testis and epididymis?
Benign - torsion
Premalignant - testicular intra-tubular germ cell neoplasia
Malignant - germ cell tumors
211
Give an example of benign, premalignant and malignant pathologies that affect the penis?
Benign - lichen sclerosis
Premalignant - penile intraepithelial neoplasia
Malignant - squamous cell carcinoma
212
What type of specimens can be received from urology?
Mucosal biopsies
Bladder tumour reception biopsies (TURBT)
Bladder tumour curetting
Cystectomy
Prostate needle call biopsies
Transurethral resection of the prostate (TURP)
Prospectomy
Kidney biopsy
Partial kidney resection
Kidney resection
Ureter
Orchidectomy
Penile specimens
Foreskin
213
What are urology mucosal biopsies and how are they handled in the lab?
Cytoscopic hot/cold snare
Sampling abnormal and normal tissue
Count
Measure
Process all
214
What are TURBT and how are they handled within the lab?
Taken with a cytoscope
Weigh
Measure
Process all
215
How is a cystectomy handled within the laboratory?
Can be partial or total
Sample tumor and margins
Process all if small
216
How can prostate needle call biopsies be taken?
Transrectally or perineally
Targeted with ultrasound or MRI
217
How are prostate needle cores handled within the lab?
Count
Measure
Handle with care
Straighten at the dissection bench to aid embedding
Process all
218
What is a TURP and how is it handled within the lab?
Transurethral resection of the prostate
Retroscope inserted into urethra
Hot loop used to scrape the prostate tissue and collected
Weigh
Sample first 12 grams then two grams for every additional five grams that are
219
How can a prostectomy sample be taken and how is it dealt with it within the laboratory?
Open surgery
Laparoscopically
Robotically
Weigh
Orientate
Ink
Measure 3 dimensions
Measure seminal vesicles and vas deferens
Process all
Mega blocks are used for prostates minus the superior and inferior poles
220
How are kidney biopsies taken and how are they handled within the laboratory?
Precutaneously
Count
Measure
Process all
Levels
Spares
Maybe for immunofluorescence - we process in FFPE plus glutaldehyde for electron microscopy
221
How is a partial or full nephrectomy handled within the laboratory?
Measure with and without surrounding fat
Describe gross appearance
Measure ureter
Measure adrenal gland if present and lymph nodes
Ink resection margin
Slice through lateral border and parallel slices
Check hilar vessels for thrombi
Describe, measure any lesions/pathology and relationship to the margins
222
How are ureters handled within the lab?
Measure 2 dimensions
Describe any pathology
Sample resection margins and adjacent slice as well as pathology
223
How are penile skin lesions treated within the laboratory?
Same manner as skin specimens
224
Compare and contrast transperineal and transrectal prostate biopsies?
Infection is lower with transperineal
Rectal bleeding is lower with transperineal
Recovery is less with transperineal
Access to the anterior aspect is easier via transperineal
Transperineal mainly samples the peripheral zone
Transrectal mainly samples the transition zone
225
What are the disadvantages of transparineal prostate biopsies?
Infection possible sepsis
Blood in urine
Blood in semen
Temporary erectile dysfunction
Bruising of skin
226
What are the disadvantages of transrectal prostate biopsies?
Infection possible sepsis
Pain and discomfort
Temporary erectile dysfunction
Recovery four to six weeks
227
What is the prostate?
An accessory gland to the male reproductive system
228
Where is the prostate located?
Inferiorly to the neck of the bladder
Superior to the external urethral sphincter
Posterior to the prostate lies the ampulla of the rectum used in digital rectal examinations allow for physical examination of the gland
229
What is a DRE?
Digital rectal examination
230
Where do the prostatic ducts open to?
Prostatic portion of the urethra
10 to 12 openings on each side
231
What is the function of the prostate?
Secrete proteolytic enzymes via the prostate ducts immediately before ejaculation to prevent clotting of the ejaculate and aid fertilisation
232
How is the prostate orientated within the body?
Prostate base is next to the bladder prostate Apex is inferior to this
233
What is the average weight of the prostate?
20 g in a young adult
234
What tissues compose the prostate?
2/3 glandular
1/3 fibromuscular
Surrounded by a thin fibrous capsule
235
What are the lobes of the prostate chord and how are they formed?
Inferioposterior
Inferiolateral
Superiomedial
Anteriomedial
They are split by the urethra and ejaculatory ducts
236
How is the prostate split clinically?
Zones plus stroma
Central zone surrounds ejaculatory ducts
Transitional zone located centrally surrounding the urethra (common area for hyperplasia)
Peripheral zone located posteriorly
The remainder of the gland is fibromuscular stroma
237
What cell types can be found in a normal prostate gland?
Basal epithelial cells
Glandular epithelial cells
Neuroendocrine cells
Stroma consists of fibroblasts, smooth muscle, nerves, lymphatics
238
What is the general presentation of prostate pathology?
Benign prostate enlargement leads to urinary tract obstruction symptoms and irritation symptoms
Acute retention
Prostatitis can lead to perineal pain (may radiate to back inguinal region or testes), associated irritation urinary symptoms
239
How do urinary obstruction symptoms present?
Hesitancy
Decreased force
Intermittent stream
Post urination dribbling
240
How do urinary irritation symptoms present?
Frequency
Urgency
Nocturia
241
What is nocturia?
Needing to urinate in the night
242
What tests can be used to diagnose prostate pathology?
Biochemistry - serum levels of PSA for cancer normal is 4ng/ml
Transrectal ultrasound +/- biopsies can show PIN, HYPERPLASIA, atrophy infarction, infection, cancer.
Does not differentiate between them
Biopsies can aid further and can be taken transperineally or transrectally
CT scan can identify spread to bladder or urethra
MRI helps with staging
243
What is a TRUS?
Transrectal ultrasound
244
What is PSA?
Prostate specific antigen
245
What are the clinical indications for taking a TRUS biopsy and how are they taken?
Taken if increased PSA
Query mass
Needle inserted transurethrally or perineally
Six cores from each lobe at the base, middle and apex
246
How are TRUS biopsies dealt with in the lab?
Count
Measure
Process all
Levels
Care - Crush artifact, separate and straighten
247
What are transperineal template prostate biopsies?
Biopsies taken through the perineal.
20 to 40 cores taken
Used to map patholigies within the prostate
Used in high risk patients with multiple negative TRUS biopsies, increased PSA previous atypia on biopsy or high grade PIN
248
What are the advantages and disadvantages of trans perineal template prostate biopsies?
**Advantages**
Better access to anterior part of prostate
Less complications with infection
Improved sampling
**Disadvantages**
Takes longer
Needs general anaesthesia
High cost
249
What is an MRI/TRUS fusion biopsy?
More accurate targeting of suspicious areas
MRI helps distinguish between aggressive and slow growing cancers
Slow growing can be monitored avoiding unnecessary procedures
Software combines previous MRI with current ultrasound to form an image to age sample retrieval
250
What is a TURP?
Transurethral resection of prostate p
Performed using cystoscopy using a diothermic loop
Bladder irrigation washes out chippings for collection
Used for hyperplasia
251
How are TURP specimens dealt within the lab?
Specimens are pale rubbery fragments including the transformation zone
Haemostasis is maintained using electro coagulation
Weigh
Process first 12 grams then two grams for every additional 5 grams of weight
If HGPIN or carcinoma is found remaining specimen needs processing
252
When is benign prostatectomy used?
Hyperplasia when prostate is over 50 to 70 grams
Can be performed retropubic (into anterior region) or superpubic (extra peritoneal incision in lower abdominal wall)
253
What are the risks of a benign prostatectomy?
Urinary incontinence
Erectile dysfunction
Retrograde ejaculation
UTIs
254
What are the advantages and disadvantages of a benign prostatectomy?
**Advantages**
Complete removal of gland no reoccurrence
**Disadvantages**
Risk of intraoperational hemorrhage
Long recovery
255
How would a benign prostatectomy be handled within the lab?
Weigh
Measure
Orientate
Ink
Serially section 6-8 blocks of pathology and background gland
256
What is prostatitis?
Clinical term only
Report would read acute/chronic/granulomatous inflammation
257
Where is commonly affected by prostatitis?
Central and peripheral zones
258
What are the causes of prostatitis?
Bacteria - E coli, pseudomonas, enterrococcus, staphylococcus species
259
What is the clinical presentation of prostatitis?
General - headache, fever, chills, malaise, low back pain
Specific - prostate tenderness, perineal pain, disuria, urgency, frequency, haematurea
260
How is prostatitis diagnosed?
Blood count
Urine analysis
Cultures
261
How is prostatitis treated?
Difficult antibiotics penetrate poorly into prostate
262
What is the microscopic appearance of Prost?
White blood cells present
Lymphoid aggregates are not specific as may be hyperplasia
263
What is the differential diagnosis of prostatitis?
Various infections that cause an inflammatory response
264
What is BPH?
Benign prostate hyperplasia
Benign nodular enlargement of the prostate gland involving stromal and glandular components
265
Where does bph commonly occur?
Transition (periurethrral) zone
266
Who is most at risk of bph?
Increasing incidence with age
Jumps to 50% between 51-60 years
267
What is the clinical presentation of bph?
Increase bladder outlet resistance
Obstructive symptoms
Urinary bladder irritation symptoms
Urinary retention
268
How is bph commonly diagnosed?
Clinical history
DRE
Urinanalysis
PSA levels
269
How is bph commonly treated?
Surveillance until symptoms impair life quality
Meditation can help inhibit
Surgery if severe - TURP, simple prostatectomy, laser vaporization, ablation
270
What is the macroscopic appearance of bph?
Variably sized nodules
Grey-yellow
Glandular appearance
Bulge overcut surface
271
What is the microscopic appearance of bph?
Nodular lesions composed of variably sized glandular structures
Dilation
Papillary in folding
Cysts
Ischemic changes
272
What additional tests can help diagnose bph?
CK5/6, P63 positive
S100, CD117 negative
273
What is the differential diagnoses of bph?
Prostatic adenocarcioma
GIST (gastrointestinal stromal tumour)
Lieomyosarcoma
274
What is pin?
Prostatic intraepithelial neoplasia
Precursor of prostatic adenocarcinoma also known as carcinoma insitu
275
How is pin diagnosed?
Histologic examination of biopsied prosthetic tissue
276
How is pin treated?
Repeat PSA, if still elevated repeat biopsy
If focal treat as benign
If multi-focal re-biopsy if patient is high-risk
No therapy needed but surveillance
277
What is the microscopic appearance of pin?
Prominent nucleoli
Medium to large ducts
Acini have large hypochromatic nuclei
Can have flat, tufted, micropapillary or cribiform variants
278
What additional tests can be used to diagnose to pin?
34BE12, p63 positive
279
What is the differential diagnoses of pin?
Urathelial metaplasia
Radiation atypia
Basal cell hyperplasia
280
How does the kidney appear?
Bilateral
Bean shaped
Red brown
Posterior of abdomen
Left kidney is slightly higher than the right (liver is on the right)
281
What is the function of the kidney?
Filter and excrete waste products from the blood within urine
Homeostasis (water and electrolyte balance) - manages fluid levels, pH
Metabolic waste excretion from protein and nucleic acid breakdown
Osmorality regulates blood pressure
Excrete excess glucose amino acids sodium and water
282
Where are the adrenal glands in relation to the kidney?
Superiomedially
283
What are the 7 parts of the kidney called?
Capsule
Cortex
Renal pyramid
Major calyx
Renal pelvis
Minor calix
Medulla
284
What is the kidney surrounded by?
Renal capsule (tough fibrous capsule)
Surrounded by perirenal fat (extra peritoneal fat)
Surrounded by renal fascia
285
What is the renal parenchyma split into?
Cortex and medulla
286
What does the renal Cortex contain?
Glomerlulus
Bowman's capsule
Afferent arteriole
Efferent arteriole
Proximal convoluted tubular
Distal convoluted tubular
Start of the collecting duct
287
What does the medulla of the kidney contain?
Renal pyramids - which include the descending limb, loop of Henle and ascending limb of the nephron
Minor calyx drain the collecting ducts which drain into the major calyx then the renal pelvis and onto the ureter
288
What is the renal Hilum?
A deep fissure in the medial margin of the kidney
Vessels and ureter enter and exit here
289
Where is the left kidney positioned with it in the body?
Posterior to Spleen, stomach, pancreas, jejuneum
290
Where is the right kidney positioned within the body?
Posterior to liver, Duodenum, hepatic flexure
291
What tests can be used when investigating kidney pathology?
Biochemistry - urea and electrolytes creati!nine, 24-hour protein/urine analysis
Cystoscopy - brushing, biopsies, visualization
Cytology - urine voided, midstream
Microbiology - urine culture
CT scan - gold standard
292
What is a medical renal specimen?
A renal needle core biopsy taken to investigate atypical presentations that cannot be diagnosed in other ways
Examples - nephratic syndrome, acute kidney injury, atypia that is sudden or unexpected or unexplained
293
How are medical renals handled within the laboratory?
2 to 3 mm in glutaldehyde for 24-72 hours then processed ready for electron microscopy
Must contain glomerlus
Wash remainder in PBS if lab freezes then freeze
Locally we process with formalin fixed paraffin embedded blocks
294
What are medical renals used to study?
Vessels, tubules glomeruli for patterns of injury that may explain or diagnose
295
What additional tests can be carried out on medical renals to aid in the diagnosis and what are their expected results?
H&E - shows vessels and tubules, give a crude idea of the glomeruli
PAS - basement membrane, elastin lamina, fibrosis, mesengial cells (shows spikes and good details of these)
AGM - same as PAS mesengial cells are better with PAS
EVG - basement membrane (no detail) = black, fibrosis = red.
Masson trichrome - good for fibrosis, also shows Lupus deposits as red
Some labs do IHC we don't
Immunofluorescence - panel = IgA , IgG , IgM , C3, C1q, lambda, kappa
296
In the kidney what is urolithiaisis?
Stones within the collecting system of kidney
Quite common
Occur due to increased stone constituents in urine, decrease urine volume or deficiency of crystal inhibitors in urine
297
What is the clinical presentation of urolithiaisis?
Unilateral
Found in calyces, pelvis or bladder
Usually 2-3 mm
If severe leads to abrupt flank pain and haematuria
298
What different types of kidney stones can occur?
Calcium oxalate/phosphate
Uric acid
Triple Stones
Cysteine
Ammonium acid urate
Stone granuloma
Xanthinuria
299
How does a staghorn calculus appear clinically?
Fever
Pain in flank
Haematuria
Pyuria (pus)
Extreme fatigue
300
What are the causes for a stag horn calculus?
Repeated UTIs
Obstruction in urinary tract
301
What is nephrotic syndrome?
Changes to glomeruli that cause too much protein to be leaked into urine mainly albumin
302
Who is most at risk of nephrotic syndrome?
Common in children>adults
Males>females
Peak incidence 2-3ys and 80-91 ys
303
What is the clinical presentation of nephrotic syndrome?
Proteinuria
Caused by hypoalbuminena leading to severe oedema
304
How is nephrotic syndrome treated?
Corticosteroids or immunosuppressants
305
What is the macroscopic description of nephrotic syndrome?
Enlarged, Waxy, yellow cortex due to lipid accumulation approximal tubules
306
What is the microscopic appearance of nephrotic syndrome?
Glomerulus normal by light microscopy
307
What is acute pylonephritis?
Acute suppurative (pus forming) infection of the kidney collecting system and renal parenchyma
308
Who is the most risk of acute pylonephritis?
Infants, young children with congenital lesions
Women of reproductive age
Adults 60 plus
Also associated with diabetes and immunocompromise
309
What is the most common causes of acute pylonephritis?
E coli
Recurrent UTIs
Instrumentation
Obstruction
Pregnancy
310
What is the clinical presentation of acute pylonephritis?
Sudden onset of costovertebral pain
Systemic infection
UTI
Pyuria
White blood cell casts
311
How is acute pylonephritis treated?
Antibiotics
312
What is the macroscopic appearance of acute pylonephritis?
Focal abscesses or wedge-shaped areas of suppuration
313
What is the microscopic appearance of acute pylon?
Patchy suppurative inflammation
Primary cortical with oedema
Neutrophils in interstitution and tubular lamina
Tubular necrosis
314
What is the differential diagnosis for acute pylon?
Other forms of pyelonephritis
Acute cystitis
315
What is chronic pylonephritis?
Diffuse patchy tubulointerstitial inflammation within the kidney
316
Who is the most risk of chronic pylo?
F>M
Common in paediatrics with congenital abnormalities
Most common site - uppper pole
317
What are the causes of chronic pylonephritis?
Urinary tract obstruction
Congenital abnormalities
Recurrent pylonephritis
Long-term catheterisation
318
What is the clinical presentation of chronic pylonephritis?
Non-specific
Malaise
Abdominal pain
Proteinuria
Hypertension
Fever
319
How is chronic pylonephritis diagnosed?
CT (gold standard)
Urinalysis
320
How is chronic pylonephritis treated?
Surgical intervention to correct congenital abnormalities
Medical management (antibiotics)
321
What is the microscopic appearance of chronic pylo?
Lymphocytes and plasma cells in interstitial areas of parenchyma
Patchy well demarcated scarring of renal pelvis and calyces
322
What is the differential diagnoses of chronic pylonephritis?
End stage renal disease
Other forms of pylonephritis
323
What is xanthogranulomatous pyelonephritis?
Rare subtype of pylonephritis
Lipid laden foamy CD68 positive macrophages (xanthoma cells) give microscopic appearance of yellow orange (hallmark)
324
Who is most at risk of xanthogranulomatous pyelonephritis?
All ages but more often in women and elderly
325
What are the risk factors for xanthogranulomatous pyelonephritis?
Diabetes
Hypertension
Immunocompromise patients
Abnormal lipid metabolism
326
What is the clinical presentation of xanthogranulomatous pyelonephritis?
Non-functioning kidney
Flank pain
Fever
Dysuria
Renal angle tenderness
Palpable lump causing renal cell carcinoma concerns
327
How is xanthogranulomatous pyelonephritis diagnosed?
Fever
Increased inflammatory markers (CRP)
328
How is xanthogranulomatous pyelonephritis treated?
Focal or wedge cases = antibiotics severe cases = nephrectomy
329
What is the macroscopic appearance of xanthogranulomatous pyelonephritis?
Zonal appearance
Inner zone = necrosis
Middle zone = granulation tissue surrounded by lipid Laden macrophages orange-yellow appearance
Outer zone = fibrosis
330
What is the microscopic appearance of xanthogranulomatous pyelonephritis?
Inner zone = bacteria, neutrophils, lymphocytes, plasma cells, foreign body giant cells, foreign body granulomas
Middle zone = granulation tissue surrounded by cd68 positive lipid laden foamy macrophages
Outer zone = giant cells, cholesterol clefs, fibrous tissue
331
What additional tests can help in the diagnosis of xanthogranulomatous pyelonephritis?
CD68 positive
PAX8 negative
332
What is the differential diagnoses of xanthogranulomatous pyelonephritis?
Renal clear cell carcinoma
Renal tuberculosis
333
What is kidney hydronephrosis?
Cystic dilation of renal pelvis and calyces
Associated with progressive atrophy of the kidney due to obstructive uropathy
334
What is obstructive uropathy?
Structural or functional hindrance of normal urine flow
Sometimes leading to renal dysfunction
335
How does acute obstruction affect kidney function?
Increases susceptibility to infection
336
How does chronic obstruction affect the kidney?
Leeds to hydronephrosis
337
What are the causes of obstruction in the kidney?
Bladder neck obstruction
PUJ narrowing
Urethral strictures
Cystocoele inflammation
Pregnancy
Prostatic hypertrophy
Blood clots
Stones
Tumors
Uterine prolapse
338
What is the macroscopic appearance of Hydronephrosis?
Cortical rim is thin (atrophy)
Calyceal dilation
339
What is the microscopic appearance of hydronephrosis?
Initial functional alterations are tubular
Due to interstitial inflammatory infiltrate
Chronic changes are cortical atrophy, diffuse interstitial fibrosis and blunting of calyces
340
What is adult polycystic kidney disease?
An autosomal dominant progressive hereditary cystic kidney disease due to various known mutations
341
Where does adult polycystic kidney disease affect?
Kidney
Also liver, pancreas, seminal vesicles, spleen and ovaries
342
Who is more at risk of adult polycystic kidney disease?
M=F but more severe in males symptoms usually present 3rd or 4th decade
343
What is the clinical presentation of adult polycystic kidney disease?
Can be asymptomatic
Abdominal pain
Hypertension
Haemoteuria
Renal failure
Increased UTIs
Calculi
344
What is apkd?
Adult polycystic kidney disease
345
How is apkd diagnosed?
Ultrasound
MRI
CT
Family history
Genetic testing
346
How is APkd treated?
Management of blood pressure
Dietary restrictions
Medical management
Surgery
Transplant
347
What is the macroscopic appearance of apkd?
Marketly enlarged kidneys
Cobbled appearance
Numerous bulging cysts of various sizes
Contains clear-yellow hemorrhagic fluid
Located in cortex and medulla
348
What is the microscopic appearance of apkd?
Cysts lined with simple flattened to cuboidal epithelium
Containing proteinaceous grungy material
Micropapillary projections may be seen
349
What is the differential diagnoses of apkd?
Autosomal recessive polycystic kidney disease (childhood)
Simple renal cysts
350
In the kidney what is rcc?
Renal cell carcinoma
Most common renal epithelial tumor typically with clear cytoplasm
Compact, nested or acinar growth patterns
351
Where is affected by rcc?
Kidney typically solitary cortical mass
Renal sinus invasion is most common pathway of spread
352
What are the risk factors for rcc?
Smoking
Obesity
Hypertension
Long-term dialysis
Family history
353
What is the clinical presentation of rcc?
Mainly incidental finding
**Symptoms**
Anaemia
Gross Haematuria
Flank pain
Mass
Weight loss
Fever in late stages
354
How is rcc treated?
Partial nephrectomy for focal/smaller lesions
Full nephrectomy if larger than 4cm
355
What is the macroscopic appearance of rcc?
Usually unilateral, unicentric renal cortical mass
Well circumscribed
Pseudocapsule protruding from cortex
Variegated solid and cystic with fibrosis, haemorrhage, necrosis
Golden yellow colour due to lipid content
356
What is the microscopic appearance of rcc?
Compact nests and sheets of cells with clear cytoplasm and distinct membrane
357
What additional tests can be used to aid the diagnosis of rcc?
PAX8, CA1X, RCC positive
CK7, 34BE12 negative
358
What are the differential diagnoses of rcc?
Capillary rcc
Adrenal cortical carcinoma
359
How do the ureters appear anatomically?
Too thick tubes
25 centimeters long
Continuation of renal pelvis
At the bladder they enter at an oblique manner and along with high intramural pressure, create a one-way valve
360
How do the ureters appear anatomically?
Too thick tubes
25 centimeters long
Continuation of renal pelvis
At the bladder they enter at an oblique manner and along with high intramural pressure, create a one-way valve
361
What is the function of the ureters?
Transport urine from the kidneys to the bladder
362
What is the function of the urethra?
Transport urine from bladder to an external orifice
363
What is the microscopic appearance of the urethra?
**Males**
Lined by stratified columnar epithelium that secretes mucus (protects from corrosive urine)
15 to 20 cm long
Three sections - prostate urethra, membranous urethra and penile urethra
**Female**
4cm long
Lined by urothelium proximately and non-keratinising stratified epithelium distally
364
How can ureter and urethra pathology present in general?
Can be asymptomatic
General urinary track symptoms -
Pain
Haematuria
Retention
Irritation
Dribbling
Urgency
Frequency
Fever
Nausea
Vomiting
Difficulty urinating
UTIs
365
What tests can be used to investigate ureter and urethra pathologies?
Cytoscopy +/- biopsies
Ultrasound
CT
MRI
Urinary analysis
Urethroscopy +/- biopsies
Resections
366
What congenital anomalies can affect the ureter?
Diverticula
Double ureters
Ectopic ureter
Ureteal agenesis
Pelviuerteric Junction obstruction
367
What is a ureter diverticulum?
Can be true or pseudodiverticulum
True diverticulum - including all layers of the normal ureter wall
Due to aberrent development of ureteric bud
Pseudodiverticulum result from mucosal protrusion through a defect in the ureter wall
Can be caused by Instrumentation, surgery, stones, obstruction
368
How does a ureteric diverticular present?
Can be asymptomatic or lead to recurrent UTIs
369
What is double ureter?
Relatively common incidental finding with duplication of the renal pelvises
370
What is an ectopic ureter?
Your return may terminate into proximal urethra, seminal vesicles, vas deferens, fallopian tubes, uterus or vagina
371
What is Ureteal agenesis ?
Mesonephric diverticulum does not develop
Associated with failure of kidney to fully develop
372
What is pelviureteric junction obstruction?
Common cause of hydronephrosis in children
Can be associated with agenesis of contralateral kidney
Narrowing of the connection between renal pelvis and ureter preventing urine flow
Symptoms - pain, stones, swelling
Treatment - for obstruction
373
What is a urethral polyp?
Uncommon, benign, polypoid or papillary growth protruding into the urethral lumen
Can be urethral or fiberoepithelial polyp
374
Who is most at risk of urethral polyps?
Prostatic type urethral polyps - men, 27-41ys
Fibroepithelial polyps - 17-70, common in males
375
What is the clinical presentation of a urethral polyp?
Haematuria
Dyurria
Haemospermia
Polyploid mass protruding into urethral lumen
376
How are urethral polyps diagnosed?
Ultrasound
Cystoscopy
377
How are urethral polyps treated?
Excision
378
What is the macroscopic appearance of a urethral polyp?
Prostatic type- pink-tan, exophytic papillary, single/multiple usually <1 cm
Fibroepithelial - pink-tan, polyploid mass with narrow stalk usually <4 cm
379
What is the microscopic appearance of a urethral polyp?
Prostatic type - delicate papilliae with true fibrovascular core
Lined by an outer layer of columnar cells and underlying flattened to cuboidal basal cells
Fibroepithelial - broad cloverleaf like and club-like projections covered by normal urothelium or numerous small papillae with stromal cell fibrous cores
380
What is polypoid urethritis?
Equivalent to polyploid cystitis
Oedema and inflammatory growth
Can be confused with papillary neoplasm
Most common in the prostatic urethra
381
What are common infections seen in the ureter and urethra?
Usually sexually transmitted
Chlamydia
Gonorrhea
382
What is a caruncle?
Polypoid, fleshy, friable lesion
Irritive urinary symptoms
Micro hyperplastic urothelial lining
Prominent stromal inflammation
Vascularity
Scattered bizarre stroma cells
Diagnostic confusion with sarcoma
383
What is the function of the bladder?
Temporary storage of urine - extendable walls, folded internal lining (rugae)
Assists in the expulsion of urine - contracts and sphincters relax
384
What are the external features of the bladder?
Apex - located superiorly pointing towards the pubic symphysis connected to the umbilicus by ligament
Body - main part of the bladder
Fundus - located posteriorly, triangular shaped with the tip of the triangle pointing backwards,
Neck - continuous with the urethra
385
What is the trigone?
An imaginary triangle on the internal surface of the bladder
Produced by joining the two ureteric orifices and the urethra orifice
This sits within the fundus
386
What is the internal appearance of the bladder?
The trigone has smooth walls, the remainder of the interior has rugae present
387
What is the general presentation of bladder pathology?
Mainly painless passage of blood in urine (Haematuria) +/- clots
Occasionally obstruction +/- infection
Retention
Hesitancy
Urgency
Frequency
Dysuria
Pain
Calculi - haematuria or asymptomatic
388
What tests can be carried out to investigate bladder pathologies?
Urinanalysis - dipstick test shows blood, protein, sugar, infection depending on the test used
MSSU - midstream sample of urine for culture
Voided urine - cytology
Biopsy
Cystoscopy
Cystography - anastomosis leaks, diverticular
CT/MRI - metastatic lymph node
389
What is acute cystitis?
A clinical diagnosis usually when a triad of frequency, lower abdominal pain and dysuria exist
390
Where does acute cystitis commonly affect?
Bladder or lower urinary tract (urethra)
391
Who is most commonly affected by acute cystitis?
Common in women of reproductive age or elderly people
392
What is the clinical presentation of acute cystitis?
Can be asymptomatic
Frequency
Pain
Dysuria
May lead to pylonephritis
393
What is the treatment for acute cystitis?
Antibiotics
394
What is the macroscopic appearance of acute cystitis?
May show no gross abnormalities
Or the mucosa may be hyperemic with variable exudate
395
What is the microscopic appearance of acute cystitis?
Neutrophils
396
What is cystitis cystica/cystitis glandularis?
Proliferative or reactive changes occuring in von Brunn nests
Luminal spaces become cystically dilated (cystitis cystica) or undergo glandular metaplasia (cystitis grandularis)
397
Where is affected by cystitis cystica/cystitis glandularis?
Bladder
Neck
Trigone area
Also ureters and renal pelvis
398
Who is most commonly affected by cystitis cystica/cystitis glandularis?
Extremely common
Often an incidental finding
Male or female
Any age
399
What is the clinical presentation of cystitis cystica/cystitis glandularis?
Mainly asymptomatic
May lead to recurrent UTIs
Polyploid or papillary mass
400
How is cystitis cystica/cystitis glandularis diagnosed?
Microscopy of resected tissue
401
How is cystitis cystica/cystitis glandularis treated?
Removal of underlying source of irritation
Antibiotics
402
What is the macroscopic appearance of cystitis cystica/cystitis glandularis?
Mucosa may be unremarkable
Cystitisis cystica can appear as translucent submucosal cysts <5mm
Cystitis granularis appears as irregular or nodular lesions with cobblestone pattern or as a polyploid mass
403
What is the microscopic appearance of cystitis cystica/cystitis glandularis?
Abundant urothelial von brunn's nests
Vaguely lobular distribution of invaginations
Gland-like lumens or cystically dilated lumens, often both coexist
404
What is interstitial cystitis?
Bladder syndrome of unknown cause that presents as chronic pelvic pain with urinary tract symptoms
Clinical diagnosis
405
Who is most at risk of interstitial cystitis?
Wide age range peak at fourth and fifth decades
406
What is the clinical presentation of interstitial cystitis?
Persistent and recurrent pelvic discomfort pain with bladder filling
Relieved by voiding
Pain is usually suprapubic accompanied by frequency, urgency or nocturia
407
How is interstitial cystitis diagnosed?
Diagnosis of exclusion
408
What is the macroscopic appearance of interstitial cystitis?
Bladder mucosa is unremarkable smooth or with focal thickening
409
What is the microscopic appearance of interstitial cystitis?
Non-specific histological features
410
What is the differential diagnoses of interstitial cystitis?
Drug or radiation cystitis
Medication cystitis
Follicular cystitis
Granulomatous cystitis
411
What is granulomatous cystitis?
Granulomas in bladder due to various infections or treatment related causes
412
What causes granulomatous cystitis?
Tuberculosis
BCG - (treatment for papillary urothelial carcinoma biopsy resection)
413
What is the clinical presentation of
Tuberculosis - lesions near trigone small lesions can merge over time into ulcers
414
What is the macroscopic appearance of granulomatous cystitis?
Can present as a mass or polyploid lesion
415
What is the microscopic appearance of
TB - caseating granulomas with langerhans giant
BCG - chronic inflammation superficial ulceration non-caseating granulomas with active and chronic inflammation
Post treatment - necrotizing and palisading. Resembles rheumatoid nodules or foreign body type or both
416
What is polypoid/papillary cystitis?
Exophytic polyploid to papillary structures characterized by normal or mildly hyperplastic urothelium
Overlying congested, chronically inflamed and oedematous stroma
417
Where does polypoid/papillary cystitis commonly occur?
Mostly the Dome and posterior wall
Corresponds to tip of catheter
418
Who is most commonly affected by polypoid/papillary cystitis?
Any age
M>F
Increases with prolonged use of catheter treatment
419
What is the clinical presentation of polypoid/papillary cystitis?
Frequency
Urgency
Dysuria
Haematuria
Obstruction
Pneumaturia and fecaliria in patients with vericointestinal fistula
420
How is polypoid/papillary cystitis diagnosed?
Polyploid mass or cobblestone appearance on cystoscopy
421
How is polypoid/papillary cystitis treated?
Removal of catheter or irritating agent
422
What is the macroscopic appearance of polypoid/papillary cystitis?
Broad-based oedematous polyp or papillary lesion (cobblestone)
Usually < 5mm
Single/multiple
423
What is the microscopic appearance of polypoid/papillary cystitis?
Variable lesions - bullous, polyploid, papillary
Stromal cores with variable oedema
Urothelium may be normal, metaplastic or hyperplastic +/- atypia
Fibrous and chronic inflammation if long standing
424
What is the differential diagnosis of polypoid/papillary cystitis?
Various papillary lesions
425
What is follicular cystitis?
Non-specific inflammatory disease of the bladder
Lymphoid follicles in lamina propria often with chronic cystitis
426
Where is commonly affected by follicular cystitis?
The trigone
427
Who is most commonly affected by follicular cystitis?
Associated with prolonged urinary tract infections
Secondary to obstruction
428
What is the macroscopic appearance of follicular cystitis?
Mucosal nodularity or granularity
429
What is the microscopic appearance of follicular cystitis?
Large numbers of plasmacytic cells and lymphoid follicles
Lymphocytes
430
What is the differential diagnosis of follicular cystitis?
Follicular lymphoma
Granulomatous process
Tuberculosis
431
What is squamous metaplasia of the bladder?
Replacement of urothelium with stratified squamous epithelia
Can be keratanising or non-keratinising
432
Where is most commonly affected by squamous metaplasia?
Bladder
Ureter
Renal pelvis
In the trigone in women it is a normal variation and not metaplasia
433
What are the causes of squamous metaplasia?
E coli
Streptococcus
Urinary tract irritants (Catheters, calculi, obstruction, fistular, tumor)
434
What is the clinical presentation of squamous metaplasia?
Vaginal (non-keratinizing) subtype - normal finding in women
Keratinizing (leukaplacia) - more common in males, chronic inflammation
435
How is squamous metaplasia diagnosed?
Cystoscopy - flaky, white, plaque-like lesions
Mucosal irregularities
436
How is squamous metaplasia treated?
Spontaneous regression
437
What is the microscopic appearance of squamous metaplasia?
Epithelial lining is paler, thicker, has irregular borders and surrounding erythmia
438
What is the microscopic appearance of squamous metaplasia?
Trigone in women may have glycogenated non-keraterising squamous metaplasia
Epithelium has abundant intracytoplasmic glycogen like vaginal or cervical epithelium
Keratanising variant - hyperkeratotic squamous epithelium with or without parakeratosis
439
What additional tests can aid in the diagnosis of squamous metaplasia?
P63, p40 positive
CK7, CK20 negative
440
What is the differential diagnosis of squamous metaplasia?
Radiation atypia
Squamous papilloma
Squamous dysplasia
441
What is carcinoma in situ within the bladder?
Urothelial carcinoma in situ (CIS) is a high grade, flat, non-invasive urothelial neoplasm involving full or partial thickness of the urothelium
442
Where does carcinoma in situ commonly occur?
Urinary tract, most commonly the bladder
443
Who is most commonly at risk of carcinoma in situ?
Mean age is 7th decade
M>F
444
What is the clinical presentation of carcinoma in situ?
Usually detected via tests for haematuria or voiding symptoms
Upper tract lesions can cause hydronephrosis
445
How is carcinoma in situ diagnosed?
Urinalysis leading to cystoscopic examination and cytology, biopsy or Transurethral resctionof the bladder (TURBT) will confirm
446
How is carcinoma in situ treated?
BCG if this fall fails TURBT
Radical nephouretertomy may follow
447
What is the macroscopic appearance of carcinoma in situ?
Erythematous patch
+/- velvety granular appearance
Can also be unremarkable
448
What is the microscopic appearance of carcinoma in situ?
Nuclear enlargement
Pleomorphism
Irregular nuclear outline/chromatin pattern
Loss of polarity
Nuclear crowding
449
What additional tests can aid in the diagnosis of carcinoma in situ?
CK20, P53 positive
CD44 negative
450
What is the differential diagnosis of carcinoma in situ?
Reactive urothelial atypia
451
What is a bladder diverticulum?
Out pouching of the urothelial mucosa through the bladder muscular wall
452
Where is commonly affected by bladder diverticulum?
Solitary lesion, usually located in the lateral walls of the bladder
453
Who is most at risk of bladder diverticulum?
M>F
Any age
Can be congenital or acquired
Congenital - failure of muscle development
Acquired - prostatic enlargement leads to muscular hypertrophy and focal mucosal herniation
454
What is the clinical presentation of a bladder diverticulum?
Usually small and asymptomatic can be associated with infections and stones
455
How are bladder diverticulum treated?
Non-operative treatment
Surgical bladder outlet reduction or removal of the diverticulum
456
What is the macroscopic appearance of bladder diverticulum?
Narrow necks
Round/ovoid pouch
1-18 cm
457
What is the microscopic appearance of bladder diverticulum?
Fibrous tissue with no/scant muscularis propria
Inflammation
Granulation tissue
Erosion
Cystitis cystica
Non-keratanizing squamous metaplasia
Reactive urothelial atypia
458
What is the microscopic appearance of bladder diverticulum?
Fibrous tissue with no/scant muscularis propria
Inflammation
Granulation tissue
Erosion
Cystitis cystica
Non-keratanizing squamous metaplasia
Reactive urothelial atypia
459
What are the underlying causes of granulomatous orchitis?
Sperm granuloma
Parasitic or tubercular infections
BCG for the treatment of bladder cancer
460
What would you see microscopically on a specimen sent for granulomatous orchitis?
Depends on cause
Granulomas
Destruction of parent tissue
Extravasated speems
Fibrosis
Inflammation
461
What is the cause of adult polycystic kidney disease?
Autosomal dominant
462
What blocks would you take from a adult polycystic kidney disease specimen?
Sample ureter resection margin
Adjacent to margin
Cysts
Abnormal areas
Background parenchyma
463
What is the microscopic appearance of a normal bladder biopsy?
Urothelium
Lamina propria
Muscle layer
464
What is vasitis nodosa?
Similar to Sperm granuloma. But involving the spermatic cord
465
What is a hydrocoele?
Accumulation of fluid between the two layers of the tunica vaginalis
466
Give 4 causes of hydrocoele?
Inflammation
Trauma
Lymphatic obstruction
Tumour
467
What is a spermatocoele?
A cyst within the epididymis filled with spermatozoa
468
What is Balanitis?
Infection of the foreskin
469
How does Balanitis appear clinically?
Inflammation (redness)
Fibrosis (phimosis)
470
Foreskin received with clinical history of untreated childhood phimosis. How would you describe and dissect the specimen?
Orientate
Palpated and look for obvious lesions
BXO flattened areas, smoothening of normal skin
Ink margins
BXO is focal sample flat areas, at least 4 sections in 2 blocks
