Flashcards in Pathology Deck (98):
What are some features of glomerulonephritis?
Secondary tubulointerstitial changes
What sort of distribution does pyelonephritis show?
Why can pregnancy predispose to pyelonephritis?
Which of the following is not a risk factor for pyelonephritis:
- Vesicoureteric reflux (Congenital/Acquired)
What are some vague signs of chronic pyelonephritis?
Hypertension and/or anaemia
How does chronic pyelonephritis appear on imaging?
Coarse cortical scarring
Distortion of calyces
How does Tuberculosis Pyelonephritis spread?
Where does Tuberculosis Pyelonephritis usually spread from?
Which of the following is not a symptoms of Tuberculosis Pyelonephritis:
- Weight loss
- Loin pain
Is the pyuria in TB pyelonephritis sterile or non-sterile?
TB pyelonephritis has caseous foci, what does this result in?
Slow growth with progressive renal destruction:
- Other viscera
What can cause necrotising cystitis?
What is characterised by multiple, small, fluid-filled cysts projecting into the lumen of the ureter. The cysts may resemble tumours?
Ureteritis + Cystitis Cystica
A 59 year old patient presents to her GP with haematuria and increased frequency. She notes that she had UTIs more frequently over the last 6 months and has also lost some weight. On further questioning, you find out that 3 years ago she went on a holiday to Egypt and returned with a papular rash and a dry cough, fever and some muscle aches. On pelvic x-ray, there is some calcification of her bladder walls. After cystoscopy and biopsy, the patient is found to have a squamous cell carcinoma of her bladder.
Schistosomiasis (caused by S. haematorium)
In males, what can cause urinary tract obstruction?
Posterior urethral valves
What can happen in prolonged urinary tract obstruction?
Detrusor muscle hypertrophy -> Diverticulum
What is hydronephrosis?
Dilation of pelvicalyceal system with parenchymal atrophy
What are the two main causes of hydronephrosis?
Urinary tract obstruction
Which of the following is not a typical cause of bilateral hydronephrosis:
- Urethral obstruction
- Neurogenic disturbance
- Vesicoureteric reflux
- Congenital abnormality
- Bilateral ureteric obstruction (Advance cervical carcinoma)
Which of the following is not a typical cause of unilateral hydronephrosis:
- Posterior urethral valve
- Pelvi-ureteric obstruction
Posterior urethral valve
If an obstruction is sudden and complete, what sort of hydronephrosis is seen?
As urine production is decreased quickly, there is little pelvicalyceal dilation
If hydronephrosis is severe, what effect does this have on the renal cortex?
What is the name given to a secondary infection due to urine stasis in hydronephrosis?
A dry and crusty full thickness epidermal lesion of the penis
A raised erythema on the glans
Erythroplasia of Queyrat
In what areas of the world is the incidence of squamous carcinoma of the penis increased?
In what people is squamous carcinoma of the penis almost exclusive to and why?
Uncircumcised men -> Poor hygiene
What infection can increase the risk of squamous carcinoma of the penis?
How do squamous carcinomas of the penis of the penis usually appear?
On glans or prepuce:
- Ulcerated and indurated OR
- Exophytic mass (growing outward)
In what people is a squamous carcinoma of the scrotum common?
What percentage of men over 70 have Benign Nodular Hyperplasia of the Prostate?
What percentage of people with Benign Nodular Hyperplasia of the Prostate have significant symptoms?
What causes Benign Nodular Hyperplasia of the Prostate?
Irregular proliferation of:
- Glandular tissue
- Fibromuscular stromal tissue
What is the aetiology of Benign Nodular Hyperplasia of the Prostate?
- Altered androgen/oestrogen ratio
- Peri-urethral/Central gland involved
-> It is oestrogen-responsive
What are the three main features of prostatism?
Difficulty starting urination
How is Benign Nodular Hyperplasia of the Prostate treated?
- 5-α-reductase inhibitors
What is the peak age for prostate cancer?
What family history increases the risk of prostate cancer?
A first degree relative with prostate cancer
Where does prostate cancer usually arise?
Peripheral ducts and glands:
- Particularly the posterior lobe
- Peri-urethral zone involved later
If prostate cancer spreads lymphatically, where does it tend to go?
- Para-aortic nodes
If prostate cancer spreads haematogenously, where does it tend to go?
- Osteosclerotic lesions
What percentage of patients with prostate cancer have locally advanced or metastatic disease at presentation?
How will prostate cancer feel on PR exam?
What imaging modalities are useful in prostate cancer?
How are prostate biopsies taken?
Needle-core biopsies under USS
What hormonal therapy is used in prostate cancer?
What surgery can be used in prostate cancer?
Painless testicular enlargement, hydrocoele and gynaecomastia are common presenting features of what?
What are the most common testicular tumours?
Germ cell tumours:
What less common tumours can affect the testicles?
- Sertoli cell
- Leydig cells
What is the peak age for seminomas?
How do seminomas appear?
How do seminomas appear histologically?
Clear (glycogen leaches out)
Stromal lymphocytic infiltrate (variable)
What seminoma variant is commoner in older men?
If a seminoma spreads lymphatically, where does it metastasize to?
Para-aortic LNs (massive)
If a seminoma spreads haematogenously, where does it metastasize to?
What is the peak age for testicular teratomas?
How do testicular teratomas appear?
Which of the following is not a class of teratoma:
- Malignant Anaplastic
- Malignant Intermediate
- Malignant Undifferentiated
- Malignant Trophoblastic
What does bHCG indicate?
Trophoblastic component of a teratoma
What does AFP (Alpha-fetoprotein) indicate?
Yolk sac component
What does PLAP (Placental alkaline phosphatase) indicate?
What can simple renal cysts be secondary to?
Native kidneys in long term dialysis
How do the kidneys in ARPKD appear?
Uniform and bilateral enlargement
Dilation of collecting ducts
Reniform shape maintained
What is ARPKD associated with?
Congenital Hepatic Fibrosis
A 36 year old man presents with haematuria. On examination there is an abdominal mass, he is hypertensive and has evidence of chronic renal failure
What benign renal tumour is common, originates in the medulla and has white nodules?
What benign renal tumour has yellowish nodules
What benign renal tumour can be multiple and bilateral, is associated with Tuberois sclerosis and is composed of a mixture of fat, muscle and blood vessels?
What does a Juxtaglomerular Cell Tumour secrete and what does this cause?
Renin -> Secondary hypertension
What is the commonest intra-abdominal tumour in children. It presents with an abdominal mass and arise from residual primitive renal tissue?
What are the alternate names for a Renal Cell Carcinoma?
Clear cell carcinoma
Where do Renal Cell Carcinomas arise from?
Renal tubular epithelium
What is the peak age of incidence for Renal Cell Carcinomas?
What is the M:F ratio of Renal Cell Carcinomas?
What are the paraneoplastic manifestations of Renal Cell Carcinomas?
Which of the following is not a feature of a Renal Cell Carcinoma's appearance:
- Well circumscribed
- Centred on cortex
- Solid, cystic, necrotic and haemorrhagic areas
If a Renal Cell Carcinoma extends into the renal vein, where can it spread?
IVC -> Right atrium
Where can Renal Cell Carcinomas spread haematogenously?
What is the commonest type of Renal Cell Carcinoma and how do they appear?
- Rich in glycogen and lipids
What grading system is used in Renal Cell Carcinomas?
Where can transitional cell carcinomas arise?
From pelvicalyceal system to the urethra
What percentage of bladder tumours do transitional cell carcinomas make up?
What is the peak age for transitional cell carcinoma of the bladder?
What chemicals increase the risk of developing a transitional cell carcinoma of the bladder?
Aniline dies (β-naphthylamine)
What drugs increase the risk of developing a transitional cell carcinoma of the bladder?
Analgesics (renal pelvis)
What other factor can increase the risk of developing a transitional cell carcinoma of the bladder (ie. Not chemicals or drugs)?
What is the most common symptoms of transitional cell carcinomas of the bladder?
Where do 75% of transitional cell carcinomas of the bladder arise? What can this cause?
Region of trigone:
- Ureteric obstruction
Papillary transitional cell carcinomas of the bladder have what characteristic?
Thicker lining than normal urothelium
How is transitional cell carcinoma of the bladder invasion graded?
By the invasion of the stroma and detrusor muscle:
- pT1 -> Stromal invasion
- pT2 -> Muscle invasion
In what part of the epithelium can a carcinoma-in-situ arise?
Where do transitional cell carcinomas of the bladder spread?
Local LNs (Obturator)
What can predispose to bladder adenocarcinomas?
Extroversion (Glandular metaplasia)
Long standing Cystitis Cystica
What can predispose to bladder squamous cell carcinomas?
Calculi -> Squamous metaplasia
What is the commonest bladder malignancy in children?
What causes glomerulosclerosis in DM?
Glucose deposits in basement membrane and forms complexes with proteins