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Pathology > Renal, Genitourinary & Breast Pathology > Flashcards

Renal, Genitourinary & Breast Pathology Flashcards

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1
Q

Kidney – Function
Structurally complex - —% of body weight, but filters —% of blood through glomeruli

A

0.4
25

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2
Q

Excretes nitrogenous waste products of metabolism - cleans the blood – turns — L into urine

A

1.5

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3
Q

Kidney Function
 Regulates (2)
 Maintains appropriate —- balance
 Endocrine organ – secretes —

A

body water and electrolytes
acid-base
hormones

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4
Q

 Endocrine organ – secretes hormones
 Renin –
 Erythropoietin –

A

blood pressure
proliferative effect on bone marrow to make RBCs

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5
Q

Nephron – Functional Unit
Morphologic Components
(3)

A

 Glomeruli
 Convoluted tubules
 Collecting ducts

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6
Q

Juxtaglomerular cells in wall of afferent arteriole
 Sensor for

A

blood pressure

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7
Q

Macula densa in wall of distal convoluted tubule
 Sensor for

A

sodium

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8
Q

Azotemia – Laboratory Findings
(4)

A

 Elevation of blood urea nitrogen and creatinine levels
 Usually related to reduced glomerular filtration rate (GFR)
 Associated with many primary renal disorders
 May also be associated with extra-renal disorders

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9
Q

skipped
 Pre-renal azotemia –

A

hypoperfusion of the kidneys decreases GFR in the
absence of parenchymal damage

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10
Q

 Post-renal azotemia –

A

urine flow obstructed below the level of the kidney

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11
Q

Uremia – Clinical Findings
(3)

A

 Progression of azotemia to produce clinical manifestations and systemic
biochemical abnormalities
 Failure of renal excretory function
 Metabolic and endocrine alterations

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12
Q

skipped
Uremia
Secondary involvement of organ systems
(4)

A

 Uremic gastroenteritis
 Peripheral neuropathy
 Uremic fibrinous pericarditis
 Uremic stomatitis

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13
Q

 Nephrotic syndrome –

A

(glomerular syndrome) – heavy proteinuria,
hypoalbuminemia, severe edema, hyperlipidemia and lipiduria

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14
Q

 Nephritic syndrome –

A

(glomerular syndrome) – acute onset of grossly-
visible hematuria, mild-to-moderate proteinuria, azotemia, edema and
hypertension (classic presentation of acute post-streptococcal
glomerulonephritis)

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15
Q

 Acute renal failure –

A

oliguria or anuria with recent onset of azotemia. May
result from glomerular injury or acute tubular necrosis

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16
Q

 Chronic renal failure –

A

prolonged symptoms and signs of uremia – the end
result of all renal disease

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17
Q

 Urinary tract infections –

A

bacteriuria and pyuria –
symptomatic or asymptomatic - kidney (pyelonephritis)
or bladder (cystitis)

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18
Q

 Nephrolithiasis –

A

kidney stones - colic, hematuria

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19
Q

Nephrotic Syndrome
(7)

A

 Glomerular syndrome
 A non-specific disorder in which the kidneys are damaged, causing them to leak large
amounts of protein from the blood into the urine.
 Heavy proteinuria
 Hypoalbuminemia
 Severe edema
 Hyperlipidemia
 Lipiduria

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20
Q

Nephritic Syndrome
(8)

A

 Glomerular syndrome
 A non-specific disorder in which the kidneys are damaged, causing them to leak protein and red blood cells from the
blood into the urine.
 Acute onset
 Grossly-visible hematuria
 Mild-to-moderate proteinuria
 Azotemia
 Edema
 Hypertension

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21
Q

 Glomerulonephritis -
def
tx

A

an immune mediated disease of
the renal glomeruli
 Treated with steroids

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22
Q

 Pyelonephritis -
def
tx

A

an infection of the kidney (not the
glomerulus) usually caused by bacteria and of
retrograde origin
 Treated with antibiotics

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23
Q

Post-Streptococcal Glomerulonephritis
(Postinfectious Glomerulonephtitis)
(2)

A

 Acute onset of nephritic syndrome in 9-14 days following
Streptococcal infection
 Type III immune injury (Immune complex-mediated inflammation)

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24
Q

skipped
Pyelonephritis
Pathway of Renal Infection
 Hematogenous dissemination –
 Ascending infection –
 Fecal bacteria from —
 Culture and sensitivity –
 Pyelonephritis is much more common than —

A

least common
most common
perineal area
Bactrim
glomerulonephritis

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25
Kidney Stones (Nephrolithiasis) Urolithiasis (7)
 Common  May cause obstruction  Pain  Ascending infection  Hematuria  Pyuria  Lithotripsy
26
Kidney Stones (Nephrolithiasis) Urolithiasis  May be associated with
hypercalcemia (for example, hyperparathyroidism, metastatic skeletal disease, multiple myeloma)
27
Renal Cell Carcinoma (3)
 Arises from renal tubular epithelium  Often silent  May grow into renal vein
28
Wilm’s Tumor (Nephroblastoma) (5)
 Children under 5 years  Abdominal mass  Chronic low-grade fever  Histopathology consists of several cell types, some of which resemble abortive glomeruli and others that resemble skeletal muscle  Better than 90% 5-year survival
29
Urothelial Carcinoma  Arises from the epithelium (transitional epithelium)  --- most common site  Painless ---
urinary tract lining Bladder hematuria
30
skipped Urothelial Carcinoma  from (5)
Cigarette smoking, industrial solvents (beta-naphthlylamine), chronic cystitis, schistosomiasis, drugs (cyclophosphamide)
31
Urothelial Carcinoma  Clinical significance depends on (2)
histologic grade, differentiation and depth of invasion
32
Prostate – Three Major Diseases (3)
 Prostatitis  Benign prostatic hyperplasia  Adenocarcinoma of prostate
33
Prostate-Specific Antigen - PSA (4)
 Protein present in the serum at low levels (nl: < 4 ng/mL)  Increased levels may suggest the presence of prostate cancer  Elevated in prostatitis  Velocity of change significant
34
Prostate-Specific Antigen - PSA  Physiologic functions (2)
 Liquefy semen, allowing sperm to swim freely  Dissolution of cervical mucous cap
35
Prostatitis
 Acute bacterial disease treated with antibiotics
36
Nodular (Benign) Prostatic Hyperplasia - BPH (6)
 Obstruction to flow  Urinary frequency  Ascending infections  Rule-out neoplasia  Pharmacologic treatment  Surgical treatment (TURP)
37
Adenocarcinoma of Prostate (5)
 70% of men develop prostate cancer by 70-80 years of age  Digital prostate examination  Biopsy – multiple cores  Wide variation in clinical behavior  Gleason grading
38
Testes  Cryptorchidism –  Seminoma –  Infections – (4)
undescended testes germ cell tumor (malignant) tuberculosis, mumps, syphilis, gonorrhea
39
Cryptorchidism (5)
 Absence of one or both testes in the scrotum  Failure of testis to descend from an abdominal position through the inguinal canal into the scrotum (“undescended” testes)  Infertility  Increased risk for neoplasia  Orchiopexy
40
Seminoma (5)
 Most common germ cell tumor of testis  Young adults (15-34 years)  Surgery plus radiation therapy and chemotherapy  One of the most treatable and curable cancers  Over 95% long-term survival in early stages
41
skipped Infectious Parotitis (Mumps)  Complications rare in the young and more common in older individuals (8)
 Orchitis,  Oophoritis,  Mastitis,  Meningitis,  Thyroiditis,  Pancreatitis  Sterility  Hearing loss
42
Hypospadias (3)
 Developmental defect of the urethra in the male  Abnormally placed urethral meatus  Urethral meatus opens on the glans penis most commonly (first degree hypospadias)
43
Phimosis
 Foreskin cannot be fully retracted from the head of the penis
44
Priapism (4)
 Erect penis or clitoris does not return to its flaccid state, despite the absence of both physical and psychological stimulation, within four hours  Medical emergency  Hematologic diseases  Trauma
45
skipped  Hematologic diseases (2)
 Sickle cell disease  Leukemia
46
Uterine Leiomyoma (4)
 Benign smooth muscle neoplasm  “Fibroids”  May cause irregular bleeding (metrorrhagia) or  Painful intercourse (dyspareunia)
47
skipped Proliferative Lesions: Endometrial Hyperplasia and Polyps (2)
Glandular epithelium Bleeding
48
Two Major Diseases of the Endometrium (2)
 Endometriosis  Adenocarcinoma
49
Endometriosis (4)
 Endometrial tissue outside the uterine cavity  Ectopic endometrial tissue influenced by hormonal changes  Recurring pelvic pain  Symptoms depend on the site involved and worsen with the menstrual cycle
50
Risk Factors for Endometrial Carcinoma  Age –  Obesity –  Infertility –
most common in the 55 to 65 age group greater synthesis of estrogen in body fat women who are nulliparous are at increased risk of endometrial carcinoma
51
Cervical Squamous Cell Carcinoma (4)
 Exfoliative cytologic screening for early detection (Papanicolau smear)  Squamo-columnar junction  High risk HPV sub-types – 16, 18  Vaccination
52
Cervical Intraepithelial Neoplasia - Grades I, II, III (2)
 LSIL (low-grade squamous intraepithelial lesion)  HSIL (high-grade squamous intraepithelial lesion)
53
Teratoma (5)
 A tumor containing tissues from all three germ layers  Most tumors are derived from one cell layer – ectoderm, endoderm, mesoderm  Generally arise in gonadal tissues  Most commonly seen in the ovary  “Dermoid cyst” of the ovary – a benign cystic teratoma – may contain a variety of tissues including hair, teeth, bone, cartillage, thyroid, etc.
54
Gonorrhea (5)
 Neisseria gonorrhea  “Mother nature’s birth control”  Pelvic inflammatory disease  Tubal scarring  Ectopic pregnancy
55
Breast (5)
 Glandular epithelium  Ducts  Lobules  Interstitial tissue  Lymphatics
56
Gynecomastia (4)
 Enlargement of male breast may occur in response to estrogen  Hyperestrinism in male  Bilateral – rule-out hormonal  Unilateral – rule out tumor
57
 Hyperestrinism in male (4)
 Cirrhosis of liver – inability to metabolize estrogens  Klinefelter syndrome  Estrogen-secreting tumors  Estrogen therapy
58
Fibroadenoma (3)
 Most common benign neoplasm of breast  Discrete, usually solitary, moveable nodule  Young women (third decade)
59
Lobules - lobular carcinoma (2)
Lobular carcinoma-in-situ Invasive lobular carcinoma
60
Ducts - ductal carcinoma (2)
Ductal carcinoma-in-situ Invasive ductal carcinoma
61
Pathogenesis of Breast Cancer (3)
 Genetic changes  Hormonal influences  Environmental variables
62
Risk Factors in Breast Cancer  Well-established risk factors (6)
 Age – uncommon < 30 y  Genetics and family history - p53, BRCA1/2 genes  Menstrual history – early menarche (<12y), late menopause (>55y)  Length of reproductive life  Nulliparous – having children is protective  Geographic variation
63
Risk Factors in Breast Cancer  Other risk factors (3)
 Exogenous estrogens – postmenopausal hormone replacement therapy  Oral contraceptives – newer formulations of balanced, low doses of estrogen and progestin safe  Ionizing radiation during breast development
64
Risk Factors in Breast Cancer  Less well-established risk factors (4)
 Alcohol consumption  High fat diet  Obesity  Cigarette smoking
65
skipped Genetic Changes  Familial syndromes (4)
Li-Fraumeni Syndrome – Cowden Syndrome – Ataxia-telangiectasia gene – BRCA1/BRCA2 –
66
Li-Fraumeni Syndrome –
germ-line mutations in p53
67
Cowden Syndrome –
germ-line mutations in PTEN
68
Ataxia-telangiectasia gene –
DNA repair genes
69
BRCA1/BRCA2 –
germ-line mutations
70
Genetic Changes HER2/NEU proto-oncogene (4)
Epidermal growth factor receptor Amplified in 30% of breast cancers Overexpression associated with poor prognosis Therapeutic intervention – Herceptin (trastuzumab)
71
skipped Genetic Changes con’t (5)
 Amplification of RAS and MYC (proto-oncogenes)  Mutations of Rb and p53 (tumor suppressor genes)  Estrogen receptor positivity Therapeutic intervention - Tamoxifen  Progesterone receptor positivity
72
Hormonal Changes – Risk Factors  Increased exposure to estrogen (3)
Long duration of reproductive life (More estrogen) Nulliparity – having children is protective Late age at birth of first child
73
skipped Summary of Exposure to Estrogen and Breast Cancer Risk
 Estrogen exposure has a proliferative effect on breast tissue. Proliferative breast disease found on biopsy indicates an exposure to increased levels of estrogen. An increased risk of breast cancer is found in women who have proliferative breast disease.  The more estrogen the breasts are exposed to over a lifetime, the higher the risk of breast cancer. During each monthly menstrual cycle, the breasts are exposed to increased estrogen levels, especially at the time of ovulation.  Both early age at the start of menstrual cycles (menarche) and late menopause increase breast cancer risk through increased exposure to estrogen during more menstrual cycles.  Late age for menarche and early age for menopause decrease breast cancer risk through fewer menstrual cycles.  Birth control pills and hormone replacement therapy increase breast cancer risk through increased exposure to estrogen.  Removal of both ovaries before natural menopause decreases breast cancer risk by decreasing levels of estrogen.  Alcohol consumption. The more alcohol consumed, the more impaired the liver becomes in its ability to metabolize estrogen. Therefore, alcohol consumption increases breast cancer.  Obesity. This is because adipose tissue produces small amounts of estrogen. After menopause, obesity increases breast cancer risk by increasing the level of estrogen. The more fat, the higher the estrogen level. Premenopausal obesity does not increase breast cancer risk. Before menopause, obesity causes hormonal changes which decrease estrogen production by the ovaries and can even result in infertility.  Age at birth of first child. There is a change in structure of breast lobule at pregnancy. Late age at birth of first child increases breast cancer risk. With late age at birth of first child, type 1 and type 2 breast lobules persist longer. They are more sensitive to carcinogens. Therefore, risk increases. During the 3rd trimester of pregnancy (after 32 weeks), the breast lobules mature into Type 3 lobules. Type 4 lobules are formed after childbirth and produce milk. Both Type 3 and Type 4 lobules are resistant to carcinogens.
74
Breast Cancer Location  Upper outer quadrant –  Central portion –  Lower outer quadrant –  Upper inner quadrant –  Lower inner quadrant –
50% 20% 10% 10% 10%
75
Classification of Breast Cancers (Abridged)  Noninvasive – (3)
have not penetrated the basement membrane  Ductal carcinoma in situ (DCIS, intraductal carcinoma)  Lobular carcinoma in situ (LCIS)
76
Classification of Breast Cancers (Abridged)  Invasive – (3)
have penetrated the basement membrane (infiltrating)  Invasive ductal carcinoma – most common (scirrhous carcinoma)  Invasive lobular carcinoma
77
Ductal Carcinoma in Situ (6)
 Precursor lesion to invasive carcinoma  When invasive carcinoma develops in a woman with a previous diagnosis of DCIS, it is usually in the same breast.  Treatment – surgery and radiation  Tamoxifen –  Aromatase inhibitors –  Good long-term prognosis
78
 Tamoxifen –
antiestrogenic if estrogen receptor + (blocks estrogen receptor)
79
 Aromatase inhibitors –
post-menopausal women (blocks estrogen formation)
80
Paget’s Disease of Nipple (4)
 Clinical variant of DCIS  Extension of DCIS up to the lactiferous ducts and into the contiguous skin of the nipple  Crusting exudate over the nipple and areolar skin  Underlying invasive carcinoma in 50%
81
Lobular Carcinoma in Situ (4)
 One-third of women with LCIS develop invasive carcinoma  The invasive carcinoma may arise in either breast  LCIS is a marker of increased risk for developing breast cancer in either breast  Bilateral prophylactic mastectomy may be performed
82
Invasive Ductal Carcinoma (4)
 Most breast carcinomas (70-80%)  Term used for all carcinomas that cannot be sub-classified into a specific type (not discussed)  Does not imply that the tumor specifically arises from the duct system  Carcinoma of “no special type” or “not otherwise specified” (NOS) are synonyms for invasive ductal carcinoma
83
skipped Clinical Features Common to all Invasive Carcinomas (3)
 Fixation secondary to adherence to pectoral muscles or deep fascia of chest wall  Adherence to overlying skin with retraction or dimpling of the skin or nipple  Lymphatic involvement may cause localized lymphedema with the skin thickened around exaggerated hair follicles (peau d’orange – orange peel appearance)
84
TNM Staging of Breast Cancer - AJCC  Stage 1 – metastases  Stage 2 -  Stage 3 –  Stage 4 –
tumor <2 cm, without nodal involvement, no tumor <5 cm with <3 nodes and no distant metastases (or more than 5 cm without nodes) * many categories, any cancer infiltration into skin and chest wall, with nodes, without disseminated metastases any cancer with disseminated metastases
85
skipped Prognostic Factors (9)
 Size of primary carcinoma  Lymph node involvement and number of nodes  Distant metastases  Histologic grade  Histologic type  Estrogen or progesterone receptor expression - Tamoxifen  Proliferative rate  Aneuploidy  HER2/NEU overexpression - Herceptin
86
Five Year Survival of Breast Cancer by Stages DCIS or LCIS - 92%  Stage 1 – --%  Stage 2 – --%  Stage 3 – --%  Stage 4 – --%  For all stages combined, 10 year survival is about --%  Natural history is long with metastases sometimes appearing decades after the initial diagnosis
87 75 46 13 50

Pathology (23 decks)

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