Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

Scientific Basis of Clinical Practice > GU Pathology > Flashcards

GU Pathology Flashcards

(95 cards)

Start Studying
1
Q

what are the types of non-neoplastic renal disease?

A

obstruction/hydronephrosis
infection
congenital abnormalities
reflux

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

what are the causes of hydronephrosis?

A 
extrinsic;
enlarged lymph nodes
retroperitoneal fibrosis
inflammatory conditions within the retroperitoneum
endometriosis

intramural;
tumour (transitional cell carcinoma)

within the lumen;
stones
renal colic blood clots

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

describe nephrolithiasis

A

the entire calyceal system and pelvis is occupied by a single calculus
moulded by the luminal cavity of the pelvis and calyces (stag horn)
found in middle-aged to elderly females
infection with proteus and sometimes E. coli
can cause hydronephrosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

describe hydronephrosis and its causes

A

requires surgical removal
markedly reduced renal function

nephrolithiasis
vesicoureteric reflux; causes massive dilatation of the upper part of the ureter, renal pelvis and much of the kidney

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

describe acute pyelonephritis

A

ascending infection
common in young children
may be blood borne; E. coli is the most common organism
usually responds well to antibiotic treatment
rarely require surgical removal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

what are the clinical features of acute pyelonephritis?

A

loin pain
fever
can be complicated by infectious element; septicaemia, abscess, mycotic abscess elsewhere

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

what are the anatomical features of acute pyelonephritis?

A

histology; collections of neutrophil polymorphs

gross; small, studded abscesses right through the renal parenchyma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

describe chronic pyelonephritis

A

repeated infections leading to chronic damage
specific pathological features; polar scars, related to the underlying calyx
causes; obstructive or reflux

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

what are the anatomical features of chronic pyelonephritis?

A

histology; inflammation fibrosis, glomerular sclerosis, thyroidisation of the tubules
dilated tubules containing pink cast-like material that resembles thyroid follicles
gross; marked cystic dilatation of the calyx and renal pelvis, small area of normal kidney remaining

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

what are the non-neoplastic congenital kidney disorders?

A

polycystic kidney disease
horseshoe kidney
duplex ureteres
agenesis; 1%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

describe adult polycystic kidney disease

A

AD condition
only presents in adulthood; 3rd decade
can present with hypertension and uni/bilateral renal masses
numerous large cysts; can rupture or bleed
10% risk of a renal carcinoma; cystic clear cell carcinoma
associated with cysts in the liver and pancreas
berry aneurysms in the arteries of the circle of willis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

describe infantile polycystic kidney disease

A

AR condition
presents at birth or shortly afterwards
very poor prognosis
renal function severely impaired; dialysis dependent from birth/shortly after

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

describe duplex ureter

A

reasonably common
complications; obstruction, increased risk of stones, dilated ureters
can form strictures; hydronephrosis, dilatation of calyxes and renal pelvis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

describe benign renal tumours

A

relatively uncommon in clinical manifestation
small; adenomas
larger; oncocytomas, impossible to differentiate from a renal cancer so are often removed
metanephric adenoma; often found incidentally

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

what are the types of malignant renal tumours?

A

clear cell; 75%
papillary; 10%
chromophobe; 5%
collecting duct
renal carcinoma unspecified; cannot be put into a category, usually poorly differentiated
urothelial tumours; involve the kidney, usually spread from the renal pelvis or ureter

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

what are the risk factors of renal tumours?

A

male
age; 5th decade or beyond
smoking
tuberous sclerosis
von hippel-lindau disease; clear cell carcinoma
brain transplants
dialysis; particularly papillary renal carcinoma due to scarring in the native kidneys

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

what are the genetic/chromosomal anomalies of renal tumours?

A

clear cell; 3p deletion, most often in those associated with syndromes
papillary carcinoma; trisomy 7 or 17
chromophobe; multiple trisomy
newer variants; specific 11p deletion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

what is the clinical triad of renal tumours?

A

renal mass
haematuria
flank pain

much worse prognosis if present with all of the components of the triad

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

what investigations are required to diagnose renal tumours?

A

USS; can identify the renal mass, tell if it is cystic or solid, attempt at telling whether it is TCC or renal cell carcinoma
IV urogram
MRI; gives a better anatomical description
metastases; classical cannonball secondary within the lungs or pleural tract

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

describe the histological appearance of clear cell carcinoma

A

sheets of clear cells
vacuolated cytoplasms
polycystic nuclei; pyknotic looking, vascular component
cystic in 15%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

describe the histological appearance of a papillary carcinoma

A

an exophytic-type tumour
soft
very friable
sometimes multifocal or bilateral; must check the other kidney

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

describe the anatomy of a chromophobe carcinoma

A

gross; brown colour
histology; very thick cell membrane, perinuclear halo

very good prognosis compared to others

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

describe a collecting duct carcinoma

A

one of the worst prognoses; very very aggressive
forms glands
tend to find it in the renal medulla
associated with lymph node and other visceral metastases

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

describe a sarcomatous carcinoma

A 
a type of collecting duct carcinoma
spindle pattern
lots of mitotic figures
associated with a very poor prognosis
usually has spread beyond the kidney
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
describe the steps of pathological staging of a kidney tumour
pT1a; <4cm, confined to kidney pT1b; 4-7cm, confined to kidney pT2; >7cm, confined to kidney pT3; involves the renal vein or vena cava pT4; spread to adjacent organs, gerota's fascia, liver, adrenal gland
26
describe furham grading
based exclusively on nuclear size 1; very small nuclei 4; quite big nuclei, lots, prominent nucleoli
27
what is the treatment of renal cell carcinomas?
radical nephrectomy; removal of the kidney, ureter, adrenal gland, higher lymph nodes partial nephrectomy; tumours <4cm, peripheral, not involving the collecting system radio frequency ablation; tumours <3cm cryotherapy; freezing of the tumour chemotherapy; offered in distant metastasis interferon; marginal benefit in distant metastasis, poorly tolerated
28
describe transitional cell carcinoma of the kidney
common tumour of the urinary tract more so involves the bladder and ureter sometimes seen in the renal pelvis classically presents as a cauliflower tumour involving the renal pelvis and extending down the ureter can be hard to distinguish from a renal cell carcinoma must take out the ureter as far as the bladder
29
describe Wilms' tumour/nephroblastoma
most common paediatric tumour affects children age 2-4 present with an abdominal mass prognosis; improved considerably, improved surgical technique and chemotherapy
30
describe the anatomy of wilms' tumour
gross; very variegated, haemorrhagic, pale, fleshy histologically; small blue tumour cells with poorly formed glomerular and tubular structure has blastema stromal component that sometimes can form muscle and cartilage
31
what is the types of clinical presentation of glomerulonephritis?
``` nephrotic syndrome; significant protein loss in the urine nephritic syndrome; renal impairment acute renal failure chronic renal failure incidental ```
32
describe nephrotic syndrome
proteinuria >3.5g/24hrs oedema; can be massive depending on the protein loss hypercholesterolaemia hypoalbuminaemia causes; minimal change disease in children, membranous glomerulonephritis or drug induced in adults
33
describe the electron microscopy of membranous glomerulonephritis
lots of sub-epithelial deposits along the basement membrane
34
what are the clinical and urinary findings in nephritic syndrome?
blood in the urine renal impairment hypertension active urine sediment urinary; hyaline casts red blood cell casts inflammatory cells; acute or chronic
35
what are the histological features of nephritic syndrome?
proliferation; lots of cells within the glomeruli | neutrophil polymorphs within the capillary loops
36
what is the clinical presentation of acute renal failure?
failing urinary output or total anuria elevated creatinine hypertension
37
describe chronic renal failure
slow onset elevated creatinine irreversible usually leads to end stage renal disease; requiring dialysis and hopeful transplantation
38
what are the types of primary glomerulonephritis?
IgA nephropathy; younger adults with chronic renal failure, younger males with nephrotic syndrome minimal change disease membranous glomerulonephritis post streptococcal GN; common, rarely pathological, good outcome ANCA associated vasculitis; anti-GBM/goodpasture's disease, occurs at springtime membranoproliferazive GN; caused by lupus nephritis, hepatitis C, cryoglobulinaemia
39
describe renal biopsy
diagnostic gold standard invasive procedure under US guidance by the nephrologists/radiologists take 2 or 3 cores; light microscopy, immunofluorescence, electron microscopy useful in looking at the ultrastructure of the glomerulus
40
what are the stains used to look for in renal biopsy?
haematoxylin eosin stain; morphology masson's trichrome; connective tissue silver stain; basement membrane PAS stain
41
describe immunofluorescence of renal biopsy
``` frozen tissue apply antibodies to it; immunoglobulins G, A and M complement factors C3, C4, C1q and fibrinogen deposits of antigen antibody complexes along the basement membrane ```
42
describe electron microscopy of renal biopsy
identifies; deposits and structural anomalies in the basement membrane hereditary renal disease conditions with a splitting of the basement membrane
43
what conditions can cause chronic renal failure?
vascular disease diabetes chronic tubulointerstitial nephritis
44
what are the types of tumour in the bladder and ureters?
transitional cell carcinoma; most common, they are lined by transitional epithelium squamous carcinoma; more common in Egypt due to endemic infection with schistosomiasis adenocarcinomas; uncommon miscellaneous; include sarcomas of the bladder
45
describe the pathology of transitional cell carcinoma
most are not invasive huge proportion recur 20-30% recur as invasive carcinomas; metastatic potential and require thorough treatment
46
what are the risk factors for bladder cancer?
smoking; rare to get a bladder tumour in a non-smoker occupational exposure to aniline dye; rubber industry male hydrocarbon exposure
47
what is the clinical presentation of bladder cancer?
sometimes asymptomatic LOTS; micro/haematuria; detected in dipstick testing mass lesion; palpable mass indicates a very advanced tumour
48
what investigations are required to diagnose bladder cancer?
``` cystoscopy CT MRI IVU; usually incidentally biopsy; can only tell exactly what it is cold cup biopsies; small lesion TURBT; large lesion ```
49
describe the potential findings of a cystoscopy
carcinoma in situ; red patches, requires a biopsy to confirm superficial TCC invasive TCC; very pale, flat, ulceration and necrosis in part of the tumour, requires resection
50
describe the histology of a bladder grade 1 TCC
multi layered; usually more than 7 loss of orientation occasional cells slightly enlarged
51
describe the histology of a bladder grade 2 TCC
loss of orientation | more marked cellular pleomorphism
52
describe the histology of a bladder grade 3 TCC
lots of cells coming off the surface | lots of cellular pleomorphism; mitotic figures throughout
53
describe the histology of a bladder adenocarcinoma
forms papillary structures and glandular structures more common in the dome of the bladder sometimes in associated with persistent urachus or brachial remnants
54
describe the staging of bladder TCC
pTa; superficial, non-invasive pT1; in the submucosa pT2; in the muscle coat pT3; beyond the muscle coat or muscularis propria pT4; gone into adjacent organs, prostate, uterine cavity, uterine cervix, advanced disease, rarely operable
55
what is the treatment of bladder cancer?
mostly superficial; resection grade 3 or associated carcinoma in situ; adjuvant BCCG therapy mitomycin C; more cytotoxic small or in the dome; may be amenable to partial cystectomy >T2; cystectomy, offered ileal conduit advanced; chemotherapy and radiotherapy, do not respond well
56
describe carcinoma in situ of the bladder
full thickness dysplasia often seen as a red patch in the bladder often found along with TCC
57
what is the treatment of carcinoma in situ of the bladder?
on its own; BCG therapy | may require numerous courses
58
what are the types of renal, pelvic and ureteric tumours?
transitional cell; almost 90% squamous cell carcinoma; occasionally adenocarcinoma; less common
59
describe ureteric cancer
multifocal and bilateral in >10% investigate the rest of the ureter and renal pelvis on both sides >50% of ureteric TCC develop bladder TCC; field change require extended follow-up sometimes synchronous
60
what are the types of penile cancer?
squamous cell carcinoma; majority malignant melanoma spindle cell carcinoma; arise in the glans penis adenosquamous carcinoma; mixture of glandular and squamous patterns in the carcinoma
61
what are the risk factors for penile cancer?
``` poor hygiene uncircumcised phimosis HPV; younger males smoking ```
62
what are the pre-neoplastic conditions associated with penile cancer?
Bowenoid papulosis; HPV related change erythroplasia de queyrat; elderly males, basically CIS in the foreskin or glans penis Bowen's disease; dysplastic condition which can affect anywhere in the body
63
describe the histology of the testes
seminiferous tubules and interjacent stroma contain leydig cells; produce testosterone Sertoli cells present; provide nutritional support germ cells; form spermatozoa
64
what can be seen in a biopsy of the testes?
spermatogenesis; normal, absent pre-neoplastic change intratubular germ cell neoplasia
65
what are the non-neoplastic conditions of the testes?
epididmyo-orchitis; common, usually following a UTI, often related to E. coli UTI torsion; young males, usually an acute surgical emergency, intense pain hydrocele; older males, can follow trauma or lower UTI
66
describe testicular torsion
``` dark congested sometimes haemorrhage causes infarction fairly uncommon acute medical/surgical emergency treatment; untwist the testicular vessels and suture it to the scrotal sac ```
67
describe testicular cancer
incidence is rising affects younger males 18-55yrs most have a good prognosis
68
what are the types of testicular cancer?
``` germ cell; 90%, always malignant sex cord stromal tumour leydig tumour Sertoli cell tumour lymphomas; elderly males leukaemia; younger males mostly benign, some of them have a malignant potential ```
69
what are the subtypes of germ cell testicular tumours?
seminomas; 50% non-seminomatous/teratomas; 15% mixed germ cell tumours; 33%
70
describe seminomas
``` mid 30-40s most common individual testicular tumour very amenable to treatment very radiosensitive good prognosis fleshy, pale tumours ```
71
describe the histology of seminomas
sheets of quite large cells look anaplastic always have lymphoid stroma sometimes contains granulomas intratubular germ cell neoplasia in the tubules; abnormal tubules virtually no spermatogenesis in tubules close to the tumours
72
describe non-seminomatous germ cell tumours
``` 4 groups; MTD; mature, can mimic normal structure MTI; some primitive epithelium in it MTU; purely anaplastic teratoma MTT; a trophoblastic or choriocarcinoma arising in the testis ``` motley MTI or MTU usually large, with haemorrhage, necrosis, cystic change, sometimes can see cartilage
73
what are the patterns of differentiation of malignant teratomas?
embryonal carcinoma yolk sac tumour choriocarcinoma mixed form; polyembryoma
74
describe the histology of embryonal carcinoma teratomas
forms glands poorly differentiated associated with spindle primitive stroma
75
describe the histology of yolk sac teratomas
schiller-duval body central vessel rim of epithelial cells second rim; almost glomerular type structure
76
describe the histology of choriocarcinoma teratomas
often associated with haemorrhage | lots of giant cells and cytotrophoblasts
77
describe primitive teratomas
very primitive neural tissue worst kind to have does not respond to chemotherapy if seen in the lymph nodes
78
how is a testicular tumour diagnosed?
usually present with a painless lump test for markers test for lymphatic spread
79
what testicular tumours will respond to which type of markers?
seminoma; only raised LDH | teratomas; raised AFP and HCG, particularly in choriocarcinoma and some mixed germ cell tumours
80
what is the treatment of testicular tumours?
radical orchidectomy; 1st line, done through the inguinal canal adjuvant radiotherapy; large seminomas that can spread to the retroperitoneal lymph nodes chemotherapy; all teratomas are given this after the initial surgery
81
what is the MRC criteria for testicular tumours?
presence of embryonal carcinoma (1) absence of yolk sac tumour (1) lymphatic invasion (1) vascular invasion (1) >2; give chemotherapy after surgery
82
what is the 5-year survival of testicular tumours?
seminomas; 95% | teratomas; 90%
83
what are the common benign conditions of the prostate?
benign nodular hyperplasia | prostatitis; polymorphs extending into the prostatic glands, often follows lower UTI
84
describe benign nodular hyperplasia
proliferation of glands and stroma form a nodule; androgen-oestrogen imbalance usually int he transitional/central zone blocks off the prostatic urethra distension of the bladder and outflow obstruction common with increasing age
85
what is the treatment of benign nodular hyperplasia?
drugs | transurethral resection of the prostate (TURP)
86
describe prostatic carcinoma
most common tumour in males | incidence increasing; increased detection of serum PSA
87
what are the types of prostatic carcinoma?
acinar; 90%, can see prostatic acini in the periphery of the gland ductal; 5%, seen in the periurethral zone of the prostate other types; lymphomas, sarcomas
88
what is the presentation of prostatic carcinoma?
``` usually asymptomatic outflow obstruction; BNP haematuria abnormal PR examination abnormal PSA ```
89
what investigations are required to diagnose a prostatic carcinoma?
TRUS biopsies; US of the rectum and prostate gland to detect areas of abnormality to biopsy MRI or CT bone scan
90
what is the treatment of prostatic carcinoma?
hormone radiotherapy combination; offered to the majority radical prostatectomy; only offered to some hormone therapy; poorly differentiated, high Gleason score radiotherapy brachytherapy; use radio isotopes
91
describe the Gleason score
1-5; well - poorly differentiated two most common patterns graded and combined total score / 10
92
describe the scores of the Gleason score
2; round glands, lots of stroma in between 3; smaller glanders, starting to infiltrate widely 4; back to back and all together 5; total lag of glands, poorly differentiated
93
describe radical prostatectomy
most realistic hope for cure usually performed in males <65yrs only performed if PSA <15 and if Gleason score <7 on biopsy
94
describe the staging of prostatic carcinoma on core biopsies
pT1; reflect what the stage is on biopsy or TURP T2; confined to the lobes T3; spread outside the lobes or into the seminal vesicle T4; involved the rectum or the bladder
95
what does the prognosis of prostatic carcinoma depend on?
PSA stage Gleason score

Scientific Basis of Clinical Practice (10 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions