Histopathology 9 - Urological pathology

Question 1

What is the most common composition of urinary calculi?

Answer 1

Calcium oxalate

Question 2

What is the most likely cause of calcium oxalate urinary calculi?

Answer 2

Hypercalciuria

Absorptive hypercalciuria – excessive calcium absorption from gut

Renal hypercalciuria – impaired absorption of calcium from proximal renal tubule

also ethylene glycol and hypercalcaemia

Question 3

What are magnesium ammonium phosphate urinary calculi also known as?

Answer 3

Triple stones

Question 4

What is the cause of triple stones?

Answer 4

Recurrent UTI → infection with urease producing organisms – proteus sp

Hyperammonaemia → alkalises urine → precipitation of magnesium phosphate salts

Question 5

Which type of renal stones are likely to cause Staghorn calculi?

Answer 5

magnesium ammonium phosphate

Question 6

Why might a small urinary stone become symptomatic?

Answer 6

If it gets out of kidney and gets into the ureter - it will cause colic at any point where the ureter bends

Question 7

What type of urinary calculi are caused by gout?

Answer 7

Uric acid stones

Most patients do not actually have hyperuricaemia or increased uric acid excretion in urine

tendency to produce slightly acidic urine

Question 8

What is papillary adenoma of the kidney?

Answer 8

Benign epithelial kidney tumour composed of papillae and/or tubules
ALWAYS 15MM OR LESS IN SIZE (>15mm = malignant)

Question 9

What are some genetic associations of renal papillary adenoma?

Answer 9

Trisomy 7, Trisomy 17, loss of Y chromosome

Question 10

What is a renal oncocytoma?

Answer 10

Benign epithelial kidney tumour composed of oncocytic cells

Question 11

What syndrome should be considered in a patient with many renal oncocytomas?

Answer 11

Birt-Hogg-Dubé syndrome

Question 12

What is an angiomyolipoma?

Answer 12

Benign mesenchymal kidney tumour composed of thick-walled blood vessels, smooth muscle and fat

derived from perivascular epitheliod cells

Question 13

REcall three examples of benign renal neoplasms

Answer 13

Papillary adenoma

oncocytoma

angiomyolipoma

Question 14

In what condition are angiomyolipomas most likely to appear?

Answer 14

Tuberous sclerosis

Question 15

What is a renal cell carcinoma?

Answer 15

Malignancy of epithelial cells of proximal convuluted tubule

Question 16

What is the main symptom of renal cell carcinoma?

Answer 16

Painless haematuria

Question 17

Which syndrome is associated with renal cell carcinoma?

Answer 17

VHL = phaeochromocytoma, neuroendocrine pancreatic tumour, clear cell renal cell carcinoma

Question 18

What is the most common subtype of renal cell carcinoma?

Answer 18

Clear cell renal cell carcinoma

(other types = papillary cell + chromophone)

Question 19

What is the genetic association of clear cell carcinoma?

Answer 19

Loss of chromosome 3p

Question 20

What is Nephroblastoma also known as?

Answer 20

Wilm’s tumour

Question 21

What is nephroblastoma?

Answer 21

Triphasic kidney tumour of childhood

Blastema – small round blue cells = feature of primitive tumours (-blastomas)

Question 22

How does nephroblastoma typically present?

Answer 22

Abdominal mass in children aged 2-5

Question 23

What is the new name for transitional cell carcinoma?

Answer 23

Urothelial carcinoma

Question 24

What is flat urothelial carcinoma in situ?

Answer 24

Very high grade lesion with high risk of progression

Question 25

What are the 2 main treatments of BPH?

Answer 25

alpha blockers (Tamsulosin) 5 alpha reductase inhibitors (Finasteride) transurethral resection

Question 26

What are the symptoms of BPH?

Answer 26

lower urinary tract symptoms Frequency, nocturia, urgency Hesitancy, poor flow, terminal dribbling May also present with UTI, acute urine retention or renal failure

Question 27

What score is used for prostatic adenocarcinoma?

Answer 27

Gleason score

Question 28

What is the most common type of testicular tumour?

Answer 28

90% = germ cell

Question 29

Recall 2 risk factors for testicular germ cell tumours

Answer 29

undescended testes LBW SGA

Question 30

What are the histological subtypes of germ cell testicular tumour?

Answer 30

Seminoma (most common) Embryonal carcinoma Post-pubertal teratoma Yolk Sac Tumour choriocarcioma

Question 31

What is the most useful form of chemo in germ cell testicular tumours?

Answer 31

Platinum based

Question 32

What are the signs and symptoms of testicular germ cell tumours

Answer 32

painless lump (10% symptoms related to mets – back pain, cough, dyspnoea)

Question 33

What are the 3 subtypes of non-germ cell testicular tumours?

Answer 33

Lymphoma Leydig cell Sertoli cell

Question 34

Which type of testicular tumour can present with precocious puberty?

Answer 34

Leydig cell

Question 35

Which testicular germ cell tumour has clear polygonal cells and a lymohcytic inflitrate?

Answer 35

Seminoma

Question 36

Which type of urinary stone is most likely to develop into a massive "staghorn calculus"?

Answer 36

Triple stone

Question 37

What is the typical histological appearance of non-invasive papillary urothelial carcinoma?

Answer 37

Frond-like growths

Question 38

What is the typical histological appearance of a seminoma?

Answer 38

Clear polygonal cells and lymphocytic infiltrate

Question 39

What type of renal cell cancer is associated with a golden yellow tumour with haemorrhagic areas?

Answer 39

Clear cell renal cell carcinoma 70%

Question 40

What type of renal cell cancer is associated with a fragile, friable brown tumour?

Answer 40

Papillary renal cell carcinoma

Question 41

What are the genetic associations of paillary renal cell carcinoma?

Answer 41

trisomy 7, trisomy 17, loss of Y

Question 42

Which subtype of renal cell carcinoma is associated with long term dialysis?

Answer 42

Papillary renal cell carcinoma

Question 43

What are some risk factors for transitional cell carciomas?

Answer 43

smoking, aromatic amines

Question 44

What is the typical presentation fo transitional cell carcioma?

Answer 44

frank haematuria

Question 45

Which organisms are usually responsible for epididymitis?

Answer 45

C trachomatis, N gonorrhoea in men \<35 and E coli in men 35+

Question 46

Where is the fluid in hydrocele?

Answer 46

fluid between layers of tunica vaginalis

Question 47

Which HPV subtypes are associated with condylomas?

Answer 47

HPV 6 and 11